利用玻璃纤维桩加固牙齿的临床应用

田鸿旭　王毅

[摘要] 目的 探讨利用玻璃纤维桩加固重度楔状缺损前磨牙、预防折断的临床应用价值。 方法 将2007～2010年烟台山医院门诊接诊的100例患者共138颗重度楔状缺损的上颌第一前磨牙完成根管治疗后预防性地将玻璃纤维桩置于已预备好的根管腔中，并采用流动树脂与纳米树脂结合的三明治技术充填牙颈部的楔状缺损部位。随访1～3年，检查牙齿颈部填充物边缘是否密合、完整性及咀嚼功能。 结果 100例患者共138颗牙随访1～3年，136颗牙治疗成功，均无自觉不适症状，咀嚼功能正常。X线片示：牙周膜腔无增宽，无继发龋。仅2例于术后1年出现因咀嚼不当导致冠部分缺损，未发现根折或冠折。 结论 充分利用玻璃纤维桩的特性加固根管治疗术后的重度楔状缺损前磨牙有良好的预防折断的临床效果，流动树脂与纳米树脂结合应用的三明治技术充填楔状缺损部位能够达到良好的近期与远期效果，这种方法尤其适合重度楔状缺损已行根管治疗术、牙冠完整且不愿接受全冠修复的患者。

[关键词] 玻璃纤维桩；加固；重度楔状缺损；前磨牙；预防牙折

[中图分类号] R783 [文献标识码] A [文章编号] 1673-7210（2015）09（c）-0120-05

[Abstract] Objective To evaluate the clinical application value of glass fiber post for reinforcing teeth to prevent tooth fracture. Methods After having been perfectly finished by root canal treatment， 138 maxillary premolar teeth of 100 patients with severe wedge-shaped defect were restored with glass fiber post and composite resin core， sandwich technique of fluid resin and nano-composite resin for wedge-shaped defect， in Yantai Shan Hospital from 2007 to 2010. Patients were followed up for 1-3 years after treatment， and the integrity， masticatory function and retention were examined. Results A total of 138 teeth of 100 patients were followed up for 1-3 years， treatment of 136 teeth were successful， without conscious symptoms， chewing function was normal. X-ray film showed that， periodontal membrane cavity without broadening， no secondary caries formation. Only 2 teeth were broken in the crown because of wrong use， found no tooth broken off or crown root fracture. Conclusion The glass fiber posts are effective for the restoration of tooth with severe wedge-shaped defect for reinforcing teeth and preventing crown and root fractures； together with the sandwich technique of fluid resin and nano-composite resin restored the cervical defect. The effective rate of instant and long-time outcome of this technique is high， especially for the tooth without any other defect or caries and person who is reluctant to receive full crown reservation.

[Key words] Glass fiber post； Reinforce； Severe wedge-shaped defect； Premolar； Prevention of tooth fracture

重度楔状缺损的患牙牙颈部缺损深度近髓或者已露髓，牙体组织的完整性遭到严重破坏，根管治疗后牙体及根管壁牙本质会进一步丧失，这使得牙体的抗折强度降低，尽早进行桩冠修复才能避免牙体折断。但是由于大多数的病例牙冠完整，患者比较抗拒进行冠修复，从而忽视了这类牙齿治疗后的潜在危险。笔者对这类牙齿在完善的根管治疗术后，预防性使用玻璃纤维桩，不仅大大降低了牙折的风险，有效地保留患牙，同时也减少了传统的桩核+冠修复的治疗方案所带来的对牙体的破坏，患者更容易接受，也为日后患者的冠修复需求做好了充足的准备。

1 资料与方法

1.1 一般资料

选取2007～2010年在山东省烟台山医院口腔科就诊的100例患者，共138颗重度楔状缺损或伴有牙体缺损的患牙。纳入标准：重度楔状缺损深度达到髓腔或近髓腔，不伴有牙体缺损或前牙因楔状缺损或颈部龋致根尖周炎或牙髓炎的患牙，经完善根管治疗后，患者无意愿接受冠修复的。