无髓变色牙内漂白术的临床疗效观察.doc

无髓变色牙内漂白术的临床疗效观察 目的:本文介绍使用无髓变色牙内漂白术的安全性及临床疗效观察研究。方法:漂白治疗前,必须拍摄X线片确认根管已做过完善根充。髓腔内置入30%过氧化氢棉球暂封1周。复诊3～6次达到正常色泽后用复合树脂进行充填,3年后复查。结果:74例患者,痊愈56例,占75.7%,好转15例,占20.3%,有效率达96%,失败3例,占4%。结论:采用髓腔内置入30%过氧化氢溶液治疗无髓变色牙方法能获得较好的长期临床疗效。 [主题词]无髓变色牙;内漂白;30%过氧化氢;过硼酸钠。 A clinical study on the effect of internal bleaching of discolored and pulpless tooth LI Qin1,JIANG Yong2,FENG Xue1 (1.Department of Dentistry,Xi’anCentralHospital,Xi’an 710003,Shaanxi,China;2.Department of Operative Dentistry and Endodontics,School of Stomatology,Fourth Military Medical University) Abstract: ObjectiveTo discuss the clinical effect of internal bleaching of discolored and plupless tooth.MethodsPrior to internal bleaching,discolored and pulpless tooth was treated with root canal therapy and the obturation of root canal was verified by radiography.Then a cotton ball soaked with 30% hydrogen peroxide solution was sealed in the cavity and replaced by a new one each interview per week. After 3～6 times of interview, the cavity was filled with composite resin when the color of tooth had turned normal.Results Among the 74 patients, teeth of 56(75.7%) patients were completely cured,15(20.3%) were improved and only 3(4%)were failed,with the total effective rate of 96%.ConculusionInternal bleaching of discolored and pulpless teeth with 30% hydrogen peroxide solution could obtain satisfactory long-term cinical effect. Key words:discolored and plupless teeth;internal bleaching;30% hydrogen peroxide;sodium perborate 无髓变色牙在临床上较多见,如重度四环素牙、死髓变色牙等多为内源性着色,特别是青年人,前牙变色影响美观,由于它的染色主要在牙本质层,目前采用的冷光漂白等外漂白法疗效不理想。采用髓腔内置入30%过氧化氢溶液加过硼酸钠糊剂治疗无髓变色牙方法简单,易于掌握。经3年临床观察疗效满意。现报道如下。 1材料和方法 1.1临床资料:共收集75例门诊患者(男30例,女45例),牙冠变色最短3年,最长20年。材料:30%过氧化氢溶液,过硼酸钠粉。 1.2方法:①完善根管:漂白治疗前,必须拍摄X线片,确认根管已作过完善根充,根充满意2周后待根充材料硬固后再行内漂白术;②髓腔清理:慢速球钻清除髓腔内容物,揭静髓顶,确保髓角及其它可能隐藏牙髓组织的区域充分暴露。髓腔内有树脂充填体时更应仔细清理,切勿残留树脂材料,以便使脱色剂能与牙本质紧密接触并有效渗透;③去除部分根充物,用磷酸锌水门汀或玻璃离子水门汀等材料垫底,以形成保护层,防止脱色剂向根方渗透。垫底材料的厚度至少2mm,冠方高度与牙龈的附着上皮一致,以使脱色剂能渗入牙颈部“S”形的牙本质小管,脱去牙冠部的颜色;④涂布凡士林、甘油等牙龈保护剂,保护牙龈不被强氧化剂烧伤;⑤除去髓腔内的