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牙根纵裂(vertical root fracture)是牙裂综合征的一种,是指发生在牙根的纵向折裂而未波及牙冠者,是一种非龋性疾病。牙根纵裂发病年龄多在40以上,多发于无髓牙,发病率约为3.69%。病因:无髓牙根裂主要与牙体组织的缺损、牙齿承受应力的大小和分布不均、牙齿的韧性和抗疲劳性有关。慢性持续性创伤性咬合力和牙根受力不均是导致活髓牙牙根纵裂的主要原因,其次为牙周病和牙根发育缺陷。临床表现:1.疼痛:多发生在咬合时,疼痛程度较轻,少有剧痛。慢性疼痛迁延不愈、完善的根管治疗后仍有疼痛应当高度警惕根裂的发生。2.牙龈肿胀:范围较广泛,与牙周脓肿相似,主要集中在附着龈区域。3.瘘道:特点是远离折裂牙根,局部可能出现不止一个瘘道,瘘口主要在附着龈上,瘘道较长,瘘口的近根端指向根尖。4.骨缺损:在早期范围比较局限,有深而窄的骨缺损,多发生在颊侧骨壁,逐渐向牙间隔骨蔓延,最终形成U字形的骨缺损。辅助检查:1.X线根尖片:典型的特点是根裂线的边缘整齐,不论其长度如何,均通过根尖孔。2.CT检查:特别是在轴位的断层图像能清晰地观察的牙根纵裂的裂纹发生部位、方向、长度以及纵裂周围牙槽骨的情况,为早期诊断牙根纵裂提供参考。3.锥形束CT(CBCT):提供了牙体及根尖周组织的三维图像,而且分辨率较高,其诊断敏感度可高达81%以上。临床特点:1.发生在牙根部,有可能会向冠方扩展到牙颈部牙周附着处;2.从牙根任何水平开始的部分或者全部折裂,一般是颊舌向;3.可以只累及牙根的一个面,也可以同时累及两个面;4.可能累及牙根全长,也可能只累及一部分;5.患者一般症状和体征并不明显,所以大部分被忽略。牙根纵裂病变部位在深部的牙根,检查诊断较为困难,预后较差。因此,针对病因预防更为重要,借助CT等先进设备,早期发现与治疗有助于患牙的保存。
Vertical root fracture (longitudinal root fracture) is a kind of tooth fracture syndrome, refers to the longitudinal fracture occurred in the root without affecting the crown, is a non-carious disease. The incidence of root longitudinal splitting more than 40 years, mainly in the absence of pulp, the incidence rate of about 3.69%. Etiology: Root fracture of non-root causes of tooth defects and tooth defects, the size and distribution of teeth to withstand stress, dental toughness and fatigue related. Chronic persistent traumatic occlusal force and uneven tooth root cause is the main reason of root pulp root dehiscence, followed by periodontal disease and root defects. Clinical manifestations: 1. Pain: Occurred in the bite, the less pain, less pain. Chronic pain delayed healing, there is still a good root canal treatment of pain should be highly vigilant root rupture. 2. Gingival swelling: a wider range, similar to periodontal abscess, mainly in the gingival area attached. 3. Fistula: the characteristics are far from the fracture root, local may appear more than one fistula, the fistula is mainly attached to the gingival, fistula longer, near the root of the fistula pointing root tip. 4. Bone defects: more limited in the early range, with deep and narrow bone defects, occurred in the buccal bone wall, and gradually spread to the interdental bone, the final formation of U-shaped bone defects. Auxiliary examination: 1.X line root tip film: The typical feature is the edge of the root fissure tidy, regardless of its length, are through the apical foramen. 2.CT examination: especially in the axial tomographic images can be clearly observed root canal longitudinal crack of the crack site, direction, length, and vertical fracture around the alveolar bone for early diagnosis of root longitudinal cracking provide a reference. 3. Cone beam CT (CBCT): provides a three-dimensional image of the tooth and periapical tissue, and high resolution, the diagnostic sensitivity of up to 81% or more. Clinical features: 1. Occurred in the root of the Ministry of the crown may extend to the periodontal attachment to the dentition; 2. From the roots of any level of some or all of the beginning of the fracture, usually buccolingual; 3. Can only Involved in one side of the root, it can also affect both surfaces; 4. May involve the entire length of roots may also involve only part of the; 5. Patients with general symptoms and signs are not obvious, so most are ignored. Root longitudinal crack lesions in the deep roots, check the diagnosis is more difficult, the prognosis is poor. Therefore, for the prevention of etiology is more important, with advanced equipment such as CT, early detection and treatment contribute to the preservation of teeth.