مروری بر روش‌های درمان ترمیمی دندان‌های بدون فرول

نوع مقاله : مقاله مروری

نویسندگان
شایان قاسمی 1
شایان گلکار 2
مهدی ابراهیمی 3
امیر قرآنی 4
1 دستیار تخصصی، بخش پروتزهای دندانی، مرکز تحقیقات ایمپلنت‌های دندانی، مرکز تحقیقات دندانی، دانشکده‌ی دندان‌پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
2 دستیار تخصصی، بخش درمان ریشه، گروه اندودانتیکس، مرکز تحقیقات دندانی، موسسه تحقیقات دندانی، دانشکده‌ی دندان‌پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
3 دستیار تخصصی، بخش ارتودانتیکس، کمیته‌ی تحقیقات دانشجویی، بخش تخصصی ارتودانتیکس، دانشکده‌ی دندان‌پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
4 دستیار تخصصی، بخش جراحی دهان، فک و صورت، کمیته‌ی تحقیقات دانشجویی، گروه جراحی دهان، فک و صورت، دانشکده‌ی دندان‌پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران
10.22122/jids.v21.i1.0063
چکیده
مقدمه: ددندان‌های شدیداً آسیب‌دیده، دندان‌هایی هستند که بخش اعظمی از ساختار تاجی خود را تحت تأثیر عواملی نظیر شکستگی تاج-ریشه، ضایعات پوسیدگی گسترده، تحلیل ناحیه سرویکال ریشه یا سایر علل از دست داده‌اند و همین امر بازسازی مجدد آن‌ها را با چالش‌های متعددی همراه کرده است. مطالعات نشان داده‌اند که استفاده از اثر فرول با وجود ۵/۱ تا ۲ میلی‌متر بافت دندانی فوق لثه‌ای به منظور افزایش مقاومت به شکست دندان می‌تواند مفید باشد.
شرح مقاله: ددر صورت تصمیم برای حفظ دندان شدیدا تخریب شده، برای ایجاد ساختار تاجی بیشتر و استفاده از اثر فرول می‌توان از روش‌هایی مانند جراحی افزایش طول تاج (Crown Lengthening)، رویش اجباری به کمک ارتودنسی (Orthodontic Extrusion) یا به کمک جراحی (Surgical Extrusion) و استفاده از تکنیک‌های محافظه‌کارانه‌تر نظیر (Deep margin elevation) DME اشاره کرد. جراحی افزایش طول تاج می‌تواند به منظور افزایش زیبایی، در معرض دید و دسترسی قرار دادن پوسیدگی یا شکستگی زیرلثه یا ترکیبی از این موارد استفاده شود. اکستروژن ارتودنسی به همراه فیبروتومی می‌تواند گزینه‌ی دیگری برای آشکارسازی ساختار دندان در برخی شرایط بالینی باشد. اما در صورتی که دندان مورد نظر انکیلوز یا هایپرسمنتوز باشد، یا دچار شکستگی عمودی ریشه، نزدیکی به ریشه دندان‌های مجاور، تحلیل شدید داخلی یا خارجی ریشه، طول کوتاه ریشه، پریودنتیت درمان نشده یا بیماری پری‌اپیکال باشد نمی‌توان از این روش استفاده نمود. اکستروژن جراحی در مقایسه با گزینه‌های درمانی جایگزین، سریع است و کم‌ترین ناراحتی را برای بیمار به همراه دارد. اما یک پروتکل واحد جهانی برای آن وجود نداشته و امکان ایجاد انکیلوز و تحلیل ریشه در اثر ترومای الیاف پریودنتال در این روش وجود دارد. DME یک روش محافظه‌کارانه به منظور افزایش طول فرول بوده و می‌تواند دشواری تکنیک‌های قالب‌گیری بعدی و فرایندهای سمان‌سازی برای ترمیم‌های غیر مستقیم را کاهش دهد.
نتیجه‌گیری: با توجه به مطالعات موجود تکنیک‌های متنوعی برای به دست آوردن فرول کافی در دندان‌هایی که به شدت تخریب شده‌اند وجود دارد که در آنها یا دندان به خارج از آلوئول هدایت می‌شود و یا ساختارهای اطراف دندان به سمت اپیکال هدایت می‌شوند و یا با افزودن به ساختار دندان بستر مناسبی برای قرار گرفتن مارژین ترمیم ایجاد می‌شود.

تازه های تحقیق

شایان قاسمی: Google Scholar, PubMed 

شایان گلکار: Google Scholar, PubMed 

مهدی ابراهیمی: Google Scholar, PubMed 

امیر قرآنی: Google Scholar, PubMed 

کلیدواژه‌ها
دندان اندوشده
استحکام شکست
افزایش طول تاج
اکتسروژن ارتودنسی

عنوان مقاله English

Comparison of Restorative Treatment Methods in Teeth Without Ferrule

نویسندگان English

Shayan Ghasemi 1
Shayan Golkar 2
Mehdi Ebrahimi 3
Amir Ghorani 4
1 Postgraduate Student, Department of Prosthodontics, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
2 Post Graduate Student, Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
3 Post Graduate Student, Dental Student Research Committee, Department of Orthodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
4 Post Graduate Student, Dental Student Research Committee, Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده English

 
Introduction: Severely damaged teeth are those that have lost a significant portion of their coronal structure due to factors such as crown-root fractures, extensive carious lesions, cervical root resorption, or other causes, which makes their restoration challenging. Studies have shown that utilizing a ferrule effect with 1.5 to 2 millimeters of supragingival tooth structure can be beneficial to increase fracture resistance.
Article Description: When deciding to retain a severely damaged tooth, methods such as crown lengthening surgery, orthodontic extrusion, surgical extrusion, or more conservative techniques like Deep Margin Elevation (DME) can be employed to create additional coronal structure and utilize the ferrule effect. Crown lengthening surgery can be used to enhance aesthetics, expose and access subgingival carious lesions or fractures, or a combination of these. Orthodontic extrusion with fibrotomy can be an alternative for revealing tooth structure in some clinical situations. However, if the tooth is ankylosed or has hypercementosis, vertical root fractures, proximity to adjacent tooth roots, severe internal or external root resorption, short root length, untreated periodontitis, or periapical disease, this method may not be applicable. Surgical extrusion is relatively fast compared to alternative treatments and causes minimal discomfort for the patient. However, there is no universal protocol, and there is a risk of ankylosis and root resorption due to periodontal fiber trauma with this method. DME is a conservative approach to increase the ferrule length and can reduce the difficulty of subsequent impression techniques and cementation processes for indirect restorations.
Conclusion: According to existing studies, there are various techniques to achieve sufficient ferrule in severely damaged teeth, where either the tooth is moved outside the alveolus, the surrounding structures are moved apically, or additional tooth structure is added to provide a suitable margin for restoration.

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مجله دانشکده دندان‌پزشکی اصفهان
دوره 21، شماره 1
دوره 21، شماره 1، بهار 1404
بهار 1404
صفحه 63-76