牙骨質剝離牙齒的牙周組織預後之研究

Periodontal Treatment Outcomes for Teeth with Cemental Tears

牙骨質剝離是一種特殊型態的牙根表面斷裂，通常會合併牙周及根尖骨質破壞。由於受限於臨床病例較少，因此關於透過非手術性或手術性治療後的預後及相關資訊相當有限。本回顧性研究的目的是希望透過多醫院整合型研究計畫，觀察牙骨質剝離的患齒經過移除剝離的牙骨質斷片治療後，評估臨床上牙周囊袋降低及牙周附連恢復的變化。在71顆牙骨質剝離的牙齒中，因預後不佳而拔除的樣本共38例（占53.5%），剩餘的33例樣本（占46.5%）經過治療後，觀察其牙周組織預後的結果可歸納為三類，分別為癒合、存疑及失敗。臨床上評估牙周組織預後的結果主要是觀察牙周囊袋的減少，以及牙周附連組織的恢復。觀察經過移除牙骨質剝離斷片的治療之後12個月的追蹤結果發現，牙周囊袋平均減少2.5毫米，而牙周附連組織的恢復則達到4.0毫米。本研究在觀察的33例樣本中，大部分的患齒經過非手術性或手術性移除段片的治療之後，均可達到保存牙齒且恢復咀嚼功能的目的。

Cemental tear is a special type of surface root fracture popularly noted in combination with periodontal and/or periapical bony destruction. Information with regard to the prognosis of teeth with cemental tears after non-surgical and surgical treatments is limited. The objective of this retrospective study was to evaluate the pocket elimination and attachment level regain for a tooth with cemental tear after removal of the cemental fragment. The periodontal treatment outcomes for teeth with cemental tears were assessed in a Multicenter Cemental Tear Study project. Of the 71 teeth with cemental tears, 38 teeth (53.5%) were extracted. The remaining 33 teeth (46.5%) were examined for treatment outcomes, i.e., healed, questioned or failed. The primary outcome measures evaluated were reduction in probing pocket depth (PPD) and gain in clinical attachment level (CAL). The results indicated that 12 months following treatment, fragment removal therapy resulted in 2.5 mm more PPD reduction (7.1 mm vs 4.6 mm) and 4.0 mm more CAL gain than the pretreatment group. The probing depth difference between the preoperative group and the 12 months follow up group was highly significant (P < 0.0001). In 33 analyzed samples, most teeth with cemental tears can be saved and maintain their function by removal of the cemental fragment. Both non-surgical and surgical interventions are effective methods for the treatment of teeth with cemental tears. These findings provide valuable insights into the management of cemental tear and its prognosis.