儿童及青少年挫入恒前牙自行再萌出的相关影响因素

doi:10.19723/j.issn.1671-167X.2025.01.022

摘要/Abstract

摘要：

目的: 探究影响儿童及青少年外伤挫入恒前牙自行再萌出的影响因素。方法: 回顾性分析2015年6月至2024年8月就诊于北京大学口腔医院儿童口腔科5~17岁发生恒前牙挫入患者的临床资料，记录外伤年龄、性别、牙根发育程度、挫入程度、挫入方向、是否伴有冠折露髓、是否伴有牙龈撕裂伤、邻牙是否发生移位性损伤、邻牙是否处于破骨后萌出期，以外伤挫入牙在建议观察时间内是否有自行再萌出作为结局变量，采用单因素分析及多因素二元Logistic回归模型进行影响因素分析。结果: 共纳入139例患者170颗患牙，包括男性84例，女性55例；年龄范围为5.3~16.3岁，平均年龄(9.0±2.1)岁。根据判断标准，在建议观察期间出现自行再萌出的患牙有112颗，无自行再萌出的患牙有58颗。挫入程度在3 mm以下患牙45颗(26.47%)，3~7 mm患牙102颗(60.00%)，>7 mm患牙23颗(13.53%)；根向挫入的患牙117颗(68.82%)，近远中向挫入的患牙17颗(10.00%)，颊舌向挫入的患牙36颗(21.18%)。二元Logistic回归分析显示，近远中向挫入(OR=0.167，95%CI: 0.031~0.9048，P=0.038)、挫入>7 mm(OR=0.065，95%CI: 0.014~0.299，P < 0.001)、邻牙发生移位性损伤(OR=0.369，95%CI: 0.144~0.944，P=0.037)是挫入牙自行再萌出的独立危险因素。挫入 < 3 mm(OR=9.860，95%CI: 2.430~40.009，P=0.001)和邻牙处于破骨后萌出期(OR=4.712，95%CI: 1.528~14.531，P=0.007)是外伤挫入恒前牙自行再萌出的独立保护性因素，Cvek牙根发育分期每增加一个分期单位(OR=0.611，95%CI: 0.408~0.914，P=0.017)，挫入牙自行再萌出可能性降低61.1%。年龄(OR=1.077，95%CI: 0.763~1.521，P=0.673)、牙龈撕裂伤(OR=0.865，95%CI: 0.290~2.578，P=0.794)并不会对挫入恒前牙自行再萌出产生影响。结论: 近远中向挫入、挫入程度>7 mm、邻牙发生移位性损伤是儿童及青少年挫入恒前牙自行再萌出的独立危险因素，挫入程度 < 3 mm、相邻恒牙处于破骨后萌出期是挫入恒前牙自行再萌出的独立保护性因素。

关键词: 牙撕脱, 恒牙列, 牙萌出, 危险因素, 儿童, 青少年

Abstract:

Objective: To analyze the factors related to spontaneous re-eruption after intruded injury in permanent anterior teeth in children and adolescents. Methods: Clinical data from 5- to 17-year-old patients who sustained intrusive luxation of permanent anterior teeth and treated in the Department of Pedia-tric Dentistry of Peking University School and Hospital of Stomatology from June 2015 to August 2024 were reviewed. Information of age, gender, degree of intrusion, direction of intrusion, tooth development, concomitant injuries, luxation and post-osteoclastic eruption of the adjacent teeth were recorded. The patients were divided into two groups based on whether they showed spontaneous re-eruption during advised observation after intrusion. Univariate and multifactor analysis were performed using Logistic regression. Results: Data from 170 teeth in 139 patients whose age ranging from 5.3-16.3 years [mean age (9.0± 2.1) years] were examined. A gender disparity was observed among the patients, with 84 being male and 55 being female. Among the 170 teeth, 112 were categorized as successfully spontaneous re-eruption during advised observation after intrusion, while 58 were not. In terms of the degree of intrusion, 45 teeth (26.47%) had intrusion less than 3 mm, 102 teeth (60.00%) experienced intrusion between 3-7 mm, and 23 teeth (13.53%) were faced with intrusion exceeding 7 mm. As for the direction of intrusion, 117 teeth (68.82%) were straight intrusion while mesial-distal and buccal-lingual intrusion respectively accounting for 17 (10.00%) and 23 (13.53%). Multivariate Logistic regression analysis showed that mesial-distal intrusion (OR=0.167, 95%CI: 0.031-0.9048, P=0.038), intrusion of >7 mm (OR=0.065, 95%CI: 0.014-0.299, P < 0.001) and luxation of adjacent teeth (OR=0.369, 95%CI: 0.144-0.944, P=0.037) were independent risk factors for spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents during advised observation after intrusion, while intrusion of < 3 mm (OR=9.860, 95%CI: 2.430-40.009, P=0.001) and post-osteoclastic eruption of adjacent teeth (OR=4.712, 95%CI: 1.528-14.531, P=0.007) were independent protective factors. The possibility of spontaneous re-eruption in permanent anterior teeth during advised observation after intrusion was decreased by 61.1% with the increase of root development using Cvek' s classification (OR=0.611, 95%CI: 0.408-0.914, P=0.017). Age (OR=1.077, 95%CI: 0.763-1.521, P=0.673) and laceration of gingival (OR=0.865, 95%CI: 0.290-2.578, P=0.794) didn't significantly affect the spontaneous re-eruption during advised observation after intrusion. Conclusion: In this study, mesial-distal intrusion, intrusion of >7 mm and luxation of adjacent teeth were independent risk factors for spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents during advised observation, while intrusion of < 3 mm and post-osteoclastic eruption of adjacent teeth were served as independent protective factors.

Key words: Tooth avulsion, Permanent dentition, Tooth eruption, Risk factors, Child, Adolescent

中图分类号:

R788.4

邓敏婷, 王楠, 夏斌, 赵玉鸣, 朱俊霞. 儿童及青少年挫入恒前牙自行再萌出的相关影响因素[J]. 北京大学学报（医学版）, 2025, 57(1): 148-153.

Minting DENG, Nan WANG, Bin XIA, Yuming ZHAO, Junxia ZHU. Factors associated with spontaneous re-eruption of traumatically intruded permanent anterior teeth in children and adolescents[J]. Journal of Peking University (Health Sciences), 2025, 57(1): 148-153.

图/表 3

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参考文献 21

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Variables	Spontaneous re-eruption			P
Variables	Total (n=170)	No (n=58)	Yes (n=112)	P
Age/years, ${\bar x}$±s	9.20±2.15	9.98±2.48	8.80±1.84	0.002
Degree of intrusion, n(%)				< 0.001
< 3 mm	45 (26.47)	3 (5.17)	42 (37.50)
3-7 mm	102 (60.00)	37(63.79)	65(58.04)
>7 mm	23(13.53)	18 (31.03)	5(4.46)
Direction of intrusion, n(%)				< 0.001
Straight	117 (68.82)	24(41.38)	93 (83.04)
Buccal-lingual	36 (21.18)	20(34.48)	16 (14.29)
Mesial-distal	17 (10.00)	14 (24.14)	3 (2.68)
Post-osteoclastic eruption of the adjacent teeth, n(%)				< 0.001
No	99(58.24)	49(84.48)	50(44.64)
Yes	71(41.76)	9(15.52)	62(55.36)
Laceration of gingival, n(%)				< 0.001
No	125 (73.53)	32 (55.17)	93 (83.04)
Yes	45 (26.47)	26 (44.83)	19 (16.96)
Luxation of adjacent teeth, n(%)				< 0.001
No	75 (44.12)	12 (20.69)	63 (56.25)
Yes	95 (55.88)	46 (79.31)	49(43.75)
Cvek’s classification, n(%)				0.009
Stage 1	9 (5.29)	1 (1.72)	8 (7.14)
Stage 2	27 (15.88)	7 (12.07)	20 (17.86)
Stage 3	48 (28.24)	12 (20.69)	36 (32.14)
Stage 4	31 (18.24)	9 (15.52)	22 (19.64)
Stage 5	55 (32.35)	29 (50.00)	26 (23.21)
Complex crown fracture, n(%)				0.895
No	156 (91.76)	53 (91.38)	103 (91.96)
Yes	14 (8.24)	5 (8.62)	9 (8.04)

Variables	β	SE	Wald χ²	P	OR (95%CI)
Age	0.074	0.176	0.178	0.673	1.077 (0.763-1.521)
Degree of intrusion
3-7 mm					1.00 (Reference)
>7 mm	-2.727	0.776	12.354	< 0.001	0.065 (0.014-0.299)
< 3 mm	2.288	0.715	10.255	0.001	9.860 (2.430-40.009)
Direction of intrusion
Straight					1.00 (Reference)
Buccal-lingual	-0.980	0.519	3.566	0.059	0.374 (0.136-1.038)
Mesial-distal	-1.793	0.863	4.313	0.038	0.167 (0.031-0.904)
Cvek’s classification	-0.493	0.205	5.748	0.017	0.611 (0.408-0.914)
Laceration of gingival
No					1.00 (Reference)
Yes	-0.145	0.557	0.068	0.794	0.865 (0.290-2.578)
Luxation of adjacent teeth
No					1.00 (Reference)
Yes	-0.997	0.479	4.331	0.037	0.369 (0.144-0.944)
Post-osteoclastic eruption of the adjacent teeth
No					1.00 (Reference)
Yes	1.550	0.575	7.277	0.007	4.712 (1.528-14.531)