43個(gè)萌出前牙冠內(nèi)吸收發(fā)病情況調(diào)查及對(duì)策

趙東方, 張媛媛, 郭青玉

(西安交通大學(xué)口腔醫(yī)院兒童口腔科, 陜西 西安 710004)

·治療與應(yīng)用·

43個(gè)萌出前牙冠內(nèi)吸收發(fā)病情況調(diào)查及對(duì)策

趙東方, 張媛媛, 郭青玉

(西安交通大學(xué)口腔醫(yī)院兒童口腔科, 陜西 西安 710004)

目的: 探討萌出前牙冠內(nèi)吸收的發(fā)病特點(diǎn)及治療方法。方法：檢索Pubmed數(shù)據(jù)庫關(guān)于萌出前牙冠內(nèi)吸收病例報(bào)告及流行病學(xué)方面的文獻(xiàn)，尋找其發(fā)病特點(diǎn)及治療對(duì)策。結(jié)果：檢索到萌出前牙冠內(nèi)吸收病例報(bào)告34篇(1978～2013)，共43個(gè)病變牙，流行病學(xué)調(diào)查6篇；該病發(fā)生于6～20歲，好發(fā)于替牙列階段，發(fā)病率1.55%～27.3%，無種族及性別差異，通常在拍攝曲面斷層片時(shí)偶然發(fā)現(xiàn)，也有個(gè)別患者出現(xiàn)疼痛癥狀。43個(gè)患牙中第二磨牙44.19%，第一磨牙18.60%，第二前磨牙和尖牙均為13.95%；其中86.05%發(fā)生在下頜，單發(fā)或多發(fā)。治療方法以臨床觀察為主，治療率高于拔除率。結(jié)論：在敏感年齡及發(fā)病因素存在的情況下常規(guī)拍攝全口曲面斷層片進(jìn)行篩查，早發(fā)現(xiàn)，早治療。

萌出前; 牙冠內(nèi)吸收; 牙冠內(nèi)缺損; 萌出前齲

[DOI] 10.15956/j.cnki.chin.j.conserv.dent.2015.10.010

[Chinese Journal of Conservative Dentistry,2015,25(10): 618]

萌出前牙冠內(nèi)吸收也稱萌出前牙冠內(nèi)缺損，是在牙齒萌出前發(fā)生在牙冠內(nèi)的一種缺陷，X線片表現(xiàn)為牙冠內(nèi)臨近釉牙本質(zhì)界向牙本質(zhì)內(nèi)不同程度破壞的透射影像，邊界清楚，透影區(qū)與髓腔之間通常有一薄層牙本質(zhì)分開。該病最早在1941年由Skillen發(fā)現(xiàn)并報(bào)道[1]，發(fā)病罕見，因發(fā)現(xiàn)不及時(shí)而容易造成牙冠完全缺損，甚至累及牙髓，導(dǎo)致牙根不能繼續(xù)發(fā)育[2]。該病病因尚不清楚，推測(cè)有鄰牙易位、萌出過程中受到擠壓、先行乳牙有慢性根尖周炎、齲病、牙本質(zhì)發(fā)育不全、釉基質(zhì)未礦化和吸收、原發(fā)性外吸收等[3-5]。目前，國內(nèi)外研究樣本數(shù)量有限、資料孤立，缺少完整的發(fā)病情況及診治流程，本調(diào)查通過分析國外已經(jīng)公開發(fā)表的文獻(xiàn)，探討其發(fā)病特點(diǎn)及治療方法。

1 臨床資料和方法

1.1 臨床資料

以 preeruptive(或pre eruptive) intracoronal radiolucency(或defect，或lesions，或resorption)為關(guān)鍵詞在pubmed數(shù)據(jù)庫中進(jìn)行檢索，納入標(biāo)準(zhǔn)：①文題中標(biāo)有以上關(guān)鍵詞的個(gè)案報(bào)道(case report)；②文題中標(biāo)有以上關(guān)鍵詞的流行病學(xué)調(diào)查。

1.2 方法

使用Microsoft Office Excel軟件對(duì)病例報(bào)告、流行病學(xué)調(diào)查等文獻(xiàn)中萌出前牙冠內(nèi)吸收的發(fā)病情況、治療方案進(jìn)行分析、整理。

2 結(jié)果

以preeruptive(pre eruptive) intracoronal radiolucency，preeruptive(pre eruptive) intracoronal defect，preeruptive(pre eruptive) intracoronal lesion，preeruptive(pre eruptive) intracoronal Caries，preeruptive(pre eruptive) intracoronal resorption為關(guān)鍵詞在pubmed數(shù)據(jù)庫中分別檢索出病例報(bào)告2(1)篇，2(6)篇，2(5)篇，4(0)篇，4(8)篇，排除重復(fù)和無關(guān)文獻(xiàn)，共計(jì)符合要求文獻(xiàn)34篇，患牙43個(gè); 流行病學(xué)調(diào)查文獻(xiàn)6篇。

2.1 流行病學(xué)情況[6-11]

該病好發(fā)年齡為6～20歲，人發(fā)病率為1.55%～27.30%，牙發(fā)病率為0.50%～2.10%，患病在種族和性別之間無統(tǒng)計(jì)學(xué)差異。該病好發(fā)于混合牙列，其次為乳牙列, 恒牙列最低，以下頜單發(fā)多見，偶爾有2個(gè)或多個(gè)牙同時(shí)發(fā)生。牙冠內(nèi)缺損多見于牙冠內(nèi)牙本質(zhì)層的近中及牙冠中部，臨近釉牙本質(zhì)界，與牙髓之間有薄層的牙本質(zhì)分界，50%的缺損小于牙本質(zhì)厚度的1/3，釉質(zhì)基本正常(表1)。

43個(gè)患牙發(fā)生牙位及頜位情況見表2。發(fā)病率由高至低：第二磨牙>第一磨牙>尖牙及第二前磨牙，43個(gè)患牙中86.05%發(fā)生在下頜。

表1 萌出前牙冠內(nèi)吸收的流行病學(xué)調(diào)查

表2 43個(gè)萌出前牙冠內(nèi)吸收牙位及頜位發(fā)生情況(n，%)

2.2 癥狀[12-20]

該病一般無自覺癥狀，通常在X線檢查時(shí)偶然發(fā)現(xiàn)。本調(diào)查結(jié)果發(fā)現(xiàn)，2例有間斷性鈍痛， 1例有繼發(fā)性疼痛， 1例發(fā)生軟組織腫脹， 1例發(fā)生不可復(fù)性牙髓炎，其余病例未描述是否有癥狀，或未提及。

2.3 治療方法[12-20]

43例萌出前牙冠內(nèi)吸收中有12例(27.91%)因正畸治療需要拔除，其中前磨牙1例，第一磨牙1例，第二磨牙10例；有23例(53.49%)采取手術(shù)暴露牙冠或等待患牙萌出后進(jìn)行充填治療，其中1例采取萌出后預(yù)成冠修復(fù)；有8例(18.60%)未提及治療方法。

3 討論

根據(jù)文獻(xiàn)該病的命名有5種：萌出前牙冠內(nèi)吸收(pre eruptive intracoronal resorption)[1]、萌出前牙冠內(nèi)透射影像(pre eruptive intracoronal radiolucency)[6]、萌出前牙冠內(nèi)缺損(pre eruptive intracoronal defect)[17]、萌出前牙冠內(nèi)腐蝕(pre eruptive intracoronal lesion)[21]、萌出前齲(pre eruptive intracoronal caries)[22]。以pre eruption intracoronal resorption為關(guān)鍵詞進(jìn)行文章發(fā)表的最多，有8篇，占40%，其中萌出前“齲”受到質(zhì)疑，原因在于該病發(fā)生在牙齒萌出前(牙齒表面有牙槽骨或牙齦覆蓋)，牙冠尚未暴露在口腔中，因此牙冠的缺損或吸收與齲病的病因不符。

不同學(xué)者對(duì)該病的流行病學(xué)情況調(diào)查結(jié)果不同，分析原因在于調(diào)查對(duì)象人數(shù)和年齡范圍不一致，該病為萌出前冠內(nèi)吸收，牙齒萌出的時(shí)間主要在替牙列階段，如果調(diào)查年齡范圍跨度大，發(fā)病率必然較低，而在好發(fā)年齡段內(nèi)(5～20歲)調(diào)查發(fā)病率相對(duì)較高是合理的。

本調(diào)查結(jié)果顯示，43個(gè)患牙治療率高于拔除率，提示，對(duì)于萌出前牙冠內(nèi)吸收的病例，根據(jù)牙位及鈣化階段預(yù)測(cè)其萌出時(shí)間，如不涉及正畸關(guān)閉間隙或牙冠缺損過大而需要拔牙的情況，建議進(jìn)行密切觀察，待患牙萌出后及時(shí)進(jìn)行間接蓋髓充填治療或預(yù)成冠修復(fù)，如果患牙臨近萌出或邊緣嵴已經(jīng)暴露，應(yīng)及時(shí)切除冠方部分牙齦組織，暴露牙冠進(jìn)行治療。

萌出前牙冠內(nèi)吸收在臨床中應(yīng)引起足夠的重視，尤其是正畸科醫(yī)生，在臨床工作中很可能最先接觸到這類患者，并建議兒童牙科醫(yī)生在替牙列階段常規(guī)進(jìn)行全口曲面斷層攝影，注意好發(fā)牙及好發(fā)部位，及時(shí)發(fā)現(xiàn)該病并給予適當(dāng)?shù)闹委煛?/p>

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Pre-eruptive intracoronal absorption: a literature review of 43 cases

ZHAO Dong- fang, ZHANG Yuan- yuan, GUO Qing- yu

(DepartmentofPediatricDentistry,StomatologicalHospitalofXi'anJiaotongUniversity,Xi′an710004,China)

AIM: To investigate the characteristics and treatment methods of pre- eruptive intracoronal absorption. METHODS: A literature research of case reports and epidemiological investigations about pre- eruptive intracoronal absorption was done in Pubmed database, using the key words of preeruptive(pre eruptive) intracoronal radiolucency，preeruptive(pre eruptive) intracoronal defect，preeruptive(pre eruptive) intracoronal lesion，preeruptive(pre eruptive) intracoronal caries，and preeruptive(pre eruptive) intracoronal resorption. RESULTS: A total of 34 case reports (1978～2013) and 6 articles of epidemiological investigation were found. The cases were usually found during routine radiographic examinations of children at the age of 6～20 years old with otherwise good oral health. Few cases of toothache had been reported. In the 43 cases, 44.19% were found in the second permanent molar, followed by the first permanent molar (18.60%) and the second permanent molar and canine (13.95%), mostly in the lower jaw (86.05%). Most of the cases were clinically treated. CONCLUSION: In the mixed dentition stage, panoramic radiograph should be taken to screen pr- eruptive intracoronal absorption. Early detection and early treatment is important.

pre- eruption; intracoronal resorption; intracoronal defect; pre- eruption caries

2015-01-25;

2015-07-16

趙東方(1973-)，女，漢族，吉林人。碩士，副主任醫(yī)師

趙東方， E-mail: zjz158297@163.com

R781.3

B

1005-2593(2015)10-0618-03