43個萌出前牙冠內吸收發病情況調查及對策

趙東方, 張媛媛, 郭青玉

(西安交通大學口腔醫院兒童口腔科, 陜西 西安 710004)

·治療與應用·

43個萌出前牙冠內吸收發病情況調查及對策

趙東方, 張媛媛, 郭青玉

(西安交通大學口腔醫院兒童口腔科, 陜西 西安 710004)

目的: 探討萌出前牙冠內吸收的發病特點及治療方法。方法：檢索Pubmed數據庫關于萌出前牙冠內吸收病例報告及流行病學方面的文獻，尋找其發病特點及治療對策。結果：檢索到萌出前牙冠內吸收病例報告34篇(1978～2013)，共43個病變牙，流行病學調查6篇；該病發生于6～20歲，好發于替牙列階段，發病率1.55%～27.3%，無種族及性別差異，通常在拍攝曲面斷層片時偶然發現，也有個別患者出現疼痛癥狀。43個患牙中第二磨牙44.19%，第一磨牙18.60%，第二前磨牙和尖牙均為13.95%；其中86.05%發生在下頜，單發或多發。治療方法以臨床觀察為主，治療率高于拔除率。結論：在敏感年齡及發病因素存在的情況下常規拍攝全口曲面斷層片進行篩查，早發現，早治療。

萌出前; 牙冠內吸收; 牙冠內缺損; 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]

萌出前牙冠內吸收也稱萌出前牙冠內缺損，是在牙齒萌出前發生在牙冠內的一種缺陷，X線片表現為牙冠內臨近釉牙本質界向牙本質內不同程度破壞的透射影像，邊界清楚，透影區與髓腔之間通常有一薄層牙本質分開。該病最早在1941年由Skillen發現并報道[1]，發病罕見，因發現不及時而容易造成牙冠完全缺損，甚至累及牙髓，導致牙根不能繼續發育[2]。該病病因尚不清楚，推測有鄰牙易位、萌出過程中受到擠壓、先行乳牙有慢性根尖周炎、齲病、牙本質發育不全、釉基質未礦化和吸收、原發性外吸收等[3-5]。目前，國內外研究樣本數量有限、資料孤立，缺少完整的發病情況及診治流程，本調查通過分析國外已經公開發表的文獻，探討其發病特點及治療方法。

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)為關鍵詞在pubmed數據庫中進行檢索，納入標準：①文題中標有以上關鍵詞的個案報道(case report)；②文題中標有以上關鍵詞的流行病學調查。

1.2 方法

使用Microsoft Office Excel軟件對病例報告、流行病學調查等文獻中萌出前牙冠內吸收的發病情況、治療方案進行分析、整理。

2 結果

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為關鍵詞在pubmed數據庫中分別檢索出病例報告2(1)篇，2(6)篇，2(5)篇，4(0)篇，4(8)篇，排除重復和無關文獻，共計符合要求文獻34篇，患牙43個; 流行病學調查文獻6篇。

2.1 流行病學情況[6-11]

該病好發年齡為6～20歲，人發病率為1.55%～27.30%，牙發病率為0.50%～2.10%，患病在種族和性別之間無統計學差異。該病好發于混合牙列，其次為乳牙列, 恒牙列最低，以下頜單發多見，偶爾有2個或多個牙同時發生。牙冠內缺損多見于牙冠內牙本質層的近中及牙冠中部，臨近釉牙本質界，與牙髓之間有薄層的牙本質分界，50%的缺損小于牙本質厚度的1/3，釉質基本正常(表1)。

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

表1 萌出前牙冠內吸收的流行病學調查

表2 43個萌出前牙冠內吸收牙位及頜位發生情況(n，%)

2.2 癥狀[12-20]

該病一般無自覺癥狀，通常在X線檢查時偶然發現。本調查結果發現，2例有間斷性鈍痛， 1例有繼發性疼痛， 1例發生軟組織腫脹， 1例發生不可復性牙髓炎，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%)采取手術暴露牙冠或等待患牙萌出后進行充填治療，其中1例采取萌出后預成冠修復；有8例(18.60%)未提及治療方法。

3 討論

根據文獻該病的命名有5種：萌出前牙冠內吸收(pre eruptive intracoronal resorption)[1]、萌出前牙冠內透射影像(pre eruptive intracoronal radiolucency)[6]、萌出前牙冠內缺損(pre eruptive intracoronal defect)[17]、萌出前牙冠內腐蝕(pre eruptive intracoronal lesion)[21]、萌出前齲(pre eruptive intracoronal caries)[22]。以pre eruption intracoronal resorption為關鍵詞進行文章發表的最多，有8篇，占40%，其中萌出前“齲”受到質疑，原因在于該病發生在牙齒萌出前(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。

不同學者對該病的流行病學情況調查結果不同，分析原因在于調查對象人數和年齡范圍不一致，該病為萌出前冠內吸收，牙齒萌出的時間主要在替牙列階段，如果調查年齡范圍跨度大，發病率必然較低，而在好發年齡段內(5～20歲)調查發病率相對較高是合理的。

本調查結果顯示，43個患牙治療率高于拔除率，提示，對于萌出前牙冠內吸收的病例，根據牙位及鈣化階段預測其萌出時間，如不涉及正畸關閉間隙或牙冠缺損過大而需要拔牙的情況，建議進行密切觀察，待患牙萌出后及時進行間接蓋髓充填治療或預成冠修復，如果患牙臨近萌出或邊緣嵴已經暴露，應及時切除冠方部分牙齦組織，暴露牙冠進行治療。

萌出前牙冠內吸收在臨床中應引起足夠的重視，尤其是正畸科醫生，在臨床工作中很可能最先接觸到這類患者，并建議兒童牙科醫生在替牙列階段常規進行全口曲面斷層攝影，注意好發牙及好發部位，及時發現該病并給予適當的治療。

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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，副主任醫師

趙東方， E-mail: zjz158297@163.com

R781.3

B

1005-2593(2015)10-0618-03