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上颌尖牙罕见III型牙内陷合并既往牙外伤的根管治疗

Endodontic management of a rare case of Type III Dens invaginatus in a maxillary canine combined with a previous occurrence of dental trauma.

作者信息

Tzanetakis Giorgos N, Mougiou Eleni, Koletsi Despina, Lygidakis Nikos N

机构信息

DDS, MSc, MSc, PhD. Associate Professor, Department of Endodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.

DDS. Private Dental Practice, Athens, Greece.

出版信息

J Clin Exp Dent. 2024 Jun 1;16(6):e778-e784. doi: 10.4317/jced.61467. eCollection 2024 Jun.

DOI:10.4317/jced.61467
PMID:39183995
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11345082/
Abstract

Dens Invaginatus (DI) is a developmental anomaly which eventually leads to pulp necrosis and has several clinical implications in sufficient instrumentation and obturation of the root canal system. The present clinical report presents a rare case of a maxillary canine affected with DI leading to pulp necrosis combined with a previous dental trauma, which also led to irreversible pulp damage of the adjacent lateral incisor. A 14-year-old male patient with a history of dental trauma at the right maxillary region, one year earlier, was referred with pain and swelling at the apical area of the right maxillary canine. After CBCT evaluation, complete removal of the invagination was decided. All the procedures were performed under operating microscope and canal obturation was done with apical plug technique using MTA. Two-year follow-up radiographic assessment confirmed complete healing of the periapical tissues for both teeth. The present case describes a rare case of dens invaginatus in a maxillary canine pointing out the importance of obtaining a thorough dental history upon diagnosis, performing also a careful clinical and radiographic evaluation and subsequent treatment planning, especially when addressing complex pathologies and unusual dental malformations. In such cases with high degree of complexity, preoperative CBCT examination is required for decision making and subsequent appropriate management. Dens Invaginatus, maxillary canine, endodontic treatment.

摘要

牙中牙(DI)是一种发育异常,最终会导致牙髓坏死,并且在根管系统的充分预备和充填方面具有多种临床意义。本临床报告展示了一例罕见病例,上颌尖牙患有牙中牙导致牙髓坏死,同时伴有既往牙外伤,该牙外伤还导致相邻侧切牙发生不可逆性牙髓损伤。一名14岁男性患者,一年前右侧上颌区域有牙外伤史,因右侧上颌尖牙根尖区疼痛和肿胀前来就诊。经锥形束计算机断层扫描(CBCT)评估后,决定彻底切除内陷部分。所有操作均在手术显微镜下进行,根管充填采用根尖屏障技术并使用矿物三氧化物凝聚体(MTA)。两年的随访影像学评估证实两颗牙齿的根尖周组织均完全愈合。本病例描述了上颌尖牙罕见的牙中牙病例,指出诊断时获取详尽牙科病史、进行仔细的临床和影像学评估以及后续治疗计划的重要性,尤其是在处理复杂病变和罕见牙畸形时。在这种高度复杂的病例中,术前需要进行CBCT检查以辅助决策和后续的恰当处理。牙中牙、上颌尖牙、牙髓治疗

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1a6/11345082/876a27b1d4a2/jced-16-e778-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1a6/11345082/9ac891d2b5d6/jced-16-e778-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1a6/11345082/876a27b1d4a2/jced-16-e778-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1a6/11345082/9ac891d2b5d6/jced-16-e778-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d1a6/11345082/876a27b1d4a2/jced-16-e778-g002.jpg

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本文引用的文献

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Long-term follow-up of single-visit pulp revascularisation for the dens evaginatus and dens invaginatus: Cases report.畸形中央尖和畸形舌侧窝单次就诊牙髓血运重建的长期随访:病例报告
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使用锥形束计算机断层扫描评估前牙内陷畸形的流行率和形态学分析:系统评价和荟萃分析。
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Prevalence, classification and dental treatment requirements of dens invaginatus by cone-beam computed tomography.锥形束计算机断层扫描对牙内陷的流行情况、分类和牙科治疗需求。
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Prevalence of Dens Invaginatus assessed by CBCT: Systematic Review and Meta-Analysis.锥形束计算机断层扫描评估的牙内陷患病率:系统评价与荟萃分析
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Clin Oral Investig. 2022 Sep;26(9):5875-5883. doi: 10.1007/s00784-022-04545-3. Epub 2022 Jun 1.
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