Baruwa Abayomi O, Anderson Craig, Monroe Adam, Cracel Nogueira Flávia, Corte-Real Luís, Martins Jorge N R
Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman 346, United Arab Emirates.
Private Practice, Biloxi, MS 39532, USA.
Medicina (Kaunas). 2025 Jul 16;61(7):1281. doi: 10.3390/medicina61071281.
is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers' classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers' classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of .
是一种发育性牙异常，其特征是在牙胚发生早期釉器向内折叠进入牙乳头。这个过程导致了广泛的解剖变异，从局限于牙冠的微小釉质衬里窝到延伸至牙根的深凹陷，偶尔与牙周或根尖周组织相通。患牙的内部复杂性带来了诊断和治疗挑战，尤其是在严重形式中，这些形式模仿根管系统或与牙髓或根尖周病变相关。上颌侧切牙最常受累，可能是由于其独特的发育时间表和形态易感性。尽管已经提出了各种分类系统，但奥勒斯分类法因其简单性以及与治疗复杂性的相关性，仍然是临床上最相关的。诊断成像的最新进展，尤其是锥形束计算机断层扫描（CBCT），彻底改变了这些异常的识别和分类。基于CBCT的奥勒斯分类法改编允许精确评估凹陷程度和牙髓受累情况，有助于改进治疗计划。当代治疗策略现在包括基于硅酸钙的封闭材料、针对难以接近的解剖结构的牙髓显微手术，以及针对牙髓坏死的未成熟牙齿的再生牙髓治疗程序。人工智能、基因研究和组织工程的新发展有望进一步完善诊断能力和治疗选择。早期检测对于预防诸如牙髓坏死或根尖疾病等并发症仍然至关重要。多学科、图像引导和以患者为中心的方法对于优化病例的临床结果至关重要。
