牙内陷分型标准与治疗理念新进展

摘要/Abstract

摘要： 牙内陷是一种牙齿形态发育畸形，其复杂的解剖结构增加了临床诊断和治疗的难度。锥形束CT结合数字化软件可以重建牙内陷的三维结构，对牙内陷的诊断、治疗及预后观察有重大意义。根管显微镜、超声技术、新型生物材料等新技术的应用使尽量保存牙髓活力与保留牙齿成为可能。治疗时要考虑患者的临床症状、牙髓感染情况、内陷严重程度、根尖发育情况、根尖周组织破坏程度等，制定个性化治疗方案。该文回顾了牙内陷的病因、流行病学、分型、诊断和治疗的最新进展，重点放在分型与治疗方法上，以期为临床治疗提供参考。

关键词: 牙内陷, 分型, 治疗, 锥形束CT

Abstract: Dens invaginatus is a developmental malformation in dental morphology. The complex anatomy of affected teeth can make diagnosis and endodontic management challenging. The diagnosis, treatment and prognosis of dens invaginatus has made progress with the application of threedimensional imaging techniques such as cone beam CT combined with digital software in endodontics. Advanced treatment options such as dental operation microscope, ultrasonic technology and biomaterials bring hope for maintaining pulp vitality and teeth that could not be saved before. Treatment depends on the clinical symptoms, pulp infection, complexity of invagination, development of apical and periapical tissue destruction. The aim of this article is to review the etiology, prevalence, classification, diagnosis and management of teeth affected by dens invaginatus. Emphasis will be placed on its classification and treatment.

Key words: dens invaginatus, classification, treatment, conebeam computed tomography

中图分类号:

R781.21

王莹张红杜奥博张志民. 牙内陷分型标准与治疗理念新进展[J]. 口腔医学, 2021, 41(10): 942-946.

参考文献 62

[1]	ACHALLI S, KATPADY M, SHETTY S R, et al.Co-occurrence of gemination and dens invaginatus: a case report[J].Cukurova Medical Journal, 2016, 41(1):175-177
[2]	BAGI?SKA J, RODAKOWSKA E, PISZCZATOWSKI S, et al.Dens invagination and root dilaceration in double multilobed mesiodentes in 14-year-old patient with anorexia nervosa[J].Folia Morphologica, 2017, 76(No.1):128-133
[3]	GOWANS L J J, CAMERON-CHRISTIE S, SLAYTON R L, et al.Missense Pathogenic variants in KIF4A Affect Dental Morphogenesis Resulting in X-linked Taurodontism,Microdontia and Dens-Invaginatus[J].Frontiers in Genetics, 2019, 10(20):800-808
[4]	LIU J, ZHANG Y, ZHANG F, et al.Microscopic removal of type III dens invaginatus and preparation of apical barrier with mineral trioxide aggregate in a maxillary lateral incisor: A case report and review of literature[J].World journal of clinical cases, 2020, 8(No.6):1150-1157
[5]	NU N L H, PHYO K P, WAI Y M T S.Coexistence of true talon cusp and double dens invaginatus in a single tooth: a rare case report and review of the literature[J].Clin Case Rep, 2017, 5(12):2017-2021
[6]	ALMAZ M E, S?NMEZ I ?, OBA A A.Prevalence and Distribution of Developmental Dental Anomalies in Pediatric Patients[J].Meandros Medical and Dental Journal, 2017, 18(No.2):130-133
[7]	KIM J H, CHOI N K, KIM S M.A retrospective study of association between peg-shaped maxillary lateral incisors and dental anomalies(Article)[J].Journal of Clinical Pediatric Dentistry, 2017, 41(No.2):150-153
[8]	ALANI A, BISHOP K.Dens invaginatusPart 1: classification,prevalence and aetiology.[Article][J].International Endodontic Journal, 2008, 41(No.12):1123-1136
[9]	胡雪, 李天博, 李雪洋, 等.右上颌第二磨牙牙内陷例报告及文献复习[J].吉林大学学报医学版, 2019, 45(05):1173-1176
[10]	承清, 夏文薇.三维打印导板在牙体牙髓专业领域中的研究和应用[J].中华口腔医学杂志, 2019, 54(01):67-70
[11]	谭军艳, 张晓敏, 孙德刚, 等.双侧下颌前磨牙牙中牙伴根尖周炎例[J].实用口腔医学杂志, 2019, 35(06):904-905
[12]	陈莹, 张绍俊, 全鹤.下颌前磨牙牙中牙伴尖周炎例[J].牙体牙髓牙周病学杂志, 2017, 27(第5期):304-305
[13]	HAGHANIFAR S, MOUDI E, ABESI F, et al.Radiographic Evaluation of Dental Anomaly Prevalence in a Selected Iranian Population[J].Journal of Dentistry, 2019, 20(No.2):90-94
[14]	ATILDE E C B B, RIBEIRO A A, SEABRA L M A.Rare Condition of Dens Invaginatus in a Maxillary Primary Molar and a Birooted Maxillary Primary Canine diagnosed during Routine Examination[J].International journal of clinical pediatric dentistry, 2017, 10(No.2):193-195
[15]	OEHLERS F A C.Dens invaginatus (Dilated composite odontome)[J].Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 1957, 10(No.12):1302-1316
[16]	张琛, 侯本祥.对牙内陷诊断和治疗的再认识[J].中华口腔医学杂志, 2020, 55(第5期):302-308
[17]	OEHLERS F A C.The radicular variety of dens invaginatus[J].Oral Surg Oral Med Oral Pathol, 1958, 11(11):1251-1260
[18]	MOHAN A, KRISHNAN U, AKBER M, et al.Successful management of a case of true radicular dens invaginatus using platelet-rich fibrin and guided tissue regeneration[J].Aust Endod J, 2020, 46(1):94-100
[19]	AHMED H M A, DUMMER P M H.A new system for classifying tooth,root and canal anomalies[J].INTERNATIONAL ENDODONTIC JOURNAL, 2018, 51(No.4):389-404
[20]	SHARMA G, NAGRA A, SINGH G, et al.An Erupted Dilated Odontoma: A Rare Presentation[J].Case reports in dentistry, 2016, 2016(16):1-5
[21]	ALMEIDA B, SILVA A, PEREIRA M, et al.Case report of a dilated odontome in the posterior mandible[J].International Journal of Surgery Case Reports, 2016, 20(7):14-16
[22]	王艳华.根管显微镜辅助的牙内陷治疗例[J].实用口腔医学杂志, 2016, 32(04):589-592
[23]	张艳, 宋文斌, 付双, 等.牙中牙例报告及文献复习[J].上海口腔医学, 2019, 28(02):191-195
[24]	刘彤曦, 郑治国, 杨健.根尖屏障技术治疗Ⅱ型牙内陷引发慢性根尖周炎例[J].华西口腔医学杂志, 2019, 37(05):568-570
[25]	SRIVASTAVA R, VERMA P K, TRIPATHI V, et al.Management of Oehlers Type II Dens in Dente with Open Apex and Alveolar Bone Defect[J].Journal of clinical and diagnostic research : JCDR, 2016, 10(No.11):J5-J6
[26]	TEBBEB N, ZAABAR D, ZOUITEN S, et al.Dens invaginatus: A review and case series[J].Saudi Endodontic Journal, 2018, 8(No.1):44-49
[27]	TEBBUTT J.Dental pathology: Early identification[J].British Dental Journal, 2017, 222(No.2):70-70
[28]	康国鹏, 钱鑫, 樊红霞, 等.上颌侧切牙牙内陷例报告[J].中国实用口腔科杂志, 2016, 9(3):191-192
[29]	陈木棠, 刘俊红, 史玉娟.牙髓血管再生术成功治疗牙中牙慢性根尖周炎例报道[J].现代口腔医学杂志, 2018, 32(04):248-249
[30]	李铎, 牛磊, 刘奕.上颌侧切牙Ⅲ型牙内陷例报告[J].中国实用口腔科杂志, 2017, 10(08):511-512
[31]	ZHANG P, WEI X.Combined Therapy for a Rare Case of Type III Dens Invaginatus in a Mandibular Central Incisor with a Periapical Lesion: A Case Report[J].Journal of Endodontics, 2017, 43(8):1378-1382
[32]	GATHANI K M.Endodontic Management of Type III Dens Invaginatus with an Open Apex[J].JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016, 10(7):4-5
[33]	BAHMANI M, ADL A, JAVANMARDI S, et al.Diagnosis and Treatment of a Type III Dens Invagination Using Cone-Beam Computed Tomography[J].Iran Endod J, 2016, 11(4):341-346
[34]	AL??KAN M K, ASGARY S, TEKIN U, et al.Amputation of an Extra-root with an Endodontic Lesion in an Invaginated Vital Maxillary Lateral Incisor: A Rare Case with Seven-year Follow-up[J].Iranian Endodontic Journal, 2016, 11(2):138-141
[35]	施雄, 李生娇, 周剑萍, 等.锥形束在牙内陷诊断中的应用[J].口腔颌面外科杂志, 2019, 29(03):164-168
[36]	LEE J, HWANG J J, KIM H.Treatment of peri-invagination lesion and vitality preservation in an immature type III dens invaginatus: a case report[J].BMC Oral Health, 2020, 20(1):29-35
[37]	LEE H, CHEN Y, CHEN C, et al.Conservative pulp treatment for Oehlers type III dens invaginatus: A case report[J].World journal of clinical cases, 2019, 7(No.18):2823-2830
[38]	李晓署, 燕梁, 旭谭, 等.锥形束在上颌侧切牙牙中牙诊疗中的辅助应用例[J].牙体牙髓牙周病学杂志, 2018, 28(第7期):431-433
[39]	IZAZ S, BOLLA N, DASARI B, et al.Endodontic Management of Calcified Oehler’s Type IIIb Dens Invaginatus in Permanent Maxillary Lateral Incisor Using Cone Beam Computed Tomography[J].J Dent (Shiraz), 2018, 19(No.3):243-247
[40]	CASTELO-BAZ P, MARTíN-BIEDMA B, VARELA-PATI?O P.Combined endodontic and surgical management of dens invaginatus in a central maxillary incisor diagnosed by cone beam computed tomography: Case report and 2-year follow-up[J].Endodontic Practice Today, 2014, 8(No.2):157-162
[41]	MENSCH K, SIMONFFY L, DOMBI C, et al.Endodontic and microsurgical treatments of maxillary lateral incisor dens invaginatus in combination with cone-beam-computed tomography fusion imaging(Article)[J].Oral Radiology, 2017, 33(No.2):147-152
[42]	AGRAWAL P K, WANKHADE J, WARHADPANDE M.A Rare Case of Type III Dens Invaginatus in a Mandibular Second Premolar and Its Nonsurgical Endodontic Management by Using Cone-beam Computed Tomography: A Case Report[J].Journal of Endodontics, 2016, 42(2):669-672
[43]	MENA-áLVAREZ J, RICO-ROMANO C, LOBO-GALINDO A B, et al.Endodontic treatment of dens evaginatus by performing a splint guided access cavity[J].Journal of Esthetic & Restorative Dentistry, 2017, 29(6):396-402
[44]	马学娟, 陈旭.牙内陷的诊断与治疗[J].中国实用口腔科杂志, 2016, 9(9):519-522
[45]	徐立杰.牙内陷非手术治疗例[J].实用口腔医学杂志, 2020, 36(01):129-131
[46]	ZHU J, WANG X, FANG Y, et al.An update of dens invaginatus in the diagnosis and treatment[J].Australian dental journal, 2017, 62(No.3):261-275
[47]	GALLACHER A, ALI R, BHAKTA S.Dens invaginatus: diagnosis and management strategies[J].British dental journal, 2016, 221(No.7):383-387
[48]	JUNEJA R, KUMAR V.Endodontic Management of a Mandibular Incisor Exhibiting Concurrence of Fusion,Talon Cusp and Dens Invaginatus using CBCT as a Diagnostic Aid[J].Journal of clinical and diagnostic research : JCDR, 2016, 10(No.2):D1-D3
[49]	ALMEIDA B, OACUTE A, SILVA N, et al.Case report of a dilated odontome in the posterior mandible[J].International journal of surgery case reports, 2016, 20(7):14-16
[50]	王萌萌, 尼娜, 许振起, 等.上颌侧切牙牙内陷例[J].实用口腔医学杂志, 2020, 36(第2期):394-396
[51]	季雄飞, 马鸣, 魏昕.例上颌侧切牙牙内陷根管再治疗病案报告[J].口腔医学, 2016, 36(09):835-837
[52]	VIEYRA J P, ACOSTA F O, ENRIQUEZ F J J.Nonsurgical orthodontic-endodontic treatment of a maxillary central incisor diagnosed with infected dens invaginatus (Oehlers' type III) and associated apical periodontitis[J].ENDO-ENDODONTIC PRACTICE TODAY, 2018, 12(No.1):43-49
[53]	BABITA P, YUAN G, LIBANG H, et al.Non-surgical removal of dens invaginatus in maxillary lateral incisor using CBCT: Two-year follow-up case report[J].Open Medicine, 2019, 14(No.1):767-771
[54]	BISHOP K, ALANI A.Dens invaginatusPart 2: clinical,radiographic features and management options[J].International Endodontic Journal, 2008, 41(12):1137-1154
[55]	张锋, 张亦文, 蒋晓琼, 等.左上侧切牙Ⅲ型牙内陷牙髓及牙周联合治疗例[J].华西口腔医学杂志, 2019, 37(04):453-456
[56]	SOARES T R C, SILVA L P D, IACUTE P, et al.Management of a Permanent Maxillary Lateral Incisor with Vital Pulp and Necrotic Dens Invaginatus Type III[J].Journal of dentistry for children (Chicago, Ill.), 2017, 84(No.3):149-151
[57]	OZGUL O, OZGUL B M, DURSUN E, et al.Combined Endodontic and Surgical Treatment of Dens Invaginatus-Associated Extraoral Fistula: A Case Report with Seven-year Follow-up[J].New York State Dental Journal, 2016, 82(No.5):44-47
[58]	GOEL S, NAWAL R R, TALWAR S.Management of Dens Invaginatus Type II Associated with Immature Apex and Large Periradicular Lesion Using Platelet-rich Fibrin and Biodentine[J].Journal of Endodontics, 2017, 43(No.10):1750-1755
[59]	TIMMERMAN A, PARASHOS P.Delayed Root Development by Displaced Mineral Trioxide Aggregate after Regenerative Endodontics: A Case Report[J].Journal of Endodontics, 2017, 43(No.2):252-256
[60]	PINTO N, HARNISH A, CABRERA C, et al.An Innovative Regenerative Endodontic Procedure Using Leukocyte and Platelet-rich Fibrin Associated with Apical Surgery: A Case Report[J].Journal of Endodontics, 2017, 43(No.11):1828-1834
[61]	谭学莲, 张岚, 黄定明.意向性牙再植术治疗上颌侧切牙畸形舌侧沟例[J].华西口腔医学杂志, 2017, 35(4):448-452
[62]	姜明欣, 杜航, 杨晓鹏, 等.上前牙畸形根面沟牙髓及牙周联合治疗一例[J].中华口腔医学杂志, 2016, 51(04):254-255