廣泛性牙骨質骨發育不良－病例報告

廣泛性牙骨質骨發育不良是一種牙根尖多發性病變，通常在常規的口腔X光片中就可看到，依X光片影像，就可作出診斷，切片是不需要的。廣泛性牙骨質骨發育不良並不需要治療，除非有細菌感染。晚期廣泛性牙骨質骨發育不良患者顎骨中會有硬化的骨塊，常缺乏血液供應，由於齒槽骨的吸收、齒槽黏膜潰瘍、或牙髓病等，硬化的骨塊可能穿出齒槽黏膜，造成細菌感染，按著引發顎骨慢性骨髓炎。我們報告一個62歲的女性患者，其右下顎後方可見一硬化的骨塊，穿出齒槽黏膜，環口放射線攝影發現硬化的骨塊，浮在右下顎齒槽骨上，其他上、下顎多個牙齒，其牙根尖區域，尚有多個放射線不透過性塊狀的鈣化物質，這些塊狀鈣化物都局限在牙根尖區，所有的牙齒都沒有牙根吸收。患者上、下顎多個牙齒，仍可看到牙周膜空間，牙髓活性試驗顯示#32、#31、#41、#42及#43仍具有活性。因爲病變爲多發性，上、下顎骨沒有明顯的腫大，且牙髓活性試驗顯示相關牙齒仍具有活性，最後的臨床診斷爲廣泛性牙骨質骨發育不良合併局部骨髓炎。患者籍由清創，去除暴露骨塊及給予一星期抗生素治療，而治癒骨髓炎。組織病理檢查發現，硬化的骨塊包含死骨及右下第三大臼齒殘根。我們猜測患者由於殘根及不良假牙影響，引發硬化的骨塊暴露於口腔中，及右下顎慢性骨髓炎。本病例報告顯示廣泛性牙骨質骨發育不良患者，必須好好的照顧自己的牙齒，維持良好的口腔衛生，避免蛀牙、牙周疾病，且假牙都應小心佩戴，儘量避免齒槽黏膜感染，以免引起其下方顎骨之慢性骨髓炎。另外環口放射線攝影對診斷廣泛性牙骨質骨發育不良很有幫助。

關鍵字

廣泛性牙骨質骨發育不良；慢性骨髓炎；殘根；死骨

並列摘要

Florid cemento-osseous dysplasia (FCOD) is a disease with multiple periapical lesions. It can be diagnosed by periapical or panoramic radiographies. Biopsy is not absolutely necessary. FCOD lesion does not need any treatment unless the involved jaw bone is infected. Sclerotic bone masses are present in the jaw bones in the late-stage FCOD. These sclerotic bone masses are easily infected due to lack of enough blood supply. In addition, they may be exposed to the oral cavity after infection caused by prosthesis-induced alveolar mucosal ulceration or infected root canals. This article reported a case of FCOD in a 62-year-old female patient. She was found to have a sclerotic bone mass on the right posterior mandibular alveolar ridge. Panoramic radiography revealed a sclerotic bone fragment floating on the right posterior mandibular alveolar ridge. In addition, multiple sclerotic bone-like masses could be found in the periapical areas of multiple mandibular and maxillary teeth. No definite root resorption was found. Periodontal ligament spaces could be found around the multiple involved teeth. Electric pulp tests revealed that the teeth #32, #31, #41, #42 and #43 were vital. Because the lesions were multiple, there was no jaw bone expansion, and the involved teeth were vital, the multiple periapical lesions were finally diagnosed as FCOD combined with focal chronic osteomyelitis. The sclerotic bone mass on the right posterior mandibular alveolar ridge was removed and the patient was treated by antibiotics for one week after surgery. The chronic osteomyelitis of the right posterior mandible was cured after treatment. Histopathological examination showed that the sclerotic bone mass contained a fragment of sequestrum and a retained root of tooth #48. We suggest that partial denture-induced trauma and subsequent infection or the infection from the residual root of #48 may lead to chronic osteomyelitis of the right posterior mandible and the exposure of the sequestrum to the oral cavity. This case report also indicates that FCOD patients should care their teeth scrutinously and maintain a good oral hygiene to avoid alveolar mucosa infection and subsequent chronic osteomyelitis of the jaw bones. In addition, panoramic radiography is very helpful for the diagnosis of FCOD.

並列關鍵字

Florid cemento-osseous dysplasia ； Chronic osteomyelitis ； Residual root ； Sequestrum

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廣泛性牙骨質骨發育不良－病例報告

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