Apexogenesis of an External Resorpted Young Permanent Tooth after Intrusive Luxation-A Case Report

根尖生成術治療內縮脫位後外吸收之年輕恆牙－病例報告

趙婉真(Wan-Chen Chao) ； 王姻麟(Yin-Lin Wang) ； 張曉華(Hsiao-Hua Chang) ； 黃桂芬(Guay-Fen Huang) ； 郭敏光(Ming-Kuang Guo)

《臺灣兒童牙醫學雜誌》 18卷2期 (2018/06) Pp. 71-76

https://doi.org/10.6319/TJPD.201806_18(2).0005

摘要

Traumatic intrusive luxation occurs frequently in children. Preservation of pulp vitality and prevention from apical periodontitis and even extraction are important in young permanent tooth. However, external root resorption is a severe complication of intruded teeth and the treatment is challenging. This case report describes the treatment of an 8-year-2-month-old boy, with tooth 11 intrusive luxation and uncomplicated crown fracture. Subsequently external root resorption (ERR) was revealed form radiographic examination one month after injury while observing for spontaneous tooth re-eruption. Vital pulp therapy was performed with calcium hydroxide disinfection and Biodentine apexogenesis for continuing root formation. Tooth 11 re-erupted and reached the level of contralateral tooth 12 months after injury. At follow-ups at 3, 6, 9 and 12 months after treatment, tooth 11 was clinically asymptomatic without discoloration and radiographic examination showed healing of resorptive lesion and continuing root formation. Children suffering from intrusive luxation of anterior permanent teeth are functionally, mentally and esthetically affected. Intruded teeth can be treated with expecting re-eruption, orthodontic reposition or surgical reposition. Prognosis of intruded teeth is related to stage of root formation, degree of intrusion and extent of pulp infection. Treatment strategies for external root resorption include eliminating the inflammatory stimulator and manipulating the inflammatory response. On the basis of sealing ability, biocompatibility and esthetically acceptability, apexogenesis with Biodentine was applied in the present case report. To conclude, waiting for spontaneous eruption is preferred in intruded teeth with incomplete root formation. In addition, after external root resorption can be controlled, Biodentine apexogenesis allows continuing root formation and provides favorable outcome.

關鍵字

Intrusive Luxation ； External Root Resorption ； Biodentine ； Young Permanent Tooth

並列摘要

兒童常因外傷造成牙齒內縮性脫位。在年輕的恆牙能保留活髓且避免根尖周圍發炎甚至避免牙齒被拔除尤其重要。然而，牙根外吸收是內縮脫位後較為嚴重的併發症且其治療也具挑戰性。本篇病例報告為一名八歲兩個月男孩其右上正中門齒內縮脫位合併非複雜性牙冠斷裂之治療。外傷後一個月，在等待外傷的牙齒自行復位期間，從放射性檢查發現有牙根外吸收。經氫氧化鈣消毒後使用百優定（Biodenine）進行根尖生成術以利牙根繼續形成。在外傷12個月後，右上正中門齒已再萌出至與臨牙相同的水平位置。在治療後三個月至一年的追蹤中，右上正中門齒在臨床檢查皆無症狀，牙冠也沒有變色，此外在放射學檢查能觀察到外吸收的病灶癒合且牙根有持續形成。孩童在他們的年輕恆牙內縮脫位後不論是在功能上、心理上，或是美觀上都會受到影響。對於這些被撞入的牙齒，可以等待它自行再度萌出，或者以矯正或是手術的方式復位。內縮脫位後牙齒的預後與牙根生長的階段，內縮的深度以及牙髓發炎的程度有關。治療牙根外吸收包含消除發炎刺激且控制發炎反應。本病例使用Biodenine因為它有良好的密封性和生物相容性，此外對牙齒不會造成美觀的影響。總結來說，等待內縮脫位的年輕恆牙自行再萌出應優先考慮。在牙根外吸收被控制後，以Biodentine進行根尖生成術能使牙根繼續形成並達到良好結果。

並列關鍵字

內縮脫位 ； 牙根外吸收 ； Biodentine ； 年輕恆牙