Clinical Study of Dens Evaginatus Cases With Pulpal Involvement

齒髓病變之齒中凸患齒的臨床研究

黃自釗(Tzyh-Jau Huang) ； 阮榮泰(Rong-Tai Roan)

《The Kaohsiung Journal of Medical Sciences》 13卷7期 (1997/07) Pp. 440-447

https://doi.org/10.6452/KJMS.199707.0440

摘要

本研究之目的在評估齒髓衍生病變之齒中凸患齒的發生率、臨床徵候及其治療．以高雄醫學院附設醫院病患 503 顆需接受齒內治療的前臼齒為研究對象，發現有 23 顆（4.6 %）前臼齒具齒中凸且衍生齒髓病變，其中又以下顎第二前臼齒最常見；臨床上所有齒中凸病發齒之結節均呈咬耗且齒髓呈失活性現象，17個病例伴隨瘤管產生，1顆患齒齒冠呈變色現象，1個病例造成臉型不對稱及6顆患齒有痛之病史；放射線攝影之檢查顯示21顆患齒有根尖或根側骨質疏鬆現象，1顆患齒牙周韌帶呈變寬及8顆患齒牙根呈未發育完全現象；臨床診斷，所有 23 病例被診斷為齒髓壞死，3 病例診斷為急性根尖牙周炎，4 病例診斷慢性根尖牙周炎，17病例診斷為化膿性根尖牙周炎及 l 病例診斷為 Garres ' osteomyelitis：這些患齒經治療後，13顆有令人滿意的結果，2顆治療失敗，1 顆治療期間牙根斷裂及7顆患齒因病人失去聯絡而無法評估，由以上結果，我們深信齒髓衍生病變之齒中凸患齒不管牙根是否發育完全，治療後均可保存下來。

並列摘要

The objective of the present study was to investigate the incidence, clinical findings, diagnosis and treatment of evaginated teeth with pulpal involvement. Five hundred and three cases requiring endodonticaily treated premolars were studied at Kaohsiung Medical College Hospital. We observed 23 (4.6%) evaginated teeth with pulpal involvement out of the 503 samples studied here. Of the 23 teeth, mandibular second premolars comprise the largest portion. Clinically, all tubercles of pulpally involved evaginated teeth had been worn down by attrition and all these teeth showed negative response in vitality tests. The study indicated that 17 cases had sinus tracts, 1 tooth had discoloration in crown portion, 1 case had facial asymmetry and 6 teeth had a painful history. Radiographs confirmed that 21 cases had apical or lateral rarefaction, 1 tooth had thickened periodontal ligament and 8 teeth had incomplete root formation. Clinical diagnosis included pulp necrosis (23 cases), acute apical perlodontitis (3 cases), chronic apical periodontitis (4 cases), suppurative apical periodontitis (17 cases )and Garrer’ osteomyelitis (1 case). After the treatment, 13 teeth showed satisfactory results. The treatment on 2 teeth was failed, 1 tooth had root fracture and 7 teeth had loss of follow-up. We conclude that the evaginated teeth can hence be preserved even if they are pulpily infected and have an incomplete root apex.

並列關鍵字

dens evaginatus ； premolars