Dens Evaginatus: Prophylactic Management and the Treatment of Pulp Infection

預防斷裂的處置及牙髓炎發生時的治療方針

劉育婷(Yu-Ting Liu) ； 歐陽黎薇(Li-Wei Ou-Yang)

《臺灣兒童牙醫學雜誌》 10卷2期 (2010/08) Pp. 78-85

https://doi.org/10.6319/TJPD.2010.10(2).5

摘要

Dens evaginatus是牙齒發育時所產生的變異。臨床特徵是在牙齒的咬合面上有結節，好發部位多在小臼齒。若是牙髓腔延伸進入突起的結節內，則在結節因受咬合力而斷裂或磨耗後可能導致牙髓暴露、牙髓壞死甚至根尖感染，而需要進一步的根管治療。若牙根已發育完成，只需進行傳統的根管清創及馬來膠封填即可；然而兒童牙科常見牙根尚未發育完全的牙齒因為Dens evaginatus斷裂導致牙髓暴露造成感染，無法直接施以馬來膠根管充填，而需要進行apexogenesis或apexification來誘導牙根持續生長及根尖閉合。
這裡分別提出一個11歲女生以及兩個11歲男生的病例，對於尚未斷裂的Dens evaginatus我們以enamoplasty-preventive resin restoration的方式保護咬合面上的結節；另外也探討了對於牙根尚未發育完全，卻因Dens evaginatus斷裂導致牙髓感染的牙齒可能的治療選項，以氫氧化鈣和MTA使用在未成熟牙根的根管治療之優缺點。

並列摘要

Dens evaginatus is a developmental anomaly. It is characterized by the occurrence of an extra cusp shaped as a tubercle projecting from the occlusal surface. Premolars are more likely to be affected. In teeth with dens evaginatus, the pulp horn may extend into the tubercle. If the tubercle is worn off or fractured, the pulp may be exposed, leading to pulpitis, pulp necrosis, and even severe dental infection. Traditional endodontic treatment with gutta point canal filling is sufficient when the root formation is completed. Unfortunately, pulp infection originated from dens evaginatus is usually found on teeth with immature root formation. In these cases, apexogenesis or apexification procedures are the choices of pulp treatment.
This report includes three cases: one 11-year-old girl and two 11-year-old boys. We display a preventive procedure of enamoplasty-preventive resin restoration for the newly erupted premolars to protect the dens evaginatus tubercle. Furthermore, the treatment options for pulp infection of teeth with immature root formation are discussed.

並列關鍵字

dens evaginatus ； endodontic treatment