發育未成熟之下顎第二小臼齒因牙中突斷裂引發急性根尖牙周炎之處理：病例報告

Management of Acute Apical Periodontitis of the Immature Mandibular Secondary Premolar Due to Fractured Dens Evaginatus - A Case Report

楊雅婷(Ya-Ting Yang) ； 林昭佑(Chao-Yu Lin) ； 莊才逸(Tsai-Yi Chuang) ； 黃慧瑜(Huei -Yu Huang)

《臺灣兒童牙醫學雜誌》 17卷2期 (2017/08) Pp. 64-69

https://doi.org/10.6319/TJPD.2017.17(2).3

摘要

牙中突〈dens evaginatus〉為一種牙冠形態上的發育異常，可在牙齒咬合面上看到一多出的結節狀突起，此結節狀突起不只包含牙釉質及牙本質，通常還包圍著牙髓組織，若臨床上 沒有早期發現並做預防性治療時，此結節狀突起常會因不正常咬合造成斷裂或磨損，之後會伴隨著牙髓神經發炎、壞死、或根尖牙周炎發生，若發生在發育未成熟之牙齒時，因牙根發育未 完成且牙根齒壁太薄，會造成牙髓治療預後不佳，此時需要進行再生性根管治療（regenerative endodontic therapy），希望牙根能持續生長、牙根壁增厚且根尖閉合增加牙根成熟程度。本病例為一11歲男孩，其發育未成熟的右下第二小臼齒因牙中突斷裂造成牙髓壞死和急性根尖牙周炎， 利用氫氧化鈣進行再生性根管治療，且達到良好的治療結果。

關鍵字

牙中突 ； 再生性根管治療 ； 牙根發育未完成 ； 牙髓壞死 ； 根尖牙周炎

並列摘要

Dens evaginatus is a developmental dental anomaly and is characterized by an extra tubercle projecting from the crown of the tooth. This anomalous structure is composed of normal enamel, dentin, and occasionally pulp extension. Early detection and management of this anomalous structure are important. If early preventive treatment do not be performed, the tubercle is easy to wear and fracture during interruption of the occlusion, that followed by pulp exposure, pulpal necrosis or apical periodontitis. When it occurs on a immature tooth, the prognosis is poor after endodontic treatment performed, because of open apex and thin dentinal wall. Therefore, regenerative endodontic therapy provides an alternative treatment approach. The aim of the therapy is to increase in both the length of the root and the thickness of the dentinal wall and to close apex. This case report is about a 11-years-old boy, whose immature secondary permanent premolar with pulp necrosis and acute apical periodontitis due to fractured dens evaginatus. After regenerative endodontic therapy by using calcium hydroxide as dressing material, a successful root maturation was observed.

並列關鍵字

dens evaginatus ； regenerative endodontic therapy ； open apex ； pulp necrosis ； apical periodontitis