牙根表面撕裂症：病人的齒位分佈，臨床特性，致病因子與影響治療預後因素的研究

Root Surface Split: Tooth Position, Clinical Characteristics, Predisposing Factors and Treatment Outcome

林學仁(Hsueh-Jen Lin)

指導教授 ： 鄭景暉

共同指導教授 ： 林俊彬 ； 張淑惠(Shu-Hui Chang)

國立臺灣大學/牙醫專業學院/臨床牙醫學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.00558

摘要

牙根表面撕裂(root surface split)包括牙骨質撕裂(cemental tear)與牙骨質牙本質撕裂(cementodentinal tear)，臨床病例很罕見，因此在疾病的診斷及治療上往往仍停留在個別醫師之經驗法則。若從年齡增長所可能對牙周組織的成份及結構之影響來看，甚多學者均認為臨床實際的發生率可能遠高於目前的認知，造成臨床診斷率偏低最主要是因為牙根表面撕裂屬於一種特殊型態的牙根表面分裂，臨床上也會出現包括慢性牙周炎、瘻管或慢性根尖周圍炎等症狀而容易與牙周或根管方面的其他疾病混淆而誤診，因此在此動機下，希望透過有系統的收集牙根表面撕裂之相關資料後加以整理及分析，同時針對各種治療方法的預後進行評估，所得到的分析結果冀能增加臨床醫師對牙根表面撕裂的瞭解，進而提高診斷的正確率與治療的成功率。本回溯性報告是屬於多院區的臨床研究，自1987年起至2008年止分別自台大醫院牙髓病科、台北長庚紀念醫院牙科部、天主教耕莘醫院牙科部、彰化秀傳紀念醫院牙科部以及高雄長庚紀念醫院牙科部等院區收集樣本，共累計71例經直接檢視法或活體檢查法證實為牙根表面撕裂的分析樣本後，針對包括：性別、年齡、全身病史、牙位、主訴、臨床症狀、臨床檢查結果、放射線檢查結果、探測式手術檢查結果、活體檢查結果、以及治療的方法與預後等因子加以分析，以探討與牙根表面撕裂相關的各變項之影響程度。在單變項分析方面發現：牙周膿腫，牙周囊袋，牙周骨缺損，根尖骨缺損，斷片垂直位置，斷片形狀是顯著的臨床特性。而性別，年齡，牙位，咬耗是導致牙根表面撕裂的顯著致病因子。在全部分析樣本的相關性分析結果顯示：性別與斷片寬、性別與治療方法、年齡與咬耗、年齡與斷片位置(II)、年齡與竇管、牙位與斷片長、牙位與斷片位置(II)、牙位與正確診斷、斷片位置(II) 與斷片形狀、X光片上發現斷片與否與正確診斷共10組雙變項之間有顯著相關性存在。針對33例接受手術及非手術治療的研究樣本之羅吉斯迴歸分析的結果發現：(1) 斷片撕裂的垂直位置是預測治療結果的最重要因子，其次是治療方法；(2) 位在根尖1/3的的斷片治療結果成功率最低；(3) 手術治療的治療結果成功率比非手術治療高。在臨床的治療結果方面，當以改善臨床症狀及恢復牙齒功能視為臨床成功，則有93.9%的病例在治療後得到改善。因此，若能增加對牙根表面撕裂的瞭解，應可提高臨床診斷的正確率，使臨床醫師得以及早診斷出牙根表面撕裂並適時以手術治療介入，以提高牙齒保存的成功率。

關鍵字

牙根表面撕裂 ； 牙骨質撕裂 ； 牙骨質牙本質撕裂 ； 牙周炎 ； 根尖周圍炎 ； 牙骨質牙本質交界

並列摘要

The differential diagnosis of root surface split was difficult even after an exhaustive history taking and comprehensive clinical and radiographic examinations. However, research which had empirically documented in etiology and clinical characteristics of root surface split was scant. Therefore, the objective of the NTU Root Surface Split Study project attempted to assess clinical characteristics, predisposing factors and treatment outcome of the tooth with root surface split. All of the 71 root surface split teeth, 10 were diagnosed by direct inspection on extracted tooth; 61 were diagnosed by histopathological examination. During which descriptive statistic, univariate analysis, bivariable analysis and logistic analysis were performed. Of the 71 teeth studied, 38 (53.5%) were extracted and were excluded. The remaining 33 teeth (46.5%) were examined for treatment outcome of healed, questioned or failed. Evidently, the results from univariate analysis revealed that thirteen variables of clinical characteristics were associated with the root surface split and ten variables of predisposing factors, which thus confirmed the variables, including swelling, periodontal bony destruction, periapical bony destruction, apicocoronal location, fragment shape, and separation mode, as the main clinical characteristics on the tooth with root surface split; as well as the variables, including gender, age, tooth type, and attrition, as the predominant predisposing factors on the tooth with root surface split. The results from bivariate analysis of the 71 study samples revealed statistically significant differences in gender, associated with separated fragment width, and treatment technique; in age, associated with sinus tract, attrition, and apicocoronal location; in tooth type, associated with separated fragment length, apicocoronal location, and initial diagnosis accuracy; in radiopaque image, associated with initial diagnosis accuracy; in apicocoronal location, associated with separated fragment shape. Additive bivariable analysis on the 33 examined subsamples of teeth revealed statistically significant differences in treatment outcome, associated with separated fragment length and apicocoronal location as significance level interpreted at the 0.05; besides, with treatment technique as significance level interpreted at the 0.1. Logistic regression analysis identified significant outcome predictors: (1) apicocoronal location of the separated fragment on apical 1/3 (odds ratio [OR], 0.083; confidence interval [CI], -5.227─0.257) and on middle 1/3 (OR, 1.333; CI, -1.752 – 2.328), and (2) treatment technique (OR, 0.2; CI, -3.41 – 0.192). Treatment outcome was better in tooth which separated root fragment was located on middle 1/3 than on apical 1/3. Although, treatment technique was suggested as an outcome predictor in tooth with root surface split, it should be required confirmation from randomized controlled trials. Consequently, for obtaining enormous amount of empirical evidence to allow assessment with better power, continuation of the project in cumulating data would be necessary.

並列關鍵字

root surface split ； cemental tear ； cementodentinal tear ； periodontitis ； apical periodontitis ； cementodentinal junction.

參考文獻

Anderson RW, Pantera EA. Influence of a barrier technique on electric pulp testing. J Endod 1988;14:179-180.

Andreana S. A combined approach for treatment of developmental groove associated periodontal defect. A case report. J Periodontol 1998;69:601-607.

Armitage GC. Clinical evaluation of periodontal diseases. Periodontology 2000 1995;7:39-53.

Arola D, Reprogel RK. Effects of aging on the mechanical behavior of human dentin. Biomaterial 2005;26:4051-61.

Blomlöf L, Lindskog S. Cervical root resorption associated with guided tissue regeneration: a case report. J Periodontol 1998;69:392-395.