右上颌第二磨牙牙内陷1例报告及文献复习

Dens invaginatus of right maxillary second molar:A case report and literature review

目的:探讨上颌第二磨牙牙内陷患者的诊疗过程,分析罕见牙内陷患者临床表现、影像学特征和病理特点,制定合理的治疗方案。方法:收集1例牙内陷患者的临床资料、影像学表现和病理资料,分析磨牙区牙内陷患者的临床及影像学特征,结合相关文献,总结其临床诊断标准和治疗方法。结果:患者,女性,28岁,因发现右上后牙有洞6个月来本院就诊。专科检查可见17牙合面平龈,牙冠巨大,牙合面正中见凹陷及龋坏,未达髓腔,影像学检查可见17牙合面类牙釉质密度影像向根方凹陷,深度约7.7 mm,确诊为牙内陷。初诊时去除腐质,采用安抚治疗,复诊时发现患牙仍有自发痛,且未能解决食物嵌塞痛,考虑到术后恢复效果不佳,故患者同意拔除患牙。离体牙做病理磨片,显微镜下观察可见内陷处牙釉质及牙本质结构异常。结论:发生于磨牙区的牙内陷患者较为罕见,诊疗过程中应结合影像学检查明确疾病类型及治疗计划,建议治疗效果不佳的患牙应及时拔除。

Objective : To explore the process of diagnosis and treatment of the patients with dens invaginatus of right maxillary second molar, to analyze the clinical features, the radiographic features and the pathological features of the dens invaginatus, and to make a reasonable treatment plan. Methods :The clinical data, imaging findings and pathological data of a patient with dens invagination were collected. The clinical diagnostic criteria and treatment methods of these cases were summarized with relevant literature review. Results : The patient, female, 28 years old, was diagnosed with a hole in the upper right posterior teeth for 6 months. The special examination results showed that the 17-toothed face was flat, the crown was huge, and the occlusal surface was seen in the sag and sputum;the medullary cavity was not reached. The radiograghic examination results showed that the enamel density image of the 17-toothed surface was sunken to the root, with a depth of about 7.7 mm, diagnosed as dens invaginatus. At the time of initial treatment, the humus was removed and the sag received sedative treatment. The spontaneous pain still existed during the follow-up examination, and the problem of food embolism was not solved. Considering the poor recovery after treatment, the patient agreed to remove the tooth. The isolated tooth was observed by pathological grinding, and the enamel and dentin structures of the invaginatus were abnormal observed under microscope. Conclusion :The patients with dens invagination occurs in the molar area are rare;the type of disease and treatment plan should be determined by imaging examination during the process of diagnosis and treatment;it suggests that the patients with poor recovery after treatment should remove the teeth.