多发性特发性牙根吸收1例及文献回顾

Multiple idiopathic root resorption:a case report and literature review

目的探讨多发性特发性牙根吸收的病因、临床表现、诊断及治疗,为临床诊疗提供参考。方法回顾1例多发性特发性牙根吸收病例的诊治并总结相关文献。结果该患者无正畸矫正史、咬合创伤、外伤史等其它导致牙根吸收的病因;临床检查患者全口牙龈充血红肿,质地松软,全口牙槽骨不同程度吸;影像学检查示13、16、26、36、46存在特发性牙根吸收。诊断为:①多发性特发性牙根吸收;②牙周炎。组织病理结果显示:患牙周围软组织内存在大量破骨细胞;人全外显子组测序示:WNT7A及HSPG2基因突变相关性较高。行牙周序列治疗,拔除不能保留的患牙13并行位点保存术,19个月后复查,牙周炎症控制的牙位牙根吸收停止。文献报道特发性牙根吸收病因可能与基因突变有关,但尚未明确;目前尚缺乏有效的治疗方法。结论多发性特发性牙根吸收病因不明,可能与WNT7A及HSPG2基因突变有关,通过控制牙周炎症可减缓牙根吸收速度。

Objective To explore the etiology,clinical manifestations,diagnosis and treatment of multiple idiopath⁃ic root resorption to provide a reference for clinical diagnosis and treatment.Methods The clinical data of a case of multiple idiopathic root resorption were analyzed retrospectively,and the related literature was reviewed.Results The patient had no history of orthodontic correction,occlusal trauma,trauma history or other causes of root resorption.Clini⁃cal examination revealed full⁃mouth gingival congestion,redness,a loose texture,and variable degrees of destruction of the alveolar bone.Imaging examination showed that teeth 13,16,26,36,46 had idiopathic root resorption.The diagno⁃ses were multiple idiopathic root resorption and periodontitis.The pathology tests showed that a large number of osteo⁃clasts were present in the soft tissue surrounding the teeth.Whole⁃exome sequencing showed that there was a strong correlation between gene mutations(WNT7a and HSPG2)and the present phenotype.Root resorption of teeth without periodontitis was stopped after periodontal treatment during the 19⁃month follow⁃up.Tooth 13 was removed,and extraction socket preservation was performed.The etiology of idiopathic root resorption may be related to gene mutations,but it is not clear.At present,there is no effective treatment.Conclusion Multiple idiopathic root resorption has an un⁃known etiology,but it may be related to WNT7A and HSPG2 gene mutations.The rate of root resorption can be slowed by controlling periodontal inflammation.