12例外伤后牙颈部外吸收患者临床特点分析

Analysis of 12 Cases of External Cervical Resorption after Trauma

目的:分析外伤后牙颈部外吸收的临床特点,探讨其治疗策略。方法:收集2020年2月~2023年2月来南华大学附属长沙中心医院就诊的牙外伤后出现牙颈部外吸收的病例,收集患者的基本信息、患牙位置、吸收程度、初诊时主要症状、采取的治疗措施、牙齿存留以及治疗后恢复情况等,并对收集的数据进行分析和讨论。结果:共收集到12例牙颈部外吸收病例,发现患牙21颗,其中上颌中切牙9颗,上颌侧切牙3颗,下颌中切牙7颗,下颌侧切牙2颗,吸收程度为Ⅰ级0颗,Ⅱ级7颗,Ⅲ级5颗,Ⅳ级9颗,根据患牙情况我们进行了根管治疗、龈下刮治、局部充填以及拔除中一种或者两种以上的治疗,在随访期内,有8例共11颗患牙因吸收严重最终拔除,其余4例中2例共4颗患牙经过根管治疗联合龈下刮治以及缺损局部充填后原有根尖瘘管消失,牙颈部透射影未见扩大,1例共4颗患牙经过根管治疗后牙颈部透射影消失,无临床阳性症状发生,1例共2颗患牙经过根管治疗联合局部充填后牙颈部透射影未见扩大,无临床阳性症状发生。结论:外伤后牙颈部外吸收早期发现较为困难,致病机制尚不清楚,但是外伤后的定期随访有助于及时发现,并采取适当的治疗可以有效终止外伤后牙颈部外吸收对牙齿的进一步破坏,避免牙齿丧失。

Objective:To analyze the clinical characteristics of cervical external resorption after trauma and to explore its treatment strategy.Methods:Patients with external cervical resorption after trauma who came to Changsha Central Hospital affiliated to the University of South China from February 2020 to February 2023 were collected.The general information,location of the affected tooth,degree of resorption,main symptoms at first visit,treatment measures taken,tooth retention,and recovery after treatment were collected,analyzed,and discussed.Results:A total of 12 cases occurred external cervical resorption were collected,and 21 affected teeth were found,including 9 maxillary central incisor teeth,3 maxillary lateral incisor teeth,7 mandibular central incisor teeth,and 2 mandibular lateral incisor teeth.The degree of resorption in gradeⅠwas 0,in gradeⅡwas 7,in gradeⅢwas 5,and in gradeⅣwas 9.According to the conditions of affected teeth,root canal therapy,subgingival scaling,and periodontal therapy were performed.During the follow-up period,11 teeth were extracted due to severe resorption in 8 cases.Among the other 4 cases,the original apical fistulas disappeared in 2 of the 4 affected teeth after root canal treatment combined with subgingival scaling and local filling of defects,and no expansion of cervical radiations was observed;cervical radiations disappeared in 4 affected teeth after root canal treatment in 1 case without any clinical positive symptoms;cervical radiations in 2 affected teeth did not expand after root canal treatment combined with local filling in 1 case.No clinical positive symptoms occurred.Conclusion:Early detection of external cervical resorption after trauma is difficult,and the pathogenic mechanism is still unclear,but regular post-traumatic follow-up is helpful to timely detection,and appropriate treatment can effectively stop the further destruction of teeth caused by external cervical absorption after trauma and avoid tooth loss.