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中华口腔医学研究杂志(电子版) ›› 2025, Vol. 19 ›› Issue (03) : 198 -203. doi: 10.3877/cma.j.issn.1674-1366.2025.03.007

病例分析

左上第一恒磨牙根尖周炎伴牙颈部外吸收一例
梅昆洲1, 孙同正2, 孙雁斐2, 张雅萌2, 崔严文2, 杨芳2,()   
  1. 1. 滨州医学院口腔医学院,烟台 264003
    2. 康复大学青岛医院,青岛市市立医院口腔医学中心,青岛 266011
  • 收稿日期:2025-01-18 出版日期:2025-06-01
  • 通信作者: 杨芳

Apical periodontitis with external cervical resorption of left upper first permanent molar:A case report

Kunzhou Mei1, Tongzheng Sun2, Yanfei Sun2, Yameng Zhang2, Yanwen Cui2, Fang Yang2,()   

  1. 1. School of Stomatology,Binzhou Medical University,Yantai 264003,China
    2. Stomatology Center,Qingdao Municipal Hospital,University of Health and Rehabilitation Sciences,Qingdao 266011,China
  • Received:2025-01-18 Published:2025-06-01
  • Corresponding author: Fang Yang
引用本文:

梅昆洲, 孙同正, 孙雁斐, 张雅萌, 崔严文, 杨芳. 左上第一恒磨牙根尖周炎伴牙颈部外吸收一例[J/OL]. 中华口腔医学研究杂志(电子版), 2025, 19(03): 198-203.

Kunzhou Mei, Tongzheng Sun, Yanfei Sun, Yameng Zhang, Yanwen Cui, Fang Yang. Apical periodontitis with external cervical resorption of left upper first permanent molar:A case report[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2025, 19(03): 198-203.

牙颈部外吸收(ECR)是在咬合创伤、缺氧、菌斑及正畸力等多种因素作用下,发生于牙颈部釉牙骨质界处的牙体硬组织病理性吸收。ECR早期较难通过临床检查发现,可通过影像学检查如锥形束CT(CBCT)等发现。本文报道了1 例发生于左上第一恒磨牙根尖周炎伴远中颊根ECR 病例,通过及时行根管治疗,根尖周病变区域及ECR部位出现修复影像。

Cervical external resorption occurs at the enamelo-cemental junction of teeth caused by various factors such as occlusal trauma,hypoxia,plaque and orthodontic forces. In the early stage,it is difficult to detect through clinical examination. It can be observed through imaging examinations such as cone beam computed tomography. This article reported a case of periapical periodontitis of the upper left first molar with cervical resorption of the distal buccal root. After timely root canal treatment,reparative imaging of both the periapical lesion and cervical resorption site was observed.

图1 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者治疗前基本情况 A:26 颊侧瘘管(红圈内);B:树脂充填物距髓腔的距离;C:患牙四根管,箭头指示部位分别为近中颊根根管(MB1)、近中颊根第二根管(MB2)、远中颊根根管(DB)、腭根根管(L);D:远颊根吸收部位(红圈内)。
图2 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者既往就诊口内情况及影像学检查图像 A:2022年5月首次就诊X线片,未见明显龋坏及根尖周炎;B:2022 年10 月上颌正畸口内照,所戴的矫治器为钟摆式矫治器,红圈内为牙合垫;C:2022 年10 月正畸治疗时锥形束CT(CBCT),未见远颊根吸收;D:2023年5月CBCT,红圈内为发生吸收部位。
图3 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者首次治疗后3 个月(2024 年3 月)锥形束CT(CBCT) 可见根尖周低密度透射影范围缩小,上颌窦内高密度阻射影范围缩小。
图4 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者根管治疗后6个月(2024年9月)复诊口内情况及锥形束CT(CBCT) A:颊侧牙龈未见红肿;B:术后6个月复诊CBCT影像,可见根尖周低密度透射影消失。
图5 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者治疗前后历次锥形束CT(CBCT)对比情况 A:2022年10月;B:2023年5月;C:2023年12月;D:2024年3月;E:2024年9月。上颌窦炎症与根尖炎症、远中牙槽骨壁高度变化密切相关;近根尖侧蓝色长线代表26远中骨壁基底部位置,彩线代表远中骨壁高度,近冠方蓝色短线代表远中骨壁冠方位置。
表1 Patel分类[20]
图6 左上第一恒磨牙根尖周炎伴牙颈部外吸收患者对比既往锥形束CT(CBCT),观察牙颈部外吸收部位 A:2023 年5 月;B:2023 年12 月;C:2024年3月;D:2024年9月;A ~B:吸收逐渐加重;C:出现硬组织再沉积;D:因根充材料阻挡无法观察。红色箭头所指部位为吸收部位。
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