国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (5): 509-515.doi: 10.7518/gjkq.2019063

• 牙体牙髓专栏 • 上一篇    下一篇

牛牙症的诊断与治疗

冷沙,黄定明(),高原,张岚,徐玮哲,傅裕杰   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院牙体牙髓病科 成都 610041
  • 收稿日期:2018-09-22 修回日期:2019-04-05 出版日期:2019-09-01 发布日期:2019-09-10
  • 通讯作者: 黄定明
  • 作者简介:冷沙,硕士,Email: 1074110240@qq.com
  • 基金资助:
    四川省科技支撑计划(2017JY0068)

Diagnosis and treatment of taurodontism

Leng Sha,Huang Dingming(),Gao Yuan,Zhang Lan,Xu Weizhe,Fu Yujie   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-09-22 Revised:2019-04-05 Online:2019-09-01 Published:2019-09-10
  • Contact: Dingming Huang
  • Supported by:
    This study was supported by Science & Technology Support Program of Sichuan Province(2017JY0068)

摘要:

掌握根管形态至关重要,利于患牙根管治疗的清理、成形及严密充填。但牙齿的发生发育受遗传因素的调控和后天因素的影响。牛牙症是一种少见的、以髓腔增大为主要特征的牙齿形态变异,因髓室底低,根分叉移向根尖段,根管数目变异,导致根管治疗难度极高,预后不确切,增加临床诊治难度,故牛牙症的诊断和治疗非常重要。本文就牛牙症的发生机制及发生率、诊断分型和鉴别诊断、治疗原则及预后,进行总结归纳,以期能帮助临床医生诊治此类疾病。

关键词: 髓腔形态变异, 牛牙症, Shifman诊断标准, 牛牙症指数

Abstract:

Understanding the root-canal system is vital and benefits canal cleanliness, shape, and block when performing root canal treatment. However, tooth genesis and development are regulated by genes and affected by the environment. Taurodontism, a rare tooth anomaly, is featured with enlarged pulp chamber, apical displacement of the pulp floor, root bifurcation, and variations in root canal. Dealing with this disease through root canal treatment is challenging and prognosis is uncertain. Thus, taurodontism diagnosis and treatment are important. This article focuses on taurodontism pathogenesis, diagnosis, classification, differential diagnosis, treatment, and prognosis and summarizes some views for dentists.

Key words: canal anomaly, taurodontism, Shifman’s diagnostic criteria;, taurodontic index

中图分类号: 

  • R781.05

图 1

牛牙症家庭聚集现象A:患儿74、84为牛牙症;B:患儿哥哥84、85为牛牙症;C:患儿姐姐84为牛牙症;D:患儿母亲46为牛牙症。"

图 2

Shifman诊断标准当AB/AC≥0.2,BD>2.5 mm时,即可诊断为牛牙症。"

图 3

牛牙症分型 a:低度牛牙症:髓室中等程度向根尖延伸;b:中度牛牙症:髓室大幅度向根尖延伸,但存在根分叉,牙根独立;c:高度牛牙症:髓室呈棱柱状或圆柱状,延伸至根尖处,无明显根分叉。"

图 4

TIa:TI=0~19.9,为犬牙状牛牙症;b:TI=20~29.9,为轻度牛牙症;c:TI=30~39.9,为中度牛牙症;d:TI=40~75,为重度牛牙症。"

图 5

牛牙症的临床诊治路径"

[1] Dineshshankar J, Sivakumar M, Balasubramanium AM , et al. Taurodontism[J]. J Pharm Bioallied Sci, 2014,6(Suppl 1):S13-S15.
[2] Keith A . Problems relating to the teeth of the earlier forms of prehistoric man[J]. Proc R Soc Med, 1913,6(Odontol Sect):103-124.
[3] Mohan RP, Verma S, Agarwal N , et al. Taurodontism[J]. BMJ Case Rep, 2013,2013.
[4] Jogendra Sai Sankar A, Sreedevi E, Satya Gopal A , et al. A rare condition of bimaxillary primary molar taurodontism[J]. J Dent (Shiraz), 2017,18(2):153-156.
[5] Ahmed HMA, Dummer PMH . A new system for classifying tooth, root and canal anomalies[J]. Int Endod J, 2018,51(4):389-404.
[6] 赵晓 . 牛牙样牙伴先天个别牙缺失一例报道[J]. 世界最新医学信息文摘, 2016,16(47):225.
Zhao X . A case report of the clinical analysis of taurodontism with hypodontia[J]. World Latest Med Inform, 2016,16(47):225.
[7] Shaw JC . Taurodont teeth in South African races[J]. J Anat, 1928,62(Pt 4):476-498.
[8] Bharti R, Chandra A, Tikku AP , et al. Prevalence of taurodont molars in a North Indian population[J]. Indian J Dent, 2015,6(1):27-31.
[9] Colak H, Tan E, Bayraktar Y , et al. Taurodontism in a central anatolian population[J]. Dent Res J (Isfahan), 2013,10(2):260-263.
[10] Li J, Parada C, Chai Y . Cellular and molecular mechanisms of tooth root development[J]. Development, 2017,144(3):374-384.
[11] Sohn WJ, Choi MA, Yamamoto H , et al. Contribution of mesenchymal proliferation in tooth root morphogenesis[J]. J Dent Res, 2014,93(1):78-83.
[12] Luder HU . Malformations of the tooth root in humans[J]. Front Physiol, 2015,6:307.
[13] Benazzi S, Nguyen HN, Kullmer O , et al. Exploring the biomechanics of taurodontism[J]. J Anat, 2015,226(2):180-188.
[14] Thuesen KJ, Gjørup H, Hald JD , et al. The dental perspective on osteogenesis imperfecta in a Danish adult population[J]. BMC Oral Health, 2018,18(1):175.
[15] Scott J, Adams C, Simmons K , et al. Dental radiographic findings in 18 individuals with SATB2-associated syndrome[J]. Clin Oral Investig, 2018,22(8):2947-2951.
[16] Whitehouse LLE, Smith CEL, Poulter JA , et al. Novel DLX3 variants in amelogenesis imperfecta with attenuated tricho-dento-osseous syndrome[J]. Oral Dis, 2019,25(1):182-191.
[17] Panigrahi A, Panigrahi RG, K T S , et al. Non syndromic familial bilateral decidious taurodontism-a first case report[J]. J Clin Diagn Res, 2014, 8(12): ZD01-ZD02.
[18] Laatikainen T, Ranta R . Taurodontism in twins with cleft lip and/or palate[J]. Eur J Oral Sci, 1996,104(2 ( Pt 1):82-86.
[19] Baron C, Houchmand-Cuny M, Enkel B , et al. Prevalence of dental anomalies in French orthodontic patients: a retrospective study[J]. Arch Pediatr, 2018,25(7):426-430.
[20] Li J, Feng J, Liu Y , et al. BMP-SHH signaling network controls epithelial stem cell fate via regulation of its niche in the developing tooth[J]. Dev Cell, 2015,33(2):125-135.
[21] Wang Y, Cox MK, Coricor G , et al. Inactivation of Tgfbr2 in Osterix-Cre expressing dental mesenchyme disrupts molar root formation[J]. Dev Biol, 2013,382(1):27-37.
[22] Fons Romero JM, Star H, Lav R , et al. The impact of the Eda pathway on tooth root development[J]. J Dent Res, 2017,96(11):1290-1297.
[23] Kim YJ, Seymen F, Koruyucu M , et al. Unexpected identification of a recurrent mutation in the DLX3 gene causing amelogenesis imperfecta[J]. Oral Dis, 2016,22(4):297-302.
[24] Arte S, Parmanen S, Pirinen S , et al. Candidate gene analysis of tooth agenesis identifies novel mutations in six genes and suggests significant role for WNT and EDA signaling and allele combinations[J]. PLoS One, 2013,8(8):e73705.
[25] Kantaputra PN, Kaewgahya M, Hatsadaloi A , et al. GREMLIN 2 mutations and dental anomalies[J]. J Dent Res, 2015,94(12):1646-1652.
[26] Reichart P, Quast U . Mandibular infection as a possible aetiological factor in taurodontism[J]. J Dent, 1975,3(5):198-202.
[27] Tulensalo T, Ranta R, Kataja M . Reliability in estimating taurodontism of permanent molars from orthopantomograms[J]. Community Dent Oral Epidemiol, 1989,17(5):258-262.
[28] Patil S, Doni B, Kaswan S , et al. Prevalence of taurodontism in the North Indian population[J]. J Clin Exp Dent, 2013,5(4):e179-e182.
[29] Jamshidi D, Tofangchiha M, Jafari Pozve N , et al. Prevalence of taurodont molars in a selected Iranian adult population[J]. Iran Endod J, 2017,12(3):282-287.
[30] 张文, 张婧 . 下颌第二前磨牙牛牙症伴C型根管的显微治疗一例[J/CD]. 中华口腔医学研究杂志(电子版), 2014,8(3):249-251.
Zhang W, Zhang J . Microscopic root canal treatment of mandibular second premolar with taurodontism and C-shaped root canal[J/CD]. Chin J Stomatol Res (Electr Ed), 2014,8(3):249-251.
[31] Shifman A, Chanannel I . Prevalence of taurodontism found in radiographic dental examination of 1,200 young adult Israeli patients[J]. Community Dent Oral Epidemiol, 1978,6(4):200-203.
[32] Jafarzadeh H, Azarpazhooh A, Mayhall JT . Taurodontism: a review of the condition and endodontic treatment challenges[J]. Int Endod J, 2008,41(5):375-388.
[33] Keene HJ . A morphologic and biometric study of taurodontism in a contemporary population[J]. Am J Phys Anthrop, 1966,25:208-209.
[34] Lim A, Le Clerc J . Endodontic treatment of a hypertaurodontic mandibular left second molar in a patient with many taurodonts combined with multiple pulp stones[J]. Aust Endod J, 2018. doi: 10.1111/aej.12291.[Epub ahead of print].
[35] 程亲秀, 王娜, 刘桂荣 , 等. 牛牙症2例病例报告[J]. 临床口腔医学杂志, 2017,33(2):104-105.
Cheng QX, Wang N, Liu GR , et al. Two case reports of taurodontism[J]. J Clin Stomatol, 2017,33(2):104-105.
[36] Floratos S, Kim S . Modern endodontic microsurgery concepts: a clinical update[J]. Dent Clin North Am, 2017,61(1):81-91.
[37] Kim S, Kratchman S . Modern endodontic surgery concepts and practice: a review[J]. J Endod, 2006,32(7):601-623.
[38] 黄政, 黄定明, 谭红 , 等. 上颌第一磨牙80颗牙体解剖的离体研究[J]. 实用口腔医学杂志, 2004,20(6):772-774.
Huang Z, Huang DM, Tan H , et al. In vitro study of the anatomy of 80 maxillary first permanent molars[J]. J Pract Stomatol, 2004,20(6):772-774.
[39] Grossman LI . Intentional replantation of teeth: a clinical evaluation[J]. J Am Dent Assoc, 1982,104(5):633-639.
[40] Grzanich D, Rizzo G, Silva RM . Saving natural teeth: intentional replantation-protocol and case series[J]. J Endod, 2017,43(12):2119-2124.
[41] 谭雪莲, 张岚, 黄定明 . 意向性牙再植术治疗上颌侧切牙畸形舌侧沟1例[J]. 华西口腔医学杂志, 2017,35(4):448-452.
Tan XL, Zhang L, Huang DM . Intentional replantation for the treatment of palatal radicular groove with endo-periodontal lesion in the maxillary lateral incisor: a case report[J]. West China J Stomatol, 2017,35(4):448-452.
[42] Hegde V, Anegundi RT, Pravinchandra KR . Biometric analysis - a reliable indicator for diagnosing taurodontism using panoramic radiographs[J]. J Clin Diagn Res, 2013,7(8):1779-1781.
[43] Mendes PA, Neiva IM, Brasileiro CB , et al. Extending coronectomy indications to third molars with taurodontism to prevent paresthesia and mandible fracture[J]. Case Rep Dent, 2018,2018:2067350.
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