国际口腔医学杂志

国际口腔医学杂志 ›› 2019, Vol. 46 ›› Issue (1): 20-25.doi: 10.7518/gjkq.2019.01.004

• 论著 • 上一篇    下一篇

46例患者第三磨牙区多生牙的影像学分析

赵文俊,刘媛媛,郝晓琪,王凯利,任家银,郭文豪,郑广宁()   

  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放射科 成都 610041
  • 收稿日期:2018-05-12 修回日期:2018-09-24 出版日期:2019-01-01 发布日期:2019-01-11
  • 通讯作者: 郑广宁
  • 作者简介:赵文俊,医师,硕士,Email：361321480@qq.com
  • 基金资助:
    中央高校基本科研业务费重点基础研究专项基金(2010-SCU2);四川省科技厅应用基础计划基金(2011JC0400)

Radiographical analysis of 46 patients’ supernumerary teeth in the third molar region

Wenjun Zhao,Yuanyuan Liu,Xiaoqi Hao,Kaili Wang,Jiayin Ren,Wenhao Guo,Guangning Zheng()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Radiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2018-05-12 Revised:2018-09-24 Online:2019-01-01 Published:2019-01-11
  • Contact: Guangning Zheng
  • Supported by:
    This study was supported by Special Fund for Basic Research and Operation of Central Colleges and Universities(2010-SCU2);Sichuan Provincial Science and Technology Department Application Foundation Program Fund(2011JC0400)

RichHTML

24

PDF (PC)

286

摘要：

目的 观察分析第三磨牙区多生牙（ST-TMR）的影像资料,分析、总结其影像学特点。方法 收集46例患者的55颗ST-TMR的X线影像资料（曲面体层片或锥形束CT）,观察其位置、形态、大小及有无伴发病变等。结果 ST-TMR以上颌单侧单颗多见（36/46）,下颌、双侧及同一区域2颗者少见。21颗ST-TMR的锥形束CT显示：埋伏阻生多见（18/21）,萌出者少见;多位于第三磨牙远中（9/21）,其余分布在第三磨牙的颊（舌）侧、根（冠）方或近中;紧邻上颌窦底壁5颗,进入翼上颌裂1颗;多生牙多体积较小,形态各异,其中呈锥形者多见（13/21）,其余如结节状、类似前磨牙者、类似磨牙者少见。可伴发含牙囊肿、前牙区多生牙、邻牙阻生、冠周骨质改变、邻牙根吸收、邻牙龋病、多个牙阻生等病变。结论 ST-TMR的发生女性多于男性,上颌单侧单颗多见;CBCT能够准确观察ST-TMR的位置、形态、大小及有无伴发病变等,为临床医生制定诊疗计划提供依据。

关键词: 第三磨牙区多生牙, 影像学特点, 鉴别诊断

Abstract:

Objective Throughout investigating imaging features of supernumerary teeth in the third molar region (ST-TMR), aims to conclude their radiographical characteristics. Methods In this study, 46 patients’ (55 teeth) X-ray materials (panoramic imagings or cone beam CT ) were collected and analysed, and investigated their location, morphology, size, whether or not concomitant lesions, etc.. Results The unilateral maxillary with single tooth is common (36/46), and those of the mandible, the bilateral and two teeth in the same area are rare. Twenty-one ST-TMRs’ cone beam CT show that impacted teeth are more (18/21); dismolars are more (9/21), others distribute in the lingual or buccal side, root or crown of third molar or shift to its mesial; 5 cases are close to the maxillary sinus floor, 1 case goes into pterygomaxillary joint; meanwhile its volume is smaller than that of the related third molar with different shape-forms, and the conical shape is common (13/21), others including nodular, similar premolar and similar molar; concomitant lesions include dentigerous cyst, anterior supernumerary teeth, adjacent teeth impacted, the change of periodontal bone, root resorption of adjacent teeth, adjacent teeth caries, other multiple impacted teeth, etc.. Conclusion The female is more than male in the incidence of ST-TMR, and the unilateral maxillary with single tooth is more common; cone beam CT can accurately evaluate the location, morphology, size, concomitant lesions of ST-TMR, etc., to provide the basis for clinical diagnosis and treatment.

Key words: supernumerary teeth in the third molar region, radiographical features, differential diagnosis

中图分类号: 

  • R816.98

图1

ST-TMR分布特点"

图2

局部曲面体层片示左上颌2颗ST-TMR（箭头）"

图3

左上颌ST-TMR曲面体层片及CBCT影像 A：局部曲面体层片示ST-TMR不清晰;B：CBCT轴位示左上颌第三磨牙舌侧ST-TMR（箭头）。"

图4

ST-TMR伴发病变 A：左下颌第三磨牙与ST-TMR呈对吻磨牙征伴囊性病变（箭头）,37远中根吸收,38阻生;B：上颌双侧各1颗ST-TMR（黑箭头）伴2颗前牙区多生牙（白箭头）,18、28阻生。"

图5

新增右上颌ST-TMR A：未见ST-TMR;B：2年后发现右上颌ST-TMR（箭头）。"

图6

左上颌ST-TMR位置移动 A：左上颌ST-TMR位于第三磨牙方（箭头）;B：2.5年后移动到第三磨牙近中（箭头）。"

[1] Reddy GS, Reddy GV, Krishna IV , et al. Nonsyn-dromic bilateral multiple impacted supernumerary mandibular third molars: a rare and unusual case report[J]. Case Rep Dent, 2013,2013:857147.
doi: 10.1155/2013/857147 pmid: 3576790
[2] Garvey MT, Barry HJ, Blake M . Supernumerary teeth—an overview of classification, diagnosis and management[J]. J Can Dent Assoc, 1999,65(11):612-616.
pmid: 10658390
[3] Koo S, Salvador PS, Ciuffi Júnior J , et al. Bilateral maxillary fourth molars and a supernumerary tooth in maxillary canine region—a case report[J]. SADJ, 2002,57(10):404-406.
pmid: 12523305
[4] Clementini M, Ottria L, Pandolfi C , et al. Four im-pacted fourth molars in a young patient: a case report[J]. Oral Implantol (Rome), 2013,5(4):100-103.
[5] Menardía-Pejuan V, Berini-Aytés L, Gay-Escoda C . Supernumerary molars. A review of 53 cases[J]. Bull Group Int Rech Sci Stomatol Odontol, 2000,42(2/3):101-105.
pmid: 11799727
[6] Mitsea A, Vardas E, Papachatzopoulou A , et al. The frequency of non-syndromic distomolar teeth in a Greek population sample[J]. J Clin Exp Dent, 2015,7(5):e589-e594.
doi: 10.4317/jced.52411 pmid: 26644834
[7] Ceperuelo D, Lozano M, Duran-Sindreu F , et al. Supernumerary fourth molar and dental pathologies in a Chalcolithic individual from the El Mirador Cave site (Sierra de Atapuerca, Burgos, Spain)[J]. Homo, 2015,66(1):15-26.
doi: 10.1016/j.jchb.2014.05.007 pmid: 25456564
[8] Schmitd LB, Assao A, Ramalho-Ferreira G , et al. An uncommon occurrence of three-fourth molars con-comitant to hypodontia in a nonsyndromic patient[J]. J Craniofac Surg, 2017,28(2):482-483.
doi: 10.1097/SCS.0000000000003322
[9] Shahzad KM, Roth LE . Prevalence and management of fourth molars: a retrospective study and literature review[J]. J Oral Maxillofac Surg, 2012,70(2):272-275.
doi: 10.1016/j.joms.2011.03.063 pmid: 21802814
[10] Kara MI, Aktan AM, Ay S , et al. Characteristics of 351 supernumerary molar teeth in Turkish population[J]. Med Oral Patol Oral Cir Bucal, 2012,17(3):e395-e400.
doi: 10.4317/medoral.17605 pmid: 3476093
[11] McCrea S . Adjacent dentigerous cysts with the ecto-pic displacement of a third mandibular molar and supernumerary (forth) molar: a rare occurrence[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009,107(6):e15-e20.
doi: 10.1016/j.tripleo.2009.02.002 pmid: 19464637
[12] 容明灯, 吴慕廉, 黄羽 , 等. 上颌埋伏第三磨牙与多生牙融合1例[J]. 华西口腔医学杂志, 2011,29(1):100-101.
doi: 10.3969/j.issn.1000-1182.2011.01.024
Rong MD, Wu ML, Huang Y , et al. The fused tooth of maxillary third molar with supernumerary tooth: a case report[J]. West Chin J Stomatol, 2011,29(1):100-101.
doi: 10.3969/j.issn.1000-1182.2011.01.024
[13] Prakash AR, Reddy PS, Rajanikanth M . Paradental cyst associated with supernumerary tooth fused with third molar: a rare case report[J]. J Oral Maxillofac Pathol, 2012,16(1):131-133.
doi: 10.4103/0973-029X.92991 pmid: 3303508
[14] Menditti D, Laino L, Cicciù M , et al. Kissing molars: report of three cases and new prospective on aetio-pathogenetic theories[J]. Int J Clin Exp Pathol, 2015,8(12):15708-15718.
pmid: 26884840
[15] Demiriz L, Hazar Bodrumlu E, Içen M , et al. Evalua-tion of the accuracy of cone beam computed tomo- graphy on measuring impacted supernumerary teeth[J]. Scanning, 2016,38(6):579-584.
doi: 10.1002/sca.21303 pmid: 26780989
[16] Ferreira-Junior O, de Avila LD, Sampieri MB , et al. Impacted lower third molar fused with a supernume-rary tooth—diagnosis and treatment planning using cone-beam computed tomography[J]. Int J Oral Sci, 2009,1(4):224-228.
doi: 10.4248/IJOS.09056 pmid: 3470106
[17] 于世凤 . 口腔组织病理学[M]. 7版. 北京: 人民卫生出版社, 2012: 139- 143, 353-354.
Yu SF. Oral histopathology[M]. 7th ed. Beijing: People’s Medical Publishing House, 2012: 139- 143, 353-354.
[18] Nayak UA, Mathian VM , Veerakumar. Nonsyndrome associated multiple supernumerary teeth: a report of two cases[J]. J Indian Soc Pedod Prev Dent, 2006,24(Suppl 1):S11-S14.
doi: 10.4103/0972-2327.25987 pmid: 16891742
[19] Cavalcanti AL, de Alencar CR, de Carvalho Neto LG . Bilateral maxillary and mandibular fourth molars: a case report and literature review[J]. J Investig Clin Dent, 2011,2(4):296-299.
doi: 10.1111/j.2041-1626.2011.00075.x pmid: 25426903
[1] 孟抒怀,罗锋,裴锡波,万乾炳. 先天性梅毒牙的研究现状[J]. 国际口腔医学杂志, 2021, 48(4): 439-443.
[2] 唐蓓,王扬,王虎,游梦. Stafne骨腔的临床和影像学研究进展[J]. 国际口腔医学杂志, 2021, 48(2): 238-242.
[3] 李继遥, 郑广宁. 原发性牙根纵裂的诊治策略[J]. 国际口腔医学杂志, 2020, 47(4): 373-382.
[4] 赵文俊, 王凯利, 刘莉, 郭文豪, 郑广宁. 2例下颌髁突动脉瘤样骨囊肿[J]. 国际口腔医学杂志, 2018, 45(3): 307-312.
[5] 李蔚 蒋文. 头颈部肌内黏液瘤[J]. 国际口腔医学杂志, 2013, 40(6): 747-749.
[6] 张媛媛. 慢性口腔溃疡的病因和临床鉴别诊断[J]. 国际口腔医学杂志, 2004, 31(S1): -.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 王昆润. 二甲亚砜和双氯芬酸并用治疗根尖周炎[J]. 国际口腔医学杂志, 1999, 26(06): .
[2] 汤庆奋,王学侠. 17β-雌二醇对人类阴道和口腔颊粘膜的渗透性[J]. 国际口腔医学杂志, 1999, 26(06): .
[3] 潘劲松. 颈总动脉指压和颈内动脉球囊阻断试验在大脑血液动力学中的不同影响[J]. 国际口腔医学杂志, 1999, 26(05): .
[4] 王昆润. 后牙冠根斜形牙折的治疗[J]. 国际口腔医学杂志, 1999, 26(05): .
[5] 杨锦波. 嵌合体防龋疫苗的研究进展[J]. 国际口腔医学杂志, 1999, 26(05): .
[6] 王昆润. 下颔骨成形术用网状钛板固定植骨块[J]. 国际口腔医学杂志, 1999, 26(04): .
[7] 汪月月,郭莉莉. 口腔机能与老化—痴呆危险因素流行病学研究[J]. 国际口腔医学杂志, 1999, 26(04): .
[8] 丁刚. 应用硬组织代用品种植体行丰颏术[J]. 国际口腔医学杂志, 1999, 26(04): .
[9] 田磊. 局部应用脂多糖后结合上皮反应性增生的变化[J]. 国际口腔医学杂志, 1999, 26(04): .
[10] 戴青. 口腔念珠菌病的新分类[J]. 国际口腔医学杂志, 1999, 26(04): .