国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (2): 230-238.doi: 10.7518/gjkq.2026009

• 综述 • 上一篇    

釉珠研究现状与临床诊疗策略

洪曼瑶(),郭米嘉,周婷,邓子龙()   

  1. 南方医科大学南方医院口腔科 广州 510515
  • 收稿日期:2025-01-17 修回日期:2025-03-09 出版日期:2026-03-01 发布日期:2026-02-13
  • 通讯作者: 邓子龙
  • 作者简介:洪曼瑶，学士，Email：906602467@qq.com
  • 基金资助:
    南方医科大学南方医院临床研究专项(2021CR011);国家自然科学基金(82100997)

Research status and clinical management of enamel pearls

Manyao Hong(),Mijia Guo,Ting Zhou,Zilong Deng()   

  1. Dept. of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2025-01-17 Revised:2025-03-09 Online:2026-03-01 Published:2026-02-13
  • Contact: Zilong Deng
  • Supported by:
    Grants from Clinical Research Program of Nanfang Hospital, Southern Medical University(2021CR011);National Natural Science Foundation of China(82100997)

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摘要：

釉珠是最常见的异位牙釉质，发生机制尚不明确。临床中釉珠主要通过影像学检查或引起相关临床症状时被发现。釉珠与牙周组织为半桥粒连接，这种连接减弱了牙周组织防御感染的能力。此外，釉珠的存在使菌斑免受唾液酶及口腔清洁措施的影响，利于菌斑滞留，易导致发生牙体牙髓和牙周疾病。釉珠的早期诊断、评估、处理具有重要的临床意义。本文通过回顾釉珠相关文献，对釉珠的命名、发生率、诊断及鉴别诊断、分类、形态特点、分布特点、理化性质、组织学特征、组织来源与发生机制、临床意义、处理策略等方面进行综述，为釉珠的临床诊治与进一步研究提供参考。

关键词: 釉珠, 分类, 发生率, 诊断, 治疗

Abstract:

Enamel pearls (EPs) are the most common ectopic enamel. The etiology of EPs remains obscure. Clinically, EPs are mainly detected through radiographic examinations or when they elicit associated clinical symptoms. A hemidesmosomal junction exists between EP and periodontal tissue, which weakens the ability of periodontium to defend against infection. Furthermore, the presence of EPs facilitates plaque retention by shielding plaque from salivary enzymes and routine oral hygiene measures, which leads to endodontic and periodontal diseases. Therefore, early diagnosis, assessment, and management of EPs are of clinical importance. This article reviews the literature on EPs; it encompasses their nomenclature, prevalence, diagnosis and differential diagnosis, classification, morphological and distribution characteristics, physicochemical properties, histological features, histogenesis and pathogenesis, clinical implications, and management strategies, to provide a reference for their clinical diagnosis and management and further investigation.

Key words: enamel pearl, classification, prevalence, diagnosis, treatment

中图分类号: 

  • R780.2

表 1

基于离体牙研究的釉珠发生率"

研究者（年份）研究人群样本牙发生率/%磨牙发生率/%
Risnes[5]（1974）挪威人8 854颗磨牙2.28
Negra等[9]（1974）巴西人30 726颗牙0.49
Loh[10]（1980）亚洲人5 674颗牙1.132.60
Sutalo等[7]（1986）克罗地亚人3 370颗磨牙0.541.13
沙继春等[11]（1986）中国人10 000颗牙3.0
解危[12]（1991）中国人12 379颗牙1.012.49
Chrcanovic等[6]（2010）巴西人45 785颗牙0.821.71
Kaminagakura等[13]（2011）巴西人2 201颗磨牙2.86
Versiani等[14]（2013）巴西人2 532颗牙0.74

表 2

基于影像学研究的釉珠发生率"

研究者（年份）研究方法研究人群样本人发生率/%牙发生率/%磨牙发生率/%
Darwazeh等[3]（2000）根尖X线片约旦人

2 986颗牙齿

1 032张根尖X线片

819份牙科记录

4.51.62.32
Akgül等[4]（2012）CBCT土耳其人

15 185颗牙

768人

4.690.240.83
?olak等[15]（2014）全景片土耳其人

6 912张全景片

97 362颗牙

5.10.85
Al-Zoubi等[16]（2018）全景片沙特阿拉伯人642张全景片4.820.962.49
Zengin等[17]（2022）CBCT土耳其人1 003份CBCT4.290.71

图 1

同一患者双侧上颌第二磨牙多发釉珠的CBCT影像上：右上第二磨牙远中邻面釉珠，a为冠状位，b为矢状位，c为轴位，d为三维重建；中：左上第二磨牙近中邻面釉珠，e为冠状位，f为矢状位，g为轴位，h为三维重建；下：左上第二磨牙远中邻面釉珠，i为冠状位，j为矢状位，k为轴位，l为三维重建。"

图 2

釉珠分类示意图a：简单型釉珠；b：釉质-牙本质型釉珠；c：釉质-牙本质型釉珠（含有髓角）；d：牙本质内釉珠（箭头示）；e：发生在牙周组织内的特殊釉珠（箭头示）。"

表 3

釉珠尺寸的研究结果"

研究者（年份）研究方法研究人群釉珠数目/个平均直径/mm标准差/mm尺寸范围/mm
Risnes[5]（1974）离体牙、放大镜挪威人2190.960.430.3~4
Loh[10]（1980）离体牙亚洲人640.2~2.6（多为1~1.9）
Sutalo等[7]（1986）离体牙欧洲人381.600.5~2.7
沙继春等[11]（1986）离体牙、放大镜中国人1831.060.3~3.0
解危[12]（1991）离体牙、放大镜中国人1391.560.5~3.2
Versiani等[14]（2013）离体牙、micro-CT巴西人231.980.85多为1.15~4.48
Zengin等[17]（2022）CBCT土耳其人720.5~2.95（多为1~2）

图 3

牙骨质与釉珠的结构关系示意图a：牙骨质容纳釉珠；b：牙骨质完全覆盖釉珠；c：牙骨质部分覆盖釉珠，载体牙根部牙本质靠近釉珠的区域可见低矿化区（箭头示）；d：牙骨质覆盖釉珠牙本质核基底部（箭头示）；e：图d箭头所指处的组织结构图，包括托姆斯颗粒层（三角形示）、透明层（箭头示）、牙骨质（虚线箭头示）。C：牙骨质；D：釉珠牙本质核；E：釉珠牙釉质；P：牙髓；RD：载体牙根部牙本质；CC：细胞牙骨质；AC：无细胞牙骨质。"

图 4

釉珠的处理策略"

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