国际口腔医学杂志

国际口腔医学杂志 ›› 2025, Vol. 52 ›› Issue (6): 713-721.doi: 10.7518/gjkq.2025098

• 牙体牙髓专栏 • 上一篇    下一篇

异位釉质的形成机制及临床诊疗策略

王诗雅1(),袁国华2,邹静1()   

  1. 1.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院儿童口腔科 成都 610041
    2.口颌系统重建与再生全国重点实验室;口腔生物医学教育部重点实验室 口腔医学湖北省重点实验室;武汉大学口腔医学院 武汉大学口腔医院儿童口腔科 武汉 430079
  • 收稿日期:2024-08-20 修回日期:2025-07-07 出版日期:2025-11-01 发布日期:2025-10-23
  • 通讯作者: 邹静
  • 作者简介:王诗雅，医师，硕士，Email：wangshiya@stu.scu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目(82170947)

The formation mechanism, clinical diagnosis, and treatment strategies of ectopic enamel

Shiya Wang1(),Guohua Yuan2,Jing Zou1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Dept. of Pediatric Dentistry, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2024-08-20 Revised:2025-07-07 Online:2025-11-01 Published:2025-10-23
  • Contact: Jing Zou
  • Supported by:
    National Natural Science Foundation of China(82170947)

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摘要：

异位釉质是一种牙齿发育异常，分为釉珠和颈部釉质突起两类。异位釉质的形成可能与Hertwig上皮根鞘和Malassez 上皮剩余中的成釉细胞有关，机械因素和遗传因素也可能发挥作用。影像学检查可用于识别异位釉质、评估病情和指导临床诊疗。本文通过对异位釉质的临床特点、形成机制和诊疗策略进行综述，以期为异位釉质的临床诊疗提供参考和临床依据。

关键词: 异位釉质, 釉珠, 颈部釉质突起, 牙周炎

Abstract:

Ectopic enamel is a type of abnormal dental development, which can be divided into two categories: enamel pearls and cervical enamel projections. The formation of ectopic enamel may be related to ameloblasts in the Hertwig’s epithelial root sheath and Malassez epithelial rest. Mechanical and genetic factors may also play a role in the formation of ectopic enamel. Radiographic examination can identify ectopic enamel, assess its condition, and guide clinical diagnosis and treatment. This article reviews the clinical characteristics, formation mechanisms, diagnosis, and treatment strategies of ectopic enamel to provide references and a clinical basis for its diagnosis and treatment.

Key words: ectopic enamel, enamel pearl, cervical enamel projections, periodontitis

中图分类号: 

  • R322.4+1

表 1

釉珠与CEP的特征差异"

特征釉珠CEP
定义牙根表面釉质的异常沉积釉质在CEJ的根方异位沉积，呈指状突起
分类根据结构不同分为釉质型釉珠、釉质-牙本质型釉珠、釉质-牙本质-牙髓型釉珠；根据部位不同分为外在性釉珠和内在性釉珠Ⅰ类：指向根分叉方向延伸至CEJ下方；Ⅱ类：比Ⅰ类更靠近但未到达根分叉区；Ⅲ类：进入根分叉内部
发生率各研究差异大，多为1.1%~5.7%总体发生率变异大，从8.3%~45.2%
发生牙位上颌磨牙根部多见，尤其是上颌第三磨牙下颌磨牙多见，尤其是第一、第二磨牙
形态球形、圆锥形、卵形、泪滴形、不规则形漏斗状，底部与牙冠釉质相延续
微观结构棱柱形，不规则区域主要在牙颈部；存在Retzius条纹、Hunter-Schreger条纹钙和磷酸盐含量较低，矿化程度低；结构缺陷，有扭曲的棱柱和不规则的间隔条纹
显微硬度大釉珠与冠部釉质相近；小釉珠显著低于冠部釉质

表 2

外在性釉珠与内在性釉珠的差异"

特征外在性釉珠内在性釉珠
发病率较低罕见
位置上颌磨牙多见磨牙、前磨牙、尖牙均可发生
发生部位主要出现在根分叉区域多出现于冠部牙本质内
起源可能来源于Hertwig上皮根鞘和Malassez上皮剩余可能来源于釉结、颈环或内釉上皮

图1

CEP的分类绿色虚线：Ⅰ类CEP，红色虚线：Ⅱ类CEP，蓝色虚线：Ⅲ类CEP。"

图 2

异位釉质的形成机制"

图 3

机械因素对异位釉质的影响"

图 4

内在性釉珠形成机制"

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