侵袭性牙颈部外吸收的研究进展

Research progress on invasive cervical resorption

摘要

牙体吸收可分为生理性吸收和病理性吸收。成熟乳牙的牙根吸收即为生理性吸收。病理性牙体吸收则包括牙内吸收和牙外吸收。牙内吸收也被称为髓腔内吸收，包括炎症性吸收和替代性吸收。牙外吸收始发于牙根外表面或牙颈部，可分为炎性吸收、替代性吸收、压力性吸收和侵袭性颈部外吸收等。侵袭性颈部外吸收是一种由多因素导致牙体硬组织丢失的病理性损害，通常从釉牙骨质界开始，在牙本质中周向或水平方向延伸，大多不侵犯牙髓。正畸、创伤、漂白、全身性疾病及某些药物的使用等均可导致侵袭性颈部外吸收。其临床表现通常为无症状或症状不明显，大部分均是在影像学检查时发现。因为在根尖平片影像中往往会误诊为龋病或牙内吸收，所以为了更好地了解牙齿颈部外吸收的情况，临床上使用锥形束CT（cone beam CT，CBCT）进行检查。对侵袭性牙颈部外吸收的发病机制及病因尚未完全了解，会导致临床上对该疾病的疏忽或治疗不当，甚至造成牙齿丧失。本文就侵袭性牙颈部外吸收的组织病理学表现、发病机制、易感因素、诊断和治疗等方面进行综述。

Abstract

Tooth absorption can be divided into physiological absorption and pathological absorption. Root absorption of mature deciduous teeth is physiological absorption. Pathological absorption includes internal absorption and external absorption. Internal absorption, also known as intramedullary absorption, includes inflammatory absorption and alternative absorption. External tooth absorption originates from the outer surface of the root or the neck of the tooth and can be divided into inflammatory absorption, alternative absorption, pressure resorption and invasive cervical resorption. Invasive cervical resorption (ICR) is pathological damage caused by many factors, which usually begins in the cemento-enamel junction and extends peripherally or horizontally in the dentin. It hardly invades the pulp. Orthodontic devices, trauma, bleaching, systemic diseases, and the use of certain medications can all lead to invasive cervical resorption. The clinical manifestations of ICR are usually asymptomatic or not obvious, and most of which are found in imaging examinations. Because caries and internal absorption are often misdiagnosed through plain apical radiography, cone beam computed tomography (CBCT) can help to better understand the situation of invasive cervical resorption. Because the pathogenesis and etiology of invasive cervical resorption are not fully understood, clinical negligence and inadequate treatment of invasive cervical resorption can even cause unnecessary tooth loss. This article reviews the latest research progress on the histopathologic features, pathogenic mechanism, susceptibility factors, diagnosis and treatment of ICR, with special emphasis on susceptibility factors and their mechanisms.

关键词

牙吸收 / 侵袭性颈部外吸收 / 核因子κB受体活化因子 / 核因子κB受体活化因子配体 / 骨保护素 / 炎症因子 / 多发性特发性颈部外吸收 / 易感因素 / 锥形束CT

Key words

tooth resorption / invasive cervical resorption / receptor activator of nuclear factor / receptor activator for nuclear factor-κB ligand / osteoprotegerin / inflammatory factor / multiple idiopathic external cervical root resorption / susceptibility factors / cone beam CT

Author summay

刘秋萍，医师，硕士，Email：[e-mail]