牙骨质撕裂临床诊治的研究进展

Research progress on cemental tears in terms of clinical diagnosis and treatment

摘要

牙骨质撕裂是指牙骨质沿牙骨质-牙本质界（dentino-cemental junction，CDJ）或牙骨质生长线完全或不完全脱离牙根表面，也可以波及部分牙本质。牙骨质撕裂的病因尚不够明确，文献回顾发现其易感因素包括牙齿类型、性别、年龄、牙周病、牙周或根管治疗史、牙外伤史、咬合创伤史或过度的咬合力。牙骨质碎片可以是片状或U形，易致牙周和根尖周组织破坏。临床上，牙骨质撕裂多表现为孤立性牙周袋，其症状类似于牙周炎、根尖周炎和牙根纵裂。影像学检查对于牙骨质撕裂的临床诊断具有重要意义，常表现为沿牙根表面纵向分布的薄“针刺状”阻射性团块。必要时需借助探查性手术，术中牙骨质碎片及根面牙骨质线可以辅助诊断。组织病理学检查是诊断牙骨质撕裂的金标准。根据牙骨质撕裂正确诊断时间及临床或放射学表现不同，治疗方法不同。随着再生性生物材料的发展及意向性再植术的成熟，越来越多患牙得以长期存留。本综述系统性描述牙骨质撕裂的生物学基础和易感因素、临床特征、影像学和组织病理学表现以及临床管理和预后，为明确诊断并制定个性化治疗计划提供依据。

Abstract

A cemental tear is defined as an incomplete or complete detachment of the cementum along the dentino-cemental junction (CDJ) or the incremental line within the body of the cementum, which can also involve part of the root dentine adjacent to the cementum. The pathogenesis of cemental tears is not fully elucidated. From the literature review, possible predisposing factors were identified, including tooth type, sex, age, periodontitis, previous periodontal treatment or root canal treatment, history of dental trauma, and occlusal trauma or excessive occlusal force. The morphology of cemental tears can be either piece-shaped or U-shaped, which usually contributes to periodontal and periapical breakdown. Clinically, cemental tears have a unitary periodontal pocket and present with symptoms mimicking localized periodontitis, apical periodontitis, and vertical root fractures. Imaging examination is of great significance for the clinical diagnosis of cemental tears, which often manifest as thin ‘prickle-like’ radiopaque masses located longitudinally adjacent to the affected root surface. Exploratory surgery is needed in some cases. Although intraoperative cemental fragments and cemental lines on the root surface can assist in the diagnostic process, histopathology examination is the gold standard for the diagnosis of cemental tears. The treatment methods vary depending on the timing of the correct diagnosis and the clinical or radiological manifestations. With the development of regenerative biomaterials and the development of intentional replantation, an increasing number of affected teeth can survive for a long time. The aim of this review is to systematically describe the biological basis and predisposing factors, clinical features, radiographic and histological characteristics, diagnosis and clinical management of cemental tears, and treatment outcomes to help make a clear diagnosis and develop a personalized treatment plan.

关键词

牙骨质撕裂 / 牙骨质 / 生长线 / 牙骨质-牙本质界 / 牙周牙髓联合病变 / 牙周翻瓣术 / 引导性组织再生术 / 意向性再植

Key words

cemental tears / cementum / incremental line / dentino-cemental junction / periodontal-endodontic combined lesions / periodontal flap operation / guided tissue regeneration / intentional replantation