牙釉质发育不全诊疗策略的研究现状

Status of research on diagnostic and treatment strategies for enamel hypoplasia

摘要

牙釉质发育不全是一种牙齿在发育过程中受到遗传或环境因素影响而导致牙釉质形成或矿化障碍的疾病，可导致患牙颜色异常、结构缺损，患者表现出牙齿变色、牙齿敏感、牙体缺损等临床症状，可严重影响患者咀嚼、吞咽、语音和笑容，给患者带来身心上的不适。本综述总结了牙釉质发育不全在基因调控水平发生异常以及后天发育中环境因素改变所致的发病机制，根据该疾病的常用分类列举了一系列临床诊断要点，这些要点包括：①轻型牙釉质发育不全仅有患牙颜色及透明度的改变；②病损常成组对称出现；③根据患者受侵犯的牙齿可以推测在牙齿发育期间，全身疾病或营养障碍等发生的年龄；④釉质表面形成的带状或窝状棕色凹陷，易与氟斑牙混淆；阐述了在轻重症患者中根据患者不同主诉需求综合运用牙齿漂白、脱敏治疗、直接或间接修复等治疗策略，并提出了在婴幼儿重症患者中运用多学科协同序列治疗的新理念。本文旨在为临床医生提供有关牙釉质发育不全的最新知识和指导，目前有关该疾病的文献资料主要局限于病例报道，未来还需要更多高质量的临床研究与系统评价，以进一步规范该疾病的诊疗策略。

Abstract

Enamel hypoplasia is a disease that results in enamel formation and mineralization abnormalities due to the effects of hereditary or environmental variables during tooth development. Affected teeth may appear to have an aberrant color and structural flaws. Patients often display clinical signs such as tooth defects, tooth sensitivity, and tooth discoloration. The disease can cause patients to feel physically and mentally uncomfortable and negatively impact their ability to chew, swallow, speak, and smile. In this review, the pathophysiology of enamel hypoplasia, which is caused by anomalies in gene regulation and changes in environmental variables, is summarized, along with a list of clinical diagnostic indicators based on the most commonly used disease classifications. The main points are as follows: ① enamel hypoplasia changes only the color and transparency of the affected teeth; ② lesions often occur symmetrically in groups; ③ the age at which systemic diseases or nutritional disorders occur during tooth development can be predicted based on the patient's impaired teeth; and ④ banded or pitted brown depression on the enamel surface can easily be confused with dental fluorosis. It also elaborates on the comprehensive application of tooth bleaching, desensitization, direct or indirect restoration and other treatment modalities according to unique chief complaints by different patients and suggests the use of multidisciplinary cooperative sequential treatment for critical infants and young children. The goal of this review is to provide professionals with the most recent information and advice about enamel hypoplasis. Current literature on this condition is primarily case reports. To further standardize the diagnostic and management approaches for this disease, additional high-quality clinical research and systematic reviews are required.

关键词

牙釉质发育不全 / 牙釉质矿化不全 / 牙釉质成熟不全 / 遗传性釉质发育不全 / 发病机制 / 临床诊断 / 治疗策略 / 序列治疗

Key words

enamel hypoplasia / enamel hypocalicific / enamel hypomaturation / amelogenesis imperfecta / pathogenesis / clinical diagnosis / treatment strategy / sequential treatment

Author summay

唐权，硕士，Email: [e-mail]