背景:Densinvaginatus(DI),不寻常的发育异常对手术牙医的诊断和治疗是一个挑战。此病例报告介绍了与大的根性囊肿和沟通性尖端边缘缺损(VonArxIIb型)相关的永久性上颌侧切牙中3b型DI的成功治疗。
结果:一名19岁女性患者报告疼痛和腭肿胀。在临床检查中,12号牙齿表现出敲击压痛,深牙周袋深度(PPD)为12毫米,以及一级流动性。射线照相检查显示,神经根周围的射线透明度大,牙齿形态不典型。锥形束计算机断层扫描阐明了复杂的根管解剖结构,即与根尖边缘缺损相关的3b型DI。该病例通过非手术牙髓治疗成功治疗,然后采用引导骨再生(GBR)方法进行手术干预。18个月的随访显示无症状和功能性牙齿,口袋深度显着减少。根尖周X光片显示骨缺损持续愈合。
结论:具有挑战性的病例的成功治愈结果,以复杂的DI形态为特征,一个大的神经根周围病变,贯穿和贯穿的缺陷,通过准确的诊断,实现了牙髓-牙周根尖边缘联合缺损,治疗计划,并使用当代牙髓和牙周治疗技术执行。在这种情况下,在手术治疗阶段应用GBR技术可能有助于改善再生愈合效果。最初被认为是预后问题。
结论:为什么这种情况是新信息?3b型DI表现出复杂的根管结构,每个案例都显示出独特的特征,需要针对具体病例的治疗计划。在这种情况下,3b型DI形态与大的周围神经根有关,通过和通过缺损和联合牙髓牙周根尖边缘缺损。治疗方法涉及在手术阶段结合引导骨再生(GBR)原则。此病例报告有助于诊断和成功治疗3b型DI并伴有顶端边缘缺陷的现有证据。成功管理此病例的关键是什么?成功管理具有预后挑战性的病例是通过牙髓医生和牙周病医生之间紧密集成的多学科协调来实现的。利用现代技术和工具有助于成功的管理。通过锥形束计算机断层扫描进行三维放射学检查可以进行精确的术前评估,促进制定治疗计划,以管理3b型DI形态和相关的神经根周围病变。在神经根周围手术中采用GBR技术可能有助于根尖周缺损和根尖边缘缺损的愈合(VonArxIIb型)。这种情况下成功的主要限制是什么?与3b型DI形态相关的复杂根管解剖结构大的神经根周围缺损并伴有根尖边缘缺损。难以对患者进行每周和长期随访。
BACKGROUND: Dens invaginatus (DI), an unusual developmental anomaly is a challenge for the operating dentist with regard to its diagnosis and treatment. This
case report presents the successful management of a Type-3b DI in a permanent maxillary lateral incisor associated with a large radicular cyst and communicating apico-marginal defect (Von Arx type IIb).
RESULTS: A 19-year-old female patient reported pain and palatal swelling. During the clinical examination, tooth #12 exhibited tenderness to percussion, and presented a deep periodontal pocket depth (PPD) of 12 mm, along with grade I mobility. Radiographic examination revealed a large peri-radicular radiolucency with atypical tooth morphology. Cone beam computed tomography clarified the complicated root canal anatomy to be Type-3b DI associated with an apico-marginal defect. The case was managed successfully by non-surgical endodontic therapy followed by surgical intervention utilizing a guided bone regenerative (GBR) approach. Eighteen-month follow-up showed an asymptomatic and functional tooth with a significant reduction in pocket depth. The periapical radiographs showed continued healing of the osseous defect.
CONCLUSIONS: The successful healing outcome of a challenging case, characterized by a complex DI morphology, a large peri-radicular lesion, a through-and-through defect, and a combined endodontic-periodontal apico-marginal defect was achieved through accurate diagnosis, treatment planning, and execution using contemporary endodontic and periodontal treatment techniques. The application of GBR techniques during the surgical phase of treatment may have contributed to the improved regenerative healing outcome in this case, which was initially considered prognostically questionable.
CONCLUSIONS: Why is this
case new information? Type-3b DI exhibits a complex root canal structure, each case displaying unique characteristics, necessitating a
case-specific treatment plan. In this case report the Type-3b DI morphology was associated with a large peri-radicular, through and through defect and combined endodontic periodontal apico-marginal defect. The treatment approach involved incorporating guided bone regenerative (GBR) principles during the surgical phase. This case report contributes to the existing evidence on the diagnosis and successful management of Type-3b DI with a concurrent apico-marginal defect. What are the keys to successful management of this
case? The successful management of a prognostically challenging case was achieved through a closely integrated multidisciplinary coordination between the endodontist and periodontist. Utilization of contemporary techniques and tools contributed to the successful management The use of three-dimensional radiological examination through cone beam computed tomography enabled a precise preoperative assessment, facilitating the formulation of a treatment plan for managing both the Type-3b DI morphology and the associated peri-radicular lesion. Employing GBR techniques in peri-radicular surgery may have assisted in the healing of through-and-through periapical defects with concurrent apico-marginal defects (Von Arx type IIb). What are the primary limitations to the success of this
case? A complex root canal anatomy associated with Type-3b DI morphology A large peri-radicular through and through defect with concurrent apico-marginal defect. Difficulty in weekly and long-term follow-up of the patient.