背景:融合牙齿通常涉及几种并发症,例如融合牙冠之间的凹槽中龋齿的发展,牙齿嵌塞,纵隔,美学和牙周问题,和牙髓病,由于融合牙齿的复杂解剖结构。彻底的诊断对于形成准确的治疗计划和获得良好的预后至关重要。随着锥形束计算机断层扫描(CBCT)的出现,现在可以很容易地获得牙齿及其周围牙槽结构的准确三维图像,该技术可以准确地提供微创方法来获取详细的诊断信息。因此,我们在此利用CBCT数据为患者的感染区域生成数字模型,这种模式使我们能够更好地计划他的案件的管理。
方法:本报告详细介绍了一例罕见病例的诊断和牙髓治疗,该病例涉及融合的上颌第二磨牙和两个顺磨牙伴根尖牙周炎。患者在上颌左磨牙区域的咬伤和冷敏感性时出现疼痛。在这些牙齿中没有发现龋齿或其他缺陷,并且观察到对纸浆电活力测试的正常反应。借助CBCT和数字模型技术,我们最初怀疑感染起源于上颌第二磨牙和两个顺齿之间的峡部。因此,我们仅通过牙髓方法治疗峡部,并没有破坏原始的牙齿结构;此外,保留了重要的纸浆,在24个月随访时观察到良好的治疗结果.
结论:这一发现可能为融合牙的诊断和治疗提供新的见解和观点。
BACKGROUND: Fused teeth usually involve several complications, such as the development of caries in the groove between fused crowns, tooth impaction, diastemas, aesthetic and periodontal problems, and pulpal pathosis, due to the complex anatomical structure of fused teeth. A thorough diagnosis is paramount to forming an accurate treatment plan and obtaining a favourable prognosis. With the advent of cone-beam computed tomography (CBCT), accurate 3-dimensional images of teeth and their surrounding dentoalveolar structures can now be readily obtained, and the technology can accurately provide a minimally invasive approach to acquire detailed diagnostic information. Therefore, we utilize CBCT data herein to generate a digital model for the infected region in a patient, and this model enables us to better plan the management of his
case.
METHODS: This report details the diagnosis and endodontic treatment of a rare
case involving a fused maxillary second molar and two paramolars with apical periodontitis. The patient experienced pain upon biting and cold sensitivity in the area of the maxillary left molar. No caries or other defects were identified in these teeth, and a normal response to a pulp electric viability test was observed. With the aid of CBCT and digital model technology, we initially suspected that the infection originated from the isthmus between the maxillary second molar and two paramolars. Therefore, we only treated the isthmus by an endodontic approach and did not destroy the original tooth structure; furthermore, the vital pulp was retained, and good treatment outcomes were observed at the 24-month follow-up.
CONCLUSIONS: This finding may provide new insights and perspectives on the diagnosis and treatment of fused teeth.