侵襲性齒頸部吸收 - 分布狀況、可能致病因子與臨床特徵

Abstract

Introduction: Invasive cervical resorption (ICR) is a relatively rare dental disease. It may cause irreversible destruction to the cervical area of the tooth. If left untreated, the tooth has to be extracted eventually. The demographic and tooth distribution of ICR had not been investigated in any Asian populations. Its etiopathology and predisposing factors are also unclear. Furthermore, the clinical and radiographic features of ICR have not been investigated in a systematic way. Objective: To investigate the distribution, predisposing factors, and clinical characteristics of invasive cervical resorption (ICR). Materials and methods: Cases with ICR from 2009 to 2019 were collected in National Taiwan University Hospital. Clinical records and radiographs were reviewed. Descriptive analysis was performed in combination with univariate analysis and Fisher’s exact test. Results: A total of 63 ICR teeth from 31 patients (14 males and 17 females) were found. The patients’ ages ranged from 18 to 81 years, with a mean age of 45.77. Most patients had a single ICR lesion. Among the 63 ICR teeth, maxillary anterior teeth (47.62%) were the most commonly affected, followed by maxillary premolars (20.63%). Maxillary teeth (76.19%) were more prone to ICR than mandibular teeth (23.81%). Most patients denied all major systemic diseases. The most common dental-related factors were dental/orofacial trauma (33.33%), periodontal treatment (26.98%), restoration/crown (17.46%), and orthodontic treatment (15.87%). Most teeth showed no percussion/palpation pain, probing depth > 3 mm, abscess formation, sinus tracts, or periapical lesions. The pulp status was mainly vital (73.02%). The presence of percussion pain and probing depth differed significantly among Heithersay ICR classification groups. Conclusion: ICR showed no difference in sex or age group. Maxillary anterior teeth were the most affected in a Taiwanese population. Traumatic injury, periodontal treatment, and orthodontic treatment were the significant predisposing factors. The influence of endocrine imbalance may be related to ICR. Furthermore, affected teeth typically lacked clinical signs and symptoms. Radiographic examination is critical for early diagnosis. In advanced cases, deep pockets and abscess formation were seen. Clinical significance: Up to our knowledge, this study is the first epidemiological study of ICR among Asian populations. In different countries and races, the distribution of affected teeth may vary according to the type of predisposing factors. In agreement with previous studies, we support the hypothesis that traumatic injury and other dental treatments may be related to the development of ICR. We have also highlighted the potential role of thyroid or parathyroid disorders in the etiopathogenesis of ICR. In addition, given that ICR-affected teeth are mainly asymptomatic and vital, clinicians should stay alerted to any possible anomalies in routine dental practice. Although most of our patients only presented one tooth affected by ICR during their observation period in National Taiwan University Hospital, few patients presented multiple teeth affected by ICR. Whether these single-ICR cases would suffer from ICR in other teeth in the future is still unknown. Literatures have shown that ICR can appear successively in different teeth of the same patients. We recommend that clinicians should take routine radiographic check-ups for these patients, to diagnosis the problem earlier, to treat earlier and to increase the success rate.