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題名 | Diagnosis and Treatment Considerations for Patients with Developmental Enamel Defects--A Case Report=牙釉質發育異常之診斷與治療--病例報告 |
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作 者 | 王詩凱; 王姻麟; 張曉華; 黃桂芬; 郭敏光; | 書刊名 | 臺灣兒童牙醫學雜誌 |
卷期 | 18:1 2018.03[民107.03] |
頁次 | 頁24-29 |
分類號 | 416.9 |
關鍵詞 | 牙釉質; 發育異常; 發育不全; 礦化不足; Developmental; Enamel; Amelogenesis imperfect; Hypoplastic; Hypomaturation; |
語文 | 英文(English) |
中文摘要 | 牙釉質發育不全(Amelogenesis imper fecta;AI)與臼齒門齒礦化不足(Molar inc isor hypomineralization;MIH)之牙釉質發育異常(Developmental enamel defects)常導致臨床診斷與治療上之困難。此類患者常常面臨咀嚼功能與美觀上之問題,需要接受長期之多科別口腔重建。本文敘述一位十二歲患有牙釉質發育異常之男孩,並針對此類案例之臨床診斷與治療考量進行討論。病患於進入青春期後,由於牙釉質之缺陷,而有咀嚼效率不足與牙齒敏感之困擾。臨床上可見病患之前牙有明顯礦化不足之斑塊;第一大臼齒則有嚴重之缺損。小臼齒與第二大臼齒亦有牙釉質較薄之情形。基於病患牙釉質之表徵,臨床診斷為hypomaturation/hypoplastic AI。由於此類患者較高之齲齒率與牙齒結構缺陷,全覆式復形物(full-veneer restorations)相較於傳統銀粉或樹脂填補,往往提供較佳之成功率與預後。因此我們針對所有嚴重缺損之第一大臼齒進行不銹鋼冠(stainless steel crowns)復形;術後病患之咀嚼功能與牙齒敏感問題獲得明顯改善。此案例顯示對牙釉質發育異常之臨床鑑別診斷與治療之重要性。 |
英文摘要 | Developmental enamel defects, such as amelogenesis imperfect (AI) and molar incisor hypomineralization (MIH), can pose a challenge in clinical diagnosis and management. Patients with these conditions suffer from both esthetic and functional burdens, and offen require multidisciplinary and multi-stage treatment. Here, we presented a case of 12-yearold boy with extensive developmental enamel defects and discussed differential diagnosis and treatment modalities for restoration. The patient has experienced insufficient chewing efficiency and occasional thermal hypersensitivity of back teeth since hitting puberty. Clinically, all permanent anterior teeth exhibited a well-demarcated hypomineralization opacity with yellow-brown discoloration over the incisal half of the tooth where enamel chipping was also noted. All permanent first molars had hypomineralized enamel with large decay and defective restorations. Although premolars and second molars appeared relatively unaffected, generally thin enamel of these teeth with sporadic opacities was evident. Although family history was not contributory, a diagnosis of hypomaturation-hypoplastic amelogenesis imperfecta was made based upon the enamel phenotypes and an insignificant perinatal history. It has been demonstrated that patients with AI, especially hypomaturation AI, have potentially higher caries risk and failure rates of restorations than normal patients. Full-veneer restorations have been shown to confer better longevity and overall clinical outcomes compared to direct amalgam or resin restorations. Considering the age of our patient, we restored all permanent first molars with stainless steel crowns, which provided durability while requiring little tooth preparation. The patient reported significantly improved chewing efficiency and reduced tooth hypersensitivity after the treatment. A definitive rehabilitation of full dentition after adulthood will ensure long-term stability of esthetics and functions. This case highlighted the significance of differential diagnosis and age-dependent treatment considerations for patients with developmental enamel defects. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。