對於雙側唇裂病患的缺牙盛行率及缺牙形態分佈之探討：回溯性研究

The Prevalence and Patterns of Tooth Agenesis Among Bilateral Cleft Lip and Palate Patients– A Retrospective Study

目的：缺牙在唇裂患者上很常見；本研究以回溯性調查方式，針對雙側唇裂患者進行缺牙發生率及形態之探討。對象：選自高雄長庚醫院顱顏中心自1974年6月至2015年9月，年齡7到23.6歲（平均年齡10.13 歲），資料記錄完整的雙側唇裂病患；並排除具有其他全身性疾病之患者。材料與方法：以臨床牙科記錄，搭配環口X光片、前牙區根尖片以及上顎咬合片檢視，並且以牙齒缺失編碼作記錄及分析。結果：總計188位符合條件的雙側唇裂患者，其中124位為男性，64位為女性。具有先天性缺牙的患者共佔77.7%；以牙齒數量而言，有6.2%的牙齒發生缺失，最常缺失的恆牙依序為上顎側門牙（右： 63.3%, 左： 62.8%）、上顎第二小臼齒、下顎第二小臼齒及下顎側門牙。若將男性及女性分別來探討，常見的缺牙類型與母族群相同；但是在女性患者中則觀察到右側上顎側門牙缺失的機率（64.1%）比左側上顎側門牙（45.3%）高出許多。在牙齒缺失的分佈形態方面，計有37種不同的缺牙形態；此外，也存在著沒有牙齒缺失的形態，總共觀察到有38種齒列形態。其中最常出現的形態為雙側側門牙同時缺失（牙齒缺失編碼“2.2.0.0”），其發生率高達37%，其次為沒有恆牙缺失的齒列型態（“牙齒缺失編碼“0.0.0.0”），發生率為22.3%。對於裂縫區與缺牙的關係而言，我們觀察到有29種缺牙形態牽涉到上顎側門牙的缺失（29/37 = 78.4%），這闡明著唇裂的發生區域與先天性缺牙的成因有一定的關係。結論：缺牙的表現在雙側唇裂的患者身上有很多種形態。此次的研究結果顯示出雙側唇裂患者，其個別牙齒缺失發生率及整體缺牙齒列型態的發生率，與其他區域種族的唇裂族群比較也有不同的表現。

Objective: Tooth agenesis is quite common in cleft lip and palate patients. This study was aimed for retrospectively investigating the prevalence and patterns of tooth agenesis among bilateral cleft lip and cleft palate (CLCP) patients. Patients: The hospital data and x-ray films of bilateral CLCP patients no younger than 7 years old in the Craniofacial Center, Kaohsiung Chang Gung Memorial Hospital from June 1974 to September 2015 were selected. The enrolled list contained 188 patients (male: 124; female: 64). The mean age of our patient was 10.13 years (range: 7.0 ~ 23.6 years). Materials and methods: Patients' dental records and x-ray imaging including panoramic radiographs, periapical films of anterior teeth and upper occlusal films were inspected. Third molars were excluded in the evaluation. Tooth agenesis code (TAC) was applied for categorizing the missing tooth patterns. Results: The prevalence of tooth agenesis among these 188 cleft subjects was 77.7% (146/188). The total teeth number present with congenital missing in these188 subjects was 328 (6.2%). The most frequent missing teeth were maxillary lateral incisors (right side: 63.3%, left side: 62.8%), followed by maxillary second premolars, mandibular second premolars and mandibular lateral incisors. Regarding the gender, the frequency of missing teeth was similar with the overall sample sizes. However, in females, the prevalence of missing upper lateral incisors was higher in the right side (64.1%) than the left side (45.3%). There were 38 different agenesis patterns, including one non-missing type. The most frequent pattern was maxillary bilateral lateral incisors missing (37%), and the second was non-missing-tooth pattern (22.3%). Agenesis pattern involved upper lateral incisors missing was highly related to the cleft site (29/37 = 78.4%). Conclusion: There were 38 different patterns of tooth agenesis presenting in bilateral CLCP patients of our study. This study showed the prevalence of individual tooth missing and percentage of agenesis patterns. The distribution of tooth agenesis patterns in our study was different from the studies in other countries. The result may support the tooth agenesis patterns in CLCP patients are region-specific.