結合組織移植とエナメル質誘導体製剤を併用した根面被覆術の4症例の組織学的評価

Histological evaluation of 4 cases of root coverage following a connective tissue graft combined with an enamel matrix derivative preparation.

抄録

背景:

このレポートの目的は、結合組織（CT）グラフトとエナメルマトリックス誘導体（EMD）製剤を併用し、臨床的に成功した4例の歯根被覆術の組織学的特性を評価することである。

BACKGROUND: The purpose of this report was to evaluate the histological characteristics of 4 clinically successful root coverage procedures performed with a combination of a connective tissue (CT) graft and an enamel matrix derivative (EMD) preparation.

方法:

粘膜歯肉の問題と Miller's Class II および III の歯肉退縮を呈した上顎歯 4 本（犬歯 3 本、第一小臼歯 1 本）を調査対象とした。根管治療には自家製CTグラフトとEMDを併用した．治療した歯は治癒後、頬側付着器の一部とともに抜歯された。術後6ヶ月目に2歯，1年目に2歯を抜歯した．組織学的に標本を作製し、光学顕微鏡で分析した。

METHODS: Four maxillary teeth (3 canines and 1) first premolar) that presented with mucogingival problems and Miller's Class II and III gingival recession were evaluated in the study. Surgical therapy for root coverage consisted of autogenous CT grafts combined with the topical application of EMD. Following healing, treated teeth were extracted with a portion of their buccal attachment apparatus. Two teeth were extracted at 6 months and 2 teeth at 1 year postoperatively. Specimens were prepared for histology and analyzed by light microscopy.

結果:

治療したすべての歯は、根の被覆が成功した臨床的徴候を呈した。組織学的観察では、4つの標本で同様の所見が得られた。接合部上皮の長さは2mm以下であった．接合部上皮の先端には，根面に近接して高密度のCT線維が認められたが，一般に，この線維の根面への挿入は認められなかった．6 ヶ月経過した 1 標本では、移植部の最頂端に新生セメント質と新生骨の形成が認められた。

RESULTS: All treated teeth presented with clinical signs of successful root coverage. Histological observations of the 4 specimens revealed similar findings. The junctional epithelium was < or = 2 mm long. Apical to the junctional epithelium, dense CT fibers were found in close proximity to the root surface, but in general, no insertion of these fibers into the root was observed. In one 6-month specimen, formation of new cementum and new bone was observed in the most apical end of the grafted area.

結論:

本研究の結果、CT グラフトと EMD の併用により、主に CT と根面との接着が生じることが示唆された。部位によっては歯根膜の再生が起こる可能性がある．また，歯肉退縮に対するこの併用療法では，長い接合上皮の形成は観察されなかった．

CONCLUSIONS: The results of this study suggest that a combination of CT grafts and EMD results mainly in an adhesion between the CT and root surface. Some periodontal regeneration may occur in some regions. The development of a long junctional epithelium was not observed with this combined therapy for the treatment of gingival recession.