臨床的歯髄診断と組織学的歯髄診断の相関性

Correlation between clinical and histologic pulp diagnoses.

抄録

はじめに:

臨床医は，歯髄を保存できるか否かを判断しなければならない状況に日常的に直面している．この研究では，正常歯髄／可逆性歯髄炎（保存可能歯髄）または不可逆性歯髄炎（非保存可能歯髄）という臨床診断が，組織学的診断と比較してどの程度信頼できるかを評価した．

INTRODUCTION: Clinicians routinely face conditions in which they have to decide whether the dental pulp can be saved or not. This study evaluated how reliable the clinical diagnosis of normal pulp/reversible pulpitis (savable pulp) or irreversible pulpitis (nonsavable pulp) is when compared with the histologic diagnosis.

方法:

一般診療所において5年間に連続して採取され、本研究とは無関係の理由で抜歯された95本の歯を対象とした。臨床的基準に基づいて，正常歯髄，可逆性歯髄炎，不可逆性歯髄炎に分類された．前2者は，予後の点で類似した状態であるため，ひとまとめにした．歯は組織学的および細菌学的分析に供され，歯髄は定義された基準に従って，健全，可逆的炎症，不可逆的炎症に分類された．また，臨床・組織学的診断が一致した症例数を記録した．

METHODS: The study material consisted of 95 teeth collected consecutively in a general practice over a 5-year period and extracted for reasons not related to this study. Based on clinical criteria, teeth were categorized as having normal pulps, reversible pulpitis, or irreversible pulpitis. The former 2 were grouped together because they represent similar conditions in terms of prognosis. Teeth were processed for histologic and histobacteriologic analyses, and pulps were categorized as healthy, reversibly inflamed, or irreversibly inflamed according to defined criteria. The number of matching clinical/histologic diagnosis was recorded.

結果:

59歯中57歯（96.6%）において，正常歯髄／可逆性歯髄炎の臨床診断と組織学的診断が一致した．不可逆性歯髄炎の臨床診断と組織学的診断の一致は32例中27例（84.4％）であった．歯髄組織への感染は，不可逆性歯髄炎の歯に共通して認められたが，正常歯髄や不可逆性歯髄炎の歯では全く観察されなかった．

RESULTS: The clinical diagnosis of normal pulp/reversible pulpitis matched the histologic diagnosis in 57 of 59 (96.6%) teeth. Correspondence of the clinical and histologic diagnosis of irreversible pulpitis occurred in 27 of 32 (84.4%) cases. Infection advancing to the pulp tissue was a common finding in teeth with irreversible pulpitis but was never observed in normal/reversibly inflamed pulps.

結論:

歯髄の状態を臨床的・組織学的に分類するために定義された基準を用いた所見は，特に無病例や可逆性疾患例においてよく一致した．すなわち，歯髄の状態を正常歯髄，可逆性歯髄炎，不可逆性歯髄炎に分類することは，大多数の症例において正しい治療を導く可能性が高いと考えられる．しかし、信頼性の高い歯髄診断のための手段の洗練と改良がまだ必要である。

CONCLUSIONS: Findings using defined criteria for clinical and histologic classification of pulp conditions revealed a good agreement, especially for cases with no disease or reversible disease. This means that the classification of pulp conditions as normal pulps, reversible pulpitis, and irreversible pulpitis has high chances of guiding the correct therapy in the large majority of cases. However, there is still a need for refined and improved means for reliable pulp diagnosis.