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根尖性歯周炎患者の根管内におけるCandida albicansの存在と歯内療法不成功への関与の可能性の検討
Presence of Candida albicans in Root Canals of Teeth with Apical Periodontitis and Evaluation of their Possible Role in Failure of Endodontic Treatment.
PMID: 25859106
抄録
背景:
カンジダ菌は口腔内の常在菌であり、その日和見感染は局所的および全身的な要因の相互作用に依存する。歯内療法の失敗は、治療後の微生物叢が根管系に残存することと関連しており、これには従来の根管灌流剤に耐性を持つCandidaなどの真菌が含まれる。
BACKGROUND: Candidal organisms are commensals of the oral cavity and their opportunistic infection depends on the interplay of local and systemic factors. Endodontic treatment failure has been associated with the persistence of microbial flora following therapy in the root canal system, and this includes fungi like Candida, which are resistant to conventional root canal irrigants.
材料と方法:
合計20本の下顎大臼歯を対象とし、そのうち15本は一次無作為化比較試験症例、一方5本は再治療症例であった。患者の唾液および根管内細菌叢を調査し、Candida albicansの存在を確認した。
MATERIALS AND METHODS: A total of 20 mandibular molars were included in the study of which 15 were primary randomized controlled trial cases, whereas 5 were retreatment cases. The patient's saliva, as well as the root canal flora, were examined for the presence of Candida organisms and further confirmed for the presence of Candida albicans.
結果:
研究グループを構成する20検体のうち、唾液培養により11検体がCFU（colony forming unit）>400を示し、20検体中9検体がCFU>400を示す根管細菌叢を示した。初回根管治療症例15例のうち，唾液検査で8例がCFU >400，管腔細菌検査で6例がCFU >400であった．再治療例では，5例中3例で唾液・根管培養ともにCFU >400であった．
RESULTS: Of the 20 samples comprising the study group, the saliva culture revealed 11 of them to have a colony forming unit (CFU) >400 and 9 of the 20 canals microbiology showed CFU >400. Among the 15 first-time root canal treatment cases, saliva examination these revealed 8 of them to have CFU >400 and the canal microbiology of these showed 6 of them to have CFU >400. Among the retreatment cases, 3 of the 5 cases showed CFU >400 in both the saliva DN canal culture.
結論:
根管内のカンジダ汚染は歯内療法失敗の原因となりうるため、治療中のラバーダム隔離と抗真菌作用のある潅注剤の十分な使用期間が重要であることが強調された。
CONCLUSION: Candidal contamination of the root canals could be the cause of endodontic treatment failure and thus emphasizes the importance of rubber dam isolation and the use of irrigants with antifungal properties for sufficient duration during treatment.