クラックドバイタルモラーズ44例の臨床所見とマネージメントについて

The clinical findings and managements in 44 cases of cracked vital molars.

抄録

背景・目的:

本研究の目的は、修復物や咬合など様々な要因で生じたクラックのあるバイタルモールの臨床所見と対処法の関連性を評価することである。

BACKGROUND/PURPOSE: The aim of this study was to evaluate the associations between the clinical findings and managements in cracked vital molars that were caused by various factors including restoration and occlusion.

材料および方法:

被験者の性別、年齢、主訴、歯の種類、打診検査結果、歯髄の活力、修復物の材質と虫歯の分類、クラックの臨床的深さ、咬合の評価、歯周プロービングの深さ、最終的な管理方法について記録した。

MATERIALS AND METHODS: The subjects' gender, age, chief complaint, type of tooth, percussion test results, pulp vitality, restoration material and cavity classification, clinical depth of the crack, evaluation of occlusion, depth of periodontal probing, and final management were recorded.

結果:

40名の患者において、合計44本の重要なクラック歯（臼歯部）が診断された。歯の種類は，上顎臼歯より下顎臼歯の方が多かった．Nonworking-side interference（NWI）は38例（86.4%）に認められた．8本（18.2%）は未修復であった．修復済みの歯は36本（81.8%）で，メタルインレーが26本（72.2%）、アマルガムが6本（16.7%）、コンポジットレジンが4本（11.1%）であった．歯内療法群の最終治療では，17本すべてに金属製フルクラウンが装着された．歯髄保存群の最終治療は，19本（70.4%）が金属製フルクラウンで，その他の管理は，咬合調整（n=4，14.8%）、コンポジットレジン（n=2，7.4%）および無治療経過観察（n=2, 7.4% ）であった．いずれの症例も臨床的に良好な予後を示した。

RESULTS: A total of 44 vital cracked teeth (molars) were diagnosed in 40 patients. Regarding the type of tooth, a greater number of mandibular molars were affected than maxillary molars. Nonworking-side interference (NWI) was recognized in 38 cases (86.4%). Eight teeth (18.2%) had not been restored. Thirty-six teeth (81.8%) had been restored; 26 teeth (72.2%) with a metal inlay, 6 (16.7%) with an amalgam, and 4 (11.1%) with a composite resin. Regarding the final treatment in the endodontically-treated group, all 17 teeth were covered with a metal full crown. Regarding the final treatment in the pulp-reserved group, 19 teeth (70.4%) were covered with a metal full crown, and the other managements were as follows: occlusal adjustment (n = 4, 14.8%), composite resin (n = 2, 7.4%), and only follow-up without treatment (n = 2, 7.4%). All of the cases showed a good clinical prognosis.

結論:

58%のメタルインレーで修復されたNWI群は，割れた歯の86%以上を占めた．したがって，良好な治療成績を得るためには，割れた歯，特に咬合干渉によって生じた歯は，被覆型修復物で保護する必要がある．

CONCLUSION: The NWI group restored with 58% of metal inlay accounted for more than 86% of the cracked teeth. Thus, in order to achieve a good outcome, cracked teeth, particularly those originating due to occlusal interference should be protected with coverage-type restorations.