上顎第一大臼歯の頂部歯周炎に対するCBCTを用いた意図的な再植術：A Case Report

Intentional Replantation to Treat Apical Periodontitis of Maxillary First Molar with Foreign Body Located Outside Apical Foramen Using CBCT: A Case Report.

抄録

近年，歯科分野ではコーンビームCT（CBCT）を用いて3次元画像を得ることができるようになり，歯内療法においてより効果的な診査・診断が可能となった。また，これらの情報は，意図的な再植などの外科的歯内療法にも有効であることが報告されている。ここでは，CBCTを用いて意図的な再植を行い，良好な治療結果が得られた症例を報告する。症例は30歳の女性で，右上顎第一大臼歯の自発的な痛みを主訴に当院を受診した。デンタルX線写真では，遠位歯根の先端部にX線透過性の領域があり，長さ約1.5mmの小型外科器具の破損した破片と思われるX線不透過性の領域が認められた。この破片は遠位端の孔の外側にあった。これらの所見から，右上顎第一大臼歯の急性化膿性頂部歯周炎と診断された。その後、感染根管治療を開始しました。しかし、患者の症状は改善せず、痛みも続いていた。そこで、歯科用CBCTを実施して3D画像を取得したところ、遠位根尖孔の外側に小型外科器具の折れた破片と思われるX線不透過部分があり、根管内から除去できない方向に向いていることが確認された。患者の症状は改善せず，根尖孔外に異物が観察されたため，インフォームド・コンセントを得て，意図的な再植と根面切除を組み合わせた治療を行った。1年後の経過観察でも経過は良好で、症状や徴候の報告はなかった。臨床所見やデンタルX線写真だけでは診断が困難な場合、CBCTの3D画像を用いることで、より確実な診断が可能となり、治療計画をより効果的に立てることができる。

The recent use of cone beam computed tomography (CBCT) in the field of dentistry to obtain 3-dimensional (3D) images has enabled more effective examination and diagnosis in endodontic treatment. Such information has also been reported to be of benefit in surgical endodontic treatment such as intentional replantation. Here, we report a case of intentional replantation with the assistance of CBCT in which a good therapeutic outcome was achieved. The patient was a 30-year-old woman who visited our hospital with the chief complaint of spontaneous pain in the right maxillary first molar. Dental radiographs revealed a radiolucent area in the apical portion of the distal root, and a radiopaque area thought to be a broken shard from a small surgical instrument measuring approximately 1.5 mm in length. The shard was located outside the distal apical foramen. Based on these findings, the diagnosis was acute suppurative apical periodontitis of the right maxillary first molar. Infected root canal therapy was subsequently commenced. The patient's symptoms showed no improvement, however, and the pain persisted. Therefore, dental CBCT was performed to obtain 3D images, which confirmed a radiopaque area thought to be a broken shard from a small surgical instrument located outside the apical foramen of the distal root and facing in a direction that made it impossible to remove from the root canal. Because the patient's symptoms had shown no improvement and a foreign body was observed outside the apical foramen, intentional replantation combined with root resection was performed with informed consent. At a 1-year follow-up visit, progress was good, and there were no reported symptoms or signs. When reaching a diagnosis is difficult based on clinical findings and dental radiographs alone, the 3D images provided by CBCT offer a means of securing a more reliable diagnosis, allowing planning of treatment to be more effective.