放射線治療後の抜歯と骨関節壊死の関連性。多施設共同レトロスペクティブスタディ

Association between dental extraction after radiotherapy and osteoradionecrosis: A multi-centre retrospective study.

抄録

目的:

放射線治療（RT）は、顎骨壊死（ORN）の発症に大きなリスクを伴う。本研究は、RT後の抜歯とORN発症の関係を調査するために行った。

OBJECTIVE: Radiotherapy (RT) carries a substantial risk for the development of osteoradionecrosis (ORN) of the jaw. This study was performed to investigate the relationship between dental extractions after RT and the development of ORN.

材料と方法:

RT後に抜歯を行った頭頸部がん患者32名を対象に、ORNの発症と様々な要因の相関を調査した。

MATERIAL AND METHODS: Thirty-two patients with head and neck cancer who underwent tooth extraction after RT were investigated for correlations between the development of ORN and various factors.

結果:

抜歯後のORNは9人12歯（12.1％）と診断された。抜歯部位に対するRT線量は、ORN群62.0Gy、非ORN群37.4Gy（p<.001）であった。RTから抜歯までの期間は、ORN群41.2ヶ月、非ORN群28.2ヶ月であった（p=.025）。抜歯は，部位に対するRT線量が高い患者（オッズ比＝1.231）およびRTからの期間が長い患者（オッズ比＝1.084）において，ORNと有意に関連していた．

RESULTS: Postextraction ORN was diagnosed in 12 (12.1%) teeth of 9 patients. The RT dose against the site of tooth extraction was 62.0 and 37.4 Gy in the ORN and Non-ORN groups, respectively (p < .001). The duration from RT to tooth extraction was 41.2 and 28.2 months in the ORN and Non-ORN groups, respectively (p = .025). Tooth extraction was significantly associated with ORN in patients with a high RT dose against the site (odds ratio = 1.231) and a longer duration of time from RT (odds ratio = 1.084).

結論:

RT を受けている場合でも、修復不可能な歯や予後不良の歯の抜歯は必ずしも延期すべきではない。しかし，RT の線量が高く，RT からの期間が長い患者では，抜歯後の術後管理に特に注意を払う必要がある．

CONCLUSIONS: Extraction of non-restorable teeth and those with a poor prognosis should not necessarily be postponed even when patients are undergoing RT. However, clinicians should pay special attention to postoperative management after tooth extraction in patients with a high RT dose and longer time from RT.