歯周病と歯内療法の複合病変を有する患者における歯周基本治療と根管治療の併用の有効性とその炎症反応への影響

Efficacy of root canal therapy combined with basic periodontal therapy and its impact on inflammatory responses in patients with combined periodontal-endodontic lesions.

抄録

目的:

歯髄-歯周病合併患者において、根管治療と歯周基本治療の効果と炎症反応への影響を検討すること。

OBJECTIVE: To investigate the effect of root canal and basic periodontal therapies on the efficacy and inflammatory response in patients with pulpal-periodontal disease.

研究方法:

歯周病と歯内療法を合併した患者103名の臨床データをレトロスペクティブに解析した。患者を対照群（n=50，通常の根管治療を行った）と観察群（n=53，根管治療と歯周基本治療を行った）に分けた。治療後の臨床効果はもちろん，治療前後のプロービングポケットの深さ（PD），歯周病指標，炎症性因子の放出量，痛みの程度（visual analogue scale）を両群間で比較した。また，治療後の病的な歯の状態や副反応についても記録した。

METHODS: Clinical data of 103 patients with combined periodontal-endodontic lesions were retrospectively analyzed. The patients were divided into a control group (n=50, treated with conventional root canal therapy) and an observation group (n=53, treated with root canal and basic periodontal therapies). The clinical efficacy after treatment, as well as the probing pocket depth (PD), periodontal indices, inflammatory factors release, and pain level (visual analogue scale) before and after treatment were compared between the two groups. The status of diseased teeth and adverse reactions after treatment were recorded.

結果:

治療開始1ヵ月後，観察群は対照群と比較して，歯のゆるみ，歯周炎，総体的な副作用の発生率が低く，歯の保持率と有効率が高かった（いずれもP<0.05）。PD，BI，PLI，GI，インターロイキン-6（IL-6）とインターロイキン-1β（IL-1β）の血清レベルは，いずれも治療開始1カ月後に両群で低下し，その低下幅は観察群が対照群よりも大きかった（いずれもP＜0.05）。投与前と比較して，視覚的アナログスケールのスコアは，両群とも薬剤封入48時間後と投与1カ月後に減少し，その減少幅は観察群が対照群よりも大きかった（いずれもP＜0.05）。

RESULTS: After 1 month of treatment, the observation group had lower incidences of loosening of teeth, periodontitis and total adverse reactions, as well as higher tooth retention rate and effective rate as compared with the control group (all P<0.05). The PD, BI, PLI, GI and serum levels of interleukin-6 (IL-6) and interleukin-1β (IL-1β) all decreased in both groups after 1 month of treatment, and the decreases were more in the observation group than those in the control group (all P<0.05). Compared with before treatment, scores of visual analogue scale decreased in both groups 48 hours after the drug was sealed and 1 month after treatment, and the decreases were more in the observation group than those in the control group (all P<0.05).

おわりに:

根管治療と歯周基本治療は，歯周病と歯内療法の複合病変を有する患者において，痛みを大幅に軽減し，口腔内の炎症の進行を抑制し，歯周病の健康を改善し，患部の歯の残存率を高めることができ，安全性と有効性が示された。

CONCLUSION: Root canal and basic periodontal therapies can significantly reduce the pain, control the progression of oral inflammation, improve periodontal health and increase the retention rate of affected teeth in patients with combined periodontal-endodontic lesions, showing safety and efficacy.