歯根が横方向に破折した2本の外傷性成熟前歯に対する再生歯内療法

Regenerative endodontic procedures for two traumatized mature anterior teeth with transverse root fractures.

抄録

背景:

再生歯内療法(REP)は、歯髄壊死/歯根膜炎を伴う未成熟外傷歯に対する代替治療法である。しかし、成熟歯の多発性横根破折に対するこの処置の報告は少ない。この症例報告では、2本の上顎中切歯に多発性水平歯根破折を有し、REPによる治療に成功した患者の管理について述べる。

BACKGROUND: Regenerative endodontic procedures (REPs) are an alternative treatment in immature traumatized teeth with necrotic pulp/apical periodontitis. However, this procedure has been infrequently reported in multiple transverse root fractures of mature teeth. This case report describes management of a patient with multiple horizontal root fractures in 2 maxillary central incisors that were successfully treated with REPs.

症例提示:

17歳の女児は、成熟歯11番と21番に外傷の既往があり、多発性横根破折を生じていた。臨床検査では、両歯とも電気的および熱的歯髄知覚検査に反応し、強い疼痛が持続し、打診および触診で圧痛が認められた。歯根周囲X線検査では、両歯とも完全に発育しており、根の中央部に複数の横方向骨折が認められた。歯髄診断は症候性不可逆性歯髄炎と一致した。歯髄組織再生の可能性を考慮し、歯根端断端の歯髄活力を維持するため、歯根端断端のみを治療してREPを開始した。REP後、臨床症状/徴候は沈静化し、2本の歯は48ヵ月間経過観察され、コーンビームCT（CBCT）撮影も実施された。最終審 査では、歯根破折は石灰化組織で治癒し、歯髄は歯根端片で石灰化していた。両歯とも安定し、機能していた。

CASE PRESENTATION: A 17-year-old girl had a history of traumatic injury to mature teeth 11 and tooth 21 resulting in multiple transverse root fractures. Clinical examination showed that both teeth responded to electric and thermal pulp sensibility tests with prolonged severe pain and were tender to percussion and palpation. Periapical radiographic examination showed both teeth were fully developed and had multiple transverse fractures in the mid-root. The pulp diagnosis was consistent with symptomatic irreversible pulpitis. REPs were initiated with only the coronal fragments treated to preserve pulp vitality in the apical fragment for potential pulp tissue regeneration. After REPs, clinical signs/symptoms subsided, and the two teeth were followed for 48 months when cone beam computed tomography (CBCT) imaging was also undertaken. At the last review, the case demonstrated root fractures healing with calcified tissue and pulp calcification in the apical fragments. Both teeth were stable and in function.

結論:

REPは、歯根が横方向に破折した外傷や症状のある成熟永久歯の治療に使用できる可能性がある。

CONCLUSIONS: REPs have the potential to be used to treat traumatized and symptomatic mature permanent teeth that have sustained transverse root fractures.