成熟臼歯に対する歯髄再生細胞療法。2症例の報告

Pulp Regenerative Cell Therapy for Mature Molars: A Report of 2 Cases.

抄録

はじめに:

自家歯髄幹細胞（DPSC）を用いた成熟単根歯に対する再生細胞療法は、従来の歯内療法に代わる治療法として期待されている。しかし、多根歯に対するDPSCの使用を支持するエビデンスはない。この症例報告は、一般的にアピカルデルタの有病率が高い成熟多根臼歯における歯髄再生細胞治療の実行可能性と結果を示すことを目的とした。

INTRODUCTION: Regenerative cell therapy using autologous dental pulp stem cells (DPSCs) in mature single-rooted teeth is a potential alternative to traditional endodontic treatment. However, there is no evidence supporting the use of DPSCs in multi-rooted teeth. This case report aimed to demonstrate the feasibility and outcomes of pulp regenerative cell therapy in mature multi-rooted molars, which typically have a higher prevalence of apical deltas.

方法:

26歳男性と29歳男性が、上顎大臼歯の歯髄再生のために紹介された。アクセス準備と根尖開存の確認後、根管治療と消毒が行われた。自家DPSCを第三大臼歯から分離し，GMPに従って培養した後，アテロコラーゲン中の顆粒球コロニー刺激因子とともに準備した根管に移植した．アクセス腔はバイオデンティンとコンポジットレジンで封鎖した．

METHODS: A 26-year-old male and a 29-year-old male were referred for the pulp regeneration of their maxillary molars. After access preparation and establishing apical patency, root canal preparation and disinfection were performed. Autologous DPSCs were isolated from extracted third molars, cultured according to the guidelines of good manufacturing practice, and transplanted into the prepared root canals with granulocyte colony-stimulating factor in atelocollagen. The access cavity was sealed with Biodentine and composite resin.

結果:

48週間の追跡期間中の臨床評価と4週間後の臨床検査では、有害事象や全身毒性は認められなかった。48週後のX線写真とコーンビームCT検査では、歯根周囲の放射性白濁は認められなかった。4週間後の電気的歯髄検査では，両症例とも良好な反応が得られた．24 週間後の患歯の再生歯髄組織の磁気共鳴画像における信号強度は，隣接歯の正常歯髄の信号強度と同程度であった．

RESULTS: Clinical evaluation during the follow-up period of 48 weeks and laboratory evaluation after four weeks revealed no adverse events or evidence of systemic toxicity. After 48 weeks, radiographs and cone-beam computed tomography showed no periapical radiolucency. The teeth showed a positive response to electric pulp testing in four weeks in both cases. The signal intensities on magnetic resonance imaging of the regenerated pulp tissue in the affected teeth were comparable to those of the normal pulp in adjacent teeth after 24 weeks.

結論:

この2例の報告は、DPSCの有用性と多根臼歯における歯髄再生細胞治療の実現性を示すものである。

CONCLUSIONS: This report of two cases demonstrates the utility of DPSCs and the feasibility of pulp regenerative cell therapy in multi-rooted molars.