乳歯列における外傷性歯牙損傷に関する2年間の後方視的研究

A two-year retrospective study on traumatic dental injury in the primary dentition.

抄録

本研究の目的は、乳歯列における外傷性歯牙損傷（TDI）の原因、臨床的特徴、社会的要因、治療の現状を分析することである。2017年12月から2020年6月までに当院で初生歯列にTDIを認めた小児144例（213歯）を対象にレトロスペクティブ分析を行った。データはカイ二乗検定およびMann-Withney-Wilcoxon検定を用いて分析した。乳歯列にTDIを認めた小児144例中、男児が68.1％（98/144例）、女児が31.9％（46/144例）を占め、男女比は2.13：1であった。乳歯列におけるTDIの主な年齢は2〜4歳で、全体の59％を占めた。乳歯の外傷の主な原因は、他者との衝突と転倒の2つで、それぞれ全体の52.1％と44.4％を占めた。歯冠破折は乳歯列におけるTDIで最も多く、全症例の37％（53/144）を占めた。144症例のうち、17.4％（25/144症例）は軟組織の裂傷を伴い、22.2％（32/144症例）は組織の腫脹または挫滅であった。上顎歯（92.4％）は下顎歯（7.5％）よりも傷害を受けやすく、上顎切歯が最も傷害を受けやすい1（91.5％）であった。受傷から24時間後に治療のために来院した子どもの割合が最も高かった（57.0％、82/144人）。来院後、74.3％の小児が歯牙外傷の治療を受けた。治療方法としては、外傷歯の抜歯（27.1％）、抜髄＋レジン充填（または形成前歯冠）修復が主流であった。症例の約28.5％（41/144例）が2年以内に再診され、歯髄炎または歯根膜感染を起こした子どもの割合が最も高かった（29.3％、12/41例）。年齢、性別、衝突、転倒は、7歳以下の小児の乳歯列におけるTDIリスクの高さに関連する因子である。 樹脂充填（または形成前クラウン）修復と歯髄摘出術は、患歯の保存と感染の制御に有効である。しかし、受診が遅れたり、経過観察率が低かったりすると、患歯の保存や感染予防が妨げられることがある。

The aim of this study was to analyze the causes, clinical characteristics, social factors, and current status of treatment of traumatic dental injury (TDI) in the primary dentition. A retrospective analysis was performed on 144 children (213 teeth) with TDI in the primary dentition from our hospital between December 2017 and June 2020. Data were analyzed using the chi-square test and the Mann-Withney-Wilcoxon test. Boys accounted for 68.1% (98/144) and girls for 31.9% (46/144) of all 144 children with TDI in the primary dentition, with a boy-girl ratio of 2.13:1. The primary age of TDI in deciduous teeth was 2 to 4 years old, accounting for 59% of all cases. Collision with others and fall were the 2 main causes of trauma to the deciduous teeth, making up 52.1% and 44.4% of all causes, respectively. Crown fracture injury was the most common type of TDI in the primary dentition, accounting for 37% of all cases (53/144). Of the 144 cases, 17.4% (25/144) was accompanied by soft tissue laceration, while 22.2% (32/144) by swelling or contusion of tissue. Maxillary teeth (92.4%) were more vulnerable to injury than mandibular teeth (7.5%), with maxillary incisor being the most vulnerable 1 (91.5%). The percentage of children arrived at the hospital for treatment 24 hours after the injury was the highest (57.0%, 82/144). After the hospital visit, 74.3% of children received treatment for the dental trauma. In terms of the treatment modalities, extraction of the traumatized teeth (27.1%) and pulpectomy + resin filling (or preformed crown) restoration were predominant. Approximately 28.5% (41/144) of cases were reviewed within 2 years, with the proportion of children with pulpitis or periapical infection being the highest (29.3%, 12/41). Age, gender, collision, and fall are the factors linked to a higher risk of TDI in the primary dentition in children under the age of 7. Resin filling (or preformed crown) restoration and pulpectomy are effective in preserving the affected tooth and controlling infection. However, the preservation of the affected tooth and the prevention of infection may be hampered by late visits and low follow-up rates.