1 1)2) 1)2) 1)2) 1)2) 2) 1) 3

Title 難 治 性 根 尖 性 歯 周 炎 に 対 する 意 図 的 歯 牙 再 植 法 の 有 用 性 古 澤, 成 博 ; 小 貫, 瑞 穂 ; 細 川, 壮 平 ; 大 迫, Author(s) 川, 裕 記 ; 根 本, 詩 子 ; 関 根, 珠 里 亜 ; 吉 田, 隆 ; 渡 部, 光 弘 Journal 日 本 歯 科 保 存 学 雑 誌, 51(4): 403-410 美 穂 ; 早 URL http://hdl.handle.net/10130/981 Right Posted at the Institutional Resources for Unique Colle Available from http://ir.tdc.ac.jp/

1 1)2) 1)2) 1)2) 1)2) 2) 1) 3

101-0061 2-9-18 TEL:03-3262-3421,FAX:03-3262-3420,E-Mail:mfurusaw@tdc.ac.jp 2

3 1 2-3

4 )

5

6 5

7 6-7 8-11 12-13

8 14-15 16-18

1 ) 12,14-23,1998. 2) 37, 627-632,1994. 3 ) 37, 1246-1253,1994. 4) 47(1), 31-36,2004. 5 43, 852-857,2000. 6) 80(11),1531-1576,1980. 7) 80(11),1577-1589,1980. 8Andreasen,J.O.:Periodontal healing after replantation and autotransplantation of incisors in monkeys; Int J Oral Surg, 10,54-61,1981. 9Polson,A.M.:Mechanisms of new attachiment formation ; Endod Dent Traumatol 3,45-57,1987. 9

10 Andreasen,J.O. Kristerson,L.:The effect of limited drying or removal of the periodontal ligament ; Acta Odontol Scand 39, 1-13,1981. 11) Andreasen,J.O.:Effect of pulp extirpation or root canal treatment on periodontal healing after replantation of permanent incisors in monkeys; J Endodont 7,245-252,1981. 12) 33, 772-802,1990. 13 34, 957-985,1991. 14 38, 63-87,1995. 15 11,375-385,1998. 16 36, 571-581,1993. 17) 38, 1024-1034,1995. 10

18 45, 100-105,1998. 11

Patients with intractable chronic apical suppurative periodontitis who underwent intentional replantation FURUSAWA Masahiro 1)2),ONUKI Mizuho 1)2), HOSOKAWA Souhei 1)2),OOSAKO Miho 1)2),HAYAKAWA Hiroki 1), NEMOTO Utako 1),SEKINE Jyuria 1),YOSHIDA Takashi 1)2), WATANABE Mitsuhiro 3) 1) Department of Clinical Oral Science,Tokyo Dental College (Chief:Prof.KAKIZAWA Takashi) 2) Division of Oral Health Sciences,Department of Health Sciences,Saitama Prefectual University School of Health and Social Services 3) Department of Dentistry Southern TOHOKU General Hospital,Southern TOHOKU Medical Clinic,Southern TOHOKU Research Institute for Neuroscience Intentional replantation has been performed for avulsed teeth caused by trauma, but can also be used to treat accidents such as perforations or intractable apical periodontitis that is unresponsive to conventional root canal treatment. We investigated shifts in symptoms for patients who did not respond to conventional root canal treatment and received intentional replantation. Subjects were 30 patients with a mean age of 41 years (range, 13-68 years) who visited the Departments of Operative Dentistry or General Dentistry at Tokyo Dental College Chiba Hospital or Suidobashi Hospital, were diagnosed with chronic apical periodontitis, and did not respond to conventional root canal treatment. Following provision of informed consent, intentional 12

replantation with apicoectomy was performed. The mean number of root canal treatments prior to the intentional replantation was 6.3, and root canal dressings such as phenol, formaldehyde, calcium hydroxide and calcium hydroxide/iodoform were used. Intentional replantation was performed as follows: after performing root canal filling by lateral condensation using gutta-percha points and hydroxyapatite root canal sealer, the affected tooth was removed, and about 1 mm of the apex was sectioned. In many patients, replantation was performed by subjecting gutta-percha on the cut surface to cold varnish. In 4 patients, after sectionning the apex, retrofilling was performed using cyanoacrylate resin cement followed by replantation. Shifts in postoperative symptoms were analyzed. All 30 patients complained of occlusal pain, percussion pain and apical discomfort before and during surgery. Symptoms improved postoperatively in 28 patients, and these patients remained asymptomatic once restorations were placed. In 2 patients, no changes in symptoms were seen before and after surgery, and the cause of symptoms could be neurogenic rather than in the apex. Based on these findings, intentional replantation appears highly useful in patients diagnosed with chronic apical periodontitis unresponsive to conventional root canal treatment where the cause of pain is in the apex. Keywords: Chronic apical suppurative periodontitis, Intentional replantation, Clinical study Corresponding author:dr.furusawa,department of Clinical Oral Science,Tokyo Dental College,2-9-18,Misakichoh,Chiyoda-ku,Tokyo 101-0061,Japan TEL:+81-3-3262-3421,FAX:+81-3-3262-3420,E-mail:mfurusaw@tdc.ac.jp 13

CT

図３ 症例番号１９ 下顎左側第一小臼歯に対してシアノアクリレートセメントにより逆根管 充填を施した症例 写真上左から 術前 術直後 下左から 術後３ヶ月 術後２年６ヶ月のエックス線写真