パーフォレーションとセメント質断裂が生じた下顎右側中切歯の歯内療法と歯周再生療法

Endodontic Approach and Periodontal Regenerative Therapy for a Mandibular Right Central Incisor Affected by a Perforation and Cemental Tear.

抄録

セメント質断裂は、セメント質接合部に沿った根面上のセメント質の完全または不完全な剥離を伴う。セメント質断裂は歯周破壊を引き起こし，歯内病変や歯周病変を模倣するため，臨床例の診断は難しく，特別な検査が必要である．72 歳の女性が，下顎右側中切歯の唇側および近心面に限局した歯周病変を呈示した．歯周外科手術中にCBCTスキャンと生検を行うことで、セメント質の断裂とその部位のパーフォレーションの確定診断が可能となった。まず、歯内療法で穿孔を修復した。その後，肉芽腫組織とセメント片を除去し，遺伝子組換えヒト線維芽細胞増殖因子-2（rhFGF-2）を用いた歯周再生療法を施行した．生検標本の検査で細菌のコロニーを確認した．本症例は，1年半の経過観察で臨床的，X線学的に良好な経過を示した．

A cemental tear involves complete or incomplete separation of the cementum on the root surface along the cementodentinal junction. Because a cemental tear can lead to periodontal breakdown and mimic endodontic and periodontal lesions, diagnosing clinical cases can be difficult and requires special examinations. A 72-year-old woman presented with a localized periodontal defect on the labial and interproximal surfaces of the mandibular right central incisor. Performing CBCT scans and a biopsy during periodontal surgery allowed definitive diagnosis of a cemental tear and perforation of the site. First, the perforation was repaired with endodontic therapy. Periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) was then performed after removing granulomatous tissue and cementum fragments. Examination of the biopsy specimen showed bacterial colonies. This case showed successful clinical and radiographic outcomes at the 18-month follow-up.