Guided Tissue Regeneration（GTR）と遺伝子組み換えヒト線維芽細胞増殖因子（rhFGF）-2を含む歯周再生療法によるIII期グレードC歯周炎の治療：1症例報告

Treatment of Stage III Grade C Periodontitis with Periodontal Regenerative Therapy including Guided Tissue Regeneration (GTR) and Recombinant Human Fibroblast Growth Factor (rhFGF)-2: A Case Report.

抄録

ガイド下組織再生法（GTR）と遺伝子組換えヒト線維芽細胞増殖因子（rhFGF）-2を含む歯周外科治療を行った歯周炎の1例について報告する。症例は54歳女性で，上顎右側歯肉の腫脹を主訴に東京歯科大学水道橋病院を受診した．初診時の検査では，プロービングデプス（PD）4mm以上の部位が30.4％存在した．プロービング時に出血を認めた部位は57.7％であった．プラークコントロールレコード（PCR）スコアは66.1％であった．X線検査では，臼歯部に垂直性骨欠損を認めた．これらの所見から，臨床診断は汎発性慢性歯周炎（Stage III, Grade C）であった．初回の歯周治療により歯周状態は改善し、PCRスコアは13.8％に減少した。PD残存率4mm以上の歯には歯周外科手術を施行した。37番と47番にはガイド下組織再生を行った。14, 15, 25, 27の角状骨欠損にrhFGF-2を応用した一連の歯周再生治療を行った。16, 17, 26, 36, 46 に Open flap debridement を行った．評価後、#21と#26にオールセラミッククラウンを装着し、口腔機能を回復させた。その後，歯周支持療法を行った．本症例は，全身性慢性歯周炎であり，GTR と rhFGF-2 による歯周再生療法により，安定した歯周病状態が得られた．

This report describes a case of periodontitis treated with periodontal surgery including guided tissue regeneration (GTR) and recombinant human fibroblast growth factor (rhFGF)-2. The patient was a 54-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of swelling in the maxillary right gingiva. An initial examination revealed 30.4% of sites with a probing depth (PD) of ≥4 mm. The prevalence of sites with bleeding on probing was 57.7%. The plaque control record (PCR) score was 66.1%. Radiographic examination revealed vertical bone defects in the molar region. Based on these findings, the clinical diagnosis was generalized chronic periodontitis (Stage III, Grade C). Initial periodontal therapy yielded an improvement in periodontal conditions, with the PCR score reducing to 13.8%. Periodontal surgery was performed for teeth with a residual PD ≥4 mm. Guided tissue regeneration was performed on #37 and 47. A series of periodontal regenerative treatments comprising application of rhFGF-2 was performed on angular bone defects in #14, 15, 25, and 27. Open flap debridement was performed on #16, 17, 26, 36, and 46. Following evaluation, oral function was restored by placing all-ceramic crowns on #21 and 26. The patient was then placed on supportive periodontal therapy. In the present case of generalized chronic periodontitis, periodontal regenerative therapy with GTR and rhFGF-2 yielded stable periodontal conditions.