歯周病の重症度が非外科的歯内療法の結果に及ぼす影響：前向きコホート研究

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

抄録

目的:

歯周病の重症度が非外科的歯内療法（NSET）後の智歯周囲治癒に及ぼす影響を検討すること。

OBJECTIVE: To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET).

材料と方法:

この前向き研究では、歯髄壊死と無症候性歯根膜炎が診断され、X線透過性歯根膜周囲指標（PAI）スコア≧3を示し、歯周病変（CEPL）を併発していない下顎大臼歯にNSETを必要とした被験者（n=45）を登録した。歯周病およびインプラント周囲疾患の分類に従った後、被験者を3つのグループに均等に割り付けた。I群-歯内病変のみ（対照：健康な歯周組織（n=15））、II群-I期およびII期の歯周炎を有するCEPL（n=15）、III群-III期の歯周炎を有するCEPL（n=15）。2％クロルヘキシジンゲルを腔内薬として使用し、標準化された2回のNSETを行った。必要に応じて歯周治療を行った。6ヵ月後と12ヵ月後に再診し、臨床的およびX線写真を評価した。群間の差を評価するためにカイ二乗検定を行った。

MATERIAL AND METHODS: In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups.

結果:

12ヵ月後の追跡調査では、3群のすべての歯が無症状であった。X線写真による智歯周囲領域の評価では、I群、II群、III群でそれぞれ80％、47％、50％の歯で治癒が観察された。しかし、その差は統計的に有意ではなかった（p=0.150）。

RESULTS: At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150).

結論:

歯周病の重症度は、歯内療法を併用した歯周病変のない歯において、NSET後の智歯周囲治癒に影響を及ぼさなかった。

CONCLUSION: The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication.

臨床的意義:

歯周病は根尖性歯周炎に大きな影響を与えるが、歯周炎の重症度は根尖性歯周炎に悪影響を与えない。

CLINICAL RELEVANCE: Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.