根尖切除術における切除面の封鎖法の違いが実験的根尖性歯周炎の長期的治癒に及ぼす影響  [in Japanese] Long-term Healing of Experimental Apical Periodontitis after Apicoectomy Using Different Sealing Methods on Resected Root End  [in Japanese]

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Author(s)

    • 大谷 香織 OHTANI Kaori
    • 北海道大学大学院歯学研究科口腔健康科学講座歯周・歯内療法学教室 Department of Periodontology and Endodontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
    • 菅谷 勉 SUGAYA Tsutomu
    • 北海道大学大学院歯学研究科口腔健康科学講座歯周・歯内療法学教室 Department of Periodontology and Endodontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine
    • 川浪 雅光 KAWANAMI Masamitsu
    • 北海道大学大学院歯学研究科口腔健康科学講座歯周・歯内療法学教室 Department of Periodontology and Endodontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine

Abstract

本実験は実験的に根尖性歯周炎を惹起し,根管が汚染されたままの状態で根尖切除術を行い,スーパーボンドC&B®によるroot-end sealing,Super-EBA™とProroot®MTAによる逆根管充填を行って,長期的な根尖歯周組織の治癒状態を病理組織学的に評価した.実験動物にはビーグル犬4頭を使用し,被験歯を抜髄後,根管内をプラークで汚染させて根尖性歯周炎を惹起させ,1ヵ月後デンタルエックス線写真で根尖部に透過像が拡大していることを確認して根尖切除術を行った.根尖部の封鎖法は以下の4群に分けた.SB群(n=15)は根尖切除面をわずかに陥凹させて形成し,形成面全体にスーパーボンドC&B®を塗布した.EBA群(n=14)とMTA群(n=14)は逆根管充填窩洞を形成し,Super-EBA™またはProroot®MTAを充填した.非封鎖群(n=10)は根尖を切除したのみで逆根管充填窩洞の形成および封鎖は行わなかった.観察期間は48週とし,エックス線写真による骨透過像面積の計測と,病理組織学的観察および計測を行った.その結果,48週後のエックス線透過像面積および組織学的骨吸収面積は,SB群,EBA群,MTA群は非封鎖群に比べて有意に小さく,SB群,EBA群,MTA群の間には有意差がなかった.切除面象牙質上へのセメント質形成率は,EBA群,MTA群はSB群,非封鎖群に比べて有意に大きく,EBA群とMTA群の間には有意差はなかった.スーパーボンドC&B®にもセメント質にも被覆されていない根尖切除面の象牙質露出率は,SB群がほかの3群に比較して有意に小さく,EBA群とMTA群は非封鎖群より有意に小さかった.露出象牙質面の根吸収率はSB群,EBA群,MTA群は非封鎖群に比べて有意に小さく,SB群,EBA群,MTA群では,象牙質露出率と象牙質吸収率との間に有意な正の相関が認められた.したがって根管が汚染された状態で根尖切除術を行う場合には,切除して露出した象牙質面を被覆することが長期的予後には大切であり,新生セメント質による完全な被覆は難しいことから,スーパーボンドC&B®でroot-end sealingを行うことがよいと考えられた.

This study evaluated the apical periodontal healing after root-end sealing using Super-Bond C & B®, and root-end filling using Super-EBA™ or ProRoot®MTA, when root canal infection persisted. Apical periodontitis was induced by contaminating root canals with dental plaque in mandibular premolars of 4 beagles. After 1 month, in the SB group (n=15), Super-Bond C & B® was applied to the resected surface following apicoectomy. In the EBA (n=14) and MTA (n=14) groups, a root-end cavity was prepared and filled with Super-EBA™ and ProRoot®MTA. In the control group (n=10), the root-end surface was not filled. The observations of periradicular radiolucency, the histological observation and histometrical analyses were performed at 48 weeks after surgery. The results were as follows. The areas of periradicular radiolucency and histological bone defect areas in the SB, EBA and MTA groups were significantly less than those in the control group. There were no significant differences between the SB, EBA and MTA groups. The percentage of new cementum on the apical dentin surface in the EBA and MTA groups was significantly more than that in the SB and control groups. There were no significant differences between the EBA and MTA groups. The percentage of exposed dentin that was not covered with Super-Bond C & B® or new cementum in the SB group was significantly less than that in the EBA, MTA and control groups. The EBA and MTA groups showed a significantly lower percentage than the control group. The percentage of resorbed dentin in the SB, EBA, and MTA groups was significantly less than that in the control group. There was a significant correlation between the percentage of exposed dentin and the percentage of resorbed dentin in the SB, EBA, and MTA groups. It was suggested that sealing of the resected dentin surface is important for long-term healing. It might be difficult for the new cementum to seal the resected root end surface completely following apicoectomy, and root-end sealing using Super-Bond C & B® has better potential when root canal infection remains.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 51(6), 648-658, 2008

    The Japanese Society of Conservative Dentistry

References:  39

Cited by:  3

Codes

  • NII Article ID (NAID)
    110007026971
  • NII NACSIS-CAT ID (NCID)
    AN00191201
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0387-2343
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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