歯根嚢胞の非外科的歯内治療法に関する新考案 : 15年以上の長期経過例からみた研究

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  • 川崎 孝一
    日本歯科大学新潟生命歯学部歯科保存学第1講座

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  • A New Rationale for the Nonsurgical Endodontic Treatment of Periapical Cysts : Evaluation Based on a Long-term Clinical Follow-up Examination over 15 Years

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Some endodontists maintain that periapical cysts do not heal following conservative endodontic therapy, and the mechanism by which periapical cysts can heal is not well understood. The purpose of the present study was to suggest a new rationale for the nonsurgical endodontic treatment of periapical cysts. To induce subepithelial hemorrhage and dissolution of the epithelial lining of the cyst wall, application of canal irrigant was carefully performed with 6% sodium hypochlorite (Purelox^[○!R]) followed by 3% hydrogen peroxide alternately into the canal. The effectiveness of the solubility of the tissue was estimated by macroscopic bleeding. The patients were a 51-year-old man and a 35-year-old man who had respectively a large periapical rarefaction over the area of the lower or the upper lateral and central incisors. The latter patient had nasal-apical communication associated with the involved tooth, and presented swelling and discomfort from the upper left lateral incisor which was accompanied in the left nostril. The diagnosis was made of inadequate root canal fillings with periapical rarefaction and the presence of epithelial cells by means of the periapical biopsy and cholesterol crystals from the periapical lesions. FR paste material containing guaiacol-folmaldehyde resin and calcium hydroxide was estimated to occupy 1 to 2 mm of the apical root canal space. The remaining canal was filled with gutta-percha cones and zinc oxide eugenol sealers (Canals^[○!R]) by lateral condensation. Radiographs of these cases demonstrated the gradual resolution of the large lesions over a period of nearly 5 to 7 years after root canal filling. This article describes the successful root canal treatment and decompression by using opened canal therapy releasing copious amounts of suppurative exudates for 6 months. The rationale behind the usefulness of this technique is reviewed and its advantages are highlighted.

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