エムドゲイン®ゲルを用いた先進医療「歯周外科治療におけるバイオ・リジェネレーション法」の治療成績  [in Japanese] Examination of Advanced Dental Technology with EMDOGAIN® Gel in Periodontal Regeneration Therapy  [in Japanese]

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Author(s)

    • 塩山 秀裕 SHIOYAMA Hidehiro
    • 東京医科歯科大学歯学部附属病院口腔ケア外来:東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Oral Health Care Clinic, Dental Hospital, Tokyo Medical and Dental University:Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 木下 淳博 KINOSHITA Atsuhiro
    • 東京医科歯科大学大学院医歯学総合研究科医療政策学講座教育メディア開発学分野 Section of Educational Media Development, Department of Health Science Policies, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 小田 茂 ODA Shigeru
    • 東京医科歯科大学歯学部附属病院歯科総合診療部 Diagnosis and General Dentistry, Dental Hospital, Tokyo Medical and Dental University
    • 和泉 雄一 IZUMI Yuichi
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野:東京医科歯科大学グローバルCOEプログラム歯と骨の分子疾患科学の国際教育拠点 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University:Global Center of Excellence (GCOE) Program, International Research Center for Molecular Science in Tooth and Bone Diseases, Tokyo Medical and Dental University
    • 水谷 幸嗣 MIZUTANI Koji
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野:ハーバード大学医学部ジョスリン糖尿病センター Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University:Joslin Diabetes Center, Harvard Medical School
    • 須田 智也 SUDA Tomonari
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 田中 敬子 TANAKA Keiko
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 青山 典生 AOYAMA Norio
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 藤原-高橋 香 FUJIWARA-TAKAHASHI Kaori
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 秋月 達也 AKIZUKI Tatsuya
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 竹内 康雄 TAKEUCHI Yasuo
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
    • 小林 宏明 KOBAYASHI Hiroaki
    • 東京医科歯科大学大学院医歯学総合研究科生体硬組織再生学講座歯周病学分野 Section of Periodontology, Department of Hard Tissue Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University

Abstract

失われた歯周組織を再生させる方法の一つとして,エナメルマトリックスタンパク質の応用が多く報告されている.東京医科歯科大学歯学部附属病院では,エムドゲイン®ゲル(EMD)を用いた「歯周外科治療におけるバイオ・リジェネレーション法」が2007年10月に先進医療として厚生労働省より認可された.本研究の目的は,先進医療として行われたEMDを用いた歯周組織再生治療の臨床成績を評価することである.本院における実施症例のうち,術後1年経過時に検査が可能であった22名30部位について,プロービングポケットデプス(PPD),臨床的アタッチメントレベル(CAL),エックス線写真上での骨欠損部の測定を行った.術前の平均PPDは6.1±1.4mm,CALは7.1±1.8mmで,エックス線写真上での平均骨欠損深さは5.6±2.7mmであった.術後1年における平均PPDは3.1±0.8mm,CALは4.8±2.1mmであり,術前と比べて統計学的に有意なPPD,CAL値の改善が認められた.アタッチメントゲインは30部位中26部位で認められ,平均獲得量は2.3±2.3mmであった.エックス線写真上での平均骨欠損深さは3.1±1.8mmに減少し,統計学的に有意な改善が認められた.以上の結果から,臨床的ならびにエックス線写真での歯周組織再生が本研究においても国内外の報告と同程度に得られていることが確認された.EMDは現在保険適用されているGTR法に比べ,術式が簡便で,骨欠損が複数に及んでいても適用できる利点があり,患者負担を軽減しつつ歯周治療に対する選択肢を拡げるという点からも,先進医療としてのエムドゲイン®ゲルの適用は効果的であると考えられる.

A growing amount of evidence indicates that enamel matrix protein is effective for periodontal regeneration therapy. Tokyo Medical and Dental University Dental Hospital were given permission to administer advanced dental technology with EMDOGAIN® gel in periodontal regeneration therapy by the Ministry of Health, Labour and Welfare of Japan in October 2007. The purpose of the present study was to evaluate the clinical outcomes of the periodontal regeneration therapy using EMDOGAIN® gel (EMD) administered as an advanced dental technology. Thirty sites of 22 patients were employed in this study. Clinical examinations were performed before and one year after surgery. Probing pocket depth (PPD), clinical attachment level (CAL), and radiographic bone defect depth were measured. The mean PPD, CAL and radiographic bone defect depth before surgery were 6.1±1.4 mm, 7.1±1.8 mm and 5.6±2.7 mm, respectively. Mean PPD and CAL after one year were significantly improved to 3.1±0.8 mm and 4.8±2.1 mm. Twenty-six of the 30 sites showed gains of CAL, and the mean clinical attachment gain was 2.3±2.3 mm. The mean radiographic bone defect depth decreased to 3.1±1.8 mm. The results of the present study were consistent with those of previous reports on clinical and radiographic periodontal tissue regeneration. EMD has several technical advantages compared with GTR, which is covered by dental health insurance, and its procedure is more simple. Additionally, it can be used for multiple bone defects at the same time. In conclusion, promoting the advanced dental technology using EMDOGAIN® gel may provide adequate clinical outcomes for periodontally-involved patients while reducing the cost of treatment.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 55(1), 22-29, 2012

    The Japanese Society of Conservative Dentistry

References:  26

Codes

  • NII Article ID (NAID)
    110009479977
  • NII NACSIS-CAT ID (NCID)
    AN00191201
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    0387-2343
  • Data Source
    CJP  NII-ELS  J-STAGE 
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