上顎洞底が近接した部位における歯の自家移植症例  [in Japanese] A Case of Autotransplantation of Teeth to Areas Close to the Maxillary Sinus  [in Japanese]

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目的:歯の移植術は,非機能歯を活用でき,義歯を回避できるなどの利点がある.歯の移植術に関しては予後良好な症例報告が多いが,受容側の残存骨量から制限を受けるため下顎に移植した報告が多く,上顎への移植症例は少ない.そこで今回,上顎洞底と近接した両側第一大臼歯部に対して,下顎第三大臼歯を移植することにより義歯の装着を回避できた症例を報告する.症例と治療経過:患者は61歳の女性.上顎右側第一大臼歯の咬合痛,および上顎左側第一大臼歯の動揺を主訴に来院した.全身状態として,2型糖尿病に11年前より罹患しており,インシュリンの自己注射により維持・管理している(HbAlc: 6.5%, NGSP値).初診時に上顎右側第一大臼歯は高度の歯槽骨吸収により保存不可能と診断,抜歯処置を施行した.歯周組織検査の結果,上顎左側第一大臼歯は歯根破折のため保存不可能と判断したが,患者は義歯の使用に対して強い嫌悪感を示したため,インプラント治療を視野に入れたコーンビームCTによる検査を行った.その結果,上顎洞底までの距離が短く,かつ洞底粘膜の肥厚を認めたため,上顎洞底挙上術を伴うインプラント治療を断念し,上顎両側第一大臼歯部に下顎両側第三大臼歯の歯の移植術を施行することに計画を変更した.通常の歯周基本治療後,48歯を16歯部に上顎洞底までの距離と歯根形態を考慮して,近遠心の方向を逆に移植し,移植後3カ月で暫間被覆冠を作製した.上顎右側移植6カ月後に移植歯の安定を確認後,38歯を26歯部に移植し,移植後3カ月で暫間被覆冠を作製した.上顎右側部移植後2年5カ月,上顎左側部移植後1年10カ月に歯周組織の安定を確認後,最終補綴物を作製した.考察:本症例では高度の歯槽骨吸収部位への歯の移植のため,歯槽骨残存量の少なさが懸念されたが,コーンビームCTにより上顎洞底までの距離や歯槽骨の厚みを三次元的に正確に計測し,移植可能であると診断した.歯の移植にはさまざまな制限を伴うが,CTなどの形態計測機器を用いることにより,より安全に欠損部への適応が可能になると考えられる.結論:今回の症例により,コーンビームCTを用いて三次元的な歯槽骨量の検査を施行し,歯根膜を有する非機能歯を用いた歯の移植術を施行することにより,義歯による欠損補綴を回避することができる可能性を示した.

Purpose: A nonfunctional tooth can be utilized in tooth transplantation, which could eliminate the need for dentures. Many case reports claim a good prognosis following tooth transplantation, but in most cases involving the lower jaw, the residual bone mass in the recipient site is limited. We report a case of autotransplantation of teeth to the areas close to the maxillary sinus, which helped eliminate the need for dentures. Case Report and Results: A 61-year-old woman consulted our department with the chief complaint of painful right maxillary molars. She had been diagnosed with type II diabetes mellitus (HbAlc: 6.5%) since 1996 and was receiving insulin therapy by self injection. At the initial consultation, the right maxillary first molar was extracted because of poor prognosis. In addition, preservation of the left maxillary first molar was deemed impossible because of root fracture. The patient expressed strong antipathy towards the use of dentures. Therefore, we checked the possibility of dental implant therapy and observed that the distance to the maxillary sinus base was too short to insert an implant and the sinus mucosa was swollen. We decided that implantation with sinus floor augmentation was impractical. Therefore, we opted for bilateral autotransplantation of the third mandibular molars to the maxillary arch. After the initial periodontal therapy, 48 was transplanted to the 16 region, along with inversion of the mesiodistal direction considering the distance and tooth root form in relation to the maxillary sinus base. Provisional restoration was provided for 3 months post-transplantation. After confirming the stability of the transplanted tooth, 38 was transplanted to the 26 region, and provisional restoration was provided for 3 months post-transplantation. After 29 and 22 months post-transplantation in the maxillary right and left sides, respectively, we confirmed the stability of the transplanted teeth as the final prosthesis. Discussion: In this case, with regard to transplantation to an area of severe alveolar bone resorption, we were concerned about residual alveolar bone mass, but the feasibility of transplantation was verified using cone beam computed tomography (CBCT) to measure the alveolar bone thickness and its distance from the maxillary sinus base. Using this method, a missing tooth portion was treated safely without implantation. Conclusion: In this case requiring treatment in areas close to the maxillary sinus, we demonstrated that the use of dentures can be avoided by tooth transplantation and using CBCT.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 56(3), 252-263, 2013

    The Japanese Society of Conservative Dentistry

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