歯根の肥大および湾曲を伴う上顎大臼歯の自家移植症例  [in Japanese] A Case of Autotransplantation of a Tooth with Curved and Hypertrophied Roots  [in Japanese]

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Author(s)

    • 呉本 勝隆 Katsutaka KUREMOTO
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 前薗 葉月 Hazuki MAEZONO
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 北川 蘭奈 Ranna KITAGAWA
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 竹田 かほる Kahoru TAKEDA
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 新野 侑子 Yuko SHINNO
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 松下 健太 Kenta MATSUSHITA
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 伊藤 祥作 Shosaku ITO
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 野杁 由一郎 Yuichiro NOIRI
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry
    • 林 美加子 Mikako HAYASHI
    • 大阪大学大学院歯学研究科 口腔分子感染制御学講座 (歯科保存学教室) Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry

Abstract

 目的 : 歯の自家移植は1歯欠損に対する処置法の選択肢の一つであり, 天然歯にほぼ一致した組織学的・解剖学的構造の再生が得られ, 天然組織の保存を図ることができるという利点を有し, 良好な経過を示す臨床症例が多数報告されている. しかしながら, 移植歯のサイズや形態に制限があり, 症例選択の際には熟考を要する. 一般的に, 移植歯は移植自体の手技, および移植歯に対する根管治療の難しさから単根歯でかつ歯根の湾曲が小さい歯が用いられることが多いが, 今回は歯根の湾曲が著しい上顎右側第三大臼歯を上顎左側第二大臼歯部に移植し良好に経過している症例について報告する. <br> 症例の概要 : 患者は37歳男性. 以前より体調不良時に上顎左側第二大臼歯の違和感を覚えていたが, 頰側および口蓋側に腫脹を認め来院. 来院時, 上顎左側第二大臼歯頰側および口蓋側に瘻孔を形成していた. <br> 治療経過 : 補綴物を除去すると髄床底に破折を認め, 保存困難と診断した. 患者より上顎右側第三大臼歯を用いた移植を希望する申し出があり, 上顎右側第三大臼歯には術前のコーンビームCT (CBCT) による診査で歯根の肥大・湾曲を認めたものの, 移植可能と判断し移植歯として用いることとした. 上顎左側第二大臼歯を抜歯し, 同日に上顎右側第三大臼歯を抜歯し口腔外にてNi-Tiロータリーファイルを用いて根管治療を行い, 上顎左側第二大臼歯部に移植し固定した. 移植歯の固定は1カ月後に除去し, 支台築造および暫間被覆冠の作製を行った. 移植後6カ月経過時に歯周組織の安定を確認したうえで, 最終補綴物を作製した. デンタルエックス線写真において, 移植歯周囲歯槽骨および歯槽硬線の回復が認められ, 現在術後1年以上経過しているが, 経過は良好である. <br> 結論 : 本症例では, CBCTによる術前診査の後に歯根の肥大および湾曲が認められる上顎大臼歯の自家移植を行い, 良好な結果が得られた.

 Purpose: Auto-transplantation of teeth is a viable treatment option for tooth loss because the transplanted tooth resembles a natural tooth histologically. Several studies have reported the advantages of this procedure. However, autotransplantation is often complicated by the size and shape of the donor tooth, thus necessitating careful consideration before implementation. Generally, donor teeth are single-rooted and almost straight, which makes transplantation and root canal treatment easier. However, in this report, we present the favorable results obtained after transplantation of a maxillary third molar with curved and hypertrophied roots in place of a maxillary second molar.<br> Case report: A 37-year-old man presented at the Osaka University Dental Hospital with gingival swelling around the left maxillary molars. At presentation, both buccal and palatal gingivae of the left maxillary second molar were swollen and had a fistula. Removal of the full cast crown resulted in a fracture of the pulpal floor, necessitating tooth extraction. The patient opted for autogenous transplantation of the right maxillary third molar (donor tooth) into the socket of the left maxillary second molar. We chose to proceed with the transplantation even though cone-beam computed tomography (CBCT) revealed that the donor tooth had hypertrophic curved roots. Following extraction of both teeth, endodontic treatment was performed extraorally on the donor tooth by using Ni-Ti rotary file systems. The resin-wire splint used for fixation was removed 1 month postoperatively, the tooth was built up with core materials, and a temporary crown was placed. Successful periodontal reattachment of the donor tooth was seen and prosthetic treatment was performed 6 months postoperatively.<br> Discussion: Hypercementosis and dilaceration of the roots make extraction of teeth difficult and increase the risk of periodontal ligament injury and rejection of the transplant by the recipient site, contributing to the low success rate of tooth transplantation. The shape of dilacerated teeth especially complicates root canal treatment. In general, the exposure time of the donor tooth to the extra-oral environment is correlated with the success rate; the prognosis is usually better when the exposure time is short. However, we opted to perform extraoral treatment taking into consideration the difficulty of root canal treatment in this case.<br> Conclusion: A careful examination of the recipient site with CBCT is recommended and the operative procedure should be chosen depending on the case, even if the donor teeth are curved and hypertrophied, so as to increase the success rate of autotransplantation.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 57(6), 589-596, 2014

    The Japanese Society of Conservative Dentistry

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