植込み型電子機器装着者に電気的根管長測定と超音波洗浄を行った2例  [in Japanese] Use of an Apex Locator and Ultrasonic Irrigation for Patients with Implanted Cardiac Pacemaker or Cardioverter Defibrillator: Two Case Reports  [in Japanese]

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Author(s)

    • 工藤 義之 Yoshiyuki KUDO
    • 岩手医科大学歯学部歯科保存学講座う蝕治療学分野 Division of Operative Dentistry and Endodontics, Department of Conservative Dentistry, School of Dentistry, Iwate Medical University
    • 櫻井 秀人 Hideto SAKURAI
    • 岩手医科大学歯学部歯科保存学講座う蝕治療学分野 Division of Operative Dentistry and Endodontics, Department of Conservative Dentistry, School of Dentistry, Iwate Medical University
    • 岡田 伸男 Nobuo OKADA
    • 岩手医科大学歯学部歯科保存学講座う蝕治療学分野 Division of Operative Dentistry and Endodontics, Department of Conservative Dentistry, School of Dentistry, Iwate Medical University
    • 野田 守 Mamoru NODA
    • 岩手医科大学歯学部歯科保存学講座う蝕治療学分野 Division of Operative Dentistry and Endodontics, Department of Conservative Dentistry, School of Dentistry, Iwate Medical University

Abstract

 目的 : 植込み型電子機器装着患者の電気的根管長測定と根管内超音波洗浄時の不整脈惹起作用について, 多チャンネル高分解能心電計 (ドリームECG) を用いて検討することを目的とした. <br> 方法 : 根管治療のために超音波洗浄器ならびに電気的根管長測定器の使用が必要であったペースメーカー (PM) 装着者1名, 植込み型除細動器 (ICD) 装着者1名を対象とした. 治療前に循環器内科専門医と歯科麻酔専門医による十分な問診を行い, 4週間以内にICD作動, 致死的不整脈, 心筋虚血, 心不全 (NYHA Ⅲ以上) がないことを確認した. その後, ドリームECGを装着して治療中の循環器動態を測定した. 治療には循環器内科専門医と歯科麻酔専門医が立ち会い, 不測事項発生時への十分な対応のためにAEDや救急薬品をチェアーサイドに配置した. <br> 症例1 : 54歳男性, ICD装着例. 歯科診断 : 下顎左側第一大臼歯慢性化膿性根尖性歯周炎. <br> 症例2 : 80歳女性, PM装着例. 歯科診断 : 上顎左側第一大臼歯慢性化膿性根尖性歯周炎. <br> 根管治療中に電気的根管長測定 (RootZX, Morita) ならびに歯科用多目的超音波治療器 (OSADA Enac 10W, Osada) での根管洗浄を行った. <br> 成績 : いずれの症例でも, ドリームECGで若干のノイズ増加を認めたが, 致死的不整脈, 脱分極指標および再分極指標で異常を認めなかった. <br> 結論 : PMあるいはICD装着患者において, 十分な問診, 歯科治療時の適切な循環動態の把握により, 超音波治療器・電気的根管長測定器を用いた場合でも安全な歯科治療遂行の可能性が示唆された. また, 歯科治療中の循環動態の把握にドリームECGが有効であると思われた.

 Purpose: The aim of this study was to evaluate by multi-channel electrocardiograph (Dream ECG) the occurrence of fatal arrhythmia in patients with an implanted cardiac heart device during root canal treatment using an electronic apex locator and/or ultrasonic irrigation.<br> Materials and Methods: In this study, we observed two patients, one with an implanted cardiac pacemaker (PM) and the other with a cardioverter defibrillator (ICD), who underwent root canal treatment using an apex locator and/or ultrasonic irrigation. Before dental treatment, a cardiologist and dental anesthesiologist asked the patients detailed questions and confirmed the absence of the following within the last four weeks: inappropriate ICD shock: fatal arrhythmia; myocardial ischemia; and congestive heart failure (NYHA Ⅲ or above). In the case of complications, a cardiologist and dental anesthesiologist observed the patients during dental treatment, and prepared emergency medicine and an AED at the chairside. In Case 1, a 54-year-old male patient had a prior myocardial infarction, ventricular fibrillation, and an implanted ICD. His dental diagnosis was chronic apical periodontitis of the lower left first molar. In Case 2, an 80-year-old female patient had severe aortic stenosis, sick sinus syndrome, and an implanted pacemaker. Her dental diagnosis was chronic apical periodontitis of the upper left first molar. In these cases, an apex locator (RootZX; Morita) and/or ultrasonic irrigation device (OSADA Enac 10W; Osada) were used during the root canal treatment.<br> Results: In these cases, slight noise was observed by Dream ECG. However, no significant lethal arrhythmia was observed during dental treatment of the patients by Dream ECG.<br> Conclusion: The results suggest the possibility of providing safe dental treatment to patients with an implanted PM or ICD by carefully asking detailed questions and confirming stable heart condition in the past four weeks, as well as by monitoring by Dream ECG.

Journal

  • The Japanese Journal of Conservative Dentistry

    The Japanese Journal of Conservative Dentistry 58(4), 331-337, 2015

    The Japanese Society of Conservative Dentistry

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