- 期刊
蓄意再植術應用於治療開放型牙根尖牙齒異物反應－病例報告
Intentional Replantation in a Tooth with Open Apex due to Foreign Body Reaction-A Case Report
摘要
開放型根尖的牙齒的根管治療難度高而且複雜，牙根會因持續性感染而中止生長，根管治療的藥物和封填材料容易推出到牙根尖外面，引起異物反應。非手術性根管治療失敗時，若發生在生長完成的牙齒，為避免手術過程破壞過多齒質，會考慮採用蓄意再植術，但是開放型牙根的齒質薄，拔牙容易造成斷裂，根尖手術為常見的最終治療方法，因此只有少數開放型根尖牙齒病例，在發生治療失敗會使用蓄意再植術。本病例為十三歲男性，其右下第二小臼齒因正中牙阜斷裂，致使牙髓壞死及慢性齒根尖周圍炎，造成開放型根尖，由診所轉介至本院治療。經由重新髓腔開擴，清創沖洗後，發現根尖周圍病灶擴大，於是以蓄意再植術作診斷及治療；小心拔除後，在根尖外組織發現一團疑似棉花狀組織；牙根以三氧礦化聚合物逆充填後再植入牙齒。術後三十一個月，患者沒有臨床症狀，X光檢查已見根尖病灶癒合。本病例使用蓄意再植術的使用考量，包括牙齒為單一牙根，操作的時間短、手術方式簡單等，因此蓄意再植術是開放型根尖牙齒治療失敗的一項有效替代性療法。
並列摘要
Root canal treatment of teeth with open apex is difficult and complicated. Endodontic materials could be easily pushed out of the root apex, such as calcium hydroxide or cotton pellets, causing foreign body reaction. When the root canal treatment of mature teeth fails, intentional replantation may be considered to avoid excessive dentin damage. However, the teeth with open apex root may be too weak to be extracted because of poor root structure. Apical surgery is a common treatment option. Teeth with open apex treated by intentional replantation were only found in few case reports. This thirteen-year-old boy suffered from pulp necrosis and chronic periapical abscess because of central cusp fracture of lower right second premolar with open apex. He was referred from the local dental clinic to our hospital for further treatment. After access opening and debridement, the lesion around the root tip was enlarged. Intentional replantation was used for diagnosis and treatment. The extracted tooth was examined under a microscope, and no root fracture was found. Mineral trioxide aggregate was filled retrogradely, and the tooth was implanted. A mass of foaming cotton-like tissue was removed from periapical tissue. The pathological report indicated a foreign body containing calcification and fibrous material. After thirty-one months follow up, the patient had no clinical symptoms, and the apical lesion was healed. In this case, indications of intentional replantation include a single-root tooth, short operation time, and a simple way. Replantation is an alternative effective therapy for the failed root canal treatment with open apex.