齒頸部牙根穿孔合併牙周病變之再生治療

牙根穿孔是牙髓之根管系統與牙根表面相連通，根管系統中的細菌可藉由牙根穿孔感染牙周組織而引起牙周組織的發炎與齒槽骨破壞，穿孔位置倘若處在齒槽嵴附近，造成上皮附連往根向移動而形成牙周囊袋，治療此類型之牙髓牙周合併病變預後較難預測，需藉助牙髓病科醫師與牙周病科醫師協同治療，方可達到較佳預後。本文提出一病例為左上第二小臼齒之齒頸部牙根穿孔合併牙周破壞，給予牙髓牙周合併手術治療，以三氧礦化物修補牙根穿孔，於骨缺損處採取放置自體移植骨及可吸收阻隔膜之引導組織再生手術，術後一年的追蹤顯示穿孔處牙周探測深度減少3毫米，無探測出血現象，附連增加1~2毫米，無探測出血的現象，放射線檢查發現骨內缺損有骨填充。近齒頸部之牙根穿孔合併牙周組織破壞，經過牙周再生治療，可以在三氧礦化物封填穿孔的牙根表面重建喪失的牙周組織。

關鍵字

牙根穿孔；三氧礦化物；牙周治療；引導組織再生手術

並列摘要

Root perforation is a communication between the root canal system and the root surface. Bacteria in root canal system will then be able to infect the periodontium and this can induce the breakdown of alveolar bone via root perforations. If the perforation is located near the alveolar marginal ridge, the epithelial attachment is likely to migrate apically and form periodontal pockets. This type of endodontic-periodontal combined lesion is complicated and difficult to manage. To ensure a better prognosis, a combination of endodontic and periodontal therapy is necessary. This article presents a case with a root perforation in the cervical area of the maxillary left second premolar and a persistent periodal defect affecting the distal surface of the tooth. After phase I periodontal treatment, we performed open flap debridement, repair of the perforation with mineral trioxide aggregate (MTA) and guided tissue regeneration using an autogenous bone graft and a resorbable membrane. A 1-year postoperative follow-up revealed a 3 mm reduction in probing depth and a 1 ~ 2 mm gain in clinical attachment level. Furthermore, radiographic bone fill at the intrabony defect nearby the root perforation area was noted. This case report demonstrated that it is possible to re-establish the attachment apparatus over the perforated root surface after carrying out periodontal regenerative procedures when aided by perforation repair with MTA.

並列關鍵字

root perforations ； mineral trioxide aggregate ； periodontal therapy ； guided tissue regeneration

國際替代計量

齒頸部牙根穿孔合併牙周病變之再生治療

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