Treatment of External Root Resorption and Radicular Cyst by Apical Surgery: A Case Report

根尖手術處理牙根外吸收與根尖囊腫：病例報告

廖婉萱(Wan-Chuen Liao)

《中華民國家庭牙醫學雜誌》 12卷4期 (2018/03) Pp. 16-24

https://doi.org/10.6566/JFD.201803_12(4).0002

摘要

This case report presented a case of a previously treated upper right first premolar with swelling abscess at buccal gingiva. Nonsurgical root canal retreatment was suggested at first. However, 1 month after the retreatment, the swelling abscess recurred. Apical surgery of upper right first premolar was further arranged. During the surgery, periradicular lesion was enucleated and the external root resorption area was removed. Retrograde preparation and retrograde filling with Mineral Trioxide Aggregate were performed. The bone cavity was then filled with Allomatrix bone graft for guided tissue regeneration. At the 18 months follow-up appointment, the upper right first premolar was without any symptom. The radiographic image indicated that the bone density had increased with healing tendency in the previous periradicular radiolucent area. The tooth presented normal function and the patient was satisfied with the treatment outcome.

關鍵字

Nonsurgical root canal treatment failure ； external apical inflammatory root resorption ； guided tissue regeneration (GTR)

並列摘要

本篇報告一個右上第一小臼齒，患者數年前於牙科診所進行根管治療與假牙製作，但近日發現右上第一小臼齒頰側牙齦出現膿腫，因此由牙科診所醫師將病患轉診至本院接受進一步的檢查與治療。評估患齒雖然有牙冠與釘柱，但因為過去根管治療充填材料的長度與緻密度應可以再改善，且釘柱位於牙根的冠部三分之一，釘柱應為可移除的狀況，因此建議右上第一小臼齒先試行非手術性根管再治療。患者後續於專科診所進行右上第一小臼齒的牙冠與釘柱拆除，以及非手術性根管再治療，期間症狀有改善，因此專科診所醫師即進行根管充填，但在術後一個月與兩個月的追蹤發現右上第一小臼齒頰側牙齦膿腫又再出現，且伴隨有膿瘍從牙齦溝流出，因此再度將患者轉回本院進行後續治療。在非手術性根管再治療無法改善右上第一小臼齒的症狀後，安排右上第一小臼齒接受根尖手術，手術過程中進行根尖囊腫剜除、牙根外吸收區域的處理、根尖逆充填的製備與封填，最後於骨窩洞內放置骨粉以引導組織再生。術後18個月的追蹤可見到右上第一小臼齒周圍牙周韌帶與齒槽骨板漸趨完整，患齒功能正常且預後良好。

並列關鍵字

非手術性根管治療失敗 ； 牙根尖發炎性外吸收 ； 引導組織再生