以再生根管治療處理牙髓壞死之未成熟恆牙－病例報告

Management of Pulpal Necrosis of Immature Permanent Tooth with Regenerative Endodontic Treatment - A Case Report

陳冠倫(Kuan-Lun Chen) ； 趙子婷(Tzu-Ting Chao) ； 李欣育(Hsin-Yu Lee)

《臺灣兒童牙醫學雜誌》 20卷2期 (2020/06) Pp. 66-72

https://doi.org/10.6319/TJPD.202006_20(2).0003

摘要

再生根管治療，是近年來牙髓病學領域中盛行的研究主題。許多文獻顯示，跟根尖誘導成形術比較起來，再生根管治療可以提供牙根持續成熟的能力，提升牙齒的抗斷裂能力，讓牙齒擁有更好的預後。本案例是一位10歲的小妹妹，其右下第二小臼齒中央牙阜斷裂，引起右臉蜂窩性組織炎。經過詳細的臨床及放射線檢查後，診斷為牙髓壞死及急性根尖膿瘍，而該牙之牙根生長發育程度為Cvek第二級。考量到病患牙根發育狀況及預後，為該牙擬定的治療計畫為「再生根管治療」。案例在經過九個月觀察後，該牙無症狀、根尖病灶有明顯的癒合、根管內有硬組織的形成、牙根長度及厚度皆有提升、電髓活性測試有反應、根尖有閉合傾向且有牙周韌帶的形成。兒童牙醫經常會面對未成熟恆牙牙髓壞死的相關案例，而再生根管治療可以提供我們在處理這類案例時一個不一樣的選擇與思維。

關鍵字

再生根管治療 ； 未成熟恆牙 ； 牙髓壞死 ； 急性根尖膿瘍 ； Biodentine

並列摘要

Regenerative endodontic treatment (RET), is a prevailing research topic in the field of endodontics in recent years. Many studies have demonstrated that, in comparison with apexification, teeth could show more root maturation, enhanced root fracture resistance and better prognosis with RET. We presented a 10-year-old patient with right facial cellulitis due to fractured central cusp over right mandibular second premolar. The diagnosis was pulpal necrosis and acute apical abscess after prudent examination. The condition of root development was Cvek stage II. Taking the root development and prognosis into account, we decided to treat the tooth with RET. Throughout the observation period of 9 months, the tooth showed no symptom, healing apical lesion, hard tissue mass formation, continuous root formation, periodontal ligament (PDL) formation and positive response to electric pulpal test (EPT). We pediatric dentists often encountered this kind of case- pulpal necrosis of immature permanent teeth, and RET will be a comparable or even better alternative in treating these cases.

並列關鍵字

Regenerative endodontic treatment ； Immature permanent tooth ； Pulpal necrosis ； Acute apical abscess ； Biodentine