再生根管治療：未成熟小臼齒因中央牙阜斷裂致牙髓壞死之處置－病例報告

Regenerative Endodontic Treatment: Management of Pulp Necrosis in an Immature Premolar with Fractured Central Cusp - A Case Report

田世瑜(Shih-Yu Tien) ； 趙子婷(Tzu-Ting Chao)

《臺灣兒童牙醫學雜誌》 21卷2期 (2021/06) Pp. 74-82

https://doi.org/10.6319/TJPD.202106_21(2).0005

摘要

近年來，已有許多研究顯示再生根管治療（Regenerative endodontic treatment）用於牙根未成熟的恆牙治療上，與根尖誘導成形術（apexification）比較起來，再生根管治療成功率高且可以提供牙根持續成熟的能力並提升牙齒的抗斷裂能力。是近年來牙髓病學及兒童牙科領域中盛行的研究主題。本案例是一位11歲的男生，其右下第二小臼齒中央牙阜斷裂，引起右下齒列疼痛、牙齦腫脹且伴有口內廔管發生。經過詳細的臨床及放射線檢查後，診斷為牙髓壞死及慢性根尖膿瘍，而該牙之牙根生長發育程度為Cvek第三級。考量到病患牙根發育狀況及預後，擬定的治療計畫為「再生根管治療」。案例在經過11個月觀察後，該牙症狀消除且不曾復發、根尖病灶有明顯的癒合、根管內有硬組織的形成、牙根厚度及長度皆有提升及牙周膜骨板（lamina dura）復原。同時，了解到小臼齒中央牙阜在統計上經常雙側發生，因此本案例除了對右下第二小臼齒進行治療外，對左下第二小臼齒可能發生的中央牙阜，必要時及早發現並介入進行跟保護性填補。有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 ； 慢性根尖膿瘍 ； Biodentine

並列摘要

There are abundant of previous reports of regenerative endodontic treatment (RET) in recent years. RET is a prevailing research issue in the field of endodontics treatment for immature permanent tooth. Many studies have demonstrated that immature tooth treated with RET shows more root maturation, enhanced root fracture resistance and btter prognosis in comparison with apexification. In this article, we presented a 11-year-old boy with toothache, a sinus tract and swelling at right mandibular gingival mucosa, which caused by a fractured central cusp on right mandibular second premolar diagnosed as pulpal necrosis and chronic apical abscess after oral examination. With radiographic evidence, infection resource was confirmed and the condition of the root development was Cvek stage III. Taking the root development and prognosis into account, we decided to treat the tooth with RET. Throughout the observation period of 11 months, the tooth had showed no symptom, no recurrence, healing apical lesion, hard tissue formation, continuing root formation and lamina dura recovery as well. Meanwhile, as the previous researches reported, central cusps on premolars often occur statistically on both sides. When we treated the second premolar on the right side of mandible, we closely focus on the opposite side of premolar, and preventive intervention should be done as early as possible. We pediatric dentists often encounters this kind of case, that is, pulpal necrosis of immature permanent teeth, and RET could be a better alternative plan in dealing with the conditions.

並列關鍵字

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