대한소아치과학회지 (Journal of the korean academy of Pediatric Dentistry)

  • 제45권1호
  • /
  • Pages.123-130
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  • 2018
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  • 1226-8496(pISSN)
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  • 2288-3819(eISSN)
대한소아치과학회 (Korean Academy of Pediatric Dentistry)
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미성숙 영구치의 치근파절시, 전체 근관치료 후 근단 파절편의 예후

Prognosis of the Apical Fragment of Root Fractures after Root Canal Treatment of Both Fragments in Immature Permanent Teeth

  • 이제식 (경북대학교 치의학대학원 소아치과학교실) ;
  • 남순현 (경북대학교 치의학대학원 소아치과학교실)
  • Lee, Jaesik (Department of Pediatric Dentistry, School of Dentistry, Kyungpook National University) ;
  • Nam, Soonhyeun (Department of Pediatric Dentistry, School of Dentistry, Kyungpook National University)
  • 투고 : 2017.11.24
  • 심사 : 2017.12.08
  • 발행 : 2018.02.28
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초록

치근 파절시, 치수괴사는 주로 치관부 파절편에서만 일어나며 근단측은 생활력을 유지한다. 치근단 파절편의 근관치료는 파절편간 사이 공간의 과잉충전의 높은 가능성 및 잔여 괴사조직 제거의 어려움으로 예후가 좋지 않다. 본 증례에서는 통상적인 치료와는 다르게 치근단 파절편의 근관치료가 이루어졌다. 하지만 재근관 치료시 치근파절 부위에서 저항성과 치근단 파절편 근관으로 접근의 어려움이 있었다. 따라서 추가적인 치료 없이, 치관부 파절편만의 수산화칼슘의 교체 및 정기적인 관찰이 시행되었으며, 최종적으로 근관 충전을 시행하였다. 정기적인 관찰결과 치근단 파절편에서 방사선학적 합병증은 관찰되지 않았으며, 일부 증례에서는 장기적으로 치근단 파절편의 수산화칼슘의 흡수 및 근관 협착 등의 양호한 치유 형태를 보였기에 보고하고자 한다.

In the root fracture, pulp necrosis tends to involve only the coronal fragment, while the pulp in the apical fragment remains vital. The prognosis of endodontic treatment of the apical fragment is poor due to the possibility of overfilling of the space between the fragments and difficulty in removing necrotic tissue. In the present cases, endodontic treatment of the apical fragment of root fracture was performed. However, in reendodontic treatment, resistance was felt at the fracture site and access to the root canal in the apical fragment was difficult. Therefore, the calcium hydroxide was periodically exchanged only in the coronal fragment without further treatment in the apical fragment and the canal of the coronal fragment was finally filled with Gutta-percha. Regular observation revealed no radiologic complications in the apical fragment. In some cases, we can observe good healing pattern such as absorption of calcium hydroxide and pulp canal obliteration of apical fragment in the long term.

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참고문헌

  1. Andreasen JO, Andreasen FM, Andersson L : Textbook and Color Atlas of Traumatic Injuries to the Teeth, 4th ed. Blackwell Munksgaard, Copenhagen, 337-367, 2007.
  2. Andreasen JO, Ravn JJ : Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg , 1:235-239, 1972. https://doi.org/10.1016/S0300-9785(72)80042-5
  3. Cvek M, Nord C, Hollender L : Antimicrobial effect of root canal debridement in teeth with immature root. A clinical and microbiologic study. Odontol Revy , 27:1-10, 1976.
  4. Andreasen JO, Andreasen FM, Mejare I, Cvek M : Healing of 400 intra-alveolar root fractures. 2, Effect of treatment factors such as treatment delay, repositioning, splinting type and period and antibiotics. Dent Traumatol , 20:203-211, 2004. https://doi.org/10.1111/j.1600-9657.2004.00278.x
  5. Andreasen FM : Pulpal healing after luxation injuries and root fracture in the permanent dentition. Endod Dent Traumatol , 5:111-131, 1989. https://doi.org/10.1111/j.1600-9657.1989.tb00348.x
  6. Andreasen FM, Andreasen JO : Resorption and mineralization processes following root fracture of permanent incisors. Dent Traumatol , 4: 202-214, 1998.
  7. Cvek M, Mejare I, Andreasen JO : Conservative endodontic treatment of teeth fractured in the middle or apical part of the root. Dent Traumatol , 20:261-269, 2004. https://doi.org/10.1111/j.1600-9657.2004.00272.x
  8. Cvek M, Andreasen JO, Borum MK : Healing and prognosis of teeth with intra-alveolar fractures involving the cervical part of the root. Dent Traumatol, 17:53-62, 2002.
  9. Mitchell DF, Shankwalker GB : Osteogenetic potential of calcium hydroxide and other materials in soft tissue and bone wounds. J Dent Res , 37:1157-1163, 1958. https://doi.org/10.1177/00220345580370061501
  10. Haapasalo M, Orstavik D : In vitro infection and disinfection of dentinal tubules. J Dent Res, 16:207-210, 1990.
  11. Hasselgren G, Olsson B, Cvek M : Effect of calcium hydroxide and sodium hypochlorite on the dissolution of necrotic porcine muscle tissue. J Endod , 14:125-127, 1988. https://doi.org/10.1016/S0099-2399(88)80212-7
  12. Orstavik D, Kerekes K, Molven O : Effects of extensive apical reaming and calcium hydroxide as a short-term intracanal dressing. Int Endod J, 24:1190125, 1991.
  13. Turkun M, Gengiz T : The effects of sodium hypochlorite and calcium hydroxide on tissue dissolution and root canal cleanliness. Int Endod J , 30:135-142, 1997.
  14. Goldberg F, Massone EJ, Spielberg C : Evaluation of the dentinal bridge after pulpotomy and calcium hydroxide dressing. J Endo , 10:318-320, 1984. https://doi.org/10.1016/S0099-2399(84)80186-7
  15. Cox CF, Bergenholtz G, Heys DR, et al . : Pulp capping of dental pulp mechanically exposed to oral microflora: A 1-2 year observation of wound healing in the monkey. J Oral Pathol , 14:165-168, 1985.
  16. Cox CF, Subay RK, Ostro E, Suzuki S, Suzuki SH : Tunnel defects in dentin bridges: their formation following direct pulp capping. Oper Dent , 21:4-11, 1996.