치근단 치주염을 가진 미성숙 제1대구치의 치수 재혈관화 : 증례 보고 = PULP REVASCULARIZATION OF IMMATURE FIRST PERMANENT MOLARS WITH APICAL PERIODONTITIS : CASE REPORT

국문 초록 (Abstract)

치수 재혈관화 술식은 항생제를 이용하여 근관 내 감염된 조직을 무균 상태로 만들면 치근단에 존재하는 자가 재생 능력과 다분화 능력을 가진 줄기 세포가 미완성 치근을 가진 미성숙 영구치의 치수 재생을 유도한다는 개념이 적용된 것이다. 이 술식은 치근의 길이와 두께가 증가하며 치근단의 폐쇄가 이루어진다. 비정상적으로 근관이 얇거나 만곡이 심해 전통적인 근관 치료시 어려움이 예상되는 경우, 전신 질환 등으로 인해 진정 요법을 시행하기 어려운 경우, 그리고 장애인와 같이 협조를 구하기 어려운 경우에서 치근단 치주염을 가진 미성숙 대구치의 치수 재혈관화 술식을 고려해 볼 수 있다. 본 증례는 우식으로 인해 감염된 미성숙 제1대구치의 근관 내에 ciprofloxacin, metronidazole, minocycline의 3종의 항생제를 적용하여 치수 재혈관화 술식을 시도하여 양호한 결과를 보였기에 이를 보고하고자 한다.

다국어 초록 (Multilingual Abstract)

Revascularization of the pulp in a necrotic, infected immature tooth with apical periodontitis was attempting several years. Revascularization of partially necrotic pulp in an immature tooth is based on the concept that vital dental stem cells can survive pulpal necrosis. Revascularization procedure obtains longer and thicker roots in teeth with necrotic pulp diagnosis. Pulp revascularization for immature permanent molars can be possibly applied on cases having difficulty to use conventional root canal treatment due to abnormally thin root canal wall or severe root curvature. Also, when an uncooperative patient does not agree with sedative treatment the revascularization can be useful. And a patient with disability who is barely cooperative can be another indication of this treatment. In this case report, pulp revascularization using triple-antibiotics, metronidazole, ciprofloxacine and minocycline, was applied on the immature first permanent molar infected by caries.

참고문헌 (Reference)

• 1 김소정, "항생제를 이용한 미성숙 영구치의 치험례" 대한소아치과학회 38 (38): 44-50, 2011
• 2 김대업, "항생제를 사용한 유치의 치수치료" 대한소아치과학회 32 (32): 126-131, 2005
• 3 대한소아치과학회, "소아∙청소년치과학" 신흥인터내셔날 123-, 1999
• 4 Trope M, "Treatment of immature teeth with nonvital pulps and apical periodontitis" 14 : 51-59, 2006
• 5 Kim J, "Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy : a case report" 36 : 1086-1091, 2010
• 6 Kwon BW, "The study of eruption pattern of the maxillary first molar using the cone beam CT" Graduates School, Chonbuk national university 2008
• 7 Huang G, "The hidden treasure in apical papilla : The potential role in pulp/dentin regeneration and bioroot engineering" 34 : 645-651, 2008
• 8 Kim S, "The effect of ledermix paste on discolouration of immature teeth" 33 : 233-237, 2000
• 9 Sato I, "Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ" 29 : 118-124, 1996
• 10 Banchs F, "Revascularization of immature permanent teeth with apical periodontitis : new treatment protocol" 30 : 196-200, 2004
• 11 Iwaya S, "Revascularization of an immature permanent tooth with periradicular abscess after luxation" 27 : 55-58, 2011
• 12 Thomson A, "Regenerative endodontics - biologically-based treatment for immature permanent teeth : a case report and review of the literature" 55 : 446-452, 2010
• 13 Nostrat A, "Regenerative endodontic treatment(Revascularization) for the necrotic immature permanent molars : A Review and Report of two cases with a new biomaterial" 37 : 562-567, 2011
• 14 King M, "Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors" 2 : 83-89, 1986
• 15 Reynold K, "Pulp revascularization of necrotic bilateral bicupids using a modified novel technique to eliminate potential coronal discoloration : a case report" 42 : 84-92, 2009
• 16 Ding R, "Pulp revascularization of immature teeth with apical periodontitis : a clinical study" 35 : 745-749, 2009
• 17 Thibodeau B, "Pulp revascularization of a necrotic infected immature permanent tooth : case report and review of the literature" 29 : 47-50, 2007
• 18 Shin S, "One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess : a case report" 42 : 1118-1126, 2009
• 19 Mohammadi Z, "On the local applications of antibiotics and antibiotic-based agents in endodontics and dental traumatology" 42 : 555-567, 2009
• 20 Schwartz RS, "Mineral trioxide aggregate : a new material for endodontics" 130 : 967-975, 1999
• 21 Hoshino E, "In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline" 29 : 125-130, 1996
• 22 Takushige T, "Endodontic treatment of primary teeth using a combination of antibiotic drugs" 37 : 132-138, 2004
• 23 Shah N, "Efficacy of revascularization to induce apexification/apexogenesis in infected, nonvital, immature teeth : a pilot clinical study" 34 : 919-925, 2008
• 24 Camp J, "Diagnosis dilemmas in vital pulp therapy : Treatment for the toothache is changing, especially in young, immature teeth" 34 : S6-S12, 2008
• 25 Friedlander L, "Dental stem cells and their potential role in apexogenesis and apexification" 42 : 955-962, 2009
• 26 Osorio RM, "Cytotoxicity of endodontic materials" 24 : 91-96, 1998
• 27 신정근, "Cone Beam CT를 이용한 하악 제 1대구치 맹출 양상에 관한 연구" 대한소아치과학회 36 (36): 325-336, 2009
• 28 Ghose LJ, "Apexification of immature apices of pulpless permanent anterior teeth with calcium hydroxide" 13 : 285-290, 1987
• 29 Rafter M, "Apexification : a review" 21 : 1-8, 2005
• 30 Huang G, "Apexification : The beginging of its end" 42 : 855-866, 2009
• 31 Huang G, "A paradigm shift in endodontic management of immature teeth : conservation of stem cells for regeneration" 36 : 379-386, 2008