Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
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RECONSIDERATION OF TREATMENT PROTOCOL ON THE REDUCTION OF ENTEROCOCCUS FAECALIS ASSOCIATED WITH FAILED ROOT CANAL TREATMENT

근관치료 실패와 관련된 Enterococcus faecalis 제거를 위한 치료 protocol의 재고찰

  • Lee, Woo-Cheol (Department of Conservative Dentistry, School of Dentistry, Seoul National University) ;
  • Hong, Seong-Tae (Department of Conservative Dentistry, School of Dentistry, Seoul National University) ;
  • Shon, Won-Jun (Department of Conservative Dentistry, School of Dentistry, Seoul National University)
  • 이우철 (서울대학교 치의학전문대학원 치과보존학교실) ;
  • 홍성태 (서울대학교 치의학전문대학원 치과보존학교실) ;
  • 손원준 (서울대학교 치의학전문대학원 치과보존학교실)
  • Published : 2008.11.30
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Abstract

Microorganism survived in the root canal after root canal cleaning and shaping procedure is a main cause of root canal treatment failure. There are several mechanisms for the bacteria to survive in the root canal after chemomechanical preparation and root canal irrigation. Bacteria organized as biofilm has been suggested as an etiology of persistent periapical lesion. Recent studies were focus on removal of Enterococcus faecalis biofilm due to the report that the persistence of this bacteria after root canal treatment may be associated with its ability to form biofilm. Several investigations demonstrated that current root canal treatment protocol including use of NaOCl, EDTA and Chlorhexidine as irrigants is quite effective in eliminating E. faecalis biofilm. However, this microorganism still can survive in inaccessible areas of root canal system and evade host immune response, suppress immune activity and produce biofilm. Up to date, there is no possible clinical method to completely get rid of bacteria from the root canal. Once the root canal treatment failure occurred, and conventional treatment incorporating current therapeutic protocol has failed, periapical surgery or extraction should be considered rather than prolong the in effected retreatment procedure.

본 review 논문의 목적은 통상의 근관치료로 해결되지 않는 persistent periapical lesion의 원인이 되는 주요 세균을 제거하고자 시행한 여러가지 실험을 비교분석하여 과연 (1) Enterococcus faecalis가 근관치료 실패의 주요 원인균인지 (2) 그리고 과연 그렇다면 근관치료에 실패한 증례에서 E. faecalis와 biofilm을 제거할 수 있는 치료 protocol이 있는 것인지를 확인하여 보다 나은 근관치료 성공을 위한 치료 protocol의 확립과 앞으로의 연구방향을 재조명하는 것이다. 지금까지 진행되어온 연구 결과에 대한 객관적인 분석이나 적절한 평가가 이루어지지 않은 가운데 어떤 특정한 연구를 통해 E. faecalis를 제거하는데 유의성있는 효과를 보인다고 알려진 세척액이나 약제를 막연한 기대감을 가지고 실제 임상에 사용하고 있는 실정에서 현재 진료실에서 사용하고 있는 치료 protocol에 대한 검증이 절실한 시점에서 review해 본 결과 현재까지 진행되어 왔던 여러 연구 결과를 통해 확신할 수 있는 것은 치료 protocol에 따라 현재 사용하고 있는 근관세척액이나 근관내 약제만으로도 E. faecalis나 그 biofilm을 대부분 제거할 수 있다는 사실이다. 하지만 이 그 protocol에 따라 근관치료 술식을 충실하게 이행한다 해도 근관치료가 100% 성공한다고 보장할 수는 없다. 물론 세균이 아닌 다른 요소에 의해 근관치료의 실패가 일어난다고도 할 수 있지만 그보다는 결국 체내의 면역반응에 저항하는 세균의 능력에 기인하는 것으로 보인다. 따라서 높은 수준의 치료 성공률을 지속적으로 유지하기 위해서는 위에서 언급된 바와 같은 제대로 된 치료 protocol을 따라 근관치료를 진행하면서 좀더 나은 결과를 얻기 위해 새로운 protocol을 개발하고 정립하는 과정이 계속되어야 한다.

Keywords

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