DOI QR코드

DOI QR Code

VITAL PULP THERAPY USING PLATELET-RICH FIBRIN IN AN IMMATURE PERMANENT TOOTH : CASE REPORTS

미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고

  • Lee, Ka-Young (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Lee, Sang-Ho (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Lee, Nan-Young (Department of Pediatric Dentistry, College of Dentistry, Chosun University)
  • 이가영 (조선대학교 치의학전문대학원 소아치과학교실) ;
  • 이상호 (조선대학교 치의학전문대학원 소아치과학교실) ;
  • 이난영 (조선대학교 치의학전문대학원 소아치과학교실)
  • Received : 2013.04.10
  • Accepted : 2013.05.08
  • Published : 2013.05.31

Abstract

Preserving the pulp is important in the treatment of carious pulp exposure in young permanent teeth. Pulpotomy is a vital pulp therapy in which a portion of the coronal pulp tissue is surgically removed, and the remaining radicular tissue is covered with suitable material that protects the pulp from further injury and permits and promotes healing. It is important to develop biocompatible treatment directed at maintaining pulp vitality and increasing tooth longevity. Platelet-rich fibrin (PRF) has been referred to as a second-generation platelet concentrate. Two clinical cases in which PRF was applied as a medicament after pulpotomy of an immature permanent tooth are presented. After isolation, caries removal and pulpotomy with PRF was performed. A layer of mineral trioxide aggregate (MTA) was placed over the PRF, and the final restoration was performed. Postoperatively, the patient had no pain or discomfort, and follow-up radiographs revealed normal periodontal ligament space and trabecular bone pattern.

심한 우식을 보이는 미성숙 영구치 치료에 있어서 치수생활력을 보존하는 것은 중요하다. 치수절단술을 시행 시 생체적합성이 있는 재료를 이용하여 치료함으로써 남아있는 생활력이 있는 치수를 보호하며 미성숙 영구치의 치근 성장을 도모할 수 있다. 혈소판 농축 섬유소는 환자의 혈액을 직접 채취하여 적용하기 때문에 생체적합성이 뛰어나며 다양한 성장인자를 함유하고 있어 치수생활력을 유지하고 미성숙 영구치의 치근 발육을 촉진시킬 수 있다. 본 증례에서는 심한 치아 우식증을 보이는 미성숙 영구치에서 치수절단술 시행 후 남아 있는 치수 상부에 혈소판 농축 섬유소를 적용하였다. 정기적인 검진 결과 미성숙 영구치의 치근 성장 및 정상적인 치아 주위 조직들이 관찰되었다. 향후 장기간의 임상적 관찰이 필요할 것이며 더 많은 임상 증례를 바탕으로 한 연구가 필요할 것이다.

Keywords

References

  1. Witherspoon DE, Small JC, Harris GZ : Mineral trioxide aggregate pulpotomies: a case series outcomes assessment. J Am Dent Assoc, 137: 610-618, 2006. https://doi.org/10.14219/jada.archive.2006.0256
  2. Holland G, Trowbridge H, Rafter M : Endodontics: principles and practice, 4th ed. Saunders Elsevier, ST Louis, 21-38, 2008.
  3. Bakland LK : Endodontics, BC Decker Inc, Toronto, 795-844, 2002.
  4. Stanley H : Criteria for standardizing and increasing credibility of pulp capping studies. Am J Dent, 11:17-34, 1998.
  5. Holland R, de Souza V, de Otoboni Filho J, et al. : Permeability of the hard tissue bridge formed after pulpotomy with calcium hydroxide: a histologic study. J Am Dent Assoc, 99:472-475, 1979. https://doi.org/10.14219/jada.archive.1979.0317
  6. Torabinejad M, Parirokh M : Mineral trioxide aggregate: a comprehensive literature review-Part II: leakage and biocompatibility investigations. J Endod, 36:190-202, 2010. https://doi.org/10.1016/j.joen.2009.09.010
  7. Haglund R, He J, Jarvis J, Zhu Q, et al. : Effects of root-end filling materials on fibroblasts and macrophages in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 95:739-745, 2003. https://doi.org/10.1067/moe.2003.231
  8. Balto HA : Attachment and morphological behavior of human periodontal ligament fibroblasts to mineral trioxide aggregate: a scanning electron microscope study. J Endod, 30:25-29, 2004. https://doi.org/10.1097/00004770-200401000-00005
  9. Camilleri J : Characterization of hydration of mineral trioxide aggregate. Int Endod J, 41:408-417, 2008. https://doi.org/10.1111/j.1365-2591.2007.01370.x
  10. Wang Z, Pan J, Preisser JS, et al. : Putative stem cells in human dental pulp with irreversible pulpitis: an exploratory study. J Endod, 36:820-825, 2010. https://doi.org/10.1016/j.joen.2010.02.003
  11. Witherspoon DE : Vital pulp therapy with new materials: new directions and treatment perspectives- permanent teet. J Endod, 34:25-28, 2008. https://doi.org/10.1111/j.1747-4477.2007.00076.x
  12. Choukroun J, Diss A, Dohan DM, et al. : Plateletrich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 101:299-303, 2006. https://doi.org/10.1016/j.tripleo.2005.07.012
  13. Massler M : Therapy conductive to healing of the human pulp. Oral Surg Oral Med Oral Pathol, 34:122-130, 1972. https://doi.org/10.1016/0030-4220(72)90281-2
  14. Eghbal M, Asgary S, Ghoddusi J, et al. : MTA pulpotomy of human permanent molars with irreversible pulpitis. Aust Endod J, 35:4-8, 2009. https://doi.org/10.1111/j.1747-4477.2009.00166.x
  15. Asgary S, Eghbal MJ, Rahimi H, et al. : A comparative study of histologic response to different pulp capping materials and a novel endodontic cement. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 106:609-614, 2008. https://doi.org/10.1016/j.tripleo.2008.06.006
  16. Sunitha Raja V, Munirathnam Naidu E : Plateletrich fibrin: evolution of a second-generation platelet concentrate. Indian J Dent Res, 19:42-46, 2008. https://doi.org/10.4103/0970-9290.38931
  17. Smith AJ : Vitality of the dentin-pulp complex in health and disease: growth factors as key mediators. J Dent Educ, 67:678-689, 2003
  18. Kim HN, Lee NY, Lee SH : Regenerative endodonctic treatment of immature permanent teeth by using platelet-rich fibrin. J Korean Acad Pediatr Dent, 39:174-180, 2012. https://doi.org/10.5933/JKAPD.2012.39.2.174
  19. Hiremath H, Saikalyan S, Hiremath V, et al. : Second-generation platelet concentrate(PRF) as a pulpotomy medicament in a permanent molar with pulpitis: a case report. Int Endod J, 45:105-112, 2012. https://doi.org/10.1111/j.1365-2591.2011.01973.x
  20. Waterhouse P, Whitworth J, Camp J, Fuks A : Pathways of the Pulp, 10th ed. Mosby, St. Louis, 808-857, 2011.
  21. Yoon YM, Lee NY, Lee HS : Conservative endodontic treatment of permanent teeth with periapical lesions: case reports. J Korean Acad Pediatr Dent, 38:276-283, 2011. https://doi.org/10.5933/JKAPD.2011.38.3.276