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재생근관치료 결과에 영향을 미치는 인자의 분석

Clinical Factors Affecting the Results of Regenerative Endodontic Procedure

  • 김인기 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김현태 (서울대학교 치의학대학원 소아치과학교실) ;
  • 송지수 (서울대학교 치의학대학원 소아치과학교실) ;
  • 신터전 (서울대학교 치의학대학원 소아치과학교실) ;
  • 현홍근 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김영재 (서울대학교 치의학대학원 소아치과학교실) ;
  • 김정욱 (서울대학교 치의학대학원 소아치과학교실) ;
  • 장기택 (서울대학교 치의학대학원 소아치과학교실)
  • Kim, In-Ki (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Hyuntae (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Song, Ji-Soo (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Shin, Teo Jeon (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Hyun, Hong-Keun (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Young-Jae (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Kim, Jung-Wook (Department of Pediatric Dentistry, School of Dentistry, Seoul National University) ;
  • Jang, Ki-Taeg (Department of Pediatric Dentistry, School of Dentistry, Seoul National University)
  • 투고 : 2021.06.29
  • 심사 : 2021.08.12
  • 발행 : 2021.11.30

초록

이 연구는 재생근관치료 결과에 영향을 줄 것으로 예상되는 인자를 후향적으로 분석하였다. 2011년 2월부터 2020년 1월까지 외상과 치외치 파절로 항생제 복합제제를 사용하여 재생근관치료를 시행한 54명의 환자와 57개의 치아를 대상으로 하였다. 의도적 출혈 여부, 치료원인, 치근발육단계에 따른 재생근관치료 결과를 분석하였다. 치료 결과는 증상의 개선, 치근단병소의 변화, 치근성장량을 토대로 판단하였다. 영상 촬영각도 및 위치에 의한 왜곡을 보정하기 위해 Turboreg plugin을 사용하였고, ImageJ softeware상에서 치근단공 크기, 치근면적, 치근길이의 변화를 측정하였다. 의도적 출혈 유무는 치료 결과에 유의한 영향이 없었다. 외상으로 인한 경우 치외치 파절로 인한 경우보다 치근면적과 치근길이의 증가가 적었다. 치근발육이 덜 진행된 치아일수록 치근면적의 성장이 크게 나타났다.

This study retrospectively analyzed the effect of clinical factors on the outcomes of REP(regenerative endodontic procedure). Patients who received the REP using triple antibiotic paste due to trauma or fracture of dens evaginatus from February, 2011 to January, 2020 were included in the study. Finally, 57 teeth in 54 patients were selected. Investigated clinical factors were as follows: intentional bleeding, etiology, and root development stage. Treatment outcomes evaluated were as follows: improvement of subjective symptoms, changes in the periapical lesion, and the amounts of root development after REP. To compensate for differences in angulation and position between repeated radiographic examinations, images were aligned by Turboreg plugin. To evaluate the amounts of root development, apical diameter, root area, and root length were measured by ImageJ software. Among the aforementioned factors, intentional bleeding had no significant effect on treatment results. Regarding the etiology, the increase in the root area and the root length was significantly less in trauma cases than in dens evaginatus fracture cases. Considering root development stage, more immature teeth presented more increase in the root area.

키워드

참고문헌

  1. Andreasen JO, Farik B, Munksgaard EC : Long-term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol, 18:134-137, 2002. https://doi.org/10.1034/j.1600-9657.2002.00097.x
  2. Kim SG, Malek M, Kahler B, et al. : Regenerative endodontics: a comprehensive review. Int Endod J, 51:1367-1388, 2018. https://doi.org/10.1111/iej.12954
  3. Hoshino E, Kurihara-Ando N, Iwaku M, et al. : In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline. Int Endod J, 29:125-130, 1996. https://doi.org/10.1111/j.1365-2591.1996.tb01173.x
  4. Iwaya S, Ikawa M, Kubota M : Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol, 17:185-187, 2001. https://doi.org/10.1034/j.1600-9657.2001.017004185.x
  5. Banchs F, Trope M : Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod, 30:196-200, 2004. https://doi.org/10.1097/00004770-200404000-00003
  6. Alobaid AS, Cortes LM, Gibbs JL, et al. : Radiographic and clinical outcomes of the treatment of immature permanent teeth by revascularization or apexification: a pilot retrospective cohort study. J Endod, 40:1063-1070, 2014. https://doi.org/10.1016/j.joen.2014.02.016
  7. Jeeruphan T, Jantarat J, Hargreaves KM, et al. : Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod, 38:1330-1336, 2012. https://doi.org/10.1016/j.joen.2012.06.028
  8. Lin J, Zeng Q, Ling J, et al. : Regenerative endodontics versus apexification in immature permanent teeth with apical periodontitis: a prospective randomized controlled study. J Endod, 43:1821-1827, 2017. https://doi.org/10.1016/j.joen.2017.06.023
  9. Torabinejad M, Nosrat A, Verma P, Udochukwu O : Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod, 43:1806-1820, 2017. https://doi.org/10.1016/j.joen.2017.06.029
  10. American Association of Endodontists : AAE Clinical Considerations for a Regenerative Procedure. Available from URL: https://www.aae.org/specialty/clinical-resources/regenerative-endodontics/ (Accessed on June 26, 2021).
  11. Ong TK, Lim GS, Singh M, Fial AV : Quantitative assessment of root development following regenerative endodontic therapy: a systematic review and meta-analysis. J Endod, 46:1856-1866, 2020. https://doi.org/10.1016/j.joen.2020.08.016
  12. Saoud TMA, Zaazou A, Gibbs JL, et al. : Clinical and radiographic outcomes of traumatized immature permanent necrotic teeth after revascularization/revitalization therapy. J Endod, 40:1946-1952, 2014. https://doi.org/10.1016/j.joen.2014.08.023
  13. Nazzal H, Duggal M : Regenerative endodontics: a true paradigm shift or a bandwagon about to be derailed? Eur Arch Paediatr Dent, 18:3-15, 2017. https://doi.org/10.1007/s40368-016-0265-5
  14. Chrepa V, Joon R, Ruparel NB, et al. : Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures-A San Antonio Study. J Endod, 46:1074-1084, 2020. https://doi.org/10.1016/j.joen.2020.04.008
  15. Chan EKM, Desmeules M, Dos Santos BF, et al. : Longitudinal cohort study of regenerative endodontic treatment for immature necrotic permanent teeth. J Endod, 43:395-400, 2017. https://doi.org/10.1016/j.joen.2016.10.035
  16. Estefan BS, El Batouty KM, Nagy MM, Diogenes A : Influence of age and apical diameter on the success of endodontic regeneration procedures. J Endod, 42:1620-1625, 2016. https://doi.org/10.1016/j.joen.2016.06.020
  17. Jeong HK, Lee NY, Lee SH : A Retrospective Study of Critical Success Factors in Regenerative Endodontic Treatment. J Korean Acad Pediatr Dent, 44:47-55, 2017. https://doi.org/10.5933/JKAPD.2017.44.1.47
  18. Thibodeau B, Trope M : Pulp revascularization of a necrotic infected immature permanent tooth: case report and review of the literature. Pediatr Dent, 29:47-50, 2007.
  19. Cvek M : Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with guttapercha. A retrospective clinical study. Dent Traumatol, 8:45-55, 1992. https://doi.org/10.1111/j.1600-9657.1992.tb00228.x
  20. Orstavik D, Kerekes K, Eriksen HM : The periapical index: a scoring system for radiographic assessment of apical periodontitis. Dent Traumatol, 2:20-34, 1986. https://doi.org/10.1111/j.1600-9657.1986.tb00119.x
  21. Flake NM, Gibbs JL, Khan AA, et al. : A standardized novel method to measure radiographic root changes after endodontic therapy in immature teeth. J Endod, 40:46-50, 2014. https://doi.org/10.1016/j.joen.2013.09.025
  22. Sang EJ, Song JS, Hyun HK, et al. : Ratio and Rate of Induced Root Growth in Necrotic Immature Teeth. J Korean Acad Pediatr Dent, 45:225-234, 2018. https://doi.org/10.5933/JKAPD.2018.45.2.225
  23. Chueh LH, Ho YC, Chiang CP, et al. : Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod, 35:160-164, 2009. https://doi.org/10.1016/j.joen.2008.10.019
  24. Kontakiotis EG, Filippatos CG, Tzanetakis GN, Agrafioti A : Regenerative endodontic therapy: a data analysis of clinical protocols. J Endod, 41:146-154, 2015. https://doi.org/10.1016/j.joen.2014.08.003
  25. Thibodeau B, Teixeira F, Trope M, et al. : Pulp revascularization of immature dog teeth with apical periodontitis. J Endod, 33:680-689, 2007. https://doi.org/10.1016/j.joen.2007.03.001
  26. Lovelace TW, Henry MA, Hargreaves KM, Diogenes A : Evaluation of the delivery of mesenchymal stem cells into the root canal space of necrotic immature teeth after clinical regenerative endodontic procedure. J Endod, 37:133-138, 2011. https://doi.org/10.1016/j.joen.2010.10.009
  27. Zhou R, Wang Y, Huang X, et al. : Radiographic, histologic, and biomechanical evaluation of combined application of platelet-rich fibrin with blood clot in regenerative endodontics. J Endod, 43:2034-2040, 2017. https://doi.org/10.1016/j.joen.2017.07.021
  28. Tong HJ, Rajan S, Nazzal H, et al. : Regenerative endodontic therapy in the management of nonvital immature permanent teeth: a systematic review-outcome evaluation and meta-analysis. J Endod, 43:1453-1464, 2017. https://doi.org/10.1016/j.joen.2017.04.018
  29. Nosrat A, Li KL, Fouad AF, et al. : Is pulp regeneration necessary for root maturation? J Endod, 39:1291-1295, 2013. https://doi.org/10.1016/j.joen.2013.06.019
  30. Lin LM, Kim SG, Martin G, Kahler B : Continued root maturation despite persistent apical periodontitis of immature permanent teeth after failed regenerative endodontic therapy. Aust Endod J, 44:292-299, 2018. https://doi.org/10.1111/aej.12252
  31. Wang X, Thibodeau B, Huang GTJ, et al. : Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod, 36:56-63, 2010. https://doi.org/10.1016/j.joen.2009.09.039
  32. Shimizu E, Ricucci D, Lin LM, et al. : Clinical, radiographic, and histological observation of a human immature permanent tooth with chronic apical abscess after revitalization treatment. J Endod, 39:1078-1083, 2013. https://doi.org/10.1016/j.joen.2013.04.032
  33. Meschi N, Hilkens P, Lambrechts P, et al. : Regenerative endodontic procedures posttrauma: immunohistologic analysis of a retrospective series of failed cases. J Endod, 45:427-434, 2019. https://doi.org/10.1016/j.joen.2019.01.007
  34. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM : An update on clinical regenerative endodontics. Endod Topics, 28:2-23, 2013. https://doi.org/10.1111/etp.12040
  35. Akcay M, Arslan H, Yasa E, et al. : Spectrophotometric analysis of crown discoloration induced by various antibiotic pastes used in revascularization. J Endod, 40:845-848, 2014. https://doi.org/10.1016/j.joen.2013.09.019
  36. Vishwanat L, Duong R, Ruparel NB, et al. : Effect of bacterial biofilm on the osteogenic differentiation of stem cells of apical papilla. J Endod, 43:916-922, 2017. https://doi.org/10.1016/j.joen.2017.01.023
  37. Kim JH, Kim YR, Jung IY, et al. : Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod, 36:1086-1091, 2010. https://doi.org/10.1016/j.joen.2010.03.031
  38. Fuss Z, Tsesis I, Lin S : Root resorption-diagnosis, classification and treatment choices based on stimulation factors. Dent Traumatol, 19:175-182, 2003. https://doi.org/10.1034/j.1600-9657.2003.00192.x
  39. Trope M : Root resorption due to dental trauma. Endod Topics, 1:79-100, 2002. https://doi.org/10.1034/j.1601-1546.2002.10106.x
  40. Santiago CN, Pinto SS, Fidel SR, et al. : Revascularization technique for the treatment of external inflammatory root resorption: a report of 3 cases. J Endod, 41:1560-1564, 2015. https://doi.org/10.1016/j.joen.2015.03.019
  41. Saoud TMA, Mistry S, Lin LM, et al. : Regenerative endodontic procedures for traumatized teeth after horizontal root fracture, avulsion, and perforating root resorption. J Endod, 42:1476-1482, 2016. https://doi.org/10.1016/j.joen.2016.04.028
  42. Tzanetakis GN : Management of intruded immature maxillary central incisor with pulp necrosis and severe external resorption by regenerative approach. J Endod, 44:245-249, 2018. https://doi.org/10.1016/j.joen.2017.11.006