[논문]미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고

이가영; 이상호; 이난영

doi:10.5933/jkapd.2013.40.2.120

미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고
VITAL PULP THERAPY USING PLATELET-RICH FIBRIN IN AN IMMATURE PERMANENT TOOTH : CASE REPORTS 원문보기

大韓小兒齒科學會誌 = Journal of the Korean academy of pediatric dentistry, v.40 no.2, 2013년, pp.120 - 126

이가영 (조선대학교 치의학전문대학원 소아치과학교실) , 이상호 (조선대학교 치의학전문대학원 소아치과학교실) , 이난영 (조선대학교 치의학전문대학원 소아치과학교실)

초록
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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.

Abstract ▼ AI-Helper

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.

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제안 방법

They restored the tooth with a crown after pulpotomy. Clinical symptoms, such as pain, were assessed, and radiographs were analyzed during 22 months of follow-up. They concluded that pulpotomy with PRF could be an alternative treatment to MTA or other materials in mature permanent teeth with pulpitis.
The patient was followed-up after 1 month and crown was placed on left mandibular first molar. The patient had no pain or discomfort, and radiographic examination revealed normal periodontal ligament space and that the alveolar bone had normal trabecular pattern at 1 month and 3 months follow-up (Fig. 1B,C). After 7 months, lengthening and thickening of roots with normal periodontal ligament space were observed(Fig.
Pulpotomy with PRF was performed, and MTA was placed over the PRF. The patient was followed-up after 1 week for radiographic examination and postoperative pain evaluation. The patient had no pain or discomfort, and glass-ionomer cement was placed over the MTA.
The patient was informed about the treatment modality of coronal pulpotomy using PRF as an alternative treatment to root canal treatment. After obtaining consent from the patients, PRF was prepared by collecting the required amount of blood into a 10 mL tube without anticoagulant and centrifuging it immediately using a centrifuge for 10 min at 3,000 rpm.

대상 데이터

A 12-year-old girl was referred from a local clinic due to caries control of the right mandibular second molar. On clinical examination, severe caries on the occlusal and lingual surface were observed.
. In this study, the patient was 9 and 12 years old. As immature permanent teeth do not respond to pulp tests reliably²⁰⁾, a pulp test for diagnosis has not been conducted before treatment.

성능/효과

4B). After 3 months, 7 months, and 11 months, lengthening and thickening of roots and a normal trabecular pattern of the alveolar bone were observed (Fig. 4C,D,E).

후속연구

Although it has a disadvantage requiring blood sampling, growth factors in PRF can help to promote root development. Based on the short-term results of this study, pulpotomy with PRF could be an alternative treatment in immature permanent teeth with carious pulp exposure. Additionally, clinical observation over the long-term is necessary in the future.
Pulpotomy with PRF could be an alternative treatment to other materials in immature permanent teeth with carious pulp exposure. Further research on this topic is required with regard to histological assessment with a larger sample size.

참고문헌 (21)

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상세보기
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Stanley H : Criteria for standardizing and increasing credibility of pulp capping studies. Am J Dent, 11:17-34, 1998.
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.

상세보기
Torabinejad M, Parirokh M : Mineral trioxide aggregate: a comprehensive literature review-Part II: leakage and biocompatibility investigations. J Endod, 36:190-202, 2010.

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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.

상세보기
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.

상세보기
Camilleri J : Characterization of hydration of mineral trioxide aggregate. Int Endod J, 41:408-417, 2008.

상세보기
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.

상세보기
Witherspoon DE : Vital pulp therapy with new materials: new directions and treatment perspectives- permanent teet. J Endod, 34:25-28, 2008.

상세보기
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.

상세보기
Massler M : Therapy conductive to healing of the human pulp. Oral Surg Oral Med Oral Pathol, 34:122-130, 1972.

상세보기
Eghbal M, Asgary S, Ghoddusi J, et al. : MTA pulpotomy of human permanent molars with irreversible pulpitis. Aust Endod J, 35:4-8, 2009.

상세보기
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.

상세보기
Sunitha Raja V, Munirathnam Naidu E : Plateletrich fibrin: evolution of a second-generation platelet concentrate. Indian J Dent Res, 19:42-46, 2008.

상세보기
Smith AJ : Vitality of the dentin-pulp complex in health and disease: growth factors as key mediators. J Dent Educ, 67:678-689, 2003

상세보기
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.

원문보기 상세보기
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.

상세보기
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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.

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미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고
VITAL PULP THERAPY USING PLATELET-RICH FIBRIN IN AN IMMATURE PERMANENT TOOTH : CASE REPORTS 원문보기

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미성숙 영구치에서 혈소판 농축 섬유소를 적용한 생활 치수 치료 : 증례보고 VITAL PULP THERAPY USING PLATELET-RICH FIBRIN IN AN IMMATURE PERMANENT TOOTH : CASE REPORTS 원문보기

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