[논문]치내치를 동반한 감염된 미성숙 영구치의 재생형 근관치료

신가영; 이광희; 안소연; 송지현; 허나랑; 라지영

doi:10.5933/jkapd.2015.42.2.188

치내치를 동반한 감염된 미성숙 영구치의 재생형 근관치료
Regenerative Endodontic Treatment of Infected Immature Permanent Teeth with Dens Invaginatus : A Report of Two Cases 원문보기

大韓小兒齒科學會誌 = Journal of the Korean academy of pediatric dentistry, v.42 no.2, 2015년, pp.188 - 196

신가영 (원광대학교 치과대학 소아치과학교실) , 이광희 (원광대학교 치과대학 소아치과학교실) , 안소연 (원광대학교 치과대학 소아치과학교실) , 송지현 (원광대학교 치과대학 소아치과학교실) , 허나랑 (원광대학교 치과대학 소아치과학교실) , 라지영 (원광대학교 치과대학 소아치과학교실)

초록
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치내치를 동반한 미성숙 영구치의 근관치료를 성공적으로 수행하는 것은 치과의사에게 어려운 과제이다. 복잡한 형태의 근관계는 근관 내부를 효과적으로 성형, 멸균, 충전하는 것이 어렵기 때문에 포괄적이고 철저한 치료계획을 수립하는 것이 중요하다. 본 증례는 치내치를 동반한 감염된 미성숙 영구치를 가진 두명의 환자에게 재생형 근관치료를 시행하여 양호한 결과를 얻었기에 이를 보고하고자 한다. 감염된 괴사치수와 각각 Oehlers type I, type III 치내치를 포함하는 두개의 미성숙 상악 측절치에 재생형 근관치료가 시행되었다. 특히 Type III 치내치의 근관치료는 보다 효과적인 감염조절과 근관 충전을 위해 복잡한 근관 내부 구조를 재형성하는 드문 접근법을 이용하였다. 이 때, Cone-beam computed tomography (CBCT)와 미세 수술 현미경의 사용은 근관 내부의 시각화 및 치료에 도움이 되었다. 결과적으로, 복잡한 형태의 치내치를 포함하는 미성숙 영구치의 재생형 근관치료는 임상적, 방사선학적 치유 뿐만 아니라 치근 상아질 벽의 두께 증가를 가능하게하는 효과적인 치료 방법이 될 수 있을 것으로 생각된다.

Abstract ▼ AI-Helper

Endodontic management of an immature permanent tooth with dens invaginatus poses a challenge to efficient treatment planning for the clinicians. Because it is difficult to shape, disinfect, and seal the canal space effectively, teeth with complex root canal structures often require particularly extensive and thorough treatment approaches. The purpose of this case report was to share clinical insight from the results of short-term follow-ups after regenerative endodontic treatment with a dens invaginatus. Two immature maxillary lateral incisors with Oehlers type I and III dens invaginatus and infected necrotic pulp were treated using regenerative endodontic procedures. For the type III dens invaginatus case, an unusual approach toward redesigning the complex internal structure was taken, in order to have sufficient infection control and sealing. Cone-beam computed tomography (CBCT) and a surgical operating microscope were used to aid visualization and treatment. As a result, regenerative endodontic treatment appears to be effective for managing immature permanent teeth with complex dens invaginatus, and can lead not only to clinical and radiographic resolution, but also increased thickness of the dentinal walls.

주제어

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가설 설정

(A) Preoperative. (B) Calcium hydroxide paste applied to the invagination in isolation. (C) Triple antibiotic dressing following complete removal of the invagination.

제안 방법

A 10-year-old boy was referred from a local dental clinic for evaluation of the right maxillary lateral incisor with a complicated internal structure. He had a history of fluctuant swelling on the labial attached gingiva of right maxillary incisors, and a root canal treatment had already been initiated with systemic antibiotics for the preceding 5 days. When he visited to our clinic for the first time, the access cavity was restored with temporary restorative material and the gingival swelling was relieved (Fig.
The internal space of the invagination was supposed to be partially connected with the main root canal space, according to the CBCT images. Thus, the endodontic treatment needed to include both the invagination and the root canal, and it was decided to remove the invagination to redesign the complex internal structure.

대상 데이터

A 9-year-old girl who had suffered from painful symptoms in her maxillary left lateral incisor visited the Dept. of Pediatric Dentistry at the dental hospital of our university. On clinical examination, the tooth was symptomatic to percussion and was tender to palpation on the labial gingiva with sinus tract formation (Fig.

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