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第39巻 第2号 >


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Title: ビスホスホネート長期服用患者に対し薬物性歯肉増殖症の手術的対応を行った1例
Other Titles: Surgical treatment of drug-induced gingival hyperplasia in a patient on prolonged bisphosphonate therapy
Authors: 三浦, 和仁1 Browse this author
松下, 貴惠2 Browse this author
新井, 絵理3 Browse this author
松下, 和裕4 Browse this author →KAKEN DB
鄭, 漢忠5 Browse this author →KAKEN DB
山崎, 裕6 Browse this author →KAKEN DB
Authors(alt): Miura, Kazuhito1
Matsushita, Takae2
Arai, Eri3
Matsushita, Kazuhiro4
Tei, Kanchu5
Yamazaki, Yutaka6
Keywords: 薬物性歯肉増殖症
drug-induced gingival hyperplasia
collaboration with home-visit dentist
Issue Date: Mar-2019
Publisher: 北海道歯学会
Journal Title: 北海道歯学雑誌
Volume: 39
Issue: 2
Start Page: 131
End Page: 136
Abstract: 今回,薬物性歯肉増殖症により総義歯が使用不可能となったビスホスホネート長期服用歴を持つ認知症患者に対し,手術的対応後に義歯新製を行い,QOLの改善をはかった1例を経験したので報告する.  患者は85歳女性で,アムロジピンおよびアレンドロン酸の長期服用歴があり,初診の4年前に上顎両側歯槽部に歯肉の腫脹を自覚したが,痛みはなく義歯も使用可能であった.その後は訪問歯科診療を定期受診していたが,初診の2か月前より上顎歯槽部の歯肉腫脹が増大し,義歯装着が困難となり,歯肉腫脹の原因精査依頼で,当科を紹介受診した.初診時,上顎両側歯槽部に表面粘膜正常,結節状で弾性軟の歯肉腫脹を認めた.画像所見では,3歯の残根を認めたが,顎骨に病的所見や,アレンドロン酸による顎骨壊死の症状はなく,残根が原因の歯性炎症と判断した.また,血液検査と病理検査で腫瘍性病変は否定され,薬物性歯肉増殖症と診断した.  当院口腔顎顔面外科と連携し,全身麻酔下で残根抜歯,歯肉切除術を施行した.アレンドロン酸は12年間内服していたが,大腿骨骨折の既往があり,休薬による骨折リスクの増大を考慮して,継続下に手術を施行した.また,手術時に歯肉増殖部の切除は骨膜上切開を行い,抜歯窩は上皮で被覆することで骨露出を予防した.術後の治癒は良好であった.その後は,訪問歯科医師と連携し,上下顎義歯の新製を依頼した.患者は新義歯を問題なく使用できており,経過は良好である.
We report a case of surgical treatment of drug-induced gingival hyperplasia in a patient with dementia on prolonged bisphosphonate therapy. An 85-year-old woman became aware of gingival swelling in the bilateral maxillary alveolar regions 4 years before visiting our department, but it caused no pain and she could use complete dentures. Since then, she had used home-visit dental care service. Two months before visiting us, it became difficult for her to use complete dentures due to increase in the swelling and she was referred to our department to check the cause of her gingival swelling. The mucosal surface mucosa was normal, but marked nodular and elastic soft gingival swelling was observed in the bilateral maxillary alveolar part at the time of first examination. Imaging findings revealed three tooth stumps, but no abnormal findings in her maxilla. Therefore, we thought the cause of her gingival swelling was not bisphosphonate related osteonecrosis but inflammation because of teeth stumps. As a malignant lesion was ruled out by a blood test and pathological examination, we made a diagnosis of drug-induced gingival hyperplasia. The three tooth stumps were extracted and she underwent gingivectomy, under general anesthesia. The patient was on alendronate for 12 years, but the operation was performed without cessation because she had a history of fracture of the femur. During surgery, we resected the area of gingival proliferation with periosteal incision and tried to prevent alveolar bone exposure of the tooth extraction cavities by gingival suture. The healing after surgery was stable, and in collaboration with the home-visit dentist complete dentures were fitted. The patient was able to use her new dentures without any problem and there was no recurrence at more than 6-months after the operation.
Type: article
Appears in Collections:北海道歯学雑誌 = Hokkaido Journal of Dental Science > 第39巻 第2号

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