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下顎エナメル上皮腫に反復処置法を適応し，腫瘍による歯根吸収を伴う歯を無治療で温存した１例
足利, 雄一;篠原, 早紀;関口, 珠希;格口, 渉;大廣, 洋一
Permalink : http://hdl.handle.net/2115/90517
KEYWORDS : エナメル上皮腫;反復処置法;顎骨保存療法;歯の保存;歯髄活性;ameloblastoma;dredging method;conservative treatment;tooth preservation;pulp vitality
Abstract
反復処置法は、顎骨の良性腫瘍または嚢胞に対して適用され、顎骨の形態回復ならびに口腔の機能温存に優れた治療である。顎骨良性腫瘍ではしばしば歯根の吸収を伴う。再発を防ぐため、一般的に病変に含まれる歯は抜歯や歯根端切除が施行される．生活歯の場合は歯の保存が可能であったとしても歯髄壊死が起こる可能性が高いことから根管治療がおこなわれる．今回，下顎エナメル上皮腫に対し反復処置法を用いて治療を行い，腫瘍により歯根が吸収された歯を無治療で温存できた症例を経験したのでその概要を報告する．
症例は19歳女性で，右側下顎体部の腫脹と軽度の鈍痛を主訴に当科を受診した．パノラマX線写真およびCTで右側下顎第1大臼歯から右側下顎枝にかけて右側下顎第1，第2大臼歯の歯根吸収を伴う境界明瞭な多房性のX線透過性病変を認めた．生検によりエナメル上皮腫の診断を得て，反復処置法による治療を行った．右側下顎第1，第2大臼歯を抜歯することなく温存に努めたところ，経過観察開始から6年後に電気歯髄診で反応がみられるようになり，歯髄に対する治療を行うことなく温存が可能であった． 10年の経過観察期間中，再発を認めず経過良好である．
The dredging method has shown excellent results in treating benign tumors or cysts, restoring the morphology of the jawbone, and preserving oral function. Benign jawbone tumors are often associated with root resorption of the involved teeth. To avoid recurrence, the teeth involved in the lesion are usually extracted, or even if the tooth can be saved, endodontic treatment or apicoectomy is performed because of the high probability of pulp necrosis. We report a case in which a tooth with a resorbed root due to a tumor was successfully preserved without treatment after applying the dredging method to a mandibular ameloblastoma. A 19-year-old woman presented to our department with a complaint of swelling and mild dull pain in the right mandibular region. Panoramic radiographs and computed tomography revealed a well-defined multilocular radiolucent lesion in the ascending ramus of the mandible with the root resorptions of the mandibular first and second molars. A biopsy was performed, and a histopathological analysis led to t he diagnosis of ameloblastoma. The patient was treated with the dredging method. The involved molars were preserved wi thout treatments. Nine years after the initial treatment, the mandibular first and second molars responded normally to the electric pulp test. No recurrence or complications were observed during a 10-year follow-up period, and the teeth were preserved and functional in their place.
The dredging method has shown excellent results in treating benign tumors or cysts, restoring the morphology of the jawbone, and preserving oral function. Benign jawbone tumors are often associated with root resorption of the involved teeth. To avoid recurrence, the teeth involved in the lesion are usually extracted, or even if the tooth can be saved, endodontic treatment or apicoectomy is performed because of the high probability of pulp necrosis. We report a case in which a tooth with a resorbed root due to a tumor was successfully preserved without treatment after applying the dredging method to a mandibular ameloblastoma. A 19-year-old woman presented to our department with a complaint of swelling and mild dull pain in the right mandibular region. Panoramic radiographs and computed tomography revealed a well-defined multilocular radiolucent lesion in the ascending ramus of the mandible with the root resorptions of the mandibular first and second molars. A biopsy was performed, and a histopathological analysis led to t he diagnosis of ameloblastoma. The patient was treated with the dredging method. The involved molars were preserved wi thout treatments. Nine years after the initial treatment, the mandibular first and second molars responded normally to the electric pulp test. No recurrence or complications were observed during a 10-year follow-up period, and the teeth were preserved and functional in their place.
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