항생제를 이용한 미성숙 영구치의 치험례 = TREATMENT OF IMMATURE TEETH WITH A 3-MIX PASTE: CASE REPORT

국문 초록 (Abstract)

미성숙 영구치의 치수가 괴사되면, 치근 형성이 더 이상 이루어지지 않아 치근벽이 매우 얇고, 치근단공이 열려 있어 근관 치료를 시행하기가 매우 어렵다. 치수가 괴사되고, 치근단 병소가 있는 치아의 근관치료를 시행할 때 가장 중요한 것은 감염 된 근관계를 소독하는 것이다. 이러한 소독은 근관 내 기계적인 기구 조작, 근관 세척, 근관 내 약제를 통해서 이루어질 수 있 는데, 최근 ciprofloxacin, metronidazole, minocycline의 세 가지 항생제 조합을 이용하여 근관 내 병원균을 제거하고, 치 수의 재혈관화를 도모하여, 치근의 지속적인 성장을 유도한 연구와 증례가 많이 보고되고 있다. 이러한 재생적인 근관 치료는 미성숙 영구치를 치료함에 있어서 통법적인 치근단형성술보다 보존적인 치료법으로서 널리 이용될 것이라 사료된다. 본 증례는 치외치의 교두파절로 인하여 치수가 괴사되고, 치근단 병소가 생긴 미성숙 영구치를 주소로 내원한 두 환아에 대 하여 세 가지 항생제 조합을 근관 내 약제로 이용하여 치료한 바, 성공적인 치료결과를 보여 이를 보고하는 바이다.

다국어 초록 (Multilingual Abstract)

An immature tooth with infected pulp has numerous potential complications. Conventional apexification with calcium hydroxide has several disadvantages, including susceptibility to tooth fracture. This method does not promote continual root development. Pulp revascularization of a necrotic, immature permanent tooth will allow further development of the root and dentinal structure. Disinfection of the root canal system is a prerequisite for pulp revascularization and tissue regeneration. A combination of antibiotic drugs (ciprofloxacin, metronidazole, and minocycline) is effective for disinfection of necrotic pulp, and has been used successfully in regenerative endodontic treatment. These case reports involve the treatment of 3 immature permanent teeth with necrotic pulp using a 3-Mix paste and mineral trioxide aggregate. All cases showed the notable apical maturation with closure of the apex and increased thickness of dentinal walls. This approach suggests a paradigm shift in treating endodontically involved immature permanent teeth from the traditional apexification with calcium hydroxide to the conservative approach by providing a favorable environment for tissue regeneration.

참고문헌 (Reference)

1 김대업, "항생제를 사용한 유치의 치수치료" 대한소아치과학회 32 (32): 126-131, 2005

2 강유진, "외상으로 실활된 미성숙 영구치에서의 계속된 치근 형성" 대한소아치과학회 36 (36): 640-646, 2009

3 Karabucak B, "Vital pulp therapy with mineral trioxide aggregate" 21 (21): 240-243, 2005

4 Akgun OM, "Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: a case report" 108 (108): 62-65, 2009

5 Trope M, "Treatment of immature teeth with nonvital pulps and apical periodontitis" 14 (14): 51-59, 2006

6 Kim ST, "The effects of Ledermix paste on discolouration of immature teeth" 33 (33): 233-237, 2000

7 Rosenberg B, "The effect of calcium hydroxide root filling on dentin fracture strength" 23 (23): 26-29, 2007

8 Sa′nchez AR, "Tetracycline and other tetracycline-derivative staining of the teeth and oral cavity" 43 : 709-715, 2004

9 Sato I, "Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ" 29 : 118-124, 1996

10 Banchs F, "Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol" 30 : 196-200, 2004

11 Iwaya SI, "Revascularization of an immature permanent tooth with apical periodontitis and sinus tract" 17 : 185-187, 2001

12 Kusgoz A, "Retreatment of a resected tooth associated with a large periradicular lesion by using a triple antibiotic paste and mineral trioxide aggregate: a case report with a thirty-month follow-up" 35 (35): 1603-1606, 2009

13 Kling M, "Rate and predictability of pulp revascularization in therapeutically reimplanted permanent incisors" 2 : 83-89, 1986

14 Ritter AL, "Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology" 20 : 75-84, 2004

15 Yanpiset K, "Pulp revascularization of replanted immature dog teeth after different treatment methods" 16 : 211-217, 2000

16 Reynolds K, "Pulp revascularization of necrotic bilateral bicuspids using a modified novel technique to eliminate potential coronal discolouration: a case report" 42 (42): 84-92, 2009

17 Fabricius L, "Predominant indigenous oral bacteria isolated from infected root canals after varied times of closure" 90 : 134-144, 1982

18 Andreasen JO, "Longterm calcium hydroxide as a root canal dressing may increase risk of root fracture" 18 : 134-137, 2002

19 Hoshino E, "In-vitro antibacterial susceptibility of bacteria taken from infected root dentine to a mixture of ciprofloxacin, metronidazole and minocycline" 29 : 125-130, 1996

20 Sato T, "In vitro antimicrobial susceptibility to combinations of drugs on bacteria from carious and endodontic lesions of human deciduous teeth" 8 : 172-176, 1993

21 Chueh LH, "Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift" 32 (32): 1205-1213, 2006

22 Takushige T, "Endodontic treatment of primary teeth using a combination of antibacterial drugs" 37 (37): 132-138, 2004

23 Cvek M, "Effect of topical application of doxycycline on pulp revascularization and periodontal healing in reimplanted monkey incisors" 6 : 170-176, 1990

24 Windley W, "Disinfection of immature teeth with a triple antibiotic paste" 31 : 439-443, 2005

25 Friedlander LT, "Dental stem cells and their potential role in apexogenesis and apexification" 42 (42): 955-962, 2009

26 Thibodeau B, "Case report: pulp revascularization of a necrotic, infected, immature, permanent tooth" 31 (31): 145-148, 2009

27 Bystro¨m A, "Bacteriologic evaluation of the efficacy of mechanical root canal instrumentation in endodontic therapy" 89 (89): 321-328, 1981

28 Huang GT, "A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration" 36 : 379-386, 2008