創傷合併巨大根尖病變牙齒的非手術性根管治療－－病例報告

Nonsurgical root canal treat ment of traumat ized tooth with large periapical lesion–a case report

根尖病變的發生主要是因為根管及牙本質有細菌感染，超過5毫米以上的病變一般稱為大病變，本病例從根尖片的影像顯示左上顎正中門齒與側門齒根尖處有一巨大瀰漫性之病變，範圍約為18×18毫米，病人曾經於16年前因跌倒而致牙齒外傷，4年後因腫痛始發現＃21及＃22根尖有巨大的病變存在，最後經由開業醫師轉診至本院接受根管治療。因病人當時年齡僅15歲同時病變區範圍太大，因此建議病人及家長採取非手術性根管治療，經過9個月的氫氧化鈣置放，待根尖病變開始有癒合的現象後，始將根管加以緻密充填。歷經10年的追蹤觀察，臨床症狀及放射線的檢查均顯示根尖組織的癒合情形良好。

The etiology of apical periodontitis is mainly caused by the bacteria present in the root canal system and the surrounding dentin. Normally, lesions of endodontic origin range from 5 to 8 mm in diameter, while cases of more than 10 mm are more rarely encountered. Radiographic examination of this report revealed an extensive periapical lesion, in which a scope of more than 18 × 18 mm occured. This patient mentioned his previous history of dental trauma involving this quadrant six years ago. Four years after the accident, an enormous lesion between 21 and 22 mm was found because of severe swelling pain, and had been treated by a local clinical dentist for two years. Eventually, the patient was referred to our clinic for further treatment. However, due to the consideration of the patient’s age and the over-sized lesion range, the boy and his parents were suggested to examine a nonsurgical means of treatment. Following chemomechanical preparation, a dressing of calcium hydroxide with sodium hypochlorite solution was applied and replaced three times over a period of nine months. As the recovery from periapical lesion progressed, the canal was then filled. Much to our relief, the following ten years of clinical and radiographic examination on the patient indicate that he has experienced normal apical regeneration.