巨大齒源性根尖病變的非手術性根管治療

Nonsurgical Root Canal Treatment of Extensive Periradicular Lesions of Endodontic Origin

根尖病變的病因，可分為根管內感染及根管外感染，其中以根管內發生感染為最主要的原因。臨床上根尖的發炎反應顯現在X-光片上就是根尖出現放射線透射的影像。病變的大小一般約為5~8毫米，超過10毫米以上的病變較少見，本病例病變的範圍達42毫米，相當罕見。此外病變區混合了原發性感染及繼發性感染，形成了一個巨大的合併性病變。治療方法因顧及病變區範圍太大及該病患因憂鬱症對手術的恐懼，因此選擇非手術性根管治療。術後一年的追蹤檢查結果顯示根尖組織癒合良好，病人腫痛的情況完全消失。不僅如此，X光觀察亦顯示根尖區有明顯的癒合趨勢，臨床上也未再有症狀復發的跡象。

Apical lesion is caused either by root canal infection, or by extraradicular infection. However, the predominant cause is probably root canal infection. Clinically, apical inflammation appears on x-ray as a radiographic radiolucency. Generally, the size range of inflammatory periapical lesions of endodontic origin is from 5 mm to 8 mm in diameter, with a lesion size exceeding 10 mm rarely observed. This case report reveals an inflammation reaching up to 42 mm, which is a true rarity. Such a huge lesion was formed by the primary infection and the secondary infection joining together. In consideration of the lesion’s large size and the patient’s history of major depression causing of surgery, nonsurgical endodontic treatment was selected as the treatment of choice. Post-treatment follow-up after 1 year showed that the healing of the apical lesion was fair. Also, the patient’s swelling and pain completely subsided. Furthermore, radiographs revealed that the size of the lesion has been decreasing and no recurrent tendency was noted clinically.