{"id":8640,"date":"2022-06-21T00:00:03","date_gmt":"2022-06-20T15:00:03","guid":{"rendered":"https:\/\/fukuoka-endodontics.com\/?p=8640"},"modified":"2022-06-20T22:01:20","modified_gmt":"2022-06-20T13:01:20","slug":"icrrno18-rctcore-build-up%e2%86%92intentional-replantation","status":"publish","type":"post","link":"https:\/\/fukuoka-endodontics.com\/?p=8640","title":{"rendered":"#18 \u4fb5\u8972\u6027\u6b6f\u9838\u90e8\u5916\u90e8\u5438\u53ce\uff08Invasive Cervical Root Resorption\uff09\u306e\u6cbb\u7642\u8a08\u753b\u306e\u7acb\u6848"},"content":{"rendered":"

\u7d39\u4ecb\u60a3\u8005\u3055\u3093\u306e\u6cbb\u7642\u3002<\/p>\n

\u4e3b\u8a34\u306f<\/p>\n

\u5de6\u4e0b\u5965\u6b6f\u9699\u9593\u304c\u5927\u304d\u304f\u7269\u304c\u8a70\u307e\u308a\u3084\u3059\u3044\uff08\u6570\u5e74\u9593\uff09\u3002CT\u3067\u795e\u7d4c\u306e\u5468\u308a\u304c\u6eb6\u3051\u51fa\u3057\u3066\u3044\u308b\u3068\u8a00\u308f\u308c\u305f\u3002\u5c11\u3057\u75db\u307f\u306f\u3042\u308b\u304c\u85ac\u3092\u98f2\u3080\u307e\u3067\u3082\u306a\u3044\u3002<\/strong><\/span><\/h1>\n

\u3067\u3042\u3063\u305f\u3002<\/p>\n

\u521d\u8a3a\u6642\uff082022.3.25\uff09\u306e\u6b6f\u5185\u7642\u6cd5\u5b66\u7684\u691c\u67fb\u306f\u4ee5\u4e0b\u306b\u306a\u308b\u3002<\/p>\n

#18 Cold++3\/4<\/strong><\/span>, Perc.(-), Palp.(-), BT(-), Perio Probe(WNL), Mobility(WNL)<\/p>\n

#19 Cold+4\/3, Perc.(-), Palp.(-), BT(-), Perio Probe(WNL), Mobility(WNL)<\/p>\n

PA<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

CBCT\u3082\u304b\u304b\u308a\u3064\u3051\u533b\u306b\u64ae\u5f71\u3057\u3066\u3044\u305f\u3060\u3044\u3066\u3044\u305f\u3002<\/p>\n

CBCT\uff082022.3.25\uff09<\/strong><\/span><\/h1>\n

\"\"<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

#18 Pulp Dx: Symptomatic Irreversible Pulpitis, Periapical Dx: Normal<\/p>\n

\u3055\u3066\u3002\u3069\u306e\u3088\u3046\u306a\u6cbb\u7642\u3092\u3042\u306a\u305f\u306f\u3053\u306e\u75c7\u4f8b\u306b\u5bfe\u3057\u3066\u884c\u3046\u3060\u308d\u3046\u304b\uff1f<\/p>\n

\u307e\u305f\u3001\u3053\u306e\u30ec\u30f3\u30c8\u30b2\u30f3\u50cf\u304c\u793a\u3057\u3066\u3044\u308b\u3082\u306e\u306f\u4f55\u304b\uff1f\u3068\u3044\u3048\u3070\u3001<\/p>\n

\u4fb5\u8972\u6027\u6b6f\u9838\u90e8\u5916\u90e8\u5438\u53ce\uff08Invasive Cervical Root Resorption\uff09<\/strong><\/span><\/h1>\n

\u3067\u3042\u308b\u3002<\/p>\n

\u3053\u306e\u624b\u306e\u7814\u7a76\u3067\u6709\u540d\u3060\u3063\u305f\u306e\u306f\u3001Heithersay\u3067\u3042\u308b\u3002<\/p>\n

\"\"<\/p>\n

\u306a\u305c\u3053\u3046\u3044\u3046\u73fe\u8c61\u304c\u8d77\u304d\u308b\u306e\u304b\uff1f\u306b\u95a2\u3057\u3066\u306f\u73fe\u5728\u3082\u5b9a\u304b\u3067\u306f\u306a\u3044\u3002<\/p>\n

\u5f7c\u306b\u3088\u308c\u3070\u3001Invasive Cervical Root Resorption\uff08ICRR\uff09\u306f\u4ee5\u4e0b\u306e\u3088\u3046\u306b\u5206\u985e\u3055\u308c\u308b\u3002<\/p>\n

\"\"<\/p>\n

Class 1: Small, well-defined lesion localized to cervical area and involving dentin only. 100% success.<\/strong><\/span><\/h1>\n

Class 2: Slightly larger, well-defined lesion localized to cervical area but penetrating further into dentin<\/span>\u00a0<\/strong>close to the coronal pulp.100% success.<\/strong><\/span><\/h1>\n

Class 3: Larger, less defined lesion extending into the coronal third of the root.78% success.<\/strong><\/span><\/h1>\n

Class 4: Large lesion extending beyond the coronal third of the root.12.5% success.<\/strong><\/span><\/h1>\n

\u6210\u529f\u7387\u306f3\u5e74\u4e88\u5f8c\u3067\u3042\u308b\u3002<\/p>\n

\u5931\u6557\u306f\u3001\u5438\u53ce\u306e\u518d\u767a\u3068\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

\u6b21\u306b\u5f7c\u304c\u63d0\u5531\u3059\u308b\u6cbb\u7642\u65b9\u6cd5\u3067\u3042\u308b\u3002<\/p>\n

Treatment of ICRR(Heithersay 1999c)<\/strong> <\/span><\/h1>\n

\u2460Debridement of the resorptive defect\uff08\u5438\u53ce\u90e8\u306e\u6a5f\u68b0\u7684\u9664\u53bb\uff09<\/p>\n

\u2461Placement of glycerol on the gingival tissues, application of 90% trichloroacetic acid for 1 to 4 minutes\uff0890% TCA\u306e\u5438\u53ce\u90e8\u3078\u306e\u5857\u5e03\uff09<\/p>\n

\u2462Restoration with glass-ionomer cements\uff08GIC\u306b\u3088\u308b\u4fee\u5fa9\uff09<\/p>\n

\u2463To access the defect, a surgical flap is often necessary.\uff08\u4fee\u5fa9\u3059\u308b\u306b\u306f\u5f97\u624b\u3057\u3066Flap Ope\u304c\u5fc5\u8981\uff09<\/p>\n

\u2464Root canal therapy is indicated in class 2 and 3 defects because of inevitable pulpal involvement.(Class2,3\u306a\u3089\u3070\u6839\u7ba1\u6cbb\u7642\u304c\u5fc5\u8981\uff09<\/span><\/strong><\/h1>\n

\u2465Trichloroacetic acid deactivates the resorptive tissue via coagulative necrosis.\uff08TCA\u306b\u3088\u308a\u5438\u53ce\u7d44\u7e54\u3092\u4e0d\u6d3b\u6027\u5316\uff09<\/p>\n

\u2466Glass-ionomer cements are advised for restoration of resorptive defects because the ability of periodontal tissue to reattach to these materials.\uff08GIC\u3067\u5145\u586b\u3002\u6b6f\u5468\u7d44\u7e54\u304c\u304f\u3063\u3064\u304f\u306e\u3067\u3002\uff09<\/strong><\/span><\/strong><\/h1>\n

\u2467While generally an external approach is recommended for treatment\u00a0an internal approach for repair can be undertaken for class 2 lesions and involves the use of intracoronal trichloroacetic acid or multiple applications of calcium hydroxide to assure clearance of resorptive soft tissue.\uff08\u6b6f\u7259\u5185\u90e8\u306bTCA\u3092\u5857\u5e03\u3059\u308b\u304b\u3001\u6c34\u9178\u5316\u30ab\u30eb\u30b7\u30a6\u30e0\u3067\u8cbc\u85ac\u3059\u308b\u304b\u3059\u308b\uff09<\/strong><\/span><\/h1>\n

\u2468Intentional replantation\uff08\u610f\u56f3\u7684\u518d\u690d\uff09<\/strong><\/span><\/h1>\n

Heithersay (1999c) \u306f\u3001classes 1, 2, and 3\u306e\u6cbb\u7642\u306f\u63a8\u5968\u3057\u3066\u3044\u308b\u304c\u3001 Class 4 lesions\u306b\u95a2\u3057\u3066\u306f\u4e88\u5f8c\u304c\u60aa\u3044\u306e\u3067\u4fdd\u5b58\u3092\u3057\u306a\u3044\u3088\u3046\u306b\u63a8\u5968\u3057\u3066\u3044\u308b\u3002<\/p>\n

\u3055\u3066\u3001\u3053\u3053\u304b\u3089\u6642\u4ee3\u304c\u9032\u5316\u3057\u73fe\u5728\u3053\u306e”\u4fb5\u8972\u6027\u6b6f\u9838\u90e8\u5916\u90e8\u5438\u53ce\uff08Invasive Cervical Root Resorption\uff09\u201d\u306b\u5bfe\u3057\u3066\u306fCBCT\u306b\u57fa\u3065\u3044\u305f\u3001Patel\u306e\u6cbb\u7642\u306e\u5206\u985e\u304c\u9069\u5fdc\u3055\u308c\u3066\u3044\u308b\u3002<\/p>\n

\u4ee5\u4e0b\u304c\u4ee3\u8868\u7684\u306a\u6587\u732e\u3060\u3002<\/p>\n

Patel 2018 External cervical resorption\/ a three-dimensional classification<\/strong><\/a><\/p>\n

Patel 2018 European Society of Endodontology position statement: External Cervical Resorption<\/strong><\/a><\/p>\n

Patel 2018 External cervical resorption-part 1: histopathology, distribution and presentation<\/strong><\/a><\/p>\n

Patel 2018 External cervical resorption: part 2 \u2013 management<\/strong><\/a><\/p>\n

\u3053\u306e\u6587\u732e\u306b\u3042\u308b\u5206\u985e\u3067\u4e0a\u8a18\u5438\u53ce\u75c7\u4f8b\u3092\u5206\u6790\u3057\u3066\u307f\u3088\u3046\u3002<\/p>\n

\"\"<\/p>\n

\u307e\u305a”Height”\u306b\u95a2\u3057\u3066\u3060\u304c\u3001<\/p>\n

\"\"<\/p>\n

\u5438\u53ce\u306f\u6b6f\u6839\u306b\u307e\u3067\u53ca\u3093\u3067\u3044\u308b\u3053\u3068\u304c\u308f\u304b\u308b\u3002<\/p>\n

Height\u306f2~3\u3067\u3042\u308b\u3002<\/strong><\/span><\/h2>\n

\u6b21\u306b\u3069\u308c\u304f\u3089\u3044\u5468\u56f2\u306b\u5e83\u304c\u3063\u3066\u3044\u308b\u304b\u3067\u3042\u308b\u304c\u3001\u4ee5\u4e0b\u306eCBCT\u50cf\u304b\u3089\u308f\u304b\u308b\u3002<\/p>\n

\"\"<\/p>\n

\u5438\u53ce\u306e\u7a0b\u5ea6\u306f90\u00b0\u301c180\u00b0\u3067\u3042\u308b\u3002<\/p>\n

Circumferential spread\u306fB\u3067\u3042\u308b\u3002<\/strong><\/span><\/h2>\n

\u305d\u3057\u3066\u6700\u5f8c\u306b\u6b6f\u9ac4\u306b\u3069\u308c\u307b\u3069\u8fd1\u63a5\u3057\u3066\u3044\u308b\u304b\uff1f\u3067\u3042\u308b\u304c\u3001<\/p>\n

\u3053\u308c\u306f\u4e3b\u8a34\u306e\u67d3\u307f\u308b\u3068\u3044\u3046\u3053\u3068\u304b\u3089\u3082\u65e2\u306b\u6b6f\u9ac4\u306b\u5230\u9054\u3057\u3066\u3044\u308b\u3068\u8003\u3048\u3089\u308c\u308b\u306e\u3067\u3001<\/p>\n

Proximity to the root canal\u306fp\u3067\u3042\u308b\u3002<\/strong><\/span><\/h2>\n

\u307e\u3068\u3081\u308b\u3068\u3053\u306e\u75c7\u4f8b\u306e\u5206\u985e\u306f\u3001<\/p>\n

2Bp\u307e\u305f\u306f3Bp<\/strong><\/span><\/h1>\n

\u3068\u306a\u308b\u3002<\/p>\n

\n

\u3055\u3066\u3001\u6b21\u306b\u65b0\u3057\u3044\u6cbb\u7642\u6cd5\u3067\u3042\u308b\u3002<\/p>\n

\u2022 External repair of the resorptive defect \u0001 endodontic\u00a0<\/em><\/strong>treatment\u00a0<\/strong><\/em><\/span><\/p>\n

Excavation of the resorptive defect and restoration of the defect with a direct restoration, for example Patel class 1Ad, 2Ad, 2Bd. Root canal treatment may be indicated if there is (probable) pulp involvement, for example Patel class 1Ap, 2Ap, 2Bp.<\/span><\/strong><\/p>\n

2Bp\u3067\u3042\u308c\u3070\u6839\u7ba1\u6cbb\u7642\uff0b\u5916\u90e8\u304b\u3089\u306e\u5438\u53ce\u306e\u30ea\u30da\u30a2\u304c\u5fc5\u8981\u3060\u3068\u3044\u3046\u3002<\/strong><\/span><\/h3>\n

\u2022 Internal repair and root canal treatment<\/strong><\/span><\/em><\/p>\n

Root canal treatment, excavation and restoration of the resorptive defect with a direct plastic restoration, for example Patel class 2Cp, 2Dp, 3Cp, 3Dp.<\/p>\n

\u5185\u90e8\u304b\u3089\u306f\u3053\u306e\u75c7\u4f8b\u306b\u95a2\u3057\u3066\u306f\u30ea\u30da\u30a2\u306f\u4e0d\u53ef\u80fd\u3067\u3042\u308b\u3002<\/strong><\/span><\/h3>\n

\u2022 Intentional replantation<\/strong><\/em><\/span>
\nExtraction of an endodontically treated tooth to allow restoration and\/or recontouring of an otherwise inaccessible ECR defect, followed by reinsertion.<\/p>\n

Flap\u3092\u958b\u3051\u3066\u3082\u30a2\u30af\u30bb\u30b9\u304c\u3067\u304d\u306a\u3044\u4f4d\u7f6e\u306b\u5438\u53ce\u304c\u3042\u308b\u5834\u5408\u3001<\/strong><\/span>Intentional Replantation\u304c\u63d0\u5531\u3055\u308c\u3066\u3044\u308b\u3002<\/strong><\/span><\/h3>\n

\u2022 Periodic review<\/strong><\/em><\/span>
\nUntreatable teeth may be reviewed on a periodic basis, for example Patel class 2-4Dd, 2-4Dp.<\/p>\n

\u5438\u53ce\u304c\u6b6f\u3092\u3050\u308b\u3063\u3068\u56de\u3063\u3066\u3057\u307e\u3063\u3066\u3044\u308b\u3068\u4fdd\u5b58\u304c\u3067\u304d\u306a\u3044\u3002\u7d4c\u904e\u3092\u898b\u308b\u3057\u304b\u306a\u3055\u305d\u3046\u3060\u3002<\/strong><\/span><\/h3>\n

\u2022 Extraction<\/strong><\/span><\/em>
\nIndicated when ECR is inaccessible for treatment, or when the lesion is so extensive that the tooth may not be restored to satisfactory function or aesthetics.<\/p>\n

\u5438\u53ce\u304c\u3072\u3069\u304f\u9032\u884c\u3059\u308b\u3068\u629c\u6b6f\u3057\u304b\u306a\u304f\u306a\u308b\u3002<\/span><\/span><\/h3>\n
\n

\u3055\u3066\u3001\u3053\u306e\u75c7\u4f8b\u3042\u306a\u305f\u306f\u3069\u306e\u3088\u3046\u306b\u6b6f\u79d1\u6cbb\u7642\u3092\u9032\u3081\u3066\u3044\u304f\u3060\u308d\u3046\u304b\uff1f<\/p>\n

\u6839\u7ba1\u6cbb\u7642\u306f\u3059\u308b\u306e\u304b\uff1f<\/p>\n

\u5916\u90e8\u5438\u53ce\u3092\u3069\u3046\u30ea\u30da\u30a2\u3059\u308b\u306e\u304b\uff1f<\/p>\n

Intentional Replantation\u3092\u3059\u308b\u306e\u304b\uff1f<\/p>\n

\u306f\u305f\u307e\u305f\u3001\u7d4c\u904e\u3092\u898b\u308b\u3060\u3051\u306b\u3059\u308b\u306e\u304b\uff1f<\/p>\n

\u305d\u308c\u3068\u3082\u629c\u6b6f\u3059\u308b\u304b\uff1f<\/p>\n

\u307e\u305f\u3001\u79c1\u306f\u3069\u306e\u3088\u3046\u306b\u3053\u306e\u6cbb\u7642\u3092\u884c\u304a\u3046\u3068\u3057\u305f\u3060\u308d\u3046\u304b\uff1f<\/p>\n

\u3061\u3087\u3063\u3068\u8003\u3048\u3066\u307f\u3088\u3046\u3002<\/p>\n

\u7d9a\u304d\u306f\u307e\u305f\u660e\u65e5\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

\u7d39\u4ecb\u60a3\u8005\u3055\u3093\u306e\u6cbb\u7642\u3002 \u4e3b\u8a34\u306f \u5de6\u4e0b\u5965\u6b6f\u9699\u9593\u304c\u5927\u304d\u304f\u7269\u304c\u8a70\u307e\u308a\u3084\u3059\u3044\uff08\u6570\u5e74\u9593\uff09\u3002CT\u3067\u795e\u7d4c\u306e\u5468\u308a\u304c\u6eb6\u3051\u51fa\u3057\u3066\u3044\u308b\u3068\u8a00\u308f\u308c\u305f\u3002\u5c11\u3057\u75db\u307f\u306f\u3042\u308b\u304c\u85ac\u3092\u98f2\u3080\u307e\u3067\u3082\u306a\u3044\u3002 \u3067\u3042\u3063\u305f\u3002 \u521d\u8a3a\u6642\uff082022.3.25\uff09\u306e\u6b6f\u5185\u7642\u6cd5\u5b66\u7684\u691c\u67fb\u306f […]<\/p>\n","protected":false},"author":1,"featured_media":8686,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"_wpas_customize_per_network":false},"categories":[23,3],"tags":[],"class_list":["post-8640","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-invasive-cervical-root-resorption-repair","category-3"],"yoast_head":"\n#18 \u4fb5\u8972\u6027\u6b6f\u9838\u90e8\u5916\u90e8\u5438\u53ce\uff08Invasive Cervical Root Resorption\uff09\u306e\u6cbb\u7642\u8a08\u753b\u306e\u7acb\u6848 - \u307e\u3064\u3046\u3089\u6b6f\u79d1\u533b\u9662 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