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An etiology and a treatment of a refractory apical periodontitis

难治性根尖周炎的病因和治疗

基本信息

批准号：
07307019
负责人：
MAEDA Katsumasa
金额：
$ 10.18万
依托单位：
Kyushu University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (A)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

项目摘要

Summary of this project's results was as follows,(1) Classification and diagnosis of a refractory apical periodontitis.It was shown that the important etiological factor of the refractory apical periodontitis was an irregularity of a root canal in the portion of the root apex. A fiberscope was newly designed and clinically applied to observe periapical tissues and root surfaces involved in periodontal disease. An efficiency of fiberscopic observation was demonstrated as an useful diagnostic procedure.(2) Pathogenesis of a refractory apical periodontitis.A sensitive detection method for the bacteria in root canal by the polymerase chain reaction (PCR) was developed. The prevalence and localization of bacteria invading dentinal tubles of the roots of teeth with infected canals were examined. Seventy-five percent of the examined teeth showed the invasion of bacteria into the dentinal tubles of the roots. At the site of chronic apical periodontitis region, and inflammatory cytokine (Interleukin 1) and prostaglandin E_2 were detected. These results suggested that the inflammatory mediators were closely related with the presence of clinical symptoms.(3) Treatments for a refractory apical periodontitis.A mixture of ciprofloxacin, metronidazole and minocycline was effective against the bacteria taken from infected root dentine and periapical lesions. The intracanal dressing of calcium hydroxide paste was also effective in a treatment of a refractory apical periodontitis. And also, a mixture of antimicrobial agent and calcium hydroxide was effective in this case. Among several dental filling materials, 4-meta resin and light-cured composite resin stimulated the ideal restoration at the apicoectomised portion.

本课题的研究结果总结如下：(1)难治性根尖周炎的分类和诊断。结果表明，难治性根尖周炎的重要病因是根尖部分的根管不规则。本文介绍了一种新设计的用于观察牙周病患者根尖周组织和根面的纤维内窥镜。纤维镜检是一种有效的诊断方法。(2)难治性根尖周炎的发病机制。建立了一种敏感的聚合酶链式反应检测根管内细菌的方法。对感染根管的牙本质小管细菌的分布情况进行了检测。75%的被检查牙齿显示细菌侵入了牙根的牙本质小管。在慢性根尖周炎区，检测炎症细胞因子(白介素1)和前列腺素E_2。这些结果提示炎症介质与临床症状的出现密切相关。(3)难治性根尖周炎的治疗。环丙沙星、甲硝唑和米诺环素的混合物对感染根牙本质和根尖周病变的细菌有有效的治疗作用。氢氧化钙糊剂根管内敷料对治疗顽固性根尖周炎也有效。此外，抗菌剂和氢氧化钙的混合物在这种情况下也是有效的。在几种牙体充填材料中，4-Meta树脂和光固化复合树脂对根尖切除部分有较好的修复效果。