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口腔衛生指導と補綴治療による唾液流量増加と口腔環境の改善に関する臨床的研究−唾液液量とカンジダ菌との関連−
Get PDFapplication/pdf近年の超高齢社会の訪れにより基礎疾患の増加，内服薬の多種類化およびストレスの負荷など により，唾液流量の低下がもたらされ，口腔乾燥 症に伴う口腔粘膜の委縮，齲蝕，嚥下困難および 真菌感染症などの症状を引き起こす結果となって いる．また，咀嚼回数の減少が，唾液腺の萎縮や 唾液の合成分泌の低下をもたらすとの説がある． 口腔乾燥症の改善方法として，飲水，含水，人工 唾液製剤や口腔保湿液の使用などが用いられてい るが，必ずしも効果があるとは限らない． 今回，口腔乾燥症治療のアプローチとして，口 腔衛生指導と補綴治療が唾液流出におよぼす影響 について検討した． 対象者は，平成１２年から１８年の７年間に神奈川 歯科大学附属病院を受診し，口腔乾燥感ならびに 口腔不快症状を訴えた３１名であり，以下の４群に 分類した． 口腔乾燥感または口腔不快感を訴えているが， 補綴治療が必要なく初診時診査から口腔衛生指導 のみを行った群（衛生指導群），口腔衛生指導の 他にクラウン・ブリッジ・部分床義歯・全部床義 歯の製作および義歯調整などの何らかの補綴治療 を併せて行った群（衛生指導＋補綴群），何らか の全身疾患を有しながら口腔衛生指導と補綴治療 を併せて行った群（有病者＋補綴群），シューグ レン症候群と診断され口腔衛生指導と補綴治療を併せて行った群（シューグレン＋補綴群）であ る．以上のように，すべての対象者に対して口腔 衛生指導は行った． 安静時唾液量は，衛生指導群，衛生指導＋補綴 群で有意に増加が認められた．刺激時唾液量は， 衛生指導＋補綴群および有病者＋補綴群におい て，初診時と比較して１２週間まで有意に増加し た． 初診時にカンジダ菌が検出された対象者の中 で，衛生指導＋補綴群，有病者＋補綴群におい て，初診後１２週間後まで経時的にカンジダ菌の減 少が著明に認められた． O’Leary のプラークコントロールレコードを利 用した評価スコアにより，口腔清掃状態の改善に ついて，それぞれの対象者群で経時的に検討し た．すべての群において，口腔清掃状態の改善を 認める対象者が認められた． 初診時の患者口腔内に認められた症状は， シェーグレン＋補綴群，有病者＋補綴群，衛生指 導＋補綴群の順番に重篤度を示した．治療が進行 するに従い，初診後１２週間後まで，経時的にその 症状は軽減した． 口腔乾燥感は，すべての患者群において，初診 後１２週間後まで経時的に軽減した． 以上の結果から，口腔衛生指導単独と比較し て，口腔衛生指導と補綴処置の併用治療により唾 液流出量を増加させることが示された．その結果 として，カンジダ菌を減少させ，口腔乾燥症状改 善が可能であると考えられた．口腔衛生指導と補 綴治療による咀嚼機能改善を同時に行うことが， 口腔乾燥症の治療に有用であることが示唆され た．journal articl
Chapter 1 : Root Canal Treatment and the Role of Filling Materials
Get PDF9784905130062application/pdfEndodontics includes diagnosis and treatment as well as management of pulpal and periapical diseases. Treatment aims to reduce inflammation of the periapical tissues, to dissolve remaining organic material, and to counteract coronal microleakage in the root canal through the use of medication and mechanical instruments. Finally, irrigated root canals should be obturated with filling material and sealer to prevent reinfection.Editor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo
Chapter 9 : Clinical and Radiographic Observation of Permanent Teeth with Incompletely Formed Roots after Root Canal Therapy
Get PDF9784905130062application/pdfA total of 33 teeth with 66 root canals were clinically diagnosed as irreversible pulpitis, and 38 teeth with 53 canals were diagnosed as apical periodontitis. Those 71 teeth had 119 root canals, with incompletely formed roots, and they underwent root canal therapy and filling using a formulation of calcium hydroxide and iodoform called Vitapex and were clinically observed for 30 to 1312 days. The following are the results and conclusions. 1: After root canal therapy, the condition of the root canal filling material was determined by radiograph In 66 root canals with irreversible pulpitis, 16 cases were overfilled, 11 cases were flush and 39 cases were underfilled. In 53 cases with apical periodontitis, 28 cases were overfilled, 10 cases were flush and 15 cases were underfilled. 2: Clinical discomfort was experienced in 10 cases with irreversible pulpitis and in 3 cases with apical periodontitis. However, most of the discomfort was of a mild degree and disappeared within a week. 3: At the last observation, a high frequency of closure of the root apex was observed by radiograph. Cases with apical periodontitis tend to have a slight delay in inducing closure of the root apex compared with cases with irreversible pulpitis. However, after 540 days, closure of the root apex was observed in all cases. 4: Clinical and radiographic findings show that in 33 cases with irreversible pulpitis, 23 cases were good, 9 cases were fair and 1 case was poor. On the other hand, in 38 cases with apical periodontitis, 35 cases were good, 2 cases were fair and 1 case was poor.Editor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo
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Get PDF9784905130062application/pdfEditor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo
Chapter 3 : An In Vivo Examination of the Fate of the Components of a Root Canal Filling Paste made of Calcium Hydroxide and Iodoform with Silicone Oil
Get PDF9784905130062application/pdfUsing radioactive compounds, we investigated the fate of the calcium hydroxide and dimethylpolysiloxane (silicone oil) components in a root canal filling paste. The paste was made of calcium hydroxide and iodoform with the addition of silicone oil. Whole body, light, and electron microscopic autoradiographic surveys were used. Additionally, quantitative analysis using a liquid scintillation spectrometer was performed on the component dimethylpolysiloxiane. The calcium component moved to the bone tissue through the body fluid and blood, and some of it was excreted through the digestive tract. The calcium came partly from the calcium components of the paste in both types of heterotopic calcifications: dystrophic and matrix vesicle. Some of dimethylpolysiloxane component also passed into the digestive tract. Furthermore, the dimethylpolysiloxane played some part in the calcification caused by the embedded paste.Editor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo
Chapter 8 : Experimental Studies of Root Canal Therapy for Infected Nonvital Permanent Teeth with Incompletely Formed Apices
Get PDF9784905130062application/pdfA total of 160 root canals in 90 teeth with incompletely formed roots of puppies were prepared for infected root canal therapy. The experimental group was treated with Vitapex and the control group was treated with calcium hydroxide-CMCP paste root canal filling material. Histopathological sections from decalcified specimens were prepared after observation periods of 30, 60, 120 and 180 days. In addition, 24 root canals in 16 teeth were treated with Vitapex on the opposite side with sound teeth and subjected to tetracycline administration. Observations were carried out by contact microradiography and tetracycline labeling and resulted in the following conclusions. 1: Almost no root growth was observed using both root canal filling materials, and the addition of newly-formed hard tissue was observed close to the root apical foramen involved. 2: The addition of hard tissue after root canal filling was thought to be primarily by cementum. 3: A greater amount of hard tissue formation resulting in closure of the apex and a more favorable outcome was observed in the control group than in the experimental group. 4: The control group had a higher percentage of hard tissue formation outside the root apex close to the root tip than did the experimental group. 5: The experimental group showed good results in each observation period. The control group showed better results with a shorter observation period than did the experimental group, but in longer observation periods, tended to decrease in cases with poor results. 6: Undecalcified specimens were examined using contact microradiography and tetracycline labeling. In the experimental group, the addition of newly-formed hard tissue was observed close to the apical foramen near the root tip formed during the course of treatment. Normal root formation in the dental arch was observed in all samples in the experimental and control groups.Editor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo
Chapter 11 : Histopathological Evaluation of Combined Root Canal Filling: An Animal Study
Get PDF9784905130062application/pdfSince the study of root canal filling combined with gutta-percha points and endodontic cement by Dixon and Rickert, many other studies have made use of radiographic evaluation. However, histopatholgical evaluations are infrequent and often incomplete in terms of findings. In this chapter we report the results of our examination using gutta-percha points and a new endodontic cement called KEZ with powder components: 40% zinc oxide, 20% calcium hydroxide, 20% iodoform, and 20% resin; and liquid components: 90. 5% eugenol, 9% resin and 0.5% setting agent. One hundred dog teeth were perforated using a rotary cutting instrument. The exposed pulp chamber was left opened for 30 days. Rotary reamers were used to perforate the infected root canals at the apical portion. They were cleaned with sodium hypochlorite and saline solution. Fifty canals were filled with combined gutta percha and KEZ. In the other fifty, no root canal filling was used and the teeth were restored with amalgam. Three months later the dogs were sacrificed and specimens for histopathological evaluation were prepared. Resuts were as follows. Root canals filled with a combination of guttapercha and KEZ manifested proper sealing of the apical apex, appropriate radiopacity, and reliable healing of the apical periodontal tissues. In unfilled root canals, no reparative change occurred. Moreover, when root canals were filled, alveolar bone regeneration, closure of the root apex and cicatrization of the periodontal tissue in deep layers occurred. In addition, sealing of the artificially-made apical foramen was observed in some cases. When canals were filled, both inflammatory cell infiltration and suppuration tended to decrease. Alveolar bone resorption and closure of the root apex occurred as a consequence of new cementum or bone deposition.Editor, Toshiyuki KawakamiLanguage Editor, David M Carlsonviii, 232 p. ill. (some col.)boo