치근단 병소를 가진 치아의 발치 후 즉시 임플란트 식립 및 보철을 통한 심미성 회복
Immediate implant placement into extraction sites with periapical lesions in the esthetic zone: a case report
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상악 전치부는 심미적 회복이 강조되는 부위다. 발치 후 치유될 때까지 기다린다면 치조골 흡수와 치간 유두 수축을 방지할 수 없다. 일단 흡수된 조직을 재생하기 위해서는 추가적인 외과적 술식이 필요하고 치료 기간도 많이 소요된다. 발치 전 치조골과 치은 조직이 건강하다면 치주 조직을 보존 유지하기 위해 발치와 동시에 즉시 임플란트 식립을 고려할 수 있다. 특히 건전한 발치와에서의 즉시 임플란트 식립은 여러 논문에서 성공적인 결과를 보였다. 치근단 병소가 존재하는 치아의 발치 후 즉시 임플란트 식립에 대해서는 부정적인 반응을 보이는 연구가 많았으나, 최근에는 확실한 발치와의 육아조직제거와 전신적 항생제 투여 시 성공률이 높다는 결과도 보고되고 있다. 본 증례는 73세 여환으로 상악 좌측 중절치의 포스트-코어와 금속도재관이 탈락되었으며 임플란트 치료를 받고 싶다는 주소로 내원하였다. 치근단 병소와 수직적 치근 파절이 존재하였으나 치근단 병소가 있는 치아에서도 즉시 임플란트 식립의 성공사례가 여러 차례 보고되어 발치 및 즉시 임플란트 식립을 계획하였다. 발치 후 발치와 육아조직제거와 클로르헥시딘 용액 소독 및 tetracycline 용액으로 soaking을 시행한 후 임플란트를 식립하였으며 식립 전 후로 전신적 항생제를 투여하였다. 임플란트를 식립하면서 인상채득하여 2일 뒤 임시 보철물을 장착하였다. 약 6개월 뒤 치경부 형태를 재연하여 최종 인상 채득하였으며 최종 보철물을 장착하였다. 보철물 장착 후 2년까지 치은선이 인접치아와 조화를 이루고 변연골 흡수없이 심미적으로 만족할만한 결과를 얻었기에 보고하는 바이다.
Abstract
Esthetics is important in restoring maxillary anterior area. Alveolar bone resorption and loss of interdental papilla may be minimized by immediate implantation. Previous studies showed successful results with the immediate implantation in healthy extraction socket, while many of these studies objected the immediate implantation into extraction sites with periapical lesions. Recent studies, however, reported successful results of the immediate implantation into extraction sites with periapical lesions with careful debridement of extraction sockets and general medication of antibiotics prior to implantation. A 73-year-old female visited the department of Prosthodontics in ○○ University Dental Hospital with the chief complaint of fallen post-core and crown on left maxillary incisor. Although the incisor was with vertical root fracture and periapical lesion, the immediate implantation following the extraction of tooth was planned. Thorough socket debridement, irrigation with chlorhexidine, and tetracycline soaking were followed by immediate implantation. The general medication of antibiotics (Moxicle Tab, 375 mg) was prescribed before and after the surgery. Immediate provisional restoration was delivered two days after the surgery, and the definitive metal-ceramic restoration was placed about six months later after reproducing the emergence profile from the provisional restoration. This case presents satisfying result esthetically and functionally upto two years after the placement of prosthesis with the harmonious gingival line and no loss of marginal bone.
참고문헌 (23)
- Chen ST, "Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes", Int J Oral Maxillofac Implants, 19, pp.12~25 (2004)
- Tan WL, "A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans", Clin Oral Implants Res, 23, pp.1~21 (2012)
- Schwartz-Arad D, "The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review", J Periodontol, 68, pp.915~923 (1997)
- Novaes AB Jr, "Immediate implants placed into infected sites: a histomorphometric study in dogs", Int J Oral Maxillofac Implants, 13, pp.422~427 (1998)
- Peñarrocha M, "Immediate implants after extraction. A review of the current situation", Med Oral, 9, pp.234~242 (2004)
- Quirynen M, "An infected jawbone site compromising successful osseointegration", Periodontol 2000, 33, pp.129~144 (2003)
- Quirynen M, "Predisposing conditions for retrograde periimplantitis, and treatment suggestions", Clin Oral Implants Res, 16, pp.599~608 (2005)
- Villa R, "Early loading of interforaminal implants immediately installed after extraction of teeth presenting endodontic and periodontal lesions", Clin Implant Dent Relat Res, 7, pp.28~35 (2005)
- Bell CL, "The immediate placement of dental implants into extraction sites with periapical lesions: a retrospective chart review", J Oral Maxillofac Surg, 69, pp.1623~1627 (2011)
- Fugazzotto P, "A retrospective analysis of immediately placed implants in 418 sites exhibiting periapical pathology: results and clinical considerations", Int J Oral Maxillofac Implants, 27, pp.194~202 (2012)
- Siegenthaler DW, "Replacement of teeth exhibiting periapical pathology by immediate implants: a prospective, controlled clinical trial", Clin Oral Implants Res, 18, pp.727~737 (2007)
- Del Fabbro M, "Immediate implant placement into fresh extraction sites with chronic periapical pathologic features combined with plasma rich in growth factors: preliminary results of single-cohort study", J Oral Maxillofac Surg, 67, pp.2476~2484 (2009)
- Casap N, "Immediate placement of dental implants into debrided infected dentoalveolar sockets", J Oral Maxillofac Surg, 65, pp.384~392 (2007)
- Evans CD, "Esthetic outcomes of immediate implant placements", Clin Oral Implants Res, 19, pp.73~80 (2008)
- Waasdorp JA, "Immediate placement of implants into infected sites: a systematic review of the literature", J Periodontol, 81, pp.801~808 (2010)
- Esposito M, "Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications", Cochrane Database Syst Rev, (3) (2008)
- Mazzocchi A, "Moretti R. Retrospective analysis of736 implants inserted without antibiotic therapy", J Oral MaxillofacSurg, 65, pp.2321~2323 (2007)
- Becker BE, "A prospective clinical trial of endosseous screw-shaped implants placed at the time of tooth extraction without augmentation", J Periodontol, 69, pp.920~926 (1998)
- Botticelli D, "Hard-tissue alterations following immediate implant placement in extraction sites", J Clin Periodontol, 31, pp.820~828 (2004)
- Botticelli D, "Resolution of bone defects of varying dimension and configuration in the marginal portion of the peri-implant bone. An experimental study in the dog", J Clin Periodontol, 31, pp.309~317 (2004)
- Covani U, "Bucco-lingual bone remodeling around implants placed into immediate extraction sockets: a case series", J Periodontol, 74, pp.268~273 (2003)
- Degidi M, "Immediate functional and non-functional loading of dental implants: a 2- to 60-month follow-up study of 646 titanium implants", J Periodontol, 74, pp.225~241 (2003)
- De Rouck T, "Single-tooth replacement in the anterior maxilla by means of immediate implantation and provisionalization: a review", Int J Oral Maxillofac Implants, 23, pp.897~904 (2008)