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치수가 괴사된 미성숙 치아에서의 재생근관치료

Regenerative endodontic treatment of an immature tooth with necrotic pulp

김민석|김선헌|박민지
대한구강해부학회 (The Korean Academy Of Oral Anatomy)|2017.12|대한구강해부학회지 (The Korean Journal of Oral Anatomy)|제38권 제1호|pp. 31-41|DOI 10.35607/kjoa.38.1.201712.003

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참고문헌

키워드

재생Regeneration근관치료Endodontic treatmentImmature tooth미성숙치아

초록

재생이란 유기체에서 상실 또는 손상된 부위가 새로 생겨나 본래의 기능을 회복하는 것이며, 재생의학은 의학계에서 최근 가장 주목받는 연구 분야이다. 이는 단순히 손상된 조직이나 기관을 대체하는 것에 그치지 않고 생물학적 재생을 촉진 또는 유도하는 성장과 분화 인자를 치료에 도입하는 것이며, 치의학 분야에서도 치아 및 그 주변조직의 손상부위를 생물학적으로 회복시키는 목표를 실현하기 위한 많은 연구가 진행되고 있다. 지금까지 외상이나 우식 등의 원인에 의해 치수조직이 손상되었을 경우 전통적으로 근관 내 오염된 치수를 제거하고 세정, 성형, 불활성재료로의 근관충전 후 수복을 실시하는 치료법이 선택되었으나, 미성숙 영구치의 치료에는 여러 한계가 있는 것이 사실이다. 따라서 성장이 멈춘 치근의 두께와 길이를 모두 증대시킬 수 있는 재생근관치료는 기존의 전통적 근관치료를 대체할 수 있는 좋은 방법으로 고려될 수 있다. 괴사된 치수를 가진 미성숙 영구치에 대한 재생근관치료의 적용을 위해 많은 연구들이 진행되어 왔으나 임상적 유용성을 높이기 위해 재생근관치료의 근거가 되는 치근 성장, 치수-상아질 복합체 발생의 이해를포함하는 보다 많은 연구를 필요로 한다. 이에 본 연구는 재생근관치료에 대한 여러 문헌 및 임상 증례를 고찰하여 그 과정을 이해하고 예후에 대한 철저한 분석을 통해 실제 임상에서 재생 근관치료의 폭 넓은 활용 방안을 모색하고자 한다.

Abstract

Regeneration is a process that involves replacing a missing or damaged part of an organism to recover its structure and function; this has recently become one of the most promising concepts in medicine. According to this concept, practitioners not only replace the damaged parts or organs but also incorporate into clinical procedure the growth and differentiating factors that biologically stimulate and induce the regeneration process. Similarly, many studies have been conducted in dentistry to develop treatment protocols that help biological recovery of a damaged tooth and the surrounding periodontal tissues. When pulp of a tooth is infected due to trauma or caries, the traditionally administered treatment is root canal therapy which removes the intracanal pulp, cleans and shapes the canal space, and fills it with inactivated material; however, some limitations of using this method in immature permanent teeth have been reported. To overcome such limitations in immature teeth, regenerative endodontic treatment procedure can be an alternative that promotes the growth of both canal wall width and canal length. Many studies regarding regenerative endodontic procedure of immature permanent teeth with necrotic pulp have been done so far; however, further studies that consider the root growth process and the development of pulp–dentin complex are necessary to increase the clinical usefulness of these methods. Accordingly, this study aimed to thoroughly understand the regenerative endodontic treatment procedure and analyze its prognosis by reviewing previous related studies. It also was focused on seeking ways to apply this procedure in actual everyday clinical situations.

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