Irokawa Daisuke, Bizenjima Takahiro, Imamura Kentaro, Inagaki Satoru, Saito Atsushi, Tomita Sachiyo
Department of Periodontology, Tokyo Dental College.
Tokyo Dental College Chiba Dental Center.
Bull Tokyo Dent Coll. 2020 Dec 16;61(4):265-273. doi: 10.2209/tdcpublication.2020-0020. Epub 2020 Nov 10.
Here, we report a case of generalized chronic periodontitis with furcation involvement that was treated successfully by means of surgical intervention. The patient was a 43-year-old man requesting treatment for periodontal disease. An initial examination revealed 42% of sites with a probing depth of ≥4 mm and 42.9% of sites with bleeding on probing. The maxillary molars showed varying degrees of furcation involvement. Radiographic examination revealed bone resorption in the molar and mandibular anterior teeth regions. Microbiological examination of subgingival plaque revealed the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia. The patient's oral health-related quality of life (OHRQL) was also assessed. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy was performed. Plaque control, scaling and root planing, extraction, temporary fixed restoration, occlusal adjustment, and root canal treatment were implemented. Following reevaluation, open flap debridement was performed at selected sites. Root resection was performed on the distal root of #16. Prosthetic treatment was then initiated for recovery of oral function. After confirmation of appropriate occlusion and cleanability, the patient was placed on supportive periodontal therapy. Root resection improved cleanability. This clinical improvement has been adequately maintained over a 2-year period. The patient's OHRQL score showed a slight deterioration during the supportive periodontal therapy OK period, however. This indicates the need for further careful monitoring of periodontal conditions, as well as of how they are perceived by the patient themselves.
在此，我们报告一例伴有根分叉病变的广泛性慢性牙周炎病例，该病例通过手术干预成功治愈。患者为一名43岁男性，因牙周疾病前来求治。初步检查发现42%的位点探诊深度≥4 mm，42.9%的位点探诊出血。上颌磨牙呈现不同程度的根分叉病变。影像学检查显示磨牙区和下颌前牙区有骨吸收。龈下菌斑的微生物学检查发现存在牙龈卟啉单胞菌、伴放线聚集杆菌和福赛坦纳菌。还评估了患者的口腔健康相关生活质量（OHRQL）。基于重度慢性牙周炎的临床诊断，进行了初始牙周治疗。实施了菌斑控制、龈上洁治和根面平整、拔牙、临时固定修复、咬合调整以及根管治疗。重新评估后，在选定部位进行了开放瓣清创术。对16号牙的远中根进行了截根术。然后开始进行修复治疗以恢复口腔功能。在确认咬合合适且易于清洁后，让患者接受支持性牙周治疗。截根术改善了清洁情况。这种临床改善在2年期间得到了充分维持。然而，在支持性牙周治疗期间，患者的OHRQL评分略有下降。这表明需要进一步仔细监测牙周状况以及患者自身对这些状况的感受。
