歯内療法成功のためのコーンビームCT活用法

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非外科的，外科的再根管治療での活用897h図8-12a：上顎右側中切歯および側切歯の口内法エックス線写真．大きな根尖部透過像が認められる．中切歯は既根管治療歯で，根管充塡の緊密度と到達度は十分に標準的であるといえる．b：上顎右側側切歯のCBCT矢状断像では，根尖部に歯根吸収と，非常に大きく，境界明瞭な透過像が確認できる．なお唇側歯槽骨は欠損している．c：上顎右側中切歯のCBCT矢状断像では，同歯が根尖部骨欠損と関連し，包含されていることがわかる．d：インプラント治療用ソフトウェアは，病変の全体像と周囲の解剖学的構造を含む三次元立体構成画像を作成できるため，治療に役立つ．e：DICOMデータを用いて作製した解剖学的構造のナイロンモデルは，視覚化の向上と外科的治療方針の立案に有用となりうる（Cavendish Imaging, London, UK）．f, g：上顎右側中切歯は外科的再根管治療，同側切歯は根管治療と根尖切除術にて対応した．h：同歯の術後1年の口内法エックス線写真では，著明な骨の増生をともなう治癒が確認できる．cebgdaf参考文献1.Abella F, Patel S, Durán-Sindreu F, Mercadé M, Roig M. Mandibular first molars with disto-lingual roots: review and clinical management. Int Endod J 2012;45:963–978.2.Azim AA, Griggs JA, Huang GT. The Tennessee study: factors affecting treatment outcome and healing time following nonsurgical root canal treatment. Int Endod J 2015; doi: 10.1111/iej.12429 [Epub ahead of print].3.Bernardes RA, de Moraes IG, Húngaro Duarte MA, Azevedo BC, de Azevedo JR, Bramante CM. Use of cone-beam volumetric tomography in the diagnosis of root fractures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:270–277.4.Blattner TC, Goerge N, Lee CC, Kumar V, Yelton CD. Efficacy of cone-beam computed tomography as a modality to accurately identify the presence of second mesiobuccal canals in maxillary first and second molars: a pilot study. J Endod 2010;36:867–870.5.Bornstein MM, Bingisser AC, Reichart PA, Sendi P, Bosshardt DD, von Arx T. Comparison between radiographic (2-dimensional and 3-dimensional) and histologic findings of periapical lesions treated with apical surgery. J Endod 2015;41:804–811.6.Bornstein MM, Lauber R, Sendi P, von Arx T. Comparison of periapical and limited cone-beam computed tomography in mandibular molars for analysis of anatomical landmarks before apical surgery. J Endod 2011;37:151–157.7.Cheung GSP, Wei WL, McGrath C. Agreement between periapical radiographs and cone-beam computed tomography for assessment of periapical status of root filled molar teeth. Int Endod J 2013;46:889–895.8.D’Addazio PS, Campos CN, Özcan M, Teixeira HGC, Passoni RM, Carvalho ACP. A comparative study between cone-beam computed tomography and periapical radiographs in the diagnosis of simulated endodontic complications. Int Endod J 2011;44:218–224. 9.Davies A, Mannocci F, Mitchell P, Andiappan M, Patel S. The detection of periapical pathoses in root filled teeth using single and parallax periapical radiographs versus cone beam computed tomography – a clinical study. Int Endod J 2015;48:582–592.10.Davies A, Patel S, Foschi F, Andiappan M, Mitchell PJ, Mannocci F. The detection of periapical pathoses using digital periapical radiography and cone beam computed tomography in endodontically retreated teeth - part 2: a 1 year post-treatment follow-up.Int Endod J 2016;49(7):623-635.