骨小片移植を応用した歯根端切除手術に関する研究

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Apicoectomy was first established by Farrar, Partsch, etc., and has found general application in dental and oral surgery at present. However, the follow-up studies on the cases where the classical technique has been applied revealed occasionally unfavorable result such as the concaved healing of the bone wound and absorption of the remaining portion of operated root. The purpose of this paper is to elucidate the healing process after apicoectomy with use of the bone chips as grafting material. The experimental apicoectomy was performed on dog's lower jaw. Both autogenous local bone chips and heterogenous ones from the Kiel bone were respectively transplanted into the defects created by apicoectomy, and the results were compared for the healing process between animals treated under the conventional technic and those treated under the bone chip implant technique. Based on these experiences, the present author attempted to go into more detailed study of the bone chip implant technic on patients admitted in the Clinic on the basis of long term observation. The results were summarized as follows. 1. In cases where grafting of local autogenous bone chips was conducted, there appeared the network of immature trabeculae growing out from the wall of the defect into the cavity at about ten days after the operation, and at the same time a vigorous neogenesis of bone was seen taking place in the peripheries of the transplanted bone chips. 2. The newly developed trabeculae proliferated progressively and became closely fused with the bone chips nearby, and at approximately 30 days after the operation, there already started reconstruction of normal bone structure eventually leading to a successful bony healing of the wound. 3. Regeneration of the periodontal membrane at the resected apical end of tooth was seen earlier in the autogenous bone chip implant cases than in the otherwise treated cases. 4. This early repair of periodontal membrane at the resected apical end of tooth would seem to be one of the excellent features of the present implant method, because it led to both the early restoration of the bony defect and prevention of local concave deformation on the mandible. 5. In case where the Kiel bone chips were used for grafting, osteogenetic process from the wall of the defect played the main role in the restoration of the wound, and the Kiel bone chips were seen to become enveloped by the proliferating trabeculae to form the picture of bony healing of the wound. 6. In the Kiel bone chips group, radiographic observations showed the presence of the bone chips left unresorbed and imbedded in the trabeculae even at 150 days after the operation, indicating marked retardation of healing as compared to the group where the autogenous local bone chips were used for the grafting. With respect to the rate of regeneration of the periodontal membrane at the apicoectomized end of tooth, however, both groups showed much the same results. 7. In patients where the autogenous local bone chips were used for grafting, disappearance of contours of individual chips by homogenous fusion with the developing trabeculae was observed by 60 days after the operation, indicating an accelerated healing of wound as compared to control patients. 8. The application of autogenous bone chips in apicoectomy has gained more favorable results than would be expected from the conventional technique in the prevention of concave defect of the bone in the operated field, the regeneration of periodontal membrane at the resected end of the root and the early healing of cavitated bony wound. 9. In patients where the Kiel bone chips were for used grafting, the retention of the grafted chips in the wound was observed by X-ray for more than several months which suggested that it would take even years to see such wound completely healed on the X-ray diagnostic basis. 10. Although the application of Kiel bone chips in filling the bony befects may have some advantage, the operator is advised in practice of the technique to pay a long continued observation for supervising the healing process of his operation.
九州歯科学会の論文
1970-05-31

骨小片移植を応用した歯根端切除手術に関する研究

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