Journal Article 大臼歯部への第三大臼歯自家移植の臨床的検討

阿部, 結奈  ,  松沢, 祐介  ,  鄭, 漢忠

36 ( 2 )  , pp.98 - 109 , 2016-03 , 北海道歯学会
【目的】歯の移植は咬合再建の選択肢の1つである.歯の移植の治療成績に関する報告は多いが,第三大臼歯の大臼歯部への移植に限定した報告は極めて少ない.本研究の目的は日常臨床で最も頻度の高い大臼歯部への第三大臼歯の移植の治療成績と予後に影響する因子を分析し,受容部と移植歯の関係と治療成績について検討を行い,その結果を日常臨床に反映させることである. 【対象と方法】1997年7月から2015年3月までに当科で歯の移植を行った症例のうち大臼歯部に第三大臼歯を移植した症例を対象1とした.そのうち経過観察期間が6か月以上の症例を対象2とした.手術は通法に従い,移植後1,2,3,6,9か月,1,1.5,2年,以後は年1回の間隔で口腔内診査およびX線学的検査を行い,結果を判定した.抜歯あるいは脱落に至った症例を抜歯群,それ以外を生着群とした.生着群のうち,臨床所見およびX線学的所見に問題がない症例を良好群,一部問題がある症例を非良好群とした.対象1に対し,全体の生存率を算出し,種々の因子(年齢,性別,移植法,移植歯の歯種,歯根完成度,萌出状態,受容部の部位,欠損の状態)における 生存率の違いを比較した.また,対象2に対し,移植歯の種類と受容部の部位の関係を検討した. 【結果】対象1は552例615歯,対象2は341例390歯であった.全体の1年生存率は97.7%,5年生存率は86.2%であった.統計学的に生存率は単変量解析では性別,移植法,移植歯の種類,受容部の部位に,多変量解析では移植歯の種類,受容部の部位,欠損の状態に有意差を認めた.移植歯の種類と受容部の部位の関係では下顎の第三大臼歯を同顎同側に移植した場合が最も良好群の割合が高かった. 【結論】移植歯は下顎第三大臼歯が,移植歯と受容部の関係では同顎同側あるいは対顎対側への移植が望ましかった.第一大臼歯部が最後方歯になると予知性は低かった.
Tooth autotransplantation is one of the valuable treatments for recovering the occlusal function of missing teeth. The purpose of this study is to analyze treatment outcomes and prognosis factors of autotransplantation of the third molar to the molar region and to reflect on the result in clinical practice. Patients and methods : Study 1 comprised of patients with transplants from July 1997 to March 2015 at Hokkaido University hospital, and third molars transplanted to the molar region. The subjects that the transplanted teeth were extracted or fell out were defined as the extraction group, the others were defined as the survival group. Among them, the survival case had a follow-up period of over 6 months and were described in study 2. The patients conditions were followed up regularly at 1, 2, 3, 6 and 9 months and at 1, 1.5 and 2 years postoperatively and afterwards once a year, clinically and radiographically. Among the survival group, the cases that clinical findings and radiographic findings were good were termed the good-outcome group, and the cases with some problems were termed the poor-outcome group. For Study 1, we calculated the overall survival rate and compared the difference in the survival rate in various factors (age, sex, transplantation method, type, root formation, eruption status of donor tooth, region of recipient site, and classification of missing tooth). For Study 2, we examined the relationship of the type of donor teeth and the region of recipient site. Results :  Study 1 was 552 cases and 615 teeth, and the study 2 was 341 cases and 390 teeth. All 1-year survival rate was 97.7%, and the 5-year survival rate was 86.2%. There were recognized significant difference in sex, transplantation method, type of donor tooth, and region of recipient site by single variable analysis, and the type of donor tooth, region of recipient site and a classification of missing tooth by multivariate analysis. When transplanting the third molar to the molar region of the same quadrant, the ratio of the good group was the highest. Conclusion :  By this result, it is thought that the transplantation of the lower third molar to the second molar region of the same quadrant resulted in good treatment outcomes.

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