2011 年 32 巻 1 号 p. 38-46
Abstract : It is known that bacterial infection spreads not only in root canals but also around periapical tissues. Periapical lesions are an infectious disease, and so it is thought that identification of bacteria in periapical lesions and systemic administration and local application of antibiotics based on a susceptibility test are very effective. This case report describes the treatment of chronic apical periodontitis with a large periapical lesion by this method.
The patient was a 40-year-old woman. An X-ray photograph of the problem tooth, a maxillary left second molar, showed a large periapical lesion. The exudates from the periapical lesion were used for the bacterial identification and antibiotics susceptibility test. Pseudomonas aeruginosa was detected in the exudates. According to the results, cefaclom was locally applied into the root canals, and levofloxacin hydrate was systemically administered. All clinical symptoms and anaerobic cultivable bacteria disappeared and then the root canals were filled. The prognosis was good 17 months after the root canal filling.
This case suggests the usefulness of root canal treatment with identification of bacteria and systemic administration of accurate and adequate antibiotics for large periapical lesions, which are generally surgically treated.
