Rejeneratif Endodontik Tedavide Biyomalzeme Seçimi ve Doku Mühendisliği Uygulamaları

Dental pulpa mine, dentin, sement gibi yüksek oranda mineralize dokularla çevrili ve dişin homeostazını sağlayan yumuşak bir bağ dokusudur. Pulpa dokusu, odontoblastik hücrelerin anatomik düzeni ve postmitotik yapısı nedeniyle kısıtlı bir rejenerasyon yeteneğine sahip özelleşmiş bir mineralize dokudur. Diş çürüğü veya enflamasyon nedeniyle çok hızlı şekilde nekrotik hale gelip, endodontik tedaviye gereksinim duyabilir. Klasik endodontik tedavi enfekte pulpa dokusu ve kök dentininin uzaklaştırılıp dezenfekte edilen kanal boşluğunun hermetik sızdırmazlığı sağlayacak şekilde bioinert bir malzeme ile doldurulması esasına dayanır. Kök oluşumunu tamamlamamış immatur ve nekrotik pulpalı dişlerde ise Ca(OH)2 ve MTA (Mineral Trioksit Agregat) kullanılarak apikal bir bariyer oluşturulacak şekilde tedavi uygulanmaktadır. Bu yöntemlerle tedavi edilen dişte kök uzunluğunda ve kalınlığında artış olmamaktadır. Bu nedenle bu dişler ömür boyu devital ve zayıf bir diş olarak kalmaktadırlar. Endodontik tedavide en çok arzu edilen devital ve nekrotik pulpanın sağlıklı pulpa dokusu ile yer değiştirmesidir. Rejeneratif endodontik tedavi klasik endodontik tedaviye bir alternatiftir. Rejeneratif endodontik tedavi ''dentin ve kök yapılarının yanı sıra pulpa-dentin kompleksinin hücreleri de dahil olmak üzere hasarlı diş yapılarını tedavi etmek için tasarlanmış biyolojik tabanlı prosedürler '' olarak tanımlanır. Biomateryal bilimi ve doku mühendisliği teknolojisindeki son gelişmeler rejeneratif endodontik tedavi yönteminin gelişmesini teşvik etmiştir. Doku mühendisliğinin temelini oluşturan kök hücre, doku iskelesi ve büyüme faktörleri ile rejeneratif endodontik tedavi alanında çok sayıda çalışmalar yapılmaktadır. Şu anda önerilmekte olan pulpa rejenerasyonu teknikleri henüz geliştirme aşamasındadır. Bu derleme de, güncel rejeneratif endodontide kullanılan klasik doku mühendisliği üçlüsü olarak da adlandırılan farklı kök hücre, büyüme faktörleri ve doku iskeleri ile ilgili çalışmalar incelenmiştir. Ayrıca rejeneratif endodontik uygulamalar için geliştirilen organoidler ve çip üstü organlar ile tedavi yaklaşımları da sunulmuştur. Rejenerasyonun kanserle olası bağlantısına yer verilmiştir. Son olarak rutin klinik uygulamalar için geliştirilen tedavi prosedürünün aşamaları özetlenmektedir.

Anahtar Kelimeler:

Dental Pulpa, , Rejeneratif Endodonti, Biyomalzeme, Doku Mühendisliği

Biomaterial Selection and Tissue Engineering Applications in Regenerative Endodontic Treatment

Dental pulp is a soft connective tissue that is surrounded by highly mineralized tissues such as enamel, dentin, cementum and provides homeostasis of the tooth. Pulp tissue is a specialized mineralized tissue with a limited regeneration ability due to the anatomical arrangement and postmitotic structure of odontoblastic cells. Classical endodontic treatment is based on removing the infected pulp tissue and root dentin and filling the disinfected canal cavity with a bioinert material to ensure hermetically sealed. It may quickly become necrotic due to tooth decay or inflammation and may require endodontic treatment. In immature that have not completed root formation and necrotic pulp teeth, an apical barrier is formed by using Ca(OH)2 and MTA (Mineral Trioxide Aggregate). There is no increase in root length and thickness in the tooth treated with these methods. For this reason, these teeth remain devital and weak teeth for life. The most desired in endodontic treatment is the replacement of devital and necrotic pulp with healthy pulp tissue. Regenerative endodontic therapy is an alternative to classical endodontic therapy. Regenerative endodontic therapy is defined as '' bio-based procedures designed to treat damaged tooth structures, including cells of the pulp-dentin complex, as well as dentin and root structures. ''Recent advances in biomaterial science and tissue engineering technology have encouraged the development of regenerative endodontic treatment method. Numerous studies are carried out in the field of regenerative endodontic treatment with stem cells, tissue scaffold and growth factors, which are the basis of tissue engineering. Pulp regeneration techniques that are currently proposed are still under development. In this review, studies on different stem cells, growth factors and tissue scaffolds used as the classical tissue engineering trio used in current regenerative endodontics are reviewed and the stages of the treatment procedure developed for routine clinical applications are summarized. In addition, organoids and organ-o-a-chip treatment approaches developed for regenerative endodontic applications were also presented. The relationship between regeneration and cancer was given. Finally, the stages of the treatment procedure developed for routine clinical applications were included.

Keywords:

Dental Pulp, Regenerative Endodontics, Biomaterials, Tissue Engineering,

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