İNFLAMASYONLU DİŞLERDE ANESTEZİ YETERSİZLİĞİ VE GÜNCEL ÇÖZÜM ÖNERİLERİ

Geri dönüşümsüz pulpitisli hastalarda başarılı lokal anestezi elde etmek, diş hekimleri için büyük bir sorun oluşturmaktadır. İnflamatuar lezyonları olan, pulpitis ve apikal periodontitisli dişlerde anestezi etkinliği oldukça azalmaktadır. Bu dişlerde anestezi başarısızlığı ile ilgili; iyon tuzağı mekanizması (inflamatuar asidoz mekanizması), peroksinitritlerin etkisi, inflamasyonun periferal vasküler sistem üzerindeki etkisi, nosiseptörlerin membran uyarılabilirliğinin değişimi, tetradoksine (TTX) dirençli sodyum (Na) kanalları ve santral sensitizasyon teorisi gibi birçok neden öne sürülmüştür. Bu derlemede geri dönüşümsüz pulpitisli dişlerde anestezi başarısızlığı için önerilen teoriler ve başarısızlığa karşı uygulanabilecek güncel yaklaşımlar literatür bilgileri ışığında tartışılmıştır. Anahtar kelimeler: Anestezi başarısızlığı, geri dönüşümsüz pulpitis, inflamasyon, lokal anestezi Anesthesia Failure in Inflamed Teeth and Current Solution Recommendations Abstract Successful local anesthesia in irreversible pulpitis is a major problem for dentists. The effects of anesthesia on the teeth with inflammatory lesions, pulpitis and apical periodontitis are considerably reduced. Several reasons have been proposed for the failure of anesthesia in these teeth, such as the mechanism of ion trap (mechanism of inflammatory acidosis), the effect of peroxynitrite, the effect of inflammation on the peripheral vascular system, the change of membrane excitability of nociceptors, tetradoxine (TTX) resistant sodium (Na) channels and central sensitization theory. In this review, the theories proposed for failure of anesthesia in irreversible pulpitis and current approaches to failure are discussed in the light of the literature. Keywords: Anesthesia failure, inflammation, irreversible pulpitis, local anesthesia

Anahtar Kelimeler:

Anestezi başarısızlığı, geri dönüşümsüz pulpitis, inflamasyon

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