Dr. Ceren YILDIRIM, Dr. Özlem Martı AKGÜN, Dr. Günseli Güven POLAT

Periapikal Lezyonlu Genç Daimi Dişlerde Pulpa Dentin Kompleksinin Yenilenmesi:

Kök gelişimi tamamlanmamış, vital olmayan genç daimi dişlerin tedavilerinde çeşitli zorluklarla karşılaşılmaktadır. Geleneksel apeksifikasyon tedavisinde çok sayıda seansa gereksinim duyulmakta, hasta uyumu ile ilgili problemler yaşanmaktadır. Kalsiyum hidroksitin uzun dönem kullanımına bağlı olarak dentinin fiziksel özellikleri değişmektedir. Bu nedenle, pulpa dentin kompleksinin fonksiyonunu yeniden kazandıran ve gelişimini devam ettiren alternatif bir yaklaşım arayışına girilmiştir. Rejeneratif endodontik tedavi uygulama prosedürleri ile geride kalan apikal papillanın mezenşimal kök hücreleri ve dental pulpa kök hücreleri korunarak revaskülarizasyonu sağlamak amaçlanmaktadır. Böylece kök gelişiminin devam etmesi teşvik edilmekte ve uzun dönemde kök kırıklarına yatkınlığın azalması sağlanmaktadır. Bu makalede kök gelişimini tamamlamamış daimi dişlerin pulpa dentin kompleksinin rejenerasyonu konusu güncel literatür ışığında derlenmiştir.

Anahtar Kelimeler:

Genç daimi diş, revaskülarizasyon, üçlü antibiyotik patı.

Periapikal Lezyonlu Genç Daimi Dişlerde Pulpa Dentin Kompleksinin Yenilenmesi:

Treatment of the young permanent tooth with non- vital pulp and an incompletely developed root is challenging. The traditional apexification procedure requires multiple treatment sessions, creating problems with patient compliance and altering the mechanical properties of dentin related to use of longterm calcium hydroxide. Thus, one alternative approach is to develop and restore a functional pulpdentin complex. Regenerative endodontic treatment procedures attempting to preserve the potentially remaining dental pulp stem cells and mesenchymal stem cells of the apical papilla can result in canal revascularization. It encourages a longer and thicker root to develop thus decreasing the propensity of long term root fracture. In this article the tissue of regeneration of pulp-dentin complex in immature permanent teeth reviewed based on the current literature.

Keywords:

Immatüre permanent teeth, revascularization, triple antibiotic paste,

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Pinkham JR, Casamassimo PS, Tigue DJ, Fields HW, Nowak AJ. Çocuk Diş Hekimliği Bebeklikten Ergenliğe. 4. Baskı, 2009.
Cvek M. Prognosis of luxated non-vital maxillary incisors treated with calcium hydroxide and filled with gutta-percha. A retrospective clinical study. Endod Dent Traumatol 1992; 8: 45-55.
Siu-Fai Leung S. Revascularization of immature permanent teeth with periapical lesions-report of three consecutive cases. Hong Kong Dent J 2010; 7: 31-5.
Andreasen JO, Farik B, Munksgaard EC. Longterm calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002; 18: 134-7.
Glossary of endodontic terms. Chicago: American Association of Endodontists 2003.
Elkarim I, Kennedy J, Hussey D. The antimicrobial effects of root canal irrigation and medication. Oral Surg Oral Med Oral Pathol 2007; 103 :560-569.
Odabaş ME. Apikal Periodontitis İzlenen İmmatür Diş Pulpasının Revaskülarizasyonu: Vaka Raporu. Atatürk Üniv Diş Hek Fak Derg 2011; 21: 236-40. Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J 2007; 40: 186-97.
Chueh LH, Huang GT. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift. J Endod 2006; 32: 1205-13.
Nygaard-Ostby B, Hjortdal O. Tissue formation in the root canal following pulp removal. Scand J Dent Res 1971;79: 333–48.
Trope M. Regenerative Potential of Dental Pulp. J Endod 2008; 34: 13-7.
Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod 2004; 30: 196-200.
Cotti E, Mereu M, Lusso D. Regenerative treatment of an immature, traumatized tooth with apical periodontitis: report of a case. J Endod 2008; 34: 611-6.
Özcan E, Altuğ Özcan SS. Periodontal Rejenerasyonda Kök Hücrenin Yeri. Atatürk Üniv. Dis Hek. Fak. Derg 2010; 20: 123-30.
Gronthos S, Brahim J, Li W, Fisher LW, Cherman N, Boyde A, DenBesten P, Robey PG, Shi S. Stem cell properties of human dental pulp stem cells. J Dent Res 2002; 81: 531-5.
Shin SY, Albert JS, Mortman RE. One step pulp revascularization treatment of an immature permanent tooth with chronic apical abscess: a case report. Int Endod J 2009; 42: 1118-26.
Akgun OM, Altun C, Guven G. Use of triple antibiotic paste as a disinfectant for a traumatized immature tooth with a periapical lesion: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 62-5.
Sato I, Ando-Kurihara N, Kota K, Iwaku M, Hoshino E. Sterilization of infected root-canal dentine by topical application of a mixture of ciprofloxacin, metronidazole and minocycline in situ. Int Endod J 1996; 29: 118-24.
Windley W, Teixeira F, Levin L, Sigurdsson A, Trope M. Disinfection of immature teeth with a triple antibiotic paste. J Endod 2005; 31: 439-43.
Iwaya SI, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol 2001; 17: 185-7.
Huang GT. A paradigm shift in endodontic management of immature teeth: conservation of stem cells for regeneration. J Dent 2008; 36: 379Ritter AL, Ritter AV, Murrah V, Sigurdsson A, Trope M. Pulp revascularization of replanted immature dog teeth after treatment with minocycline and doxycycline assessed by laser Doppler flowmetry, radiography, and histology. Dent Traumatol 2004; 20: 75-84.
Gomes-Filho JE, Duarte PC, de Oliveira CB, Watanabe S, Lodi CS, Cintra LT, Bernabé PF. Tissue reaction to a triantibiotic paste used for endodontic tissue self regeneration of nonvital immature permanent teeth. J Endod 2012; 38: 91Bose R, Nummikoski P, Hargreaves K. A retrospective evaluation of radiographic outcomes in immature teeth with necrotic root canal systems treated with regenerative endodontic procedures. J Endod 2009; 35: 1343Cehreli ZC, Sara S, Aksoy B. Revascularization of immature permanent incisors after severe extrusive luxation injury. J Can Dent Assoc 2012; 78: 4.
Molander A, Reit C, Dahlén G. Microbiological evaluation of clindamycin as a root canal dressing in teeth with apical periodontitis. Int Endod J 1990; 23: 113-8.
Yamada Y, Ueda M, Naiki T, Takahashi M, Hata K, Nagasaka T. Autogenous injectable bone for regeneration with mesenchymal stem cells and platelet-rich plasma: tissue-engineered bone regeneration. Tissue Eng 2004; 10: 955-64.
Young CS, Terada S, Vacanti JP, Honda M, Bartlett JD, Yelick PC. Tissue engineering of complex tooth structures on biodegradable polymer scaffolds. J Dent Res 2002; 81: 695700.
Hargreaves KM, Geisler T, Henry M, Wang Y. Regeneration potential of the young permanent tooth: what does the future hold? Pediatr Dent 2008; 30: 253-60.
Kundabala M, Parolia A, Neeta S. Regenerative Endodontics: A Review Malaysian Dental Journal 2010; 31: 94-100.
Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod 2007; 33: 377Kim JH, Kim Y, Shin SJ, Park JW, Jung IY. Tooth discoloration of immature permanent incisor associated with triple antibiotic therapy: a case report. J Endod 2010; 36: 1086-91. Yazışma Adresi: Dr. Ceren YILDIRIM
GATA Çocuk Diş Hekimliği Bilimleri Merkezi ANKARA Telefon: 03123046045 e-mail: cerenk.yildirim@gmail.com