Klinik Koşullarda Etkilenmiş Dentin Ve Enfekte Dentin Ayrımı

Dünya genelinde en yaygın görülen hastalıklardan olan diş çürüğü, ağrı ve hassasiyet gibi semptomlarla ortaya çıkabilmekte ve diş dokusunun yıkımına, çiğneme fonksiyonu kaybına ve estetik olmayan görünüme sebep olabilmektedir. Günümüzde artan çürük oranıyla beraber süt ve sürekli dişlerde derin dentin çürükleriyle karşılaşılma sıklığı da artmıştır. Derin dentin çürüğü terimi; çürüğün tamamının kaldırılmasıyla pulpanın ekspoz olma riskinin bulunduğu durumlarda kullanılmaktadır. Süt dişlerinin, sürekli dişler sürene kadar yer tutucu olarak görev yapmaları ve genç sürekli dişlerin kök gelişimlerinin devam edebilmesi amacıyla bu dişlere uygulanacak tedavilerin mümkün olduğunca vital tedaviler olması gerektiği vurgulanmaktadır. Bu sayede pulpa dokusunun canlılığını koruması ve devam ettirmesi amaçlanmaktadır. Derin çürük tedavisi sırasında çürüğün tamamının temizlenmesi pulpa perforasyonlarının ortaya çıkmasına yol açmaktadır. Meydana gelen pulpa perforasyonu dişin uzun dönem prognozunu olumsuz yönde etkilemektedir. Bu nedenle, etkilenmiş ve enfekte dentin ayrımı konservatif tedavide koruyucu yönlendirme sağlaması açısından önemlidir. Laboratuvar çalışmalarında, enfekte dentin ile etkilenmiş dentin arasındaki sınır gözle ayırt edilebilirken, klinikte diş hekimleri belli rehber kriterler kullanarak, bu sınırın nerede ortadan kalktığına ve uzaklaştırılması gereken dentin miktarına subjektif olarak karar verirler. Bu nedenle hekimler arasında kaldırılan dokunun nitelik ve miktarında varyasyonlar olabilmektedir. Sonuç olarak, ideal bir tedavi için tüm hekimlerin etkilenmiş ve enfekte dentin ayrımını ve klinik özelliklerini iyi bilip ne kadarının uzaklaştırılması gerektiğine doğru olarak karar verebilmesi gerekmektedir.

Differentiation of Affected Dentin and Infected Dentin Under Clinical Conditions

Tooth decay, which is one of the most common diseases in the world, can occur with symptoms such as pain and tenderness and can cause destruction of the tooth tissue, loss of chewing function and non-aesthetic appearance. Nowadays, with increasing caries rate, the incidence of deep dentin caries in deciduous and permanent teeth has increased. The term deep dentin caries; it is used in cases where there is a risk that the pulp may be exposed by removing the entire caries. It is emphasized that the treatments to be applied to these teeth should be as vital as possible. Thus, it is aimed to maintain the vitality of pulp tissue. Removal of the entire caries during deep caries treatment leads to pulpal perforations. The resulting pulp perforation negatively affects the long-term prognosis of the tooth. Therefore, the distinction between affected and infected dentin is important in terms of providing protective guidance in conservative treatment. In laboratory studies, the boundary between the infected dentin and the affected dentin can be distinguished visually, while in the clinic, dentists subjectively determine where this limit disappears and the amount of dentin to be removed. Therefore, there may be variations in the quality and amount of tissue removed by physicians. As a result, for an ideal treatment, all physicians should know the affected and infected dentin differentiation and clinical characteristics well and decide how much of it should be removed.

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