Semptomatik İrreversible Pulpitisli Daimi Dişin MTA İle Amputasyonu: Olgu Raporu

Year 2023, Volume: 2 Issue: 2, 47 - 53, 31.08.2023

Enes Karabulut , Berk Çelikkol

Abstract

Yıllardır "İrreversible pulpitis" teşhisi konan daimi dişlerin, tamir edilemeyecek ve kök kanal tedavisini gerektiren geri dönüşümsüz olarak hasar görmüş bir pulpaya sahip olduğu belirtilmiştir. Bu nedenle irreversible pulpitisli matür daimi dişlerin tedavisi sıklıkla kök kanal tedavisi olmuştur. Bununla birlikte, bugüne kadar, reversible veya irreversible pulpitisin teşhisi, tam olarak pulpanın inflamasyon durumunu yansıtmadan, yalnızca klinik ağrı niteliğine ve miktarına dayanmaktaydı. Bu yüzden minimal invaziv ve biyolojik temelli bir prosedür olan pulpotomi gibi daha yeni klinik yaklaşımlar, pulpitisli dişleri tedavi etmek için yeniden ortaya çıkmıştır. Vital pulpa tedavileri süt dişlerinde ve immatür daimi dişlerde kullanılmıştır fakat yeni biyoaktif materyallerin ortaya çıkmasıyla birlikte bu yaklaşım, matür daimi dişlere doğru kaymaktadır. Pulpa patolojisi olan daimi dişlerde biyoaktif materyal ile koronal pulpotominin kök kanal tedavisi kadar başarılı olduğunu bildiren birçok prospektif ve retrospektif çalışma, randomize kontrollü çalışma ve sistematik derleme vardır. Koronal pulpotomi, hem diş hekimleri hem de hastalar için uygun maliyetli, kök kanal tedavisi gibi çok teknik zahmetli olmayan ve daha az zaman alan bir yöntemdir. Bu tedavi hastaya endodontik tedaviye alternatif olarak sunulabilir. Bu olgu sunumunda amaç kliniğimize şiddetli ağrı ile başvuran hastaya MTA (mineral trioksit agregat) ile uygulanan total pulpotomi tedavisinin klinik ve radyografik sonuçlarını değerlendirmektir.

Keywords

MTA, İrreversible pulpitis, Pulpotomi

MTA Amputation of a Permanent Tooth with Symptomatic Irreversible Pulpitis: A Case Report

Abstract

For years, it is described that permanent teeth, which have been examined for "irreversible pulpitis", have an irreversibly damaged pulp that cannot be repaired and requires root canal treatment. Therefore, the treatment of mature permanent teeth with irreversible pulpitis has consistently been the root canal treatment. However, to date, examination of reversible or irreversible pulpitis has been based solely on the level and amount of clinical pain, without accurately reflecting the course of pulp inflammation. Therefore, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure, have reemerged to treat teeth with pulpitis. Vital pulp treatments have been used in primary teeth and immature permanent teeth, but with the emergence of new bioactive samples, this approach is shifting towards mature permanent teeth. There are many prospective and retrospective studies, randomized controlled studies and systems reporting that coronal pulpotomy with bioactive material is as successful as root canal treatment in permanent teeth with pulpal pathology. Coronal pulpotomy is cost effective for both dentists and patients, a less time-consuming and technically demanding method such as root canal treatment. This treatment may be offered to the patient as an alternative to endodontic treatment. The aim of this case report is to evaluate the clinical and radiographic results of total pulpotomy treatment with MTA (mineral trioxide aggregate) in a patient who applied to our clinic with severe pain.

Keywords

MTA, Irreversible pulpitis, Pulpotomy

References

• 1. Kassebaum, N. J. et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: A systematic analysis for the global burden of diseases, injuries, and risk factors. J. Dent. Res. 2017; 96, 380–387.
• 2. Yu, C. & Abbott, P. V. An overview of the dental pulp: Its functions and responses to injury. Aust. Dent. J. 2007; 52, S4-16.
• 3. Glickman, G. N. AAE consensus conference on diagnostic terminology: Background and perspectives. J. Endod. 2009; 35, 1619–1620.
• 4. Ricucci, D., Loghin, S. & Siqueira, J. F. Jr. Correlation between clinical and histologic pulp diagnoses. J. Endod. 2014; 40, 1932–1939.
• 5. Bjorndal, L., Simon, S., Tomson, P. L. & Duncan, H. F. Management of deep caries and the exposed pulp. Int. Endod. 2019; J. 52, 949–973.
• 6. Solomon, R. V., Faizuddin, U., Karunakar, P., Deepthi Sarvani, G. & Sree Soumya, S. Coronal pulpotomy technique analysis as an alternative to pulpectomy for preserving the tooth vitality, in the context of tissue regeneration: A correlated clinical study across 4 adult permanent molars. Case Rep Dent 2015, 916060.
• 7. Linsuwanont, P., Wimonsutthikul, K., Pothimoke, U. & Santiwong, B. Treatment outcomes of mineral trioxide aggregate pulpotomy in vital permanent teeth with carious pulp exposure: Te retrospective study. J. Endod. 2017; 43, 225–230.
• 8. Alqaderi, H. E., Al-Mutawa, S. A. & Qudeimat, M. A. MTA pulpotomy as an alternative to root canal treatment in children’s permanent teeth in a dental public health setting. J. Dent. 2014; 42, 1390–1395.
• 9. Chin, J.; Thomas, M.; Locke, M.; Dummer, P. A survey of dental practitioners in Wales to evaluate the management of deep carious lesions with vital pulp therapy in permanent teeth. Br. Dent. J. 2016; 221, 331–338.
• 10. Schwendicke, F.; Stolpe, M. Direct pulp capping after a carious exposure versus root canal treatment: A cost-effectiveness analysis. J. Endod. 2014; 40, 1764–1770.
• 11. American Academy of Pediatric Dentistry. Guideline on pulp therapy for primary and immature permanent teeth. Pediatr. Dent. 2009; 31, 179–186.
• 12. American Association of Endodontists. Endodontic Diagnosis. Endodontics: Colleagues for Excellence; MediVisuals, Inc.: Richmond, VA, USA, 2013.
• 13. S. Asgary and S. Ehsani, “Permanent molar pulpotomy with a new endodontic cement: a case series,” Journal of Conservative Dentistry: JCD 2009; vol. 12, no. 1, pp. 31–36.
• 14. G. S. S. Lin, Y. Q. Yew, H. Y. Lee et al., “Is pulpotomy a promising modality in treating permanent teeth? An umbrella review,” Odontology. 2022; vol. 110, no. 2, pp. 393–409.
• 15. Santos, J.M.; Pereira, J.F.; Marques, A.; Sequeira, D.B.; Friedman, S. Vital pulp therapy in permanent mature posterior teeth with symptomatic irreversible pulpitis: A systematic review of treatment outcomes. Medicina (Kaunas) 2021; 57, 573.9.
• 16. Aguilar, P. & Linsuwanont, P. Vital pulp therapy in vital permanent teeth with cariously exposed pulp: A systematic review. J. Endod. 2011; 37, 581–587.
• 17. Li, Y. et al. Pulpotomy for carious pulp exposures in permanent teeth: A systematic review and meta-analysis. J. Dent. 2019; 84, 1–8.
• 18. Hasselgren, G. & Reit, C. Emergency pulpotomy: Pain relieving efect with and without the use of sedative dressings. J. Endod. 1989; 15, 254–256.
• 19. Tan, S. Y. et al. Long-term pulpal and restorative outcomes of pulpotomy in mature permanent teeth. J. Endod. 2020; 46, 383–390.
• 20. AAE Position Statement on Vital Pulp Terapy. J. Endod. 2021; 47, 1340–1344.
• 21. European Society of Endodontology developed by Duncan, H. F. et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int. Endod. J. 2019; 52, 923–934.
• 22. Cushley, S. et al. Pulpotomy for mature carious teeth with symptoms of irreversible pulpitis: A systematic review. J. Dent. 2019; 88, 103158.
• 23. Maeda, H. Aging and senescence of dental pulp and hard tissues of the tooth. Front Cell Dev. Biol. 2020; 8, 605996.
• 24. Qudeimat, M. A., Barrieshi-Nusair, K. M. & Owais, A. I. Calcium hydroxide vs mineral trioxide aggregates for partial pulpotomy of permanent molars with deep caries. Eur. Arch. Paediatr. Dent. 2007; 8, 99–104.
• 25. Meschi, N., Patel, B. & Ruparel, N. B. Material pulp cells and tissue interactions. J. Endod. 2020; 46, S150–S160.
• 26. Pulpotomy survival analysis: Retrospective follow-up. J. Dent. 2015; 43, 1125–1131.
• 27. Parirokh, M. & Torabinejad, M. Mineral trioxide aggregate: A comprehensive literature review–Part III: Clinical applications, drawbacks, and mechanism of action. J. Endod. 2010; 36, 400–413.
• 28. Ward, J. Vital pulp therapy in cariously exposed permanent teeth and its limitations. Aust. Endod. 2002; J. 28, 29–37.
• 29. Shallal-Ayzin, M. et al. A prospective analysis of the correlation between postoperative pain and vital pulp therapy. Front. Dent. Med. 2021.
• 30. Matsuo, T., Nakanishi, T., Shimizu, H. & Ebisu, S. A clinical study of direct pulp capping applied to carious-exposed pulps. J. Endod. 1996; 22, 551–556.
• 31. American Academy of Pediatric Dentistry. Pulp Terapy for Primary and Immature Permanent Teeth. Te Reference Manual of Pediatric Dentistry, 2021; 339–407.
• 32. Galani, M.; Tewari, S.; Sangwan, P.; Mittal, S.; Kumar, V.; Duhan, J. Comparative evaluation of postoperative pain and success rate after pulpotomy and root canal treatment in cariously exposed mature permanent molars: A randomized controlled trial. J. Endod. 2017, 43, 1953–1962.
• 33. Simon, S. et al. Should pulp chamber pulpotomy be seen as a permanent treatment? Some preliminary thoughts. Int. Endod. J. 2013; 46, 79–87.
• 34. Taha, N. A., Ahmad, M. B. & Ghanim, A. Assessment of Mineral Trioxide Aggregate pulpotomy in mature permanent teeth with carious exposures. Int. Endod. 2017; J. 50, 117–125.
• 35. Ather, Amber, et al. "Outcome of pulpotomy in permanent teeth with irreversible pulpitis: a systematic review and meta-analysis." Scientific reports. 2022; 12.1: 19664. 36. F. Elmsmari, X. F. Ruiz, Q. Miró, N. Feijoo-Pato, F. Durán Sindreu, and J. G. Olivieri, “Outcome of partial pulpotomy in cariously exposed posterior permanent teeth: a systematic review and meta-analysis,” J Endod. 2019; vol. 45, pp. 1296–1306 e1293.
• 37. A. Ramani, P. Sangwan, S. Tewari, J. Duhan, S. Mittal, and V. Kumar, “Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: a randomized clinical trial,” International Endodontic Journal. 2022; vol. 55, no. 5, pp. 430–440.
• 38. N. A. Taha and S. Z. Abdelkhader, “Outcome of full pulpotomy using biodentine in adult patients with symptoms indicative of irreversible pulpitis,” International Endodontic Journal. 2018; vol. 51, no. 8, pp. 819–828.
• 39. G. S. S. Lin, A. R. B. Hisham, C. I. Y. Ch Er, K. K. Cheah, N. R. N. A. Ghani, et al. “Success rates of coronal and partial pulpotomies in mature permanent molars: a systematic review and single-arm meta-analysis,” Quintessence International. 2021; vol. 52, no. 3, p. 196.
• 40. N. Taha, I. About, C. Sedgley, and H. Messer, “Conservative management of mature permanent teeth with carious pulp exposure,” Journal of Endodontics. 2020; vol. 46, no. 9, pp. S33– S41.
• 41. N. A. Taha and H. Al-Khatib, “4-year follow-up of full pulpotomy in symptomatic mature permanent teeth with carious pulp exposure using a stainproof calcium silicate-based material,” Journal of Endodontia. 2020; vol. 48, no. 1, pp. 87–95.
• 42. M. I. Hussain and A. M. Bashar, “Outcome of mineral trioxide aggregate pulpotomy for mature permanent molars with symptoms indicative of irreversible pulpitis,” Mymensingh Medical Journal. 2022; vol. 31, no. 1, pp. 223–229.
• 43. S. Anta, N. Diouma, N. S. Ousmane, L. B. Fatou, F. Florence, and T. Babacar, “Evaluation of complete pulpotomy with biodentine on mature permanent molars with signs and symptoms of symptomatic irreversible pulpitis: 12-months follow-up,” Journal of Endodontia 2022; vol. 48, no. 3, pp. 312– 319.
• 44. X. V. Tran, L. T. Q. Ngo, and T. Boukpessi, “BiodentineTM full Pulpotomy in mature permanent teeth with irreversible pulpitis and apical periodontitis,” Healthcare (Basel). 2020; vol. 9, no. 6.
• 45. K. Zafar, M. R. Nazeer, R. Ghafoor, and F. R. Khan, “Success of pulpotomy in mature permanent teeth with irreversible pulpitis: a systematic review,” Journal of Conservative Dentistry. 2020; vol. 23, no. 2, pp. 121–125.
• 46. D. Sadaf, “Success of coronal pulpotomy in permanent teeth with irreversible pulpitis: an evidence-based review,” Cureus. 2020; vol. 12, no. 1, article e6747.
• 47. S. Asgary, M. J. Eghbal, and A. A. Bagheban, “Long-term outcomes of pulpotomy in permanent teeth with irreversible pulpitis: a multi-center randomized controlled trial,” American Journal of Dentistry. 2017; vol. 30, no. 3, pp. 151–155.
• 48. L. M. Lin, D. Ricucci, T. M. Saoud, A. Sigurdsson, and B. Kahler, “Vital pulp therapy of mature permanent teeth with irreversible pulpitis from the perspective of pulp biology,” Australian Endodontic Journal. 2020; vol. 46, no. 1, pp. 154– 166.