Management of Endodontic Perforations

Abstract

Endodontik Perforasyonların Yönetimi

Öz

Kök perforasyonu, Amerikan Endodontistler Birliği (AAE) tarafından kök kanal sistemi ile dişin dış yüzeyi arasında mekanik veya patolojik iletişim olarak tanımlanır ve endodontik tedavi ile ilişkili en yaygın başarısızlık sebeplerinden biri olduğu rapor edilmiştir. Literatürde perforasyonların görülme sıklığının %3-10 arasında değiştiği gösterilmiştir. Endodontik perforasyonlar, restoratif işlemler veya endodontik tedavi sırasında meydana gelen iyatrojenik hatalarla veya çürük ve rezorpsiyon gibi patolojik durumlarda ortaya çıkabilir. Endodontik perforasyonların teşhisinde çeşitli yöntemler kullanılır. Bunlar, kanama kontrolü, radyografiler, elektrikli apex bulucular, konik ışınlı bilgisayarlı tomografi ve dental operasyon mikroskobudur. Perforasyonların prognozunu etkileyen faktörler, perforasyonun lokalizasyonu, perforasyonun büyüklüğü, perforasyon kapatılana kadar geçen zaman, periodontal durum, hekimin manipülasyonu ve görüşü, hastanın oral hijyeni ve kooperasyonu ve kullanılan tamir materyalleridir. Perforasyon tamirinde amaç, perfore alandaki mikroorganizmaları uzaklaştırıp, perfore alanın hermetik şekilde biyouyumlu bir malzeme kullanılarak kapatılmasıdır. Perforasyonun tamiri iki şekilde yapılabilir: 1- Ortograd, 2- Cerrahi yaklaşım. Ortograd yöntemde perfore bölge konvansiyonel olarak bir onarım malzemesi ile tamir edilir. Cerrahi tekniklerde direkt perfore bölgeye ulaşılarak tıkama yapılabilir ayrıca kök amputasyonu, kasti replantasyon, biküspidizasyon veya hemiseksiyon da uygulanabilir. Başarılı bir perforasyon tamiri sonucu, kalıcı enflamasyon veya periodontal ataşman kaybı olmamalı, periodontal doku parçalanması olması durumunda doku ataşmanı yeniden sağlanmalıdır.

Anahtar Kelimeler

• perforasyon tamiri
• perforasyon
• endodontik tedavi

Kaynakça

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