REGENERATIVE ENDODONTIC TREATMENTS PERFORMED ON IMMATURE PERMANENT TEETH

Öz

Immature permanent teeth may lose their vitality during their development due to trauma, caries or developmental anomalies. When pulp vitality is lost, root development stops, resulting in open apexed teeth with thin root dentin walls, making the treatment difficult. The endodontic treatment of immature and non-vital teeth is a challenging procedure for pediatric dentists and requires technical sensitivity. Additionally, the risk of root fracture increases due to weak tooth structure. Apexification is a non-surgical method that allows endodontic treatment to be performed by creating a calcific barrier in non-vital immature teeth. However, apexification treatments with both Ca(OH)₂ and MTA fail to thicken thin dentin walls and increase root length. Additionally, while apexification can induce apical closure, it cannot maintain pulp vitality. Nowadays, regenerative endodontic treatment procedure has been suggested to replace the damaged pulp tissue with pulp-like viable tissue. Regenerative procedures are biologically based treatments for the treatment of the dentin, root and dentin-pulp complex of the tooth. The aim of these treatments is to alleviate clinical symptoms in non-vital immature permanent teeth, heal apical lesions, increase the thickness of root walls, and promote continued root development. Thus, these teeth can have a more durable structure. Therefore, regenerative procedures have gained importance as an alternative treatment approach for teeth with open apices. The aim of this review is to examine the current information on regenerative endodontic treatments applied in non-vital immature permanent teeth as well as studies conducted in this field utilizing different biological factors based on tissue engineering principles.

Anahtar Kelimeler

• apexogenesis
• open apex
• regenerative endodontics

İmmatür Daimi Dişlerde Uygulanan Rejeneratif Endodontik Tedaviler

Öz

İmmatür daimi dişler, gelişimleri esnasında travma, çürük veya gelişimsel anomaliler sebebiyle vitalitelerini kaybedebilmektedir. Pulpa vitalitesini kaybetmiş dişlerin kök gelişiminin durması ile, apikal gelişim sekteye uğramakta ve kök dentin duvarları yeterli kalınlığa ulaşamamaktadır. Çocuk diş hekimleri için zorlu bir prosedür olan immatür ve devital dişlerin endodontik tedavisi, teknik açıdan hassasiyet gerektirmektedir. Ayrıca ilerleyen zamanlarda zayıf diş dokusu sebebi ile kök kırığı riski artmaktadır. Apeksifikasyon, vital olmayan immatür dişlerde kök ucunda kalsifik bir bariyer oluşturarak endodontik tedavinin yapılmasını sağlayan ve cerrahi olmayan bir yöntemdir. Ancak hem Ca(OH)₂ hem de MTA ile yapılan apeksifikasyon tedavileri, ince dentin duvarlarının kalınlaşmasını ve kök uzunluğunda artışı sağlayamamaktadır. Bununla birlikte, apeksifikasyon apikal kapanmayı indükleyebilirken, pulpa canlılığını koruyamamaktadır. Günümüzde, hasarlı pulpa dokusunun sağlıklı pulpa benzeri doku ile değiştirilmesini amaçlayan rejeneratif endodontik tedavi prosedürü önerilmektedir. Rejeneratif prosedürler, dişin dentin, kök ve dentin-pulpa kompleksinin tedavisi için yapılan biyolojik temelli tedavilerdir. Bu tedavilerin amacı, devital immatür daimi dişlerde klinik semptomların giderilmesi, apikal lezyonun iyileşmesi, kök duvarlarının kalınlığının artması ve kök gelişiminin devam etmesini sağlamaktır. Böylelikle dişler daha dayanıklı bir yapıya sahip olabilmektedir. Bu nedenle, rejeneratif prosedürler açık apeksli immatür dişlerde alternatif ve güncel bir tedavi yaklaşımı olarak önem kazanmaktadır. Bu derlemenin amacı devital immatür daimi dişlerde uygulanan rejeneratif endodontik tedavilerin ve doku mühendisliği temelinde farklı biyolojik unsurlardan yararlanılarak bu alanda yapılan çalışmaların güncel bilgiler ışığında incelenmesidir.

Anahtar Kelimeler

• Açık apeks
• apeksogenezis
• rejeneratif endodonti

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