TRAVMAYA BAĞLI KOMPLİKE KRON KIRIĞININ TEDAVİSİ: OLGU SUNUMU

Yıl 2021, Cilt: 31 Sayı: 1, 109 - 114, 15.01.2021

Ebru Kalkan Özkan Kerem Engin Akpınar Demet [e-mail] Altunbaş

Öz

AMAÇ: Komplike kron kırıkları, daimi dişlenme döneminde sıklıkla görülmektedir. Dental travma prevelansının yüksek olduğu dişler maksiller anterior dişlerdir. Bu dişlerin fonksiyonel ve estetik etkileri düşünüldüğünde doğru teşhis ve tedavi planlaması ile ağızda kalmasının sağlanması son derece önemlidir. Pulpotomi uygulaması, pulpa vitalitesinin devamlılığını sağlayan en iyi tedavi alternatiflerinden biridir. Bu olgu sunumunun amacı; travma sonucu pulpası ekspose olmuş maksiller sağ santral kesici dişin MTA ile yapılan vital tedavisi ve kısa dönem klinik ve radyolojik kontrollerinin sunulmasıdır.
OLGU: 14 yaşında kadın hasta maksiller sağ santral kesici dişinde kırık şikayeti ile kliniğimize başvurmuştur. Hastadan alınan dental anamnezde ilgili dişin 2 saat önce travmaya maruz kaldığı öğrenilmiştir. Radyografik incelemede periapikal dokuların sağlıklı olduğu görülmüştür. Yapılan intraoral muayenede perküsyon ve palpasyonda hassasiyet, mobilite ve periodontal harabiyet olmadığı tespit edilmiştir. Maksiller kesici dişlere vitalite testi yapılmış ve ilgili dişte negatif yanıt alınmıştır. Tüm teşhis verileri değerlendirdikten sonra, hastanın ilgili dişine total amputasyon yapılması planlanmıştır. Lokal anestezinin ardından rubber dam izolasyonu altında enfekte olduğu düşünülen koronal pulpa dokusu uzaklaştırılmıştır. %2.5’lik sodyum hipoklorit ile kanama kontrolü yapılarak MTA yerleştirilmiştir. Hastanın içme suyu içinde getirdiği kırık parça asitle pürüzlendirilmiş, tek basamaklı bonding sistem kullanılarak akışkan kompozitle yapıştırılmıştır. Hastanın 1 ay sonraki kontrolünde vitalite testine gecikmiş yanıt alınmıştır. 3 ay ve 6 ay sonraki kontrolünde ise pulpanın normal yanıt verdiği görülmüştür. Bu süreçte klinik ve radyografik olarak herhangi bir semptoma rastlanmamıştır.
SONUÇ: Travma sonrası oluşan komplike kron kırıklarının restorasyonunda MTA ile total pulpotomi ve dişin kendi parçası ile restore edilmesi etkili bir tedavi yöntemidir. Hastanın fonksiyonel ihtiyaçlarının yanında estetik beklentilerini de karşılamaktadır.
ANAHTAR KELİMELER: Dental travma, Kron kırıkları, MTA

TREATMENT OF TRAUMATIC COMPLICATED CROWN FRACTURE: CASE REPORT
AIM: Complicated crown fractures are frequently seen in permanent dentition. The teeth with high dental trauma prevalence are maxillary anterior teeth. Considering the functional and aesthetic effects of these teeth, it is very important to ensure that they stay in the mouth with correct diagnosis and treatment planning. Pulpotomy is one of the best treatment alternatives for the continuation of pulp vitality. The aim of this case report is to present the short-term clinical and radiological controls of the vital treatment of maxillary right central incisor with expose pulp after trauma.
CASE: 14-year-old female patient referred to our clinic with complaint of fracture of maxillary right central incisor. In a dental anamnesis taken from patient, it was learned that related teeth were traumatized 2 hours ago. Radiographic examination revealed that periapical tissues were healthy. Intraoral examination showed that there is no percussion and palpation sensitivity, mobility and periodontal damage. Pulp vitality tests were applied to maxillar incisor teeth and the test resulted in negative response in related tooth. After evaluating all the diagnostic data, total amputation for patient's tooth were planned. After local anesthesia, infected coronal pulp tissue was removed under rubber dam isolation. Hemostasis was obtained with 2.5% sodium hypochlorite and MTA paste was placed. The broken piece that patient brought in drinking water was acid-etched and bonded with the fluid composite using a single-step bonding system. The patient had a delayed response to the vitality test at 1-month follow-up. The pulp responded normally at 3-months and 6-months follow-up. There were no clinical and radiographic signs in this process.
CONCLUSION: In the restoration of complicated crown fractures after trauma, total pulpotomy with MTA and restoration of the tooth with its own part is an effective treatment method. Besides the functional needs of the patient, it also provides aesthetic expectations.
KEY WORDS: Dental Trauma, Crown Fracture,MTA

Anahtar Kelimeler

Dental travma, Kron kırıkları, MTA

Kaynakça

• 1. Dewhurst SN, Mason C, Roberts GJ. Emergency treatment of orodental injuries: a review. Br J Oral Maxillofac Surg 1998;36: 165-75.
• 2. Sandalli N, Cildir S, Guler N. Clinical investigation of traumatic injuries in Yeditepe University, Turkey during the last 3 years. Dent Traumatol 2005;21: 188-94.
• 3. Andreasen JO, Andreasen FM, Andersson L. Textbook and color atlas of traumatic injuries to the teeth, 4th edn. Oxford, UK: Wiley-Blackwell; 2007.
• 4. Petersson EE, Andersson L, Sorensen S. Traumatic oral vs nonoral injuries. Swed Dent J 1997;21:55-68.
• 5. Glendor U. Epidemiology of traumatic dental injuries – a 12 year review of the literature. Dent Traumatol 2008;24: 603-11.
• 6. Flores MT. Traumatic injuries in the primary dentition. Dent Traumatol 2002;18:287-98.
• 7. Kramer PF, Zembruski C, Ferreira SH, Feldens CA. Traumatic dental injuries in Brazilian preschool children. Dent Traumatol 2003;19:299-303.
• 8. Güngör H.C., Uysal S., Altay N. A retrospective evaluation of crown-fractured permanent teeth treated in a pediatric dentistry clinic. Dent Traumatol 2007; 23: 211-7
• 9. Andreasen JO, Andreasen FM. Essentials of traumatic injuires to the teeth. Andreasen FM, Andreasen JO. Munksgard and Mosby Copenhagen Denmark, 2000; 9-154. 10. Rafter M. Apexification: a review. Dent Traumatol. 2005;21:1-8.
• 11. Huang G.T.J. Apexification: the beginning of its end. Int Endod J 2009;42: 855-66.
• 12. Tziafas D. The future role of a molecular approach to pulp dentinal regeneration. Caries Res 2004;38: 314-20.
• 13. Cohenca N, Paranjpe A, Berg J. Vital Pulp Therapy. Dent Clin North Am 2013;57:59-73.
• 14. McDonald RE, Avery DR, Dean JA. Dentistry for the Child and Adolescent. 8 ed. St. Louis; Mo: Mosby Co: 2004;350-1.
• 15. Smith AJ, Cassidy N, Perry H, Begue-Kirn C, Ruch JV, Lesot H. Reactionary dentinogenesis. Int J Dev Biol 1995;39:273-80.
• 16. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a compherensive literature review- Part I: Chemical, physical, and antibacterial properties. J Endod 2010;36:16-27.
• 17. Tunç EŞ, Çetiner S. Mineral trioxide aggregate: bir literatür derlemesi. J Dent Fac Atatürk Uni 2006;16:46-53.
• 18. Kuratate M, Yoshiba K, Shigetani Y, Yoshiba N, Ohshima H, Okiji T. Immunohistochemical analysis of netsin, osteopontin and proliferating cells in the reperative process of exposed dental pulp capped with MTA. J Endod 2008;34:970-4.
• 19. Rao A, Rao A, Shenoy R. Mineral trioxide aggregate- a review. J Clin Pediatr Dent 2009;34:1-7.
• 20. Abdulkhayum A., Munjal S., Babaji P., Chaurasia V. R., Munjal S., Lau H., Olekar S. T., Lau M. In-vitro evaluation of fracture strength recovery of reattached anterior fractured tooth fragment using different re-attachment techniques. J Clin Diag Res. 2014;8:208–11.
• 21. Pagliarini A., Rubini R., Rea M., Campese M. Crown fractures: effectiveness of current enamel-dentin adhesives in reattachment of fractured fragments. Quintessence Int 2000;31:133–6.
• 22. Baratieri LN, Ritter AV, Monterio Júnior S, de Mello Filho JC. Tooth fragment reattachment: an alternative for restoration of fractured anterior teeth. Pract Periodontics Aesthet Dent 1998; 10: 115–25.
• 23. JO Andreasen, FM Andreasen. Classification, etiology and epidemiology. In: Andreasen JO, Andreasen FM. Textbook and color atlas of traumatic injuries to the teeth. Copenhagen: Munksgaard 1994;151-80.
• 24. S Nysether. Dental injuries among Norwegian soccer players. Community Dent Oral Epidemiol. 1987;15:141-3.
• 25. A Dhingra, DK Srivastava. Immediate reattachment of fractured crown fragment: a case report. Endod. 2006;18:94-6.
• 26. Alaçam A. Travma nedeniyle oluşan diş yaralanmaları ve tedavileri. Alaçam T, ed. Endodonti. Ankara: Özyurt Yayınevi; 2012;985-1058.
• 27. Flores MT, Andersson L, Andreasen JO, Bakland LK, Malmgren B, Barnett F. et al. Guidelines for the management of traumatic dental injuries. Dent Traumatol 2007;2:66-71.
• 28. Moule AJ, Moule CA. The endodontic management of traumatized permanent anterior teeth: a review. Aust Dent J 2007;52:12-37.
• 29. Cvek M. A clinical report on partial pulpotomy and capping with calcium hydroxide in permanent incisors with complicated crown fracture. J Endod 1978; 4:232-7.
• 30. Parirokh M, Kakoei S. Vital pulp therapy of mandibular incisors: a case report with 11-year follow up. Aust Endod J 2006; 32: 75-8.
• 31. Öktem ZB, Özer L. Komplike kron kırıklarında vital pulpa tedavisi: bir olgu sunumu. ADO Klinik Bilimleri Derg 2009; 2: 380-4.
• 32. Mohammadi Z, Dummer PMH. Properties and applications of calcium hydroxide in endodontics and dental traumatology. Int Endod J 2011; 44: 697-730
• 33. Aslan B. Kalsiyum hidroksitli medikamanların dentin tübüllerine penetrasyonlarının incelenmesi. Atatürk Üniv. Diş Hek. Fak. Derg. 2002; 12:9-12.
• 34. Olsburg S, Jacoby T, Krejei I. Crown fractures in the permanent dentition: pulpal and restorative considerations. Dent Traumatol 2002; 18: 103-15
• 35. Alaçam A. Kök ucu kapanmamış genç sürekli dişlerde kök oluşumunun teşviki ve tedavi yöntemleri. Alaçam T, ed. Endodonti. Ankara: Özyurt Yayınevi; 2012;1303-31.
• 36. Paranjpe A, Smoot T, Zhang H, Johnson JD. Direct contact with mineral trioxide aggregate activates and differentiates human dental pulp cells. J Endod 2011;37:1691-5.
• 37. Hilton TJ, Ferracane JL, Mancl L. Comparison of CaOH with MTA for direct pulp capping: A PBRN randomized clinical trial. J Dent Res 2013;92:16-22.
• 38. Krastl G, Allgayer N, Lenherr P, Filippi A, Taneja P, Weiger R. To¬oth discoloration induced by endodontic materials: a literature review. Dent Traumatol 2013;29:2-7.
• 39. Akbari M, Rouhani A, Samiee S, Jafarzadeh H. Effect of dentin bon¬ding agent on the prevention of tooth discoloration produced by mineral trioxide aggregate. Int J Dent 2012; 10:1-3.
• 40. Patni P, Jain D, Goel G. A holistic approach to managment of fractured teeth fragments: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109:70-4
• 41. Goenka P, Marwah N, Dutta S. Biological approach for managment of anterior tooth trauma: Triple case report. J Indian Soc Pedod Prev Dent 2010;28:223-9
• 42. Rajput A, Ataide I, Fernandes M. Uncomplicated crown fracture, complicated crown-root fracture, and horizontal root fracture simultaneously treated in a patient during emergency visit: a case report. Oral Med Oral Pathol Oral Radiol Endod 2009; 107:48-52.
• 43. Turgut MD, Gönül N, Altay N. Multiple complicated crown-root fracture of a permanent incisor. Dent Traumatol 2004;20:288-92