Vital pulp treatments in mature permanent teeth: An up-to-date overview–review article

Öz

Vital pulp therapy in mature permanent teeth with carious pulp exposure has been a controversial issue, with root canal therapy being the conventional standard of care. Vital pulp treatments, which aim to preserve the health of a part or all of the dental pulp, are based on the principle of minimal intervention and include indirect capping, direct capping, partial pulpotomy and total pulpotomy procedures. Vital pulp treatments are less time-consuming and less technically complex compared to root canal treatment. At the same time, it is more advantageous in terms of undesirable effects such as discoloration, root fracture or residual periapical inflammation that can be seen after root canal treatment. The traditional indications for vital pulp treatments have been limited to the treatment of teeth diagnosed with reversible pulpitis, with complete or incomplete root formation. However, the advent of regenerative endodontics, the promotion of biologically based therapies aimed at reducing intervention, a better understanding of the histopathology of caries-exposed pulp and the healing potential of inflamed pulp, the development of new materials such as hydraulic calcium silicate cement with sealing and bioactive potentials have promoted vital pulp treatment adoption as a treatment protocol in teeth with signs and symptoms indicative of irreversible pulpitis. However, most of the available evidence is supported by studies containing relatively low patient numbers. Consequently, there remains a need forwell-designed prospective research on this topic to develop more representative pulp diagnostic tools and to establish evidence-based management strategies.

Anahtar Kelimeler

• calcium silicate
• pulpitis
• pulpotomy
• root canal therapy

Matür daimi dişlerde vital pulpa tedavilerine güncel bir bakış-derleme makalesi

Öz

Çürükle ekspoze matür daimi dişlerin tedavisinde geleneksel kök kanal tedavisine alternatif olarak vital pulpa tedavilerinin uygulanması tartışmalı bir konudur. Diş pulpasının bir kısmının veya tamamının sağlığını korumayı amaçlayan vital pulpa tedavileri minimal müdahale prensibine dayanmaktadır ve indirekt kuafaj, direkt kuafaj, parsiyel pulpotomi ve total pulpotomi prosedürlerini içermektedir. Vital pulpa tedavileri kök kanal tedavisi ile karşılaştırıldığında daha hızlı ve teknik olarak daha az karmaşık olmasıyla birlikte kanal tedavisi sonrası görülebilen renk değişikliği, kök kırığı veya rezidüel periapikal inflamasyon gibi istenmeyen etkiler açısından daha avantajlıdır. Vital pulpa tedavilerinin geleneksel endikasyonları, geri dönüşümlü pulpitis teşhisi konmuş, kök oluşumu tamamlanmış veya henüz tamamlanmamış dişlerin tedavisi ile sınırlı kalmıştır. Bununla birlikte, rejeneratif endodontinin ortaya çıkışı ve invaziv müdahaleyi azaltmayı amaçlayan biyolojik temelli tedavilerin teşviki, çürükle ekspoze pulpanın histopatolojisinin ve iltihaplı pulpanın iyileşme potansiyelinin daha iyi anlaşılması, hidrofilik kalsiyum silikat simanlar gibi yüksek sızdırmazlık yeteneği ve biyoaktif poyansiyeli olan yeni materyallerin geliştirilmesi, vital pulpa tedavilerinin geri dönüşümsüz pulpitise işaret eden belirti ve semptomları olan dişlerde de bir tedavi protokolü olarak benimsenmesini teşvik etmiştir. Bununla birlikte mevcut kanıtların büyük bir bölümü nispeten düşük hasta sayısı içeren çalışmalarla desteklenmektedir. Sonuç olarak daha temsili pulpa teşhis araçlarının geliştirilmesi ve kanıta dayalı yönetim stratejilerinin oluşturabilmesi için bu konuyla ilgili iyi tasarlanmış ileriye dönük araştırmalara olan ihtiyaç devam etmektedir.

Anahtar Kelimeler

• kalsiyum silikat
• kök kanal tedavisi
• pulpit
• pulpotomi

Kaynakça

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