Rejeneratif Endodontik Tedavi Sonrası Nadir Görülen Ayrık Kök Gelişimi: Olgu Sunumu

Yıl 2022, , 244 - 248, 27.04.2022

Enes Mustafa Aşar , Murat Selim Botsalı

https://doi.org/10.15311/selcukdentj.1091147

Öz

ÖZ
Rejeneratif endodontik tedavi başarılı tedavi sonuçları sayesinde son yıllarda popülerlik kazanmıştır. Bu tedavinin immatür dişlerde semptomların ortadan kaldırılması, durmuş olan kök gelişiminin devamı ve dişlerin canlılık kazanması gibi hedefleri vardır. İmmatür dişlerde rejeneratif endodontik tedavi sonrası kök gelişiminin devam ettiği birçok çalışmada gösterilmiştir. Fakat tedavi sonrası kök oluşum şekilleri değişkenlik göstermektedir. Chen ve ark. tarafından bu tedaviden sonra görülen 5 farklı tip kök yanıtı gösterilmiştir. Bunlar köklerin uzayıp kapanması, köklerin künt kapanması, kök apeksinin açık kalması, kanal obliterasyonu, kanal içerisinde sert doku bariyeri oluşmasıdır. Fakat bu kök yanıtlarından farklı olarak kök apeksinin ana kökten ayrılarak gelişimini devam ettirdiği nadir görülen farklı bir kök yanıt tipi bildirilmiştir. Bu çalışmada da rejeneratif endodontiden sonra nadir görülen ayrık kök gelişiminin teşhisi, tedavisi ve takibi anlatılmıştır.

ABSTRACT
Regenerative endodontic treatment has gained popularity in recent years thanks to successful treatment results. This treatment has goals such as eliminating symptoms in immature teeth, continuation of the stopped root development and vitality of teeth. It has been shown in many studies that root development continues after regenerative endodontic treatment in immature teeth. Five different types of root response seen after this treatment were demonstrated by Chen et al. These are elongation and closure of the roots, blunt closure of the roots, open root apex, canal obliteration, formation of a hard tissue barrier. However, unlike these root responses, a different type of root response, which is rarely seen, has been shown to continue its development by separating the root apex from the main root. In this study, the diagnosis, treatment and follow-up of split root development, which is rare after regenerative endodontics, is explained.

Anahtar Kelimeler

Dental travma, kök gelişimi, rejeneratif endodontik tedavi

Kaynakça

• 1. Iwaya Si, Ikawa M, Kubota M. Revascularization of an immature permanent tooth with apical periodontitis and sinus tract. Dent Traumatol. 2001;17(4):185-7.
• 2. Banchs F, Trope M. Revascularization of immature permanent teeth with apical periodontitis: new treatment protocol? J Endod. 2004;30(4):196-200.
• 3. Bezgin T, Yilmaz AD, Celik BN, Kolsuz ME, Sonmez H. Efficacy of platelet-rich plasma as a scaffold in regenerative endodontic treatment. J Endod. 2015;41(1):36-44.
• 4. Chueh L-H, Huang GT-J. Immature teeth with periradicular periodontitis or abscess undergoing apexogenesis: a paradigm shift. J Endod. 2006;32(12):1205-13.
• 5. Ulusoy AT, Turedi I, Cimen M, Cehreli ZC. Evaluation of blood clot, platelet-rich plasma, platelet-rich fibrin, and platelet pellet as scaffolds in regenerative endodontic treatment: a prospective randomized trial. J Endod. 2019;45(5):560-6.
• 6. Endodontists AAo. Clinical considerations for a regenerative procedure. American association of Endodontists Chicago; 2015.
• 7. Kim S, Malek M, Sigurdsson A, Lin L, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367-88.
• 8. Chen MH, Chen KL, Chen CA, Tayebaty F, Rosenberg P, Lin L. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45(3):294-305.
• 9. Jiang X, Liu H. An uncommon type of segmental root development after revitalization. Int Endod J. 2020;53(12):1728-41.
• 10. Jung I-Y, Kim E-S, Lee C-Y, Lee SJ. Continued development of the root separated from the main root. J Endod. 2011;37(5):711-4.
• 11. Tucker A, Sharpe P. The cutting-edge of mammalian development; how the embryo makes teeth. Nat Rev Genet. 2004;5(7):499-508.
• 12. Yang SF, Yang ZP, Chang KW. Continuing root formation following apexification treatment. Dent Traumatol. 1990;6(5):232-5.
• 13. Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e37-e44.
• 14. Jiang X, Liu H, Peng C. Continued root development of immature permanent teeth after regenerative endodontics with or without a collagen membrane: A randomized, controlled clinical trial. Int J Clin Pediatr Dent. 2022;32(2):284-93.
• 15. Welbury R, Walton A. Continued apexogenesis of immature permanent incisors following trauma. Br Dent J. 1999;187(12):643-4.
• 16. Gibson A. Continued root development after traumatic avalsion of partly-formed permanent incisor. Br Dent J. 1969;126:356.
• 17. Barker B, Mayne J. Some unusual cases of apexification subsequent to trauma. Oral Surg Oral Med Oral Pathol. 1975;39(1):144-50.
• 18. Burley M. Root formation following traumatic loss of an immature incisor. Br Dent J. 1976;141:315.
• 19. Andreasen J, Borum M, Andreasen F. Replantation of 400 avulsed permanent incisors. 3. Factors related to root growth. Dent Traumatol. 1995;11(2):69-75.
• 20. Smith BE, Thaler MN. Detached root apexogenesis. Oral Surg Oral Med Oral Pathol. 1992;73(1):129-.
• 21. Pashley D, Liewehr F. Structure and functions of the dentin-pulp complex. Pathways of the Pulp. 2006;9:460-513.
• 22. Huang GT-J, Sonoyama W, Liu Y, Liu H, Wang S, Shi S. The hidden treasure in apical papilla: the potential role in pulp/dentin regeneration and bioroot engineering. J Endod. 2008;34(6):645-51.
• 23. Hill F, Lee K. Continued development of the dental papilla after the removal of premaxillary supernumerary teeth. A report of two cases. Br Dent J. 1983;154(10):333-5.
• 24. Wang X, Thibodeau B, Trope M, Lin LM, Huang GT-J. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010;36(1):56-63.
• 25. Song M, Cao Y, Shin S-J, Shon W-J, Chugal N, Kim RH, et al. Revascularization-associated intracanal calcification: assessment of prevalence and contributing factors. J Endod. 2017;43(12):2025-33.
• 26. Chueh L-H, Ho Y-C, Kuo T-C, Lai W-H, Chen Y-HM, Chiang C-P. Regenerative endodontic treatment for necrotic immature permanent teeth. J Endod. 2009;35(2):160-4.
• 27. Diogenes A, Henry MA, Teixeira FB, Hargreaves KM. An update on clinical regenerative endodontics. Endod Topics. 2013;28(1):2-23.
• 28. Lei L, Chen Y, Zhou R, Huang X, Cai Z. Histologic and immunohistochemical findings of a human immature permanent tooth with apical periodontitis after regenerative endodontic treatment. J Endod. 2015;41(7):1172-9.
• 29. Shivashankar VY, Johns DA, Maroli RK, Sekar M, Chandrasekaran R, Karthikeyan S, et al. Comparison of the effect of PRP, PRF and induced bleeding in the revascularization of teeth with necrotic pulp and open apex: a triple blind randomized clinical trial. J Clin Diagn Res. 2017;11(6):ZC34.