KLİNİK KOŞULLARDA ETKİLENMİŞ DENTİN VE ENFEKTE DENTİN AYRIMI

Yıl 2021, Cilt: 8 Sayı: 1, 266 - 271, 30.04.2021

Seren Kaya , Firdevs Tulga Öz

https://doi.org/10.15311/selcukdentj.650568

Öz

Dünya genelinde en yaygın görülen hastalıklardan olan diş çürüğü, ağrı ve hassasiyet gibi semptomlarla ortaya çıkabilmekte ve diş dokusunun yıkımına, çiğneme fonksiyonu kaybına ve estetik olmayan görünüme sebep olabilmektedir. Günümüzde artan çürük oranıyla beraber süt ve sürekli dişlerde derin dentin çürükleriyle karşılaşılma sıklığı da artmıştır. Derin dentin çürüğü terimi; çürüğün tamamının kaldırılmasıyla pulpanın ekspoz olma riskinin bulunduğu durumlarda kullanılmaktadır. Süt dişlerinin, sürekli dişler sürene kadar yer tutucu olarak görev yapmaları ve genç sürekli dişlerin kök gelişimlerinin devam edebilmesi amacıyla bu dişlere uygulanacak tedavilerin mümkün olduğunca vital tedaviler olması gerektiği vurgulanmaktadır. Bu sayede pulpa dokusunun canlılığını koruması ve devam ettirmesi amaçlanmaktadır. Derin çürük tedavisi sırasında çürüğün tamamının temizlenmesi pulpa perforasyonlarının ortaya çıkmasına yol açmaktadır. Meydana gelen pulpa perforasyonu dişin uzun dönem prognozunu olumsuz yönde etkilemektedir. Bu nedenle, etkilenmiş ve enfekte dentin ayrımı konservatif tedavide koruyucu yönlendirme sağlaması açısından önemlidir. Laboratuvar çalışmalarında, enfekte dentin ile etkilenmiş dentin arasındaki sınır gözle ayırt edilebilirken klinikte diş hekimleri belli rehber kriterler kullanarak, bu sınırın nerede ortadan kalktığına ve uzaklaştırılması gereken dentin miktarına subjektif olarak karar verirler. Bu nedenle hekimler arasında kaldırılan dokunun nitelik ve miktarında varyasyonlar olabilmektedir. Sonuç olarak, ideal bir tedavi için tüm hekimlerin etkilenmiş ve enfekte dentin ayrımını ve klinik özelliklerini iyi bilip ne kadarının uzaklaştırılması gerektiğine doğru olarak karar verebilmesi gerekmektedir.

Anahtar Kelimeler

çürük tespit yöntemleri, enfekte dentin, etkilenmiş dentin, derin dentin çürüğü

DIFFERENTIATION OF INFECTED DENTINE AND AFFECTED DENTINE IN CLINICAL CONDITIONS

Öz

Tooth decay, which is one of the most common diseases in the world, can occur with symptoms such as pain and tenderness and can cause destruction of the tooth tissue, loss of chewing function and non-aesthetic appearance. Nowadays, with increasing caries rate, the incidence of deep dentin caries in deciduous and permanent teeth has increased. The term deep dentin caries; it is used in cases where there is a risk that the pulp may be exposed by removing the entire caries. It is emphasized that the treatments to be applied to these teeth should be as vital as possible. Thus, it is aimed to maintain the vitality of pulp tissue. Removal of the entire caries during deep caries treatment leads to pulpal perforations. The resulting pulp perforation negatively affects the long-term prognosis of the tooth. Therefore, the distinction between affected and infected dentin is important in terms of providing protective guidance in conservative treatment. In laboratory studies, the boundary between the infected dentin and the affected dentin can be distinguished visually, while in the clinic, dentists subjectively determine where this limit disappears and the amount of dentin to be removed. Therefore, there may be variations in the quality and amount of tissue removed by physicians. As a result, for an ideal treatment, all physicians should know the affected and infected dentin differentiation and clinical characteristics well and decide how much of it should be removed.

Anahtar Kelimeler

caries detection methods, infected dentine, affected dentine, deep dentine decay

Kaynakça

• Boucher CO. Current clinical dental terminology: a glossary of accepted terms in all disciplines of dentistry: C. V. Mosby Co., 1974.
• Fejerskov OT. The oral environment-an introduction. In. Textbook oc Clinical Cariology, A. Thystrup 2nd Ed. Copenhagen: Munskgaard, 1994.
• Krutchkoff D. The Pathogenesis of dental caries, Chapter 10. D.j. Forrester, M.L. Wagner, J. Fleming.Philadelphia: Lea&Febiger, 1981.
• Marsh PM. Oral Microbiology, 4th edn. Chapter3. Oxford: Wright, 1999.
• Mellberg JR. Fluoride in Preventive Dentistry: Theory and Clinical Applications, Chapter 1. Chicago, Illinois: Quintessence Publishing Co., 1983.
• Fejerskov O, Kidd EA. Dental caries: the disease and its clinical management. John Wiley & Sons, 2015.
• Bjorndal L. Indirect pulp therapy and stepwise excavation. JOE 2008; 34(7S), 29-33.
• Fuks AB. Pulp therapy for the primary and young permanent dentitions. Dental Clinics of North America. 2000; 44(3):571-96.
• Schröeder A. Chapter 2, In:. Endodontics- Science and Practice, 1st edn., Chicago Quintessence Publishing Co Inc, 1981.
• Bjorndal L, Mjor IA. Pulp-dentin biology in restorative dentistry. Part 4: Dental caries characteristics of lesions and pulpal reactions. Quintessence Int., 2001; 32: 717-736.
• McDonald RA. Chapter 19: Treatment of deep caries, vital pulp exposure and pulpless teeth . R. A. McDonald içinde, Dentistry for the Child and Adolescent, 7th edn. Mosby, USA, 1999.
• Camp JH, Barrett EJ, Pulver F. Pediatric endodontics: Endodontic treatment for the primary and young permanent dentition. 2002; 797-844.
• Fitzgerald M, Heys R. A clinical and histological evaluation of conservative pulpal therapy in human teeth. Oper dent. 1991; 16(3):101-12.
• Shovelton D. The maintenanse of pulp vitality. Br Dent J, 1972; 133:95-101.
• Fusayama T. The process and results of revolution in dental caries treatment. Int Dent J. 1997; 47(3): 157-66.
• Kozemi RM. Effect of Caries Disclosing Agents on Bond Strengths of Total Etch and Self Etching Primer Dentin Bonding Systems to Resin Composite. Oper Dent. 2002; 27:238-42.
• Yoshiyama M, Urayama A, Kimochi T, Matsuo T, Pashley DH. Comparison of conventional vs self-etching adhesive bonds to caries-affected dentin. Oper dent. 2000; 25(3):163-9.
• Kozemi R, Meiers J, Peppers K. Laboratory Research. Oper dent. 2002; 27:238-42.
• Fusayama T. New concepts in operative dentistry. Differentiating two layers of carious denitin and using an adhesive resin. 1980; 61-156.
• Lundeen TR. Cariology: The lesion, etiology, prevention and control. The Art and Science of Operative Dentistry. içinde Ed.: C.M. Sturdevant. 3rd Ed. St. Louis: Mosby C, Chapter 3, 1995.
• Banerjee AK. In vitro validation of carioes dentine after removed using different excavation criteria. Am J Dent 2003; 16:228-30.
• Rodd H, Waterhouse P, Fuks A, Fayle S, Moffat M. Pulp therapy for primary molars. International Journal of Paediatric Dentistry. 2006; 16:15-23.
• Dumsha T, Hovland E. Considerations and treatment of direct and indirect pulp-capping. Dental clinics of North America 1985; 29(2):251-9.
• Kidd EA, Joyston-Bechal S. The use of a caries detectos dye during cavity preparation: a microbial assesment. Br. Dent J. 1993; 174: 245-8.
• Fusayama T. Clinical guide for removing caries using a caries-detecting solution. Quintessence Int. 1988; 19:397-401.
• Boston D, Liao J. Staining of non-carious human coronal dentin by caries dyes. Operative dentistry-University of Washington. 2004; 29:280-6.
• Kidd EA, Joyston-Bechal S, Smith M, Allan R, Howe L, Smith S. The use of a caries detector dye in cavity preparation. British dental journal. 1989; 167(4):132.
• Ekfelt AF. Replica techniques for in-vivo studies of tooth surfaces and prosthetic materials. Scand J Dent Res. 1985; 93:560-5.
• Anttonen VS. A follow-up study of the use of Diagnodent for monitoring fissure caries in children. Community Dent Oral Epidemiol. 2004; 32:312-8.
• Heinrich-Weltzien RW. Clinical evaluation of visual, radiographic, and laser fluorescence methods for detection of occlusal caries. ASDC J Dent Child. 2002; 69:127-32.
• Lussi AM. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J oral Sci. 2001; 109:14-9.
• Sheehy EB. Comparison between visual examination and a laser fluorescence system for in vivo diagnosis of occlusal caries. Caries Res. 2000; 34:151-8.
• Lennon AB. Efficiency of fluorescence-aided caries excavation (FACE) compared to convantional methods. Caries Res. 2002; 36:186.
• Coll J. Indirect pulp capping and primary teeth: ıs the primary tooth pulpotomy out of date. journal of endodontics. 2008; 34,7:34-39.
• Massler M. Treatment of profound caries to prevent pulpal damage. The journal of pedodontics. 1978; 2(2): 99-105.
• Schutzbank SG, Galaini J, Kronman JH, Goldman M, Clark RE. A comparative in vitro study of GK-101 and GK-101E in caries removal. J Dent Res. 1978; 57:861-4.
• Beeley JA, Yipp HK, Stevenson AG. Chemomechanical caries removal: Areview of the techniques and latest developments. Br Dent J. 2000; 188:427-430.
• Ganesh M, Patrikh D. Chemomechanical caries removal agents: Review and clinical application in primary teeth. Journal of Dentistry and Oral Hygiene. 2011; 3:34-35.
• Yip HK, Samaranayake L. Caries removal techniques and instrumentation: a review. Clin Oral Investig. 1998; 2:148-54.
• Pereira SA, Silva LR, Piccinini DPF, Santos EM, Bussadori SK. Comparison antimicrobial potential in vitro between two materials for the Chemomechanical caries removal. In: 21ª Annual Reunion SBPqO, Águas de Lindóia. Pesqui Odont Bras., 18: 78, 2004.
• Willmott N, Wong F, Davis G. An X-Ray Microtomography Study on the Mineral Concentration of Carious Dentine Removed during Cavity Preparation in Deciduous Molars. Caries research. 2007; 41:129–134.
• Stark M. Direct and indirect pulp capping. Dent clin north. 1976; 20(2):341-349.
• Leksell E, Ridell K, Cvek M, Mejare I. Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth. Endodontics & dental traumatology. 1996; 12(4):192-6.
• American Academy of Pediatric Dentistry. Council on Clinical Affairs. Guadline on Restorative Dentistry. Pediatr Dent. 2016; 38(6): 250-62.
• Newbrun E. Cariology. 3rd Ed. Chicago: Quintessence Publishing Co. Inc., 1989.
• Kidd EA. Caries removal and the pulpo-dentinal complex. E. K. O. Fejerskov içinde, Dental Caries. The Disease and its Clinical Management . Oxford: Blackwell Munksgaard, Chapter 17, 2003.
• Dean JA. McDonald and Avery's Dentistry for the Child and Adolescent-E-Book: Elsevier Health Sciences, 2015.
• Kidd EA, Ricketts DN, Beighton D. Criteria for caries removal at the enamel-dentin junction: a clinical and microbiological study. Br Dent J. 1996; 180: 287-91.
• Fusayama T, Okuse K, Hosoda H. Relationship between hardness, discoloration, and microbial invasion in carious dentin. J Dent. Res. 1966; 45: 1033-1046.
• Ogawa K, Yamashita Y, Ichijo T, Fusayama T. The ultrastructure and hardness of the transparant layer of human carious dentin. J. Dent. Res. 1983; 62:7-10.
• Alaçam T. Dentin ve pulpa tedavileri. Endodonti, II Baskı, Bölüm 6, 107, 2000.
• Mjör IA, Hörsted-Bindslev P. Modern concepts in operative dentistry: Munksgaard, 1988.
• Schwendicke F. Managing carious lesions: Consensus recommendations on carious tissue removal. Adv Dent Res. 2016; 28(2):58-67.
• Fuks AG. Current developments in pulp therapy for primary teeth . Endodontic Topics. 2012; 23:50-72.
• Mertz- Fairhurst EC. Ultraconservative and cariostatic sealed restorations: results at year 10. J. Am. Dent. Assoc. 1998; 129: 55-66.
• Paddick J, Brailsford S, Kidd E, Beighton D. Phenotypic and genotypic selection of microbiota surviving under dental restorations. Appl Environ Microbiol. 2005; 71(5):2467-72.Ricketts DL. Operative caries management in adults and children. Cochrane Database Syst Rev, s. (3): CD003808, 2013.
• Bjorndal L, Larsen T, Thylstrup A. A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals. Caries Res. 1997; 31(6):411-7.
• Kidd EA. What constitutes dental caries? Histopathology of carious enamel and dentin related to the action of cariogenic biofilms. J. Dent. Res. 2004; 83: Spec. No. C:C35-8.
• Orhan A. Tek aşamalı indirekt pulpa tedavisi, iki aşamalı indirekt pulpa tedavisi ve çürüğün tek seansta tamamen kaldırılması yöntemlerinin derin çürüklü süt ve genç sürekli dişlerde karşılaştırmalı olarak değerlendirilmesi, Doktora tezi. Ankara: Ankara Üniversitesi, Pedodonti Anabilim Dalı; 2007.