İmmatür Dişlerde Rejeneratif Endodonti Uygulamaları
Özet
İmmatür daimi dişlerde travma veya çürük kaynaklı pulpa nekrozu kök gelişimini durdurarak geleneksel tedavileri zorlaştırmaktadır. Bu amaçla uygulanan kalsiyum hidroksit veya MTA ile apeksifikasyon yöntemleri, kök duvarlarının ince ve kısa kalmasına yol açarak kırılma riskini artırmaktadır. Alternatif bir yaklaşım olarak öne çıkan rejeneratif endodonti, hasar görmüş pulpa-dentin kompleksinin yenilenmesini amaçlayan doku mühendisliği temelli bir uygulamadır. Bu tedavi kök hücreler, büyüme faktörleri ve doku iskeleti (kan pıhtısı, PRP, PRF) bileşenlerine dayanmaktadır. Kök kanal dezenfeksiyonu için düşük konsantrasyonda sodyum hipoklorit ve kalsiyum hidroksit kullanımı, apikal papilladaki kök hücreleri korurken dentin büyüme faktörlerinin salınımını tetiklemektedir. AAE rehberine göre ilk seansta kanal yıkanıp ilaçlanmakta; 1-4 hafta sonraki ikinci seansta ise kanama indüklenerek veya trombosit konsantreleri kullanılarak doku iskeleti oluşturulmak olmakta, ardından MTA ve restoratif materyal yerleştirilmektedir. Tedavinin temel hedefleri semptomların ortadan kaldırılması, periapikal iyileşme, kök duvar kalınlığı ile uzunluğunun artırılması ve pulpa canlılığının geri kazandırılmasıdır.
In immature permanent teeth, pulp necrosis due to trauma or caries halts root development, making traditional treatments difficult. Calcium hydroxide or MTA apexification methods applied for this purpose lead to thin and short root walls, increasing the risk of fracture. Emerging as an alternative approach, regenerative endodontics is a tissue engineering-based procedure aiming to regenerate the damaged pulp-dentin complex. This treatment relies on the components of stem cells, growth factors, and scaffolds (blood clot, PRP, PRF). The use of low-concentration sodium hypochlorite and calcium hydroxide for root canal disinfection protects stem cells in the apical papilla while triggering the release of dentin growth factors. According to the AAE guidelines, the canal is irrigated and medicated in the first session; in the second session 1-4 weeks later, a scaffold is created by inducing bleeding or using platelet concentrates, followed by the placement of MTA and restorative material. The primary goals of the treatment are the elimination of symptoms, periapikal healing, increasing root wall thickness and length, and restoring pulp vitality.
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