Rejeneratif Endodontide Kan Pıhtısı ve Trombosit Konsantrasyonları
Özet
Rejeneratif endodontik tedavilerde (RET) geleneksel apeksifikasyon yöntemlerine alternatif olarak pulpa-dentin kompleksinin biyolojik esaslı uygulamalarla yeniden oluşturulması amaçlanmaktadır. Bu süreçte doku mühendisliğinin üç ana unsuru olan kök hücreler, büyüme faktörleri ve uygun bir üç boyutlu iskele yapısına ihtiyaç duyulmaktadır. Dokunun hasar görmesiyle devreye giren pıhtılaşma mekanizması sonucu oluşan fibrin matrisi, hücre tutunmasını ve doku rejenerasyonunu destekleyen doğal bir iskele görevi görür. RET’te kök hücre kaynağı ve biyolojik iskele olarak kan pıhtısından yararlanılmakta; bu işlem kasıtlı apikal kanatmayla kanal boşluğuna mezenkimal kök hücrelerin ve büyüme faktörlerinin çekilmesini hedeflemektedir. Ancak her vakada yeterli kan hacmine ulaşılamaması gibi kısıtlamalar nedeniyle, kan pıhtısına alternatif olarak trombosit konsantrasyonlarının kullanımı gündeme gelmiştir. Bu doğrultuda geliştirilen birinci nesil Trombositten Zengin Plazma (PRP) yüksek oranda büyüme faktörü içerirken; ikinci nesil Trombositten Zengin Fibrin (PRF) ve gelişmiş türevleri (A-PRF, T-PRF, CGF) antikoagülan gerektirmeyen yapıları ve sitokinleri yavaşça salma yetenekleriyle doku iyileşmesinde uzun süreli etki sunmaktadır. Klinik ve radyografik çalışmalarda kan pıhtısı ve trombosit konsantrasyonlarının kök gelişimi ile periapikal iyileşmede birbirlerine göre kesin bir üstünlüğü net olarak kanıtlanamamış olsa da, bu biyolojik iskelelerin endodontik tedavi gerektiren açık apeksli dişlerin canlılığını sürdürmesinde yüksek bir başarı potansiyeli bulunmaktadır.
In regenerative endodontic treatments (RET), it is aimed to reconstruct the pulp-dentin complex with biologically based applications as an alternative to traditional apexification methods. In this process, three main elements of tissue engineering, namely stem cells, growth factors, and a suitable three-dimensional scaffold structure, are required. The fibrin matrix formed as a result of the coagulation mechanism triggered by tissue damage serves as a natural scaffold supporting cell attachment and tissue regeneration. In RET, blood clots are utilized as a stem cell source and biological scaffold, aiming to attract mesenchymal stem cells and growth factors into the canal space through intentional apical bleeding. However, due to limitations such as the inability to achieve adequate blood volume in every case, the use of platelet concentrates has been introduced as an alternative to blood clots. Accordingly, the first-generation Platelet-Rich Plasma (PRP) contains a high rate of growth factors, while the second-generation Platelet-Rich Fibrin (PRF) and its advanced derivatives (A-PRF, T-PRF, CGF) offer a long-term effect in tissue healing with their anticoagulant-free structures and ability to release cytokines slowly. Although a definitive superiority of blood clots and platelet concentrates over each other in root development and periapical healing has not been clearly proven in clinical and radiographic studies, these biological scaffolds hold a high success potential in maintaining the vitality of open-apex teeth requiring endodontic treatment.
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