İrreversible Pulpitis Tanılı Dişlerde Vital Pulpa Tedavi Yaklaşımları
Özet
Pulpa çürük, travma veya iyatrojenik nedenlerle hasar görebilir. Hasar görmüş pulpanın canlılığının devam etmesi, diş yapısının korunması ve dişin fizyolojik fonksiyonun sürdürülmesi açısından önemlidir. Pulpa hastalıklarının sınıflandırılmasında reversible ve irreversible pulpitis terimleri, endodontide uzun yıllardır kullanılmaktadır. Vital pulpa tedavileri, pulpayı koruyarak dişin canlılığını sürdürmeyi amaçlar. Bu süreçte, mikrobiyal irritasyonun ortadan kaldırılması, açık dentin ve pulpanın korunması için biyomateryal uygulamaları önemlidir. Son yıllarda biyoseramikler, kalsiyum hidroksit gibi geleneksel materyallere göre üstün histolojik ve klinik özellikler sunarak vital pulpa tedavilerinde altın standart haline gelmiştir. Biyoseramiklerin kullanımı, vital pulpa tedavilerinin endikasyonlarını genişletmiş ve pulpitis tedavisinde kök kanal tedavisine benzer klinik sonuçlar elde edilmesini sağlamıştır. İrreversible pulpitisli dişlerde uygulanan vital pulpa tedavileri, kök kanal tedavisine alternatif bir seçenek olarak değerlendirilmektedir.
The pulp tissue can be damaged by caries, trauma or iatrogenic causes. The continuation of the vitality of the damaged pulp tissue is important for the preservation of the tooth structure and the maintenance of the physiological function of the tooth. The terms reversible and irreversible pulpitis have been used for many years in the classification of pulp diseases in endodontics. Vital pulp treatments aim to maintain the vitality of the tooth by protecting the pulp. In this process, biomaterial applications are important for eliminating microbial irritation and protecting the exposed dentin and pulp. In recent years, bioceramics have become the gold standard in vital pulp therapies, offering superior histological and clinical properties compared to traditional materials such as calcium hydroxide. The use of bioceramics has expanded the indications for vital pulp therapies and has provided clinical results similar to root canal treatment in the treatment of pulpitis. Vital pulp therapies applied to teeth with irreversible pulpitis are considered an alternative option to root canal treatment.
Referanslar
Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod.2009;35(12):1645-57. https://doi.org/10.1016/j.joen.2009.09.032
Duncan H, Galler K, Tomson P, Simon S, El‐Karim I, Kundzina R, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. International Endodontic Journal. 2019;52(7):923-34. https://doi.org/10.1111/iej.13080
Cushley S, Duncan H, Lappin M, Chua P, Elamin A, Clarke M, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis. International endodontic journal. 2021;54(4):556-71. https://doi.org/10.1111/iej.13449
Fava LR, Saunders WP. Calcium hydroxide pastes: classification and clinical indications. Int Endod J. 1999;32(4):257-82. https://doi.org/10.1046/j.1365-2591.1999.00232.x
Shang W, Zhang Z, Zhao X, Dong Q, Schmalz G, Hu S. The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective. Biomed Res Int. 2022;2022:8788358. https://doi.org/10.1155/2022/8788358
Duncan HF. Present status and future directions-Vital pulp treatment and pulp preservation strategies. Int Endod J. 2022;55 Suppl 3(Suppl 3):497-511. https://doi.org/10.1111/iej.13688
Cobanoglu N, Alptekin T, Kitagawa H, Blatz MB, Imazato S, Ozer F. Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB. Dental Materials Journal. 2021;40(3):689-96. https://doi.org/10.4012/dmj.2020-145
Komabayashi T, Zhu Q, Eberhart R, Imai Y. Current status of direct pulp-capping materials for permanent teeth. Dental materials journal. 2016;35(1):1-12. https://doi.org/10.4012/dmj.2015-013
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. The Journal of the American Dental Association.2006;137(12):1699-705. https://doi.org/10.14219/jada.archive.2006.0116
Hirschberg C, Galicia J, Ruparel N. AAE Position statement on vital pulp therapy. J Endod. 2021;47(9):1340-4. https://doi.org/10.1016/j.joen.2021.07.015
Demant S, Dabelsteen S, Bjørndal L. A macroscopic and histological analysis of radiographically well‐defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response. International endodontic journal. 2021;54(3):319-30. https://doi.org/10.1111/iej.13424
Bjørndal L, Fransson H, Bruun G, Markvart M, Kjældgaard M, Näsman P, et al. Randomized clinical trials on deep carious lesions: 5-year follow-up. Journal of Dental Research. 2017;96(7):747-53. https://doi.org/10.1177/0022034517702620
Maltz M, Koppe B, Jardim J, Alves L, De Paula L, Yamaguti P, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clinical oral investigations. 2018;22:1337-43. https://doi.org/10.1007/s00784-017-2221-0
Matsuo T, Nakanishi T, Shimizu H, Ebisu S. A clinical study of direct pulp capping applied to carious-exposed pulps. Journal of endodontics. 1996;22(10):551-6. https://doi.org/10.1016/s0099-2399(96)80017-3
Taha N, Ahmad M, Ghanim A. Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. International endodontic journal. 2017;50(2):117-25. https://doi.org/10.1111/iej.12605
Taha NA, Abdulkhader SZ. Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure. J Endod. 2018;44(6):932-7. https://doi.org/10.1016/j.joen.2018.03.003
Uesrichai N, Nirunsittirat A, Chuveera P, Srisuwan T, Sastraruji T, Chompu-Inwai P. Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: a noninferiority randomized controlled trial. Int Endod J. 2019;52(6):749-59. https://doi.org/10.1111/iej.13071
Seltzer S, Bender I, Ziontz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp. Oral Surgery, Oral Medicine, Oral Pathology. 1963;16(7):846-71. https://doi.org/10.1016/0030-4220(63)90323-2
Ghoddusi J, Forghani M, Parisay I. New approaches in vital pulp therapy in permanent teeth. Iranian endodontic journal. 2014;9(1):15.
Dummer PM, Hicks R, Huws D. Clinical signs and symptoms in pulp disease. Int Endod J. 1980;13(1):27-35. https://doi.org/10.1111/j.1365-2591.1980.tb00834.x
Galicia JC, Peters OA. Proposal for a new diagnostic terminology to describe the status of the dental pulp. International Endodontic Journal. 2021;54(8):1415-6. https://doi.org/10.1111/iej.13545
Ballal N, Duncan H, Wiedemeier D, Rai N, Jalan P, Bhat V, et al. MMP-9 levels and NaOCl lavage in randomized trial on direct pulp capping. Journal of Dental Research. 2022;101(4):414-9. https://doi.org/10.1177/00220345211046874
Rechenberg DK, Zehnder M. Call for a review of diagnostic nomenclature and terminology used in Endodontics. International Endodontic Journal. 2020;53(10):1315-7. https://doi.org/10.1111/iej.13374
Wolters W, Duncan H, Tomson P, Karim I, McKenna G, Dorri M, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017;50(9):825-9. https://doi.org/10.1111/iej.12793
Goldberg M, Farges JC, Lacerda-Pinheiro S, Six N, Jegat N, Decup F, et al. Inflammatory and immunological aspects of dental pulp repair. Pharmacol Res. 2008;58(2):137-47. https://doi.org/10.1016/j.phrs.2008.05.013
Biodentine™ Properties and Clinical Applications 2022.
Lin L, Shovlin F, Skribner J, Langeland K. Pulp biopsies from the teeth associated with periapical radiolucency. J Endod. 1984;10(9):436-48. https://doi.org/10.1016/s0099-2399(84)80266-6
Lin L, Langeland K. Light and electron microscopic study of teeth with carious pulp exposures. Oral Surg Oral Med Oral Pathol. 1981;51(3):292-316. https://doi.org/10.1016/0030-4220(81)90060-8
Chinadet W, Sutharaphan T, Chompu-Inwai P. Biodentine™ Partial Pulpotomy of a Young Permanent Molar with Signs and Symptoms Indicative of Irreversible Pulpitis and Periapical Lesion: A Case Report of a Five-Year Follow-Up. Case Rep Dent. 2019;2019:8153250. https://doi.org/10.1155/2019/8153250
Lee SM, Yu YH, Karabucak B. Endodontic treatments on permanent teeth in pediatric patients aged 6-12 years old. J Dent Sci. 2023;18(3):1109-15. https://doi.org/10.1016/j.jds.2022.11.003
Ricucci D, Siqueira JF, Jr., Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent. 2019;86:41-52. https://doi.org/10.1016/j.jdent.2019.05.022
Qudeimat M, Alyahya A, Hasan A, Barrieshi‐Nusair K. Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study. International endodontic journal. 2017;50(2):126-34. https://doi.org/10.1111/iej.12614
Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J. 2018;51(8):819-28. https://doi.org/10.1111/iej.12903
Taha NA, Khazali MA. Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial. J Endod. 2017;43(9):1417-21. https://doi.org/10.1016/j.joen.2017.03.033
Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent. 2018;40(6):343-51.
Eşian D, Monea A. Management of the young permanent teeth with pulp diseases—a therapeutic guide of teeth with open apex. Acta Medica Transilvanica. 2011;16(3):446-9.
Hanna SN, Alfayate RP, Prichard J. Vital pulp therapy an insight over the available literature and future expectations. European endodontic journal. 2020;5(1):46. https://doi.org/10.14744/eej.2019.44154
AAPD. Guideline on pulp therapy for primary and young permanent teeth. Pediatr Dent. 2005;27(7 Suppl):130-4.
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Referanslar
Levin LG, Law AS, Holland GR, Abbott PV, Roda RS. Identify and define all diagnostic terms for pulpal health and disease states. J Endod.2009;35(12):1645-57. https://doi.org/10.1016/j.joen.2009.09.032
Duncan H, Galler K, Tomson P, Simon S, El‐Karim I, Kundzina R, et al. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. International Endodontic Journal. 2019;52(7):923-34. https://doi.org/10.1111/iej.13080
Cushley S, Duncan H, Lappin M, Chua P, Elamin A, Clarke M, et al. Efficacy of direct pulp capping for management of cariously exposed pulps in permanent teeth: a systematic review and meta‐analysis. International endodontic journal. 2021;54(4):556-71. https://doi.org/10.1111/iej.13449
Fava LR, Saunders WP. Calcium hydroxide pastes: classification and clinical indications. Int Endod J. 1999;32(4):257-82. https://doi.org/10.1046/j.1365-2591.1999.00232.x
Shang W, Zhang Z, Zhao X, Dong Q, Schmalz G, Hu S. The Understanding of Vital Pulp Therapy in Permanent Teeth: A New Perspective. Biomed Res Int. 2022;2022:8788358. https://doi.org/10.1155/2022/8788358
Duncan HF. Present status and future directions-Vital pulp treatment and pulp preservation strategies. Int Endod J. 2022;55 Suppl 3(Suppl 3):497-511. https://doi.org/10.1111/iej.13688
Cobanoglu N, Alptekin T, Kitagawa H, Blatz MB, Imazato S, Ozer F. Evaluation of human pulp tissue response following direct pulp capping with a self-etching adhesive system containing MDPB. Dental Materials Journal. 2021;40(3):689-96. https://doi.org/10.4012/dmj.2020-145
Komabayashi T, Zhu Q, Eberhart R, Imai Y. Current status of direct pulp-capping materials for permanent teeth. Dental materials journal. 2016;35(1):1-12. https://doi.org/10.4012/dmj.2015-013
Al-Hiyasat AS, Barrieshi-Nusair KM, Al-Omari MA. The radiographic outcomes of direct pulp-capping procedures performed by dental students: a retrospective study. The Journal of the American Dental Association.2006;137(12):1699-705. https://doi.org/10.14219/jada.archive.2006.0116
Hirschberg C, Galicia J, Ruparel N. AAE Position statement on vital pulp therapy. J Endod. 2021;47(9):1340-4. https://doi.org/10.1016/j.joen.2021.07.015
Demant S, Dabelsteen S, Bjørndal L. A macroscopic and histological analysis of radiographically well‐defined deep and extremely deep carious lesions: carious lesion characteristics as indicators of the level of bacterial penetration and pulp response. International endodontic journal. 2021;54(3):319-30. https://doi.org/10.1111/iej.13424
Bjørndal L, Fransson H, Bruun G, Markvart M, Kjældgaard M, Näsman P, et al. Randomized clinical trials on deep carious lesions: 5-year follow-up. Journal of Dental Research. 2017;96(7):747-53. https://doi.org/10.1177/0022034517702620
Maltz M, Koppe B, Jardim J, Alves L, De Paula L, Yamaguti P, et al. Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial. Clinical oral investigations. 2018;22:1337-43. https://doi.org/10.1007/s00784-017-2221-0
Matsuo T, Nakanishi T, Shimizu H, Ebisu S. A clinical study of direct pulp capping applied to carious-exposed pulps. Journal of endodontics. 1996;22(10):551-6. https://doi.org/10.1016/s0099-2399(96)80017-3
Taha N, Ahmad M, Ghanim A. Assessment of mineral trioxide aggregate pulpotomy in mature permanent teeth with carious exposures. International endodontic journal. 2017;50(2):117-25. https://doi.org/10.1111/iej.12605
Taha NA, Abdulkhader SZ. Full Pulpotomy with Biodentine in Symptomatic Young Permanent Teeth with Carious Exposure. J Endod. 2018;44(6):932-7. https://doi.org/10.1016/j.joen.2018.03.003
Uesrichai N, Nirunsittirat A, Chuveera P, Srisuwan T, Sastraruji T, Chompu-Inwai P. Partial pulpotomy with two bioactive cements in permanent teeth of 6- to 18-year-old patients with signs and symptoms indicative of irreversible pulpitis: a noninferiority randomized controlled trial. Int Endod J. 2019;52(6):749-59. https://doi.org/10.1111/iej.13071
Seltzer S, Bender I, Ziontz M. The dynamics of pulp inflammation: correlations between diagnostic data and actual histologic findings in the pulp. Oral Surgery, Oral Medicine, Oral Pathology. 1963;16(7):846-71. https://doi.org/10.1016/0030-4220(63)90323-2
Ghoddusi J, Forghani M, Parisay I. New approaches in vital pulp therapy in permanent teeth. Iranian endodontic journal. 2014;9(1):15.
Dummer PM, Hicks R, Huws D. Clinical signs and symptoms in pulp disease. Int Endod J. 1980;13(1):27-35. https://doi.org/10.1111/j.1365-2591.1980.tb00834.x
Galicia JC, Peters OA. Proposal for a new diagnostic terminology to describe the status of the dental pulp. International Endodontic Journal. 2021;54(8):1415-6. https://doi.org/10.1111/iej.13545
Ballal N, Duncan H, Wiedemeier D, Rai N, Jalan P, Bhat V, et al. MMP-9 levels and NaOCl lavage in randomized trial on direct pulp capping. Journal of Dental Research. 2022;101(4):414-9. https://doi.org/10.1177/00220345211046874
Rechenberg DK, Zehnder M. Call for a review of diagnostic nomenclature and terminology used in Endodontics. International Endodontic Journal. 2020;53(10):1315-7. https://doi.org/10.1111/iej.13374
Wolters W, Duncan H, Tomson P, Karim I, McKenna G, Dorri M, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017;50(9):825-9. https://doi.org/10.1111/iej.12793
Goldberg M, Farges JC, Lacerda-Pinheiro S, Six N, Jegat N, Decup F, et al. Inflammatory and immunological aspects of dental pulp repair. Pharmacol Res. 2008;58(2):137-47. https://doi.org/10.1016/j.phrs.2008.05.013
Biodentine™ Properties and Clinical Applications 2022.
Lin L, Shovlin F, Skribner J, Langeland K. Pulp biopsies from the teeth associated with periapical radiolucency. J Endod. 1984;10(9):436-48. https://doi.org/10.1016/s0099-2399(84)80266-6
Lin L, Langeland K. Light and electron microscopic study of teeth with carious pulp exposures. Oral Surg Oral Med Oral Pathol. 1981;51(3):292-316. https://doi.org/10.1016/0030-4220(81)90060-8
Chinadet W, Sutharaphan T, Chompu-Inwai P. Biodentine™ Partial Pulpotomy of a Young Permanent Molar with Signs and Symptoms Indicative of Irreversible Pulpitis and Periapical Lesion: A Case Report of a Five-Year Follow-Up. Case Rep Dent. 2019;2019:8153250. https://doi.org/10.1155/2019/8153250
Lee SM, Yu YH, Karabucak B. Endodontic treatments on permanent teeth in pediatric patients aged 6-12 years old. J Dent Sci. 2023;18(3):1109-15. https://doi.org/10.1016/j.jds.2022.11.003
Ricucci D, Siqueira JF, Jr., Li Y, Tay FR. Vital pulp therapy: histopathology and histobacteriology-based guidelines to treat teeth with deep caries and pulp exposure. J Dent. 2019;86:41-52. https://doi.org/10.1016/j.jdent.2019.05.022
Qudeimat M, Alyahya A, Hasan A, Barrieshi‐Nusair K. Mineral trioxide aggregate pulpotomy for permanent molars with clinical signs indicative of irreversible pulpitis: a preliminary study. International endodontic journal. 2017;50(2):126-34. https://doi.org/10.1111/iej.12614
Taha NA, Abdelkhader SZ. Outcome of full pulpotomy using Biodentine in adult patients with symptoms indicative of irreversible pulpitis. Int Endod J. 2018;51(8):819-28. https://doi.org/10.1111/iej.12903
Taha NA, Khazali MA. Partial Pulpotomy in Mature Permanent Teeth with Clinical Signs Indicative of Irreversible Pulpitis: A Randomized Clinical Trial. J Endod. 2017;43(9):1417-21. https://doi.org/10.1016/j.joen.2017.03.033
Pulp Therapy for Primary and Immature Permanent Teeth. Pediatr Dent. 2018;40(6):343-51.
Eşian D, Monea A. Management of the young permanent teeth with pulp diseases—a therapeutic guide of teeth with open apex. Acta Medica Transilvanica. 2011;16(3):446-9.
Hanna SN, Alfayate RP, Prichard J. Vital pulp therapy an insight over the available literature and future expectations. European endodontic journal. 2020;5(1):46. https://doi.org/10.14744/eej.2019.44154
AAPD. Guideline on pulp therapy for primary and young permanent teeth. Pediatr Dent. 2005;27(7 Suppl):130-4.
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