Yaşlı Bireylerde Endodontik Tedavi Yaklaşımları
Özet
Dünya genelinde hızla artan yaşlı nüfus oranı, geriatrik endodontinin önemini artırmakta ve ağız sağlığının genel sağlığın bir parçası olması nedeniyle yaşlı bireylerin yaşam kalitesini doğrudan etkilemektedir. Yaşlanma süreciyle birlikte diş minesi kırılganlaşmakta, atrizyon, abrazyon ve erozyon gibi etkenlerle dentin dokusu açığa çıkabilmektedir. Zamanla sekonder ve tersiyer dentin yapımının artması pulpa odasını daraltarak kalsifikasyonlara yol açmakta, bu durum ise pulpanın hücresel, damarsal ve sinirsel yapısını azaltarak vitalite testlerine verilen yanıtı zayıflatıp tanı koymayı güçleştirmektedir. Yaşlı hastaların tedavisinde sistemik hastalıklar ile kullanılan ilaçların varlığı nedeniyle multidisipliner bir yaklaşım benimsenmeli, lokal anestezi ve ilaç seçiminde dikkatli olunmalıdır. Tedavi sırasında daralan kanalları tespit etmek amacıyla preoperatif radyografiler, büyütmeli gözlükler, operasyon mikroskopları ve kalsifiye kanallara uygun dayanıklı özel el eğeleri ile Ni-Ti döner alet sistemlerinden yararlanılmalıdır. Kök boyu tespitinde sement artışına bağlı olarak elektronik apex bulucular güvenle tercih edilmeli ve dişlerin artan kırılganlığı sebebiyle lateral kondensasyon yerine tek kon tekniği gibi daha az basınç uygulayan dolum yöntemleri seçilerek tedavi sonrasında hızla koronal restorasyon tamamlanmalıdır.
The rapidly increasing proportion of the elderly population worldwide enhances the importance of geriatric endodontics, directly impacting their quality of life, as oral health is an integral reflection of general health. With the aging process, tooth enamel becomes more brittle, and dentin can be exposed due to factors such as attrition, abrasion, and erosion. Over time, the increased formation of secondary and tertiary dentin narrows the pulp chamber, leading to calcifications; this reduces the cellular, vascular, and neural structures of the pulp, weakening responses to vitality tests and complicating diagnosis. In treating elderly patients, a multidisciplinary approach must be adopted due to the presence of systemic diseases and multiple medications, requiring careful selection of local anesthetics and drugs. During treatment, preoperative radiographs, magnification loupes, operating microscopes, durable specialized hand files suitable for calcified canals, and Ni-Ti rotary instrument systems should be utilized to locate narrowed canals. Electronic apex locators should be safely preferred for working length determination due to increased cementum deposition, and to avoid root fractures from increased tooth fragility, filling methods applying less pressure, such as the single-cone technique instead of lateral condensation, should be chosen, followed by prompt coronal restoration after treatment.
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