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Travmaya Uğramış Olgunlaşmamış Nekrotik Daimi Lateral Kesici Dişin Trombosit Açısından Zengin Plazma ve Mineral Trioksit Agregat ile Rejeneratif Endodontik Tedavisi
Regenerative Endodontic Treatment of Traumatized Immature Necrotic Permanent Lateral Incisor with Platelet-Rich Plasma and Mineral Trioxide Aggregate
Turkiye Klinikleri J Dental Sci. 2024;30(1):164-8
doi: 10.5336/dentalsci.2023-99964
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
On altı yaşında erkek hasta, sol üst yan kesici dişinden dolayı Erciyes Üniversitesi Endodonti Ana Bilim Dalına başvurdu. İlgili diş devitaldi ve radyografik değerlendirmede apeksinin açık olduğu görüldü. Periapikal bölgede izlenen lezyonun iyileşmesi ve köklerin kapanmasını sağlamak amacıyla rejeneratif tedavi yapılmasına karar verildi. Lokal anestezinin ardından giriş kavitesi, lastik örtü izolasyonu altında açıldı. Mekanik preparasyon yapılmadan kanallar %1,5 sodyum hipoklorit solüsyonu ile irrige edildi ve paperpoint ile kurutuldu. Kalsiyum hidroksit (KH) kanala yerleştirildi ve 21 gün bekletildi. İkinci seansta KH uzaklaştırıldıktan sonra periapikal bölgeden yeterince kanama sağlanamadığı için hastadan alınan 10 mL kan ile trombositten zengin plazma hazırlandı ve kanala yerleştirildi. Diş üzerine 3-4 mm kalınlığında mineral trioksit agregat konularak kompozit ile restore edildi. Hasta 6, 12 ve 15. aylarda kontrole çağrıldı. On beş aylık kontrol radyografisinde periapikal lezyonun düzeldiği ve kök kanal duvarlarında kalınlaşmanın arttığı gözlendi. Diş soğuk testine yanıt vermedi ancak elektrikli pulpa testine gecikmiş pozitif cevap verdi.
Anahtar Kelimeler: Kan pıhtılaşması; rejenerasyon; trombositten zengin plazma
On altı yaşında erkek hasta, sol üst yan kesici dişinden dolayı Erciyes Üniversitesi Endodonti Ana Bilim Dalına başvurdu. İlgili diş devitaldi ve radyografik değerlendirmede apeksinin açık olduğu görüldü. Periapikal bölgede izlenen lezyonun iyileşmesi ve köklerin kapanmasını sağlamak amacıyla rejeneratif tedavi yapılmasına karar verildi. Lokal anestezinin ardından giriş kavitesi, lastik örtü izolasyonu altında açıldı. Mekanik preparasyon yapılmadan kanallar %1,5 sodyum hipoklorit solüsyonu ile irrige edildi ve paperpoint ile kurutuldu. Kalsiyum hidroksit (KH) kanala yerleştirildi ve 21 gün bekletildi. İkinci seansta KH uzaklaştırıldıktan sonra periapikal bölgeden yeterince kanama sağlanamadığı için hastadan alınan 10 mL kan ile trombositten zengin plazma hazırlandı ve kanala yerleştirildi. Diş üzerine 3-4 mm kalınlığında mineral trioksit agregat konularak kompozit ile restore edildi. Hasta 6, 12 ve 15. aylarda kontrole çağrıldı. On beş aylık kontrol radyografisinde periapikal lezyonun düzeldiği ve kök kanal duvarlarında kalınlaşmanın arttığı gözlendi. Diş soğuk testine yanıt vermedi ancak elektrikli pulpa testine gecikmiş pozitif cevap verdi.
Anahtar Kelimeler: Kan pıhtılaşması; rejenerasyon; trombositten zengin plazma
ABSTRACT
A 16-year-old male patient was referred to Erciyes University, Department of Endodontics due to his left upper lateral incisor. The tooth was devital and had an open apex. It was decided to perform regenerative treatment in order to heal the lesion observed in the periapical region and ensure the closure of the roots. The access cavity was prepared under rubber dam isolation after local anesthesia. Without mechanical preparation, the root canal was disinfected with 1.5% sodium hypochlorite solution and dried with paper points. Calcium hydroxide (CH); was placed in the canal and left for 21 days. Since there was no bleeding in the periapical area after the CH was removed in the second session, platelet-rich plasma was prepared with 10 mL of blood, taken from the patient. Then it was placed in the canal. The tooth was restored by placing mineral trioxide aggregate that has a thickness of 3- 4 mm on it. The patient was called for follow-up sessions at 6, 12, and 15 months. 15th month follow-up radiograph showed that the periapical lesion recovered and the thickness of the root canal walls increased. The tooth did not respond to the cold test; however, showed delayed positive response to electric pulp testing.
Keywords: Blood coagulation; regeneration; platelet-rich plasma
A 16-year-old male patient was referred to Erciyes University, Department of Endodontics due to his left upper lateral incisor. The tooth was devital and had an open apex. It was decided to perform regenerative treatment in order to heal the lesion observed in the periapical region and ensure the closure of the roots. The access cavity was prepared under rubber dam isolation after local anesthesia. Without mechanical preparation, the root canal was disinfected with 1.5% sodium hypochlorite solution and dried with paper points. Calcium hydroxide (CH); was placed in the canal and left for 21 days. Since there was no bleeding in the periapical area after the CH was removed in the second session, platelet-rich plasma was prepared with 10 mL of blood, taken from the patient. Then it was placed in the canal. The tooth was restored by placing mineral trioxide aggregate that has a thickness of 3- 4 mm on it. The patient was called for follow-up sessions at 6, 12, and 15 months. 15th month follow-up radiograph showed that the periapical lesion recovered and the thickness of the root canal walls increased. The tooth did not respond to the cold test; however, showed delayed positive response to electric pulp testing.
Keywords: Blood coagulation; regeneration; platelet-rich plasma
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