Rejeneratif Endodontik Tedavide Yeni Bir Yaklaşım Olarak Pulpa Transplantasyonları
Year 2025,
Volume: 11 Issue: 1, 97 - 108, 30.04.2025
Emir Yeşiltepe
,
Irmak Yeşiltepe
,
Mine Koruyucu
,
Koray Gençay
Abstract
Günümüzde rejeneratif endodontik tedavi immatür nektrotik dişlerin endodontik tedavisinde ilk seçeneklerden biri olarak önerilmektedir. Bu tedavinin diş sağkalımı üzerinde yüksek başarı oranlarına sahip olduğu kanıtlanmış olsa da rejeneratif endodontik tedavinin asıl hedefi olan organize pulpa dokusunun oluşumu kanıtlanamamıştır. Geleneksel rejeneratif endodontik tedavileri izleyen çalışmalardan elde edilen histolojik veriler, rejenere edilmiş bir pulpa-dentin kompleksinin yerine bir onarım dokusunun oluştuğunu kanıtlamıştır. Asıl hedef olan pulpa dokusunun tüm tabakaları ile beraber yeniden oluşmasını sağlamak için doku mühendisliği teknolojilerinde hızla ilerleyen gelişmelerin de katkısıyla yeni rejenerasyon teknikleri üzerinde çalışılmaktadır. Modern doku mühendisliğinin üç temel kavramı olan kök hücreler, büyüme faktörleri ve doku iskelesini içermekte olan ve geliştirilmekte olan bu teknikler “hücre bazlı rejeneratif endodontik tedavi” şeklinde tanımlanmaktadır. Dental pulpa kök hücrelerinin ve diğer dental mezenkimal kök hücrelerin başarılı bir şekilde izolasyonundan bu yana ise kök hücre transplantasyonu ve kök hücre aracılı pulpa rejenerasyonunun klinik öncesi araştırmaları önemli ölçüde ilgi görmektedir. Bu çabalar ise yakın zamanda süt dişi pulpa dokusunun daimi dişe transplantasyonu gibi klinik uygulamalara dönüşerek endodonti ve pedodonti alanlarında büyük ses ve yeni bir bakış açısı getirmiştir. Bu derlemede geleneksel rejeneratif endodonti tekniği ile ilgili başarı tartışmalarına yer verilmiş ve geliştirilmekte olan yeni rejeneratif endodonti teknikleri incelenmiş ve bu tekniklerin kullanıldığı olgu raporları incelenmiştir.
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Year 2025,
Volume: 11 Issue: 1, 97 - 108, 30.04.2025
Emir Yeşiltepe
,
Irmak Yeşiltepe
,
Mine Koruyucu
,
Koray Gençay
References
- Yılmaz A. Rejeneratif Endodonti. J Istanbul Univ Fac Dent. 2012;46(3):91–8.
- Martin G, Ricucci D, Gibbs JL. Histological findings of revascularized/revitalized immature permanent molar with apical periodontitis using platelet-rich plasma. J Endod. 2013;39(1):138-44. doi: 10.1016/j.joen.2012.09.015
- Torabinejad M, Milan M, Shabahang S, Wright KR, Faras H. Histologic Examination of Teeth with Necrotic Pulps and Periapical Lesions Treated with 2 Scaffolds: An Animal Investigation. J Endod. 2015;41(6):846–52.
- Becerra P, Ricucci D, Loghin S, Gibbs JL, Lin LM. Histologic study of a human immature permanent premolar with chronic apical abscess after revascularization/revitalization. J Endod. 2014;40(1):133–9. doi:10.1016/j.joen.2013.07.017
- Feitosa VP, Mota MNG, Vieira LV, de Paula DM, Gomes LLR, Solheiro LKR, et al. Dental Pulp Autotransplantation: A New Modality of Endodontic Regenerative Therapy—Follow-Up of 3 Clinical Cases. J Endod. 2021;47(9):1402–8. doi:10.1016/j.joen.2021.06.014
- Xuan K, Li B, Guo H, Sun W, Kou X, He X, et al. Deciduous autologous tooth stem cells regenerate dental pulp after implantation into injured teeth. Sci. Transl. Med. 2018;10(455):eaaf3227. DOI: 10.1126/scitranslmed.aaf3227
- Nakashima M, Iohara K, Murakami M, Nakamura H, Sato Y, Ariji Y, et al. Pulp regeneration by transplantation of dental pulp stem cells in pulpitis: a pilot clinical study. Stem Cell Res Ther. 2017;8(1).doi:10.1186/s13287-017-0506-5
- Feitosa VP, Mota MN, Savoldi R, Rifane T, de Paula D, Borges L, et al. The Allogenic Dental Pulp Transplantation from Son/Daughter to Mother/Father: A Follow-Up
of Three Clinical Cases. Bioengineering. 2 0 2 2 ; 9 ( 11 ) : 6 9 9 . d o i : 1 0 . 3 3 9 0 /bioengineering9110699
- Murray PE, Garcia-Godoy F, Hargreaves KM. Regenerative endodontics: a review of current status and a call for action. J Endod. 2007;33(4):377–90. doi:10.1016/j.joen.2006.09.013
- Huang GT, Lin LM. Letter to the editor: comments on the use of the term “revascularization” to describe root regeneration. J Endod. 2008;34(5):511–2. doi:10.1016/j.joen.2008.02.009
- Lenzi R, Trope M. Revitalization procedures in two traumatized incisors with different biological outcomes. J Endod. 2012;38(3):411-4. doi:10.1016/j.joen.2011.12.003
- Weisleder R., Benitez CR. Maturogenesis: is it a new concept? J Endod. 2003;29(11):776–8. doi:10.1097/00004770-200311000-00022
- Hargreaves KM, Giesler T, Henry M, Wang Y. Regeneration potential of the young permanent tooth: what does the future hold? Pediatr Dent. 2008;30(3):253-60.
- Diogenes A, Ruparel NB, Shiloah Y, Hargreaves KM. Regenerative endodontics: a way forward. J Am Dent Assoc. 2016;147(5):372-80. doi:10.1016/j. adaj.2016.01.009
- Lin LM, Huang GT, Sigurdsson A, Kahler B. Clinical cell-based versus cell-free regenerative endodontics: clarification of concept and term. Int Endod J. 2021;54(6):887-901. doi:10.1111/iej.13471
- Ahmed GM, Abouauf EA, Abubakr N, Fouad AM, Dörfer CE, Fawzy El-Sayed KM. Cell-Based Transplantation
versus Cell Homing Approaches for Pulp-Dentin Complex Regeneration. Stem Cells Int. 2021;2021:8483668. doi:10.1155/2021/8483668
- Cartı Dörterler Ö, Ayhan F. Rejeneratif Endodontik Tedavide Biyomalzeme Seçimi ve Doku Mühendisliği Uygulamaları. Avrupa Bilim ve Teknoloji Dergisi. 2021;23:31-42. doi:10.31590/ejosat.842306
- Almutairi W, Yassen GH, Aminoshariae A, Williams KA, Mickel A. Regenerative Endodontics: A Systematic Analysis of the Failed Cases. J Endod. 2019;45(5):567-77. doi:10.1016/j.joen.2019.02.004
- Chaniotis A. Treatment Options for Failing Regenerative Endodontic Procedures: Report of 3 Cases. J Endod. 2017;43(9):1472-8. doi:10.1016/j.joen.2017.04.015
- Nosrat A, Seifi A, Asgary S. Regenerative endodontic treatment (revascularization) for necrotic immature permanent molars: a review and report of two cases with a new biomaterial. J Endod. 2011;37(4):562-7. doi:10.1016/j.joen.2011.01.011
- Nosrat A, Li KL, Vir K, Hicks ML, Fouad AF. Is pulp regeneration necessary for root maturation? J Endod. 2013;39(10):1291-5. doi:10.1016/j.joen.2013.06.019
- Bukhari S, Kohli MR, Setzer F, Karabucak B. Outcome of Revascularization Procedure: A Retrospective Case Series. J Endod. 2016;42(12):1752-9. doi:10.1016/j.joen.2016.06.021
- American Association of Endodontists. AAE Clinical Considerations for a Regenerative Procedure Revised 5/18/2021. Available online: https://www.aae.org/specialty/wp-content/uploads/sites/2/2021/08/
- Tong HJ, Rajan S, Bhujel N, Kang J, Duggal M, Nazzal H. Regenerative Endodontic Therapy in the Management of Nonvital Immature Permanent Teeth: A Systematic Review—Outcome Evaluation and Meta-analysis. J Endod. 2017;43(9):1453-64. doi:10.1016/j.joen.2017.04.018
- Torabinejad M, Nosrat A, Verma P, Udochukwu O. Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod. 2017;43(11):1806-20. doi:10.1016/j.joen.2017.06.029
- Chen MY, Chen KL, Chen CA, Tayebaty F, Rosenberg PA, Lin LM. Responses of immature permanent teeth with infected necrotic pulp tissue and apical periodontitis/abscess to revascularization procedures. Int Endod J. 2012;45(3):294-305. doi:10.1111/j.1365-2591.2011.01978.x
- Diogenes A, Henry M, Teixeira F, Hargreaves KM. An update on clinical regenerative endodontics. Endod Topics. 2013;28(1):2-23.
- Cehreli ZC, Unverdi GE, Ballikaya E. Deciduous Tooth Pulp Autotransplantation for the Regenerative Endodontic Treatment of Permanent Teeth With Pulp Necrosis: A Case Series. J Endod. 2022;48(5):669-74. doi:10.1016/j.joen.2022.01.015
- Song M., Cao Y., Shin SJ. Revascularization-associated intracanal calcification: assessment of prevalence and contributing factors. J Endod. 2017;43:2025-33. doi:10.1016/j.joen.2017.06.018
- Ulusoy AT, Turedi I, Cimen M, Cehreli Z. Evaluation of Blood Clot, Platelet-rich Plasma, Platelet-rich Fibrin, and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial. J Endod. 2019;45(5):560-6. doi:10.1016/j.joen.2019.02.002
- Wang X, Thibodeau B, Trope M, Lin LM, Huang GT. Histologic characterization of regenerated tissues in canal space after the revitalization/revascularization procedure of immature dog teeth with apical periodontitis. J Endod. 2010;36(1):56-63. doi:10.1016/j.joen.2009.09.039
- Gathani KM, Raghavendra SS. Scaffolds in regenerative endodontics: A review. Dent Res J (Isfahan). 2016;13(5):379-86. doi:10.4103/1735-3327.192266.
- Nivedhitha MS, Deepak S, Jacob B, et al. Scaffolds in Regenerative Endodontics: A Review. J Oper Dent Endod. 2020;5(2):88-98. doi: 10.5005/jp-journals-10047-0098
- Kim SG, Malek M, Sigurdsson A, Lin LM, Kahler B. Regenerative endodontics: a comprehensive review. Int Endod J. 2018;51(12):1367-88. doi:10.1111/iej.12954
- Chrepa V, Joon R, Austah O, Diogenes A, Hargreaves KM, Ezeldeen M, et al. Clinical Outcomes of Immature Teeth Treated with Regenerative Endodontic Procedures—A San Antonio Study. J Endod. 2020;46(8):1074-84. doi:10.1016/j.joen.2020.04.008
- Ong TK, Lim GS, Singh M, Fial AV. Quantitative Assessment of Root Development after Regenerative Endodontic Therapy: A Systematic Review and Meta-Analysis. J Endod. 2020;46(12):1856-66.e2. doi:10.1016/j.joen.2020.08.016
- Elmas S, Uçkan Çetinkaya D. Kemik İliği ve Kök Hücre Transplantasyon İlkeleri. STED/Sürekli Tıp Eğitimi Dergisi. 2007;16(5):61-5.
- Aşar EM, Botsalı MS. Rejeneratif Endodontik Tedavi: Bir Literatür Derlemesi. Selcuk Dent J. 2022;9(1):335-43.
- Gimble JM, Guilak F. Adipose-derived adult stem cells: Isolation, characterization, and differentiation potential. Cytotherapy. 2003;5(5):362-9. doi:10.1080/14653240310003026
- Téclès O, Laurent P, Zygouritsas S et al. Activation of human dental pulp progenitor/stem cells in response to odontoblast injury. Arch Oral Biol. 2005;50(2):103-8. doi:10.1016/j.archoralbio.2004.11.009
- Bi R, Lyu P, Song Y, Li P, Song D, Cui C, et al. Function of dental follicle progenitor/stem cells and their potential in regenerative medicine: From mechanisms to applications. Biomolecules. 2021;11(7):997. doi:10.3390/biom11070997
- Botelho J, Cavacas MA, Machado V, Mendes JJ. Dental stem cells: recent progresses in tissue engineering and regenerative medicine. Ann Med. 2017;49(8):644-51. doi:10.1080/07853890.2017.1347705
- Soudi A, Yazdanian M, Ranjbar R, Tebyanian H, Yazdanian A, Tahmasebi E, et al. Role and application of stem cells in dental regeneration: A comprehensive overview. EXCLI J. 2021;20:454-89. doi:10.17179/excli2021-3335
- Wei Y, Lyu P, Bi R, Chen X, Yu Y, Li Z, et al. Neural Regeneration in Regenerative Endodontic Treatment: An Overview and Current Trends. Int J Mol Sci. 2022;23(24):15492. doi:10.3390/ijms232415492
- Huang AH, Chen YK, Lin LM, Shieh TY, Chan AW. Isolation and characterization of dental pulp stem cells from a supernumerary tooth. J Oral Pathol Med. 2008;37(9):571–4. doi:10.1111/j.1600-0714.2008.00654.x
- Gronthos S, Mankani M, Brahim J, Robey PG, Shi S. Postnatal human dental pulp stem cells (DPSCs) in vitro and in vivo. Proc Natl Acad Sci U S A. 2000;97(25):13625-30. doi:10.1073/pnas.240309797
- Reznick JB. Continuing Education: Stem Cells: Emerging Medical and Dental Therapies for the Dental Professional. Dentaltown Magazine. 2008;42-53.
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