Pediatrik Hastalarda Ototransplantasyon
Özet
Diş kayıplarına yol açan travmatik yaralanmalar çocukluk döneminde sık görülmekte olup, büyüme sürecinde sabit protez ve implant uygulamaları kontrendikedir. Bu dönemde uygulanan diş ototransplantasyonu; agenezi, travma ve ortodontik problemlerde estetik ve fonksiyonu geri kazandıran önemli bir alternatiftir. Diş transplantasyonu allojenik ve otojenik olarak ikiye ayrılır. Ototransplantasyonun; kemik rezorbsiyonunu engelleme, komşu dişleri koruma, düşük maliyet, alveolar gelişimi destekleme ve sonraki ortodontik tedavilere izin verme gibi avantajları vardır. Cerrahi sürenin uzunluğu ve başarı öngörülemezliği ise dezavantajlarıdır. Tedavi başarısı; donör dişin morfolojisine, kök gelişim evresine (en uygun %50-75 gelişim), atravmatik cerrahiye ve kısa ekstraoral süreye bağlıdır. Replantasyon sonrası periodontal ligament 4 haftada tamamlanırken, immatür dişlerde yüksek revaskülarizasyon ve pulpa rejenerasyonu kabiliyeti sayesinde kök gelişimi devam eder. Matür dişlerde ise operasyon sonrası endodontik tedavi gerekir. Klinik ve radyografik başarı için normal mobilite, periodontal aralık bütünlüğü ve enflamasyon olmaması kriter alınır. Standart bir protokol olmasa da bu multidisipliner yaklaşım çocuklarda güvenli bir tedavi seçeneğidir.
Traumatic injuries resulting in tooth loss are frequently observed during childhood, a period during which fixed prostheses and dental implants are contraindicated. Tooth autotransplantation serves as an effective alternative for managing agenesia, trauma, and orthodontic issues in children and adolescents, restoring both esthetics and function. Transplants are classified as allogenic or autogenic. Autotransplantation offers key advantages, including preventing bone resorption, preserving adjacent teeth, cost-effectiveness, promoting alveolar growth, and compatibility with subsequent orthodontic treatments. However, prolonged surgical duration and unpredictable long-term prognosis remain primary disadvantages. Clinical success relies heavily on donor tooth morphology, root development stage (ideally 50-75% formed), atraumatic handling, and minimized extraoral time. Post-transplantation, the periodontal ligament completely regenerates within 4 weeks; moreover, immature teeth exhibit high revascularization and pulp regeneration capacities, allowing continued root development. Conversely, mature teeth strictly require endodontic intervention post-surgery. Success is radiographically and clinically verified by normal mobility, an intact periodontal space, and the absence of inflammation. While a standardized international protocol is lacking, this multidisciplinary approach provides a viable solution for growing patients.
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