Pulpanın Enflamasyon Durumunun Teşhisinde Biyobelirteçlerin Rolü
Özet
Dental pulpanın enflamasyon durumunu (pulpitis) ve iyileşme potansiyelini sadece klinik semptomlar ve geleneksel testlerle (termal/elektriksel uyaranlar, röntgen) doğru şekilde teşhis etmek, bu yöntemlerin öznel ve histopatolojik durumu yansıtmada yetersiz kalması nedeniyle oldukça zordur. Mevcut yetersizlikleri aşmak ve vital pulpa tedavilerinde doğru kararlar verebilmek amacıyla, biyolojik sıvılarda objektif olarak ölçülebilen ve enflamasyon seviyesini kısa sürede gösteren "hasta başı" moleküler biyobelirteç testlerine ihtiyaç duyulmaktadır. Bu doğrultuda yapılan araştırmalarda; dentin sıvısı, pulpa sıvısı ve pulpa kanı gibi lokal örnekler üzerinden enflamasyon ve doku onarım süreçlerinde rol oynayan MMP-9, TIMP-1, IL-6, IL-8, IL-1 ve TNF-α gibi proenflamatuar sitokinler, proteazlar ile anjiyojenik faktörler ve biyoinformatik tabanlı gen ekspresyon analizleri incelenmektedir. Gelecekte, hem enflamasyon hem de onarım evrelerini yansıtan bu moleküler belirteçler ile histolojik tanılar arasında doğrudan korelasyon kurulması ve klinik ayrımı sağlayacak basit, ucuz teşhis kitlerinin geliştirilmesi hedeflenmektedir. Böylece gereksiz kök kanal tedavilerinin önüne geçilerek hastalara biyolojik ve sosyoekonomik avantajlar sunulabilecektir.
Accurate diagnosis of the severity of dental pulp inflammation (pulpitis) and its healing potential using only clinical symptoms and traditional tests (thermal/electrical stimuli, radiography) is highly challenging due to the subjective nature of these methods and their insufficiency in reflecting the true histopathological status. To overcome existing limitations and make correct decisions in vital pulp therapies, there is a critical need for "point-of-care" molecular biomarker tests that objectively measure biological fluids and rapidly demonstrate inflammation severity. Research in this area evaluates local samples such as dentinal fluid, pulp fluid, and pulpal blood to investigate proinflammatory cytokines, proteases, angiogenic factors, and bioinformatic-based gene expression analyses—including MMP-9, TIMP-1, IL-6, IL-8, IL-1, and TNF-α—which play key roles in inflammatory and tissue repair processes. Future studies aim to establish direct correlations between these molecular markers, which reflect both inflammation and repair stages, and histological diagnoses to develop simple, cost-effective diagnostic kits capable of making clinical distinctions. Consequently, preventing unnecessary root canal treatments will provide both biological and socioeconomic advantages for patients.
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