Pulpa Kuafaj Materyallerinin Biyouyumlulukları ve Sitotoksisiteleri
Özet
Vital pulpa tedavileri, diş çürüğü, travma veya iyatrojenik nedenlerle etkilenmiş diş pulpasının canlılığını korumayı amaçlayan ve indirekt/direkt pulpa kuafajı olarak ikiye ayrılan klinik yaklaşımlardır. Tedavinin başarısı; hastanın yaşı, ekspozisyonun büyüklüğü, kontaminasyon durumu gibi faktörlere ve kullanılan kuafaj materyalinin biyouyumluluğu ile dentin köprüsü oluşturma yeteneğine doğrudan bağlıdır. Kalsiyum hidroksit uzun yıllardır tedavilerde altın standart olarak kabul görse de, irrite edici savunma mekanizmaları tetiklemesi ve sızdırmazlık sorunları nedeniyle yerini daha modern ajanlara bırakmaktadır. Son yıllarda geliştirilen Mineral Trioksit Agregat (MTA) ve Biodentin gibi kalsiyum silikat esaslı biyoseramikler; yüksek biyouyumlulukları, minimum sitotoksisiteleri, mükemmel sızdırmazlık yetenekleri, antimikrobiyal aktiviteleri ve kalın dentin köprüsü oluşturma kapasiteleriyle direkt pulpa kuafajında çok daha başarılı sonuçlar ortaya koymaktadır. Buna karşın, çinko oksit öjenol, rezin modifiye cam iyonomer simanlar ve adeziv sistemler direkt pulpa dokusuyla temas ettiklerinde kronik enflamasyon ile hücresel toksisiteye yol açtıklarından bu tedavilerde önerilmemektedir. Sonuç olarak, vital pulpa tedavilerinde kullanılacak yeni dental materyallerin klinik başarı sağlaması için doku dostu olması kaçınılmaz bir gereklilik olup, gelecekte pulpa biyolojisine dair bilgilerin artmasıyla sitotoksik etkileri düşük ve çok daha öngörülebilir tedavi sonuçları sunan biyoaktif ajanların geliştirilmesi hedeflenmektedir.
Vital pulp therapies are clinical approaches aimed at preserving the viability of the dental pulp affected by caries, trauma, or iatrogenic causes, and are divided into indirect and direct pulp capping. The success of the treatment directly depends on factors such as the patient's age, the size of the exposure, contamination status, and the biocompatibility and dentin bridge formation capability of the capping material used. Although calcium hydroxide has been considered the gold standard in treatments for many years, it is replacing its position with more modern agents due to its triggering of irritating defense mechanisms and leakage problems. Calcium silicate-based bioceramics developed in recent years, such as Mineral Trioxide Aggregate (MTA) and Biodentine, demonstrate much more successful outcomes in direct pulp capping owing to their high biocompatibility, minimal cytotoxicity, excellent sealing abilities, antimicrobial activities, and capacity to form thick dentin bridges. On the other hand, zinc oxide eugenol, resin-modified glass ionomer cements, and adhesive systems are not recommended in these treatments because they cause chronic inflammation and cellular toxicity when in direct contact with pulp tissue. Consequently, new dental materials to be utilized in vital pulp therapies must inevitably be biocompatible to achieve clinical success, and with the increasing knowledge of pulp biology in the future, it is aimed to develop bioactive agents that possess low cytotoxic effects and offer much more predictable treatment outcomes.
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