Regenerativna endodoncija u dječjoj stomatologiji

master's thesis

• Title (english): Regenerative endodontics in pediatric dentistry
• Author: Martin Narančić
• Mentor: Tomislav Škrinjarić (mentor)
• Committee member: Tomislav Škrinjarić
• Committee member: Kristina Goršeta
• Committee member: Domagoj Vražić
• Granter: University of Zagreb; School of Dental Medicine; (Department of Paediatric and Preventive Dentistry); Zagreb
• Defense date and country: 2015-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Dental Medicine; Children's and Preventive Dental Medicine

Abstract

Revaskularizacija pulpe je relativno nova i obećavajuća biološka metoda liječenja
mladih trajnih zubi s nezavršenim rastom korijena. Revaskularizacija ovih zubi se
temelji na ideji da matične stanice zubne papile mogu preživjeti nekrozu pulpe, čak i
u prisutnosti periapikalne upale. Ove stanice imaju sposobnost stvaranja visoko
vaskulariziranog tkiva. Nadalje, potrebna je minimalna mehanička instrumentacija da
se očuvaju matične stanice i ionako tanki dentinski zidovi. Preporuča se kemijska
dezinfekcija s NaOCl, CHX i intrakanalna uporaba trostruke antibiotske paste (TAP).
TAP se smatra zlatnim standardom za ovu vrstu zahvata, a sastoji se od jednakih
omjera metronidazola, ciprofloksacina i minociklina. Namjernim poticanjem
krvarenja iz periapeksa i stvaranjem intrakanalnog krvnog ugruška, dobiva se matriks
za stanice koje potječu iz periapikalne regije. Ne samo krv, već i plazma bogata
trombocitima, te fibrin bogat trombocitima služe kao bogati izvor faktora rasta i
mogući dodatak ili nadomjestak postojećem matriksu, kako bi se poboljšao ishod
zahvata. Koronarno treba napraviti bakterijama nepropustan ispun, kako bi se
spriječila invazija istih u prostor pulpe. MTA ima izvrsne opturirajuće sposobnosti,
jer stvara tvrdu barijeru i potiče aktivnost signalnih molekula na rast matičnih
stanica. Konačan ispun treba biti, što je više moguće, nepropustan i postojan. Mogu
se koristiti kompoziti i smolom-modificirani staklenoionomerni cementi.
Regenerativna terapija zahtijeva manji broj posjeta za razliku od apeksifikacije.
Stimulira rast korijena u dužinu, zatvaranje apeksa i učvršćuje dentinske zidove
odlaganjem tvrdog zubnog tkiva.

Abstract (english)

Pulp revascularization is a relatively new and promising biological method in the
treatment of immature permanent teeth. The revascularization of these teeth is based
on the concept that vital stem cells in the apical papilla can survive pulpal necrosis,
even in the presence of periapical infection. These cells have the ability to generate a
highly vascularized living tissue. Therefore, a minimal mechanical instrumentation is
recommended to preserve steam cells and an already thin dentinal walls. Chemical
disinfection with NaOCl, CHX and intracanal placement of triple antibiotic paste
(TAP) is recommended. A TAP is considered to be the golden standard for this
procedure containing equal proportions of metronidazole, ciprofloxacin and
minocycline. An intentional induction of bleeding from peri-apex and a formation of
an intra-canal blood clot acts as a matrix for the cells from the periapical area. Not
only the blood, but also the platelet-rich plasma and the platelet-rich fibrin are a rich
source of growth factors and a potential addendum or substitute matrix which
improve the outcome of the procedure. A bacteria-tight seal should be created
coronally to inhibit bacterial invasion into the pulp space. MTA is considered to have
excellent sealing ability, because it creates a hard barrier and also provides signaling
molecules for the growth of stem cells. Final hermetic filling should be as airtight as
possible and sustainable. Composites or resin-modified glass ionomer cements can
be used. The regenerative therapy requires less dental appointments when compared
to the apexification and provides root elongation, apex closure as well as
reinforcement of lateral dentinal walls with deposition of hard dental tissue.

• Keywords: revaskularizacija pulpe zuba; matične stanice zubne papile
• Keywords (english): tooth pulp revascularization; apical papilla stem cells
• Language: croatian
• URN:NBN: urn:nbn:hr:127:791965
• Study programme: Title: dental medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica dentalne medicine (doktor/doktorica dentalne medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-04-06 11:43:21