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Publication
RevascularizaĆ§Ć£o pulpar
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Advisor(s)
Abstract(s)
O tratamento de dentes permanentes imaturos com comprometimento pulpar pode ser muitas vezes um desafio. Em dentes com a polpa vital, a manutenĆ§Ć£o da vitalidade pulpar Ć© essencial, o que permitirĆ” a continuaĆ§Ć£o do desenvolvimento natural da porĆ§Ć£o radicular do elemento dentĆ”rio. JĆ” em dentes onde a polpa se encontre necrosada e/ ou infetada, hĆ”, inevitavelmente, a interrupĆ§Ć£o do desenvolvimento radicular, deixando o elemento dentĆ”rio com paredes dentinĆ”rias finas e com o Ć”pice aberto, o que torna o tratamento ainda mais desafiante, uma vez que o tratamento endodĆ“ntico convencional, baseado na preparaĆ§Ć£o quĆmico-mecĆ¢nica e no preenchimento do sistema de canais radiculares com um material bioinerte, torna-se difĆcil ou atĆ© impossĆvel.
Atualmente, os tratamentos mais realizados para estes dentes passam pela apexificaĆ§Ć£o com HidrĆ³xido de cĆ”lcio (Ca(OH)2), ou a inserĆ§Ć£o de uma barreira apical de Agregado de Mineral TriĆ³xido (MTA) seguidas pela obturaĆ§Ć£o convencional do canal radicular. Ambas as tĆ©cnicas tĆŖm um bom potencial na resoluĆ§Ć£o das infeƧƵes e no encerramento apical; no entanto, nĆ£o permitem a continuaĆ§Ć£o do desenvolvimento radicular, o que mantĆ©m as paredes dentinĆ”rias finas e frĆ”geis e o elemento dentĆ”rio mais susceptĆvel a fraturas.
Estudos recentes tĆŖm vindo a demonstrar resultados positivos com uma nova abordagem de base biolĆ³gica denominada revascularizaĆ§Ć£o pulpar. A tĆ©cnica baseia-se na desinfeĆ§Ć£o do canal radicular e uma subsequente induĆ§Ć£o da formaĆ§Ć£o de um coĆ”gulo sanguĆneo no interior no canal, que servirĆ” de base para a proliferaĆ§Ć£o de um novo tecido, e uma possĆvel regeneraĆ§Ć£o do tecido pulpar. Desta forma pode-se alcanƧar alĆ©m da resoluĆ§Ć£o das infeƧƵes, a continuaĆ§Ć£o do desenvolvimento radicular, o que resulta em raĆzes mais longas, com paredes mais espessas e no fecho apical normal.
Embora a revascularizaĆ§Ć£o pulpar tenha vindo a demonstrar bons resultados clĆnicos e radiogrĆ”ficos, estudos histolĆ³gicos demonstraram que o tecido formado no espaƧo pulpar pode nĆ£o ser exatamente polpa. Mais estudos parecem ser necessĆ”rios para que a tĆ©cnica possa vir a ser executada com uma maior previsibilidade. A engenharia tecidular tem vindo a estudar diversas possibilidades para aprimorar a tĆ©cnica, o que pode tornĆ”-la mais previsĆvel no futuro.
Treatment of immature permanent teeth with affected pulp can often be a challenge. In teeth with vital pulp, the pulp vitality maintenance is essencial, which will allow the natural development of the root's portion of the tooth. However, in teeth with necrotic and/or infected pulp, there is, inevitably, the interuption of the root development, keeping the tooth with thin dentinal walls and an open apex, which turns the treatment even more challenging, once the conventional endodontic treatment, based on the chemical-mechanical preparation and filling of the root canal with a bioinert material, becomes difficult or even impossible. Currently, the most performed treatments for these clinical cases are apexification with calcium hidroxide (Ca(OH)2), or the insertion of an apical barrier of mineral trioxide aggregate (MTA) followed by the conventional obturation of the root canal. Both techniques have good potential in resolution of infections and apex closure; however, they do not allow the continuation of the root development, which keeps dentinal walls thin and fragile, and so the tooth more susceptible to fractures. Recent studies have shown positive results with a biological based new approach called pulp revascularization. This technique is based on the desinfection of the root canal and later induction of a blood clot formation into the root canal, wich will be the basis to the proliferation of a new tissue, and possibly regeneration of the pulp tissue. Thus, it is possible to get not only resolution of infections, but also the continuation of the root development, resulting in longer roots, thicker walls and normal apex closure. Although pulp revascularization has shown good clinical and radiographic results, histologic studies have shown that the tissue formed into the pulp space can be not exactly pulp. Further studies seem to be required, so that the technique can be performed more predictably. Tissue engineering has been studying many possibilities to improve this technique; wich can turn it more predictable in the future.
Treatment of immature permanent teeth with affected pulp can often be a challenge. In teeth with vital pulp, the pulp vitality maintenance is essencial, which will allow the natural development of the root's portion of the tooth. However, in teeth with necrotic and/or infected pulp, there is, inevitably, the interuption of the root development, keeping the tooth with thin dentinal walls and an open apex, which turns the treatment even more challenging, once the conventional endodontic treatment, based on the chemical-mechanical preparation and filling of the root canal with a bioinert material, becomes difficult or even impossible. Currently, the most performed treatments for these clinical cases are apexification with calcium hidroxide (Ca(OH)2), or the insertion of an apical barrier of mineral trioxide aggregate (MTA) followed by the conventional obturation of the root canal. Both techniques have good potential in resolution of infections and apex closure; however, they do not allow the continuation of the root development, which keeps dentinal walls thin and fragile, and so the tooth more susceptible to fractures. Recent studies have shown positive results with a biological based new approach called pulp revascularization. This technique is based on the desinfection of the root canal and later induction of a blood clot formation into the root canal, wich will be the basis to the proliferation of a new tissue, and possibly regeneration of the pulp tissue. Thus, it is possible to get not only resolution of infections, but also the continuation of the root development, resulting in longer roots, thicker walls and normal apex closure. Although pulp revascularization has shown good clinical and radiographic results, histologic studies have shown that the tissue formed into the pulp space can be not exactly pulp. Further studies seem to be required, so that the technique can be performed more predictably. Tissue engineering has been studying many possibilities to improve this technique; wich can turn it more predictable in the future.
Description
Keywords
Pulp necrosis Apexogenesis Apexification Pulp revitalization Pulp revascularization Regenerative endodontics