Klinički i radiografski ishodi autologne transplantacije pulpe unapređene koncentrovanim faktorom rasta kod stalnih nekrotičnih zuba: klinička studija
Sažetak
Uvod/Cilj. Regenerativna endodontska terapija kod stalnih zuba predstavlja izazov zbog ograničene migracije matičnih ćelija i nedovoljne apikalne vaskularizacije. Cilj ove prospektivne pilot kliničke studije bio je da se procene izvodljivost i preliminarni klinički, radiografski i funkcionalni ishodi autologne transplantacije pulpe unapređene koncentrovanim faktorom rasta (concentrated growth factor – CGF) kod stalnih nekrotičnih zuba. Metode. Studijom je obuhvaćeno šest sistemski zdravih pacijenata (pet ženskog i jedan muškog pola, starosti 18–27 godina) sa jednokorenim stalnim zubima, kod kojih je dijagnostikovana nekroza pulpe sa pratećim periapikalnim lezijama. Autologno pulpno tkivo uzeto je iz ekstrahovanih trećih molara i transplantirano u dezinfikovane kanale korena recipijentnih zuba u kombinaciji sa CGF dobijenim iz venske krvi. Kliničke i radiografske procene sprovedene su nakon 3, 6 i 12 meseci. Periapikalno zarastanje procenjivano je pomoću kompjuterizovane tomografije konusnog zraka (cone-beam computed tomography – CBCT), dok je osetljivost pulpe procenjivana električnim testiranjem pulpe (electric pulp testing – EPT). Mere ishoda lečenja uključivale su postoperativne simptome, funkciju zuba, radiografsko zarastanje i oporavak osetljivosti pulpe. Rezultati. Svi lečeni zubi (6/6) ostali su asimptomatski i funkcionalni tokom 12 meseci praćenja, bez postoperativnih komplikacija kao što su bol, otok, formiranje sinusnog trakta ili abnormalna pokretljivost. Tokom praćenja zabeležen je progresivan oporavak pulpne osetljivosti, a pozitivni EPT odgovori (koji odražavaju osetljivost nerva) otkriveni su u dva slučaja posle 4 meseca, u jednom slučaju posle 6 meseci i u svim slučajevima do kraja 12. meseca. Primenom CBCT nakon 12 meseci pokazana je potpuna rezolucija periapikalnog rasvetljenja i obnova apikalne koštane strukture u svim lečenim zubima (6/6). Zaključak. Uzimajući u obzir ograničenja ove pilot kliničke studije, autologna transplantacija pulpe unapređena primenom CGF bila je povezana sa povoljnijim kratkoročnim kliničkim i radiografskim ishodima, kao i sa oporavakom pulpne osetljivosti kod stalnih nekrotičnih zuba. Ovi preliminarni nalazi ukazuju na potencijal tog biološki zasnovanog regenerativnog pristupa. Međutim, uporedna efikasnost tek treba da bude utvrđena.
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