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Zahnmedizin up2date 2018; 12(01): 23-41
DOI: 10.1055/s-0043-121604
Zahnerhaltung, Prävention und Restauration
Georg Thieme Verlag KG Stuttgart · New York

Zahnpulpa: Vitalerhaltung bis Regeneration

Matthias Widbiller
,
Kerstin M. Galler
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Publication History

Publication Date:
14 February 2018 (online)

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Die Erhaltung der eigenen Zähne stellt für Patient und Zahnarzt eines der wichtigsten Behandlungsziele dar. Dabei spielt die Zahnpulpa als sensibles und dentinbildendes Organ eine entscheidende Rolle. Um die Vitalität der Pulpa lange Zeit zu bewahren und eine Wurzelkanalbehandlung zu vermeiden, stehen etliche Therapiemöglichkeiten zur Verfügung. Selbst die Wiederherstellung der Vitalität durch die Regeneration der Zahnpulpa ist nicht mehr undenkbar.
Kernaussagen

  • Die Zahnpulpa nimmt wichtige Aufgaben wahr und ihre Vitalität ist entscheidend für einen langfristigen Zahnerhalt.

  • Die Regenerationsfähigkeit der Zahnpulpa sowie die Reversibilität der Entzündung sind Voraussetzungen für den Erfolg vitalerhaltender Maßnahmen.

  • Der Entzündungsgrad kann präoperativ (Schmerzanamnese, Sensibilitätstest, Perkussionstest) und intraoperativ beurteilt werden (Blutungsgrad der Pulpa).

  • Vitalerhaltende Maßnahmen bei der Kariesexkavation oder nach Zahntrauma unterschieden sich i. d. R. im Entzündungsgrad der Pulpa. Während bei Traumata die Zahnpulpa initial meist entzündungsfrei ist, liegt bei kariösen Defekten i. d. R. eine mikrobielle Besiedlung und somit eine Pulpitis vor.

  • Bioaktive Werkstoffe induzieren die Bildung von Reiz- oder Reparaturdentin in der Zahnpulpa und müssen biologischen sowie mechanischen Ansprüchen genügen.

  • Die Revitalisierung stellt eine vielversprechende Alternativtherapie bei Zähnen mit nicht abgeschlossenem Wurzelwachstum und Pulpanekrose dar.

  • Regelmäßige Nachkontrollen nach vitalerhaltenden Maßnahmen bzw. einer Revitalisierung sind äußerst wichtig, um Misserfolge früh zu erkennen und Komplikationen zu vermeiden.

Schlüsselwörter

Pulpa-Dentin-Komplex - indirekte Überkappung - direkte Überkappung - Pulpotomie - Revitalisierung
 

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