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Zahnmedizin up2date 2019; 13(04): 355-369
DOI: 10.1055/a-0928-7435
Endodontologie
Georg Thieme Verlag KG Stuttgart · New York

Pulpa: Beurteilung von Vitalität und Sensibilität

Sebastian Bürklein
,
Martin Sabandal
,
Till Dammaschke
Further Information

Publication History

Publication Date:
24 September 2019 (online)

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Die korrekte Diagnose des Status der Pulpa vor vitalerhaltenden Maßnahmen spielt eine wichtige Rolle für den Therapieerfolg, sodass eine Beurteilung ihres Infektions- und Entzündungsgrads erforderlich ist. Im klinischen Alltag werden Sensibilitätstests genutzt, die einen Rückschluss auf die Vitalität des untersuchten Zahns zulassen. Nur mit angemessenem Kenntnisstand, Fähigkeiten und Materialien können die Zähne möglichst lange erhalten werden.
Kernaussagen

  • Eine korrekte Diagnose des Status der Pulpa vor vitalerhaltenden Maßnahmen ist ein Garant für eine erfolgreiche Behandlung, sodass hierfür eine genaue Beurteilung des Infektions- und der Entzündungsgrads der Pulpa zwingend erforderlich ist [59].

  • Den Zustand der Pulpa durch klinische Tests genau zu beurteilen und zwischen gesundem und verändertem Pulpagewebe zu unterscheiden, gestaltet sich häufig schwierig [26].

  • Histologisch verifizierte chronische Entzündungen, Mikroabszesse oder Nekrosen können sowohl vor als auch nach vitalerhaltenden Maßnahmen ohne Beschwerdebild auftreten [60]. Auch besteht nicht zwingend ein signifikanter Zusammenhang zwischen spontanen Schmerzen vor der Behandlung und einer erfolgreichen vitalerhaltenden Maßnahme [57], [61].

  • Trotz aller Einschränkungen liefern Sensibilitätstests deshalb wertvolle diagnostische Informationen, wenn sie von einem erfahrenen Zahnarzt durchgeführt und interpretiert werden [26]. Sensibilitätstests sollten mit einem möglichst kalten Medium (z. B. CO2-Schnee) erfolgen [11].

  • Grundvoraussetzungen für alle vitalerhaltenden Maßnahmen sind eine zumindest regenerationsfähige Pulpa und die Abwesenheit von Bakterien [62].

  • Bei Einhaltung elementarer therapeutischer Spielregeln bei der Kariesexkavation ist das Risiko einer Kontamination durch vorheriges Anlegen eines Kofferdams („conditio sine qua non“) und einer stringenten peripher zentral gerichteten Exkavation in Verbindung mit einer Kavitätentoilette (z. B. NaOCl) erheblich reduziert.

  • Zusätzlich gibt es auf dem Gebiet der Überkappungsmaterialien sehr gute Präparate, die nicht nur das ideale Milieu für die Vitalerhaltung schaffen, sondern auch noch druckstabil und nicht resorbierbar sind.

  • Zur Versorgung und Überschichtung von pulpalem Gewebe gelten hydraulische Zemente auf Kalziumsilikatbasis [63] als viel versprechende Alternative zu Kalziumhydroxid.

  • Voraussetzung für den Erfolg ist in allen Fällen eine definitive bakteriendichte Restauration.

Schlüsselwörter

Zahnpulpa - Vitalitätsprüfung - Sensibilitätstest - Pulsoxymetrie - Pulpablutung
 

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