Vitalerhaltung der Pulpa – Update

Die neuere Literatur zeigt einen deutlichen Trend in Richtung Vitalerhaltung der Pulpa. Eine Pulpaeröffnung, sei es durch ein Trauma oder durch eine kariöse Exposition, ist heute kein alleiniger Grund, einen Zahn zu „devitalisieren“. Ein besseres Verständnis der Pulpapathophysiologie sowie neuere biokompatible Materialien ermöglichen die Vitalerhaltung und stellen die Wurzelkanalbehandlung unter bestimmten Voraussetzung in den Hintergrund.

Kernaussagen

• Die hohen Erfolgsraten sprechen für entsprechende Maßnahmen, die Pulpa vital zu erhalten.

• Die Pulpa weist ein großes Regenerationspotenzial auf. Eine reversible Entzündungsreaktion ist dabei Bestandteil des Heilungsprozesses.

• Werden die nekrotischen oder irreversibel entzündeten Anteile entfernt, kann das noch vorhandene, gesunde Pulpagewebe bei entsprechender Indikation vital erhalten werden und der reversibel geschädigte Anteil regenerieren.

• Bei Kronenfrakturen mit exponierter Pulpa gilt als oberstes Ziel deren Vitalerhaltung.

• Die Behandlung einer tiefen Dentinkaries ist je nach Exkavationstechnik mit einem deutlichen Risiko einer Pulpaeröffnung assoziiert. Es gibt dabei unterschiedliche Therapiekonzepte für eine Vitalerhaltung der Pulpa.

• Entsprechend der Möglichkeit zur Vitalerhaltung der Pulpa wird eine modifizierte Einteilung der Pulpitiden postuliert.

Schlüsselwörter

Zahnmedizin - Karies - tiefe Dentinkaries - Vitalerhaltung der Pulpa - Pulpitis - Überkappung - Pulpotomie

• Literatur

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