Periodontal Doku Mühendisliğinde Yeni Yaklaşımlar
Synopsis
Periodontal hastalıklar, dişlerin destekleyici yapılarını oluşturan periodontal ligament, sement ve alveol kemiğinin hasar görmesi sonucu oluşan iltihabi ve enfeksiyöz hastalıklardır. Periodontal sağlığın yeniden kazanılması ve korunabilmesi, patojenik mikroorganizmaların periodontal tedavilerle uzaklaştırılmasına ek olarak hastanın kolayca uygulayabileceği plak kontrolüne dayanmaktadır. Uygulanan periodontal tedavi yöntemleri, mikroorganizmaların eliminasyonunu sağlamakla birlikte iyileşme sonrasında anatomik yapı bozuklukları ve azalmış bir periodonsiyumu da beraberinde getirmektedir. Bu yapısal bozuklukları düzeltmek ve periodontal dokuların rejenerasyonunu sağlamak için kök yüzeyi biyomodifikasyonu, periodontal defektlere greft materyallerinin yerleştirilmesi ve defekt bölgesinin bariyer membranlarla kaplanması gibi yönlendirilmiş doku rejenerasyonu teknikleri kullanılmıştır, ancak elde edilen rejenerasyon sınırlıdır. Doku mühendisliği, kaybedilmiş veya zarar görmüş dokuların yeniden kazanılmasıyla normal yapı ve işlevlerini geri getirmeyi amaçlayan bir alandır. Periodontal rejenerasyon ise bu doku mühendisliğinin önemli bir parçasıdır ve sementin, periodontal ligamentin ve dişlerin çevresindeki alveol kemiğinin yeniden oluşturulmasını içerir. Periodontal rejenerasyon için birçok tedavi yöntemi mevcut olmasına rağmen, bu tedavilerle istikrarlı ve başarılı sonuçlar elde etmek mümkün değildir. Yeni tedavi yöntemleri geliştirmek için, yara iyileşmesine katkıda bulunacak hücrelerin uygun taşıyıcılar ve biyolojik aracı moleküllerle birlikte hedeflenen bölgelere uygulanması esasına dayanan doku mühendisliği yaklaşımları kullanılabilir. Periodontal doku mühendisliği, hasar görmüş periodontal dokuların yeniden oluşturulmasına yönelik çeşitli stratejilere sahiptir. Bu stratejiler arasında; büyüme faktörleri ve sinyal molekülleri, doku iskeleleri, gen ve hücre tedavileri yer almaktadır. Doku mühendisliğindeki ilerlemeler, periodontal doku rejenerasyonu çalışmalarına ışık tutmakla beraber, kompleks doku defektlerinin tedavisi üzerine daha çok araştırma yapılmasına ihtiyaç vardır.
Periodontal diseases are inflammatory and infectious diseases that occur as a result of damage to the periodontal ligament, cementum and alveolar bone, which are the supporting structures of the teeth. Regaining and maintaining periodontal health is based on plaque control that the patient can easily implement, in addition to the removal of pathogenic microorganisms through periodontal treatments. Although the applied periodontal treatment methods ensure the elimination of microorganisms, they also cause anatomical structural disorders and a reduced periodontium after healing. Guided tissue regeneration techniques such as root surface biomodification, placement of graft materials in periodontal defects and covering the defect area with barrier membranes have been used to correct these structural defects and ensure the regeneration of periodontal tissues, but the regeneration achieved is limited. Tissue engineering aims to restore normal structure and functions by regenerating lost or damaged tissues. Periodontal regeneration is an important part of this tissue engineering and involves the regeneration of cementum, periodontal ligament and alveolar bone around the teeth. Although there are many treatment methods available for periodontal regeneration, it is not possible to achieve stable and successful results with these treatments. To develop new treatment methods, tissue engineering approaches based on the application of cells that will contribute to wound healing to targeted areas with appropriate carriers and biological mediator molecules can be used. Periodontal tissue engineering has various strategies for regenerating damaged periodontal tissues. Among these strategies; growth factors and signaling molecules, tissue scaffolds, gene and cell therapies. Although advances in tissue engineering have lead to periodontal tissue regeneration studies, more research is needed on the treatment of complex tissue defects.
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Nibali L, Koidou VP, Nieri M, et al. Regenerative surgery versus access flap for the treatment of intra‐bony periodontal defects: A systematic review and meta‐analysis. J Clin Periodontol. 2020;47:320–351.
Tavelli L, McGuire MK, Zucchelli G, et al. Biologics‐based regenerative technologies for periodontal soft tissue engineering. J Periodontol. 2020;91:147–154.
Isehed C, Svenson B, Lundberg P, et al. Surgical treatment of peri‐implantitis using enamel matrix derivative, an RCT: 3‐and 5‐year follow‐up. J Clin Periodontol. 2018;45:744–753.
Isehed C, Holmlund A, Renvert S, et al. Effectiveness of enamel matrix derivative on the clinical and microbiological outcomes following surgical regenerative treatment of peri‐implantitis. A randomized controlled trial. J Clin Periodontol. 2016;43:863–873.
Sanz M, Dahlin C, Apatzidou D, et al. Biomaterials and regenerative technologies used in bone regeneration in the craniomaxillofacial region: Consensus report of group 2 of the 15th European Workshop on Periodontology on Bone Regeneration. J Clin Periodontol. 2019;46:82–91.
Esposito M, Grusovin MG, Papanikolaou N, et al. Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects. Cochrane database Syst Rev . 2009;4:
Weibrich G, Kleis WKG, Hafner G. Growth factor levels in the platelet-rich plasma produced by 2 different methods: curasan-type PRP kit versus PCCS PRP system. Int J Oral Maxillofac Implants. 2002;17:184-190
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31-54
Published
April 16, 2024
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Çetin Özdemir E. Periodontal Doku Mühendisliğinde Yeni Yaklaşımlar. In: Kesim S, editor. Güncel Periodontoloji Çalışmaları III (Bahar) [Internet]. Türkiye: Academician Publishing Book DOI Portal; 2024 [cited 2026 Jul. 13]. pp. 31-54. Available from: https://omp35.books.akademisyen.net/index.php/akya/catalog/book/3052/chapter/13770
