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    Reversibl ve İrreversibl Pulpitis Tanılı İmmatür Dişlerde Parsiyel Pulpotomi Tedavisi: İki Olgu Sunumu

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    AmaçPulpa dokusunun iyileşme kapasitesinin kanıtlanmasıyla birlikte, çürükle açığa çıkmış pulpanın tedavisinde reversibl pulpitis olgularının yanı sıra irreversibl pulpitisin erken evrelerinde de vital pulpa tedavisi (VPT) yaklaşımları uygulanabilmektedir. Bu olgu sunumunun amacı, irreversibl ve reversibl pulpitis tanısı almış immatür daimi dişlerde parsiyel pulpotomi tedavisinin klinik ve radyografik sonuçlarını değerlendirmektir.Olgu TanımlamasıDokuz yaşındaki erkek hasta, sol alt çenesinde ağrı şikayetiyle; on iki yaşındaki kız hasta üst ön dişlerindeki estetik kaygı nedeniyle kliniğimize başvurmuştur. Medikal anamnezde her iki hastanın da sistemik olarak sağlıklı olduğu, dental anamnezde ilk olguda spontan, ikinci olguda provake ağrı öyküsü olduğu öğrenilmiştir. İntraoral muayenede yumuşak dokular sağlıklı bulunmuş, birinci olguda 36; ikinci olguda ise 22 numaralı dişte derin çürük lezyonu tespit edilmiştir. Her iki diş perküsyon ve palpasyona negatif, vitalite testlerine ise pozitif yanıt vermiştir. Radyografik değerlendirmede, her iki dişte kök gelişiminin devam ettiği ve pulpa ile ilişkili çürük lezyonu bulunduğu gözlenmiştir. İlk olguda periapikal patoloji saptanırken, ikinci olguda patoloji gözlenmemiştir. Bulgular doğrultusunda ilk olguya irreversibl, ikinci olguya reversibl pulpitis tanısı konulmuş ve parsiyel pulpotomi uygulanmıştır. Lokal anestezi sonrası dişler rubber dam ile izole edilmiş, çürük dokular uzaklaştırılmıştır. Her iki dişte perforasyon alanındaki 2–3 mm’lik etkilenmiş pulpa dokusu steril karbid frez ile çıkarılmış, ardından %2,5 NaOCl ile hemostaz sağlanmıştır. Ekspoze pulpa üzerine posterior dişte MTA, anterior dişte Biodentin uygulanmış ve kompozit rezin ile daimi restorasyon tamamlanmıştır.BulgularDokuz aylık kısa dönem takiplerde klinik semptomların iyileştiği, şişlik ve fistülün bulunmadığı ve dişlerin vitalitesini koruduğu gözlenmiştir. Radyografik değerlendirmede; kök gelişiminin devamlılığın yanı sıra ilk olguda periapikal lezyonun iyileştiği, ikinci olguda yeni bir patoloji oluşmadığı belirlenmiştir.SonuçParsiyel pulpotomi ile reversibl pulpitis ve periapikal radyolüsensiye dair radyografik bulgu gösteren irreversibl pulpitis tanılı olgularda kısa dönemli başarılı sonuçlar elde edilmiştir. Bu yaklaşım, hücre açısından zengin koronal pulpa dokusunun korunmasına olanak tanımış ve pulpa canlılığını sürdürerek kök gelişimininin devamlılığını sağlamıştır.AimWith the proven healing capacity of pulp tissue, vital pulp therapy (VPT) can now be applied not only in reversible pulpitis but also in early-stage irreversible pulpitis where the pulp is exposed due to caries. This case report aims to evaluate the clinical and radiographic outcomes of partial pulpotomy in immature permanent teeth diagnosed with reversible and irreversible pulpitis.Case Description A 9-year-old male presented with pain in the lower left jaw, and a 12-year-old female with esthetic concerns in the anterior maxilla. Both patients were systemically healthy. In dental anamnesis, the first case had spontaneous pain, the second had provoked pain. Clinical examination showed healthy soft tissues. Deep carious lesions were found in tooth 36 (first case) and tooth 22 (second case). Both teeth were negative to percussion and palpation, but responded positively to vitality tests. Radiographs showed ongoing root development and pulp-involved caries. A periapical lesion was observed in the first case, none in the second. Based on these findings, the first case was diagnosed with irreversible pulpitis, the second with reversible pulpitis. Partial pulpotomy was performed under local anesthesia. After rubber dam isolation, carious tissue was removed. About 2–3 mm of affected pulp was excised using a sterile carbide bur, and hemostasis achieved with 2.5% NaOCl. MTA was placed in the posterior tooth, Biodentine in the anterior. Final restoration was completed with composite resin.Results At 9-month follow-up, both teeth were asymptomatic, with no swelling or fistula, and retained pulp vitality. Radiographs showed continued root development, healing of the periapical lesion in the first case, and no pathology in the second.ConclusionPartial pulpotomy provided short-term clinical and radiographic success in immature teeth with reversible or early-stage irreversible pulpitis. This approach preserved vital coronal pulp tissue and supported continued root development.</p

    Global Registries and Surveys Programme–Heart Failure (GRASP-HF): Rationale, study design and research implications

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    Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcarecosts. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials intoclinical practice remains suboptimal. The Global Registries and Surveys Programme–Heart Failure (GRASP-HF) is a pan-European, snapshot,observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acuteand chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. Italso serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in HeartFailure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries,GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HFoffers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-careindicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis,genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designedto inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunctionwith ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement.GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights tofuture guideline development.</p

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