Ki te tango, ki te tuhi ranei i tenei wharangi ki tetahi reo rereke, whiriwhiria to reo mai i te tahua taka iho kei te taha maui o runga o te paetukutuku i te tuatahi. Mena kei te pirangi koe kia ta nga tohutoro me te pepa tuunga, panuihia te waahi "References" kei raro o te tuhinga hei whakawhanui ki te tirohanga ka paato i te paatene taa.

Te Āhua o te Pūtaiao mō ngā Niho i Maimoatia ki te Awa Pūtake (RCTT)

I whakahiato, i whakawhanakehia, i tuhia, i tukuna e

Jack Kall, DMD, FAGD, MIAOMT

Teri Franklin, PhD, Kaituhi Pūtaiao Matua, IAOMT

E hiahia ana te IAOMT ki te whakamihi i ngā takoha nui a

Tākuta Valerie Kanter, DMD MS BCN

Kua tukua:

I whakaaetia e te Komiti Pūtaiao IAOMT: 12 Maehe, 2026

I whakaaetia e te Poari Kaiwhakahaere o te IAOMT: 12 Maehe, 2026

Whakakape: Kua whakamahia e te IAOMT ngā taunakitanga pūtaiao, ngā whakaaro o ngā tohunga, me tana whakatau ngaio i roto i te aromatawai i ēnei mōhiohio me te whakatakoto i tēnei pepa. Kāore he whakamana, he whakaaturanga rānei kua whakapuakina, kua whakaarohia rānei, mō te whakamaoritanga, te tātari, me/ranei te whai huatanga o ngā mōhiohio e whakaarohia ana i roto i tēnei pepa. Kāore ngā tirohanga kua whakapuakina i roto i tēnei tuhinga e whakaata ana i ngā tirohanga a te Kaunihera Whakahaere o te IAOMT, te Poari Tohutohu Pūtaiao, te whakahaere, te mema, ngā kaimahi, ngā kaimahi kirimana, me ētahi atu. Ko tēnei pūrongo e hangai ana ki ngā mōhiohio kua riro mai i te IAOMT tae noa ki tēnei wā, ā, me tumanako kia whakahoutia. Hei tāpiri, pērā i ngā aratohu katoa, me mōhio hoki te āheinga o ngā tūnga rerekē ki ngā taunakitanga i runga i ngā kitenga takitahi me te hītori hauora. E whakakore ana te IAOMT i tētahi kawenga, i tētahi kawenga rānei ki tētahi tangata, ki tētahi rōpū rānei mō tētahi mate, kino, whakapaunga, whiu, whiu rānei ka puta mai i te whakamahinga o tētahi mōhiohio, taunakitanga rānei kei roto i tēnei pūrongo. Ko tētahi whakamahinga a tētahi rōpū tuatoru i tēnei pūrongo, i tētahi whakawhirinakitanga rānei ki ngā whakataunga rānei i mahia i runga i taua pūrongo, ko te kawenga anake a te rōpū tuatoru.

Ripanga o Ihirangi

1. whakarāpopototanga
2. He aha te Maimoatanga o te Pūtake o te Niho (RCT)?
   Pikitia 1. Maimoatanga o te Awa Pūtake
3. Te Periodontitis Apical (AP)
4. He Haumaru, he Whai Hua rānei te Maimoatanga o te Pūtake o te Niho?
        Te Whakamārama i te 'Haumaru' me te 'Whai Hua'
   Ngā Here i roto i ngā Tuhinga e pā ana ki te horapa o te CAP
   Ripanga 1. Ngā Āhuatanga Tukanga e Pā Ana ki ngā Putanga RCT Kino
   Ngā Take Mōrearea o te Tūroro
   Pikitia 2. Te hanganga o te pakiaka
   Ngā Hua Hauora Pea o te RCT Angitu
5. RCT me ngā Hononga ki te Mate Pūnaha
        Ripanga 2. Ngā hononga i waenga i te AP me te mate pūnaha
6. RCT: Ngā Rangahau Kararehe me te Rangahau-Mua
7. Putanga Motuhake
8. Ngā Huarahi Maimoatanga Hei Whakaora i te Pūtake o te Wai
9. Ngā Hangarau Hou me ngā Hangarau Hou i roto i te Endodontics
        Cone Beam Compute Tomography (CBCT)
   Hauora Ozone
   Te Whakamakuku Whakahohe i roto i te Endodontics
   Pikitia 3. Ngā whakaahua o te urunga o ngā pakiaka o ngā wai whakamākūkū mā te whakamahi i ngā tikanga rerekē
   Pikitia 4. Kauwhata o te urunga o ngā pakiaka o ngā wai whakamakuku mā te whakamahi i ngā tikanga rerekē
   Te Whakarerekētanga Whakaahua-koiora (PBM)
   Te fibrin whai rawa i te pereti (PRF)
   Ngā Rautaki Ā-Mārama Pea
            * Ngā Wawaotanga Kai me te Oranga
            * Ngā rautaki patu huakita o te whakatipuranga e whai ake nei (NGAS)
10. Te Whakatau mēnā ka Pupuri, ka Tangohia rānei ngā Niho Kua Maimoatia ki te Awa Pūtake
11. whakatau
12. Tohutoro

1. whakarāpopototanga

Ka arotakehia e tēnei pepa IAOMT te āhua o te pūtaiao o nāianei mō ngā niho e rongoatia ana ki te pakiaka niho, me te arotahi ki te periodontitis apical mau tonu (CAP), ngā herenga me ngā putanga maimoatanga, me ngā pānga hauora pūnaha pea. Ahakoa e whakamahia whānuitia ana te maimoatanga pakiaka niho (RCT) hei whakahaere i te pulp niho pangia, necrotic rānei, he nui ngā taunakitanga e whakaatu ana kei te tino kitea tonu te periodontitis apical i muri i te maimoatanga, e pā ana ki te 40 – 60% o ngā niho e rongoatia ana ki te endodont. Ko ngā whanaketanga o te whakaahua, inā koa ko te tomography rorohiko cone beam (CBCT), e whakaatu ana ko te whakaahua X-ray rua-ahu (2-D) tuku iho he iti rawa te whakaiti i te mate periapical pumau. Ko ngā āhuatanga tukanga, ngā āhuatanga mōrearea motuhake ki te tūroro, me ngā uauatanga anatomical katoa e whai wāhi ana ki te patu huakita kāore i oti me te pumau o te moroiti, e pātai ana i ngā reiti angitu e pūrongohia ana mō te RCT.

Ka whakakotahi anō te pepa i ngā rangahau whānui mō te mate urutā, te pūnaha, me te kararehe e whakaatu ana i ngā hononga kaha i waenga i te CAP e pā ana ki te RCT me te whānuitanga o ngā āhuatanga pūnaha, tae atu ki te mate pūnaha toto, te mate huka, te mumura roro, te mate pāwera, ngā mate pūnaha ārai mate, me ngā putanga kino o te hāputanga. Ko ngā tikanga koiora kua whakaarohia ko te bacteremia, te mumura e puta mai ana i te endotoxin, te koretake o te pūnaha ārai mate, me ngā taunekeneke pūnaha ā-waha/pūpū. Ahakoa kāore e taea te whakaū i te take i roto i te tangata, e whakaatu tonu ana ngā rangahau kararehe i ngā pānga pūnaha kino o te CAP, e whakapakari ana i te tūponotanga koiora o ēnei hononga. Ka matapakihia hoki e tēnei pepa te whakatau haumanu mō te pupuri me te tango i ngā niho kua rongoatia ki te awa pakiaka, ngā taupori motuhake e mōrearea ana, ngā taputapu tātaritanga hou, me ngā hangarau hou e aro ana ki te whakapai ake i ngā putanga patu huakita me te whakaora.

2. He aha te Maimoatanga o te Pūtake o te Niho (RCT)?

Ko te whakaora endodontic, e mōhiotia ana ko te maimoatanga endodontic, ko te whakaora pakiaka rānei (RCT), he raupapa maimoatanga e tango ana i te penupenu mumura, pangia, me/ranei te necrotic (e kiia ana ko te io) mai i roto i te pakiaka o te niho, me te patu huakita me te tiaki i te niho kua horoia mai i te whakaekenga mai o ngā moroiti a meake nei. Ka tutuki tēnei mā te tukanga horoi e pā ana ki te patu huakita e uru ana ki ngā tikanga matū, ā, i ētahi wā ko ngā tikanga ultrasonic me/ranei te laser e whai wāhi ana ki te tukanga whakamakuku. Mā te whakanui ā-ringa o te diameter o te awa matua ka whakarei ake i te tango i te paparanga paru, ā, ka pai ake te urunga atu ki ngā pakitara dentin, ngā awa tāpiri me ngā ngongo dentinal. Ko te taahiraa whakamutunga ko te tukanga obturation, te whakakī rānei i te nuinga o te wā mā te gutta percha me te hiri awa pakiaka.^1,2

Whakaatu 1

He whakaahua nā Jack Kall, DMD

Ko te tikanga, ka whakahaerehia ngā RCT e te tohunga niho e mōhiotia ana ko te endodontist, engari i ētahi wā, ka whakahaerehia hoki e ngā tākuta niho whānui. Ko te Endodontics te peka o te mahi niho e aro ana ki te maimoatanga o te pulp niho, arā, ngā kiko ngohengohe i roto i te niho (ngā io, ngā uaua toto me ngā kiko honohono). Ko te whāinga o te rongoā endodontic, te RCT rānei, he ārai me te/ranei te rongoā i ngā mate o ēnei hanganga. Ko te tautuhi i te AP ka mahia mā te tirotiro i te radiolucency periapical, te tohu radiographic o ngā whara wheua mumura huri noa i te pito o te pakiaka niho, he tohu tera pea e tika ana te RCT, te tango rānei.

3. Te Ānini o te Niho (AP)

E ai ki te kōrero i runga ake nei, ko te AP he whara mumura whakapeka, mau tonu rānei i te pito o te pito o te pakiaka. Ko tōna āhuatanga he mumura, he whakangaromanga, he mimiti rānei o te wheua kei te taha o te pito o te niho. Ahakoa he mate pāwera ā-rohe, ka tae atu ngā pathogens me ō rātou hua i te rohe periapical, me ngā cytokine mumura, ki ētahi atu rohe o te tinana, ā, ka taea te whakaoho i te urupare ārai mate/mumura ā-tinana i roto i te tinana.³ Kua honoa tēnei āhuatanga ki ētahi momo mate pūnaha.⁴

Ko te AP te tātaritanga e arahi ana ki te tango niho, ki te RCT rānei Mena kei te hiahia te tūroro kia mau tonu te hanganga o te niho, kia taea ai te whakaora (ahakoa kāore i te ora). Ahakoa i whaihia ngā mahi ārai katoa, ā, i whakahaerehia he RCT tino pai, ka mau tonu te AP, ā, kāore pea e tino memeha ahakoa kua kore ngā tohu o mua, pērā i te mamae, te mate rānei e mau tonu.

E ai ki te American Association of Endodontics (AAE) i runga i tā rātou paetukutuku, e 40%–61% te horapa o te AP i roto i ngā niho kua oti kē te RCT i mua.⁵ E tautokona ana ēnei tatauranga e tētahi arotake tata nei, ā, e kī ana kei te piki haere ngā tatauranga, ā, he nui ake i roto i ngā tāngata kāore i te pai te maimoatanga whakaora me te endodontic: I kitea te AP i roto i te 41% o ngā pakeke he niho i rongoatia ki te RCT, ki te 2% i roto i ngā niho kāore i rongoatia, e kī ana ko te RCT o mua te pūtake o te tātaritanga o te AP. Hei tāpiri, i kitea ngā pānga motuhake ki te ira tangata, i reira he nui ake te kitea o te AP i roto i ngā niho i rongoatia i mua i roto i ngā tāne.⁶ Heoi anō, e kī ana te AAE i runga i tā rātou paetukutuku: "E kī ana te AAE kāore he taunakitanga pūtaiao tika e hono ana i ngā niho kua rongoatia ki ngā mate pūnaha. E kī ana te AAE he haumaru, he whai hua te RCT, ā, me te whakaora tika, ka āwhina i ngā tūroro ki te pupuri i ngā niho tūturu. Ko te ariā e hono ana i ngā awa pakiaka ki te mate e ahu mai ana i ngā rangahau kua roa e whakahēngia ana."E mārama ana kāore e ranea te tūnga o te AAE mō te haumaru me te whai huatanga o te RCT ki te aro atu ki ngā raruraru pūnaha ka puta pea."

Mena ko te horapa o te ao whānui o te hunga kua rongoatia te niho kotahi, neke atu rānei, ki te awa pakiaka, he 56%⁷ ā, ki te mea he AP e pā ana ki te RCT te haurua o aua tāngata,⁶ Ko te tikanga o tēnei, kotahi i roto i te whā o ngā pakeke he AP e pā ana ki te RCT. He tau whakamiharo ēnei e tohu ana kei te noho te AP i roto i ngā ōwehenga mate urutā. Ka tirotirohia e te mahi niho koiora ngā taunakitanga pūtaiao katoa e wātea ana hei whakatakoto aratohu me ngā whakatau mō tēnei raruraru hauora nui o te AP i roto i ngā niho kua rongoatia ki te endodont (mō ētahi atu kōrero mō te mahi niho koiora tirohia He Kupu Whakataki ki te Niho Koiora).

I ngā tau tōmua o te rautau 1900, i whakaarohia e te tākuta niho o Kanata, a Weston A. Price, te "ariā mate puku," i kī ai ko ngā huakita e noho ana i roto i ngā pakiaka i muri i te RCT ka taea te heke ki ētahi atu wāhi o te tinana, ka arahi ki ngā mate pūnaha, tae atu ki te mate pukupuku, te mate rumatiki, te mate manawa, me te mate tākihi. I whakahaerehia e Tākuta Price ngā rau whakamātautau e whakaū ana i tana whakapae. Ahakoa he āhua taketake ngā whakamātautau a Price, i whakaputaina ki roto i ngā hautaka arotake-a-hoa, e tohu ana i tirotirohia e te pūtaiao. I te tau 1951, i whakaputaina e te American Dental Association (ADA) tētahi arotake o ngā tikanga a Price i roto i tā rātou hautaka niho, Tuhinga o te American Dental Association (JADA), e kī ana kāore i te tino pakari ngā tikanga a Price i te pūtaiao hou, tae atu ki ngā rōpū whakahaere tika. Heoi, ehara te whakaputanga i te arotake, ā, he rite tonu ki te ētita, arā, he whakaaro.^8,9

I te tau 2019, i tukuna e Netflix tētahi pakipūmeka ko Root Cause te taitara, ā, i puta ai te āwangawanga i waenganui i te marea, ā, i puta ai te ngangau i waenganui i te tini o ngā tohunga niho. E whakaatu ana te kiriata i te rapunga tekau tau a tētahi taitama e ngana ana ki te whakaora i tōna hauora, ā, i te mutunga ka kitea ko tana RCTT te take i pāngia ai ia e te mate. He tokomaha i roto i te hapori niho i whakahē i te kiriata he hē, ā, i kīia he horapa kōrero teka kino.¹⁰ Ahakoa rā, i ara ake i te kiriata te tautohetohe hou mō te RCT, ā, kua tae ki tētahi wā tino nui. Kei te whakaarahia ngā āwangawanga mō tēnei tikanga niho me tōna pānga pea ki te toenga o te tinana e ngā tūroro me ngā kaiwhakarato ratonga niho, tae atu ki ngā kura niho me ngā whakahaere. Ko tētahi tūranga ko te whakahē i ngā RCT katoa e kore e aro ki ngā taunakitanga o tōna whai huatanga ki te whakaiti i te mate me te whakarato i te whakaora i ngā tohu, ko te tūranga whakahē ko te kī he haumaru te RCT me te kore e manukanuka ki te mate pea e roa ana me ngā pānga pūnaha roa. Ko te whāinga o tēnei pepa IAOMT ko te arotake i te āhua o te pūtaiao i tēnei wā, i te tau 2026. I whakahaerehia he rapunga tuhinga kupu matua mā te whakamahi i te PUBMED (kei roto a Medline i te PUBMED). Ka whakaratohia e PUBMED ngā tuhinga, i runga i te raupapa, i runga i te 'taurite pai' me ngā kupu matua. Pāwhiritia hei tiro i te rautaki rapu, i roa i waenganui i te tau 2000 ki te 2025, ā, mō te rārangi tohutoro, kei roto ko te 561 ngā tohutoro.

4. He haumaru, he whai hua hoki te RCT?

Te Whakamārama i te 'Haumaru' me te 'Whai Hua'

Ka ara ake te pātai; e whakaae ana rānei tātou ki te tūnga a te ADA me te AAE e kī ana he haumaru, he whai hua hoki te RCT? Ko te whakautu māmā ko te kāo – engari he nui ake te hononga o tēnei ki ngā whakamāramatanga e whakamahia ana e ngā whakahaere niho, me ngā whakamāramatanga a ngā tohunga niho koiora mō te 'haumaru' me te 'whai hua'.

Ko te tikanga, ko te haumaru e pā ana ki te 1) mōrearea o ngā pānga kino nui; 2) mōrearea o te whai wāhi ki te mate pūnaha; me te 3) mōrearea ki te whakataurite ki ngā maimoatanga rerekē. Ki tā te AAE, mēnā 1) kāore he pānga kino i kitea (arā, kāore he mamae o te tūroro); 2) kāore he kōrero whakaae mō ngā pānga o te tikanga ki te mate pūnaha; me te 3) te āhua nei he iti ake te mōrearea i ngā maimoatanga rerekē (arā, te tango niho, he whakatau motuhake ki ia take); kātahi ka whakamahia pea e te AAE te kupu 'haumaru' hei whakaahua i te RCT. Hei tākuta niho koiora, ka kite pea mātou i te tikanga he kore haumaru nā te mea 1) he nui te tūponotanga o te AP tonu (arā, te mate huna) ahakoa te mamae o te tūroro; 2) ngā rau o ngā rangahau tangata e whakaatu ana i ngā hononga ki te mate pūnaha me ngā rau o ngā rangahau kararehe e whakaatu ana i te tūponotanga o te koiora; me te 3) te tūponotanga kāore te tango niho, e tango ana i te niho pangia katoa, e arahi ki te CAP.

Ko ngā whakahaere nui e tahuri atu ana te iwi ki ngā mōhiotanga me ngā aratohu, ka whakamahi i ngā mātāpono matua hei whakatau i te whai huatanga o tētahi tikanga. Nō reira, ki te tika te tātaritanga, te mahi, te whakaora me te whai i te mate, te āhua nei he teitei ngā reiti whakaora RCT, nō reira te āhua nei he teitei te whai huatanga, ka taea te whakamaori e te whakahaere hei ine i te whai huatanga. Engari i roto i ngā āhuatanga o te ao tūturu, puta noa i ngā taupori whānui, tae atu ki te rerekētanga o te pūkenga/tohungatanga o te tohunga e mahi ana i te tikanga me ētahi atu taurangi maha kua whakaahuatia i roto i te Ripanga 1, he nui ake ngā reiti CAP,⁵ tērā pea he iti ake te whai huatanga mai i te tirohanga a te mahi niho koiora.

Ko te tino take – mēnā he AP tonu te roa i muri i te RCT, ka whakaaro pea ngā tākuta niho koiora he haumaru, he koretake hoki te maimoatanga, engari ki te iti ake te whara, ā, kāore te tūroro e mamae ana, ka whakaaro pea te AAE he haumaru, he whai hua hoki te tikanga. I tua atu, kei te whānui haere te mōhio, mēnā ka pāngia te hauora o te waha, ka pāngia hoki te hauora o te tinana. Ko te waha te kuwaha ki te ara nakunaku – ko ngā mea e tupu ana i roto i te kōhao waha ka pā ki tō tātou tinana katoa. Tirohia te IAOMT's Te Whakauru Hauora-a-waha me te Taakuta Toi koiora ki te ako atu mō te hononga i waenganui i te waha me te tinana.

Ngā Here i roto i ngā Tuhinga e pā ana ki te horapa o te CAP

Ahakoa e whakaatu ana ngā tuhinga ko te horapa o te AP i roto i ngā niho e rongoatia ana ki te endodontics he 40% pea,^{5 6} E kī ana a Wu me ētahi atu he maha ngā herenga o ngā rangahau kua whakaputaina i mua me ngā arotake pūnaha e aromatawai ana i ngā putanga o te RCT. I ngā wā o mua, ko te whakamahinga o te ira-X periapical 2-D hei aromatawai i ngā putanga o te RCT, me te korenga o te ira-X periapical e tohu ana i te hauora o te rohe periapical. I roto i tētahi tuhinga arotake, 57% o ngā rangahau i whakamahi i ngā kitenga haumanu me te ira-X hei whakatau i te putanga maimoatanga. I te mea he maha ngā wā ka kore he tohu o te AP i muri i te maimoatanga, i whakatauhia te putanga mā te whakamātautau ira-X anake i roto i ngā rangahau e 43% e toe ana. Ko ngā paearu ira-X 2-D tino pakari (te whakatau katoa o te ira-X periapical o nāianei i te wā e maumahara ana) ko ngā paearu rānei e wetekina ana (te whakaiti i te rahi o te ira-X periapical o nāianei i te wā e maumahara ana) i whakamahia i roto i ēnei rangahau.¹¹ Heoi, he nui te ōrau o ngā kēhi i whakaūtia he hauora mā ngā whakaahua x-ray 2-D i whakaatu i te AP me te whakaahua tomography rorohiko hihi koni (CBCT) me te histology. I roto i ngā niho i kitea ai te iti o te rahi o te irahiko o nāianei mā ngā whakaahua x-ray 2-D, ā, i whakaarohia hei tohu i te whakaora periapical, i whakaatuhia e te CBCT te whakanui ake o te whara.¹¹

I roto i ngā rangahau haumanu, e rua atu ngā āhuatanga i whai wāhi atu pea ki te whakanui rawa i ngā putanga angitu i muri i te RCT: 1) kāore i te maha ngā wā i tuhia ai ngā tangohanga me ngā maimoatanga anō hei rahunga; me te 2) he iti iho i te 50% te whakapā atu ki te tūroro i muri i te maimoatanga, ā, e rua ngā tohu kāore i angitu te RCT. I tua atu, ko te tohu periapical, e whakamahia pinepine ana hei whakatau i te angitu, i ahu mai i ngā kitenga radiographic me te histological i te rohe periapical o ngā niho kakati maxillary. He ruarua te whai mana o te whakamahi i tēnei tohu mō ngā tūranga niho katoa, nā te mea he rerekē te matotoru o te wheua cortical me te tūranga o te pito pakiaka e pā ana ki te cortex i runga i te tūranga o te niho. Nō reira, he tinihanga ngā arotake pūnaha e pūrongo ana i ngā reiti angitu RCT me te kore e pā ki ēnei herenga. Me whai rangahau roa e whakamahi ana i te CBCT me ngā paearu aromatawai pakari ake hei aromatawai tika i ngā putanga RCT.¹²

Kei te ripanga i raro nei ētahi o ngā āhuatanga e pā ana ki ngā putanga kino o te RCT e pā ana ki te tikanga tonu. Ko te kounga o te maimoatanga me te whakaoranga whakamutunga he tohu kaha.

Ngā āhuatanga mōrearea o te tūroro Pikitia 2 Te Anatomi o te Pūtake

Ka pāngia hoki ngā putanga e ngā āhuatanga mōrearea o te tūroro. I te taumata tūroro, ko ngā āhuatanga mōrearea ko te whakamahi waipiro mau tonu, engari kāore i te herea ki tēnā, ki tēnā.²⁷ te momi hikareti,^28,29 kai warowaihā nui,³⁰ te mate huka o mua,³¹ te whakamahinga o ngā rongoā,³² me te mate urutomo.³³ Ko tētahi o ngā tohu nui ko te koroheketanga.^17,29 engari me whakaaro te tangata he hononga kaha te kaumātuatanga ki ngā raruraru hauora me te whakamahinga rongoā. Kei reira anō ngā taunakitanga mō te whakahaere ira i runga i ngā urupare ki te kohikohinga huakita ka arahi pea ki te AP, engari me nui ake ngā rangahau i tēnei wāhanga.³⁴ Nā te uaua o ngā pūnaha awa pakiaka ka uaua ake ngā putanga maimoatanga. Kua whakaaturia ko ngā rerekētanga hanganga tinana, pērā i ngā awa tāpiri, ka taea te pupuri i te kiko penupenu necrotic me te maha atu o ngā huakita ka whai wāhi atu ki ngā mate pūmau mena kāore e whakatikahia tika i te wā o te maimoatanga.³⁵ Kei te Whakaahua 2 tētahi tauira o te uauatanga o ngā pūnaha awa pakiaka).

Ngā Hua Hauora Pea o te RCT Angitu

Ahakoa he iti ake te kitea, kei reira ngā taunakitanga e tautoko ana i ngā painga ā-tinana o te maimoatanga endodontic angitu. I kitea i roto i tētahi rangahau o te 15 tāngata whai AP i whakaitihia e te RCT ngā taumata o te tohu mumura, te pūmua C-reactive tairongo-teitei (hs-CRP), ā, i whakaatuhia e te 10 o ngā tūroro 15 i whakaitihia tō rātou tūnga mōrearea CVD i muri i te RCT.³⁶ He mea nui kia mōhiotia, i roto i ngā marama e 6 i muri i te RCT, kua tino heke te kaute taupū periapical toharite (PAI) mai i te 3.2 ki te 1.4. He tautoko tētahi atu rangahau tino pakari i mahia e Kumar et al (2022). I whakaritea ngā taumata hs-CRP i mua atu, ā, i muri mai i te RCT i roto i ngā tūroro hauora kāore he tohu o te AP (n=25) me ngā mana hauora ōrite (n=25). He nui ake te hs-CRP i roto i te rōpū AP i te tīmatanga. I roto i te rōpū AP, i te 6-marama whai muri (n=22) kua tino heke te hs-CRP, e kī ana kua iti ake te mōrearea CVD. Kua tino heke ngā kaute PAI mai i te 3.9 ki te 2.3.³⁷

Tērā atu anō ngā rangahau e 'whakahua' ana ko te angitu o te RCT ka arahi ki te whakahekenga o ngā tohu mumura, engari mā te tirotiro tata atu ka kitea he koretake. Hei tauira, i tīmata tētahi raupapa rangahau mā te tirotiro tuatahi i ngā tohu mumura teitei ake o te mōrearea CVD i roto i te hunga whai AP ki te whakataurite ki te hunga hauora.³⁸ Muri iho, i kitea e ngā kaituhi he hononga i waenganui i ngā tohu mumura i roto i te microbiome o te huware, te toto me ngā tauira intracage o ngā tāngata AP, e whakaatu ana ka horapa te mate AP mai i te awa pakiaka ki te tinana mā te toto, ka whai wāhi pea ki te taumahatanga mumura.³⁹ I whakahaerehia te RCT ki ēnei kaupapa AP. I te rua tau i muri mai, neke atu i te haurua o ngā kaupapa (37) i hoki mai mō te tirotiro ā-muri, ā, i roto i ēnei, e kī ana ngā kaituhi he angitu 100%, i whakaūtia e ngā pūrongo haumanu me ngā pūrongo whakaahua-X 2-D: 21 ngā kēhi i ora katoa, ā, 16 ngā kēhi kei te ora. E whā ngā tohu mōrearea CVD i tino heke, i te mea e iwa atu kua piki ake, ā, he iti noa iho kāore i rerekē.⁴⁰

Nō reira, ahakoa i whakaitihia e te maimoatanga endodontic angitu ngā taumata serum o ētahi tohu mōrearea CVD, hs-CRP, asymmetric dimethylarginine, me te matrix metalloprotease-2, he maha atu anō i piki ake tae atu ki te IL-1β, IL-6 me te MMP-8.⁴⁰ I tapaina tēnei mahi e ngā kaituhi ko 'Successful endodontic treatment reduces levels of serum biomarkers morearea mate cardiovascular –high-sensitivity C-reactive protein [pēnei i runga ake nei, hs-CRP], asymmetrical dimethylarginine, and matrix metalloprotease-2', me te kore e whakahua i te pikinga o ngā āhuatanga morearea CDV neke atu i te rua ngā wā.

I tirotirohia e tētahi atu rangahau e 44 ngā matū matū i te tīmatanga i ngā wā e 4 (3 marama, 6 marama, 1 tau me te 2 tau). Ko tētahi whakapae i whakamatautauria ko te whakapai ake a te RCT i ngā taumata huka. I te whai muri i te 2-tau, i whakaitihia ngā taumata huka. Ko tētahi atu whakapae i whakamatautauria ko te whakapai ake a te RCT i te pākia o te ngako. I muri i te RCT, he iti ake ngā taumata cholesterol i ngā whai muri i te 3- me te 6-marama i te whakataurite ki te taumata tīmatanga. I whakaitihia ngā taumata choline i te whai muri i te 6-marama. I whakaitihia ngā taumata waikawa ngako i te whai muri i te 3-marama engari i piki ake i ngā whai muri i te 1- me te 2-tau. Kāore i whakaatuhia he huringa nui e ngā taumata triglyceride i ngā whai muri i te 3- me te 6-marama engari i piki ake i ngā whai muri i te 1- me te 2-tau. Ko te whakatau a ngā kaituhi "i te taha o ēnei kitenga, i whakaatuhia he hononga i waenga i te maimoatanga endodontic angitu me te painga poto ki te pākia o te ngako".⁴¹

He tika pea tētahi wāhanga o taua whakatau, heoi, e whakaaetia whānuitia ana i roto i te ao hauora ko te tohu tino tairongo me te tohu tino whai tikanga haumanu o te ngoikore o te pākia o te ngako ko te nui o ngā triglycerides.^42-45 Ko ngā triglycerides teitei he tohu matua mō te dyslipidemia me te ngoikore o te pūnaha io. E whakaatu ana ēnei i te ātete ki te insulin me te ngoikore o te waikura ngako, ā, he hononga kaha ki te mate pūnaha io me te mōrearea CVD.^42-45 E mōhiotia whānuitia ana hoki kāore e ranea te ine i te cholesterol, me te kore e wehewehe i waenga i ngā ngako matotoru me ngā ngako iti. Ka kitea ngā taumata cholesterol noa i roto i te tangata he nui te mate. paheketanga metabolic.^46,47 Ahakoa he pai te kitenga o te pikinga o ngā taumata huka toto, he mea āwangawanga te kore o te kōrero mō te pikinga o ngā triglycerides.

Ko te tuatoru o ngā rangahau i whai kia kitea mēnā i heke te RCT i ngā tohu koiora. Ko te taitara o tēnei pepa ko "Te whakahekenga o ngā taumata pūmua C-reactive i muri i te maimoatanga awa pakiaka i roto i ngā tāngata taitamariki hauora hauora e pāngia ana e te mate periodontitis apical me te mōrearea cardiovascular. He rangahau tirohanga whakamua." I tirotirohia e tēnei rangahau ngā tohu koiora maha i te 1- me te 6-marama i muri i te RCT i roto i te 29 tāngata. I roto i ngā tohu koiora katoa, haunga te kotahi, kāore i kitea he rerekētanga nui. I heke te hs-CRP i te 1 marama engari i piki anō i te 6 marama. Ko te haurua o ngā tāngata (15) i tautuhia i te tīmatanga he mōrearea CVD. I roto i ēnei, 7 anake i hoki mai mō te aromatawai 6-marama. I roto i ēnei tāngata i heke te hs-CRP i ngā wā e rua. I heke ngā kaute PAI mai i te 5 pea i te haerenga whai muri tuatahi ki te 3 engari kāore i heke anō i te 6-marama. He maha ngā herenga o tēnei rangahau, tae atu ki te kore e whakahaere i ngā whakataurite maha (arā, ngā hua hē nā te maha o ngā taurangi i aromatawaitia), me te iti rawa o ngā kaupapa i hoki mai mō te 2^nd aromatawai i roto i te rōpū mōrearea CVD.⁴⁸

I roto i ētahi o ngā rangahau kua whakarārangihia i runga ake nei, i whakaitihia ngā kaute PAI, e whakaatu ana i ētahi painga haumanu. Ahakoa rā, i te ngana a ngā kaituhi o tēnei pepa RCTT ki te whakamārama i te pūmanawa ngā painga hauora pūnaha o te RCT, ko te mea i kitea, kāore anō kia tautokona ngā kereme mō ngā painga hauora.

I ētahi wā ka whiriwhiria te tikanga endodontic. Tērā pea ko ngā huarahi kē atu, e whakamāramahia ana i raro nei, ā, ko te tikanga ka tīmata mā te tango niho, ehara i te mea pai mā te tūroro nā te mea he take hauora, he take ataahua, he take pūtea rānei. I ētahi wā, kāore anō te tūroro kia rite ki te hinengaro ki te ngaro i te niho, ahakoa he mea kāore i te ora. Mēnā ka whakaarohia ngā mea nui, he kōwhiringa pai pea te RCT mō ētahi tāngata.

5. RCT me ngā Hononga ki te Mate Pūnaha

E whakaatu ana ngā rau rangahau hui i waenga i te AP me ngā take hauora ā-tinana, tae atu ki te CVD, te mate huka me ētahi atu. Kia maumahara he mea tika ngā whakamātautau whakahaere roa e whai ake nei hei whakaatu Tuhinga, Nui atu i te rōpūHe tata kore e taea te whakahaere i ēnei rangahau i roto i te tangata. Nō reira, ko te rangahau pūtaiao ka whakawhirinaki mō ngā rangahau hononga kua whakahaeretia pai me ngā rangahau haumanu-mua (kararehe).

Hei tauira, i roto i te neke atu i te 2 miriona tūroro, i kitea he hononga nui i waenga i te noho mai o te mate endodontic me te hītori o te toto toto tiketike, te mate myocardial infarction, te aituā roro, te ngoikore o te ngakau, te aukati ngakau, te thrombosis uaua hohonu, me te pokanga ngakau.⁴⁹ Kei te Ripanga 2 ngā tuhinga arotake mō tēnei kaupapa e whakahua ana i te rangahau taketake mō te kaipānui e hiahia ana. He mea nui kia whakaarohia i te wā e aromatawai ana i ēnei rangahau ko te ariā e whakamatautauria ana – i pātai ngā kaituhi: 'He hononga te AP ki te mate pūnaha?' 'He hononga te mate pūnaha ki te AP?' He mea nui hoki kia maumahara he rua ngā taha o te moni: Ahakoa ka pā te mate pūnaha ki te pathogenesis o te mate endodontic, ka taea hoki e te mate endodontic te pā ki te hauora pūnaha. Hei tauira, i whakaatuhia e tētahi arotake pūnaha ka taea e ngā mate mau tonu, tae atu ki te mate huka me te toto toto tiketike, te whakararu i ngā putanga whakaora i muri i te maimoatanga endodontic, ka hua ake he nui ake te horapa o ngā mate pumau me ngā raruraru i muri i te RCT.⁵⁰ Ahakoa e whakaatu ana ētahi rangahau ka taea e te noho mai o te AP te whakararuraru i ngā āhuatanga pūnaha pēnei i te mate huka momo 2, ka whakararu pea i te whakaora patunga i muri i te maimoatanga endodontic.³³ Nā tēnei hononga e rua ngā taha, kua rongonui te Rongoā Endodontic i roto i te mara o te endodontics.⁵¹

Ko ngā tikanga e ārahi ana i te hononga i waenga i te AP me te mate pūnaha ka taea te ārahi, i tētahi wāhanga rānei, e te endotoxin.⁵² Ko te Endotoxin he momo lipopolysaccharide, he wāhanga nui o te kiriuhi o waho o ngā huakita gram-negative, he nui te ātete ki ngā paturopi, nō reira ka tino morearea ki te hauora o te tangata. E whakaatu ana tēnei kiriuhi o waho i te kaha o te whakaoho urupare ārai mate.⁵³ I tapaina te Endotoxin pērā nā te mea i whakaarohia i te tīmatanga he paitini kei roto i te huakita. Heoi, e mōhio ana tātou ināianei ka tukuna te endotoxin mai i te huakita. Ko tōna paitini nā te tauhohenga mumura o te tinana ki a ia, kaua ki te paitini ā-roto ki te huakita tonu.⁵⁴ Kei roto i ngā rauropi katoa tētahi taumata o te endotoxin i roto i ō rātou tinana. I roto i ngā kararehe whakangote, ka kitea ngā taumata teitei i roto i te puku. Ka kitea hoki i roto i te huware, te paraka niho, te kiri, ngā pukahukahu, ngā ara manawa me te mimi me te toto. Ina kitea i roto i te toto, ahakoa i ngā taumata nanogram, he tohu mate te nuinga o te wā. E ai ki te whakaahuatanga a Gomes et al (2018), ka puta he urupare mumura i te endotoxin mā roto i tētahi ara uaua, ka whakahohe i ngā rau ira mumura. Heoi, i te korenga o te mate, ka taea tonu e te endotoxin te whiti i ngā kiriuhi mucosal o te puku, ngā kapia, te ihu me/ngā pukahukahu rānei. I whakaatu a Gomes mā ko ngā hoa mahi ko te pikinga o ngā taumata endotoxin o te awa pakiaka e pā ana ki te AP, te ahotea oxidative me te nitrosative, me te mate roro me te kaha o te pouri nui.⁵⁴ Kua honoa te endotoxin ki ngā mate neurodegenerative pērā i te mate a Parkinson me te mate a Alzheimer.^52,55,56 He nui ake te endotoxin i roto i te toto o te hunga e mate ana i te mate kapia mau tonu⁵⁷ ā, he nui ake te mōrearea o te mate a Alzheimer me te tere ake o te hekenga o te hinengaro.⁵⁸ Kāore anō kia tino mōhiotia me pēhea te urunga o ngā endotoxins ki te roro, ā, me pēhea hoki te pakaru o te pūnaha io, engari kei te haere tonu ngā rangahau.⁵²

6. RCT: Ngā Rangahau Kararehe me te Rangahau-mua

He mea whakamiharo te arotake i te Ripanga 2 (ngā hononga i waenga i te AP me te Mate Pūnaha) engari kāore e homai he kōrero mō te take. Heoi, e hono ana te AP ki tētahi microflora kitakita matatini e 200 pea ngā momo.⁷⁶ Mā te tata o te hanganga o tēnei microflora ki te toto ka taea te āwhina i te bacteremia, arā, te horapa o ngā huakita me ōna wāhanga ki te toto. Ina hoki, i kitea te bacteremia i roto i te 18 ki te 54% o ngā tūroro i muri i te RCT.⁷⁷ He taunakitanga anō tēnei ka taea e te AP te whakaputa mate, engari kāore anō kia tino tuturu.

E toru ngā tikanga, ngā ara rānei e hono ana i ngā mate waha, pērā i te AP ki ngā pānga pūnaha tuarua kua whakaarohia: 1) te horapa o ngā huakita ki te tinana mai i te waha, 2) te whara metastatic mai i ngā pānga o ngā paitini moroiti waha e rere ana, me te 3) te mumura metastatic i puta mai i te whara ārai mate i puta mai i ngā moroiti waha.⁷⁸ Ahakoa he iti ake te mōhiotia mō te ara e tangohia ana, ko ngā rangahau kararehe e whakahaeretia pai ana, e whakaohokia ana te AP i roto i ngā kararehe, ka taea te whakarato i ngā kōrero tāpiri nui me whai whakaaro i te wā e tirotirohia ana te pūtaiao. Hei tauira, hei tirotiro mēnā ka taea e te AP te whakaputa i te atherosclerosis, i whakaohokia te AP i roto i ngā rōpū e rua o ngā kiore kua whakarerekētia te ira (apolipoprotein E-deficient): I whāngaihia tētahi rōpū ki te kai noa, ā, i whāngaihia te rōpū tuarua ki te kai nui te ngako hei whakaoho i te atherosclerosis. I muri i ngā marama e 4 i whakamatea ngā kiore. I pāngia ngā rōpū e rua e te atherosclerosis ahakoa te kai,⁷⁹ e whakarato ana i ngā mōhiotanga whai hua engari he iti hoki nā te mea kāore i whakaurua he rōpū whakahaere kāore i a rātou he AP.

Nō reira, i whakahaerehia e Gan me ētahi atu tētahi whakamātautau ōrite i reira i whakaohokia ai te AP i roto i tētahi rōpū kiore, ā, i whakaritea ki tētahi rōpū whakahaere kāore he AP. I kitea he pikinga nui o te hanganga o te papa atherosclerotic i roto i ngā āwhata aorta o ngā kiore AP, ki te whakaritea ki te rōpū whakahaere.⁸⁰ Ko tētahi atu kitenga ko te whakarerekētanga a te AP i ngā moroiti puku. I haere tonu a Gan mā i tēnei mahi e whakaatu ana i ngā huringa nui o ngā moroiti puku: i tupu pai ngā momo huakita kino i te mea i heke ngā momo whai hua. I kitea ngā whakararuraru i roto i te pākia o te ngako me te hanga waikawa au, ka hua ake he taumata teitei o ngā waikawa kino, ka whai wāhi pea ki te whanaketanga o te atherosclerosis. Ko te pikinga o te urunga o te puku he hononga pai ki te kaha o ngā whara atherosclerotic, e whakaatu ana i te hiranga o te arai puku ki te hauora o te ngakau. Ehara i te mea ko tēnei rangahau haumanu-mua anake e tautoko ana i te tūranga ka taea e te AP te whakararu i te mate ngakau coronary, engari e whakaatu ana i te hononga uaua i waenga i te hauora o te waha, te hanganga o ngā moroiti puku, me te maha o ngā mate ngakau.⁸¹

I tirotirohia e ētahi atu mahi kararehe te pānga o te AP ki te mumura me ngā whara o te aorta i ngā kiore i whāngaihia ki te kai momona nui. I wehea ngā kiore kia 4 ngā rōpū hei tirotiro i ngā pānga taunekeneke o te momona me te AP. Ki te whakatauritea ki ngā kiore kāore he AP, he kai momona nui rānei, i whakapiki ake te AP i ētahi tohu mumura, tae atu ki te IL-2, IL-6, me te IL-10 i roto i te toto, i te mea ko te kai momona nui i whakapiki ake i te whakaaturanga MCP-1, TLR-4, me te NF-κB p65. I whakaatuhia e ngā kiore me te kai momona nui me te AP te pikinga ake o te TLR-4. E kī ana ngā kitenga ka whakatairanga te AP i te mumura pūnaha, ā, ka whai wāhi pea ki te whara o te aorta i ngā wā tōmua, e whakaatu ana i tōna tūranga pea i roto i te mate cardiovascular.⁸² E tautokona ana ēnei kitenga e ngā rangahau tikanga, ā, e tohu ana ki te whakahohenga o te whakapuakanga kino ake o te microRNA cytokine mumura o te aorta.⁸³

I te mea he 12-15% o te taupori o Amerika he mate huka, me te kī anō he 1 i roto i te 4 ngā pakeke he AP, kei te whakahaerehia he rangahau hei tirotiro i te mahi a te AP i roto i te mate huka. Ko te Interleukin-17 (IL-17) he cytokine mumura kaha e piki ake ana i roto i te mate huka Momo 1 me te Momo 2, ā, ka whai wāhi ki te ātete insulin, te ngoikore o ngā pūtau beta, me ngā raruraru mate huka. Ko ngā taumata IL-17 teitei ake e pā ana ki te aroaro me te kaha o te mate huka me ōna raruraru e pā ana. I tirotirohia e Cintra mā rātou ko ōna hoa mahi ngā taumata IL-17 toto o ngā kiore normoglycemic me te mate huka me te kore AP. Ahakoa te āhua o te mate huka, i tino whakanuia e te AP ngā taumata IL-17 toto. I kitea anō hoki ngā hua kino i roto i ētahi atu inenga i roto i ngā kiore he mate huka engari kāore he AP, he mea ohorere tēnei. E tautoko ana ēnei hua i te tūnga e arahi ana te AP ki te pikinga o ngā tohu mumura e tohu ana i te mate huka.⁸⁴ E tautoko ana ētahi atu rangahau kararehe i te aroaro o ngā tohu mumura teitei ake i roto i te AP.^{85 86}

E ai ki tētahi pūnaha Te taumahatanga o te mate o te ao E ai ki te rangahau, tata ki te 1 i roto i te 6 ngā pakeke e kiia ana he mate pūnaha io.⁸⁷ Kei te piki haere tonu tēnei tatauranga nui. Tērā pea ko te mea e pā ana ki te 1 i roto i te 4 ngā pakeke he AP e pā ana ki te RCT, ka whakamārama i te pikinga o ngā mate pūnaha io. Neke atu i te 3 ngā rōpū rangahau haumanu rerekē kua ako i ngā pānga o te AP ki te roro. I whakaatuhia e Simões mā te hunga mahi he pikinga ake o ngā cytokine mumura pēnei i te tumor necrosis factor-alpha (TNF-α), te interleukin 1 beta (IL1β), me te interleukin 6 (IL-6) i roto i te hippocampus me te cortex o mua o te roro.⁸⁸ I kitea i roto i tētahi rangahau tuarua te toto toto i roto i te roro i te wā i puta ai te AP mā te werohanga motuhake Mutan Streptococcus ki roto i te kiko penupenu.⁸⁹ Heoi anō, i roto i tētahi atu rangahau e aro ana ki ngā pānga perinatal, i puta ai te AP i roto i ngā kiore hapu, ā, i kitea te pikinga o ngā tohu mumura (IL-6, TNF-α, me te IL-1-b) i roto i ngā roro o ngā kurī.⁹⁰ e kī ana i ngā awe epigenetic.

I tirotirohia anō hoki e Bain et al (2009) ngā pānga o te AP ki ngā putanga o te hāputanga. Ki te whakaritea ki ngā kiore hapū kāore he AP, he roa ake te hapūtanga o ngā kiore he AP, ā, i whānau mai he pēpi he taumaha whānau teitei ake. He nui ake hoki te kukū o te IL-6, VEGF, IL-1-beta, me te IL-10 i roto i te haona kōpū, me te IL-6, CRP me te TNF-alpha i roto i te ate (p<0.01). He nui ake te kukū o te huka toto me te toto TNF-alpha, IL-6, endothelin-1, IL-10, me te insulin i roto i ngā kararehe hapū AP. Ko te pikinga nui o te kukū o te TNF-alpha, te huka toto me te insulin i roto i te toto, e kī ana kua whanaketia e ngā kararehe AP te ātete insulin, ā, ka pā ki ngā putanga o tā rātou hapūtanga.⁹¹

Kua tirohia e ētahi atu rangahau kararehe te pānga o te AP ki te mate rumatiki (RA). Ki te whakatauritea ki ngā kararehe whai RA anake, he nui ake te mumura me te kaha o ngā hononga o ngā kararehe whai RA me te AP (he nui ake te porowhita o te waewae/turi, he kino ake te pakaru o te wheua me ngā āhua rerekē); he kino ake ngā tawhā wheua, tae atu ki te iti o te rahinga me te mātotoru o te wheua, he iti ake ngā trabeculae, me te nui ake o te wehenga trabecular; me te whakarerekētanga o te āhua mumura, me te TNF-α teitei ake, te IL-2 iti iho, me te IL-17 teitei ake. Ko te whakatau a ngā kaituhi ka kino ake te AP i te haere whakamua me te kaha o te RA, e whakaatu ana i te hononga i waenga i te mate/mumura ā-waha me te mate pūnaha ārai mate.⁹²

Ahakoa he iti noa iho ngā mea kua whakaaturia ki konei, kei te pahū te mara o mua-haumanu (arā, kararehe) me ngā rangahau hou e whakaatu ana i ngā pānga kino o te AP ki te hauora pūnaha. He mea kino te whakahaere i ēnei momo rangahau ki te tangata, ā, kāore e taea te 'whakahaere' ki te taumata kotahi, heoi, he mea nui ki tō tātou māramatanga, ā, e tohu tika ana ki ngā tikanga take. Hei tauira, ko ngā rangahau mō te ngoikore o te mahi ngākau i roto i ngā kiore toto tiketike me te AP⁹³; te mahi ngākau i roto i ngā kiore mate huka me te AP⁹⁴; ngā hua ka puta ake o te mate huka i roto i ngā kiore me te AP⁹⁵; ngā cytokine mumura i roto i te toto o ngā kiore AP^96,97ngā pānga ki ngā mate pāwera o te pūnaha io⁹⁸; me te mumura ā-pūnaha me te ate i whakahohehia e te AP⁹⁹I arotakehia e tētahi rangahau kararehe te awe ā-rua pea o te mate pāwera me te AP, ā, i kitea ko te AP ka kino ake te mate pāwera, engari kāore he pānga o te mate pāwera ki te AP.¹⁰⁰

Hei whakamutunga, kāore i kitea e tēnei rangahau pūtaiao IAOMT tētahi rangahau kararehe kāore i whakaatu i ngā pānga kino o te AP ki ngā tawhā hauora.

7. Ngā Taupori Motuhake

Kāore te IAOMT e pupuri i te tūnga me tango katoa ngā niho kore-ora. Heoi, e mārama ana ko ngā niho kore-ora, ahakoa te rongoā endodontic, ahakoa te kore rānei, ka taea te whakararu i te hauora pūnaha i roto i te nuinga o te tangata. Engari ko wai ēnei tāngata, ā, e hia ōrau kei roto i te mōrearea? I roto i tēnei tuhinga kua tautuhia e mātou ētahi rōpū iti o te hunga kei roto i te mōrearea ki te kino haere i tō rātou āhua mai i te RCT. Hei tauira, ko te 1 piriona tāngata (1/4 o te taupori o te ao) he mate pūmua tō rātou.¹⁰¹ kei te mōrearea. Ka piki ake tēnei mā te 12-15% o te hunga mate huka¹⁰² me te 48% e pāngia ana e te toto toto tiketike.¹⁰³ Mā te hītori hauora hōhonu e whakahaeretia e te tākuta niho ka tautuhia he tokomaha o ngā pakeke o US kei roto i te 'mōrearea'. Me whai whakaaro ngā tākuta niho me ngā tohunga endodontic ki te hauora whānui o te tūroro i roto i ā rātou mahere maimoatanga kia pai ai ngā putanga hauora niho me te hauora pūnaha katoa.¹⁰⁴ Whai muri i tēnei, me aromatawai takitahi ia tūroro, me te whai whakaaro ki tōna āhua hauora me ētahi atu āhuatanga.

8. Ngā Huarahi Maimoatanga Hei Whakakore i te RCT

Ina pakaru, ina pangia rānei te kiri o te niho (arā, te niho kore ora), i te nuinga o te wā, ko te huarahi tino pai hei whakakapi i te RCT ko te tango katoa i te niho, e karo ana i te mōrearea roa o te RCTT ki te pupuri tonu i ngā huakita, ā, e aukati ana i te horapa tonu o ngā huakita kino puta noa i te tinana. Kia tangohia, ka taea te whakakapi i te niho ngaro ki te tākai niho, ki te piriti niho pumau, ki te niho rūpahu wāhanga tango rānei. He otinga pakari, motuhake te tākai, e whakanohoia ana he whakakapinga pakiaka (te titanium, te uku rānei) ki roto i te kauae hei tautoko i te karauna. Mā tēnei ka ārai i te ngaronga o te wheua, ā, ka tiakina te tūnga o ngā niho e karapoti ana. Ko te whakaaro o nāianei o te IAOMT ko ngā tākai zirconia uku, kāore he konganuku, te huarahi tino hototahi ki te koiora. Ka whakamahia e te piriti niho pumau ngā karauna i runga i ngā niho tata hei tautoko i te niho horihori e "honohono" ana i te āputa. Ko ngā niho rūpahu wāhanga tango he tikanga kore-pokanga, he tikanga utu-pai hoki mō te whakakapi i tētahi, neke atu rānei o ngā niho ngaro. Heoi, hei tiaki i te hanganga me te hauora o ngā wheua, me te ārai i te nekenekehanga o ngā niho, ko te mea pai rawa atu i tūtohutia e te IAOMT ko te tāpiringa he mea hanga ki tētahi rauemi hototahi ki te koiora (ko te uku te mea pai), kua hipokina ki te karauna zirconia.

Mō ngā niho he ngawari ake te mumura o te penupenu (arā, ngā niho ora), he kōwhiringa ngā maimoatanga ātaahua ake, pērā i te whakaora penupenu ora.¹⁰⁵ Mena ka kitea te penupenu nā te whara, te pirau hohonu rānei, ka whakatakotoria he rauemi rongoā he konupūmā ki runga i te penupenu hei whakaoho i te whakaora me te tiaki i a ia. Mena kua tae te pirau ki te penupenu engari kei te whanake tonu te pakiaka, tērā pea ka pērā i roto i ngā tamariki, ka taea te mahi i te pulpotomy hei tango i te wāhanga pangia o te penupenu. Ahakoa he nui ake te whakamahinga i roto i ngā mahi niho tamariki, kua kitea he hua pai o tēnei tikanga i roto i ngā pakeke.^106,107

9. Ngā Hangarau Hou me ngā Hangarau Hou i roto i te Endodontics

E ai ki ngā tikanga me ngā hangarau hou, he maha ngā wā kāore i te whai i ngā hītori mahi, i ngā rangahau kua whakaputaina rānei e whakaū ana i ō rātou painga pea. Heoi, nā te mōrearea o ngā putanga kāore i te tino pai mō te RCT kua whakaahuahia i roto i tēnei pūrongo, ko te hunga e whiriwhiri ana ki te pupuri i ō rātou niho ka hiahia pea ki te whakaaro ki te rapu i tētahi tākuta niho e whakamahi ana i ētahi o ngā tāpiringa e whai ake nei ki te RCT tuku iho, ka pai ake pea ngā putanga.

Cone Beam Compute Tomography (CBCT)

E ai ki te kōrero i runga ake nei, he mea noa ngā rerekētanga hanganga o te aroaro me te maha o ngā awaawa i roto i te pūtake o te niho (Tirohia te Pikitia 2). Ko te hanganga o te pūtake o ngā niho molar tuatahi o runga ko ngā pūtake e toru me ngā awaawa e toru, heoi tae atu ki te ono, ā, e rua noa iho ngā awaawa kua pūrongohia.¹⁰⁸ He uaua ki te tiro i ngā awa tāpiri mā te whakamahi i te whakaahua X-ray 2-D anake, ā, ki te kore e whakatikahia tika, ka taea e rātou te huna i te kiko penupenu necrotic e whai wāhi atu ai ki ngā mate pūmau.^35,109 He mea nui te whakamahinga o ngā tikanga whakaahua matatau pēnei i te cone-beam computed tomography (CBCT) i roto i te tautuhi i mua i te pokanga hei tautuhi i ngā raruraru pea kāore e kitea e ngā hihi-X 2-D tuku iho, pēnei i ngā awaawa tāpiri.¹¹⁰ Ko te tūāpapa o te hangarau CBCT ko tōna kaha ki te tiro i tētahi whara e hiahiatia ana i roto i te 3-D (frontal, sagittal, coronal). Mā te whakamahinga o te CBCT ka nui ake te tino mōhio (ki runga ake i ngā whakaahua X-ray 2-D) kua rongoatia ngā awa katoa, kia kore ai e puta mai ngā raruraru hauora pūnaha ka puta mai i te RCT tuku iho. He mea whai hua anō hoki mō te tautuhi i ngā tohu wawe, te horapa rānei o te mate. Nō reira, kua noho te whakamātautau X-ray CBCT hei paerewa koura mō te aromatawai i ngā niho me te wheua e karapoti ana.

Hauora Ozone

Kua pai ake ngā hua mō ngā niho RCT me ngā momo rongoā kē atu nā te whakamahinga o ngā tikanga patu huakita me te whakaora matatau.^111,112 He patu huakita kaha te hau ozone, te wai ozone rānei, e patu ana i ngā huakita, i ngā huaketo, me ngā harore i te wā o ngā mahi niho, ā, e āwhina ana hoki ki te whakaora i ngā niho, i ngā kapia me ngā wheua. Mā te noho i roto i te paerewa tiaki kua whakaaetia, me te whakamahi tika, ka taea e te hāora/ozone te whakapai ake i ngā hua i roto i ngā āhuatanga maha o te mahi niho.¹¹¹ Hei tauira, i roto i te maimoatanga anō a te RCT, ka taea te whakamahi hei tikanga iti ake te whara i te tango niho, hei whakamakuku me te horoi i ngā awa pakiaka; ā, ka taea hoki te whakamahi hei patu huakita i te wāhi pokanga i muri i te tangohanga niho. Ki te hiahia koe ki te ako atu mō te whakamahinga o te whakaora ozone, pāwhiritia te IAOMT's Ozone Therapy in Biological Dentistry.

Te Whakamakuku Whakahohe i roto i te Endodontics

Ko tētahi wāhanga nui o te tukanga horoi o ngā awaawa i roto i te pakiaka ko te tango i ngā paru e kiia nei ko te irrigation. E ai ki a Mirza et al (2019), kua puta ake te irrigation whakahohe i roto i ngā endodontics hei whakautu ki ngā herenga kua tuhia pai o te irrigation tikanga me te ngira.¹¹³ E whakaatu ana ngā rangahau tawhito me ngā rangahau o nāianei ko te hanganga uaua o te awa pakiaka – tae atu ki ngā tara, ngā isthmus, ngā toronga porowhita, me ngā hapa o te pito, he maha ngā wā ka kore e horoia pai mā te whakamahi i ngā taputapu miihini anake, ahakoa ngā pūnaha nickel-titanium matatau. I whakatūria e ngā mahi tōmua ko te urunga me te whakakapinga o te wai whakamakuku he mea nui hei whakatau i te whai huatanga o te horoi,^114,115 ā, i muri mai ka whakaūtia e ngā rangahau micro-CT me ngā rangahau āhuahanga kāore anō kia pāngia e ngā wāhanga nui o ngā pakitara o te awaawa i muri i te whakaritenga.^116-118 Nā te mea ko te pumau o te moroiti te mea nui e whakatau ana i te korenga o te endodontic, e ai ki ngā rangahau hua nui me ngā tātaritanga-meta (Tirohia te Ripanga 1), ko te tuku me te whakahohenga whakarei ake i te wai whakapūmau te arotahi matua. He āhuatanga ārai mate me te whakarewa kiko kua whakamātauhia mō ngā wai whakapūmau matū pēnei i te konutai hypochlorite me te EDTA, engari he kaha te awe o te kaha o te wai, te whakahoutanga, me te pā atu ki ngā biofilm ki tō rātou whai huatanga, e akiaki ana i te whanaketanga o ngā rautaki wai whakapūmau whakahohe.¹¹³

Ko ngā tikanga whakamakuku whakahohe, tae atu ki te whakamakuku ultrasonic kore mahi (PUI), te whakahohenga oro (GentleWave™), te whakamakuku whakahohe-laser (LAI), me te rere whakaahua-orooro i tīmatahia e te photon (PIPS me te SWEEPS), ka whakapai ake i te tohatoha whakamakuku, te tango i te paparanga paru, me te whakararuraru i te biofilm mā te rere oro me te cavitation (Tirohia ngā Pikitia 3 me te 4).¹¹⁹ Kua whakaatuhia te whakahohenga ultrasonic ki te whakaputa i te cavitation oro me te tango paru nui ake, i te mea ka puta te hanganga mirumiru kohu tere me te hinganga o ngā pūnaha laser erbium, ka puta he nekehanga wai kaha ahakoa i roto i ngā awaawa iti rawa te rahi. Ko te tirohanga me ngā rangahau whakamātautau e whakaatu ana i te urunga pai ki roto i te hanganga taha me ngā rohe apical ki te whakataurite ki te whakamakuku tikanga. He maha ex vivo a i roto i te vitro e whakaatu ana ngā rangahau i te nui ake o te whakahekenga o Enterococcus faecalis ngā kiriata koiora ina whakahohehia ngā wai whakapūkara mā te whakamahi i te ultrasonic, mā te whakamahi rānei i ngā laser, inā koa ka honoa ki te sodium hypochlorite. He mea nui, mā te wai whakapūkara whakahohehia e te laser ka taea te horoi pai me te iti o te rahinga wai whakapūkara me te whakaiti i te putanga apical, e hangai ana ki ngā mātāpono o te endodontics iti rawa te whakaekenga. I te katoa, e tautoko ana ngā taunakitanga i te wai whakapūkara whakahohehia hei tāpiri nui ki te hanga, te whakarei ake i te patu huakita, te whakapai ake i te haumaru, me te whai wāhi pea ki te angitu endodontic mō te wā roa e taea ai te matapae.¹¹³ Ahakoa rā, e kitea ana i te Pikitia 3, ahakoa te whakamahi i ngā tikanga pai rawa atu (arā, PIPS), kāore anō te wai whakapūmau kia uru katoa ki roto i te niho, he mea tino pai tēnā. Hei tāpiri, kāore te urunga o te wai whakapūmau e whakaū i te taumata o te patu huakita.

Pikitia 3 Ngā whakaahua o te urunga o ngā pakiaka o ngā wai whakapūkara mā te whakamahi i ngā tikanga rerekē

Pikitia 4 Kauwhata o te urunga o te pakiaka o ngā wai whakamakuku mā te whakamahi i ngā tikanga rerekē

Te Whakarerekētanga Whakaahua-koiora (PBM)

Ko tētahi atu huarahi hei whakapai ake i ngā putanga niho ko te whakamahinga o te Photobiomodulation (PBM), e kiia ana hoki ko te whakaora taiaho taumata-iti (LLLT).¹²⁰ Ko te irahiko e puta ai te mārama taiaho he kore-ionizing, nō reira kāore e puta ngā pānga rite ki te irahiko-X. Kua whakaaetia e te FDA te whakamahinga o tēnei tikanga hei tango i ngā kiko kapia mate me ngā pirau niho; hei āwhina i te whakatakotoranga o ngā whakatikatika; me te hei maimoatanga tāpiri i roto i ngā tikanga awa pakiaka, pērā i te pulpotomy.¹²¹ He tikanga ngāwari, kāore he mamae, he kore whakaekenga te PBM, nō reira he rerekētanga nui tēnei i ētahi o ngā tikanga maimoatanga kaha rawa atu e pā ana ki te mahi niho.¹²²

Te fibrin whai rawa i te pereti (PRF)

Ko te rongoā PRF tētahi atu maimoatanga tāpiri kua whakaatuhia hei whakapai ake i ngā putanga niho. Ko tēnei maimoatanga he tango toto i te tari, mā te whakamahi i te centrifuge hei wehe i te toto ki ōna wāhanga takitahi, ā, mā reira ka whakaemihia ngā pereti toto o te tūroro hei hanga i tētahi matrix fibrin, he nui ngā mea whakatipu. Ko te matrix PRF he mea tito mai i ngā leukocyte, ngā cytokine, me ngā glycoprotein pērā i te thrombospondin, ā, ka tukuna atu mō te iti rawa i te 7 rā i te wāhi tono. Ko ngā mea whakatipu me ngā cytokine kua tukuna ka whakaoho i te mahi a ngā osteoblast me te whakateretere i te whakahoutanga kiko mā te whakanui ake i te hekenga o ngā fibroblast.¹²³ Kua whakaatuhia e te whakamahinga o te PRF te whakapai ake i ngā reiti angitu i roto i ngā take pokanga pēnei i ngā tikanga hiki sinus, te whakaora i ngā kōhao tango, me te whakahaere i te AP.¹²⁴ Ina hoki, i whakaatuhia e tētahi arotake pūnaha/tātaritanga-maha tata nei mō te PRF i roto i te pokanga periapical he hononga pai ki te whakaiti i te mamae i muri i te pokanga me te whakapai ake i te whakaora i te whakaahua X-ray.¹²⁵ engari me nui ake ngā whakamātautau whakahaere hei whakaū.¹²⁶

Ngā Rautaki Ā-Mārama Pea

Ngā Wawaotanga Kai me te Oranga

Kei te puta ake ētahi atu maimoatanga tāpiri, ā, tera pea ka kitea he pai ki te whakapai ake i ngā putanga ā muri ake nei. I roto i tētahi rangahau kararehe, i pai ake ngā putanga CAP i te whakakori tinana taurite me te tāpiringa omega 3. I whakaitihia e te whakakori tinana anake te mumura mā te whakatikatika TNF-α me te whakahaere i te poke o te huakita. I te wā i honoa ai ki te tāpiringa omega-3, i whakapai ake te whakakori tinana i te whakahaere mumura mā te whakatikatika i ngā taumata IL-17, te whakaiti i te ngaronga o te wheua, me te whakaoho i te hanga collagen, ā, nā reira ka whakawhāitihia te mumura me te whakaiti i te mahi osteoclastic.¹²⁷ Kua whakaatuhia hoki e Azuma mā ko te tāpiringa omega-3 i roto i ngā kiore AP ka whakaiti i ngā takawaenga mumura,^128,129 ka whakaiti i te mimiti o te wheua, ka whakatairanga hoki i te whakaputanga o te wheua.¹³⁰

Kua tirohia e ētahi atu rangahau ngā pānga o te tāpiringa ki te CAP. I roto i tētahi rangahau, i tirohia te toto, te huware me ngā awa pakiaka i roto i ngā kiore i whakaaweahia e te AP i tāpirihia ki ngā probiotics me ngā kiore kāore i tāpirihia. Ahakoa kāore he rerekētanga i kitea i waenga i ngā rōpū i roto i ngā kōtaha toto me te huware, i roto i ngā awa, ko te urunga mumura me te IL-1β me te IL-6 i roto i te AP he iti ake i roto i te rōpū probiotic i whakaritea ki te rōpū whakahaere.¹³¹ Kua whakaatuhia hoki mā te tāpiritanga o te curcumin ki te waha ka whakaiti i te kaha o te AP i roto i ngā kiore, e whakaatu ana i te pānga ārai-mumura o te curcumin ki te whanaketanga o te AP.¹³² E whā pea ngā rangahau kararehe kua whakaatu i te iti o te mumura me te mimiti wheua i roto i ngā kiore AP i hoatu he melatonin pūnaha ki te whakataurite ki ngā kararehe mana whakahaere.^{17,86,133,134} He kaha ngā āhuatanga antioxidant, anti-inflammatory, me te whakahou wheua o te melatonin, ā, ka tiaki pea i ngā kiko periodontal mā te tango i ngā rauropi kore utu me te whakarerekē i te urupare ārai mate.¹³⁵  Me whakahaere ētahi atu rangahau wawaotanga ki te tangata hei whakaū i tōna whai huatanga, hei whakatū hoki i ngā tikanga tono tika.

Ngā rautaki patu huakita o te whakatipuranga e whai ake nei (NGAS)

Kāore e taea te kī atu, ahakoa ngā taputapu me te patu huakita o te awa pakiaka paerewa, he nui tonu ngā reiti rahunga nā te mau tonu o ngā kiriata koiora i roto i te hanganga uaua o te awa. E ai ki te whakaahuatanga i roto i tētahi arotake kōrero, ko ngā rautaki patu huakita o te whakatupuranga e whai ake nei (NGAS) e whakamahi ana i ngā nanopolymer, pērā i ngā nanoparticles, nanofibres, me ngā hydrogels, ka tuku i te tukunga rongoā me te tukunga patu huakita pumau i roto i ngā rohe awa uaua ki te tae atu. Ko te horahanga mata teitei me te tauhohenga ka whakapai ake i te whakapā atu ki ngā huakita i roto i ngā awa pakiaka. Ko ngā kaikawe noa ko te polycaprolactone (PCL), te poly (lactic-co-glycolic acid) (PLGA), me te chitosan. Ka taea te utaina ki ēnei ngā paturopi, ngā katote konganuku, tae atu ki ngā matū taiao pērā i te curcumin, te chitosan rānei.¹³⁶

He pai ngā NGAS mō te rongoā endodontic nā te mea ka tukuna e rātou he tukunga huakita kua whakahaeretia, pumau hoki mō ngā rā ki ngā wiki; ka whakaatuhia e rātou he whakapai ake i te pakaru o te biofilm me te hohonu o te urunga o te awaawa; ā, ko ētahi whakatakotoranga e whakaatu ana i ngā pānga osteogenic, anti-inflammatory, me te antioxidant, e āwhina ana pea i te whakaora periapical. Heoi, kei te whanake tonu te whakamahinga o te NGAS me te iti noa o ngā rangahau haumanu kua whakaputaina. Ahakoa rā, he rongoā tāpiri pai te NGAS mō te AP, e tuku ana i te mahi huakita kua arotahihia me ngā painga whakaora pea.¹³⁶

10. Te Whakatau Me Pupuri, Me Tango rānei i ngā Niho Kua Maimoatia ki te Awa Pūtake (RCTT)

He whakatau uaua, he whakatau taumaha hoki mā ngā tūroro te whakatau mēnā me pupuri tonu ngā niho kua rongoatia ki te RCT. He maha ngā āhuatanga me whai whakaaro. Ko ngā tohu me ngā tohumate o te mate pēnei i te mamae, te pupuhi, te hanganga o te fistula, te irahiko periapical (PARL; ka kitea i ētahi wā i runga i ngā whakaahua X-ray 2-D, i te 3-D CBCT rānei), me te nekenekehanga o te niho, he paearu noa ēnei ka whakaarohia e te tākuta niho ina tohutohu ana mēnā me tango he niho. He whānuitanga o te kaha o ēnei paearu ka matapakihia e te tākuta niho ki te tūroro ina tuku taunakitanga ana. I ētahi wā, hei wāhanga o te tukanga whakaae whai whakaaro, ka whakahuatia e te tākuta niho te āheinga o te mahi tuarua ('whakatikatika') RCT ki te niho.

He whakatau uaua ake pea ko ngā take kāore he mamae, he tohu mārama rānei o ngā raruraru RCT. I roto i ēnei take, he mea nui te aromatawai X-ray CBCT o te niho me te wheua e karapoti ana. Ko tētahi tohu nui mō te noho mai o te periodontitis apical mau tonu ko te PARL e ai ki te kōrero i runga ake nei. I runga i te rahi o te PARL, ka tūtohu ētahi tākuta niho kia mau tonu te niho me te aroturuki i te rahi o te PARL mā te CBCT i ia wā, i te korenga o ngā tohu.

Ahakoa ehara i te mea noa, kāore hoki i te whakaaetia hei paerewa tiaki, kei te wātea ētahi atu whakamātautau. Mā te ine wera e hanga he mahere wera o te rohe o te mahunga me te kaki e whakaatu ana i ngā wāhi mumura pea. Ka taea e te ine wera te kite i ngā tauhohenga mumura i ngā wāhanga tōmua o te mate, ka ārahi ki te tautuhi wawe. Heoi, he whānui ngā hua, ā, kāore e taea te aromatawai i te hauora o ngā niho motuhake pērā i te CBCT engari he pai ki te whakamahi hei tikanga tāpiri.^137,138

Ngā whakamātautau toto e ine ana i ngā taumata o te hs-CRP, Tērā pea ka homai e te fibrinogen, te interluken-6, te interluken-10, me/ranei te CCL5 (RANTES) ngā tohu mō te āhua o te mumura i roto i te tinana.¹³⁹ Engari, kāore ēnei tohu koiora e tohu ana i te pūtake o te mumura. Hei whakatutuki i te tino taipitopito o te tātaritanga, ka taea te tātari i te wai o te pito o waho o te niho (GCF) mai i te niho i rongoatia ki te awa pakiaka mō ngā taumata o te whākōkī active matrix metalloproteinase-8 (aMMP-8).¹⁴⁰ Ko te aMMP-8 te takawaenga matua o te whakangaromanga kiko, ā, ka taea te whakamahi i tōna kukū i roto i te GCF hei aromatawai i te AP mau tonu. Ko ngā taumata aMMP-8 teitei e tohu ana i te aroaro me te kaha o te mate, ā, kei te wātea ngā whakamātautau tere i ētahi whenua mō te tautuhi i te mate i te wā e tiaki ana. Heoi, me whai rangahau anō hei whakatū i ngā uara tapahi mō ngā putanga maimoatanga, me te whakamārama i te mahi a te whākōkī ki te wehewehe i waenga i te kaha o te mate.¹⁴⁰

11. Whakamutunga

Hei whakamutunga, ahakoa he mea nui tonu te RCT hei wawaotanga niho mō te whakahaere i te mate pulpal, e whakaatu ana ngā taunakitanga pūtaiao kua kohia he maha tonu ngā wā ka mau tonu te mumura apical mau tonu me te taumahatanga moroiti i roto i te RCTT ka whai wāhi pea ki te mate pūnaha i roto i ngā tāngata ngoikore. He mea noa te CAP, he maha ngā wā kāore he tohu o ngā niho, ā, kāore i te tino kitea te mate ina whakawhirinaki ana ki te whakaahua X-D tikanga anake. Ko ngā hononga i waenga i te CAP me ngā mate mumura pūnaha, te mate pāwera, te mate ngakau, te mate pūnaha io, me te mate pūnaha ārai mate e tautokona ana e ngā raraunga mate urutā, ngā ara tikanga, me te tinana rangahau kararehe e tere haere ana te tipu e whakaatu ana i te tūponotanga o te koiora. E whakaatu ana ēnei kitenga i te hiahia kia neke atu i te tauira tiaki e aro ana ki te niho ki tētahi huarahi hauora/niho whakauru e whakaaro ana ki ngā āhuatanga mōrearea takitahi o te tūroro, te āhua hauora pūnaha, me ngā hua koiora mō te wā roa. Ko te whakaaetanga whai whakaaro, te tātaritanga matatau, te whiriwhiri take tupato, me te whakaaro ki ngā rautaki maimoatanga rerekē, tāpiri rānei, he mea nui ki te arotau i ngā putanga hauora ā-waha me te hauora whānui.

Ki te tango, ki te tuhi ranei i tenei wharangi ki tetahi reo rereke, whiriwhiria to reo mai i te tahua taka iho kei te taha maui o runga o te paetukutuku i te tuatahi. Mena kei te pirangi koe kia ta nga tohutoro me te pepa tuunga, panuihia te waahi "References" kei raro o te tuhinga hei whakawhanui ki te tirohanga ka paato i te paatene taa.

12. He Tohutoro

IAOMT: Te Āhua o te Pūtaiao mō ngā Niho i Maimoatia ki te Awa Pūtake (RCTT)

Jack Kall, DMD, MIAOMT( Tiamana o te Poari )

Ko Dr. Jack Kall, DMD, FAGD, MIAOMT, he hoa o te Academy of General Dentistry me te Perehitini o mua o te pene Kentucky. He Kaiwhakaako ia mo te International Academy of Oral Medicine and Toxicology (IAOMT) a mai i te tau 1996 ko ia te Tiamana o te Poari Whakahaere. Ka mahi ano ia i te Poari Kaitohutohu o te Bioregulatory Medical Institute (BRMI). He mema ia no te Institute for Functional Medicine and American Academy for Oral Systemic Health.

iaomt.org

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• IAOMT Pepa Whakatika Ki Te Nekehua Mercury Amalgam
• Taonga Niho Koiora: He Whakatakitanga mo te Rongoa-waha - Toxicology niho

Teri Franklin, PhD

He kaipūtaiao rangahau a Teri Franklin, PhD, ā, ko ia te Kaiako Emeritus i Te Whare Wānanga o Pennsylvania, Philadelphia PA, ā, he kaituhi tahi hoki rāua ko James Hardy, DMD o te pukapuka, Mercury-free. He mema a Tākuta Franklin nō te IAOMT me te Komiti Pūtaiao IAOMT mai i te tau 2019, ā, i whiwhi ia i te Tohu Perehitini o te IAOMT i te tau 2021. Ko Tākuta Franklin te Kaituhi Pūtaiao Matua mō te IAOMT.

Karekau he panui.