Farklı tekniklerle üretilmiş implant üstü dayanak ve kronların in-vitro olarak karşılaştırılması
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/embargoedAccess
Özet
İmplant destekli protetik restorasyonlar günümüzde, özellikle tek diş eksikliklerinin
tamamlanmasında sıklıkla başvurulan bir tedavi protokolü olarak öne çıkmaktadır.
İmplant destekli protetik restorasyonların uzun dönem klinik başarısı, doğru
endikasyon ve cerrahi uygulamanın yanı sıra olguya uygun protetik planlama ile
doğrudan ilişkilidir. Doğru protetik planlama kapsamında üst yapıyı oluşturacak
komponentlerin özelliklerinin de dikkatle seçilmesi gerekmektedir. Bu doğrultuda
dayanağın ve üst yapı tasarımının seçimi oldukça önem taşımaktadır. Dayanak seçimi
yapılırken dayanak materyali ve üretim tekniği göz önüne alındığında restorasyonun
uzun dönem başarısı artmaktadır. Görülen komplikasyonlar, doğru dayanak seçimi ve
üst yapı tasarımı ile en aza indirgenebilmektedir. Son yıllarda dayanak ve üstyapı
kronun tek parça olarak üretilip implanta vidalandığı modifiye hibrit restorasyonlar
“hibrit-dayanak-kronlar” şeklinde anılmaktadır. Siman tutuculu ve vida tutuculu
implant destekli restorasyonların avantajlarını buluşturan bu tasarımın,
restorasyonların uzun dönem klinik başarısını olumlu yönde etkilediği ifade
edilmektedir. Fakat söz konusu tasarım hakkında literatürde yeterli bilgi
bulunmamaktadır. Bu çalışmada farklı materyallerle ve farklı tekniklerle üretilen
implant destekli tek kron restorasyonların kırılma dayanımları ve vida gevşeme
miktarları incelenmektedir. Bu amaçla toplam 40 adet implant 4 gruba ayrılmıştır.
Birinci gruptaki restorasyonlar fabrikasyon titanyum dayanaklar üzerine titanyum
altyapılı porselen kronların simante edilip implantlara vidalanmasıyla hazırlanan
fabrikasyon titanyum dayanaklı simante-vidalı kronlardan oluşmaktadır. İkinci
gruptaki restorasyonlar fabrikasyon zirkonya dayanaklar üzerine zirkonya altyapılı
porselen kronların simante edilip vidalanmasıyla hazırlanan fabrikasyon zirkonya
dayanaklı simante-vidalı kronlardan meydana gelmektedir. Üçüncü grup, CAD/CAM
yöntemiyle bireysel olarak üretilen titanyum temsili dayanaklar üzerine veneer
porseleninin direkt olarak işlenmesiyle elde edilen monoblok titanyum hibrit-dayanakkronlardır.
Dördüncü ve son grup ise CAD/CAM yöntemiyle bireysel olarak üretilen zirkonya temsili dayanaklar üzerine veneer porseleninin direkt olarak işlenerek Tibase’ler
ile bağlanması yoluyla elde edilen monoblok zirkonya hibrit-dayanakkronlardan
oluşmaktadır. Farklı teknik ve materyallerle üretilen bu restorasyonların,
termal siklus işlemini takiben önce çözülme torku değerleri hesaplanarak vida
gevşeme oranları belirlenmiş, ardından da kırılma dayanımları ölçülmüş ve kırık
modları incelenmiştir. Dayanak materyali ve vida gevşemesi arasında istatistiksel
olarak anlamlı bir ilişki bulunamamıştır. Vida gevşeme oranları titanyum hibritdayanak-
kronlar, zirkonya simante-vidalı kronlar, zirkonya hibrit-dayanak-kronlar ve
titanyum simante-vidalı kronlar için sırasıyla %20,09±6,49; %15,23±6,07;
%11,63±7,48 ve %9,59±8,84 olarak hesaplanmıştır. Dayanağın üretim tekniği ve
üstyapı tasarımının zirkonya dayanaklar için vida gevşeme miktarını etkileyen bir
faktör olmadığı belirlenmiştir. Vida gevşemesinin en fazla olduğu grup titanyum
hibrit-dayanak-kron grubu, en az olduğu grup ise titanyum simante-vidalı kron grubu
olarak belirlenmiştir. Yalnızca bu iki grubun vida gevşeme değerleri arasındaki fark
istatistiksel olarak anlamlı bulunmuştur. İmplant destekli tek kron örneklerin
üretiminde kullanılan dayanak materyalinin, üretim tekniğinin ve üstyapı tasarımının;
örneklerin kırılma dayanımlarını etkilediği gözlemlenmiştir. Hibrit-dayanak-kronların
kırılma dayanımının, konvansiyonel simante-vidalı kronlara göre daha yüksek olduğu
görülmüş; sistemin iki parça yerine tek parça halinde üretilmesinin kırılma dayanımını
arttırdığı gözlemlenmiştir. Hem hibrit-dayanak-kron, hem de simante-vidalı kron
gruplarında titanyumdan üretilen dayanakların kırılma dayanımlarının zirkonyaya
göre anlamlı şekilde daha yüksek olduğu belirlenmiştir. En yüksek kırılma dayanımına
sahip grup 385,84±27,68 N ile CAD/CAM tekniği ile üretilen titanyum hibritdayanak-
kron grubudur. Bu grubu sırası ile 313,18±39,97 N ile CAD/CAM tekniği ile
üretilen zirkonya hibrit-dayanak-kron grubu; 272,69±35,03 N ile titanyum simantevidalı
kron grubu ve 156,71±19,83 N ile zirkonya simante-vidalı kron grubu takip
etmektedir. Grupların ortalama kırılma dayanımları arasındaki farklar istatistiksel
olarak anlamlı bulunmuştur.
Implant-supported prosthetic restorations stand out as a frequently used treatment protocol contemporarily, especially for the single missing tooth. The long-term clinical success of implant-supported prosthetic restoration is directly related to the right indication and surgical application, as well as the suitable prosthetic planning for the case. Within the scope of right prosthetic planning, the properties of the superstructural components should also be carefully selected. Accordingly, the selection of the abutment and superstructure design is crucial. The long-term success of the restoration increases when the abutment material and manifacture technique are taken into consideration. The complications seen can be minimized by choosing the proper abutment and superstructure design. Of the late years, modified hybrid restorations in which the abutment and superstructure crowns are manifactured as one piece and screwed to the implant are referred to as “hybrid-abutment-crowns”. It is stated that this design, which combines the advantages of cement-retained and screw-retained implant-supported restorations, positively affects the long-term clinical success of the restorations. However, there is lack of information in the literature about the design in question. In this study, the fracture strength and screw loosening rate of implantsupported single crown restorations manifactured with different materials and different techniques are evaluated. For this purpose, a total of 40 implants are divided into 4 groups. Restorations in the first group consist of prefabricated titanium abutment supported screwmentable crowns prepared by cementing titanium-based-porcelain crowns on prefabricated titanium abutments and screwing the cemented crowns to the implants. Restorations in the second group consist of prefabricated zirconia abutments supported screwmentable crowns prepared by cementing zirconia-based-porcelain crowns on prefabricated zirconia abutments and screwing the cemented crowns to the implants. The third group is monoblock titanium hybrid-abutment-crowns produced by the veneer porcelain baked directly on titanium representative abutments manifactured individually by CAD/CAM. The fourth and last gruop consist of monoblock zirconia hybrid-abutment-crowns produced by the veneer porcelain baked directly on zirconia representative abutments manifactured individually by CAD/CAM and bonded to Ti-bases. Following the thermocycle process, screw loosening ratios of the abutment screws of the restorations produced with different techiques and materials were first determined by measuring the removal torque values (RTV), afterwards the fracture strength of the restorations were measured and failure modes were examined. No statistically significant relationship was found between the abutment material and screw loosening. Screw loosening rates were %20,09±6,49; %15,23±6,07; %11,63±7,48 and %9,59±8,84 for titanium hybrid-abutment-crowns, zirconia screwmentable crowns, zirconia hybrid-abutment-crowns and titanium screwmentable crowns respectively. It has been determined that the manifacture technique and superstructure design of the abutment is not a factor affecting the screw loosening for zirconia abutments. The group with the highest screw loosening ratio was determined as the titanium hybrid-abutment-crown group and the group with the lowest was the titanium screwmentable crown group. Only the difference between the screw loosening values of these two groups was found statistically significant. It has been observed that; abutment material, manifacture technique and superstructural design affect the fracture strength of the restorations. The fracture strength of hybridabutment- crowns were determined higher than conventional screwmentable crowns and found that the manifacturing of the system in one piece instead of two pieces increases the fracture strength. It has been determined that the fracture strength of the abutments manifactured from titanium in both the hybrid-abutment-crown and screwmentable crown groups were significantly higher than zirconia. The group with the highest fracture strength is the titanium hybrid-abutment-crown group with 385,84±27,68 N. This group is followed by 313,18±39,97 N; 272,69±35,03 N and 156,71±19,83 N for the zirconia hybrid-abutment-crown group, titanium screwmentable crown group and zirconia screwmentable crown group respectively. The differences between the mean fracture strength of the groups were found to be statistically significant.
Implant-supported prosthetic restorations stand out as a frequently used treatment protocol contemporarily, especially for the single missing tooth. The long-term clinical success of implant-supported prosthetic restoration is directly related to the right indication and surgical application, as well as the suitable prosthetic planning for the case. Within the scope of right prosthetic planning, the properties of the superstructural components should also be carefully selected. Accordingly, the selection of the abutment and superstructure design is crucial. The long-term success of the restoration increases when the abutment material and manifacture technique are taken into consideration. The complications seen can be minimized by choosing the proper abutment and superstructure design. Of the late years, modified hybrid restorations in which the abutment and superstructure crowns are manifactured as one piece and screwed to the implant are referred to as “hybrid-abutment-crowns”. It is stated that this design, which combines the advantages of cement-retained and screw-retained implant-supported restorations, positively affects the long-term clinical success of the restorations. However, there is lack of information in the literature about the design in question. In this study, the fracture strength and screw loosening rate of implantsupported single crown restorations manifactured with different materials and different techniques are evaluated. For this purpose, a total of 40 implants are divided into 4 groups. Restorations in the first group consist of prefabricated titanium abutment supported screwmentable crowns prepared by cementing titanium-based-porcelain crowns on prefabricated titanium abutments and screwing the cemented crowns to the implants. Restorations in the second group consist of prefabricated zirconia abutments supported screwmentable crowns prepared by cementing zirconia-based-porcelain crowns on prefabricated zirconia abutments and screwing the cemented crowns to the implants. The third group is monoblock titanium hybrid-abutment-crowns produced by the veneer porcelain baked directly on titanium representative abutments manifactured individually by CAD/CAM. The fourth and last gruop consist of monoblock zirconia hybrid-abutment-crowns produced by the veneer porcelain baked directly on zirconia representative abutments manifactured individually by CAD/CAM and bonded to Ti-bases. Following the thermocycle process, screw loosening ratios of the abutment screws of the restorations produced with different techiques and materials were first determined by measuring the removal torque values (RTV), afterwards the fracture strength of the restorations were measured and failure modes were examined. No statistically significant relationship was found between the abutment material and screw loosening. Screw loosening rates were %20,09±6,49; %15,23±6,07; %11,63±7,48 and %9,59±8,84 for titanium hybrid-abutment-crowns, zirconia screwmentable crowns, zirconia hybrid-abutment-crowns and titanium screwmentable crowns respectively. It has been determined that the manifacture technique and superstructure design of the abutment is not a factor affecting the screw loosening for zirconia abutments. The group with the highest screw loosening ratio was determined as the titanium hybrid-abutment-crown group and the group with the lowest was the titanium screwmentable crown group. Only the difference between the screw loosening values of these two groups was found statistically significant. It has been observed that; abutment material, manifacture technique and superstructural design affect the fracture strength of the restorations. The fracture strength of hybridabutment- crowns were determined higher than conventional screwmentable crowns and found that the manifacturing of the system in one piece instead of two pieces increases the fracture strength. It has been determined that the fracture strength of the abutments manifactured from titanium in both the hybrid-abutment-crown and screwmentable crown groups were significantly higher than zirconia. The group with the highest fracture strength is the titanium hybrid-abutment-crown group with 385,84±27,68 N. This group is followed by 313,18±39,97 N; 272,69±35,03 N and 156,71±19,83 N for the zirconia hybrid-abutment-crown group, titanium screwmentable crown group and zirconia screwmentable crown group respectively. The differences between the mean fracture strength of the groups were found to be statistically significant.
Açıklama
Anahtar Kelimeler
Dayanak, Dental İmplant, Hibrit-Dayanak-Kron, Vida Gevşemesi, Kırılma Dayanımı, Abutment, Dental Implant, Hybrid-Abutment-Crown, Screw Loosening, Fracture Strength
