Geniş madde kayıplı vital dişlerde direkt, indirekt ve CAD/CAM restorasyonların klinik başarısının karşılaştırmalı olarak incelenmesi
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Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada bir ya da daha fazla tüberkül hasarını da içine alan geniş ve büyük lezyonlu posterior bölge dişlerinin direkt, indirekt rezin kompozit ya da bir CAD/CAM rezin nano-seramik ile restore edilmesi ve 30 ay süreyle klinik olarak izlenmesi amaçlandı. Bu arada elde edilen klinik bulgulara göre restorasyon tiplerinin performansları birbirleriyle kıyaslandı. Bu amaçla çalışmaya 82 hastada toplam 139 restorasyon dahil edildi. Direkt rezin kompozit uygulanan kavitelere preparasyon sonrası "self-etch" yani kendinden asitli bir adeziv sistem (Clearfil SE Bond, Kuraray, Okayama, Japonya) uygulandı. Ardından kavitelere mikro-hibrit rezin kompozit (Gaenial Posterior, GC Dental Products Corp., Aichi, Japonya) yerleştirilerek restorasyonlar tamamlanıp, polisaj ve bitirme işlemleri yapıldı. İndirekt restorasyonlar için mekanik kavite prensiplerine göre kaviteler hazırlandıktan sonra, ölçüsü alınıp alçı modelleri elde edildi. Alçı modeller üzerinde, mikro-hibrit rezin kompozitle (TesceraTM Indirect Composite System, Bisco, Schaumburg, IL, Amerika) restorasyonlar laboratuvarda hazırlandı ve sistemin kendine özgü kompozit fırınınında (TesceraTMATLTM Bisco, Schaumburg, IL, Amerika) su, ısı, ışık ve basınç altında polimerizasyon tamamlandı. Bitirme işlemi laboratuvarda tamamlanan restorasyonlar, bir "self-adhesive" yani kendinden bağlanan rezin yapıştırıcı siman (RelyX U-200, 3M ESPE, St.Paul, MN, ABD) aracılığıyla sadece minenin asit ile pürüzlendirilmesini takiben kavitelere yerleştirildi. Bilgisayar destekli tasarım ve bilgisayar destekli üretim "CAD/CAM" restorasyonlar için yine mekanik kavite prensiplerine göre hazırlanan kavitelerin ağız içi kamerayla dijital ölçüleri (Bluecam AC, Sirona, Bensheim, Almanya) alındı. Alınan bu ölçüler bilgisayara (Cerec System, Sirona, Bensheim, Almanya) aktarılıp ilgili yazılımla (Cerec 4.2, Sirona, Bensheim, Almanya) tasarımı gerçekleştirildi (bilgisayar destekli tasarım = CAD). Tasarımı tamamlanan restorasyonlar sisteme bağlı kazıma ünitesine yerleştirilen rezin nano-seramik blokların (LavaTM Ultimate, 3M ESPE, II St.Paul, MN, ABD) hasta başında işlenmesi sonucu üretildi (bilgisayar destekli üretim = CAM). Ardından restorasyonlar yine "self-adhesive" rezin yapıştırıcı siman aracılığıyla sadece minenin asit ile pürüzlendirilmesini takiben kavitelere yerleştirildi. Restorasyonların klinik başarısı, FDI kriterleri (World Dental Federation-Clinical criteria) kullanılarak estetik, biyolojik ve fonksiyonel parametrelerde yer alan toplamda 14 adet kriter üzerinden başlangıçta ve 6, 12, 18, 24 ve 30.aylarda değerlendirildi. Restorasyon tipleri arasında biyolojik açıdan çalışmanın herhangi bir döneminde anlamlı bir farklılık izlenmezken (p>0.05); estetik parametrelerde direkt rezin restorasyonların, fonksiyonel parametrede ise indirekt restorasyonların üstünlüğü (p<0.05) dikkat çekti. Bununla birlikte estetik, fonksiyonel ve biyolojik parametrelerde yer alan tüm kriterler üzerinden karşılaştırma yapıldığında ilk 18 ayda CAD/CAM restorasyonların üstünlüğü izlenirken (p<0.05), 18.aydan sonra bu fark tamamen ortadan kalktı (p>0.05). Böylece çalışmanın sonunda genel değerlendirmede restorasyon tipleri arasında herhangi bir farka rastlanmadı (p>0.05). Restorasyon tipleri kendi içlerinde değerlendirildiklerinde; indirekt restorasyonların başarısının çalışmanın başından sonuna kadar değişmeden aynı kaldığı gözlendi. Direkt ve CAD/CAM restorasyonlarda çeşitli kontrol dönemlerinde performans değişiklikleri izlendi. Bu çalışmanın sonuçlarına göre, restorasyonların ağızda kalma oranları 30 aylık izleme periyodunun sonunda indirekt rezin kompozit restorasyonlar için %95,6 direkt rezin restorasyonlar için %89,4 ve CAD/CAM restorasyonlar için %84,4'tü.
The aim of this study was to follow the clinical performance of direct, indirect resin composite and CAD/CAM resin nano-ceramic restorations in wide and deep lesions of posterior teeth during 30 months. Additionally, clinical success of indirect, direct and CAD/CAM restorations were compared with each other. 139 restorations in 82 patients were included to this study. For direct restorations, following the preparation of the cavities as usual, microhybrid resin composites (Gaenial posterior, GC Dental Products Corp., Aichi, Japan) were applied with the self-etch adhesive system (Clearfil SE Bond, Kuraray, NewYork, USA). After placement of the restorations, finishing and polishing procedures were completed. For indirect restorations, cavities were prepared according to mechanical cavity designs and stone moulds were obtained after the impression. Via those moulds, microhybrid resin composite restorations (TesceraTM Indirect Composite System, Bisco, Schaumburg, IL, USA) were tailored and polymerized under pressure/water/heat/light oven of the system TesceraTM ATLTM (Bisco, Schaumburg, IL, USA). Before placement of the restorations to the cavity, finishing and polishing procedures were completed. Obtained restorations which were completed in the laboratory were placed to the cavities by self-adhesive luting cement (RelyX U-200, 3M ESPE, St.Paul, MN, USA) after selective enamel etching. For another group computer aided design and computer aided manifacturing "CAD/CAM" resin nano-ceramic restorations, cavities were prepared according to mechanical cavity designs and digital impressions were made with intraoral camera (Bluecam, Sirona, Bensheim, Germany). The digital impressions transferred to the computer (Cerec System, Sirona, Bensheim, Germany) and were carried out of the design with the corresponding software (Cerec 4.2, Sirona, Bensheim, Germany) (computer aided design = CAD). The completely designed restorations were produced IV by using a chairside CAD/CAM technology (computer aided manifacturing = CAM) after resin nano-ceramic blocks (LavaTM Ultimate, 3M ESPE, St.Paul, MN, USA) were placed in the scraping unit attached to the system. Then fabricated restorations were luted using a self-adhesive resin cement with selective enamel conditioning. The clinical success of all restorations were evaluated with FDI Criteria as esthetically, biologically and functionally at baseline, 6, 12, 18, 24 and 30 months. While there was no significant difference biologically in restoration types at any time during the whole study (p>0.05); it was emphasized the superiority of indirect restorations in functional parameters and direct resin restorations in esthetic parameters were observed (p<0.05). In addition, when comparing all the criteria in esthetic, functional and biological parameters, the superiority of CAD / CAM restorations was observed in the first 18 months (p<0.05); after 18 months, this difference completely disappeared (p>0.05). Thus, at the end of the study, no difference was found between the types of restorations in overall clinical success (p>0.05). When restoration types are evaluated within themselves; the success of indirect restorations remained unchanged from beginning to end of the study. The performance of the direct and CAD / CAM restorations were changed at various control periods of this study. As a result, survival rate of this study was 95.6% for the indirect resin composite restorations, 89.4% for the direct resin restorations and 84.4% for CAD/CAM restorations at the end of the 30-month follow-up period of study.
The aim of this study was to follow the clinical performance of direct, indirect resin composite and CAD/CAM resin nano-ceramic restorations in wide and deep lesions of posterior teeth during 30 months. Additionally, clinical success of indirect, direct and CAD/CAM restorations were compared with each other. 139 restorations in 82 patients were included to this study. For direct restorations, following the preparation of the cavities as usual, microhybrid resin composites (Gaenial posterior, GC Dental Products Corp., Aichi, Japan) were applied with the self-etch adhesive system (Clearfil SE Bond, Kuraray, NewYork, USA). After placement of the restorations, finishing and polishing procedures were completed. For indirect restorations, cavities were prepared according to mechanical cavity designs and stone moulds were obtained after the impression. Via those moulds, microhybrid resin composite restorations (TesceraTM Indirect Composite System, Bisco, Schaumburg, IL, USA) were tailored and polymerized under pressure/water/heat/light oven of the system TesceraTM ATLTM (Bisco, Schaumburg, IL, USA). Before placement of the restorations to the cavity, finishing and polishing procedures were completed. Obtained restorations which were completed in the laboratory were placed to the cavities by self-adhesive luting cement (RelyX U-200, 3M ESPE, St.Paul, MN, USA) after selective enamel etching. For another group computer aided design and computer aided manifacturing "CAD/CAM" resin nano-ceramic restorations, cavities were prepared according to mechanical cavity designs and digital impressions were made with intraoral camera (Bluecam, Sirona, Bensheim, Germany). The digital impressions transferred to the computer (Cerec System, Sirona, Bensheim, Germany) and were carried out of the design with the corresponding software (Cerec 4.2, Sirona, Bensheim, Germany) (computer aided design = CAD). The completely designed restorations were produced IV by using a chairside CAD/CAM technology (computer aided manifacturing = CAM) after resin nano-ceramic blocks (LavaTM Ultimate, 3M ESPE, St.Paul, MN, USA) were placed in the scraping unit attached to the system. Then fabricated restorations were luted using a self-adhesive resin cement with selective enamel conditioning. The clinical success of all restorations were evaluated with FDI Criteria as esthetically, biologically and functionally at baseline, 6, 12, 18, 24 and 30 months. While there was no significant difference biologically in restoration types at any time during the whole study (p>0.05); it was emphasized the superiority of indirect restorations in functional parameters and direct resin restorations in esthetic parameters were observed (p<0.05). In addition, when comparing all the criteria in esthetic, functional and biological parameters, the superiority of CAD / CAM restorations was observed in the first 18 months (p<0.05); after 18 months, this difference completely disappeared (p>0.05). Thus, at the end of the study, no difference was found between the types of restorations in overall clinical success (p>0.05). When restoration types are evaluated within themselves; the success of indirect restorations remained unchanged from beginning to end of the study. The performance of the direct and CAD / CAM restorations were changed at various control periods of this study. As a result, survival rate of this study was 95.6% for the indirect resin composite restorations, 89.4% for the direct resin restorations and 84.4% for CAD/CAM restorations at the end of the 30-month follow-up period of study.
Açıklama
Anahtar Kelimeler
İndirekt Rezin Kompozit, Direkt Rezin Kompozit, CAD/CAM Rezin Nano-Seramik, Daimi Diş, Klinik Başarı, Indirect Resin Composite, Direct Resin Composite, CAD/CAM Resin Nano-Ceramic, Vital Teeth, Clinical Success
