Endokron Restorasyonların Başarısına Etki Eden Faktörler
Özet
Endokron restorasyonlar, ciddi madde kaybı olan endodontik tedavili arka grup dişlerin rehabilitasyonunda intraradiküler post, kor ve kuron yapılarını tek bir bileşende birleştiren, post kavitesi veya ferrule tasarım hazırlığı gerektirmeyen muhafazakar bir tedavi seçeneğidir. Yapılan sistematik derlemeler ve meta-analizler, molar (%72-99) ve premolar (%68-100) dişlerde yüksek başarı ve sağkalım oranları ortaya koyarken, kesici dişler için henüz kesin bir klinik sonuç bildirmemektedir. Endokron başarısızlıklarının önde gelen nedenleri retansiyon kaybı (%53), periodontitis (%14) ve restorasyon kırığı (%14) iken, kök kırığı sıklığı geleneksel kronlara kıyasla çok daha düşüktür (%6'ya karşı %29). Başarıyı etkileyen en önemli faktörler arasında korunmuş rezidüel diş dokusu miktarı (%30'un altındaki hacimler düşük sağkalım ile ilişkilidir), oklüzal faktörler ve preparasyon derinliği (marjinal adaptasyon ve retansiyon için kanal içi uzantılardan kaçınılarak pulpa odasından maksimum yararlanılmalıdır) yer almaktadır. Derin subgingival marjinlerin yönetiminde derin kenar yükseltmesi (DME) tekniği cerrahi kron boyu uzatmaya alternatif olarak kullanılabilmektedir. Materyal seçiminde ise, rezin simana güçlü bağlanması ve yüksek kırılma dayanımı nedeniyle lityum disilikat seramikler ilk sırada tercih edilmekle birlikte, dentine benzer elastisite modülü ile stresi daha iyi absorbe eden ve karşıt dişi daha az aşındıran nanoseramik rezinler de benzer başarı oranlarıyla güvenilir bir alternatif sunmaktadır.
Endocrown restorations are a conservative treatment option for rehabilitating endodontically treated posterior teeth with severe tissue loss by combining intraradicular post, core, and crown structures into a single component without requiring post cavity or ferrule design preparation. Systematic reviews and meta-analyses demonstrate high success and survival rates in molars (72-99%) and premolars (68-100%), while no definitive clinical conclusions are reported for incisors. The leading causes of endocrown failures are loss of retention (53%), periodontitis (14%), and restoration fracture (14%), though the incidence of root fracture is significantly lower compared to conventional crowns (6% vs. 29%). The most critical factors influencing success include the amount of remaining residual tooth structure (volumes below 30% correlate with low survival), occlusal factors, and preparation depth, where the existing pulp chamber depth must be maximally utilized while avoiding intra-canal extensions to prevent poor marginal adaptation. For managing deep subgingival margins, the deep margin elevation (DME) technique serves as an alternative to surgical crown lengthening. Regarding material selection, lithium disilicate ceramics are primarily preferred due to their reliable bonding to resin cement and high fracture resistance; however, nanoceramic resins offer a reliable alternative with comparable success rates as they better absorb stress with an elasticity modulus similar to dentin and cause less wear on opposing teeth.
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