Tam Seramik Restorasyonlarda Preparasyonun Önemi
Özet
Tam seramik restorasyonlar, günümüz diş hekimliğinde estetik ve biyouyumluluk avantajları nedeniyle metal seramiklerin yerini alarak giderek daha fazla tercih edilmektedir. Gelişen mikroyapısal teknolojiler ve üretim yöntemleri sayesinde, lityum disilikat, zirkonya ile güçlendirilmiş lityum silikat ve polimer infiltre edilmiş seramikler gibi materyaller geliştirilmiş; monolitik veya tabakalı tasarımlarla onlay, tam kron, laminate veneer ve endokron gibi farklı restorasyon seçenekleri sunulmuştur. Bu restorasyonların ağız içi fonksiyonu, marjinal uyumu ve uzun dönem başarısı (prognozu) için doğru diş preparasyonu hayati bir öneme sahiptir; çünkü ideal olmayan preparasyonlar çatlaklara, kırıklara, ikincil çürüklere veya pulpa irritasyonuna yol açabilmektedir. Tam kronlarda shoulder veya derin chamfer bitim çizgileri kırılma direncini artırırken, laminate veneerlerde ise mine dokusunun korunması adeziv bağlantının kalıcılığı açısından kritik faktörlerden biridir. Parsiyel onlay restorasyonlar, geleneksel kronlara kıyasla daha konservatif ve doku koruyucu bir tedavi yaklaşımı sağlarken, endodontik tedavili dişlerde uygulanan endokronlar pulpa odasından retansiyon alarak minimal invaziv çözümler sunmaktadır. Her klinik durumun kendine özgü şartları bulunmakla birlikte, seramiklerin yapısal özellikleri göz önünde bulundurularak yuvarlatılmış iç geometrilerin oluşturulması ve uygun frezlerin kullanılması, restorasyonların ömrünü uzatarak hasta memnuniyetini maksimum seviyeye çıkarmaktadır.
All-ceramic restorations are increasingly preferred in contemporary dentistry, replacing metal-ceramics due to their aesthetic and biocompatibility advantages. Thanks to advancing microstructural technologies and manufacturing methods, materials such as lithium disilicate, zirconia-reinforced lithium silicate, and polymer-infiltrated ceramics have been developed, providing diverse restorative options including onlays, full crowns, laminate veneers, and endocrowns through monolithic or layered designs. Proper tooth preparation is vital for the intraoral function, marginal adaptation, and long-term success (prognosis) of these restorations, as non-ideal preparations can lead to cracks, fractures, secondary caries, or pulpal irritation. In full crowns, shoulder or deep chamfer finish lines enhance fracture resistance, whereas in laminate veneers, preserving the enamel tissue is a critical factor for the durability of the adhesive bond. Partial onlay restorations offer a more conservative and tissue-preserving treatment approach compared to traditional crowns, while endocrowns applied to endodontically treated teeth provide minimally invasive solutions by gaining retention from the pulp chamber. Although every clinical situation has unique requirements, utilizing appropriate burs and establishing rounded internal geometries by considering the structural properties of ceramics extends the lifespan of restorations and maximizes patient satisfaction.
Referanslar
The Glossary of Prosthodontic Terms. J Prosthet Dent. Mayıs 2017;117(5):C1-e105.
Rice RW. Ceramic processing: An overview. AIChE J. Nisan 1990;36(4):481-510.
Fasbinder DJ, Dennison JB, Heys D, Neiva G. A Clinical Evaluation of Chairside Lithium Disilicate CAD/CAM Crowns. J Am Dent Assoc. Haziran 2010;141:10S-14S.
Silva LH da, Lima E de, Miranda RB de P, Favero SS, Lohbauer U, Cesar PF. Dental ceramics: a review of new materials and processing methods. Braz Oral Res [Internet]. 28 Ağustos 2017 [a.yer 22 Ağustos 2022];31(suppl 1). Erişim adresi: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-83242017000500203&lng=en&tlng=en
Yang Y, Yang Z, Zhou J, Chen L, Tan J. Effect of tooth preparation design on marginal adaptation of composite resin CAD-CAM onlays. J Prosthet Dent. Temmuz 2020;124(1):88-93.
Blunck U, Fischer S, Hajtó J, Frei S, Frankenberger R. Ceramic laminate veneers: effect of preparation design and ceramic thickness on fracture resistance and marginal quality in vitro. Clin Oral Investig. Ağustos 2020;24(8):2745-54.
Akbar JH, Omar R, Al-Tarakmah Y. Marginal Integrity of CAD/CAM Ceramic Crowns Using Two Different Finish Line Designs. Med Princ Pract. 2021;30(5):443-7.
James Zhijian Shen YL. Clinical Failures of Ceramic Dental Prostheses. İçinde: Advanced Ceramics for Dentistry. Elsevier Inc; 2013.
Rekow ED, Silva NRFA, Coelho PG, Zhang Y, Guess P, Thompson VP. Performance of Dental Ceramics: Challenges for Improvements. J Dent Res. Ağustos 2011;90(8):937-52.
Rice RW. Monolithic and composite ceramic machining flaw-microstructure-strength effects: model evaluation. J Eur Ceram Soc. Eylül 2002;22(9-10):1411-24.
Pegoraro LF, Jr GCS. Current All-Ceramic Systems in Dentistry: A Review. 2015;36(1):9.
Kelly J, Benetti P. Ceramic materials in dentistry: historical evolution and current practice: Ceramic materials in dentistry. Aust Dent J. Haziran 2011;56:84-96.
Angerame D, De Biasi M, Agostinetto M, Franzò A, Marchesi G. Influence of preparation designs on marginal adaptation and failure load of full‐coverage occlusal veneers after thermomechanical aging simulation. J Esthet Restor Dent. Mayıs 2019;31(3):280-9.
Taha D, Spintzyk S, Schille C, Sabet A, Wahsh M, Salah T, vd. Fracture resistance and failure modes of polymer infiltrated ceramic endocrown restorations with variations in margin design and occlusal thickness. J Prosthodont Res. Temmuz 2018;62(3):293-7.
Vaswani PL. An In-vitro Comparative Stereomicroscopic Analysis and Evaluation of Marginal Accuracy in Porcelain Fused to Metal Copings Fabricated in Two Different Finish Lines Using Variant Die Materials. J Clin Diagn Res [Internet]. 2017 [a.yer 22 Ağustos 2022]; Erişim adresi: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&volume=11&issue=1&page=ZC01&issn=0973-709x&id=9131
Dai N, Zhong Y, Liu H, Yuan F, Sun Y. Digital modeling technology for full dental crown tooth preparation. Comput Biol Med. Nisan 2016;71:190-7.
Wake R, Buck R, DuVall N, Roberts H. Effect of Molar Preparation Axial Height on Retention of Adhesively-luted CAD-CAM Ceramic Crowns. J Adhes Dent. 2019;21(6):545-50.
Beuer F, Edelhoff D, Gernet W, Naumann M. Effect of preparation angles on the precision of zirconia crown copings fabricated by CAD/CAM system. Dent Mater J. 2008;27(6):814-20.
Beuer F, Richter J, Gernet W. Influence of preparation angle on marginal and internal fit of CAD/CAM-fabricated zirconia crown copings. QUINTESSENCE Int. 2008;40(3):8.
Edelhoff D, Özcan M. To what extent does the longevity of fixed dental prostheses depend on the function of the cement? Working Group 4 materials: cementation. Clin Oral Implants Res. Haziran 2007;18:193-204.
Faruqi S, Ganji KK, Bandela V, Nagarajappa AK, Mohamed RN, Ahmed MA, vd. Digital assessment of marginal accuracy in ceramic crowns fabricated with different marginal finish line configurations. J Esthet Restor Dent. Temmuz 2022;34(5):789-95.
Findakly MB, Jasim HH. Influence of preparation design on fracture resistance of different monolithic zirconia crowns: A comparative study. J Adv Prosthodont. 2019;11(6):324.
Renne W, McGill ST, Forshee KV, DeFee MR, Mennito AS. Predicting marginal fit of CAD/CAM crowns based on the presence or absence of common preparation errors. J Prosthet Dent. Kasım 2012;108(5):310-5.
Lockard MW. A retrospective study of pulpal response in vital adult teeth prepared for complete coverage restorations at ultrahigh speed using only air coolant. J Prosthet Dent. Kasım 2002;88(5):473-8.
Evans CD, Wilson PR. The effects of tooth preparation on pressure measured in the pulp chamber: a laboratory study. Int J Prosthodont. Ekim 1999;12(5):439-43.
Podhorsky A, Rehmann P, Wöstmann B. Tooth preparation for full-coverage restorations—a literature review. Clin Oral Investig. Haziran 2015;19(5):959-68.
Ayad MF. Effects of Tooth Preparation Burs and Luting Cement Types on the Marginal Fit of Extracoronal Restorations. J Prosthodont. Şubat 2009;18(2):145-51.
Magne P, Magne M. Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers. Eur J Esthet Dent Off J Eur Acad Esthet Dent. Nisan 2006;1(1):10-9.
Çötert HS, Dündar M, Öztürk B. Quin Copyrig ftoerssPeubnlciceation. J Adhes Dent. 2009;11(5):8.
Alothman Y, Bamasoud MS. The Success of Dental Veneers According To Preparation Design and Material Type. Open Access Maced J Med Sci. 14 Aralık 2018;6(12):2402-8.
Arora A, Upadhyaya V, Arora S, Jain P, Yadav A. Evaluation of fracture resistance of ceramic veneers with different preparation designs and loading conditions: An in vitro study. J Indian Prosthodont Soc. 2017;17(4):325.
Ferraris F, Founder A, Sammarco E, Master A, Cincera S, Tutor A, vd. Comparison of posterior indirect adhesive restorations (PIAR) with different preparation designs according to the adhesthetics classification. Part 1: Effects on the fracture resistance. Clin Res. :24.
Xiao W, Chen C, Yang T, Zhu Z. Influence of Different Marginal Forms on Endodontically Treated Posterior Teeth Restored with Lithium Disilicate Glass-Ceramic Onlays: Two-Year Follow-up. Int J Prosthodont. Ocak 2020;33(1):22-8.
Lin CL, Chang YH, Pai CA. Evaluation of failure risks in ceramic restorations for endodontically treated premolar with MOD preparation. Dent Mater Off Publ Acad Dent Mater. Mayıs 2011;27(5):431-8.
Zarone F, Sorrentino R, Apicella D, Valentino B, Ferrari M, Aversa R, vd. Evaluation of the biomechanical behavior of maxillary central incisors restored by means of endocrowns compared to a natural tooth: a 3D static linear finite elements analysis. Dent Mater Off Publ Acad Dent Mater. Kasım 2006;22(11):1035-44.
Zheng Z, Sun J, Jiang L, Wu Y, He J, Ruan W, vd. Influence of margin design and restorative material on the stress distribution of endocrowns: a 3D finite element analysis. BMC Oral Health. Aralık 2022;22(1):30.
