Diş Çürüğünün Doku Koruyucu Yönetimi: Minimal İnvaziv Diş Hekimliği Perspektifi
Özet
Bu bölümde diş çürüğünün doku koruyucu yönetimi, minimal invaziv diş hekimliği yaklaşımı doğrultusunda ele alınmaktadır. Güncel çürük yönetimi, hastalığın yalnızca restoratif işlemlerle tedavi edilmesi yerine; erken tanı, çürük risk değerlendirmesi, koruyucu uygulamalar ve düzenli izlem basamaklarını içeren biyolojik temelli bir yaklaşım olarak değerlendirilmektedir. Demineralizasyon remineralizasyon dengesi, çürük oluşumunda rol oynayan risk faktörleri ve erken tanı yöntemleri modern çürük kontrolünün temelini oluşturmaktadır. Minimal invaziv diş hekimliği, restoratif müdahaleyi son seçenek olarak kabul eden ve sağlam diş dokusunun mümkün olan en yüksek düzeyde korunmasını amaçlayan bir klinik yönetim modelidir. Bu yaklaşımda hastalığın kontrol altına alınması, bireysel risk profilinin belirlenmesi ve uzun dönem izlem temel basamaklar olarak kabul edilmektedir.
This chapter presents the tissue-preserving management of dental caries from the perspective of minimal intervention dentistry. Contemporary caries management is based on a biologically oriented approach that emphasizes early diagnosis, caries risk assessment, preventive strategies, and regular follow-up rather than purely restorative treatment. The balance between demineralization and remineralization, factors influencing caries development, and modern diagnostic methods are described as key components of current caries control. Minimal intervention dentistry is defined as a clinical management model in which restorative procedures are considered the last step, and preservation of sound tooth structure is the primary objective. Determination of individual risk profile, control of disease activity, and long-term monitoring are essential elements of this approach.
Referanslar
Reis A, Feitosa VP, Chibinski AC, Favoreto MW, Gutierrez MF, Loguercio AD. Biomimetic Restorative Dentistry: an evidence-based discussion of common myths. J Appl Oral Sci. 2024;32:e20240271.
Zafar MS, Amin F, Fareed MA, Ghabbani H, Riaz S, Khurshid Z, Kumar N. Biomimetic Aspects of Restorative Dentistry Biomaterials. Biomimetics (Basel). 2020;5(3):34.
Tzimas K, Pappa E, Fostiropoulou M, Papazoglou E, Rahiotis C. Highly Filled Flowable Composite Resins as Sole Restorative Materials: A Systematic Review. Materials. 2025;18(14):3370.
Kanar O, Meseli S, Korkut B, Koken S, Tagtekin D, Yanikoglu F. Assessment of a highly-filled flowable composite for the repair of indirect composites. J Oral Sci. 2024;66(1):42-9.
Kitasako Y, Sadr A, Burrow MF, Tagami J. Thirty-six month clinical evaluation of a highly filled flowable composite for direct posterior restorations. Aust Dent J. 2016;61(3):366-73.
Gestakovski D. The injectable composite resin technique: minimally invasive reconstruction of esthetics and function. Clinical case report with 2-year follow-up. Quintessence Int. 2019;50(9):712-9.
Cortes-Breton Brinkmann J, Albanchez-Gonzalez MI, Lobato Pena DM, Garcia Gil I, Suarez Garcia MJ, Pelaez Rico J. Improvement of aesthetics in a patient with tetracycline stains using the injectable composite resin technique: case report with 24-month follow-up. Br Dent J. 2020;229(12):774-8.
Badr C, Spagnuolo G, Amenta F, Khairallah C, Mahdi SS, Daher E, et al. A Two-Year Comparative Evaluation of Clinical Performance of a Nanohybrid Composite Resin to a Flowable Composite Resin. J Funct Biomater. 2021;12(3):51.
Zhang YR, Du W, Zhou XD, Yu HY. Review of research on the mechanical properties of the human tooth. Int J Oral Sci. 2014;6(2):61-9.
Imbeni V, Kruzic JJ, Marshall GW, Marshall SJ, Ritchie RO. The dentin-enamel junction and the fracture of human teeth. Nat Mater. 2005;4(3):229-32.
Mohammadi R, Alkurt Kaplan S, Harmankaya A, Gonder HY. Investigation of Stress Distribution and Fatigue Performance in Restored Teeth Using Different Thicknesses of Adhesive Materials and Different Restorative Materials: 3D Finite Element Analysis (FEM). Materials (Basel). 2025;18(16):3888.
Tsujimoto A, Barkmeier WW, Takamizawa T, Latta MA, Miyazaki M. Bonding performance and interfacial characteristics of short fiber-reinforced resin composite in comparison with other composite restoratives. Eur J Oral Sci. 2016;124(3):301-8.
Oz FD, Meral E, Gurgan S. Does a Self-adhesive Flowable Resin Composite Perform Similarly to Highly Filled and Conventional Flowable Resin Composites in Occlusal Cavities? A 2-year Follow-up Study. Journal of Adhesive Dentistry. 2021;23(6).
Perdigão J. Current perspectives on dental adhesion:(1) Dentin adhesion–not there yet. Japanese Dental Science Review. 2020;56(1):190-207.
Baroudi K, Rodrigues JC. Flowable Resin Composites: A Systematic Review and Clinical Considerations. J Clin Diagn Res. 2015;9(6):ZE18-24.
ZHANG H, CHOE H-S, LIN H, ZHENG G, HONG G. Abrasive wear and surface roughness of contemporary dental composite resin. Dental materials journal. 2014;33(6):725-32.
Francois P, Attal JP, Fasham T, Troizier-Cheyne M, Gouze H, Abdel-Gawad S, et al. Flexural Properties, Wear Resistance, and Microstructural Analysis of Highly Filled Flowable Resin Composites. Oper Dent. 2024;49(5):597-607.
Baldi A, Rossi T, Comba A, Vergano EA, Montrella R, Pampaloni B, et al. The ability of highly-filled flowable composites in preventing marginal gap in class V restorations: an optical coherence tomography study. BMC Oral Health. 2025;25(1):619.
Checchi V, Generali L, Corciolani L, Breschi L, Mazzitelli C, Maravic T. Wear and roughness analysis of two highly filled flowable composites. Odontology. 2025;113(2):724-33.
Korkut B, Haciali C. Color Stability of Flowable Composites in Different Viscosities. Clinical and Experimental Health Sciences. 2020;10(4):454-61.
Mirica IC, Furtos G, Baldea B, Lucaciu O, Ilea A, Moldovan M, Campian RS. Influence of Filler Loading on the Mechanical Properties of Flowable Resin Composites. Materials (Basel). 2020;13(6):1477.
Lopez C, Nizami B, Robles A, Gummadi S, Lawson NC. Correlation between Dental Composite Filler Percentage and Strength, Modulus, Shrinkage Stress, Translucency, Depth of Cure and Radiopacity. Materials. 2024;17(16):3901.
Zhang H, Wang L, Hua L, Guan R, Hou B. Randomized controlled clinical trial of a highly filled flowable composite in non-carious cervical lesions: 3-year results. Clin Oral Investig. 2021;25(10):5955-65.
Szesz A, Parreiras S, Martini E, Reis A, Loguercio A. Effect of flowable composites on the clinical performance of non-carious cervical lesions: A systematic review and meta-analysis. J Dent. 2017;65:11-21.
Cieplik F, Scholz KJ, Tabenski I, May S, Hiller KA, Schmalz G, et al. Flowable composites for restoration of non-carious cervical lesions: Results after five years. Dent Mater. 2017;33(12):e428-e37.
Ilie N, Hickel R. Investigations on mechanical behaviour of dental composites. Clin Oral Investig. 2009;13(4):427-38.
Torres CRG, Rego HMC, Perote LCCC, Santos LFTF, Kamozaki MBB, Gutierrez NC, et al. A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations. Journal of Dentistry. 2014;42(7):793-9.
Baldi A, Scattina A, Ferrero G, Comba A, Alovisi M, Pasqualini D, et al. Highly-filled flowable composite in deep margin elevation: FEA study obtained from a microCT real model. Dental Materials. 2022;38(4):e94-e107.
Attar N, Tam LE, McComb D. Flow, strength, stiffness and radiopacity of flowable resin composites. J Can Dent Assoc. 2003;69(8):516-21.
Turk S, Erden Kayalidere E, Celik EU, Yasa B. In vitro wear resistance of conventional and flowable composites containing various filler types after thermomechanical loading. Journal of Esthetic and Restorative Dentistry. 2024;36(4):643-51.
Cavalheiro CP, Scherer H, Imparato JCP, Collares FM, Lenzi TL. Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis. Clinical Oral Investigations. 2021;25(10):5629-39.
Hosaka K, Tichy A, Motoyama Y, Mizutani K, Lai WJ, Kanno Z, et al. Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow. J Esthet Restor Dent. 2020;32(7):638-44.
Basheer RR, Hasanain FA, Abuelenain DA. Evaluating flexure properties, hardness, roughness and microleakage of high-strength injectable dental composite: an in vitro study. BMC Oral Health. 2024;24(1):546.
Bazos P, Magne P. Bio-emulation: biomimetically emulating nature utilizing a histo-anatomic approach; structural analysis. Eur J Esthet Dent. 2011;6(1):8-19.
Hulac S, Kois JC. Managing the transition to a complex full mouth rehabilitation utilizing injectable composite. J Esthet Restor Dent. 2023;35(5):796-802.
Liaropoulou YM, Jimenez AK, Chierico F, Blatz MB. The Multilayer Flowable Injection Technique for Highly Esthetic Restorations. J Esthet Restor Dent. 2025;37(10):2161-70.
Rajabi H, Denny M, Karagiannopoulos K, Petridis H. Comparison of Flexural Strength and Wear of Injectable, Flowable and Paste Composite Resins. Materials (Basel). 2024;17(19):4749.
Lawson NC, Radhakrishnan R, Givan DA, Ramp LC, Burgess JO. Two-year Randomized, Controlled Clinical Trial of a Flowable and Conventional Composite in Class I Restorations. Oper Dent. 2015;40(6):594-602.
Anatavara S, Sitthiseripratip K, Senawongse P. Stress relieving behaviour of flowable composite liners: A finite element analysis. Dent Mater J. 2016;35(3):369-78.
Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998;10(1):47-54; quiz 6.
Roggendorf MJ, Kramer N, Appelt A, Naumann M, Frankenberger R. Marginal quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent. 2011;39(10):643-7.
Çalışkan MA, Değirmenci A, Boyacıoğlu H, Turkun S. Yüksek Dolduruculu Akışkan Kompozit Rezinlerin Çarklı Cila Sistemleri ile Parlatıldıktan Sonraki Yüzey Özellikleri ve Renk Değişimleri. Selcuk Dental Journal. 2024;11(2):162-8.
Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G. Physico-mechanical characteristics of commercially available bulk-fill composites. J Dent. 2014;42(8):993-1000.
Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR technology. Dent Mater. 2011;27(4):348-55.
Van Ende A, De Munck J, Lise DP, Van Meerbeek B. Bulk-Fill Composites: A Review of the Current Literature. J Adhes Dent. 2017;19(2):95-109.
Paravina RD, Ghinea R, Herrera LJ, Bona AD, Igiel C, Linninger M, et al. Color difference thresholds in dentistry. J Esthet Restor Dent. 2015;27 Suppl 1:S1-9.
Referanslar
Reis A, Feitosa VP, Chibinski AC, Favoreto MW, Gutierrez MF, Loguercio AD. Biomimetic Restorative Dentistry: an evidence-based discussion of common myths. J Appl Oral Sci. 2024;32:e20240271.
Zafar MS, Amin F, Fareed MA, Ghabbani H, Riaz S, Khurshid Z, Kumar N. Biomimetic Aspects of Restorative Dentistry Biomaterials. Biomimetics (Basel). 2020;5(3):34.
Tzimas K, Pappa E, Fostiropoulou M, Papazoglou E, Rahiotis C. Highly Filled Flowable Composite Resins as Sole Restorative Materials: A Systematic Review. Materials. 2025;18(14):3370.
Kanar O, Meseli S, Korkut B, Koken S, Tagtekin D, Yanikoglu F. Assessment of a highly-filled flowable composite for the repair of indirect composites. J Oral Sci. 2024;66(1):42-9.
Kitasako Y, Sadr A, Burrow MF, Tagami J. Thirty-six month clinical evaluation of a highly filled flowable composite for direct posterior restorations. Aust Dent J. 2016;61(3):366-73.
Gestakovski D. The injectable composite resin technique: minimally invasive reconstruction of esthetics and function. Clinical case report with 2-year follow-up. Quintessence Int. 2019;50(9):712-9.
Cortes-Breton Brinkmann J, Albanchez-Gonzalez MI, Lobato Pena DM, Garcia Gil I, Suarez Garcia MJ, Pelaez Rico J. Improvement of aesthetics in a patient with tetracycline stains using the injectable composite resin technique: case report with 24-month follow-up. Br Dent J. 2020;229(12):774-8.
Badr C, Spagnuolo G, Amenta F, Khairallah C, Mahdi SS, Daher E, et al. A Two-Year Comparative Evaluation of Clinical Performance of a Nanohybrid Composite Resin to a Flowable Composite Resin. J Funct Biomater. 2021;12(3):51.
Zhang YR, Du W, Zhou XD, Yu HY. Review of research on the mechanical properties of the human tooth. Int J Oral Sci. 2014;6(2):61-9.
Imbeni V, Kruzic JJ, Marshall GW, Marshall SJ, Ritchie RO. The dentin-enamel junction and the fracture of human teeth. Nat Mater. 2005;4(3):229-32.
Mohammadi R, Alkurt Kaplan S, Harmankaya A, Gonder HY. Investigation of Stress Distribution and Fatigue Performance in Restored Teeth Using Different Thicknesses of Adhesive Materials and Different Restorative Materials: 3D Finite Element Analysis (FEM). Materials (Basel). 2025;18(16):3888.
Tsujimoto A, Barkmeier WW, Takamizawa T, Latta MA, Miyazaki M. Bonding performance and interfacial characteristics of short fiber-reinforced resin composite in comparison with other composite restoratives. Eur J Oral Sci. 2016;124(3):301-8.
Oz FD, Meral E, Gurgan S. Does a Self-adhesive Flowable Resin Composite Perform Similarly to Highly Filled and Conventional Flowable Resin Composites in Occlusal Cavities? A 2-year Follow-up Study. Journal of Adhesive Dentistry. 2021;23(6).
Perdigão J. Current perspectives on dental adhesion:(1) Dentin adhesion–not there yet. Japanese Dental Science Review. 2020;56(1):190-207.
Baroudi K, Rodrigues JC. Flowable Resin Composites: A Systematic Review and Clinical Considerations. J Clin Diagn Res. 2015;9(6):ZE18-24.
ZHANG H, CHOE H-S, LIN H, ZHENG G, HONG G. Abrasive wear and surface roughness of contemporary dental composite resin. Dental materials journal. 2014;33(6):725-32.
Francois P, Attal JP, Fasham T, Troizier-Cheyne M, Gouze H, Abdel-Gawad S, et al. Flexural Properties, Wear Resistance, and Microstructural Analysis of Highly Filled Flowable Resin Composites. Oper Dent. 2024;49(5):597-607.
Baldi A, Rossi T, Comba A, Vergano EA, Montrella R, Pampaloni B, et al. The ability of highly-filled flowable composites in preventing marginal gap in class V restorations: an optical coherence tomography study. BMC Oral Health. 2025;25(1):619.
Checchi V, Generali L, Corciolani L, Breschi L, Mazzitelli C, Maravic T. Wear and roughness analysis of two highly filled flowable composites. Odontology. 2025;113(2):724-33.
Korkut B, Haciali C. Color Stability of Flowable Composites in Different Viscosities. Clinical and Experimental Health Sciences. 2020;10(4):454-61.
Mirica IC, Furtos G, Baldea B, Lucaciu O, Ilea A, Moldovan M, Campian RS. Influence of Filler Loading on the Mechanical Properties of Flowable Resin Composites. Materials (Basel). 2020;13(6):1477.
Lopez C, Nizami B, Robles A, Gummadi S, Lawson NC. Correlation between Dental Composite Filler Percentage and Strength, Modulus, Shrinkage Stress, Translucency, Depth of Cure and Radiopacity. Materials. 2024;17(16):3901.
Zhang H, Wang L, Hua L, Guan R, Hou B. Randomized controlled clinical trial of a highly filled flowable composite in non-carious cervical lesions: 3-year results. Clin Oral Investig. 2021;25(10):5955-65.
Szesz A, Parreiras S, Martini E, Reis A, Loguercio A. Effect of flowable composites on the clinical performance of non-carious cervical lesions: A systematic review and meta-analysis. J Dent. 2017;65:11-21.
Cieplik F, Scholz KJ, Tabenski I, May S, Hiller KA, Schmalz G, et al. Flowable composites for restoration of non-carious cervical lesions: Results after five years. Dent Mater. 2017;33(12):e428-e37.
Ilie N, Hickel R. Investigations on mechanical behaviour of dental composites. Clin Oral Investig. 2009;13(4):427-38.
Torres CRG, Rego HMC, Perote LCCC, Santos LFTF, Kamozaki MBB, Gutierrez NC, et al. A split-mouth randomized clinical trial of conventional and heavy flowable composites in class II restorations. Journal of Dentistry. 2014;42(7):793-9.
Baldi A, Scattina A, Ferrero G, Comba A, Alovisi M, Pasqualini D, et al. Highly-filled flowable composite in deep margin elevation: FEA study obtained from a microCT real model. Dental Materials. 2022;38(4):e94-e107.
Attar N, Tam LE, McComb D. Flow, strength, stiffness and radiopacity of flowable resin composites. J Can Dent Assoc. 2003;69(8):516-21.
Turk S, Erden Kayalidere E, Celik EU, Yasa B. In vitro wear resistance of conventional and flowable composites containing various filler types after thermomechanical loading. Journal of Esthetic and Restorative Dentistry. 2024;36(4):643-51.
Cavalheiro CP, Scherer H, Imparato JCP, Collares FM, Lenzi TL. Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis. Clinical Oral Investigations. 2021;25(10):5629-39.
Hosaka K, Tichy A, Motoyama Y, Mizutani K, Lai WJ, Kanno Z, et al. Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow. J Esthet Restor Dent. 2020;32(7):638-44.
Basheer RR, Hasanain FA, Abuelenain DA. Evaluating flexure properties, hardness, roughness and microleakage of high-strength injectable dental composite: an in vitro study. BMC Oral Health. 2024;24(1):546.
Bazos P, Magne P. Bio-emulation: biomimetically emulating nature utilizing a histo-anatomic approach; structural analysis. Eur J Esthet Dent. 2011;6(1):8-19.
Hulac S, Kois JC. Managing the transition to a complex full mouth rehabilitation utilizing injectable composite. J Esthet Restor Dent. 2023;35(5):796-802.
Liaropoulou YM, Jimenez AK, Chierico F, Blatz MB. The Multilayer Flowable Injection Technique for Highly Esthetic Restorations. J Esthet Restor Dent. 2025;37(10):2161-70.
Rajabi H, Denny M, Karagiannopoulos K, Petridis H. Comparison of Flexural Strength and Wear of Injectable, Flowable and Paste Composite Resins. Materials (Basel). 2024;17(19):4749.
Lawson NC, Radhakrishnan R, Givan DA, Ramp LC, Burgess JO. Two-year Randomized, Controlled Clinical Trial of a Flowable and Conventional Composite in Class I Restorations. Oper Dent. 2015;40(6):594-602.
Anatavara S, Sitthiseripratip K, Senawongse P. Stress relieving behaviour of flowable composite liners: A finite element analysis. Dent Mater J. 2016;35(3):369-78.
Dietschi D, Spreafico R. Current clinical concepts for adhesive cementation of tooth-colored posterior restorations. Pract Periodontics Aesthet Dent. 1998;10(1):47-54; quiz 6.
Roggendorf MJ, Kramer N, Appelt A, Naumann M, Frankenberger R. Marginal quality of flowable 4-mm base vs. conventionally layered resin composite. J Dent. 2011;39(10):643-7.
Çalışkan MA, Değirmenci A, Boyacıoğlu H, Turkun S. Yüksek Dolduruculu Akışkan Kompozit Rezinlerin Çarklı Cila Sistemleri ile Parlatıldıktan Sonraki Yüzey Özellikleri ve Renk Değişimleri. Selcuk Dental Journal. 2024;11(2):162-8.
Leprince JG, Palin WM, Vanacker J, Sabbagh J, Devaux J, Leloup G. Physico-mechanical characteristics of commercially available bulk-fill composites. J Dent. 2014;42(8):993-1000.
Ilie N, Hickel R. Investigations on a methacrylate-based flowable composite based on the SDR technology. Dent Mater. 2011;27(4):348-55.
Van Ende A, De Munck J, Lise DP, Van Meerbeek B. Bulk-Fill Composites: A Review of the Current Literature. J Adhes Dent. 2017;19(2):95-109.
Paravina RD, Ghinea R, Herrera LJ, Bona AD, Igiel C, Linninger M, et al. Color difference thresholds in dentistry. J Esthet Restor Dent. 2015;27 Suppl 1:S1-9.
