Nikel Titanyum Döner Eğelerde Kırılmaya Etki Eden Faktörler
Özet
Endodontik tedavide yaygın olarak kullanılan nikel titanyum (NiTi) döner eğeler, paslanmaz çelik eğelere kıyasla daha hızlı ve etkin kök kanal şekillendirmesi yapabilmelerine ve iatrojenik hata riskini azaltmalarına rağmen, kullanım sırasındaki kırılma riskleri nedeniyle önemli bir dezavantaja sahiptir. Bu kırılmalar; operatörün el becerisi ve tecrübesi, anatomi, eğe tasarımı ile teknik ve kullanım faktörleri gibi çok boyutlu etkenlere bağlıdır. Operatörün in vitro eğitimi ve dokunsal geri bildirim azlığı nedeniyle klinik deneyimi hayati önem taşırken, yetersiz giriş kaviteleri ve kavisli kök kanalları eğeler üzerindeki stresi artırarak döngüsel yorgunluk kırıklarına yol açmaktadır. Eğelerin üretim süreçlerindeki yüzey kusurları, enine kesit alanları ve metalurjik kaliteleri kırılma direncini doğrudan etkiler; ayrıca motorun tork kontrolü, dönüş hızı ve crown-down gibi enstrümantasyon teknikleri de bu süreçte belirleyicidir. Eğelerin kullanım sayısı arttıkça yorgunluk direnci azalmakta ve her kullanım öncesi büyütme altında kontrol edilmeleri gerekmektedir; korozyon riski oluşturan sodyum hipoklorit gibi yıkama solüsyonlarının etkisi tartışmalı olsa da kuru kanallarda enstrümantasyondan kaçınılmalı ve sıvı lubrikasyon tercih edilmelidir.
Nickel-titanium (NiTi) rotary files, widely used in endodontic treatment, offer faster and more efficient root canal shaping and reduce the risk of iatrogenic errors compared to stainless steel files, yet they possess a major disadvantage due to their risk of fracture during use. These fractures depend on multidimensional factors such as the operator's manual skill and experience, anatomy, file design, and technical and usage factors. While the operator's in vitro training and clinical experience are vital due to the lack of tactile feedback, inadequate access cavities and curved root canals increase the stress on files, leading to cyclic fatigue fractures. Surface defects from manufacturing processes, cross-sectional areas, and metallurgical quality directly affect fracture resistance; furthermore, torque control of the motor, rotational speed, and instrumentation techniques like crown-down are also decisive in this process. As the number of file uses increases, fatigue resistance decreases, requiring careful inspection under magnification before each use; although the effect of irrigating solutions like sodium hypochlorite, which pose a risk of corrosion, remains controversial, instrumentation in dry canals must be avoided and liquid lubrication should be preferred.
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