Çürüksüz Servikal Lezyonların Tedavisi: Ne Zaman, Niçin, Nasıl?
Özet
Çürüksüz servikal lezyonlar (ÇSL), mine-sement sınırında bakteriyolojik neden olmaksızın oluşan sert doku kayıplarıdır ve prevelansı %5 ile %85 arasında değişerek yaşla birlikte artış göstermektedir. Bu lezyonlar morfolojilerine göre sığ oluklardan keskin kama şekillerine kadar değişebilir ve premolar dişlerde daha sık gözlenirler. Etiyolojisinde erozyon (kimyasal korozyon), abrazyon (hatalı fırçalama gibi mekanik sürtünmeler) ve abfraksiyon (okluzal stresler) faktörlerinin tek başına veya kombine etkileri rol oynamaktadır. Tedavi yaklaşımları koruyucu yöntemleri, etiyolojik faktörlerin elimine edilmesini, düzenli takibi ve non-invaziv desensitizan ajanlarla veya adeziv rezinlerle dentin hassasiyetinin giderilmesini kapsar. İleri derece sert doku kaybı, estetik beklentiler, pulpa yakınlığı veya subgingival marjin varlığında ise kompozit rezinler, cam iyonomerler veya universal adeziv sistemler kullanılarak restoratif tedavi uygulanır; gerekli durumlarda bu süreç kök yüzeyinin cerrahi olarak örtülenmesi gibi periodontal tedavilerle de desteklenir. Başarılı sonuçlar için rubber-dam veya retraksiyon ipliği ile doğru izolasyon, mine bizotajı, sklerotik dentinin pürüzlendirilmesi, tabakalı kompozit uygulaması ile minimum bitim-polisaj işlemleri ve yıllık klinik takipler kritik önem taşımaktadır.
Non-carious cervical lesions (NCCLs) are hard tissue losses occurring at the cementoenamel junction without bacteriological causes, with a prevalence ranging from 5% to 85% that increases with age. These lesions vary morphologically from shallow grooves to sharp wedge shapes and are more frequently observed in premolar teeth. Their etiology involves the individual or combined effects of erosion (chemical corrosion), abrasion (mechanical friction such as faulty brushing), and abfraction (occlusal stresses). Treatment approaches encompass preventive methods, elimination of etiological factors, regular follow-ups, and managing dentin hypersensitivity using non-invasive desensitizing agents or adhesive resins. In cases of severe hard tissue loss, aesthetic expectations, pulp proximity, or subgingival margins, restorative treatment is performed using composite resins, glass ionomers, or universal adhesive systems; when necessary, this process is supported by periodontal treatments such as surgical root coverage. For successful outcomes, proper isolation using rubber-dam or retraction cords, enamel beveling, roughening of sclerotic dentin, layered composite application with minimal finishing-polishing procedures, and annual clinical follow-ups are of critical importance.
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