Diş Hekimliğinde CAD/CAM Tekniğinde Kullanılan Seramik Esaslı Restoratif Materyaller
Özet
Diş hekimliğinde bilgisayar destekli tasarım ve üretim (CAD/CAM) teknolojisinde kullanılan seramik esaslı restoratif materyaller; silikat seramikler, rezin matriks içeren seramikler ve oksit seramikler olarak üç ana grupta sınıflandırılmaktadır. Restoratif tedavilerde en uygun materyali seçmek ve tedavi sonuçlarını öngörebilmek için bu materyallerin estetik, bağlanma ve mekanik özelliklerinin bilinmesi kritik önem taşır. Silikat seramikler (feldspatik, lösitle güçlendirilmiş, lityum disilikat), içerdikleri camsı matriks sayesinde doğal diş minesine benzer yüksek yarı saydamlık sunarak özellikle estetik ön bölge restorasyonlarında tercih edilirler. Rezin matriks içeren yeni nesil seramikler (rezin bazlı ve hibrit seramikler) ise yüksek yorulma direnci, esneklik ve çiğneme kuvvetlerine karşı dayanıklılık sağlarken kristalizasyon gerektirmeden zaman tasarrufu sunar ve karşıt dişte daha az aşınmaya yol açarlar. Mekanik özellikleri çok güçlü olan oksit seramikler (alüminyum oksit ve zirkonyum oksit) ise düşük yarı saydamlıkları nedeniyle estetik açıdan zayıf olsalar da 900 MPa'a kadar ulaşan yüksek eğme dayanımları sayesinde posterior bölgedeki köprüler gibi ağır yük taşıyan alanlarda geleneksel simanlarla başarıyla uygulanabilmektedir.
Ceramic-based restorative materials used in computer-aided design and manufacturing (CAD/CAM) technology in dentistry are classified into three main groups: silicate ceramics, resin matrix-containing ceramics, and oxide ceramics. In restorative treatments, knowing the aesthetic, bonding, and mechanical properties of these materials is of critical importance for selecting the most appropriate material and predicting treatment outcomes. Silicate ceramics (feldspathic, leucite-reinforced, lithium disilicate) offer high translucency similar to natural tooth enamel due to the glass matrix they contain, and are preferred especially in aesthetic anterior restorations. The new generation of ceramics containing resin matrix (resin-based and hybrid ceramics) provide high fatigue resistance, elasticity, and resistance to masticatory forces, while offering time savings without requiring crystallization and causing less wear on the opposing tooth. Oxide ceramics (aluminum oxide and zirconium oxide), which have very strong mechanical properties, are aesthetically weak due to their low translucency, but owing to their high flexural strength reaching up to 900 MPa, they can be successfully applied with conventional cements in heavy load-bearing areas such as bridges in the posterior region.
Referanslar
Blatz, MB., Sadan, A., Kern, M (2003). Resin-ceramic bonding—a review of the literature. J Prosthet Dent. 89(3), 268-274
Blatz, MB. & Conejo J. (2019) The Current State of Chairside Digital Dentistry and Materials. Dent Clin North Am. 63(2), 175-197.
Conejo, J. Nueesch, R. Vonderheide, M.; Blatz, MB. (2017) Clinical Performance of All-Ceramic Dental Restorations. Curr. Oral Heal. Reports. 4, 112–123.
Davidowitz, G. & Kotick, PG. (2011) The use of CAD/CAM in dentistry. Dent Clin North Am., 55(3), 559-570.
Guazzato, M., Albakry, M., Ringer, SP., Swain, MV. (2004) Strength, fracture toughness and microstructure of a selection of all-ceramic materials. Part I. Pressable and alumina glass-infiltrated ceramics. Dent Mater. 20(5), 441-8.
Lassila, L., Keulemans, F., Seailynoja, E., Vallittu, P.K., Garoushi, S. (2018). Mechanical properties and fracture behavior of flowable fiber reinforced composite restorations. Dent. Mater. 34, 598–606.
May, MM., Fraga, S. & May LG. (2021) Effect of milling, fitting adjustments, and hydrofluoric acid etching on the strength and roughness of CAD-CAM glass-ceramics: A systematic review and meta-analysis. J Porsthet Dent. S0022-3913(21)00134-7.
Mayinger, F., Lümkemann, N., Musik, M., Eichberger, M., Stawarczyk, B. (2020) Comparison of mechanical properties of different reinforced glass-ceramics. J. Prosthet. Dent. 1–8.
Matzinger, M, Hahnel, S, Preis, V, Rosentritt, M. (2019) Polishing effects and wear performance of chairside CAD/CAM materials. Clin Oral Investig. 23(2),725-737.
Naves, LZ., Soares, CJ., Moraes, RR., Gonçalves, LS., Sinhoreti, MAC., Correr-Sobrinho, L. (2010) Surface/interface morphology and bond strength to glass ceramic etched for different periods. Oper Dent. 35(4), 420-7.
Pieger, S., Salman, A., Bidra, AS. (2014) Clinical outcomes of lithium disilicate single crowns and partial fixed dental prostheses: a systematic review. J Prosthet Dent. 112(1),22-30.
Raigrodski, A.J. (2003) Clinical and laboratory considerations for the use of CAD/CAM Y-TZP-based restorations. Pract. Proced. Aesthet. Dent. 15, 469–476.
Reich, S. & H. Hornberger. (2002) The effect of multicolored machinable ceramics on the esthetics of all-ceramic crowns. J Prosthet Dent. 88(1): 44-9.
Reich, S. (2015) Tooth-colored CAD/CAM monolithic restorations. Int J Comput Dent. 18(2), 131-46.
Reiss B. (2006) Clinical results of cerec inlays in a dental practice over a period of 18 years. Int J Comput Dent. 9(1), 11-22
Rogula, J., Kuzniar-Folwarczny, A., Sulewski, M., Błaszczyk, A. (2020) Charakterystyka kompozytowych materiałów stomatologicznych stosowanych w gabinetowych systemach CAD/CAM. Inzynier i Fizyk Medyczny. 9, 57–61.
Skorulska, A., Piszko, P., Rybak, Z., Szymonowicz, M., Dobrzyński, M. (2021) Review on Polymer, Ceramic and Composite Materials for CAD/CAM Indirect Restorations in Dentistry—Application, Mechanical Characteristics and Comparison. Materials (Basel). 14(7), 1592.
Spitznagel, FA., Boldt, J. & Gierthmuehlen, PC. (2018) CAD/CAM Ceramic Restorative Materials for Natural Teeth. J Dent Res. 97(10), 1082-1091.
Sulaiman, TA. (2020) Materials in digital dentistry-a review. J Esthet Restor Dent. 32(2), 171-181.
Sulaiman, TA., Delgado, AJ., Donovan, TE. (2015) Survival rate of lithium disilicate restorations at 4 years: a retrospective study. J Prosthet Dent. 114(3),364-366
Tysowsky, G.W. (2009) The science behind lithium disilicate: a metal-free alternative. Dent Today. 28(3), 112-3.
