Restoratif Diş Hekimliğinde Endokronlar
Özet
Endodontik tedavili posterior dişlerin restorasyonunda kullanılan adeziv endokronlar, geleneksel kanal içi post uygulamalarına güçlü bir alternatif oluşturmaktadır. İlk olarak 1995 yılında tanımlanan bu yöntem, kron ve korun tek bir parça halinde üretilmesiyle adeziv simantasyon prensibine dayanır ve pulpa odası duvarlarından makro-mekanik, adeziv simanlardan ise mikro-mekanik tutunma sağlar. Molar dişlerde geniş adeziv bağlantı alanı bulunması ve horizontal kuvvetlerin azlığı sebebiyle daha sık tercih edilen endokronlar, tek bir adeziv arayüze sahip olduklarından post-kor restorasyonlara kıyasla daha düşük başarısızlık riski ve daha yüksek kırılma direnci sunarlar. Aşırı madde kaybı, sınırlı interdental mesafe veya kavisli/kalsifiye kanallar gibi post uygulanamayan durumlarda endike olan bu restorasyonlar, preperasyon sonrası kalan doku miktarına göre üç sınıfa ayrılmaktadır. Laboratuvar çalışmaları, rezin nanoseramik ve kompozit rezin bloklardan CAD/CAM ile üretilen endokronların, dentine benzer elastisite modülleri sayesinde oklüzal kuvvetleri daha homojen dağıttığını, böylece lityum disilikat veya feldspatik porselenlere göre daha yüksek kırılma direnci ve daha düşük yıkıcı başarısızlık oranları sergilediğini göstermektedir. Uzun dönemli klinik kanıtlar henüz yetersiz olsa da endokronlar, posterior dişler için kabul edilebilir sağkalıma sahip, konservatif, estetik ve maliyet etkin bir seçenek olarak öne çıkmaktadır.
Adhesive endocrowns used in the restoration of endodontically treated posterior teeth constitute a strong alternative to traditional intra-canal post applications. First defined in 1995, this method is based on the principle of adhesive cementation, where the crown and core are produced as a single piece, providing macro-mechanical retention from the pulp chamber walls and micro-mechanical retention from adhesive cements. More frequently preferred in molar teeth due to the presence of a wide adhesive bonding area and low horizontal forces, endocrowns offer a lower risk of failure and higher fracture resistance compared to post-core restorations since they possess a single adhesive interface. Indicated in cases where post application is impossible, such as excessive substance loss, limited interdental space, or curved/calcified canals, these restorations are classified into three categories based on the amount of remaining tissue after preparation. Laboratory studies demonstrate that CAD/CAM endocrowns produced from resin nanoceramic and composite resin blocks distribute occlusal forces more homogeneously due to their dentin-like modulus of elasticity, thereby exhibiting higher fracture resistance and lower catastrophic failure rates compared to lithium disilicate or feldspathic porcelains. Although long-term clinical evidence is still lacking, endocrowns stand out as a promising, conservative, aesthetic, and cost-effective option with acceptable survival rates for posterior teeth.
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