Restoratif Diş Hekimliğinde İndirekt Adeziv Restorasyonlarda Erken Dentin Örtülenmesi (Immediate Dentin Sealing)
Özet
Erken Dentin Örtülenmesi (IDS), indirekt adeziv restorasyonların kavite preparasyonu sırasında açığa çıkan dentin dokusunun hemen dentin bağlayıcı sistemlerle kapatılması işlemidir. Bu yöntem, geçici restorasyon aşamasından önce uygulandığında hibrit tabakanın stressiz bir ortamda olgunlaşmasına izin vererek bağlanma kapasitesini artırmakta, bakteriyel mikrosızıntıyı azaltmakta ve postoperatif dentin hassasiyetini önemli ölçüde engellemektedir. Geleneksel gecikmiş dentin örtülenmesinde tübüller kalıcı simantasyonda kapatılırken, IDS tekniği temiz ve yeni kesilmiş dentinin yüksek bağlanma potansiyelinden faydalanır. Klinik başarı için oksijen inhibisyon tabakasının gliserin jel ile elimine edilmesi ve elastomerik ölçü maddeleriyle etkileşimi önlemek amacıyla pomza ile temizlenmesi kritik adımlardır. Ayrıca, rezin bazlı geçici materyallerin güçlü bağlanmasını ve uzaklaştırma zorluklarını önlemek için preparasyon yüzeyinin vazelin ile izole edilmesi veya ters nokta bağlama tekniğinin kullanılması önerilmektedir. Adeziv sistemlerden özellikle üç aşamalı total-etch ve iki aşamalı self-etch sistemler yüksek dayanıklılık sağlarken; doldurucusuz adezivlerin üzerine akışkan bir kompozit tabakası eklenmesi hem kalınlığı optimize eder hem de hibrit tabakayı korur. Sonuç olarak, indirekt adeziv restorasyonlarda IDS protokolünün benimsenmesi, hasta konforunu ve restorasyonun uzun dönemli prognozunu maksimuma çıkaran, klinik olarak kanıtlanmış güvenilir bir yaklaşımdır.
Immediate Dentin Sealing (IDS) is the immediate coverage of exposed dentin tissue with dentin bonding systems during the cavity preparation of indirect adhesive restorations. When applied before the provisional restoration stage, this method allows the hybrid layer to mature in a stress-free environment, thereby increasing bond strength, reducing bacterial microleakage, and significantly preventing postoperative dentin sensitivity. While traditional delayed dentin sealing closes the tubules during final cementation, the IDS technique leverages the high bonding potential of freshly cut, clean dentin. For clinical success, eliminating the oxygen inhibition layer with glycerin gel and cleaning the surface with pumice to prevent interaction with elastomeric impression materials are critical steps. Furthermore, isolating the preparation surface with petroleum jelly or utilizing the reverse spot bonding technique is recommended to prevent strong bonding and subsequent removal difficulties of resin-based provisional materials. Among adhesive systems, three-step total-etch and two-step self-etch systems provide high durability, while adding a flowable composite layer over unfilled adhesives optimizes thickness and protects the hybrid layer. Consequently, adopting the IDS protocol in indirect adhesive restorations is a clinically proven, reliable approach that maximizes patient comfort and the long-term prognosis of the restoration.
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