Restoratif Diş Hekimliğinde İndirekt Adeziv Restorasyonlarda Servikal Marjin Relokasyonu (Cervical Margin Relocation)
Özet
Servikal Marjin Relokasyonu (CMR), posterior dişlerde mine-sement sınırının altına uzanan derin proksimal kavite kenarlarını supragingival seviyeye yükseltmek için direkt kompozit rezin tabakası yerleştirilmesi işlemidir. Bu teknik; teknik operasyonel zorlukları azaltmayı, rubber dam izolasyonunu, ölçü alımını ve indirekt adeziv restorasyonların simantasyonunu kolaylaştırmayı amaçlayarak cerrahi kron uzatmaya invaziv olmayan bir alternatif sunar. CMR uygulamasında genellikle üç adımlı total-etch veya iki adımlı self-etch adeziv sistemler ile akıcı veya geleneksel kompozitler tercih edilir. Yapılan çalışmalar, CMR uygulanan restorasyonların marjinal adaptasyonunun doğrudan dentine yapılan restorasyonlarla benzer olduğunu göstermekle birlikte, sement ve dentine bağlanma kalitesini artırmadığını ve hibrit tabaka bozunmasını önleyemediğini ortaya koymaktadır. Klinik başarı için restoratif sınırlar ile alveol kret arasındaki 3 mm'lik biyolojik genişliğin korunması ve izolasyonun eksiksiz sağlanması kritik öneme sahiptir; aksi takdirde teknik kontrendikedir. Subgingival sınırlar diş eti iltihabı ve kemik kaybı riski taşıdığından, kemik kretine 2 mm'den yakın yerleşimlerde sondalamada kanama görülebilir. Sonuç olarak CMR, derin marjinli sınıf II defektlerde klinisyenlere kolaylık sağlayan bir yöntem olsa da, uzun dönemli periyodontal etkilerini ve cerrahi alternatiflerin yerini alabilirliğini kesinleştirmek için daha fazla bilimsel kanıta ve uzun süreli takiplere ihtiyaç duyulmaktadır.
Cervical Margin Relocation (CMR) is a procedure involving the placement of a direct composite resin layer to elevate deep proximal cavity margins extending below the cemento-enamel junction in posterior teeth to a supragingival level. Aiming to minimize technical operational difficulties and facilitate rubber dam isolation, impression taking, and adhesive cementation of indirect restorations, this technique offers a non-invasive alternative to surgical crown lengthening. In CMR application, three-step total-etch or two-step self-etch adhesive systems along with flowable or conventional composites are generally preferred. Studies demonstrate that while the marginal adaptation of restorations with CMR is similar to those placed directly on dentin, it does not enhance bonding quality to cementum and dentin, nor does it prevent hybrid layer degradation. Preserving a 3 mm biologic width between restorative margins and the alveolar crest, as well as achieving perfect isolation, is critical for clinical success; otherwise, the technique is contraindicated. Since subgingival margins carry risks of gingival inflammation and bone loss, margins placed 2 mm or closer to the bone crest may exhibit bleeding on probing. In conclusion, although CMR facilitates clinical steps in class II defects with deep margins, further scientific evidence and long-term follow-ups are required to confirm its long-term periodontal outcomes and viability as an alternative to surgery.
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