Publication: Aşırı madde kayıplı dişlerde IPS empress II onley restorasyonların klinik ve in vitro şartlarda incelenmesi
Abstract
Bu çalışmanın in vitro kısmının amacı, 8 farklı rezin siman ile dentin yüzeyine simante edilen IPS Empress II ve IPS e-max seramik blokların makaslama bağlanma kuvvetlerinin değerlendirilmesidir. In vivo kısmının amacı 64 hastada uygulanan 78 adet aşırı madde kayıplı küçük azı ve büyük azı dişlere uygulanan IPS Empress II (Ivoclar Vivadent, Schaan, Liechtenstein) seramiği ile hazırlanan onley restorasyonların modifiye USPHS (The United States Public Health Service) kriterleri kullanılarak değerlendirilmesidir. Çalışmanın in vitro kısmında, toplam 160 adet olmak üzere, 2 farklı silindirik şekilli seramik numunesi (IPS Empress II ve IPS e.max) kullanılmıştır. IPS Empress II ve IPS e.max seramiklerinin kullanıldığı numunelerin oluşturduğu 2 farklı grubun her ikisi de 8 farklı simanın kullanıldığı 8 alt gruba ayrılmıştır (Heliobond adeziv sistemle Variolink , Solobond Plus adeziv sistemle Bifix QM, One Step Plus adeziv sistemle Choice, Primer A+B adeziv sistemle Multilink, Futurabond DC adeziv sistemle Bifix QM, deneysel self adeziv rezin siman, G-cem self adeziv rezin siman, Biscem self adeziv rezin siman). Tüm numunelere HF asit (%5) ve silan uygulanmıştır. Tüm numuneler 24 saat suda bekletildiler ve sonrasında 10000 kez ısısal çevirime maruz bırakıldılar (5 Cº ve 55 Cº). Kopma gerçekleşene kadar 0.5 mm/ dk hızında Zwick Z010 (Zwick GmbH, Ulm, Germany) universal test cihazı kullanılarak, bağlanma kuvveti makaslama değerleri ölçüldü. Adeziv, koheziv ve karma başarısızlık gösteren yüzeylerin analizi için stereomikroskop kullanıldı. Makaslama bağlanma kuvveti değerleri arasındaki istatistiksel farklılıkların değerlendirilmesi için, Kruskal-Wallis ve Mann-Whitney-U testleri kullanıldı. Çalışmanın in vivo kısmında, 64 hastanın arka bölge dişleri 78 adet IPS Empress II onley ile restore edilmiştir. IPS Empress II restorasyonlar adeziv olarak dual cure rezin yapıştırıcı siman Bifix QM ile yapıştırıldılar. Restorasyonların değerlendirilmesi modifiye USPHS kriterleri kullanılarak başlangıç, 6 ay, 12 ay ve 24 aylık takiplerle gerçekleştirildi. USPHS kriterleri arasındaki farklılıkların belirlenmesi için, Mc Nemar’s testi kullanıldı. Restorasyonların yaşam ömrü, Kaplan-Meier istatistiksel analizi kullanılarak belirlenmiştir.
CLINICAL AND IN VITRO EVALUATION OF IPS EMPRESS II ONLAY RESTORATIONS ON EXTENSIVELY DAMAGED TEETH The aim of in vitro part of this study was to evaluate the shear bond strength of IPS Empress and IPS e.max ceramics luted with 8 different resin cements onto dentinal surfaces. The aim of the in vivo part of this study was to evaluate IPS Empress II onlay restorations in 78 extensively damaged premolar and molar teeth on 64 patients, using modified USPHS criteria. At the in vitro part of this study, two cylindrical shaped (7mm× 4.1 mm) ceramic specimens (IPS Empress II, IPS e.max) were used for each test group yielding a total number of 160 specimens. The specimens in each group which were randomly divided into 8 groups (n:10) were luted with eight different resin composite luting cements ( Variolink with Heliobond adhesive system, Bifix QM with Solobond Plus adhesive system, Choice with One Step Plus adhesive system, Multilink with Primer A+B adhesive system, Bifix QM with Futurabond DC adhesive system, experimental self adhesive resin cement, G-cem self adhesive resin cement, Biscem self adhesive resin cement). In all specimens, HF (%5) and silane were applied. All specimens were stored in water for 24 h and then subjected to 10000 cycles of thermocycling (5 Cº and 55 Cº). Bond strength was measured by means of a shear test, using Zwick Z010 (Zwick GmbH, Ulm, Germany) universal testing machine with 0.5 mm/ min. speed until failure. A stereo microscope was used to analyse the surfaces for adhesive, cohesive and mixed failure in percentages. To determine the statistical significance of the differences between the mean shear bond strength values, Kruskal-Wallis and Mann-Whitney-U tests were used. At the in vivo part of this study, posterior teeth of 64 patients were restored with 78 IPS Empress II onlays. IPS Empress II restorations were adhesively luted with dual-cure resin luting cement Bifix QM. Evaluations of the restorations were performed at baseline, 6 month, 12 month and 24 month follow-up periods using modified USPHS criteria. To determine the differences between USPHS criterias, Mc Nemar’s test was used. The survival rate of the restorations were determined, using Kaplan-Meier statistical analysis. In vitro part of study; shear bond strength of resin cements using total etch system had better mean values than the resin cements using self etch and self adhesive systems. The shear bond strength values of self adhesive system were significantly lower (p<0.05) than the other systems. No significantly differences were observed between IPS Empress and IPS e.max ceramics according to shear bond strength. Mixed failure was the most prevalent type of failure for both IPS Empress and IPS e.max. In vivo part of the study; clinical results after 2 year revealed 87.1 % survival rate with 3 debonding, 1 catastrophic fracture, 2 caries and 6 loss because of the endodontic complications. No significant differences were found statistically except color match and marginal discoloration. In conclusion, IPS Empress II ceramic restorations were successful at either in vitro or in vivo conditionsof this study, using with total etch adhesive systems. IPS Empress II, IPS e.max, shear, in vivo, resin cement, survival rate
CLINICAL AND IN VITRO EVALUATION OF IPS EMPRESS II ONLAY RESTORATIONS ON EXTENSIVELY DAMAGED TEETH The aim of in vitro part of this study was to evaluate the shear bond strength of IPS Empress and IPS e.max ceramics luted with 8 different resin cements onto dentinal surfaces. The aim of the in vivo part of this study was to evaluate IPS Empress II onlay restorations in 78 extensively damaged premolar and molar teeth on 64 patients, using modified USPHS criteria. At the in vitro part of this study, two cylindrical shaped (7mm× 4.1 mm) ceramic specimens (IPS Empress II, IPS e.max) were used for each test group yielding a total number of 160 specimens. The specimens in each group which were randomly divided into 8 groups (n:10) were luted with eight different resin composite luting cements ( Variolink with Heliobond adhesive system, Bifix QM with Solobond Plus adhesive system, Choice with One Step Plus adhesive system, Multilink with Primer A+B adhesive system, Bifix QM with Futurabond DC adhesive system, experimental self adhesive resin cement, G-cem self adhesive resin cement, Biscem self adhesive resin cement). In all specimens, HF (%5) and silane were applied. All specimens were stored in water for 24 h and then subjected to 10000 cycles of thermocycling (5 Cº and 55 Cº). Bond strength was measured by means of a shear test, using Zwick Z010 (Zwick GmbH, Ulm, Germany) universal testing machine with 0.5 mm/ min. speed until failure. A stereo microscope was used to analyse the surfaces for adhesive, cohesive and mixed failure in percentages. To determine the statistical significance of the differences between the mean shear bond strength values, Kruskal-Wallis and Mann-Whitney-U tests were used. At the in vivo part of this study, posterior teeth of 64 patients were restored with 78 IPS Empress II onlays. IPS Empress II restorations were adhesively luted with dual-cure resin luting cement Bifix QM. Evaluations of the restorations were performed at baseline, 6 month, 12 month and 24 month follow-up periods using modified USPHS criteria. To determine the differences between USPHS criterias, Mc Nemar’s test was used. The survival rate of the restorations were determined, using Kaplan-Meier statistical analysis. In vitro part of study; shear bond strength of resin cements using total etch system had better mean values than the resin cements using self etch and self adhesive systems. The shear bond strength values of self adhesive system were significantly lower (p<0.05) than the other systems. No significantly differences were observed between IPS Empress and IPS e.max ceramics according to shear bond strength. Mixed failure was the most prevalent type of failure for both IPS Empress and IPS e.max. In vivo part of the study; clinical results after 2 year revealed 87.1 % survival rate with 3 debonding, 1 catastrophic fracture, 2 caries and 6 loss because of the endodontic complications. No significant differences were found statistically except color match and marginal discoloration. In conclusion, IPS Empress II ceramic restorations were successful at either in vitro or in vivo conditionsof this study, using with total etch adhesive systems. IPS Empress II, IPS e.max, shear, in vivo, resin cement, survival rate