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REZUMAT...Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de...
Transcript of REZUMAT...Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de...
Universitatea TITU MAIORESCU
ȘCOALA DOCTORALĂ MEDICINĂ DENTARĂ
REZUMAT
TEZĂ DE DOCTORAT
CONCEPTE ACTUALIZATE ÎN REABILITAREA ESTETICO-
FUNCȚIONALĂ PRIN INCRUSTAȚII INTEGRAL CERAMICE
Coordinator științific,
Prof. Univ. Dr. Bîcleșanu Cornelia
Doctorand ,
Buruiană Ana-Maria
BUCUREȘTI
2019
CUPRINS
Introducere
1. Inlay-ul ceramic
1.1. Caracteristicile inlay-ului ceramic
1.2. Principii de preparare
1.3. Principii de cimentare
2. Stomatologia restaurativă biomimetică
2.1. Principiile si protocoalele biomimetice actuale
2.2. Rășinile compozite și ceramica conform principiului biomimetic
3. Materiale utilizate pentru fabricarea și cimentarea inlay-urilor integral ceramice
3.1. Introducere
3.2. Masele ceramice
3.2.1. Compoziția
3.2.2. Clasificare
3.3. Cimenturile răşinice
3.3.1. Clasificarea pe baza mecanismului de polimerizare
3.3.2. Clasificare pe baza schemei adezive
3.4. Metode de cimentare
3.4.1. Adeziunea la țesuturile dure dentare
3.4.2. Sisteme adezive amelo-dentinare
3.4.3. Adeziunea la ceramică
4. Studiu clinic comparativ privind restaurarea cu inlay-uri integral ceramice prin
metoda clasică și biomimetică
4.1. Scop
4.2. Material și metodă
4.2.1. Pregătirea dinților
4.2.2. Restaurarea dinților
4.3. Rezultate
4.4. Discuții
4.5. Concluzii
5. Studiu FEA pentru evaluarea rezistenței mecanice a cimenturilor autoadezive
utilizate pentru restaurarea inlay-urilor integral ceramice
5.1. Noțiuni generale cu privire la cimenturile autoadezive
5.2. Material și metodă
5.3. Rezultate și discuții
5.4. Concluzii
6. Studiu clinico-statistic privind longevitatea inlay-urilor integral ceramice
6.1. Introducere
6.2. Scop
6.3. Material și metodă
6.3.1. Protocolul clinic
6.3.2. Protocolul de cimentare
6.4. Rezultate
6.5. Discuții
6.6. Concluzii
7. Concluzii finale
Bibliografie
Cuvinte cheie: inlay integral ceramic, performanțe clinice, longevitate, metoda biomimetică,
materiale de cimentare rășinice.
Introducere: Tema aleasă pentru cercetare este o temă de actualitate întrucât incidența
cariilor dentare a crescut în ultimii ani, principalul factor fiind alimentația extraprocesată la
care se adaugă și o igienă dentară necorespunzătoare. De asemenea, reconstituirea leziunilor
carioase, în special a celor întinse din zona posterioară, ridică în continuare semne de
întrebare în ceea ce privește adaptabilitatea obturațiilor, fie ele directe sau indirecte, la
structurile dentare restante, dar și la nivelul dinților vecini și antagoniști, cât și în ceea ce
privește atât durabilitatea obturațiilor în timp, dar și cea a țesuturilor dentare cu care aceasta
vine în contact.În cazul leziunilor carioase întinse rășinile compozite nu reprezintă varianta de
elecție în ceea ce privește tratamentul restaurator, întrucât s-au înregistrat eșecuri atât din
punct de vedere funcțional, cât și din punct de vedere estetic, la un timp relativ scurt de la
realizarea manoperei. Inlay-ul ceramic, fiind o piesă protetică realizată în laborator, oferă un
prognostic superior rășinilor compozite, atât din punct de vedere funcțional, cât și estetic dar
și din punct de vedere al adaptabilității la țesuturile dentare restante. Inlay-ul ceramic oferă
posibilitatea de a controla limitele cervicale ale restaurației, de a realiza o adaptare corecta la
pragul gingival și o morfologie corectă a feței proximale precum și realizarea unui punct de
contact optim și a unei ocluzii corecte. De asemenea, proprietățile fizice sunt superioare ceea
ce determină creșterea rezistenței la abraziune, la flexiune și a modului de elasticitate.
Sigilarea marginilor restaurării este superioară, ceea ce reduce mult posibilitatea de apariție a
cariei secundare și a colorațiilor la nivelul dinților cuspidați în raport cu obturațiile directe cu
rășină compozită. În acest context, prin lucrarea de față am considerat util studiul
comportamentului, din punct de vedere clinic, al inlay-urilor integral ceramice, comparând în
același timp diferite metode de restaurare și diferite materiale de cimentare.
Partea generală: este descris -
Capitolul 1. Inlay-ul ceramic cuprinde o trecere în revistă a metodelor de preparare în
vederea restaurării indirecte, precum și design-ul pe care ar trebui să îl aibe cavitatea
preparată.
Capitolul 2. Stomatologia restaurativă biomimetică prezintă paradigmele și protocoalele
biomimetice actuale.
Capitolul 3. Materiale utilizate pentru fabricarea și cimentarea inlay-urilor integral
ceramice parcurge caracteristicile generale și clasificarea tipurilor de materiale utilizate în
cadrul studiilor din această teză.
Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de cercetare.
Capitolul 4. Studiu clinic comparativ privind restaurarea cu inlay-uri integral ceramice
prin metoda clasică și biomimetică. În cadrul acestui studiu au fost urmărite, la nivel
microscopic, integritatea și calitatea materialului de cimentare, etanșeizarea canaliculelor
dentinare și închiderea marginală, a 4 loturi de dinți extrași, a câte 15 dinți fiecare. Loturile au
fost împărțite în funcție de metoda de restaurare utilizată și în funcție de materialul de
cimentare folosit. În urma cercetării s-a constat faptul că integritatea straturilor de materiale
utilizate în tratamentul biomimetic este superioară integrității straturilor de material utilizate
în tratamentul clasic.
Capitolul 5. Studiu FEA pentru evaluarea rezistenței mecanice a cimenturilor
autoadezive utilizate pentru restaurarea inlay-urilor integral ceramice a avut ca scop
studierea rezistenței adeziunii inlay-ului integral ceramic, în 3 situații clinice diferite (inlay
ocluzal, mezio-ocluzo-distal și oculzo-proximal), comparând în același timp și performanțele
clinice a două materiale de cimentare diferite. Analiza cu element finit s-a realizat cu
software-ul FEA Ansys 13. Modelele geometrice provin din SolidWorks 2013, unde au fost
asamblate și exportate apoi în format compatibil Ansys. A rezultat faptul că ambele tipuri de
ciment prezintă valori de rezistență mai ridicate decât valorile de tensiune înregistrate atât la
nivelul suprafeței cât și la interfață. Acest lucru indică faptul că oricare dintre cele două valori
de solicitare, aplicate după oricare dintre cele 3 direcții, nu va produce ruptura niciunuia
dintre cele două tipuri de materiale de cimentare. Datorită apariției tensiunilor de forfecare, în
cazul inlay-ului ocluzo-proximal, solicitarea orizontală depășește valoarea rezistenței
mecanice a materialului de cimentare pentru solicitarea accidentală de 230 N, dar nici în acest
caz nu se va produce ruptura.
Capitolul 6. Studiu clinico-statistic privind longevitatea inlay-urilor integral ceramice a
observat performanțele clinice ale inlay-urilor integral ceramice pe o perioadă de 3 ani, cu
evaluări clinice realizate la 3, 6, 12, 24 și 36 de luni, în cadrul controalelor periodice
urmărindu-se existența infiltrației marginale, existența fracturilor, atât la nivelul restaurărilor,
cât și la nivelul țesutului dentar remanent, apariția complicațiilor pulpare la nivelul dinților
vitali restaurați, apariția cariei secundare. În cadrul studiului au participat 146 de pacienți cu
vârste cuprinse între 28 și 55 de ani, atât femei (63), cât și bărbați (83). S-au realizat 213 de
inlay-uri integral ceramice. Dinții restaurați au fost 126 molari, din care 69 au fost tratați
endodontic și 57 au rămas vitali, și 87 premolari, din care 39 devitali și 48 vitali. Pentru a
integra datele obținute în cadrul acestui studiu a fost realizat și un review al datelor, fiind
efectuată o căutare PubMed în vederea indentificării studiilor clinice privind longevitatea
inlay-urilor ceramice, realizate din diferite tipuri de ceramică, publicate în ultimii 8 ani (2009-
2017). S-au folosit cuvinte cheie “clinic performance”, “dental ceramics” “inlays, onlays”,
precum și un studiu statistic. În urma cercetării curente reiese faptul că inlay-urile integral
ceramice, realizate din tipuri diferite de ceramică și cimentate cu material compozit cu priză
duală, prezintă o longevitate acceptabilă, atât pentru medic, cât și pentru pacient.
Capitolul 7. Concluzii finale : cercetarea prezentă a demonstrat faptul că restaurarea
biomimetică este superioară celei clasice, defectele observate la nivel microscopic la nivelul
straturilor de materiale și a interfețelor fiind de 2 ori mai reduse ca și dimensiune în cazul
metodei biomimetice. De asemenea s-a demonstrat faptul că inlay-urile de dimensiuni
geometrice mari (mezio-ocluzo-distale) pot prelua și transmite mai bine tensiunile de la
suprafața dintelui, prin intermediul cimentului adeziv la structura dentară, comparativ cu
inlay-ul cu geometrie nesimetrică (ocluzo-proximal) care se caracterizează prin salturi bruște
de tensiune la interfețele de trecere de la un material la altul, acest caz fiind cel mai
susceptibil de a genera tensiuni care să depășească limita de rezistență la adeziune a
materialelor de cimentare. În urma cercetării curente se poate, de asemenea, concluziona
faptul că inlay-urile integral ceramice, realizate din tipuri diferite de ceramică și cimentate cu
material compozit cu priză duală, prezintă performanțe clinice optime.
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