REZUMAT...Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de...

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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

Transcript of REZUMAT...Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de...

Page 1: REZUMAT...Partea personală: cuprinde 3 capitole, fiecare capitol reprezentând un studiu de cercetare. Capitolul 4. Studiu clinic comparativ privind restaurarea cu inlay-uri integral

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

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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

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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.

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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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