Клінічна оцінка фотокомпозиційних відновлень зубів, виконаних за удосконаленими підходами

Abstract

У статті представлені результати клінічної оцінки прямих відновлень зубів, виконаних з нанофо- токомпозиційного і рідкотекучих фотокомпозиційних матеріалів за різними технологіями. Оцінку проводили за критеріями «крайове прилягання», «крайове забарвлення», «чутливість» та «вторинний карієс» після відновлення, через 6 та 12 місяців. Максимальна кількість ускладнень виявлена у пацієнтів, у яких застосовували зміцнений рідкотекучий фотокомпозит за технікою об’ємного відновлення. Мінімальна кількість порушень отримана у пацієнтів, відновлення зубів у яких проводили із застосуванням одночасної світлової полімеризації адгезивної системи і першого шару нанофотокомпозиту.

В статье представлены результаты клинической оценки прямых восстановлений зубов, выполненных из нанофотокомпозиционного и жидкотекучих фотокомпозиционных материалов по разным технологиям. Оценку проводили по критериям «краевое прилегание», «краевое окрашивание», «чувствительность» и «вторичный кариес» после восстановления, через 6 и 12 месяцев. Максимальное количество осложнений выявлено у пациентов, у которых применяли упрочненный жидкотекучий фотокомпозит в технике объемного восстановления. Минимальное количество нарушений получено у пациентов, восстановления зубов у которых проводили с применением одновременной световой полимеризации адгезивной системы и первого слоя нанофотокомпозита.

The fluid photocomposites used for the restoration of V class cavities and as a liner are actively being introduced into practical dentistry to simplify restoration technologies. These materials were proposed to be changed for reinforced photocomposites with a higher content of filler, improved physical and mechanical properties; they provide the high-volume restoration of teeth with large cavities up to 4 mm layer thickness. The new possibilities of materials and improved technologies applied for teeth restoration require their clinical assessment. The aim of the study was the clinical evaluation of direct teeth restoration using nanophotocomposites and various fluid photocomposite materials applying certain technological approaches. Object and methods. The dental health of 180 patients aged from 20 to 40 years was examined and the patients were distributed into 4 groups. The I group included 45 patients, whose 50 caries-affected teeth were restored using the standard method with adhesive system application and nanophotocomposites in layer-by-layer softstart polymerization. The II group included 44 patients whose 53 teeth were restored with adhesive material, fluid photocomposite material as a liner and nanophotocomposite under polymerization condition in the same regime. In 46 patients of III group 50 teeth were restored with the same adhesive system and reinforced fluid photocomposite applying the high-volume restoration with light polymerization under the same conditions. In 45 patients of IV group 54 teeth were restored applying the same adhesive system and nanophotocomposite with simultaneous light polymerization of adhesive system and the first layer of material with direct light flux exposure following nanophotocomposite soft-start polymerization. The clinical evaluation of restorations was carried out the next day, after 6 and 12 months according to Ryge criteria, among which “marginal fit”, “marginal staining”, “sensitivity” and “secondary caries” were pointed out. Results and discussion. The hygienic index of Fedorov-Volodkina was determined in all the patients before teeth restoration as well as the structural and functional acid resistance of the teeth enamel using enamel resistance test; the index of caries decay intensity was also evaluated; the corresponding indices in patients of all groups did not differ statistically. Restoration disorders were not determined the next day, except for postoperative sensitivity in the restored teeth in patients of I and III groups. In six months the patients of I group presented with 3 restorations (6.0%) with marginal fit disorder and presence of marginal staining, and 2 cases (4.0%) of postoperative sensitivity. Patients of II and IV groups presented with the same number of restorations with marginal fit disorders (2 restorations each, 3.8% and 3.7%, correspondingly) and presence of marginal staining (1 restorations each, 1.9% and 1.9%, respectively). Five restorations (10.0%) with marginal fit disorders, 4 restorations (8.0%) with marginal staining and 1 case (2.0%) with postoperative sensitivity were determined in III group of patients. After 12 months, 7 restorations (14.9%) with marginal fit disorders and 5 restorations (10.6%) with marginal staining were determined in I group of patients; in patients of II and IV groups such abnormalities were, respectively, in 4 (7.8%) and 3 restorations (5.9%) and in 3 (5.8%) and 2 restorations (3.8%). The most complications were determined in III group of patients, marginal secondary caries: 2 cases (4.3%) and 1 (2.3%), respectively. Conclusions. The obtained results make it possible to determine that the number of complications according to the certain clinical criteria was systematically and significantly higher in patients of the III group, where reinforced fluid nanophotocomposite with high-volume technique was used for caries-affected teeth restoration. The minimum number of disorders was determined in IV group of patients, where the teeth restoration was performed using modern approaches with one-stage polymerization of adhesive system and the first layer of the nanophotocomposite material.