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MEDICAL SCIENCES
Aliyev Vugar Ismet
Doctor of Philosophy in Medicine, Azerbaijan Medical University, hourly paid teacher Department of Orthopedic Dentistry.Assistent
Baku, Azerbaijan DOI: 10.24412/2520-6990-2022-27150-5-7
COMPARATIVE ANALYSIS OF THE RESTORATION OF THE ANTERIOR GROUP OF TEETH WITH VENEERS AND MODERN LIGHT-CURING COMPOSITE FILLING MATERIALS.
Алиев Вугар Исмет
СРАВНИТЕЛЬНЫЙ АНАЛИЗ ВОССТАНОВЛЕНИЯ ПЕРЕДНЕЙ ГРУППЫ ЗУБОВ ВИНИРАМИ И СОВРЕМЕННЫМИ СВЕТООТВЕРЖДАЕМЫМИ КОМПОЗИЦИОННЫМИ ПЛОНИРОВОЧНЫМИ МАТЕРИАЛАМИ.
Abstract.
Veneers allow you to achieve a high aesthetic result with a change in tooth color and the presence of defects in the tooth surface. In the process of vital activity, a variety of organic and inorganic dyes affect the teeth, which can affect the teeth in different ways: some dyes are deposited only on the surface of the teeth, some penetrate into hard tissues (enamel, dentin). Veneers have become the best option for aesthetic prosthetics of the anterior group of teeth. Their manufacture does not affect the adjacent periodontal tissues, which is very important. Modern materials used in the manufacture of ceramic and zirconia veneers are inorganic substances and compounds such as: porcelain (ceramic) and zirconia. Porcelain is a vitreous ceramic material, smooth and completely impenetrable. Zirconium dioxide is a naturally occurring zirconium compound that has been used in orthopedic dentistry for 10-15 years.
Аннотация.
Виниры позволяют достичь высокого эстетического результата при изменении цвета зуба и наличии дефектов зубной поверхности. В процессе жизнедеятельности на зубы оказывают воздействие разнообразные органические и неорганические красители, которые могут влиять на зубы по-разному: какие-то красители осаждаются лишь на поверхности зубов, некоторые проникают в твердые ткани (эмаль, дентин). Виниры стали наилучшим вариантом эстетического протезирования фронтальной группы зубов. Их изготовление не затрагивает прилежащие ткани пародонта, что совсем немаловажно. Современные материалы, используемые при изготовлении керамических и циркониевых виниров представляют собой неорганические вещества и соединения такие как: фарфор (керамика) и диоксид циркония. Фарфор - это керамический стекловидный материал, гладкий и абсолютно непроницаемый. Диоксид циркония - это соединение циркония, которое встречается в природе и применяется в ортопедической стоматологии уже на протяжении 10-15 лет
Keywords; defect of the frontal group of teeth, veneers. Ключевые слова;дефект фронтальной группы зубов,виниры.
Priority in dentistry are high technologies, which include the method of direct veneer of anterior teeth with light-cured composites. [5] An indication for the use of direct veneering (veneer) is a defect in the hard tissues of the tooth from 1/3 to 1/2 of the volume of the crown, the need to correct the shape, color or position of the tooth [1, 4]. It is known that with the help of veneer it is easier to achieve a good aesthetic result and the long-term data on this indicator are better in comparison with the traditional method of aesthetic restoration of teeth using even the most modern light-curing composite filling materials [2, 3, 7]. For several years, we have studied the effectiveness of anterior restorations using veneers in the treatment of caries and non-carious lesions of the teeth, taking into account the factors indicated above, and have obtained the most detailed data on several criteria for the condition of direct composite veneers [6.8].
The purpose of this study was to investigate the benefits of using veneers based on the evaluation of detailed criteria for their condition in the restoration of the anterior group of teeth.
Materials and methods of research
Under our observation there were 29 patients aged 19 to 50 years (of which 18 women - 62.07%, and 11 men - 37.93%), who underwent restoration of 81 front teeth with carious cavities of 3, 4, 5 classes according to Black and with non-carious lesions - wedge-shaped defects and erosions with severe defects requiring restoration.
All patients with defects in the hard tissues of the anterior teeth who underwent restoration were divided into 2 groups: group 1 - patients who underwent restoration of 39 teeth using veneers; Group 2 - patients who had tissue defects of 42 teeth restored by adhesive restoration without veneer of the vestibular surface.
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To use identical conditions, restorations of defects in caries and non-carious lesions of the teeth, covering 1/3 of the vestibular surface, were compared. In both groups, the restoration was carried out taking into account absolute and relative contraindications.
In the first group of patients, after the preparation of the cavities, the vestibular surface of the crowns of the teeth was excised with diamond burs to a depth of 0.3-0.4 mm; a ledge was created at the level of the gingival margin; a groove was formed on the contact surfaces; a wide bevel of enamel was made towards the cutting edge.
Patients of the second group underwent preparation in accordance with the cavity class: when forming a cavity of class 3, a retention point was created in the form of a groove at the border of the pulpal and gingival walls, an enamel bevel was made on the vestibular surface 2 mm wide; class 4 cavities were prepared in this group according to the same principles as class 3 cavities, but to improve the macromechanical retention of the filling, an additional platform was created, the enamel bevel was 4 mm wide; when forming class 5 cavities, an oval or kidney-shaped cavity was created with a gingival wall parallel to the gingival margin, with a convex bottom, with retention grooves running along the enamel-dentin border on the gingival wall and the wall facing the occlusal plane, with an enamel bevel 2- 5 mm towards the incisal edge. Treatment of deep caries was carried out using calcium-containing therapeutic pads and their isolation from the composite using glass ionomer cements.
When preparing erosions and wedge-shaped defects in patients of the second group, dentin was excised from the walls and bottom of the cavity to a depth of 0.5-1 mm and the surface layer of enamel was ground with a fine diamond bur around wedge-shaped defects to a width of 3-4 mm in the direction of the occlusal plane with a gradual decrease in the expansion zone on the sides; if possible, a shape was created that provided macromechanical retention of the filling.
At the last stage of preparation, the enamel edges were finished according to the type of polishing.
After preparation, drug treatment and drying, tooth tissues were restored with a light-curing composite, which was used with an adhesive system in accordance with the instructions for use. The restorations were carefully ground and polished. All patients were given recommendations on individual oral hygiene.
The assessment of the state of the restorations was carried out for 5 years according to the criteria, the preservation of the anatomical shape (AF); edge adaptation (MA); the occurrence of secondary caries (C); surface roughness (SR); edge staining (MD); color matching of the restoration (color retention and its correspondence to the tooth tissues) (CM); the presence of discomfort (sensitivity) in the treated tooth (DF).
Each criterion was evaluated depending on the degree of its severity by the following ratings: Alfa (A) -excellent rating (excellent treatment outcome); Bravo (B) - a satisfactory assessment, i.e. there are minor changes in the restoration that do not require correction
or are easily corrected; Charlie (C) and Delta (D) - unsatisfactory rating, i.e. the restoration needs to be replaced (C - delayed replacement, D - immediate replacement).
Research results and discussion
After 1 year, all restorations in patients of the 1st group had a score of "jnkbxyj" for all criteria. In the 2nd group of patients by this time in 2 restorations there was a discoloration along the edge of the restorations (satisfactory), which was eliminated.
After 2 years in the 1st group of patients, all restorations also scored "Excellent" in all criteria. In the 2nd group, by this time, in 3 cases, a discoloration was observed along the edge of the entire restoration, characterized by the rating "Satisfactory", eliminated by grinding and polishing.
After 3 years in the 1st group, there was a discoloration along the edge of 2 restorations in the cervical region (with a rating of "Satisfactory"), eliminated by grinding and polishing. In the 2nd group of patients, such a defect was observed in 4 cases along the entire edge of the restorations (in 3 teeth - with a rating of "satisfactory", in 2 teeth - with a rating of "unsuccessful", 4 years later, in the 1st group, a discoloration was detected in cervical area 2 restorations-satisfactory
In the 2nd group, 2 restorations needed to be replaced. In 2 restorations, the defect was eliminated. In addition, in the same group of patients, in 2 cases, a part of the restoration broke off in the area of the angle of the cutting edge in carious cavities of class 4 according to Black, which led to a replacement.
After 5 years, the same defects were noted in the 1st group of patients - marginal staining in 3 restorations in the cervical region. In the 2nd group, this defect was expressed in 4 cases along the entire border of the restorations. Thus, the results obtained showed the advantage of using veneers in terms of aesthetic characteristics and the shelf life of fillings in the restoration of anterior teeth. As a result of a 5-year follow-up, there were differences in the first and second groups of patients in terms of the time of occurrence of defects, their number and severity. In the 1st group of patients, the total number of restorations with defects was 14.28%, replacement of restorations was not required, the defects were eliminated. In the 2nd group, 38.46% of restorations with defects were observed, of which 15.38% (8 restorations) needed to be replaced due to chipping of the material in the area of the cutting edge in class 4 cavities, a pronounced discoloration along the edge of the restoration, the appearance recurrent caries. The most common defect was a discoloration along the edge of the restoration. However, among the first group of patients, this defect appeared only after 3 years; by 5 years of observation, the number of such defects increased to 7, and they were located only in the cervical area, and their severity was insignificant, which made it possible to eliminate them by grinding and polishing the surface of the restoration. In the 2nd group of patients, a discoloration, already expressed along the entire outer edge of the restoration, appeared after 1 year, and by 5 years of observation, the number of such defects increased to 17. In 12 cases, they were eliminated by grinding, in 5 cases, the severity of defects requiring
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replacement restorations, and in two restorations this defect was combined with recurrent caries. In addition, in the 2nd group of patients in the period from 3 to 5 years of follow-up, 3 defects were noted in the form of a violation of the anatomical shape (split of the restoration in the area of the cutting edge in the cavities of class 4 according to Black), which required the replacement of restorations.
conclusions
The obtained results of the study confirm the advantages of the composite veneer in comparison with the traditional adhesive restoration technique in terms of initial and remote aesthetic characteristics, and also indicate the advantages in terms of durability and preservation of the restoration. In this regard, the expediency of a wider use of veneers in the practice of therapeutic dentistry is obvious.
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