devam ettiği ancak pozitif kontrol değerleri ile karşılaştırıldığında bu azalmanın hiçbir grupta istatistiksel olarak önemli bulunmadığı görülmektedir. Bu nedenle, hidrolik iletkenliğin azaltılabilmesi için polimerizasyonunun güçlendirilmesinden ziyade kullanılan dentin bağlayıcı ajanın dentine olan bağlantısının güçlendirilmesinin daha önemli olduğunu ve bu çalışmada kullanılan Adper Prompt L-Pop self-etch bağlayıcı sistemin dentin geçirgenliğine karşı yeterli koruma sağlayamadığını dolayısı ile genç sürekli dişlerde kullanımının pulpanın sağlığının korunması açısından önerilemeyeceğini söylemek mümkündür.
Bu nedenle, genç sürekli dişlerde dentin geçirgenliğinin diğer dentin bağlayıcı sistemlerle yeniden değerlendirilmesinin uygun olduğunu düşünmekteyiz.
ÖZET
Genç Sürekli Dişlerin Tedavisinde Dentin Geçirgenliğinin İncelenmesi
Genç sürekli dişlerin dentinini örterek zararlı uyaranlara karşı pulpayı etkin bir şekilde koruyabilecek restoratif uygulamaların belirlenebilmesi için çalışmamızda, light-emitting diode (LED) ve bir halojen ışık kaynağı (Hilux) kullanmak suretiyle polimerize edilen bir nanokompozit restoratif materyalin genç sürekli dişlerin dentin geçirgenliği üzerindeki etkisinin sıvı fıltrasyon yöntemi ile ölçülerek karşılaştırmalı olarak değerlendirilmesi amaçlanmıştır.
Araştırmada; 12-15 yaş grubundaki bireylerin ortodontik amaçla çekilmiş 68 adet premolar dişi kullanılmış ve dişler her grupta 34 diş bulunacak şekilde 2 gruba ayrılarak bir grupta sığ (1.5 mm) diğer grupta derin (2.5 mm) kaviteler açılmıştır. Açılan kaviteler kendinden asitli 6. nesil dentin bağlayıcı sistem olan Adper Prompt L-Pop ile kombine olarak bir nanokompozit olan Filtek Supreme XT ile doldurulmuş ve daha sonra her grup kendi içinde tekrar 2 alt gruba ayrılarak her grupta 17 dişte Elipar Freelight 2 LED, 17 dişte ise Hilux kullanmak suretiyle rezinler polimerize edilmiştir.
Dentin geçirgenliği, dentin bağlayıcı ajan uygulandıktan ve rezin restorasyonlar tamamlandıktan hemen sonra ölçülmüş, restorasyonların tamamlanmasını takiben 24 saat, 1.
hafta, 1. ay, 3. ay, 6. ay ve 12. ayda ölçümler tekrarlanmıştır. Ölçümler arasındaki dönemde dişler, 37 oC’lik sabit sıcaklıktaki çalkalamalı su banyosunda yapay tükürükte bekletilmiş ve bakteri plağının günlük asit oluşturmasını taklit etmek için her gün 2 saat süreyle asit demineralizasyon solüsyonuna atılmıştır.
Örneklerden elde edilen Lp (hidrolik iletkenlik) değerleri, maksimum iletkenliğin (%100) ölçüldüğü pozitif kontrollere göre oransal olarak hesaplanmış ve buna göre yapılan değerlendirmelerde dentin bağlayıcı ajan uygulanmasından ve rezin restorasyonların tamamlanmasından hemen sonra bütün gruplarda hidrolik iletkenliğin arttığı ancak rezinlerin LED ile polimerize edildiği gruplarda restorasyonların tamamlanmasından 24 saat sonra hidrolik iletkenliğin istatistiksel olarak önemli derecede azaldığı görülmektedir.
Sığ kavitelerde, LED ve Hilux ile polimerize edilen örnekler arasında hidrolik iletkenlik değerleri bakımından hiçbir zaman diliminde istatistiksel olarak önemli bir fark oluşmadığı görülmektedir. Derin kavitelerde ise, LED ile polimerize edilen örneklerin hidrolik iletkenliğinin Hilux ile polimerize edilen örneklere göre 6. Aydan itibaren istatistiksel olarak önemli derecede azaldığı, bu farkın 12 aylık gözlem periodunun sonunda değişmeden kaldığı gözlenmiştir. Ancak, pozitif kontrol değerleri ile karşılaştırıldığında bu azalmanın hiçbir grupta istatistiksel olarak önemli olmadığı görülmüştür.
Buna göre; dentin geçirgenliğinin azaltılmasında, rezinin polimerizasyonunun güçlendirilmesinden ziyade kullanılan dentin bağlayıcı ajanın dentine bağlanma gücünün arttırılmasının daha önemli olduğu sonucuna varılmıştır.
Anahtar Sözcükler: Dentin Geçirgenliği, Dentin Bağlayıcı Ajan, LED cihazı, Nanofil Hibrit Kompozit, Sıvı Filtrasyon Yöntemi
SUMMARY
Investigation of Dentin Permeability in Treatment of Young Permanent Teeth
In this study, it was aimed to compare the effect of nanocomposite restorative material application on dentin permeability after polymerization with using either light-emitting diode (LED) or a halogen light source (Hilux) and by measuring the hydraulic conductance across dentine of young permanent teeth, in order to determine the restorative applications to protect the pulp against the harmful stimuli effectively.
A total of 68 premolar teeth extracted for orthodontic reasons from patients aged 12-15 years were used in this study. The teeths were randomly divided into 2 groups of 34 teeth each. In one of the groups, shallow cavities (1.5 mm in depth) were prepared and in the other group, deep cavities (2.5 mm. in depth) were prepared. The cavities were restored with Adper Prompt L-Pop which is a self-etch adhesive dentin bonding system (6th generation) and Filtek Supreme XT which is a nanocomposite and then each group were divided into 2 sub-groups of 17 teeth. In the first group, teeth were polymerized with Elipar Freelight 2 LED and in the other one with Hilux.
The dentin permeability was measured after dentin bonding agent application, immediately after resin restorations, 24 hours, 1 month, 3 months, 6 months and 12 months after the restoration application. All teeth were stored at 37 oC in artificial saliva by shaking in a water bath and they were immersed in an acid demineralization solution for 2 hours everyday to simulate the daily acid production of the bacteria plaques.
The Lp (hydraulic conductance) values obtained from the samples were calculated as ratios compared to the maximal permeability (positive control- %100 leakage). Accordingly, it was observed that hydraulic conductance was increased following the application of the dentin bonding agent and immediately after the completion of resin restoration in all groups.
However, it was decreased significantly 24 hours after restorations, if the resin restorations were polymerized with LED.
Any significant difference between the hydraulic conductance values in shallow cavities polimerized with LED or Hilux was not observed in any period. However, in deep cavities, it was observed that the hydraulic conductance values of the samples polymerized with LED significantly decreased after 6th month and this difference remained at the end of the 12th month compared with the samples polymerized by Hilux. But, it sould be noted that, when compared with the positive control values, it is seen that the decrease in conductance is not statistically significant in any group.
Therefore, it is more significant to improve the bond strength of the dentin bonding agents rather than to enhance the polymerization of the rezins in order to decrease dentin permeability.
Key Words: Dentin permeability, Dentin Bonding Agent, LED, Nanofil Hybrid Composite, Fluid Filtration Method.
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