Endokron Restorasyonlar
Özet
Endodontik tedavi görmüş, aşırı kron harabiyeti olan dişlerin restorasyonunda geleneksel post-kor ve tam kron uygulamalarına alternatif olarak sunulan endokronlar, monoblok yapıda adeziv restorasyonlardır. İlk kez 1995 yılında Pissis tarafından uygulanan bu yöntem, pulpa odasının anatomik boşluğundan ve kavite marjinlerinden makromekanik ve mikromekanik retansiyon sağlar. Genellikle okluzal kuvvetlerin daha dengeli dağıldığı molar dişlerde tercih edilmekle birlikte, premolar dişlerde de başarılı sonuçlar gösterdiğini belirten çalışmalar mevcuttur. Kök kanalında post yuvası hazırlanmasını gerektirmediği için iatrojenik perforasyon ve kök kırığı risklerini ortadan kaldıran bu yaklaşım, minimal invaziv ve supragingival marjinli olması sayesinde periodontal dokuları korur, klinikte geçirilen süreyi kısaltır. Preparasyon aşamasında keskin iç açılardan ve undercut yapılarından kaçınılması, pulpa odası derinliğinin en az 3 mm, duvar kalınlıklarının ise minimum 2 mm olması başarı için kritiktir. Günümüzde lityum disilikat bazlı cam seramikler yüksek eğilme dayanımları ve başarılı adeziv bağlantıları nedeniyle en çok öne çıkan materyaller arasındayken; nano dolgulu kompozitler, hibrit seramikler ve PEEK gibi alternatif malzemeler de klinik ve in-vitro çalışmalarda değerlendirilmektedir. Endokronlar, okluzal risk faktörleri veya yetersiz klinik kron boyu varlığında bile posterior dişler için uzun dönemde kabul edilebilir sağ kalım oranları sunan, umut vadedici ve konservatif bir tedavi seçeneğidir.
Endocrowns, which are offered as an alternative to traditional post-core and full crown applications in the restoration of endodontically treated teeth with excessive crown destruction, are monoblock adhesive restorations. First applied by Pissis in 1995, this method provides macromechanical and micromechanical retention from the anatomical cavity of the pulp chamber and cavity margins. Although it is generally preferred in molar teeth where occlusal forces are distributed more evenly, there are studies indicating successful results in premolar teeth as well. Eliminating the risks of iatrogenic perforation and root fracture because it does not require a post space preparation in the root canal, this minimally invasive approach protects periodontal tissues thanks to its supragingival margins and shortens the clinical chair time. Avoiding sharp internal angles and undercuts during the preparation phase, and ensuring a pulp chamber depth of at least 3 mm and wall thickness of minimum 2 mm are critical for success. Nowadays, while lithium disilicate-based glass-ceramics are among the most prominent materials due to their high flexural strength and successful adhesive bonding, alternative materials such as nano-filled composites, hybrid ceramics, and PEEK are also evaluated in clinical and in-vitro studies. Endocrowns are a promising and conservative treatment option that offers acceptable long-term survival rates for posterior teeth, even in the presence of occlusal risk factors or insufficient clinical crown length.
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