İmplant Destekli Sabit Protezlerde Kullanılan CAD-CAM Yüksek Performans Polimerleri
Özet
İmplant destekli sabit protezlerde biyomekanik ve estetik başarı için geleneksel metal ve seramik altyapılara alternatif olarak CAD-CAM yüksek performans polimerleri (PAEK grubu: PEEK ve PEKK) ile fiber takviyeli modifiye kompozit rezinler geliştirilmiştir. Metal içermeyen bu materyaller; yüksek biyouyumluluk, mükemmel elektrik yalıtımı, düşük bakteri plağı tutumu ve X-ışını gibi tanısal görüntülemelerde daha az artefakt oluşturma avantajlarına sahiptir. Ayrıca, insan kortikal kemiğine yakın düşük elastisite modülleri sayesinde çiğneme kuvvetlerini emerek şok emici işlev görür ve peri-implant kemik ile bileşenler üzerindeki stresi azaltırlar. PEKK, saf PEEK'e göre daha yüksek eğilme ve basınç dayanımı sergilerken, PEEK'in zayıf yarı saydamlık özelliği titanyum dioksit gibi doldurucularla iyileştirilmektedir. Bu polimerlerin estetik beklentileri karşılaması için üzerlerine uygulanan CAD-CAM veya geleneksel kompozit veneerlerin kırılma direnci, posterior fizyolojik çiğneme kuvvetlerinden (870 N) oldukça yüksektir. Fiber takviyeli kompozit rezinler ise yüksek mukavemetlerinin yanı sıra rezin simana kimyasal adezyon ve hasta başı onarılabilirlik avantajları sunar. Klinik olarak kabul edilebilir marjinal ve internal adaptasyon değerleri (ortalama <90-120 μm) sunan bu yeni nesil polimerler, metale alerjisi olan veya metal içermeyen restorasyon talep eden hastalar için umut verici bir tedavi seçeneğidir. Ancak, uzun dönemli klinik başarılarının değerlendirilmesi için daha fazla ileri çalışmaya ihtiyaç duyulmaktadır.
CAD-CAM high-performance polymers (PAEK group: PEEK and PEKK) and fiber-reinforced modified composite resins have been developed as alternatives to traditional metal and ceramic frameworks for biomechanical and aesthetic success in implant-supported fixed prostheses. These metal-free materials offer advantages such as high biocompatibility, excellent electrical insulation, low bacterial plaque retention, and reduced artifact formation in diagnostic imaging like X-rays. Furthermore, due to their low modulus of elasticity close to human cortical bone, they act as shock absorbers by absorbing masticatory forces and reducing stress on the peri-implant bone and components. While PEKK exhibits higher flexural and compressive strength compared to pure PEEK, the poor translucency of PEEK is improved with fillers like titanium dioxide. To meet aesthetic demands, these polymers require veneering, and the fracture resistance of CAD-CAM or conventional composite veneers applied to them is significantly higher than physiological posterior masticatory forces (870 N). On the other hand, fiber-reinforced composite resins offer significant clinical advantages in terms of high strength, chemical adhesion to resin cement, and chairside repairability. Providing clinically acceptable marginal and internal adaptation values (average <90-120 μm), these next-generation polymers represent a promising treatment option for patients with metal allergies or those requesting metal-free restorations, although further long-term clinical studies are required to safely confirm their long-term performance.
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