kbilis arxovani dentinis eleqtronulmikroskopuri daxasiaTeba
mJavuri agentebiTa da adheziuri sistemebiT
damuSavebis Semdeg
n. manjaviZe
stomatologiuri
klinika `roial-denti~.
kbilis fesvis arxebis postobturaciuli garTulebebis mizezi fesvis kedlebsa da sabJen masalebs
Soris gaCenili mikronapralia. es
movlena erTi mxriv gamowveulia arxis sabJeni masalebis
gamyarebis Semdgom moculobaSi klebiT da advilad gawovadobiT,
meore mxriv ki myar sabJen
masalebsa da fesvis dentins Soris mikavSirebis Zalis SesustebiT. zemoTqmuli
TvalsaCinod avlens mikronapralSi arxis rezidentuli mikroorganizmebis inficirebis realur Sanss da qsovilovani
siTxis dinebis SesaZleblobas. stomatologiur
praqtikaSi endodontiuri teqnikis daxvewam daAadheziuri sistemebis danergvam bevrad gaaumjobesa kbilTa mkurnalobis Sedegebi da xeli Seuwyo
postrestavraciuli garTulebebis
Tavidan acilebas. Ddentinis adheziuri sistemebisa da Kkbilis magar
qsovilTa sagravirebeli mJavebis intraradikuluri gamoyenebis klinikuri gamocdilebebi sakmaod mwiria.
kvlevis procesSi gamoyenebuli adheziuri sistemebis moqmedebis meqanizmebze saubari mxolod mis Semdegaa SesaZlebeli, rac kbilis fesvebis mikrooarxebis zedapirs gapoxili anu webovani Sre mocildeba.
webovani Sre – araorganizebuli organuli masaa,
romelic fesvis dentinis kedelze arxis instrumenturi damuSavebiT Cndeba da
praqtikulad xuravs dentinis milakebis aperturebs. Aadhezivis mier hibriduli
zonis formireba ki mxolod dentinis milakTa eqspoziciis Semdeg xdeba
SesaZlebeli, rac mJauri agentebis moqmedebiT xorcieldeba.
zemoTqmulidan gamomdinare Cveni kvlevis mizans
warmoadgenda kbilis arxovani dentinis morfologiur TaviseburebaTa Seswavla
maskanirebeli eleqtronuli mikroskopis saSualebiT, maTi adheziuri sistemebiTa da
sagravirebeli mJavebiT damuSavebis Semdeg.
adheziur sistemaTa nimuSebad AQ Bond (MORITA) – (4 META 4 metakriloqsieTil - trimelitat anhidridi), Etch &
Prime (DEGUSSA) (piro-fosfati,
2 hidroqsieTil metakrilati, eTanoli, distilirebuli wyali da stabilizatorebi)
.da Prime& Bond NT
(DENTSPLY) (di,
trimetakrilaturi fisebi,
funqcionalizebuli amorfuli kremniumis orJangi, Penta _ dipentaeritritol_ monofosfati, fotoiniciatorebi,
stabilizatorebi, acetilaminis hidroftoridi, acetoni) gamoviyeneT. mJauri
agentebis saxiT ki 16% edt da 35% H3PO4 SevarCieT.
kvlevis obieqts warmoadgenda adamianis eqstragirebuli 20 kbili, romlebic 3 jgufad davyaviT: I _ 16% edt da AQ Bond (MORITA); II _ 16% edt da Etch& Prime (DEGUSSA); III _ a) 16% edt da Prime& Bond NT (DENTSPLY), b) 35% H3PO4. da Prime& Bond NT (DENTSPLY).
adheziur
sistemebSi AQ
Bond (MORITA) da
Etch& Prime (DEGUSSA) mJavaTa(4 META da piro-fosfati) Semcvelobis gamo saeqsperimento kbilebi aRniSnuli adhezivebis aplikaciamde mxolod 16% edt-iT davamuSaveT, xolo radgan adheziuri sistema Prime&
Bond NT ar Seicavs sagravirebel komponents, am jgufis kbilebSi gamoviyeneT ori sxvadasxva koncentraciis mJava 16% edt (KERR) da
35% H3PO4.(KERR).
saeqsperimento kbilTa samive Jgufis eleqtronulmikroskopiuri gamokvlevebis Sedegad gamovlinda ori tipis cvlileba:
1. fesvis arxis kedelze “webovani Sris” gadnoba da wvrilmarcvlovani nivTierebis Tanabari fenis warmoqmna.
2.
fesvis dentinSi hibriduli Sris warmoqmna da dentinis milakebis
Sesasvlelebis daxurva.
16% edt-iT da AQ Bond adheziuri sistemiT
damuSavebis Semdeg fesvis apikalur nawilSi ZiriTadad mxolod mJauri gravirebis
Sedegi aRiniSneboda. dentinis milakebis
umravlesobis Sesasvlelebi erTeulebis garda Ria iyo. distalur mxareze ki daxuruli dentinis
milakebis raodenoba izrdeboda.
adhezivis nivTierebas, romelic dentins faravda mkveTrad gamoxatuli wvrilmarcvlovani struqtura hqonda, romelic webovani Sris modificirebas axdenda. dentinis
struqtura ufro homogenuri xdeboda rac milakebis adhezivis
nivTierebiT amovsebis Sedegi iyo. Ffesvis dentinis
sisqeSi yalibdeboda Txeli hibriduli Sre. eleqtronogramebze
(maRali gadidebiT) dentinis struqturis cvlilebac Canda _ igi erTgvarovani da wvrilmarcvlovani xdeboda. mJaviTa
da adheziviT modificirebul dentins da adhezivis nivTierebas, romelic avsebda dentinis milakebs msgavsi “faqtura” hqondaT. hibirduli
Sris gareT (fesvis kedlebisaken miqceul zedapirze) dentinis milakebs ubrundebodaT maTTvis damaxasiaTebeli struqturuli adeqvaturoba da ukve mTel sigrZeze
SesaZlebeli xdeboda maTi mkveTri vizualizacia.
(sur.1)
meore jgufis gamokvlevebSi (16%-iani edt + Etch & Prime 3.0) adgili hqonda rogorc raodenobriv aseve xarisxobriv cvlilebebs. fesvis arxis proqsimalur mesamedSi, apikaluri xvrelidan garkveul manZilze Ria dentinis milakebTan erTad Canda sakmaod sqeli, faSari nivTierebiT dafaruli aperturebi (sur 2).
sur. 1. kbilis arxis
damuSaveba 16%-iani edt-Ti da AQ Bond (Morita) adheziviT. eleqtronogramaze – Cans adheziviT
dafaruli ubnebi da agreTve Ria
dentinis milakebis aperturebic. X 1000.
sur. 2. kbilis arxis kedlis damuSaveba 16%-iani edt-Ti da Etch
& Prime 3.0 (DEGUSSA) adheziviT. dentinis milakebi adhezivis sqeli da faSari SriT
arian dafaruli. X 1500.
anaTlebis guldasmiT daTvalierebis
Semdeg dentinSi mkveTrad gamoxatuli, eleqtronulad diferencirebuli Sre Canda, romelSic
adhezivi da hibriduli Sre erT
mTlian struqturas qmnida. (sur
3).
sur. 3. kbilis
arxis damuSaveba 16%-iani edt-Ti da da
Etch & Prime 3.0 (DEGUSSA) adheziviT. eleqtronogramaze Cans hibriduli
Sris sqli fena, romlis qveS
dentinis qsovili mis normalur struqturas
ubrundeba. X1000.
hibriduli zonis gareT dentinis milakebis sanaTurSi mosCanda zonrebis msgavsi odontoblastebis morCebi. maTi
arseboba metyvelebda im faqtze, rom sakvlevi
kbilebi adhezivebiT damuSavebuli iyo uSualod kbilis eqstraqciis da pulpis eqstirpaciis Semdeg. odontoblastebis
morCebis arseboba garkveulwilad arTulebda maT diferenciacias adhezivis nivTierebisagan. diferencirebis safuZvels
warmoadgenda odontoblastTa Taviseburi bunebrivi qsovilovani Seneba, rac mas pulpis
qsovils amsgavsebs da maTi registrireba
dentinis milakebis mTel sigrZeze xdeboda.
adhezivis nivTiereba ki hibriduli
Sris qvemoT dentinis milakis Rrma fenebSi ver aRwevda.
kbilTa mesame jgufis pirveli qvejgufis (16% edt + Prime&Bond NT) gamokvlevebma gviCvena Semdegi: adheziuri sistemis Prime&Bond NT wvrilmarcvlovani, homogenuri struqtura arxis kedlis zedapirs “galaqul” elfers aZlevda. igi mTlianad faravda dentinis milakebis Sesasvlelebs, rac arxis edt-Ti winaswari damuSavebis Sedegs warmoadgens. zogierT ubnebSi ramodenime eqspozirebuli Sesasvlelic Canda. Aadhezivis fena TavisTavad araTanabari sisqiT gamoirCeoda, zogan mis qveS SeimCneoda dentinis namsxvrevebi sxvadasxva zomis “beltebis” saxiT. Aamgvari sxeulebi fesvis arxis endo instrumentebiT damuSavebis Sedegad Cndeba da maTi mTliani gamodevna arxis irigaciiT SeuZlebelia. (sur.4)
sur. 5. 35% H3PO4. +
Prime& Bond NT .
adhezivi Tanabari
sqeli feniT nawildeba fesvis arxis kedelze. Cans
erTeuli dentinis milakis Sesasvleli.
saeqsperimento kbilTa mesame jgufis meore
qvejgufSi (35% H3PO4.
+
Prime& Bond NT) mJavis koncentraciis gazrdis gamo webovani
Sris damuSavebis efeqti ufro mkafiod
vlindeboda da aqedan gamomdinare
Aadhezivis fena ufro Tanabri feniT nawildeboda
arxis kedlis zedapirze vidre wina SemTxvevaSi. (sur.5)
miuxedevad zemoaRwerili
efeqtisa endodontur praqtikaSi webovani Sris mosacileblad fosformJavis gelis gamoyeneba aramizanSewonilad migvaCnia, rameTu SeuZlebelia misi absoluturi gamorecxva makroarxidan, rac periapeqsuri qsovilebis qimiuri gaRizianebis da postobturaciuli garTulebis risks maqsimalurad zrdis.
Cvens mier Catarebuli eqsperimentuli kvlevis Sedegebma gviCvena, rom adheziuri
sistema Etch & Prime 3.0 efeqturi
saSualebaa fesvis arxis hermetizaciisaTvis. MmasSi Semavali
pirofosfaturi monomeri xels uwyobs arxis
instumenturi damuSavebis Sedegad warmoqmnili webovani Sris dekalcinacias,
igi adhezivis polimerizebis damTavrebamde moqmedebs, Semdeg ki polimeris struqturaSi
Tavsdeba da demineralizaciisa da polimerizaciis procesebi sinqronulad mimdinareobs. adhezivi
dentinis Rrma fenebSi sakmao sisqis hibridul Sres qmnis. Kkbilis arxis
16% edt-iT damuSaveba ki adheziuri sistemis
aplikaciamde mniSvnelovnad zrdis mis mahermetizebel
efeqts.
l i t e r a t u r
a
1.
Батюков
Н. М., Ронь Г.И.,
Мандра Ю. В.
К вопросу
использования
корневых
адгезивов \\
Терапевтическая
стоматология.
Материалы
итоговой
научно-практической
конференции –
Екатеринбург
– 1999 г. с. 44
2,
Винниченко
Ю.А.,
Винниченко
А.В., Баулин М.В.
Адгезионная
техника в
эндодонтии // Клиническая
стоматология.
1997 г. №4 с 6-11.
3.
Максимовский
Ю.М.
Как оценить
успех или
неудачу в
планируемом
эндодонтическом
лечении //
Клиническая стоматология.
1997 г.
№3 с 4-7
4, Коскарап С.: Die Bedeutung der Schmierschicht bei der Wurzelkanalbehandlung.
Endodontic
5. Baumgartner, J.C., Cuenin, P.R. : Efficacy of several
coneentrations of sodium hypochlorite for root canal
irrigation. J. Endodont. 18: 605, 1992
6. Lumely,
P.J., Walmsley, A.D., Walton, R.E., Rippin, J.W.
Effect of precurving endosonic files on the of debris and
smear layer remaining in curved root canals. J. Endodont.
18: 616, 1992.
Summary
The mechanism of intraradical use of dentin adhesive systems and etching acids of hard tissues is unknown today. Therefore our research was aimed at studying the degree of their adhesion and penetration into tooth canal tissues with the help of scanning electronic microscope.
3 various adhesives AQ Bond (Morita), Etch & Prime (Degussa) and Prime & Bond NT (Dentsply) were used in the process of the research. 16% EDTA and 35% H3PO4 were selected as etching components. Human extracted teeth were used as objects of the research. The sections of teeth were studied with scanning electronic microscope after their treatment with the above-mentioned systems.
Adhesive system Etch & Prime 3.0 (Degussa) together with 16% EDTA demonstrated the best qualities. Dissolution of smear layer on the canal wall after the operation of EDTA and the exposition of dentin apertures stimulated penetration of the adhesive into deep layers of dentins and formation of wide hybrid zones.
manjaviZe natalia amiranis asuli
el. fosta:
Mediana@tbiline.com
stomatologiuri klinika “roial denti”
tel: 22 61 68; faqsi
23 33 66.