hellenic stomatological review

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TOMO™ 57 ñ TEYXO™ 2
A¶PI§IO™ - IOYNIO™ 2013
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ISSN 1011 - 4181
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T· E™X ‚Ú›ÛÎÔÓÙ·È Î·Ù·¯ˆÚË̤ӷ ÛÙÔÓ
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¶ÂÚÈÔ‰ÈÎÒÓ ÙÔ˘ EıÓÈÎÔ‡ K¤ÓÙÚÔ˘ TÂÎÌËÚ›ˆÛ˘
TA «E§§HNIKA ™TOMATO§O°IKA XPONIKA» ™TO ¢IA¢IKTYO
To ¢ÈÔÈÎËÙÈÎfi ™˘Ì‚Ô‡ÏÈÔ Ù˘ EOO Î·È Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹
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ÙȘ ‰˘Ó·ÙfiÙËÙ˜ Ù˘ Û‡Á¯ÚÔÓ˘ ËÏÂÎÙÚÔÓÈ΋˜ Ù¯ÓÔÏÔÁ›·˜, ·ÔÊ¿ÛÈÛÂ,
Ë ÙÚÈÌËÓÈ·›· ¤Î‰ÔÛË ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Ó· Á›ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο
ËÏÂÎÙÚÔÓÈο, Ì ·Ó¿ÚÙËÛË ÙˆÓ Ù¢¯ÒÓ ÛÙÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ
Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜.
HÏÂÎÙÚÔÓÈ΋ EÈÎÔÈÓˆÓ›·
Î·È AÔÛÙÔÏ‹ EÈÛÙËÌÔÓÈÎÒÓ EÚÁ·ÛÈÒÓ
ÛÙË ‰È‡ı˘ÓÛË
[email protected]
TOMO™ 57
A¶PI§IO™ - IOYNIO™ 2013
hellenic stomatological review
HELLENIC DENTAL ASSOCIATION
VOLUME 57, ISSUE 2, APRIL - JUNE 2013
ISSN 1011 - 4181
2
EÏÏËÓÈ΋ O‰ÔÓÙÈ·ÙÚÈ΋ OÌÔÛÔÓ‰›·
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TOMO™ 57, TEYXO™ 2
A¶PI§IO™ - IOYNIO™ 2013
ISSN 1011 - 4181
¶EPIEXOMENA
¶APOY™IA™H ¶EPI™TATIKøN
ñ K¿Ù·ÁÌ· Ù˘ οو ÁÓ¿ıÔ˘ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜
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M. °Ú›‰Ô˘ , A. BÏ·¯¿ÎË, M. ¢ËÌÔÔ‡ÏÔ˘ Î·È º. T˙¤ÚÌÔ˜ .........73-78
ñ T¯ÓÈ΋ ¿ÌÂÛ˘ ·ÈÛıËÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ì ۇÓıÂÙ˜ ÚËÙ›Ó˜
Û ÚfiÛıÈ· ¿Óˆ ‰fiÓÙÈ· II˘ Û˘ÁÎÏÂÈÛȷ΋˜ Ù¿Í˘.
E. TÛÈÔ‡ÚË, ¢. ™·ÁfiÔ˘ÏÔ˜ Î·È M. AÓÙˆÓÈ¿‰Ô˘ .......................79-90
ñ OÏÈ΋ AÔηٿÛÙ·ÛË ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘
Ì ÔÏÔÎÂÚ·ÌÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ.
Œ. E˘·ÁÁ¤ÏÔ˘, I. T˙Ô‡Ù˙·˜ Î·È ¶. Zˆ›‰Ë˜ .....................................91-99
¶APOY™IA™H ¶EPI™TATIKøN KAI ANA™KO¶H™H
TH™ BIB§IO°PAºIA™
ñ ZÈÚÎÔÓ›·: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÂÓfi˜ ÔÏ˘Û˘˙ËÙË̤ÓÔ˘ ˘ÏÈÎÔ‡.
¢ÔÌ‹, ÂÊ·ÚÌÔÁ¤˜ Î·È ÎÏÈÓÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ›.
E. T˙·Ó·Î¿Î˘, I. T˙Ô‡Ù˙·˜ Î·È E. KÔÓÙÔÓ·Û¿ÎË.......................101-137
Hellenic Dental Association
Hellenic
Stomatological
Review
PROPRIETOR:
Hellenic Dental Association
EDITOR -IN- CHIEF:
J. G. Tzoutzas
EDITORIAL BOARD:
G. Douvitsas
F. Zervou-Valvi
H. Karkazis
G. Polyzois
A. Kossioni
P. Lagouvardos
G. Mountouris
H. Paximada
L. Papagiannoulis D. Sakellari
F. Tzerbos
V. Topitsoglou-Themeli
D. Tziafas
PRODUCTION SUPERVISORS:
M. Antoniadou, E.T. Farmakis
COPY EDITOR:
Evelin Babai
PRODUCTION - PROMOTION:
TypeProduct
V. & E. Babai Ltd
32 Epikourou Str., Athens Hellas
Phone#: (3210) 32.14.904
Fax#: (3210) 32.14.991
ADVERTISEMENTS - PUBLIC
RELATIONS:
M. Morfoniou - S. Gogas
Phone#: (3210) 33.02.343
Fax: (3210) 38.34.385
e-mail: [email protected]
Hellenic Stomatological Review is the
official publication of the Hellenic Dental
Association, published trimonthly.
Annual subscription
40 $ USD
PUBLISHER:
Athanasios Katsikis
President of the Hellenic Dental Association
HEADQUARTERS
38 Themistokleous Str., Athens, 106 78
Phone#: (3210) 38.13.380
Fax#: (3210) 38.34.385
e-mail: [email protected]
VOLUME 57, ISSUE 2
APRIL - JUNE 2013
ISSN 1011 - 4181
CONTENTS
CASE REPORTS
ñ Fracture of the mandible as a complication of preimplant
surgery. Case report.
M. Gridou, A. Vlachaki, M. Dimopoulou and F. Tzermpos............73-78
ñ Anterior upper teeth direct esthetic bonding
in a class II bite case.
E. Tsiouri, D. Spagopoulos and M. Antoniadou ............................79-90
ñ Full Fixed Mandibular Restoration
with Monolithic Zirconia All Ceramic Material.
E. Evangelou, I, Tzoutzas and P. Zoidis.........................................91-99
CASE REPORT AND LITERATURE REVIEW
ñ Zirconia: Contemporary views of a much talked material:
Structure, applications and clinical considerations.
E. Tzanakakis, I. Tzoutzas, E. Kontonasaki ................................101-137
™YNTAKTIKH ™E§I¢A
YÏÈο Î·È T¯ÓÈΤ˜
H ÂͤÏÈÍË ÙˆÓ BÈÔ˘ÏÈÎÒÓ ¤¯ÂÈ Ê¤ÚÂÈ ÛÙÔ ÚÔÛ΋ÓÈÔ ÌÈ· ÛÂÈÚ¿ ˘ÏÈÎÒÓ Ô˘ ˘fiÛ¯ÔÓÙ·È ‚ÈÔÏÔÁÈ΋ Û˘Ì‚·ÙfiÙËÙ·, Ì·ÎÚÔ‚ÈfiÙËÙ·, ¿ÚÈÛÙ˜ ÎÏÈÓÈΤ˜ ÂȉfiÛÂȘ ηÈ
Û˘ÌÂÚÈÊÔÚ¿, ·ÈÛıËÙÈ΋ ÙÂÏÂÈfiÙËÙ· Î·È ˘„ËϤ˜ Ì˯·ÓÈΤ˜ ÂȉfiÛÂȘ.
T· ˘ÏÈο ·˘Ù¿ ·Ó‹ÎÔ˘Ó ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ÔÏ˘ÌÂÚÒÓ Î·È ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Î·È
Û ۇÓÙÔÌ· ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù· ‚ÂÏÙÈÒÓÔ˘Ó ÙȘ Ê˘ÛÈÎÔÌ˯·ÓÈΤ˜ ÂȉfiÛÂȘ ÙÔ˘˜,
·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚ˜ ηÈÓÔÙÔÌÈΤ˜ Ù¯ÓÈΤ˜ Î·È ÎÏÈÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ÙÔ˘˜.
EÓ ÙÔ‡ÙÔȘ Ù· ˘ÏÈο ·˘Ù¿ ··ÈÙÔ‡Ó Â˘Ú›· ÁÓÒÛË ÂÚÈ ·˘Ù¿, ηÙÔ¯‹ ÙˆÓ ÏÂÙÔÌÂÚÂÈÒÓ ¯Ú‹Û˘ Î·È ÂÊ·ÚÌÔÁ‹˜ ÙÔ˘˜, ·fiÏ˘ÙÔ Û‚·ÛÌfi ÛÙȘ ÂӉ›ÍÂȘ Î·È ÙÔ˘˜
ÂÚÈÔÚÈÛÌÔ‡˜ ÙÔ˘˜ Î·È ÔˆÛ‰‹ÔÙ ÁÓÒÛË ÙˆÓ ÎÏÈÓÈÎÒÓ ÛÙ·‰›ˆÓ Ô˘ Ú¤ÂÈ Ó·
·ÎÔÏÔ˘ıËıÔ‡Ó ÒÛÙ ӷ ÌÂÁÈÛÙÔÔÈËıÔ‡Ó ÔÈ ‰˘Ó·ÙfiÙËÙ¤˜ ÙÔ˘˜.
EȉÈο ÛÙÔ ÛΤÏÔ˜ Ù˘ Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ˘ÏÈÎÒÓ ·˘ÙÒÓ Ì ÙÔ˘˜ ÛÎÏËÚÔ‡˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜, ›ӷÈ
¿ÎÚˆ˜ ··Ú·›ÙËÙË Ë ÂÈÌÂÏ‹˜ Ù‹ÚËÛË ÙˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ‰È·¯Â›ÚÈÛ‹ ÙÔ˘˜ Î·È Ë ÈÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÙˆÓ
ηٿÏÏËÏˆÓ ˘ÏÈÎÒÓ Ô˘ ı· ÂÈÙÚ¤„Ô˘Ó ÙËÓ Ì·ÎÚfi¯ÚÔÓË ·Ú·ÌÔÓ‹ ÙÔ˘˜ ÛÙÔ ÛÙfiÌ· Î·È ÙËÓ ‰È·Ù‹ÚËÛË Ù˘ ·ÎÂÚ·ÈfiÙËÙ¿˜ ÙÔ˘˜.
I‰È·›ÙÂÚ· Ù· ÎÂÚ·ÌÈο ˘ÏÈο, ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ¤Ó· ·ÎÏÔ Û˘Óԉ¢ÙÈÎÒÓ Ù¯ÓÈÎÒÓ Î·È ˘ÏÈÎÒÓ, ··Ú·›ÙËÙˆÓ ÁÈ· ÙËÓ ÚÔÂÙÔÈÌ·Û›· Ù˘ ÂÛˆÙÂÚÈ΋˜ ÂÈÊ¿ÓÂÈ¿˜ ÙÔ˘˜ Î·È ÙË Û˘ÁÎfiÏÏËÛ‹ ÙÔ˘˜ Ì ÙÔ˘˜
ÛÎÏËÚÔ‡˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜.
H ·ÍÈÔÔ›ËÛË Ù˘ ‰˘Ó·ÙfiÙËÙ¿˜ ÙÔ˘˜ Ó· ÂÈÙÚ¤Ô˘Ó ÛÙÔ ÊÒ˜ Ó· ‰È¤Ú¯ÂÙ·È ÂÈÏÂÎÙÈο ·ÏÏ¿ Î·È ·ÓÂÌfi‰ÈÛÙ· ̤۷ ·fi ÙË Ì¿˙· ÙÔ˘˜, ‰ËÌÈÔ˘ÚÁ› ÙËÓ ·Ó¿ÁÎË ·ÚÔ˘Û›·˜ ÛÙÔ O‰ÔÓÙÈ·ÙÚ›Ô, ÛÂÈÚ¿˜ ÔÏfiÎÏËÚ˘ ·fi ‰ÔÎÈÌ·ÛÙÈο ˘ÏÈο, ˘ÏÈο ÚÔÛÔÌÔ›ˆÛ˘, ˘ÏÈο ÙÚÔÔÔ›ËÛ˘ Ù˘ ÙÂÏÈ΋˜ ·ÈÛıËÙÈ΋˜ ·fi‰ÔÛ˘ Î·È ˘ÏÈο Û˘ÁÎfiÏÏËÛ‹˜ ÙÔ˘˜ Ì ÈηÓfiÙËÙ· ÌÂÁÈÛÙÔÔ›ËÛ˘ ÙˆÓ ·ÈÛıËÙÈÎÒÓ ‰˘Ó·ÙÔÙ‹ÙˆÓ ÙÔ˘˜.
T· ˘ÏÈο ·˘Ù¿ fï˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰˘ÛÙÚÔ›Â˜ ÛÙË Û˘ÁÎfiÏÏËÛ‹ ÙÔ˘˜ Ì ÙËÓ Ô‰ÔÓÙ›ÓË Ì ÙË ¯Ú‹ÛË
ÙˆÓ ÎÏ·ÛÛÈÎÒÓ ÚËÙÈÓˆ‰ÒÓ ÎÔÓÈÒÓ Î·È ··ÈÙÔ‡Ó È‰È·›ÙÂÚË ÌÂÙ·¯Â›ÚÈÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ú·Ì›ÓÔ˘Ó Û˘ÁÎÔÏÏË̤ӷ Î·È ·Ó¤·Ê·.
ŒÙÛÈ ÏÔÈfiÓ ÛÙÔ O‰ÔÓÙÈ·ÙÚÂ›Ô Â›Ó·È ϤÔÓ ··Ú·›ÙËÙË Ë ·ÚÔ˘Û›· ÂÈϤÔÓ ˘ÏÈÎÒÓ, ÂÈϤÔÓ Û˘Û΢ÒÓ Î·È Ë ·Ó¿ÏˆÛË ÈηÓÔ‡ ¯ÚfiÓÔ˘, ÁÈ· ÙËÓ ÂÈÙ˘¯‹ Û˘ÁÎfiÏÏËÛË ÔÏÔÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ
Â›Î·ÈÚ˘ Ù¯ÓÔÏÔÁ›·˜.
T· ˘ÏÈο ·˘Ù¿ Â›Ó·È ÌÈÎÚÔ‡ fiÁÎÔ˘, ˘„ËÏÔ‡ ÎÔÛÙÔÏÔÁ›Ô˘ Î·È ÂÍÂȉÈÎÂ˘Ì¤Ó˘ ‰È·¯Â›ÚÈÛ˘ Î·È ··ÈÙÔ‡Ó
ÙËÓ Â·Ú΋ ÂÎ·›‰Â˘ÛË Î·È ÁÓÒÛË ÂΠ̤ÚÔ˘˜ ÙÔ˘˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘, ÁÈ· fiϘ ÙȘ Ù˘¯¤˜ ÙˆÓ ÂÊ·ÚÌÔÁÒÓ
ÙÔ˘˜.
H ·Ï‹ ·Ó¿ÁÓˆÛË ÙˆÓ Ô‰ËÁÈÒÓ ¯Ú‹Û˘ οı ˘ÏÈÎÔ‡, Â›Ó·È ÂÍ·ÈÚÂÙÈο ·ÓÂ·Ú΋˜ ÁÈ· ÙËÓ ÂÈÙ˘¯›· ÌÈ·˜
Ù¤ÙÔÈ·˜ ·ÔηٿÛÙ·Û˘. AÓÙ›ıÂÙ· Ë ·Ú·ÎÔÏÔ‡ıËÛË ÔÚÁ·ÓˆÌ¤ÓˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Ì·ıËÌ¿ÙˆÓ, Ë ·fiÎÙËÛË ÂÌÂÈÚ›·˜ ·fi ÂÊ·ÚÌÔṲ̂Ó˜ ·Û΋ÛÂȘ (hands-on), Ë ·Ú·ÎÔÏÔ‡ıËÛË ÔÏÔÎÏËÚˆÌ¤ÓˆÓ ÂÓÔÙ‹ÙˆÓ Û˘Ó¯È˙fiÌÂÓ˘ ÂÎ·›‰Â˘Û˘ Î·È Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ÂÓË̤ڈÛË, Â›Ó·È ÔÈ ÌfiÓ˜ ·Ú¿ÌÂÙÚÔÈ Ô˘ ÂÁÁ˘ÒÓÙ·È ÙËÓ ÂÈÙ˘¯‹ ¤Î‚·ÛË ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ô˘ ·Ó·Ï·Ì‚¿ÓÔÓÙ·È, ÙÔÓ ÂÚÈÔÚÈÛÌfi ÙˆÓ ·ÓÂÈı˘Ì‹ÙˆÓ ηٷÛÙ¿ÛÂˆÓ Î·È ÙË ‰ËÌÈÔ˘ÚÁ›· ÈηÓÔÔÈËÌ¤ÓˆÓ ·ÛıÂÓÒÓ, Ô˘ ˙ËÙÔ‡Ó ÏÂÈÙÔ˘ÚÁÈ΋ Î·È ·ÈÛıËÙÈ΋
ÙÂÏÂÈfiÙËÙ· Î·È fi¯È ·Ï¿ οÔȘ Û˘Ì‚·ÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ.
I. °. TZOYTZA™
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O‰ËÁ›Â˜ ÁÈ· ÙËÓ ·Ó·˙‹ÙËÛ‹ ÙÔ˘˜
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EÌÊ·Ó›˙ÂÙ·È Ë ÛÂÏ›‰·
EÈϤͷÙ ٷ «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο».
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EÈϤͷÙ ÙËÓ ÂÚÁ·Û›· Ô˘ Û·˜ ÂӉȷʤÚÂÈ
¢ÒÛÙ ÂÓÙÔÏ‹ ÁÈ· ·Ôı‹Î¢ÛË ‹ ÂÎÙ‡ˆÛË Ù˘ ÂÓfiÙËÙ·˜ Ô˘ Û·˜ ÂӉȷʤÚÂÈ
™˘ÓÙÌ‹ÛÂȘ Î·È ™‡Ì‚ÔÏ· ™Ù·ıÂÚÒÓ MÔÓ¿‰ˆÓ, ™Ù·ÙÈÛÙÈÎÒÓ ŸÚˆÓ Î·È OÚÁ·ÓÔÏÔÁ›·˜
ŸÚÔ˜
™‡ÓÙÌËÛË
‹ ۇ̂ÔÏÔ
™Ù·ıÂÚ¤˜ ÌÔÓ¿‰Â˜
ampere
A
angström
AÆ
barm
b
calorie
cal
candela
cd
coulomb
C
counts per minute
cpm
counts per second
cps
curie
Ci
degree Celsius
ÆC
disintegration
per minute
dpm
disintegration
per second
dps
electron Volt
eV
equivalent
Eq
farad
F
gauss
G
gram
g
henry
H
hertz
Hz
hour
h
inch
in
ŸÚÔ˜
international unit
joule
kelvin
kilogram
liter/litre
meter, metre
minute
molar
mole
newton
normal (concentration)
ohm
osmol
pascal
pound
pound per square inch
revolutions per minute
second
square centimeter
volt
watt
week
year
™‡ÓÙÌËÛË
‹ ۇ̂ÔÏÔ
IU
J
K
kg
I or L
m
min
M
mol
N
N
ø
osmol
Pa
lb
psi
rpm
s
cm2
V
W
wk
yr
™‡ÓÙÌËÛË
‹ ۇ̂ÔÏÔ
ŸÚÔ˜
correlation coefficient
degrees of freedom
mean
mean not significant
number of
observations
teragigamegakilohectodecadeciSEM:
TEM:
ESEM:
CSEM:
AFM:
SPM:
EELS:
EDS:
EPMA:
XRF:
XRD:
FTIR:
(1012)
(109)
(106)
(103)
(102)
(10)
(10-1)
™‡ÓÙÌËÛË
‹ ۇ̂ÔÏÔ
ŸÚÔ˜
™Ù·ÙÈÛÙÈÎÔ› fiÚÔÈ
probability
standard deviation
Standard error
of the mean
Student’s test
n
variance
r
df
x
NS
™˘Ó‰˘·ÛÌfi˜ ÚÔıÂÌ¿ÙˆÓ
T
centiG
miliM
microk
nanoh
picoda
femtod
atto-
(10-2)
(10-3)
(10-6)
(10-9)
(10-12)
(10-15)
(10-18)
Scanning Electron Microscopy
Transmission Electron Microscopy
Environmental Scanning Electron Microscopy
Confocal Scanning Electron Microscopy
Atomic Force Microscopy
Scanning Probe Microscopy
Electron Energy Loss Spectrometry
Element Dispersive Spectroscopy
Electron Probe Microanalysis
X-ray Fluorescence analysis
X-ray Diffraction
Fourrier Transformation Infrared Spectroscopy
p
SD
SE
t test
F
c
m
Ìm
n
p
f
a
O¢H°IE™ °IA TOY™ ™Y°°PAºEI™
T· ™TOMATO§O°IKA XPONIKA Â›Ó·È Ë Â›ÛËÌË ÂÈÛÙËÌÔÓÈ΋ ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ OÌÔÛÔÓ‰›·˜ Î·È ˆ˜ ÛÙfi¯Ô ¤¯Ô˘Ó ÙË Û˘Ó¯‹ ÂÈÛÙËÌÔÓÈ΋ ÂÓË̤ڈÛË ÙÔ˘ ŒÏÏËÓ· O‰ÔÓÙÈ¿ÙÚÔ˘ Î·È ÙËÓ ÚÔÒıËÛË Ù˘
O‰ÔÓÙÈ·ÙÚÈ΋˜ EÈÛÙ‹Ì˘ ÛÙÔÓ EÏÏËÓÈÎfi ¯ÒÚÔ. °È· ÙËÓ
Ú·ÁÌ¿ÙˆÛË ÙÔ˘ ÛÎÔÔ‡ ·˘ÙÔ‡ ‰ËÌÔÛȇÔÓÙ·È:
1. K‡ÚÈ· ı¤Ì·Ù·:
ÕÚıÚ· Û ÌÔÚÊ‹ ·Ó·ÛÎfiËÛ˘, Ô˘ ·ÊÔÚÔ‡Ó Â›Î·ÈÚ·
Î·È ·ÌÊÈÏÂÁfiÌÂÓ· ı¤Ì·Ù· Î·È Ô˘ ÁÚ¿ÊÔÓÙ·È Ì ÚÔÙÚÔ‹
Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·fi Û˘Ó·‰¤ÏÊÔ˘˜ Ì ÂȉÈΤ˜
Û ‚¿ıÔ˜ ÁÓÒÛÂȘ ÙÔ˘ ı¤Ì·ÙÔ˜.
2. EÈÛÙËÌÔÓÈο ¿ÚıÚ· Ô˘ ÛÙ¤ÏÓÔÓÙ·È ·fi Û˘Ó·‰¤ÏÊÔ˘˜:
T· ¿ÚıÚ· ·˘Ù¿ ÌÔÚ› Ó· ·Ó‹ÎÔ˘Ó Û ̛· ·fi ÙȘ ·Ú·Î¿Ùˆ ηÙËÁÔڛ˜: ·) AÓ·ÛÎÔ‹ÛÂȘ (̤¯ÚÈ 3 Û˘ÁÁÚ·Ê›˜)
‚) EÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ (¶ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈΤ˜
ÌÂϤÙ˜, EÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜, EȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, KÏÈÓÈÎÔÛÙ·ÙÈÛÙÈΤ˜ ÌÂϤÙ˜, KÏÈÓÔ·ıÔÏÔÁÈΤ˜ ÌÂϤÙ˜) Á) EӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰) ¶Ú·ÎÙÈο ı¤Ì·Ù·,
Â) E·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ÂÈÛÙËÌÔÓÈο ÙÂÎÌËÚȈ̤ӷ, ÛÙ)
£¤Ì·Ù· ¢ËÌfiÛÈ·˜ YÁ›·˜, ˙) £¤Ì·Ù· ÛÙÚ·ÙËÁÈ΋˜ , Ë)
EÎ·È‰Â˘ÙÈο £¤Ì·Ù· Î·È È) £ÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜.
3. °Ú¿ÌÌ·Ù· ÚÔ˜ ÙË ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹:
T· ÁÚ¿ÌÌ·Ù· Ô˘ ‰ËÌÔÛȇÔÓÙ·È ÌÂÙ¿ ·fi ¤ÁÎÚÈÛË Ù˘
™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜ ·ÊÔÚÔ‡Ó: ·) ÎÚ›ÛÂȘ ÁÈ· ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ· Î·È ‚) Û˘ÁÎÂÎÚÈ̤ӷ ÂÚˆÙ‹Ì·Ù· Û¯ÂÙÈο ÌÂ
ÂÈÛÙËÌÔÓÈο ı¤Ì·Ù· Î·È Ô˘ ı· ‰›ÓÔÓÙ·È ··ÓÙ‹ÛÂȘ ·fi
ÙË ÛÙ‹ÏË Ù˘ ·ÏÏËÏÔÁÚ·Ê›·˜.
4. ™‡ÓÙÔ̘ ÚˆÙfiÙ˘˜ ‰ËÌÔÛȇÛÂȘ:
£· ·ÊÔÚÔ‡Ó ÚˆÙfiÙ˘˜ ÂÚÁ·Û›Â˜ ‹ Â˘Ú‹Ì·Ù·, ‰Â ı·
¤¯Ô˘Ó ¤ÎÙ·ÛË ÌÂÁ·Ï‡ÙÂÚË ·fi 2.000 ϤÍÂȘ Î·È ı· ‰ËÌÔÛȇÔÓÙ·È ÙÔ Û˘ÓÙÔÌfiÙÂÚÔ ‰˘Ó·Ùfi ·fi ·ÍÈÔÏfiÁËÛË Ù˘
™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜.
5. ¶ÂÚÈÏ‹„ÂȘ ¿ÚıÚˆÓ:
OÈ ÂÚÈÏ‹„ÂȘ ·˘Ù¤˜ ı· ·ÊÔÚÔ‡Ó ¿ÚıÚ· EÏÏ‹ÓˆÓ Û˘Ó·‰¤ÏÊˆÓ Ô˘ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ÚfiÛÊ·Ù· Û ÂÚÈÔ‰Èο
ÙÔ˘ Â͈ÙÂÚÈÎÔ‡.
ŒÎÙ·ÛË ¿ÚıÚˆÓ: OÈ ·Ó·ÛÎÔ‹ÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ÍÂÂÚÓÔ‡Ó ÙȘ 7.500 ϤÍÂȘ (25 ‰·ÎÙ˘ÏÔÁÚ·ÊË̤Ó˜ ÛÂÏ›‰Â˜) Î·È ÙȘ 100 ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ì ÂÍ·›ÚÂÛË
ÂȉÈο ı¤Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ‚·ÛÈΤ˜ ÂÈÛً̘. OÈ
ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ Î·È Ù· Ú·ÎÙÈο ı¤Ì·Ù· ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 3.000 ϤÍÂȘ (10 ÛÂÏ›‰Â˜) Î·È ÙȘ 40
·Ú·ÔÌ¤˜. T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ÂӉȷʤÚÔ˘Û˜ ÂÚÈÙÒÛÂȘ ‰Â ı· Ú¤ÂÈ Ó· ˘ÂÚ‚·›ÓÔ˘Ó ÙȘ 1.000 ϤÍÂȘ (4
ÛÂÏ›‰Â˜), ÂÓÒ Ù· Â·ÁÁÂÏÌ·ÙÈο ı¤Ì·Ù· ı· Ú¤ÂÈ Ó· ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙȘ 5.000 ϤÍÂȘ (20 ÛÂÏ›‰Â˜). ™ÙËÓ ¤ÎÙ·ÛË
ÙˆÓ ·Ú·¿Óˆ ¿ÚıÚˆÓ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È Ë ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ı· Ú¤ÂÈ Ó· Â›Ó·È Â›Î·ÈÚË Î·È Ó· ¤¯ÂÈ ¿ÌÂÛË
Û¯¤ÛË Ì ÙÔ ‰È·Ú·ÁÌ·Ù¢fiÌÂÓÔ ı¤Ì·.
™‡ÓÙ·ÍË ÎÂÈ̤ӈÓ: T· ¿ÚıÚ· Ô˘ ˘Ô‚¿ÏÏÔÓÙ·È ÁÈ·
‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· Â›Ó·È ÁÚ·Ì̤ӷ ÛÙË ÓÂÔÂÏÏËÓÈ΋
‰ËÌÔÙÈ΋, Ì ÌÔÓÔÙÔÓÈÎfi Û‡ÛÙËÌ·, ηıÒ˜ Â›Û˘ Î·È ÛÙËÓ
·ÁÁÏÈ΋ ÁÏÒÛÛ·. H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ÂϤÁÍÂÈ ÙËÓ ·ÎÚ›‚ÂÈ· ÙˆÓ ·ÁÁÏfiÊˆÓˆÓ fiÚˆÓ Î·È
‰È·Ù˘ÒÛÂˆÓ ·¢ı˘ÓfiÌÂÓË Û Â·ÁÁÂÏ̷ٛ˜ È·ÙÚÈÎÔ‡˜
ÌÂÙ·ÊÚ·ÛÙ¤˜. O ‰ÈÔÚıˆÙ‹˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ¤¯ÂÈ ÙÔ ‰ÈηÈÒÌ· Ó· ÙÚÔÔÔÈ‹ÛÂÈ ÁψÛÛÈο ÙÔ Î›ÌÂÓÔ, ¯ˆÚ›˜ fï˜ Ó·
·ÏÏÔÈÒÛÂÈ ÙÔ ‡ÊÔ˜ ÙÔ˘ Û˘ÁÁڷʤ·.
OÈ ÂÚÁ·Û›Â˜ ·˘Ù¤˜ Ú¤ÂÈ Ó· Â›Ó·È ÏËÎÙÚÔÏÔÁË̤Ó˜
Û ‰ÈÏfi ‰È¿ÛÙËÌ·, Ì ÁÚ·ÌÌ·ÙÔÛÂÈÚ¤˜ Arial, Tahoma ‹
Verdana Ì ÂÚÈıÒÚÈÔ ·fi ÙȘ ‰‡Ô Ï¢ڤ˜.
™Â ȉȷ›ÙÂÚË ÛÂÏ›‰· ·Ú¯›˙Ô˘Ó ÔÈ ÂÍ‹˜ ÂÓfiÙËÙ˜: Ë ÛÂÏ›‰· Ù›ÙÏÔ˘, Ë ÂÚ›ÏË„Ë Î·È ÔÈ Ï¤ÍÂȘ ÎÏÂȉȿ, ÙÔ Î›ÌÂÓÔ Ù˘
ÂÚÁ·Û›·˜, Ë ÂÚ›ÏË„Ë ÛÙËÓ ·ÁÁÏÈ΋ Î·È ÔÈ Ï¤ÍÂȘ ÎÏÂȉȿ
ÛÙËÓ ·ÁÁÏÈ΋, ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜, ÔÈ ÏÂ˙¿ÓÙ˜, ÔÈ ›Ó·Î˜ Î·È ÔÈ ÂÈÎfiÓ˜. ŸÏ˜ ÔÈ ÛÂÏ›‰Â˜ ·ÚÈıÌÔ‡ÓÙ·È Ì ÙËÓ ·ÓˆÙ¤Úˆ ÛÂÈÚ¿.
¶ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÍÈÔÔÈËıÔ‡Ó ÔÈ Â˘ÎÔϛ˜ Ù˘ Û‡Á¯ÚÔÓ˘ Ù¯ÓÔÏÔÁ›·˜ Î·È ÚÔ˜ ·ÔÊ˘Á‹Ó ÙˆÓ ÛÊ·ÏÌ¿ÙˆÓ Î·Ù¿
ÙËÓ ÏËÎÙÚÔÏfiÁËÛË ÎÚ›ÓÂÙ·È Û·Ó ··Ú·›ÙËÙË Ë ˘Ô‚ÔÏ‹
Ù˘ ÂÚÁ·Û›·˜ ÂȘ ÙÚÈÏÔ‡Ó Û˘Óԉ¢fiÌÂÓË ·fi CD fiÔ˘ Ù·
ΛÌÂÓ· ı· Ú¤ÂÈ Ó· Â›Ó·È ÏËÎÙÚÔÏÔÁË̤ӷ Û ÚfiÁÚ·ÌÌ· Word Û ¯·Ú·ÎÙ‹Ú˜ 12 ÛÙÈÁÌÒÓ. Afi ÙÔÓ I·ÓÔ˘¿ÚÈÔ
ÙÔ˘ 2010 ÔÈ ÂÚÁ·Û›Â˜ ˘Ô‚¿ÏÏÔÓÙ·È Î·È ËÏÂÎÙÚÔÓÈο ÛÙËÓ
‰È‡ı˘ÓÛË ·ÏÏËÏÔÁÚ·Ê›·˜ ÙˆÓ E™X [email protected]
™ÂÏ›‰· Ù›ÙÏÔ˘: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ: ·) ÙÔÓ Ù›ÙÏÔ Ù˘ ÂÚÁ·Û›·˜,
‚) ÙÔ fiÓÔÌ· Î·È ÙÔÓ Ù›ÙÏÔ ÙÔ˘ (ÙˆÓ) Û˘ÁÁڷʤ· (ˆÓ), Á) ÙÔ
›‰Ú˘Ì· ·’ fiÔ˘ ÚÔ¤Ú¯ÂÙ·È Ë ÂÚÁ·Û›·, ‰) ÙÔ ·Ó Ë ÂÚÁ·Û›·
¤¯ÂÈ ·Ó·ÎÔÈÓˆı› Û οÔÈÔ Û˘Ó¤‰ÚÈÔ Î·È ÔÈÔ, Â) ÙÔ fiÓÔÌ·,
‰È‡ı˘ÓÛË Î·È ÙËϤʈÓÔ ÙÔ˘ Û˘ÁÁڷʤ· ÁÈ· ÙËÓ ·ÏÏËÏÔÁÚ·Ê›·, ÛÙ) ÙÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÂÚÁ·Û›·˜ (‚¿ÛÂÈ ÙÔ˘ 2 ‹
4), ˙) ¶Èı·Ó‹ ËÁ‹ ¯ÚËÌ·ÙÔ‰fiÙËÛ˘ Ù˘ ¤Ú¢ӷ˜.
¶ÂÚ›ÏË„Ë Î·È Ï¤ÍÂȘ ÎÏÂȉȿ: H ÂÚ›ÏË„Ë ı· Ú¤ÂÈ Ó·
¤¯ÂÈ ¤ÎÙ·ÛË Ì¤¯ÚÈ 200 ϤÍÂȘ. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜,
Ë ÂÚ›ÏË„Ë ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ ÛÎÔfi ÂÚÁ·Û›·˜, ÙÔ ˘ÏÈÎfi, ÙË ÌÂıÔ‰ÔÏÔÁ›· Î·È Ù· Û˘ÌÂÚ¿ÛÌ·Ù·. OÈ
ϤÍÂȘ - ÎÏÂȉȿ ı· ·Ú·Ù›ıÂÓÙ·È Ì ÙËÓ ÂÚ›ÏË„Ë Î·È ı·
Ú¤ÂÈ Ó· Â›Ó·È 3-10 ÌÂÌÔӈ̤ÓÔÈ fiÚÔÈ ‹ ÌÈÎÚ¤˜ ÊÚ¿ÛÂȘ.
OÈ Ï¤ÍÂȘ ·˘Ù¤˜ ı· Ú¤ÂÈ Ó· ·ÓÙÈÛÙÔÈ¯Ô‡Ó ÛÙÔ˘˜ ‰ÈÂıÓ›˜
fiÚÔ˘˜ ÏÂÍÈÎÔÁÚ¿ÊËÛ˘ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Index
Medicus Î·È Dental Index Î·È Ó· ÂÌÂÚȤ¯ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ
Ù˘ ÂÚ›Ï˄˘.
K›ÌÂÓÔ: T· ¿ÚıÚ· Ô˘ ·ÊÔÚÔ‡Ó ·Ó·ÛÎÔ‹ÛÂȘ ı·
Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Ì›· ·ÓÙÈÚÔÛˆ¢ÙÈ΋ ÂÈÛ·ÁˆÁ‹ Î·È Î·ÙfiÈÓ Ó· ·Ó·Ê¤ÚÔÓÙ·È ÙÂÎÌËÚȈ̤Ó˜ ‚È‚ÏÈÔÁÚ·ÊÈο fiϘ ÔÈ ·fi„ÂȘ Ô˘ ·ÊÔÚÔ‡Ó ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ı¤Ì·.
T¤ÏÔ˜, ı· Ú¤ÂÈ Ó· ·Ú·Ù›ıÂÙ·È ÌÈ· ÎÚÈÙÈ΋ ·Ó¿Ï˘ÛË ÙˆÓ
·fi„ÂˆÓ ·˘ÙÒÓ ·fi ÙÔ Û˘ÁÁڷʤ· Î·È Ó· ηٷϋÁÂÈ ÛÂ
Û˘ÁÎÂÎÚÈ̤ӷ Û˘ÌÂÚ¿ÛÌ·Ù·.
OÈ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó· ·ÔÙÂÏÔ‡ÓÙ·È
·fi Ù· ÎÂÊ¿Ï·È·: EÈÛ·ÁˆÁ‹, YÏÈο Î·È M¤ıÔ‰Ô˜,
E˘Ú‹Ì·Ù·-AÔÙÂϤÛÌ·Ù·, ™˘˙‹ÙËÛË Î·È ™˘ÌÂÚ¿ÛÌ·Ù·.
™Ù· ˘fiÏÔÈ· ›‰Ë ÙˆÓ ¿ÚıˆÓ ÙÔ Î›ÌÂÓÔ ‰È·ÌÔÚÊÒÓÂÙ·È Û‡Ìʈӷ Ì ÙȘ ··ÈÙ‹ÛÂȘ ÙÔ˘ ¿ÚıÚÔ˘.
BÈ‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜: OÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ ÛÙÔ Î›ÌÂÓÔ, fiˆ˜ Î·È ÛÙÔ˘˜ ›Ó·Î˜ Î·È ÛÙȘ ÂÈ-
ÎfiÓ˜ Ì ÙȘ ÏÂ˙¿ÓÙ˜ ÙÔ˘˜, ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜ ·ÚÈıÌÔ‡˜ Û ·Ú¤ÓıÂÛË. TÂÏ›˜ ‹ ÎfiÌ·Ù· ÛËÌÂÈÒÓÔÓÙ·È ÌÂÙ¿ ÙËÓ ·Ú¤ÓıÂÛË Ô˘ ·Ú¤¯ÂÈ ÙË ‚È‚ÏÈÔÁÚ·ÊÈ΋
·Ú·ÔÌ‹. H ·Ú›ıÌËÛË ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ·Ú·ÔÌÒÓ Á›ÓÂÙ·È Î·Ù’ ·‡ÍÔÓÙ· ·ÚÈıÌfi Î·È Ì ÙË ÛÂÈÚ¿ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ.
ŸÏ˜ ÔÈ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È
ÛÙÔ Î›ÌÂÓÔ Î·Ù·¯ˆÚÔ‡ÓÙ·È ÛÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ
Ô˘ ·Ú¯›˙ÂÈ Û ȉȷ›ÙÂÚË ÛÂÏ›‰· ÌÂÙ¿ ÙÔ Î›ÌÂÓÔ. ¶ÚÈÓ ·fi
οı ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ÛÙÔÓ Î·Ù¿ÏÔÁÔ, ÚÔËÁÂ›Ù·È Ô ·ÓÙ›ÛÙÔȯԘ ·ÚÈıÌfi˜ Ô˘ ÛËÌÂÈÒıËΠÛÙÔ Î›ÌÂÓÔ
Î·È ÛÙÔÓ ÔÔ›Ô ·ÓÙÈÛÙÔȯ› Ë ‚È‚ÏÈÔÁÚ·Ê›·.
™ÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ηٿÏÔÁÔ ÚÔËÁÔ‡ÓÙ·È Ù· ÔÓfiÌ·Ù·
ÙˆÓ Û˘ÁÁڷʤˆÓ (ÚÒÙ· ÙÔ ÂÒÓ˘ÌÔ Î·È ÌÂÙ¿ ÙÔ fiÓÔÌ·,
·ÎÔÏÔ˘ı› ÎfiÌ· Î·È ÙÔ ÂÒÓ˘ÌÔ ÙÔ˘ ÂfiÌÂÓÔ˘ Û˘ÁÁڷʤ·
Î.Ô.Î.), Ù›ıÂÙ·È ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ (:) Ô Ù›ÙÏÔ˜ ÙÔ˘ ¿ÚıÚÔ˘, ÙÂÏ›·, ÙÔ ÂÚÈÔ‰ÈÎfi ÛÂ Û˘ÓÙÔÌÔÁÚ·Ê›·, ÙÔ ¤ÙÔ˜, ÙÔ
ÚfiÛËÌÔ (;), Ô ÙfiÌÔ˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, Û ·Ú¤ÓıÂÛË ÙÔ
Ù‡¯Ô˜, ¿Óˆ Î·È Î¿Ùˆ ÛÙÈÁÌ‹ Î·È ÔÈ ÛÂÏ›‰Â˜ ÙÔ˘ ¿ÚıÚÔ˘
(ÚÒÙË, ·‡Ï· Î·È ÙÂÏÂ˘Ù·›·). OÈ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ Ù›ÙψÓ
ÂÚÈÔ‰ÈÎÒÓ Ú¤ÂÈ Ó· ÁÚ¿ÊÔÓÙ·È Û‡Ìʈӷ Ì ÙÔ Dental
Index Î·È Index Medicus. °È· ÙȘ Û˘ÓÙÌ‹ÛÂȘ ÙˆÓ ÂÏÏËÓÈÎÒÓ
ÂÚÈÔ‰ÈÎÒÓ ˘¿Ú¯ÂÈ Û¯ÂÙÈÎfi˜ ηٿÏÔÁÔ˜ ÙÔ˘ IATPOTEK.
¶Ú¤ÂÈ Ó’ ·ÔʇÁÂÙ·È ÁÂÓÈο Ë ¯ÚËÛÈÌÔÔ›ËÛË ÂÚÈÏ‹„ÂˆÓ (abstracts) ˆ˜ ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹, fiˆ˜ Â›Û˘
«·‰ËÌÔÛ›Â˘Ù˜ ·Ú·ÙËÚ‹ÛÂȘ» Î·È «ÚÔÛˆÈΤ˜ ÂÈÎÔÈӈӛ˜». T· «EÏÏËÓÈο ™ÙÔÌ·ÙÔÏÔÁÈο XÚÔÓÈο» Ú¤ÂÈ Ó·
Û˘ÓÙÔÌÔÁÚ·ÊÔ‡ÓÙ·È Û·Ó EÏÏ. ™ÙÔÌ. XÚÔÓ. ‹ ·ÁÁÏfiʈӷ
Hel Stom Rev.
EÚÁ·Û›Â˜ Ô˘ ¤¯Ô˘Ó Á›ÓÂÈ ‰ÂÎÙ¤˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË, ·ÏÏ¿
‰Â ‰ËÌÔÛȇıËÎ·Ó ·ÎfiÌË, ÌÔÚÔ‡Ó Ó· ·Ó·ÊÂÚıÔ‡Ó ÛÙË
‚È‚ÏÈÔÁÚ·Ê›·. ™ÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ ÛËÌÂÈÒÓÂÙ·È ÛÙÔ ÂÚÈÔ‰ÈÎfi Î·È Ë ÊÚ¿ÛË «˘fi ‰ËÌÔÛ›Â˘ÛË» Û ·Ú¤ÓıÂÛË.
E¿Ó Î·È ÂÊfiÛÔÓ ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· ÂÌÂÚȤ¯ÔÓÙ·È ¿ÚıÚ·
·fi ÂÚÈÔ‰Èο Ì ϷÙÈÓÔÁÂÓ‹ ÁÏÒÛÛ· Ô˘ ¤¯ÂÈ ÙÔÈΤ˜ ȉȷÈÙÂÚfiÙËÙ˜ (°ÂÚÌ·ÓÈο, ™Î·Ó‰ÈÓ·˘Èο, °·ÏÏÈο), Ô ÙÔÓÈÛÌfi˜ ÙˆÓ Ï¤ÍÂˆÓ Â›Ó·È Â˘ı‡ÓË ÙˆÓ Û˘ÁÁڷʤˆÓ.
¶·Ú¿‰ÂÈÁÌ· ÙÔ˘ ÔÚıÔ‡ ÙÚfiÔ˘ ÁÚ·Ê‹˜ ÙˆÓ ‚È‚ÏÈÔÁÚ·ÊÈÎÒÓ ‰›ÓÂÙ·È ·Ú·Î¿Ùˆ:
¶ÂÚÈÔ‰ÈÎfi: AӷʤÚÔÓÙ·È Ù· ÂÒÓ˘Ì· Î·È Ù· ·Ú¯Èο ÙˆÓ
ÔÓÔÌ¿ÙˆÓ fiÏˆÓ ÙˆÓ Û˘ÁÁڷʤˆÓ ̤¯ÚÈ ¤ÍË (fiÙ·Ó Â›Ó·È ÂÚÈÛÛfiÙÂÚÔÈ ·ÎÔÏÔ˘ı› Ë ¤Ó‰ÂÈÍË «et al», ÛÙ· ÂÏÏËÓÈο ¿ÚıÚ· ÁÚ¿ÊÔ˘Ì «Î·È Û˘Ó.»), Ô Ù›ÙÏÔ˜ Ù˘ ÂÚÁ·Û›·˜, Ë Û˘ÓÙÔÌÔÁÚ·Ê›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡, ÙÔ ¤ÙÔ˜, Ô ÙfiÌÔ˜, ÙÔ Ù‡¯Ô˜,
Ë ÚÒÙË Î·È Ë ÙÂÏÂ˘Ù·›· ÛÂÏ›‰· Ù˘ ‰ËÌÔÛ›Â˘Û˘. ¶.¯.
Papagiannoulis L, Kakaboura A, Eliades G: In vivo Vs in
Vitro anticariogenic behavior of glass-ionomer and
resin composite restorative materials. Dent Mater 2002;
18 (8): 561-569.
BÈ‚Ï›· Î·È ¿ÏϘ ÌÔÓÔÁڷʛ˜: AӷʤÚÔÓÙ·È Ì ÙË ÛÂÈÚ¿ Ù· ÂÒÓ˘Ì· Î·È ·Ú¯Èο ÙˆÓ Û˘ÁÁڷʤˆÓ, Ô Ù›ÙÏÔ˜ ÙÔ˘
‚È‚Ï›Ô˘, Ô ·ÚÈıÌfi˜ ¤Î‰ÔÛ˘, Ë fiÏË ¤Î‰ÔÛ˘. AÎÔÏÔ˘ı› Ô
ÂΉfiÙ˘, ÙÔ ¤ÙÔ˜ (¿Óˆ - οو ÙÂÏ›·) ÎÈ Ë ÛÂÏ›‰·. ¶.¯.
Ryge GM: Dental Corrosion. 2nd ed. New York. Harper
and Row. 1985: 204.
AÓ Ë ‚È‚ÏÈÔÁÚ·ÊÈ΋ ·Ú·ÔÌ‹ ·ÔÙÂÏ› ÎÂÊ¿Ï·ÈÔ
ÂÓfi˜ ‚È‚Ï›Ô˘ Ô˘ ¤¯ÂÈ ÁÚ·Ê› ·fi ¿ÏÏÔ Û˘ÁÁڷʤ·, Ë
·Ó·ÊÔÚ¿ Á›ÓÂÙ·È ˆ˜ ÂÍ‹˜: Johnston AJ: Corrosion
Resistance of Amalgams. In: Goldman AK, Johns KO,
eds. Restorative Materials, Baltimore. Williams and
Wilkins Co., 1984-87.
IÛÙÔÛÂÏ›‰Â˜:
http://www.eudental.org/Community
strategy concerning mercury, fiˆ˜ ·˘Ùfi ÂÌÊ·Ó›˙ÂÙ·È ÙËÓ
.............. (ËÌÂÚÔÌËÓ›· ·Ó·˙‹ÙËÛ˘).
H ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ˘ÂÓı˘Ì›˙ÂÈ ÛÙÔ˘˜ Û˘ÁÁÚ·Ê›˜
ÙˆÓ ÂÚÁ·ÛÈÒÓ fiÙÈ Î·Ïfi ›ӷÈ, ÛÙȘ ηٷÙÈı¤ÌÂÓ˜ ÂÚÁ·Û›Â˜
Ó· Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙȘ ‚È‚ÏÈÔÁÚ·ÊÈΤ˜ ·Ú·ÔÌ¤˜, ÂÊfiÛÔÓ ‚¤‚·È· ˘Ê›ÛÙ·ÓÙ·È, ÔÈÔÙÈο EÏÏËÓÈο ¿ÚıÚ· Û¯ÂÙÈο Ì ÙÔ ı¤Ì·.
AÁÁÏÈ΋ ÂÚ›ÏË„Ë: ¶ÂÚÈÏ·Ì‚¿ÓÂÈ, ÛÙËÓ AÁÁÏÈ΋ ÁÏÒÛÛ·, Ù· ÔÓfiÌ·Ù· ÙˆÓ Û˘ÁÁڷʤˆÓ Î·È ÙÔÓ Ù›ÙÏÔ Ù˘ ÂÚÁ·Û›·˜. ™ÙȘ ·Ó·ÛÎÔ‹ÛÂȘ ı· Ú¤ÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È
ÛÙÔȯ›· ÁÈ· fiÏ· Ù· ÎÂÊ¿Ï·È· Ô˘ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó Î·È Ù·
Û˘ÌÂÚ¿ÛÌ·Ù·. ™ÙȘ ÂÚ¢ÓËÙÈΤ˜ ÂÚÁ·Û›Â˜ ı· Ú¤ÂÈ Ó·
·Ó·Ê¤ÚÂÙ·È Ë ÂÈÛ·ÁˆÁ‹ Ô ÛÎÔfi˜, Ù· ˘ÏÈο Î·È Ë Ì¤ıÔ‰Ô˜,
Ù· ·ÔÙÂϤÛÌ·Ù· Ù· Û˘ÌÂÚ¿ÛÌ·Ù· Î·È Ë Û˘˙‹ÙËÛË. H
¤ÎÙ·ÛË ÙˆÓ ÂÚÈÏ‹„ÂˆÓ ı· Ú¤ÂÈ Ó· Î˘Ì·›ÓÂÙ·È ÌÂٷ͇
ÙˆÓ 250 ¤ˆ˜ 350 Ϥ͈Ó.
¶›Ó·Î˜: ¢·ÎÙ˘ÏÔÁÚ·ÊÔ‡ÓÙ·È Û ¯ˆÚÈÛÙ‹ ÛÂÏ›‰· Ô˘
ÂÚÈÏ·Ì‚¿ÓÂÈ Î·È ÙË ÏÂ˙¿ÓÙ·. H ÏÂ˙¿ÓÙ· Ú¤ÂÈ Ó· ›ӷÈ
Û‡ÓÙÔÌË Î·È Î·Ù·ÙÔÈÛÙÈ΋. AÚÈıÌÔ‡ÓÙ·È Ì ·Ú·‚ÈÎÔ‡˜
·ÚÈıÌÔ‡˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ Î›ÌÂÓÔ. OÈ ÂÂÍËÁ‹ÛÂȘ
ÙˆÓ Û˘ÓÙÔÌÔÁÚ·ÊÈÒÓ, ηıÒ˜ Î·È ¿ÏϘ ‰È¢ÎÚÈÓ‹ÛÂȘ, Á›ÓÔÓÙ·È ÛÙÔ Ù¤ÏÔ˜ ÙÔ˘ ›Ó·Î·.
EÈÎfiÓ˜: T· Û¯‹Ì·Ù·, Ù· ‰È·ÁÚ¿ÌÌ·Ù· Î·È ÔÈ ÊˆÙÔÁڷʛ˜ Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÔÓÙ·È ÛÙÔ ÚˆÙfiÙ˘Ô Î·È Ó· ›ӷÈ
˘„ËÏ‹˜ ¢ÎÚ›ÓÂÈ·˜. OÈ ÏÂ˙¿ÓÙ˜ ÙˆÓ ÂÈÎfiÓˆÓ ÁÚ¿ÊÔÓÙ·È
Ì ÙÔÓ ·‡ÍÔÓÙ· ·ÚÈıÌfi ÙÔ˘˜ ۠ͯˆÚÈÛÙ‹ ÛÂÏ›‰· ηٿ
ÙËÓ ˘Ô‚ÔÏ‹ Ù˘ ÂÚÁ·Û›·˜. Y¿Ú¯ÂÈ ‰˘Ó·ÙfiÙËÙ· ÂÎÙ‡ˆÛ˘ ¤Á¯ÚÒÌˆÓ ÂÈÎfiÓˆÓ ÌÂÙ¿ ·fi Û˘ÓÂÓÓfiËÛË Ì ÙÔ
¢È¢ı˘ÓÙ‹ ™‡ÓÙ·Í˘ Î·È ÙËÓ ËÏÂÎÙÚÔÓÈ΋ ·ÔÛÙÔÏ‹ ÂÁ¯ÚÒÌˆÓ ÊˆÙÔÁÚ·ÊÈÒÓ.
OÈ ÂÈÎfiÓ˜ ı· Ú¤ÂÈ Ó· ¤¯Ô˘Ó Û·Úˆı› Ì ·Ó¿Ï˘ÛË
ÙÔ˘Ï¿¯ÈÛÙÔÓ 300 dpi, Ó· ¤¯Ô˘Ó ÙË ÌÔÚÊ‹ ·Ú¯Â›ˆÓ JPG ηÈ
Ó· ÌËÓ ÂÌÂÚȤ¯ÔÓÙ·È ÛÙË ÚÔ‹ ÙÔ˘ ηٷÙÈıÂ̤ÓÔ˘ ÎÂÈ̤ÓÔ˘. EÊfiÛÔÓ ÛÙȘ ÂÈÎfiÓ˜ ÂÌÊ·Ó›˙ÂÙ·È ÙÔ ÚfiÛˆÔ ÙÔ˘
¿Û¯ÔÓÙÔ˜, Ë ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹, ηٿ ÙË ‰ËÌÔÛ›Â˘ÛË,
ı· ηχÙÂÈ ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ÔÊı·ÏÌÒÓ Ì ̷‡ÚË Ù·ÈÓ›·
ÁÈ· ÏfiÁÔ˘˜ Û‚·ÛÌÔ‡ ÚÔÛˆÈÎÒÓ ‰Â‰Ô̤ӈÓ.
H ÎÚ›ÛË ÙˆÓ ÂÚÁ·ÛÈÒÓ Á›ÓÂÙ·È ·fi ‰‡Ô ÎÚÈÙ¤˜ Ô˘
¤¯Ô˘Ó ÂÈÏÂÁ› ·fi ÙËÓ EÈÙÚÔ‹ ™‡ÓÙ·Í˘. H ™˘ÓÙ·ÎÙÈ΋
EÈÙÚÔ‹ ÙÔ˘ ¶ÂÚÈÔ‰ÈÎÔ‡ ‰È·ÙËÚ› ÙÔ ‰Èη›ˆÌ· Ó· ÚÔÙ›ÓÂÈ ÙÚÔÔÔÈ‹ÛÂȘ ‹ Ó· ·ÔÚÚ›ÙÂÈ Ù· ¿ÚıÚ· Ô˘ ‰ÂÓ Â›Ó·È
ÁÚ·Ì̤ӷ Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜.
OÈ Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÙËÓ ˘Ô¯Ú¤ˆÛË Ì›·˜ Ù˘ÔÁÚ·ÊÈ΋˜ ‰ÈfiÚıˆÛ˘ ̤۷ Û 2 ‚‰ÔÌ¿‰Â˜ ·fi ÙËÓ ·ÔÛÙÔÏ‹
ÙÔ˘ ‰ÔÎÈÌ›Ô˘. MÂÙ¿ ÙËÓ ÛÙËÏÔı¤ÙËÛË ‰Â Á›ÓÔÓÙ·È ‰ÂÎÙ¤˜
ÌÂÙ·‚ÔϤ˜ ÙÔ˘ ÎÂÈ̤ÓÔ˘.
T· ‰ËÌÔÛÈÂ˘Ì¤Ó· ¿ÚıÚ·, ÂÈÎfiÓ˜ Î·È ‰È·ÁÚ¿ÌÌ·Ù· ·ÔÙÂÏÔ‡Ó È‰ÈÔÎÙËÛ›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. °È· ÙËÓ ·Ó·‰ËÌÔÛ›Â˘Û‹
ÙÔ˘˜ Â›Ó·È ··Ú·›ÙËÙË Ë ¿‰ÂÈ· Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ EÈÙÚÔ‹˜
Î·È ÙÔ˘ Û˘ÁÁڷʤ·.
EÈÛ‹Ì·ÓÛË: °È· ÙËÓ ·Ú·Ï·‚‹ ÂÈÛÙËÌÔÓÈ΋˜ ÂÚÁ·Û›·˜ ÁÈ· ‰ËÌÔÛ›Â˘ÛË Ú¤ÂÈ Ó· ÂÈÛ˘Ó¿ÙÂÙ·È ‰È·‚‚·›ˆÛË ÙˆÓ Û˘ÁÁڷʤˆÓ fiÙÈ Ë ÂÚÁ·Û›· ‰ÂÓ ¤¯ÂÈ Î·Ù·ÙÂı› ÛÂ
¿ÏÏÔ ÂÈÛÙËÌÔÓÈÎfi ¤ÓÙ˘Ô ÂÚÈÔ‰ÈÎÔ‡ Ù‡Ô˘, fiÙÈ ‰ÂÓ ÂÚȤ¯ÔÓÙ·È ·˘ÙÔ‡ÛȘ ÚÔÙ¿ÛÂȘ ·fi ¿ÏϘ ÂÈÛÙËÌÔÓÈΤ˜
‰ËÌÔÛȇÛÂȘ –ÏËÓ ÙˆÓ ÔÚÈÛÌÒÓ, ÓfïÓ, ηÓfiÓˆÓ Î·È
‰È·Ù¿ÍˆӖ Î·È fiÙÈ ÙÔ ÊˆÙÔÁÚ·ÊÈÎfi ˘ÏÈÎfi Â›Ó·È ›‰ÈÔ ‹ ÌÂٷۯ‰›·ÛË ‹ ¿Ïψ˜ Ó· ·Ó·Ê¤ÚÂÙ·È Û·ÊÒ˜ Ë ËÁ‹, ηıÒ˜ Â›Û˘ Î·È fiÙÈ ÏËÚÔ‡ÓÙ·È ÔÈ ÚÔ¸Ôı¤ÛÂȘ ÙÔ˘
¶.¢.39 Ù˘ 1˘ AÚÈÏ›Ô˘ 2009 ·Ú. ºEK 55.
INSTRUCTIONS FOR AUTHORS
HELLENIC STOMATOLOGICAL REVIEW is the official
peer-reviewed open access electronic publication of the
Hellenic Dental Association and aims at providing Greek
and international dentists with ongoing up-to-date
scientific information in all fields of dental science.
The Journal publishes the following types of articles:
1. Focus articles:
Review articles addressing contemporary and controversial topics proposed by the Editorial Board and
written by colleagues with expertise on the particular
topics.
2. Original articles:
These articles may fall into one of the following categories: (a) Reviews (up to 3 authors), (b) Research
papers (Experimental studies, Clinical studies, Laboratory studies, Epidemiological Studies, Clinicostatistical
studies, Clinopathological studies), (c) Interesting case
reports, (d) Practice-related topics, (e) Scientifically-documented professional issues, (d) Public Health issues,
(e) Strategy-related topics, (f) Educational issues and (g)
Specific issues.
3. Letters to the Editorial Board:
The letters must be approved by the Editorial Board prior
to publication and may pertain to: (a) critical reviews of
published articles and (b) specific queries on sciencerelated topics, answers to which are provided in the correspondence section.
4. Short reports:
These original papers or findings should not exceed
2.000 words and are published as soon as possible after
undergoing a review process by the Editorial Board.
5. Reviews from published articles:
These reviews focus on Greek colleagues articles
recently published in international journals.
Article length: Reviews should not exceed 7.500 words
(25 typed pages) and should have no more than 100
references, with the exception of special issues related
to basic sciences. Research papers and practice-related
topics should not exceed 3.000 words (10 pages) and
have no more than 40 references. Any articles on
important case reports should not exceed 1.000 words
(4 pages) while articles addressing professional issues
should be no more than 5.000 words (20 pages). The
reference list is included in the total word count and must
be timely and pertinent to the topic under discussion.
Text structure: The manuscripts submitted for publication must be written both in modern Greek, using the
monotonic system and in English. The Editorial Board
reserves the right to check the accuracy of the English
terms and phrasings, consulting with professional medical translators. The Copy Editor of the Journal reserves
the right to proceed to linguistic modifications without
distorting, though, the authors style.
Particularly for the English speaking authors, manuscripts
may be submitted only in English language with an
extensive (300 words) Greek summary. In this case the
scientific editorial board will undertake the preparation of
the summary applying the appropriate Greek terminology.
All papers submitted must be double spaced, typed in
Arial, Tahoma or Verdana font with margins on both
sides.
The title page, the summary and key words, the main
text of the paper, the English summary and key words,
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¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
K¿Ù·ÁÌ· Ù˘ οو ÁÓ¿ıÔ˘ ˆ˜ ·ÔÙ¤ÏÂÛÌ·
ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜.
¶·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘
M. °Ú›‰Ô˘* , A. BÏ·¯¿ÎË*, M. ¢ËÌÔÔ‡ÏÔ˘*, º. T˙¤ÚÌÔ˜**
Fracture of the mandible as a result
of preimplant surgery. Case report
M. Gridou* , A. Vlachaki* , M. Dimopoulou* , F.Tzermpos**
¶EPI§HæH
SUMMARY
H ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋, ·ÔÙÂÏ› ¤Ó·Ó
ÙÔ̤· Ù˘ E·ÓÔÚıˆÙÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ȉȷ›ÙÂÚ·
··Ú·›ÙËÙÔ Û ÂÚÈÙÒÛÂȘ ÌÂȈ̤ÓÔ˘ ÈÛÙÈÎÔ‡ ηÈ
΢ڛˆ˜ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜. A˘Ù¿ Ù· ÔÛÙÈο ÂÏÏ›ÌÌ·Ù· ÌÔÚÔ‡Ó Ó· ÏËÚˆıÔ‡Ó Ì ÔÛÙÈο ÌÔۯ‡̷ٷ, Ù· ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ·˘ÙÔÁÂÓ‹, ·ÏÏÔÏ·ÛÙÈο, ÍÂÓÔÁÂÓ‹ Î·È ·ÏÏÔÁÂÓ‹. ™ÎÔfi˜ Ù˘
·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜, Â›Ó·È Ë ·ÚÔ˘Û›·ÛË ÙˆÓ Èı·ÓÒÓ ÂÈÏÔÎÒÓ ·fi ÙË Ï‹„Ë ·˘ÙÔÁÂÓÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, Ô˘ ÛÙË Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË ÚfiÎÂÈÙ·È
ÁÈ· οٷÁÌ· ÛÙËÓ Î¿Ùˆ ÁÓ¿ıÔ Î·ıÒ˜ Î·È ÙÔ˘ ÙÚfiÔ˘ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘.
¶·ÚÔ˘ÛÈ¿˙ÂÙ·È ¤Ó· ÎÏÈÓÈÎfi ÂÚÈÛÙ·ÙÈÎfi Á˘Ó·›Î·˜
28 ÂÙÒÓ, ÛÙËÓ ÔÔ›· Ú·ÁÌ·ÙÔÔÈ‹ıËÎÂ Ï‹„Ë ÔÛÙÈ-
Pre-implant surgery is a part of restorative dentistry,
which in nowadays is necessary in areas with specific
characteristics, such as bone and tissue deficits.
These deficits can be reconstructed with bone grafts.
Autogenous, allografts, xenogenous and alloplastic
are the types of bone grafts. The purpose of this paper
is to present possible complications of harvesting of
autogenous bone grafts, which in this case is a fracture of the mandible and its management.
A 28 years old woman suffered a delayed fracture of
the mandible which was in the post- which also was
the area of the bone donor region. The bone graft
was obtained in order to reconstruct a bone deficit
in the anterior region of the maxilla, for future implant
* O‰ÔÓÙ›·ÙÚÔ˜
** E›Î. K·ıËÁËÙ‹˜ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ΋˜
XÂÈÚÔ˘ÚÁÈ΋˜ EK¶A
KÏÈÓÈ΋ ™ÙÔÌ·ÙÈ΋˜ Î·È °Ó·ıÔÚÔÛˆÈ΋˜ XÂÈÚÔ˘ÚÁÈ΋˜ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ EK¶A
H ÂÚÁ·Û›· ·ÚÔ˘ÛÈ¿ÛÙËΠˆ˜ ÂÈÙÔ›¯È· ·Ó·ÎÔ›ÓˆÛË ÛÙÔ 32Ô
¶O™ - AÏÂÍ·Ó‰ÚÔ‡ÔÏË 2012
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 73-78, 2013
·ÚÂÏ‹ÊıË 9/10/2013 - ÂÎÚ›ıË 4/11/2013
* Dentist
** Assist. Professor of Oral and Maxillofacial Surgery
National and Kapodistrian University of Athens
Clinic of Oral and Maxillofacial Surgery , School of Dentistry ,
National and Kapodistrian University of Athens
This article was presented as a poster in 32nd Annual Congress
of the Hellenic Dental Association in Alexandroupolis on 2012
Hellenic Stomatological Review 57: 73-78, 2013
paper received 9/10/2013 - accepted 4/11/2013
73
¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
ÎÔ‡ ÌÔۯ‡̷ÙÔ˜ ·fi ÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ¤ÁÎÏÂÈÛÙÔ˘
ÙÚ›ÙÔ˘ ÁÔÌÊ›Ô˘ 48, ÁÈ· ÙËÓ ·ÔηٿÛÙ·ÛË ÔÛÙÈÎÔ‡
ÂÏÏ›ÌÌ·ÙÔ˜ ÛÙËÓ ÚfiÛıÈ· ÂÚÈÔ¯‹ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘, Ì ÛÎÔfi ÙË ÌÂÙ·ÁÂÓ¤ÛÙÂÚË ÙÔÔı¤ÙËÛË ÂÌÊ˘Ù‡̷ÙÔ˜. T· ÎÏÈÓÈο Î·È ·ÎÙÈÓÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Ô‰‹ÁËÛ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ù· ÌÂı‡ÛÙÂÚ·
ÌÂÙÂÁ¯ÂÈÚËÙÈο Û˘ÌÙÒÌ·Ù· Ù˘ ·ÛıÂÓÔ‡˜ ÔÊ›ÏÔÓÙ·Ó Û οٷÁÌ· Ù˘ οو ÁÓ¿ıÔ˘, Ô˘ ÚÔÎÏ‹ıËÎÂ Û˘ÓÂ›· Ù˘ Ï‹„˘ ÙÔ˘ ÌÔۯ‡̷ÙÔ˜. H ·ÛıÂÓ‹˜ ·ÓÙÈÌÂÙˆ›ÛıËΠ̠ÎÏÂÈÛÙ‹ ·Ó¿Ù·ÍË ÙÔ˘ ηٿÁÌ·ÙÔ˜ Î·È ÙË ¯Ú‹ÛË ÙÔ˘ ·ÈÌÔÂÙ·ÏÈ·ÎÔ‡ ·Ú¿ÁÔÓÙ· PRGF (Plasma-Rich Growth Factors).
§¤ÍÂȘ ÎÏÂȉȿ: ¶ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋, οٷÁÌ·, ÂÈÏÔ΋, ÔÛÙÈÎfi ÌfiÛ¯Â˘Ì·.
EI™A°ø°H
H ‡·ÚÍË ÈηÓÔÔÈËÙÈÎÔ‡ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ ·ÔÙÂÏ› ·Ó·Áη›· ÚÔ¸fiıÂÛË ÁÈ· ÌÈ· ÂÈÙ˘¯Ë̤ÓË ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ·ÔηٿÛÙ·ÛË. øÛÙfiÛÔ, Û ÂÚÈÙÒÛÂȘ ÂÏ·Ùو̤ÓÔ˘ ÔÛÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜, Ë ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋, ̤ۈ Ù˘ ÙÔÔı¤ÙËÛ˘ ÔÛÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ‹ ˘ÔηٿÛÙ·ÙˆÓ ·˘ÙÔ‡, ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ÙÔ Î·Ù¿ÏÏËÏÔ ÔÛÙÈÎfi ˘fi‚·ıÚÔ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ1.
ŸÛÔÓ ·ÊÔÚ¿ Ù· ›‰Ë ÙˆÓ ÔÛÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ, ·˘Ù¿ Â›Ó·È Ù· ÂÍ‹˜: Ù· ·˘ÙÔÁÂÓ‹, Ù· ·ÏÏÔÁÂÓ‹, Ù· ÍÂÓÔÁÂÓ‹ ηÈ
Ù· ·ÏÏÔÏ·ÛÙÈο. H ÂÈÏÔÁ‹ ÙÔ˘ ÔÛÙÈÎÔ‡ ÌÔۯ‡̷ÙÔ˜
ÂÍ·ÚÙ¿Ù·È Î˘Ú›ˆ˜ ·fi ÙËÓ ‚ÈÔÏÔÁÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘
·ÏÏ¿ Î·È ·fi ÙÔ Ì¤ÁÂıÔ˜, ÙÔ Û¯‹Ì· Î·È ÙË ı¤ÛË ÙÔ˘ ÂÏÏ›ÌÌ·ÙÔ˜. H ‚·ÛÈÎfiÙÂÚË Î·È ÔÈÔÙÈÎfiÙÂÚË ÂÈÏÔÁ‹, ÏfiÁˆ ÙˆÓ ÔÛÙÂÔÁÂÓÓËÙÈÎÒÓ È‰ÈÔًوÓ, ȉȷ›ÙÂÚ· Û ÂÚÈÔ¯¤˜ ÌÂÁ¿ÏˆÓ ÂÏÏÂÈÌÌ¿ÙˆÓ, Â›Ó·È Ù· ·˘ÙÔÁÂÓ‹ ÌÔۯ‡̷ٷ. H ¯Ú‹ÛË ÙˆÓ ÔÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓˆÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ
Ì·˙› Ì ٷ ·˘ÙÔÁÂÓ‹ ÔÛÙÈο ÌÔۯ‡̷ٷ, Û˘˙ËÙ‹ıËΠÁÈ·
ÚÒÙË ÊÔÚ¿ ·fi ÙÔ Branemark Î·È ÙÔ˘˜ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘
Î·È ÂÍ·ÎÔÏÔ˘ı› Ó· ıˆÚÂ›Ù·È Ë «¯Ú˘Û‹ ÛÙ·ıÂÚ¿» ÁÈ· ÙȘ
ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ1, 2.
™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÂÚÁ·Û›·˜ ›ӷÈ, Ë ·ÚÔ˘Û›·ÛË ÂÚ›ÙˆÛ˘ ÌÂı‡ÛÙÂÚÔ˘ ηٿÁÌ·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘,
Û˘ÓÂ›· Ï‹„˘ ·˘ÙÔÌÔۯ‡̷ÙÔ˜ ÛÙ· Ï·›ÛÈ· Ù˘
ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜. ¶·ÚÔ˘ÛÈ¿˙ÂÙ·È Ô
ÙÚfiÔ˜ ·ÓÙÈÌÂÙÒÈÛ‹˜ ÙÔ˘, ÛÙËÓ ÔÔ›· ÂÊ·ÚÌfiÛÙËÎÂ
Î·È Ô ·ÈÌÔÂÙ·ÏÈ·Îfi˜ ·Ú¿ÁÔÓÙ·˜ PRGF Î·È Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙȘ ÂÈÏÔΤ˜ ·fi ÙËÓ Ï‹„Ë ·˘ÙÔÁÂÓÒÓ ÔÛÙÈÎÒÓ
ÌÔÛ¯Â˘Ì¿ÙˆÓ.
¶APOY™IA™H ¶EPI™TATIKOY
°˘Ó·›Î· ËÏÈΛ·˜ 28 ÂÙÒÓ, ·ÚÂ¤ÌÊıË ÁÈ· ·ÓÙÈÌÂÙÒÈÛË
ηٿÁÌ·ÙÔ˜ Ù˘ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ οو ÁÓ¿ıÔ˘ ‰ÂÍÈ¿. TÔ
È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ÂχıÂÚÔ, ‰ÂÓ ·Ó¤ÊÂÚ ·ÏÏÂÚÁ›Â˜ Î·È Û˘ÛÙËÌ·ÙÈ΋ Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È
‰ÂÓ ¤Î·Ó ¯Ú‹ÛË Î·ÓÔ‡. ™ÙÔ Ô‰ÔÓÙÈ·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Ù˘
74
placement. The clinical and radiographic findings
showed that the delayed postoperative patient’s
symptoms were due to fracture of the mandible. The
closed reduction and the use of PRGF (Plasma Rich Growth Factors) was the medical treatment for
this fracture.
Key Words: Pre-implant surgery, fracture, complication,
bone graft.
INTRODUCTION
Successful osseointegration of dental implants requires
sufficient bone surrounding the implant. However, preimplant surgery, can provide the appropriate bone volume for implant placement, in cases of reduced bone substrate, by placing bone graft1.
The types of bone grafts are the following: the autogenous grafts, the allogenous grafts, the xenogenous grafts
and the alloplastic grafts. The selection of bone graft
depends on the size and shape of the defecit, the quantity
and quality of bone and mainly the biological behaviour of
the graft. Autogenous grafts are the most common choices because of their osteogenic properties, especially in
areas of small defects. The use of osseointegrated implants along with autogenous bone grafts, first discussed
by Branemark and his colleagues and is still considered
the gold standard in pre-implant surgery1, 2.
The purpose of this paper is to present the management
of mandibular fracture which was a delayed complication
of pre-implant surgery. The complications of intraoral
autogenous bone graft harvesting and the use of Plasma
Rich Growth Factor (PRGF) are also discussed.
CASE REPORT
A 28-year-old female patient, was referred to a private oral
and maxillofacial surgical clinic for the management of a
right angle mandibular fracture. The patient reported free
medical history, no allergies and no use of smoking. The
patient reported that one month ago she underwent a
surgical extraction of the impacted right third molar (48)
and simultaneous autogenous bone graft harvesting from
the same area. The graft was obtained for reconstruction
of a bone defect of the anterior maxilla of missing tooth 12,
in order to an implant to be placed later on. After a month
of bone harvesting procedure, during mastication the
patient felt severe pain in the area of the right angle of the
mandible and subsequently swelling and distortion of the
occlusion was developed. After the initial dental examination, the patient was referred to the maxillofacial surgeon
for further evaluation and management. The clinical examination revealed swelling of the right angle of the
mandible, trismus, malocclusion and pain on palpation.
The patient did not report any signs of hypoesthesia in the
distribution of the lower right trigeminal nerve. The radioHellenic Stomatological Review 57: 73-78, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
·ÛıÂÓÔ‡˜, ·Ó·Ê¤ÚÂÙ·È Ë ÚÔ ÌËÓfi˜ ÂÍ·ÁˆÁ‹ ÙÔ˘ ÂÁÎÏ›ÛÙÔ˘ ÙÚ›ÙÔ˘ ÁÔÌÊ›Ô˘ Ù˘ οو ÁÓ¿ıÔ˘ ‰ÂÍÈ¿ (48) Ì ٷ˘Ùfi¯ÚÔÓË Ï‹„Ë ·˘ÙÔÁÂÓÔ‡˜ ÌÔۯ‡̷ÙÔ˜. H Ï‹„Ë ÙÔ˘
·˘ÙÔÌÔۯ‡̷ÙÔ˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÚÔÎÂÈ̤ÓÔ˘ Ó·
·ÔηٷÛÙ·ı› ÙÔ ÔÛÙÈÎfi ¤ÏÏÂÈÌÌ· Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ¿Óˆ Ï·Á›Ô˘ ÙÔ̤· ‰ÂÍÈ¿ (12), Ì ÛÎÔfi ÙË Û ÌÂı‡ÛÙÂÚÔ
¯ÚfiÓÔ ÙÔÔı¤ÙËÛË ÂÌÊ˘Ù‡̷ÙÔ˜. H ¿ÌÂÛË ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó ¯ˆÚ›˜ ÂÈÏÔΤ˜. ŒÓ·
Ì‹Ó· ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË Î·È Î·Ù¿ ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ì¿ÛËÛ˘, Ë ·ÛıÂÓ‹˜ ·ÈÛı¿ÓıËΠ¤ÓÙÔÓÔ fiÓÔ ÛÙËÓ ÌÂÙÂÍ·ÎÙÈ΋ ÂÚÈÔ¯‹ Î·È ‰È·Ù·Ú·¯‹ Ù˘ Û‡ÁÎÏÂÈÛ˘. TËÓ ÂfiÌÂÓË Ë̤ڷ, ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÂÎÙ›ÌËÛË ·fi ÙÔÓ ıÂÚ¿ÔÓÙ·
È·ÙÚfi, Ë ·ÛıÂÓ‹˜ ·ÚÂ¤ÌÊıË ÁÈ· ÂÚ·ÈÙ¤Úˆ ·ÓÙÈÌÂÙÒÈÛË. K·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, Ë ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙Â
Ô›‰ËÌ· ÛÙËÓ ÁˆÓ›· Ù˘ οو ÁÓ¿ıÔ˘ ‰ÂÍÈ¿, ÙÚÈÛÌfi, ‰È·Ù·Ú·¯‹ Ù˘ Û‡ÁÎÏÂÈÛ˘ ηıÒ˜ Î·È Â˘·ÈÛıËÛ›· ÛÙËÓ „ËÏ¿ÊËÛË ·ÓÙ›ÛÙÔȯ· ÚÔ˜ ÙËÓ ÌÂÙÂÍ·ÎÙÈ΋ ÂÚÈÔ¯‹. H ·ÛıÂÓ‹˜ ‰ÂÓ ·Ó¤ÊÂÚ ˘·ÈÛıËÛ›· ÛÙËÓ ÂÚÈÔ¯‹ ηٷÓÔÌ‹˜ ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÁÂÓÂÈ·ÎÔ‡ Ó‡ÚÔ˘. AÎÙÈÓÔÁÚ·ÊÈο
‰È·ÈÛÙÒıËΠοٷÁÌ· ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ÌÂÙÂÍ·ÎÙÈÎÔ‡
Ê·ÙÓ›Ô˘ ÙÔ˘ ÙÚ›ÙÔ˘ ÁÔÌÊ›Ô˘ Ì ÌÈÎÚ‹ ·ÚÂÎÙfiÈÛË ÙˆÓ
ηÙ·ÁfiÙˆÓ ÙÌËÌ¿ÙˆÓ (EÈÎ. 1 Î·È 2). °È· ÙËÓ ıÂÚ·›·
ÙÔ˘ ηٿÁÌ·ÙÔ˜ ÂÈϤ¯ıËÎÂ Ë ÎÏÂÈÛÙ‹ ·Ó¿Ù·ÍË Ì ‰È·ÁÓ·ıÈ΋ ·ÎÈÓËÙÔÔ›ËÛË Ì ÙËÓ ¯Ú‹ÛË Ó·Úı‹ÎˆÓ Ù‡Ô˘
Erich Î·È ÔÚıÔ‰ÔÓÙÈÎÒÓ ÂÏ·ÛÙÈÎÒÓ ‰·ÎÙ˘Ï›ˆÓ. Yfi Ó¢ÚÔÏËÙ·Ó·ÏÁËÛ›· Î·È ÙÔÈ΋ ·Ó·ÈÛıËÛ›· (•˘ÏÔη˝ÓË 2%
Î·È ·‰ÚÂÓ·Ï›ÓË 1:100.000) ÙÔÔıÂÙ‹ıËÎ·Ó ÔÈ Ó¿ÚıËΘ
ÛÙËÓ ¿Óˆ Î·È Î¿Ùˆ ÁÓ¿ıÔ Î·È ·ÎÈÓËÙÔÔÈ‹ıËÎ·Ó Ì ÂÚÈÔ‰ÔÓÙÈΤ˜ Û˘ÚÌ¿ÙÈÓ˜ ÚÔÛ‰¤ÛÂȘ. AÎÔÏÔ‡ıˆ˜ ¤ÁÈÓÂ
‰È¿ÓÔÈÍË Ù˘ ÌÂÙÂÍ·ÎÙÈ΋˜ ÂÚÈÔ¯‹˜, ·Ê·›ÚÂÛË ÙÔ˘ ÎÔÎÎÈÒ‰Ô˘˜ ÈÛÙÔ‡ Î·È ¤ÎÏ˘ÛË ÌÂ Ê˘ÛÈÔÏÔÁÈÎfi ÔÚfi ÙÔ˘
ÙÚ·‡Ì·ÙÔ˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔÔıÂÙËı› Ô ·ÈÌÔÂÙ·ÏÈ·Îfi˜ ·Ú¿ÁÔÓÙ·˜ PRGF (Plasma Rich Growth Factor). H
Û˘ÚÚ·Ê‹ ÙÔ˘ ÙÚ·‡Ì·ÙÔ˜ ¤ÁÈÓ Ì ·ÔÚÚÔÊ‹ÛÈÌÔ Ú¿ÌÌ·
Vicryl 3:0. MÂÙÂÁ¯ÂÈÚËÙÈο ¯ÔÚËÁ‹ıËΠ·ÓÙÈ‚ÈÔÙÈ΋ Î·È ·Ó·ÏÁËÙÈ΋ ·ÁˆÁ‹ (AÌÔ͢ÎÈÏÏ›ÓË 500mg/6ˆÚÔ ÁÈ· 7 Ë̤Ú˜ Î·È ¶·Ú·ÎÂÙ·ÌfiÏË 500mg/4ˆÚÔ) Î·È ‰fiıËÎ·Ó ÔÈ Î·Ù¿ÏÏËϘ Ô‰ËÁ›Â˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ‰›·ÈÙ· Î·È ÙËÓ ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹. H ÌÂÙÂÁ¯ÂÈÚËÙÈ΋ ÔÚ›· Ù˘ ·ÛıÂÓÔ‡˜ ‹Ù·Ó
¯ˆÚ›˜ ÂÈÏÔΤ˜. MÂÙ¿ ÙËÓ ¿ÚÔ‰Ô ÂÓfi˜ ÌËÓfi˜ Î·È ·ÊÔ‡
‰È·ÈÛÙÒıËΠ·ÎÙÈÓÔÁÚ·ÊÈο Ë ÔÌ·Ï‹ ÂԇψÛË ÙÔ˘ ηٿÁÌ·ÙÔ˜, ¤ÁÈÓÂ Ë ‰È¿ÓÔÈÍË ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Ì ÙËÓ ·Ê·›ÚÂÛË ÙˆÓ ÂÏ·ÛÙÈÎÒÓ ‰·ÎÙ˘Ï›ˆÓ Î·È ·ÎÔÏÔ‡ıˆ˜ Î·È Ë ·Ê·›ÚÂÛË ˘fi ÙÔÈ΋ ·Ó·ÈÛıËÛ›· ÙˆÓ Ó·Úı‹ÎˆÓ. H ·ÛıÂÓ‹˜
¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ Â¤Ì‚·ÛË, ¤¯ÂÈ ÔÏÔÎÏËÚÒÛÂÈ ÙËÓ ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ·ÔηٿÛÙ·ÛË (EÈÎ. 3) Î·È Ë ÂÚÈÔ¯‹
ÙÔ˘ ηٿÁÌ·ÙÔ˜ ÂÌÊ·Ó›˙ÂÈ Ï‹ÚË ÂԇψÛË (EÈÎ. 4).
™YZHTH™H
¶ÔÏϤ˜ Â›Ó·È ÔÈ ‰fiÙÚȘ ÂÚÈÔ¯¤˜ ÁÈ· ÙË Ï‹„Ë ·˘ÙÔÁÂÓÒÓ
ÌÔÛ¯Â˘Ì¿ÙˆÓ Ô˘ ¤¯Ô˘Ó ‰ÈÂÚ¢ÓËı› Î·È ÂÚÈÁÚ·Ê› ÛÙË
‚È‚ÏÈÔÁÚ·Ê›·. ™ÙȘ Â͈ÛÙÔÌ·ÙÈΤ˜ ÂÚÈÔ¯¤˜ ·Ó‹ÎÔ˘Ó Ë
ÚfiÛıÈ· Î·È Ë Ô›ÛıÈ· Ï·ÁfiÓÈÔ˜ ·ÎÚÔÏÔÊ›·, Ë ÎÓ‹ÌË Î·È
ÙÔ ÎÚ·Ó›Ô. ™ÙȘ ÂÓ‰ÔÛÙÔÌ·ÙÈΤ˜ ÂÚÈÔ¯¤˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ô ÎÏ¿‰Ô˜ Ù˘ οو ÁÓ¿ıÔ˘, Ë Û‡ÌÊ˘ÛË Î·È ÙÔ ÁÓ·ıÈ·›Ô ·Úو̷2, 3.
™˘ÁÎÚ›ÓÔÓÙ·˜ ÙȘ ÂÓ‰ÔÛÙÔÌ·ÙÈΤ˜ Ì ÙȘ Â͈ÛÙÔÌ·ÙÈΤ˜
Hellenic Stomatological Review 57: 73-78, 2013
graphical examination revealed a mildly displaced fracture
in the area of the post extraction third molar socket (Fig.1
and 2), a diagnosis of a delayed mandibular fracture was
established and led to the conclusion that the fracture
emerged as a postoperative complication of pre-implant
surgery. The treatment of choice was closed reduction with
intramaxillary fixation using Erich arch-bars fixed with
circumdental wires and orthodontic elastic bands. Under
local anaesthesia (xylocaine 2% with adrenaline 1:100.000)
with intravenous sedation the Erich arch bars were placed
around the maxillary and mandibular teeth. Following that a
full thickness mucoperiosteal flap in the area of the post
extraction socket was developed and the granulomatous
tissue was removed. The area was copious irrigated using
EÈÎ. 1: ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ·ÓÔÚ·ÌÈ΋ ·ÎÙÈÓÔÁÚ·Ê›·
Fig. 1: Preoperative panoramic x-ray
EÈÎ. 2: ¶ÚÔÂÁ¯ÂÈÚËÙÈ΋ ·ÍÔÓÈ΋ ÙÔÌÔÁÚ·Ê›·
Fig. 2: Preoperative Dental Scan
normal saline 0,9% and the gap was filled with autologous
fibrin membrane PRGF. The area was sutured with resorbable suture 3:0 Vicryl. Analgesics and antibiotic were
prescribed [Amoxicillin 500mg p.o. every 6 hours for a
week and paracematol 500mg p.o. every 4 hours]. The
post operative course was uneventful and one month later
the intramaxillary fixation was released and under local
anesthesia the arch bars were removed. One year later the
implant supported prostheses was completed (Fig. 3) and
the healing of the fracture was radiographically confirmed
(Fig. 4).
DISCUSSION
Many donor sites for receiving autogenous grafts have
75
¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
‰fiÙÚȘ ı¤ÛÂȘ ·˘ÙÔÌÔۯ‡̷وÓ, Ë Ï‹„Ë ·fi ÂÓ‰ÔÛÙÔÌ·ÙÈΤ˜ ˘ÂÚÙÂÚ› ÏfiÁˆ Ù˘ ¢ÎÔÏfiÙÂÚ˘ Ù¯ÓÈ΋˜, ÙÔ˘
ÌÂȈ̤ÓÔ˘ ·ÚÈıÌÔ‡ Î·È ‚·Ú‡ÙËÙ·˜ ÂÈÏÔÎÒÓ, Ù˘ ÌË ‡·Ú͢ Ô˘Ï‹˜ ÌÂÙ¿ ÙÔ ¤Ú·˜ Ù˘ Â¤Ì‚·Û˘ ηıÒ˜ ηÈ
ÙÔ fiÙÈ ‰ÂÓ ··ÈÙÂ›Ù·È ÓÔÛËÏ›· ÙˆÓ ·ÛıÂÓÒÓ. E›Û˘, ÛËÌ·ÓÙÈο ÏÂÔÓÂÎÙ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó Ë ÂÁÁ‡ÙËÙ· ÌÂٷ͇
‰fiÙÚÈ·˜ Î·È ‰¤ÎÙÚÈ·˜ ÂÚÈÔ¯‹˜, Ë ·ÔÊ˘Á‹ ÁÂÓÈ΋˜ ·Ó·ÈÛıËÛ›·˜ Î·È Ë Û˘Ó‹ıˆ˜ ÌÂȈ̤ÓË ‰È¿ÚÎÂÈ· Ù˘ Â¤Ì‚·Û˘. TÔ Î‡ÚÈÔ ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋˜ ‰fiÙÚÈ·˜
ı¤Û˘ Â›Ó·È fiÙÈ Ë ÔÛfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡ Ô˘ ÌÔÚ› Ó· ÏËÊı› ÂÓ‰ÔÛÙÔÌ·ÙÈο, ¯ˆÚ›˜ Ó· ˘ÂÚ‚·›ÓÂÈ ÙËÓ ÂÈÙÚÂÙ‹
ÓÔÛËÚfiÙËÙ· Ù˘ ‰fiÙÚÈ·˜ ÂÚÈÔ¯‹˜, Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË3.
™¯ÂÙÈο Ì ÙȘ ÂÓ‰ÔÛÙÔÌ·ÙÈΤ˜ ı¤ÛÂȘ Ï‹„˘ ÌÔÛ¯Â˘Ì¿ÙˆÓ,
Ë Î¿Ùˆ ÁÓ¿ıÔ˜ Î·È Û˘ÁÎÂÎÚÈ̤ӷ Ô ÎÏ¿‰Ô˜ Î·È Ë ÁÂÓÂȷ΋
Û‡ÌÊ˘ÛË ÏÂÔÓÂÎÙÔ‡Ó ÏfiÁˆ ÙÔ˘ ·˘ÍË̤ÓÔ˘ ÔÛÙÈÎÔ‡ fiÁÎÔ˘
Î·È Ù˘ ·˘ÍË̤Ó˘ ÔÛÙÈ΋˜ ˘ÎÓfiÙËÙ·˜ Ô˘ ·Ú¤¯Ô˘Ó3, 4.
OÈ Clavero Î·È Lundgren3, Û ÌÂϤÙË ÙÔ˘˜ ÁÈ· ÙË Û‡ÁÎÚÈÛË
Ù˘ ÓÔÛËÚfiÙËÙ·˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ÙˆÓ ÂÚÈÔ¯ÒÓ Ù˘
οو ÁÓ¿ıÔ˘ ·fi ÙȘ Ôԛ˜ Ï·Ì‚¿ÓÔÓÙ·È ÔÛÙÈο ÌÔۯ‡̷ٷ, η٤ÏËÍ·Ó ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ, Û ·ÛıÂÓ›˜ ÛÙÔ˘˜
ÔÔ›Ô˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ÎÏ¿‰Ô˜ ˆ˜ ‰fiÙÚÈ· ı¤ÛË ÔÛÙÔ‡, ÂÌÊ¿ÓÈÛ·Ó ÏÈÁfiÙÂÚ˜ ÂÈÏÔΤ˜ Û ۯ¤ÛË Ì ÂΛÓÔ˘˜ ÛÙÔ˘˜ ÔÔ›Ô˘˜ ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ë ÁÂÓÂȷ΋ Û‡ÌÊ˘ÛË. EȉÈÎfiÙÂÚ·, Ë Ï‹„Ë ÔÛÙÔ‡ ·fi ÙÔÓ ÎÏ¿‰Ô Ù˘ οو
ÁÓ¿ıÔ˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Ô‰ËÁ‹ÛÂÈ Û ˘·ÈÛıËÛ›· ÙÔ˘ ‚˘Î·ÓËÙÈÎÔ‡ Ó‡ÚÔ˘ Î·È Û ‰˘ÛÎÔÏ›· ÂÎÙ¤ÏÂÛ˘ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ·Ó·ÁÎÒÓ, fiˆ˜ Ë Ì¿ÛËÛË. E›Û˘, Û Ôχ ÌÈÎÚfi ÔÛÔÛÙfi ¤¯ÂÈ ·Ú·ÙËÚËı› ˘·ÈÛıËÛ›· ÙÔ˘ ÁψÛÛÈÎÔ‡ Ó‡ÚÔ˘, Ë ÔÔ›· fï˜ Â›Ó·È ·ÚÔ‰È΋. ™Â ·ÓÙȉȷÛÙÔÏ‹, Ë Ï‹„Ë ÔÛÙÔ‡ ·fi ÙË ÁÂÓÂȷ΋ Û‡ÌÊ˘ÛË Â›Ó·È ‰˘Ó·ÙfiÓ Ó·
ÚÔηϤÛÂÈ ˘·ÈÛıËÛ›· ÙÔ˘ ÁÂÓÂÈ·ÎÔ‡ Ó‡ÚÔ˘, Ó¤ÎÚˆÛË
ÙˆÓ ÚÔÛı›ˆÓ Ô‰fiÓÙˆÓ Ù˘ οو ÁÓ¿ıÔ˘ ηıÒ˜ Î·È ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi fiÓÔ ÌÂÁ·Ï‡ÙÂÚ˘ ‰È¿ÚÎÂÈ·˜ Î·È ¤ÓÙ·Û˘.
O Pikos2, Û ÌÂϤÙË ÙÔ˘ ·Ó·Ê¤ÚÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÌfiÏ˘ÓÛ˘ Î·È ÌfiÓÈÌ˘ Ó¢ÚÔ·ÈÛıËÙÈ΋˜ ‚Ï¿‚˘ Û ÔÛÔÛÙfi ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 1% ·fi ÙË Ï‹„Ë ÔÛÙÔ‡, ÙfiÛÔ ·fi ÙË ÁÂÓÂȷ΋ Û‡ÌÊ˘ÛË, fiÛÔ Î·È ·fi ÙÔÓ ÎÏ¿‰Ô Ù˘ οو ÁÓ¿ıÔ˘.
E›Û˘, ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ÂÌÊ¿ÓÈÛË ÌÂÙÂÁ¯ÂÈÚËÙÈÎÔ‡ ÙÚÈÛÌÔ‡ Û ÔÛÔÛÙfi 60% ÌÂÙ¿ ÙË Ï‹„Ë ÌÔۯ‡̷ÙÔ˜ ·fi
ÙÔÓ ÎÏ¿‰Ô Ù˘ οو ÁÓ¿ıÔ˘, Ô ÔÔ›Ô˜ ÌÔÚ› Ó· ‰È·ÚΤÛÂÈ Ì¤¯ÚÈ Î·È 4 ‚‰ÔÌ¿‰Â˜. ™‡Ìʈӷ Ì ÙÔÓ ›‰ÈÔ ÂÚ¢ÓËÙ‹, Ë ÁÂÓÂȷ΋ Û‡ÌÊ˘ÛË ˆ˜ ‰fiÙÚÈ· ÂÚÈÔ¯‹ ÂÌÊ·Ó›˙ÂÈ ÛÂ
ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·ÚÔ‰È΋ ˘·ÈÛıËÛ›· Û ۇÁÎÚÈÛË
Ì ÙÔÓ ÎÏ¿‰Ô Ù˘ οو ÁÓ¿ıÔ˘. H ÔÈfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡ Â›Ó·È ·ÚfiÌÔÈ· ÙfiÛÔ ÛÙÔÓ ÎÏ¿‰Ô fiÛÔ Î·È ÛÙË ÁÂÓÂȷ΋
Û‡ÌÊ˘ÛË, ˆÛÙfiÛÔ Ô ÎÏ¿‰Ô˜ ÏÂÔÓÂÎÙ› Û fiÙÈ ·ÊÔÚ¿
ÙËÓ ÔÛfiÙËÙ· ÙÔ˘ ÔÛÙÔ‡, Ô˘ ‰‡Ó·Ù·È Ó· ÏËÊı› Î·È ÛÙÔÓ
ÌÂȈ̤ÓÔ Î›Ó‰˘ÓÔ ÙÚ·˘Ì·ÙÈÛÌÔ‡ Ó‡ÚÔ˘.
™ÙȘ Èı·Ó¤˜ ÂÈÏÔΤ˜5 Ù˘ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜, Ô˘ ÌÔÚ› Ó· ÚÔ·„Ô˘Ó ·fi ÙË Ï‹„Ë ÂÓ‰ÔÛÙÔÌ·ÙÈÎÒÓ ÌÔÛ¯Â˘Ì¿ÙˆÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Î·È ÙÔ Î¿Ù·ÁÌ· Ù˘ οو ÁÓ¿ıÔ˘. ™ÙÔÓ ›Ó·Î· 1 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ
·Ú¿ÁÔÓÙ˜ Ô˘ ·˘Í¿ÓÔ˘Ó ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘
·˘Ù‹˜ Ù˘ ÂÈÏÔ΋˜6. Afi ÙËÓ ·Ó·ÛÎfiËÛË Ù˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, ‰ÂÓ ˘¿Ú¯ÂÈ ¿ÏÏË ·Ó·ÊÔÚ¿ ÂÚ›ÙˆÛ˘ ÌÂı‡ÛÙÂÚÔ˘ ηٿÁÌ·ÙÔ˜ Ù˘ οو ÁÓ¿ıÔ˘ Û˘ÓÂ›· Ï‹„˘
·˘ÙÔÌÔۯ‡̷ÙÔ˜ ÛÙ· Ï·›ÛÈ· Ù˘ ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋˜
¯ÂÈÚÔ˘ÚÁÈ΋˜. Afi ÙËÓ ·ÎÙÈÓÔÁÚ·ÊÈ΋ ÌÂϤÙË Ù˘ ÂÚÈÔ76
EÈÎ. 3: KÏÈÓÈ΋ ÂÈÎfiÓ· ¤Ó· ¯ÚfiÓÔ ÌÂÙ¿ ÙËÓ ·ÔηٿÛÙ·ÛË
Fig. 3: Clinical picture one year post rehabilitation
EÈÎ. 4: ¶·ÓÔÚ·ÌÈ΋ ·ÎÙÈÓÔÁÚ·Ê›· ¤Ó· ¯ÚfiÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈο
Fig. 4: Panoramic x-ray one year postoperatively
been studied and described in the literature. The extraoral sites for bone graft harvesting are the anterior and
posterior iliac crest, the tibial bone and the calvarial bone.
The intra-oral sites include the mandibular symphysis, the
mandibular ramus and body, the mandibular coronoid
process and the zygomatic buttress2, 3.
However, the use of intra-oral grafts have more advantages than the extra-oral grafts. The reasons are the
technical ease, the reduced number of complications, as
patients do not require hospitalization, and the absence of
scar at the end of surgery. Also important advantages are
the proximity between donor and receiving area and the
fact that general anaesthesia is not necessary and subsequently the duration of surgery is reduced. However, a
disadvantage is the limited amount of bone which can be
obtained, without exceeding acceptable donor site morbidity3. Among the intra-oral donor sites, the mandibular ramus and the madibular symphysis have the advantages
of better quality and more sufficient quantity comparing to
the other sites3, 4.
Clavero and Lundgren3 in their study, compared the
morbidity and the complications of mandibular donor
areas. The result of this study was that patients in whom
mandibular ramus was the donor site suffered less
Hellenic Stomatological Review 57: 73-78, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
¯‹˜, Èı·ÓÔÏÔÁÂ›Ù·È Ë ·Ô‰˘Ó¿ÌˆÛ‹ Ù˘ ·fi ÙËÓ Ù·˘Ùfi¯ÚÔÓË Ï‹„Ë ÙÔ˘ ·˘ÙÔÌÔۯ‡̷ÙÔ˜ Î·È ÙËÓ ¯ÂÈÚÔ˘ÚÁÈ΋
ÂÍ·ÁˆÁ‹ ÙÔ˘ Û‡ÛÙÔÈ¯Ô˘ ÂÁÎÏ›ÛÙÔ˘ ÛˆÊÚÔÓÈÛÙ‹Ú·, Ô ÔÔ›Ô˜ ηٷϿ̂·Ó ۯ‰fiÓ fiÏÔ ÙÔ ‡„Ô˜ Ù˘ ÁÓ¿ıÔ˘.
™ÙËÓ Û˘ÁÎÂÎÚÈ̤ÓË ÂÚ›ÙˆÛË, Ë ÂÈÏÔÁ‹ ›Ù Ù˘ ÂÚÈÔ¯‹˜ Ù˘ Û‡ÌÊ˘Û˘ ›Ù ϤÔÓ ¿ˆ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘ ÂÁÎÏ›ÛÙÔ˘ 48 ı· ‹Ù·Ó ηٷÏÏËÏfiÙÂÚË.
¶›Ó·Î·˜ 1: ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘
ÁÈ· οٷÁÌ· ÛÙËÓ Î¿Ùˆ ÁÓ¿ıÔ
1.
2.
3.
4.
5.
6.
HÏÈΛ· ·ÛıÂÓÔ‡˜
¶˘ÎÓfiÙËÙ·, ÔÛfiÙËÙ· Î·È ‡„Ô˜ ÔÛÙÔ‡
OÛÙÈΤ˜ ÌÂÙ·‚ÔÏÈΤ˜ ‰È·Ù·Ú·¯¤˜
OÛÙÂÔÌ˘ÂÏ›Ùȉ·
™¯ÂÙÈ˙fiÌÂÓ˜ Ô‰ÔÓÙÔÁÂÓ›˜ ‰È·Ù·Ú·¯¤˜
TÚ›ÙÔÈ ÁÔÌÊ›ÔÈ Ô˘ ηٷϷ̂¿ÓÔ˘Ó ÙÔ ‡„Ô˜
Ù˘ ÁÓ¿ıÔ˘
7. ÕÛÎËÛË ˘¤ÚÌÂÙÚ˘ ‰‡Ó·Ì˘ ÛÙÔ ¯ÂÈÚÔ˘ÚÁ›Ô
¶ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ·Ó·‰Â›ÍÂÈ ÙËÓ Â˘ÂÚÁÂÙÈ΋ Â›‰Ú·ÛË ÙÔ˘ ·ÈÌÔÂÙ·ÏÈ·ÎÔ‡ ·Ú¿ÁÔÓÙ· PRGF (Plasma
Rich Growth Factor) ÛÙËÓ ÂÔ˘ÏˆÙÈ΋ ‰È·‰Èηۛ·7. °È·
ÙËÓ ·Ú·Û΢‹ ÙÔ˘ PRGF ··ÈÙÂ›Ù·È Ë Ï‹„Ë 10-15cc ·›Ì·ÙÔ˜ ·fi ÙÔÓ ·ÛıÂÓ‹, ÙÔ ÔÔ›Ô Ì ÙËÓ Î·Ù¿ÏÏËÏË ÂÂÍÂÚÁ·Û›· ·Ú¤¯ÂÈ ‰È¿ÊÔÚ· ÚÔÈfiÓÙ·, Ì ÛËÌ·ÓÙÈÎfiÙÂÚÔ
·˘Ùfi Ù˘ ÌÂÌ‚Ú¿Ó˘ ÈÓÈ΋˜ PRGF, Ë ÔÔ›· ·ÂÏ¢ıÂÚÒÓÂÈ ·˘ÍËÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜. ¶ÚfiÎÂÈÙ·È ÁÈ· Ì›· ·˘ÙfiÏÔÁË
ÌÂÌ‚Ú¿ÓË ‹ÁÌ·ÙÔ˜ ÈÓÈ΋˜, Ë ÔÔ›· ·ÂÏ¢ıÂÚÒÓÂÈ ÛÙ·‰È·Î¿ ·˘ÍËÙÈÎÔ‡˜ Î·È ÌÈÙˆÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Â¿ÁÔÓÙ·˜ Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÙË ‰È·ÊÔÚÔÔ›ËÛË ÙˆÓ Î˘ÙÙ¿ÚˆÓ, ÙËÓ ÔÛÙÂÔÁ¤ÓÂÛË Î·È ÙËÓ ·ÁÁÂÈÔÁ¤ÓÂÛË ÛÙËÓ ÂÚÈÔ¯‹ Ô˘ ÂÊ·ÚÌfi˙ÂÙ·È8. EÌÊ·Ó›˙ÂÈ ·ÓÙÈ‚·ÎÙËÚȉȷ΋ ‰Ú¿ÛË ¤Ó·ÓÙÈ ÙÔ˘ Staphylococcus aureus Î·È ÙÔ˘ Escherichia
coli, ηıÒ˜ Î·È ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ‰Ú¿ÛË ·fi ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ MCP-1 ÚˆÙ½Ó˘ Î·È ÙËÓ ·Ú·ÁˆÁ‹ ÏÈÔ͛Ӣ
A4. H ¯Ú‹ÛË ÙÔ˘ PRGF ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÔÈ ·ÛıÂÓ›˜
Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù·¯‡ÙÂÚË ÂԇψÛË, ¯·ÌËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÊÏÂÁÌÔÓÒÓ Î·È ÌÂȈ̤ÓÔ ÌÂÙÂÁ¯ÂÈÚËÙÈÎfi fiÓÔ9, 10.
™ÙËÓ ÚÔÎÂÈ̤ÓË ÂÚ›ÙˆÛË, ÙÔ PRGF ÏÂÈÙÔ‡ÚÁËÛ ÌfiÓÔ
˘ÔÛÙËÚÈÎÙÈο Î·È ‰ÂÓ ·ÔÙ¤ÏÂÛ ÙË ‚·ÛÈ΋ ̤ıÔ‰Ô ·ÓÙÈÌÂÙÒÈÛ˘ ÙÔ˘ ηٿÁÌ·ÙÔ˜. TÔ Î¿Ù·ÁÌ· ·ÓÙÈÌÂÙˆ›ÛÙËΠ̠ÎÏÂÈÛÙ‹ ·Ó¿Ù·ÍË Î·È Ù·˘Ùfi¯ÚÔÓË ·ÎÈÓËÙÔÔ›ËÛË Ì ÙË ¯Ú‹ÛË ‰È·ÁÓ·ıÈÎÒÓ Ó·Úı‹ÎˆÓ Ù‡Ô˘ Erich ηÈ
Û˘ÚÌ¿ÙÈÓ˜ ÚÔÛ‰¤ÛÂȘ Î·È fi¯È Ì ·ÓÔÈÎÙ‹ ·Ó¿Ù·ÍË Î·È
¯Ú‹ÛË Ï·ÎÒÓ ÔÛÙÂÔÛ‡ÓıÂÛ˘. H Û˘ÁÎÂÎÚÈ̤Ó˘ ̤ıÔ‰Ô˜ ÂÈϤ¯ıËΠˆ˜ Ë ϤÔÓ Û˘ÓÙËÚËÙÈ΋ ·ÊÂÓfi˜ ‰ÈfiÙÈ Ë
·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÌÈÎÚ‹ ·ÚÂÎÙfiÈÛË ÙˆÓ Î·Ù·ÁfiÓÙˆÓ ÙÌËÌ¿ÙˆÓ Î·È ÂÏ·ÊÚ¿ ‰È·Ù·Ú·¯‹ Ù˘ Û‡ÁÎÏÂÈÛ˘
Î·È ·ÊÂÙ¤ÚÔ˘ ÚÔ˜ ·ÔÊ˘Á‹ Ù˘ ÁÂÓÈ΋˜ ·Ó·ÈÛıËÛ›·˜11.
™YM¶EPA™MATA
H ÚÔÂÌÊ˘ÙÂ˘Ì·ÙÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋, ÛÙËÓ Î·ıË̤ڷ Ú¿ÍË Â›Ó·È Ì›· ··Ú·›ÙËÙË ‰È·‰Èηۛ·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÙÔHellenic Stomatological Review 57: 73-78, 2013
postoperative complications compared to those who the
mandibular symphysis was the donor. Particularly, harvesting bone from the mandibular ramus can lead to
hypoesthesia of the buccinator nerve and difficulties in
executing operational needs such as chewing. In
contrast, bone from the mandibular symphysis may cause
hypoesthesia of the mental nerve, necrosis of anterior
teeth of the mandible and severe postoperative pain.
On the other hand, Pikos2, in his study indicates reduced
possibility of infection and of permanent neurosensory
damage in a rate of <1%, by harvesting bone from both
mandibular symphysis and mandibular ramus. He
supported also the occurrence of 60% of postoperative
trismus after ramus bone harvesting, which disappears
after 4 weeks. Also, the same paper stated that the incidence of transient paresthesia is lower when mandibular symphysis is used as a donor site comparing to ramus. In
conclusion, the quality of the bone is similar both in ramus
and in mandibular symphysis, whereas the ramus has more
advantages, such as the increased amount of bone that
may be obtained and the reduced risk of nerve injury.
Fracture of the mandible is a rare complication in preimplant surgery. The risk factors for mandibular fracture
are shown in table 16. Fractures of the mandibular angle
associated with third molar removal are generally avoidable when precise preoperative clinical and radiographic
evaluation are completed. In our case the post extraction
panoramic x-ray revealed that the simultaneous extraction of the impacted third molar and the harvesting of the
bone graft led to weakening of the area which a normal
daily activity caused the fracture.
Table 1: Risk factors for mandibular
fracture
1.
2.
3.
4.
5.
6.
7.
Older patient
Dense bone and small mandible
Metabolic bone disease
Osteomyelitis
Associated odontogenic pathology
Third molar occupies the height of jaw
Injudicious surgical forces
Recent studies have highlighted the beneficial effect of
platelet factor PRGF (Plasma Rich Growth Factor) in the
healing process7. The preparation of the PRGF technique
is quite simple. Initially, 10-15cc of patient’s blood are
obtained and thereafter the blood is placed in a centrifuge
where platelet poor plasma, red blood cells sediment and
fibrin membrane PRGF are produced.
The PRGF is a material with a lot of applications enhancing the healing process. It is an autologous fibrin gel
membrane, which gradually releases growth and mitotic
factors, inducing thereby modulation osteogenesis and
angiogenesis in8. Also, it is very important that it exhibits
antibacterial activity against Staphylococcus aureus and
77
¶·ÚÔ˘Û›·ÛË ¶ÂÚ›ÙˆÛ˘
Case report
ÔıÂÙËıÔ‡Ó ÂÌÊ˘Ù‡̷ٷ Û ÂÚÈÙÒÛÂȘ ÔÛÙÈÎÔ‡ ÂÏÏ›ÌÌ·ÙÔ˜ Î·È ÂÊ·ÚÌfi˙ÂÙ·È ϤÔÓ Ì ÌÂÁ¿ÏË ÂÈÙ˘¯›·. øÛÙfiÛÔ, ˘¿Ú¯ÂÈ ¿ÓÙ· Ë Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ Î·È Ë ÂÈÏÔÁ‹ Ù˘ ηٿÏÏËÏ˘ ‰fiÙÚÈ·˜ ÂÚÈÔ¯‹˜ ı·
Ú¤ÂÈ Ó· ‚·Û›˙ÂÙ·È ÛÙË ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË Î·È ÂÎÙ›ÌËÛË
Ù˘ ÂοÛÙÔÙ ‰fiÙÚÈ·˜ ÂÚÈÔ¯‹˜.
T· ·˘ÙÔÁÂÓ‹ ÌÔۯ‡̷ٷ ıˆÚÔ‡ÓÙ·È Ë Î·Ï‡ÙÂÚË ÂÈÏÔÁ‹ Û fiÙÈ ·ÊÔÚ¿ ÙËÓ ÔÛÙÂÔÁÂÓÂÙÈ΋ ÈηÓfiÙËÙ·, Ì ÙÔÓ
ÎÏ¿‰Ô Ù˘ οو ÁÓ¿ıÔ˘ Ó· ˘ÂÚÙÂÚ› ¤Ó·ÓÙÈ ÙˆÓ ¿ÏψÓ
‰fiÙÚÈˆÓ ÂÓ‰ÔÛÙÔÌ·ÙÈÎÒÓ ÂÚÈÔ¯ÒÓ. T¤ÏÔ˜, Ô ·ÈÌÔÂÙ·ÏÈ·Îfi˜ ·Ú¿ÁÔÓÙ·˜ PRGF, Ì ÙËÓ ˘Ô‚Ô‹ıËÛË ÙÔ˘ ÂÔ˘ÏˆÙÈÎÔ‡ Ì˯·ÓÈÛÌÔ‡, Â›Ó·È ÌÈ· ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ÂÈÎÔ˘ÚÈ΋ ÂÈÏÔÁ‹ ÛÙËÓ ıÂÚ·›· ÙˆÓ Î·Ù·ÁÌ¿ÙˆÓ.
Escherichia coli, and antiinflammatory activity by blockade of MCP-1 protein and the production of lipoxin A4.
Thus, patients taking any of the PRGF products generally
have lower levels of inflammation and reduced postoperative pain during the postoperative period9, 10.
In our case, PRGF was an auxiliary tool in the management
of the fracture. The choice of treatment was the conservative approach using closed reduction with intramaxillary
fixation because the fracture was not severily displaced
with slight malloclusion. Choosing also this treatment
general anesthesia and hospitalization were avoided.
BIB§IO°PAºIA
The pre-implant surgery is a necessary process in order
to place implants in cases of a bone defect. The
autogenous grafts are considered to be the best choice,
regarding the quality of the graft. However, there is always
the possibility of complications and it is very important to
select the accurate and suitable donor area, based on
specific criteria.The mandibular ramus overweights over
the other intraoral donor sites as the most reliable source,
especially in cases of small bone defects. Finally, the
platelet factor PRGF is a promising choice in enhancing
the healing process of fractures.
1. Sittitavornwong Somsak, Gutta Rajesh: Bone graft harvesting
from regional sites. Atlas Oral Maxillofacial Surg Clin N Am
2010; 22: 317-330.
2. Pikos A Michael: Mandibular block autografts for alveolar
ridge augmentation. Atlas Oral Maxillofacial Surg Clin N Am
2005; 13: 91-107.
3. Clavero Jaime, Lundgren Stefan: Ramus or chin grafts for maxillary sinus inlay and local onlay augmentation: Comparison
of donor site morbidity and complications. Clinical Implant
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4. AÁÁÂÏfiÔ˘ÏÔ˜ A, AÏÂÍ·Ó‰Ú›‰Ë˜ K, K·ÙÛÈΤÚ˘ N: ™‡Á¯ÚÔÓË
ÛÙÔÌ·ÙÈ΋ Î·È ÁÓ·ıÔÚÔÛˆÈ΋ ¯ÂÈÚÔ˘ÚÁÈ΋. 2Ë ¤Î‰ÔÛË.
Aı‹Ó·. I·ÙÚÈΤ˜ ÂΉfiÛÂȘ §›ÙÛ·˜. 2009; 313-319.
5. AÏÂÍ·Ó‰Ú›‰Ë˜ K: EÈÛ·ÁˆÁ‹ ÛÙËÓ ÂÌÊ˘ÙÂ˘Ì·ÙÔÏÔÁ›·. 1Ë ¤Î‰ÔÛË. Aı‹Ó·. I·ÙÚÈΤ˜ ÂΉfiÛÂȘ §›ÙÛ·˜. 2009: 55.
6. Marciani DR: Complications of third molar surgery and their
management. Atlas Oral Maxillofacial Surg Clin N Am 2012;
20: 233-251.
7. Delgado JJ, Sanchez E, Baro M, Reyes R, Evora C, Delgado
A: A platelet derived growth factor delivery system for bone
regeneration. J Mater Sci: Mater Med 2012; 23: 1903-1912.
8. Anitua E, And›a I: PRGF (Plasma Rich in Growth Factors).
Dental Dialogue 2004: 56-66.
9. Kaigler D, Avila G, Wisner-Lynch L, Nevins Mar, Nevins Myr,
Rasperini G, Lynch S, Giannobile W: Platelet-Derived Growth
Factor Applications in Periodontal and Peri-Implant Bone
Regeneration. Expert Opin Biol Ther 2011; 11 (3): 375-385.
10. Anitua E: The use of Plasma-Rich Growth Factors (PRGF) in
oral surgery. Practical procedures & aesthetic dentistry 2001;
13 (6): 486-493.
11. £ÂÔÏfiÁË-§˘Áȉ¿ÎË N, ™·Ì¿Ú·˜ X, ™ÎfiÓ‰Ú·˜ A, I·ÙÚÔ‡ I: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË È·ÙÚÔÁÂÓÒÓ Î·Ù·ÁÌ¿ÙˆÓ Ù˘ οو ÁÓ¿ıÔ˘. O‰ÔÓÙÔÛÙÔÌ·ÙÔÏÔÁÈ΋ ¶ÚfiÔ‰Ô˜
1997; 51 (4): 238-243.
CONCLUSION
Corresponding author:
F. Tzermpos
e-mail: [email protected]
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
º.T˙¤ÚÌÔ˜
e-mail: [email protected]
78
Hellenic Stomatological Review 57: 73-78, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
T¯ÓÈ΋ ¿ÌÂÛ˘ ·ÈÛıËÙÈ΋˜ ·Ú¤Ì‚·Û˘ Ì ۇÓıÂÙ˜
ÚËÙ›Ó˜ Û ÚfiÛıÈ· ¿Óˆ ‰fiÓÙÈ· II˘ Û˘ÁÎÏÂÈÛȷ΋˜ Ù¿Í˘
E. TÛÈÔ‡ÚË*, ¢. ™·ÁfiÔ˘ÏÔ˜**, M. AÓÙˆÓÈ¿‰Ô˘***
Anterior upper teeth direct esthetic bonding
in a class II bite case
E. Tsiouri E*, D. Spagopoulos**, M. Antoniadou***
¶EPI§HæH
SUMMARY
™ÎÔfi˜: OÈ Û‡Á¯ÚÔÓ˜ ÂÍÂÏ›ÍÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙȘ
Û‡ÓıÂÙ˜ ÚËÙ›Ó˜ Î·È Ù· ÚˆÙfiÎÔÏÏ· ÂÓ‰ÔÛÙÔÌ·ÙÈ΋˜ Û˘ÁÎfiÏÏËÛ˘ ·˘ÙÒÓ, ¤¯Ô˘Ó ÚÔÛʤÚÂÈ Ì›· ÂÓ·ÏÏ·ÎÙÈ΋ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ Ï‡ÛË,
ÁÈ· ·ÈÛıËÙÈ΋ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÂÓfi˜
¯·ÌfiÁÂÏÔ˘ Ì ‰È·‰Èηۛ˜ ÂÏ¿¯ÈÛÙ˘ ·Ú¤Ì‚·Û˘
ÛÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜. ™Ùfi¯Ô˜ ÙÔ˘ ¿ÚıÚÔ˘ ·˘ÙÔ‡ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË Ù˘ Ù¯ÓÈ΋˜ ¿ÌÂÛ˘ ·ÈÛıËÙÈ΋˜ ·ÔηٿÛÙ·Û˘ ¯·ÌfiÁÂÏÔ˘ Ì ۇÓıÂÙ˜
ÚËÙ›Ó˜ ̤ۈ ¿ÌÂÛ˘ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋˜ ÚÔÛÔÌÔ›ˆÛ˘ (‰È·ÁÓˆÛÙÈÎfi ÂÓ‰ÔÛÙÔÌ·ÙÈÎfi mock-up) Û ·ÛıÂÓ‹ II˘ Û˘ÁÎÏÂÈÛȷ΋˜ Ù¿Í˘ ηٿ Angle.
¶·ÚÔ˘Û›·ÛË ÂÚÈÛÙ·ÙÈÎÔ‡: °˘Ó·›Î· 22 ÂÙÒÓ ÚÔÛ‹Ïı ÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ ÚÔÙ˘¯È·ÎÔ‡ ÙÌ‹Ì·ÙÔ˜
Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, Ì ÚfiÛıÈ· ‰fiÓÙÈ· ¿Ù˘˘ ÌÔÚÊÔÏÔÁ›·˜ ηÈ
‰È·ÛÙ‹Ì·Ù· ÌÂٷ͇ ·˘ÙÒÓ ‰ËÏÒÓÔÓÙ·˜ ‰˘Û·ÚÂÛÙË̤ÓË Ì ÙËÓ ÂÈÎfiÓ· ÙÔ˘ ¯·ÌfiÁÂÏÔ‡ Ù˘. ◊Ù·Ó
Aims and objectives: Recent advances in composite resins and adhesive bonding protocols offer an
alternative to ceramics solution, for restoring esthetically and functionally a patient’s smile with a minimally interventional technique. The aim of this case
presentation is to illustrate a direct approach for
smile enhancement in a class II bite patient with
diastemas using a direct resin mock-up technique.
Case description: A 22-year-old female patient presented in the clinic of the graduate department of
the Dental School of Athens, with untypically shaped teeth and diastemas in the anterior upper esthetic zone and claimed to be unhappy with her smile.
She had class II bite and was not a bruxist. Possible
treatment options were presented and the direct
bonding technique with composite resins was selected for the case by both patient and the dentist.
Conclusions: The esthetic advantage of this direct
* O‰ÔÓÙ›·ÙÚÔ˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ AıËÓÒÓ
** MÂÙ·Ù˘¯È·Îfi˜ ºÔÈÙËÙ‹˜, ¶ÚfiÁÚ·ÌÌ· O‰ÔÓÙÈ΋˜
XÂÈÚÔ˘ÚÁÈ΋˜, O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ AıËÓÒÓ
*** §¤ÎÙÔÚ·˜, EÚÁ·ÛÙ‹ÚÈÔ O‰ÔÓÙÈ΋˜ XÂÈÚÔ˘ÚÁÈ΋˜,
O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹ AıËÓÒÓ
* Dentist, University of Athens, Greece
** Postgraduate student, Department of Operative Dentistry,
Dental School, University of Athens, Greece
*** Lecturer, Department of Operative Dentistry, Dental
School, University of Athens, Greece
H ÎÏÈÓÈ΋ ÂÚÁ·Û›· Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ¿ÚıÚÔ ·˘Ùfi ¤¯ÂÈ Ú·ÁÌ·ÙÔÔÈËı› ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. OÈ Û˘ÁÁÚ·Ê›˜ ‰ËÏÒÓÔ˘Ó fiÙÈ
‰ÂÓ ¤¯Ô˘Ó ηӤӷ ÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ ·fi ÙË ¯Ú‹ÛË Î·È ÂÚÈÁÚ·Ê‹ ˘ÏÈÎÒÓ, ‚ÔËıËÙÈÎÒÓ Ì¤ÛˆÓ Î·È ÂÙ·ÈÚÂÈÒÓ ÛÙÔ ¿ÚıÚÔ ·˘Ùfi.
The clinical work described in this paper is performed by
the authors. Authors declare no financial interest whatsoever
on dental products and companies mentioned in this article.
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 79-90, 2013
·ÚÂÏ‹ÊıË 21/1/2014 - ÂÎÚ›ıË 25/2/2014
Hellenic Stomatological Review 57: 79-90, 2013
paper received 21/1/2014 - accepted 25/2/2014
79
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
II˘ Û˘ÁÎÏÂÈÛȷ΋˜ Ù¿Í˘, ¯ˆÚ›˜ ‚Ú˘ÁÌfi. MÂÙ¿ ÙËÓ
·ÚÔ˘Û›·ÛË fiÏˆÓ ÙˆÓ Èı·ÓÒÓ Û¯Â‰›ˆÓ ıÂÚ·›·˜, ·ÔÊ·Û›ÛÙËÎÂ Ë ÂÊ·ÚÌÔÁ‹ Ù˘ Ù¯ÓÈ΋˜ ¿ÌÂÛ˘ Û˘ÁÎfiÏÏËÛ˘ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ.
™˘ÌÂÚ¿ÛÌ·Ù·: TÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Ù˘ ¿ÌÂÛ˘ ·˘Ù‹˜ Ù¯ÓÈ΋˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË Û˘ÓÙËÚËÙÈ΋ ·Ú¤Ì‚·ÛË ÛÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜ Ô‰‹ÁËÛ·Ó
Û ¤Ó· ·fiÏ˘Ù· ÈηÓÔÔÈËÙÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. H Ì·ÎÚÔ‚ÈfiÙËÙ· Ù¤ÙÔÈˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ¤¯ÂÈ ÙÂÎÌËÚȈı› Î·È ÌÔÚ› Ó· ÂÍ·ÛÊ·ÏÈÛÙ› Ì ٷÎÙÈΤ˜ Â·ÓÂÍÂÙ¿ÛÂȘ ÁÈ· ¤ÏÂÁ¯Ô Î·È Û˘ÓÙ‹ÚËÛË.
§¤ÍÂȘ ÎÏÂȉȿ: ·ÈÛıËÙÈ΋ ˙ÒÓË ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ, ۯ‰ȷÛÌfi˜
¯·ÌfiÁÂÏÔ˘, ¿ÌÂÛ˜ ·ÔηٷÛÙ¿ÛÂȘ Û‡ÓıÂÙ˘
ÚËÙ›Ó˘, ÎÏ›ÛÈÌÔ ‰È·ÛÙËÌ¿ÙˆÓ, fi„ÂȘ Û‡ÓıÂÙ˘
ÚËÙ›Ó˘, IIË Û˘ÁÎÏÂÈÛȷ΋ Ù¿ÍË Î·Ù¿ Angle
EI™A°ø°H
H ȉ·ÓÈ΋ ·ÔηٿÛÙ·ÛË ÂÓfi˜ ¯·ÌfiÁÂÏÔ˘ ÏÂÈÙÔ˘ÚÁÈο
Î·È ·ÈÛıËÙÈο, ·ÔÙÂÏ› ÚfiÎÏËÛË ÁÈ· ÙÔ˘˜ ÎÏÈÓÈÎÔ‡˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜ Ù· ÙÂÏÂ˘Ù·›· ›ÎÔÛÈ ¯ÚfiÓÈ·, ÂȉÈο Û ÂÚÈÙÒÛÂȘ Ô˘ Ë ÔÚıÔ‰ÔÓÙÈ΋ ‰ÂÓ ·ÚΛ ˆ˜ χÛË ‹ ‰ÂÓ Â›Ó·È ·Ô‰ÂÎÙ‹ ·fi ÙÔÓ ·ÛıÂÓ‹ ÁÈ· ‰È¿ÊÔÚÔ˘˜ ÏfiÁÔ˘˜. OÈ
Û‡Á¯ÚÔÓ˜ ÂÍÂÏ›ÍÂȘ fiÛÔÓ ·ÊÔÚ¿ ÙȘ Û‡ÓıÂÙ˜ ÚËÙ›Ó˜
Î·È Ù· ÚˆÙfiÎÔÏÏ· Û˘ÁÎfiÏÏËÛ˘ ¤¯Ô˘Ó ÚÔÛʤÚÂÈ Ì›·
ÂÓ·ÏÏ·ÎÙÈ΋ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ, ÂÈÏÔÁ‹.
™Â Û˘Ó‰˘·ÛÌfi Ì ÙÔ ÛˆÛÙfi ۯ‰ȷÛÌfi Ù˘ ıÂÚ·›·˜,
·˘Ù¤˜ ÔÈ ÂÍÂÏ›ÍÂȘ ÂÈÙÚ¤Ô˘Ó ÛÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ Ó· ÚÔÛʤÚÂÈ ·ÈÛıËÙÈΤ˜ χÛÂȘ Ì ÂÏ¿¯ÈÛÙË ·Ú¤Ì‚·ÛË ÛÙÔ˘˜
Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜1.
H ¤ÓÓÔÈ· Ù˘ ÂÏ¿¯ÈÛÙ˘ ·Ú¤Ì‚·Û˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÂÏ¿¯ÈÛÙË Ì˯·ÓÈ΋ ÚÔÂÙÔÈÌ·Û›· ‹ ·ÔÎÔ‹ ΢ڛˆ˜ ·‰·Ì·ÓÙ›Ó˘ Û ÂÚÈÔÚÈṲ̂ÓË ¤ÎÙ·ÛË, ¯Ú‹ÛË Û˘ÁÎÔÏÏËÙÈÎÒÓ ˘ÏÈÎÒÓ, ÂÊ·ÚÌÔÁ‹ ¿ÌÂÛˆÓ Ù¯ÓÈÎÒÓ ·ÔηٿÛÙ·Û˘ ÛÂ
Ì›· Û˘Ó‰ڛ· Î·È ÂȉÈfiÚıˆÛË ·ÔηٷÛÙ¿ÛÂˆÓ ·ÓÙ› ÁÈ·
·ÓÙÈηٿÛÙ·ÛË, fiÔ˘ ·˘Ùfi Â›Ó·È ÂÊÈÎÙfi1. M ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ, Ô ÎÏÈÓÈÎfi˜ Ô‰ÔÓÙ›·ÙÚÔ˜ ¤¯ÂÈ ·fiÏ˘ÙÔ ¤ÏÂÁ¯Ô ¿Óˆ ÛÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, ÒÛÙ ӷ ÂÙ‡¯ÂÈ ¤Ó· ¯·ÌfiÁÂÏÔ Ô˘ Ó· ÚÔÛÔÌÔÈ¿˙ÂÈ fiÔ˘ ··ÈÙÂ›Ù·È ‹ Ó· ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÚÔ¸¿Ú¯Ô˘Û· ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ηٿÛÙ·ÛË2.
TÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÏÂÔÓ¤ÎÙËÌ· ÙˆÓ ¿ÌÂÛˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Ì ۇÓıÂÙË ÚËÙ›ÓË Â›Ó·È fiÙÈ ·˘Ù¤˜ ÌÔÚÔ‡Ó Ó· ÔÏÔÎÏËÚˆıÔ‡Ó Û ̛· Û˘Ó‰ڛ· Î·È Û˘Ó‹ıˆ˜ ‰ÂÓ ··ÈÙÂ›Ù·È Î·Ó ·Ó·ÈÛıËÛ›·. H Ô‰ÔÓÙÈ΋ ÂÈÊ¿ÓÂÈ· Û˘ÁÎfiÏÏËÛ˘
ÚÔÂÙÔÈÌ¿˙ÂÙ·È Ì ÂÏ¿¯ÈÛÙË ·Ê·›ÚÂÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜
·‰·Ì·ÓÙ›Ó˘ fiÔ˘ ÎÚ›ÓÂÙ·È ··Ú·›ÙËÙÔ, ȉȷ›ÙÂÚ· Û ÂÚÈÙÒÛÂȘ Ô˘ ··ÈÙÂ›Ù·È Ë ‰ËÌÈÔ˘ÚÁ›· ¯ÒÚÔ˘ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÙÔ˘ ˘ÏÈÎÔ‡ ÒÛÙÂ Ë ÙÂÏÈ΋ ·ÔηٿÛÙ·ÛË Ó·
ÌËÓ Â›Ó·È ÔÁÎ҉˘2. MÂÙ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ·‰ÚÔÔÈËÙÈÎÔ‡
ÔͤԘ Î·È Û˘ÁÎÔÏÏËÙÈÎÔ‡ ·Ú¿ÁÔÓÙ·, ÙÔÔıÂÙÂ›Ù·È Î·È
‰È·ÌÔÚÊÒÓÂÙ·È Ë ÚËÙ›ÓË ÛÙÔ ÂÈı˘ÌËÙfi Û¯‹Ì·. X¿ÚË
ÛÙËÓ ÂͤÏÈÍË ÙˆÓ ˘ÏÈÎÒÓ, ÔÈ Û‡ÓıÂÙ˜ ÚËÙ›Ó˜ ‰È·Ù›ıÂÓÙ·È
Û ÔÏϤ˜ ·Ô¯ÚÒÛÂȘ, ¯ÚÔȤ˜, ‰È·Ê¿ÓÂȘ Î·È ·‰È·Ê¿ÓÂȘ, Ô˘ ·Ó Û˘Ó‰˘·ÛÙÔ‡Ó ÌÂٷ͇ ÙÔ˘˜ ÌÔÚÔ‡Ó Ó· ÚÔÛÔÌÔÈ¿ÛÔ˘Ó È‰·ÓÈο ÙËÓ ÂÈÎfiÓ· ÙÔ˘ Ê˘ÛÈÎÔ‡ ‰ÔÓÙÈÔ‡3, 4.
80
method and its minimal intervension on tooth structures was well accepted by the young patient. The
good longevity of such restorations can be guaranteed by recall and maintenance appointments that
should be discussed further with the patient.
Key Words: esthetic anterior zone, smile design, direct bonding,
diastema closure, veneers, Angle Class II bite
INTRODUCTION
Establishing ideal function and esthetics in a smile has
been a challenge for clinicians the past twenty years, especially when orthodontic intervention is not enough or
not accepted by patients for various reasons. Recent advances in composite resins and adhesive protocols have
expanded the restorative options. Used in combination
with proper treatment planning, these innovations enable
dental professionals to provide enhanced aesthetic care
by using minimally invasive techniques1.
The idea of “minimal invasion” includes smaller tooth
preparations, direct bonding without excessive removal of
dental tissue, adhesive dental materials and repairs rather
than replacements when feasible1. In such cases, dentists
have full artistic control over the aesthetic outcome of the
restorations resulting in a smile that can mimic if needed
or improve pre-existing conditions2. The most important
advantage of direct bonding is that it can be applied in a
single dental visit and usually without anesthesia. The
tooth is prepared with an appropriate amount of enamel
structure removed if/when necessary, so as to permit
material placement without making the tooth too bulky2.
After the application of an acidic and a bonding agent,
resin is formed into the shape desired. Due to material
evolution, composite resins are available in many shades,
hues, translucency and opacity types, which in combination can mimic the appearance of natural teeth3, 4. Once
satisfactory completed, the tooth is polished and functionally ready. Current developments in adhesive techniques and materials allow the clinician to achieve successful bonding to enamel and dentin, so that the potential of
microleakage, subsequent caries and staining is reduced.
Furthermore, stress distribution at the margin between
composite resin and the tooth is more evenly distributed,
contributing in the increase of restoration longevity5.
One of the main challenges in these procedures is selecting composites that have adequate strength and provide natural optical properties that render the restoration
functionally sound and esthetically pleasing, especially in
the anterior zone1. Composites currently used for anterior
aesthetic restorations are characterized by different mechanical and physical properties, as well as handling
characteristics. Nanofills have shown excellent esthetics,
improved mechanical properties, better handling, and
polishability than previous used hybrids. Like nanofills,
nanohybrids can be polished to a relatively smooth finish
Hellenic Stomatological Review 57: 79-90, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
T· Û‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù· Û˘ÁÎfiÏÏËÛ˘ ÂÈÙÚ¤Ô˘Ó ÈηÓÔÔÈËÙÈÎfi ‰ÂÛÌfi ÙˆÓ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ Ì ÙËÓ ·‰·Ì·ÓÙ›ÓË Î·È ÙËÓ Ô‰ÔÓÙ›ÓË, ÒÛÙ ӷ ÌÂÈÒÓÂÙ·È Ë Èı·ÓfiÙËÙ· ÌÈÎÚԉțۉ˘Û˘, ‰ËÌÈÔ˘ÚÁ›·˜ ‰Â˘ÙÂÚÔÁÂÓÔ‡˜ ÙÂÚˉfiÓ·˜
Î·È ¯ÚÒÛ˘ ÛÙ· fiÚÈ· Ù˘ ·ÔηٿÛÙ·Û˘. AÎfiÌË, ÔÈ ‰˘Ó¿ÌÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙË ÌÂÛfiÊ·ÛË Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ Î·È Ô‰ÔÓÙÈ΋˜ Ô˘Û›·˜ ηٷӤÌÔÓÙ·È ÔÌ·ÏfiÙÂÚ· ÛÙ·
Û‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù·, Û˘Ì‚¿ÏÏÔÓÙ·˜ Ì ÙÔÓ ÙÚfiÔ ·˘Ùfi
ÛÙËÓ ·‡ÍËÛË Ù˘ Ì·ÎÚÔ‚ÈfiÙËÙ·˜ Ù˘ ·ÔηٿÛÙ·Û˘5.
H ‚·ÛÈ΋ ÚfiÎÏËÛË ÙˆÓ ¿ÌÂÛˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ÂȉÈο ÛÙËÓ ·ÈÛıËÙÈ΋ ˙ÒÓË ÙˆÓ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ, Â›Ó·È Ë
ÛˆÛÙ‹ ÂÈÏÔÁ‹ Ù˘ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ Ë ÔÔ›· Ú¤ÂÈ Ó·
ʤÚÂÈ ÔÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È ·ÓÙÔ¯‹ Ô˘ ı· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó Ì›· ÛˆÛÙ‹ ÏÂÈÙÔ˘ÚÁÈο Î·È ·ÈÛıËÙÈο ·ÔηٿÛÙ·ÛË1. OÈ Û‡ÓıÂÙ˜ ÚËÙ›Ó˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ
·ÔηٿÛÙ·ÛË ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Ú¤ÂÈ Ó· ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ‰È·ÊÔÚÂÙÈΤ˜ Ì˯·ÓÈΤ˜ Î·È Ê˘ÛÈΤ˜ ȉÈfiÙËÙ˜ Î·È Ó· ÚÔÛʤÚÔ˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ ¯ÂÈÚÈÛÌÔ‡ Û ۯ¤ÛË Ì ·˘Ù¤˜ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û Ô›ÛıÈ· ‰fiÓÙÈ·. OÈ Ó·ÓfiÎÔÎΘ ÚËÙ›Ó˜ ÚÔÛʤÚÔ˘Ó ¿ÚÈÛÙË
·ÈÛıËÙÈ΋, ‚ÂÏÙȈ̤Ó˜ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ Î·È ‰˘Ó·ÙfiÙËÙ· ¢ÎÔÏfiÙÂÚÔ˘ ¯ÂÈÚÈÛÌÔ‡ Î·È Ï›·ÓÛ˘ Û ۯ¤ÛË ÌÂ
ÙȘ ·Ï·ÈfiÙÂÚ· ¯ÚËÛÈÌÔÔÈÔ‡ÌÂÓ˜ ˘‚ÚȉÈΤ˜. Ÿˆ˜ ÔÈ
Ó·ÓfiÎÔÎΘ, ¤ÙÛÈ Î·È ÔÈ Ó·ÓÔ¸‚ÚȉÈΤ˜ ÚËÙ›Ó˜ ÌÔÚÔ‡Ó
Ó· ÏÂÈ·ÓıÔ‡Ó Û ÈηÓÔÔÈËÙÈÎfi ‚·ıÌfi ·Ì¤Ûˆ˜ ÌÂÙ¿ ÙËÓ
ÙÔÔı¤ÙËÛ‹ ÙÔ˘˜, fï˜ ÛÙ·‰È·Î¿ Ë ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜ Á›ÓÂÙ·È ÈÔ ·‰Ú‹, ·ÚfiÏÔ Ô˘ ·˘Ùfi Û¿ÓÈ· Á›ÓÂÙ·È ·ÓÙÈÏËÙfi
·fi ÙÔÓ ›‰ÈÔ ÙÔÓ ·ÛıÂÓ‹5. X¿ÚË ÛÙËÓ ÈηÓfiÙËÙ· ‡ÎÔÏÔ˘
¯ÂÈÚÈÛÌÔ‡ ÙÔ˘˜, Ë Ù¯ÓÈ΋ Ù˘ ‰È·ÛÙڈ̿وÛ˘ Á›ÓÂÙ·È È‰È·›ÙÂÚ· ·Ï‹ Ì ٷ ˘ÏÈο ·˘Ù¿. AÓ Î·È ÔÈ ÌÈÎÚfiÎÔÎΘ
ÚËÙ›Ó˜ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË ·ÓÙÔ¯‹ ÛÙË ıÚ·‡ÛË Î·È ÛÙËÓ
ÎfiˆÛË Û ۯ¤ÛË Ì ÙȘ ÚÔ·Ó·ÊÂÚı›Û˜ ηÙËÁÔڛ˜
ÚËÙÈÓÒÓ, Â›Ó·È ÁÂÓÈο ·Ô‰ÂÎÙfi fiÙÈ ‰›ÓÔ˘Ó ÈÔ ÛÙÈÏÓ‹ ÙÂÏÈ΋ ÂÈÊ¿ÓÂÈ· ÙËÓ ÔÔ›· Î·È ‰È·ÙËÚÔ‡Ó ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ
¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÂӉ›ÎÓ˘Ù·È Ë ÙÔÔı¤ÙËÛ‹ ÙÔ˘˜ ˆ˜ ÙÂÏÈÎfi ÛÙÚÒÌ· ÛÙȘ fi„ÂȘ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ Û ÂÚÈÙÒÛÂȘ Ô˘ ‰ÂÓ ˘¿Ú¯ÂÈ ‚Ú˘ÁÌfi˜2, 6.
OÈ Ù¯ÓÈΤ˜ ÁÈ· ¿ÌÂÛË ·ÔηٿÛÙ·ÛË ‰ÔÓÙÈÒÓ Ì fi„ÂȘ
ÚËÙ›Ó˘ ¤¯Ô˘Ó Â›Û˘ ÂÍÂÏȯı› fiˆ˜ Î·È Ù· ˘ÏÈο, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜ ÂÍÂÏÈÁ̤ӷ ÚˆÙfiÎÔÏÏ· Û˘ÁÎfiÏÏËÛ˘ Î·È Ù¯ÓÈΤ˜ ‰È·ÛÙڈ̿وÛ˘. H Ù¯ÓÈ΋ Ù˘ ‰È·ÌfiÚʈÛ˘ Ù˘ ÚËÙ›Ó˘ Ì «ÂχıÂÚÔ ¯¤ÚÈ» ÚÔÛʤÚÂÈ Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÙËÓ ·›ÛıËÛË Ù˘ ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ·˜4. AÎfiÌË,
Ë Ù¯ÓÈ΋ ‰È·ÌfiÚʈÛ˘ Ù˘ ÚËÙ›Ó˘ Ì ̋ÙÚ· ÛÈÏÈÎfiÓ˘
ÁψÛÛÈο, ηıÔ‰ËÁ› ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ ÛÙËÓ È‰·ÓÈ΋ ·Ó··Ú·ÁˆÁ‹ ÙˆÓ ‰È·ÛÙ¿ÛˆÓ, ÙÔ˘ Û¯‹Ì·ÙÔ˜ Î·È Ù˘ ·Ó·ÙÔÌ›·˜, fiˆ˜ ‰È·ÌÔÚÊÒıËÎ·Ó ÛÙÔ ‰È·ÁÓˆÛÙÈÎfi Τڈ̷, ÂÍÔÈÎÔÓÔÌÒÓÙ·˜ ÔχÙÈÌÔ ÎÏÈÓÈÎfi ¯ÚfiÓÔ ÂÚÁ·Û›·˜5.
M¤Û· ·fi ÙËÓ ·ÚÔ˘Û›·ÛË ÂÓfi˜ ÎÏÈÓÈÎÔ‡ ÂÚÈÛÙ·ÙÈÎÔ‡,
ηٷÁÚ¿ÊÔÓÙ·È ÛÙÔ ¿ÚıÚÔ ·˘Ùfi, Ù· ‚‹Ì·Ù· ÚÔÂÙÔÈÌ·Û›·˜ Î·È ÂÊ·ÚÌÔÁ‹˜ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙËÓ ·ÈÛıËÙÈ΋
·ÔηٿÛÙ·ÛË ÂÓfi˜ ·ÚÌÔÓÈÎÔ‡ ¯·ÌfiÁÂÏÔ˘ Ì ۇÓıÂÙ˜
ÚËÙ›Ó˜, ÛÙ· ÚfiÛıÈ· ¿Óˆ ‰fiÓÙÈ· ·ÙfiÌÔ˘ II˘ Û˘ÁÎÏÂÈÛȷ΋˜ Ù¿Í˘ ηٿ Angle.
¶APOY™IA™H ¶EPI™TATIKOY
°˘Ó·›Î· 22 ÂÙÒÓ, ·ÚÔ˘ÛÈ¿ÛÙËΠÛÙËÓ ÎÏÈÓÈ΋ ÙÔ˘ ÚÔHellenic Stomatological Review 57: 79-90, 2013
at placement, but develop a slightly frosty appearance
over a period of time which anyway would likely go
unnoticed by most patients5. Their handling properties are
extremely conducive to direct resin stratification techniques. Although microfilled composites have shown lower
fracture resistance and fatigue in comparison with the
more heavily filled previous mentioned composites, it is
generally accepted that they polish extremely well and
can retain their surface smoothness over time. For these
reasons, they are indicated for resin veneers, as the last
material layer, in cases when bruxism is not present2, 6.
Techniques on restoring teeth with direct composite veneers have also evolved, with sophisticated bonding and
stratification procedures. “Freehand” techniques offer a
great deal of creativity4. Furthermore, the lingual silicone
matrix technique can be extremely effective in guiding the
clinical reproduction of the ideal proportions, shapes, and
anatomy created in the diagnostic wax up and saving
invaluable chair side time5.
Using a case presentation, this article documents the steps
required to harmoniously integrate smile design with direct
composite resins in the provision of aesthetic dental care in
the anterior zone of a class II bite occlusion status.
CASE DESCRIPTION
A 22-year-old female patient presented in the graduate
clinic of the dental School of Athens, with the right maxillary lateral incisor endodontically treated and restored
with labial and palatal resin composite nine years ago in
the form of a canine. One year before the first visit of the
patient in the clinic, she underwent intracoronal bleaching
in a private office, but discoloration reappeared after 8
months from completion of the treatment. She also
desired aesthetic enhancement of her entire smile.
Her medical history was noncontributory and oral hygiene
was excellent. The patient had no abrasive habits and was
not a bruxist. She did not smoke and claimed to drink at
least two cup of coffees per day, although her natural
teeth were not stained.
Comprehensive clinical examination revealed that the
discolored tooth #12 did not have the typical morphology
of a maxillary lateral incisor and that multiple diastemas
were present in all upper anterior teeth. It was also
observed that the incisal part of the maxillary canines
were sharp while tooth #14 was introverted. Cervical
embrasures were evaluated and imbalance between #12
and #22 was noticed. Both patient and dentist agreed
that the imbalance was not aesthetically involved when
she talks or smiles. Her occlusion was Angle class II and
vertical overbite of 3,6mm was measured (Fig. 1, 2).
Examining the occlusion of the patient it was revealed that
no temporomandibular joint pathology was present. In
lateral excursions, canine rise was present bilaterally. In
protrusion, only teeth #11 and #41 were in contact.
Posterior disclusion existed in both lateral and protrusive
movements.
81
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
EÈÎ. 1: ¶ÚÔÛÙÔÌȷΤ˜ Î·È fiÌÔÚ˜ fi„ÂȘ. (A. ™˘ÁÎÏÂÈÛȷ΋ fi„Ë. B. ‰È·ÁÓˆÛÙÈÎfi Τڈ̷)
Fig. 1: Facial and lateral views. (A. occlusal view. B. custom wax-up)
Ù˘¯È·ÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜
AıËÓÒÓ, Ì ÙÔÓ ‰ÂÍÈfi Ï¿ÁÈÔ ÙÔ̤· #12, ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ ÚÔ ÂÓÓ¤· ÂÙÒÓ Î·È Ì ·ÔηٿÛÙ·ÛË ÚËÙ›Ó˘ ÚÔÛÙÔÌȷο Î·È ˘ÂÚÒÈ· Û ÌÔÚÊÔÏÔÁ›· ΢Ófi‰ÔÓÙ·. ŒÓ· ¯ÚfiÓÔ ÚÈÓ ÙËÓ ÚÒÙË ·˘Ù‹ Â›ÛÎÂ„Ë ÛÙËÓ ÎÏÈÓÈ΋, ›¯Â ‰ÔÎÈÌ¿ÛÂÈ ÂÛˆÙÂÚÈ΋ χηÓÛË ÛÙÔ ‰fiÓÙÈ ·˘Ùfi,
Û ȉȈÙÈÎfi Ô‰ÔÓÙÈ·ÙÚ›Ô, ·ÏÏ¿ Ë ‰˘Û¯ÚˆÌ›· Â·Ó‹ÏıÂ
ÌÂÙ¿ ·fi 8 Ì‹Ó˜. H ·ÛıÂÓ‹˜ ‹ıÂÏ ӷ Û˘˙ËÙ‹ÛÂÈ ÙËÓ Û˘ÓÔÏÈ΋ ·ÈÛıËÙÈ΋ ‚ÂÏÙ›ˆÛË ÙÔ˘ ¯·ÌfiÁÂÏÔ‡ Ù˘.
H ·ÛıÂÓ‹˜ ›¯Â ÂχıÂÚÔ È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Î·È ¿ÚÈÛÙË
ÛÙÔÌ·ÙÈ΋ ˘ÁÈÂÈÓ‹. ¢ÂÓ ·Ó·Ê¤ÚıËΠη̛· ‰È·ÈÙËÙÈ΋ Û˘Ó‹ıÂÈ· Ô˘ Ó· ÚÔηÏ› ·ÔÙÚÈ‚¤˜ Î·È ‰ÂÓ ˘‹Ú¯·Ó ÛËÌ›· Î·È Û˘ÌÙÒÌ·Ù· ‚Ú˘ÁÌÔ‡. ¢ÂÓ ‹Ù·Ó ηÓ›ÛÙÚÈ· ηÈ
·Ó Î·È ·Ó·Ê¤ÚıËΠ۠ηٷӿψÛË ·ÚÎÂÙ‹˜ ÔÛfiÙËÙ·˜
ηʤ (ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰‡Ô ÔÙ‹ÚÈ· ·Ó¿ Ë̤ڷ), ‰ÂÓ ˘‹Ú¯·Ó ÎÏÈÓÈο ÂÌÊ·Ó›˜ ¯ÚÒÛÂȘ ÛÙ· Ê˘ÛÈο ‰fiÓÙÈ·.
EÎÙÂÓ‹˜ ÎÏÈÓÈ΋ ÂͤٷÛË ·ÔÎ¿Ï˘„ fiÙÈ ÙÔ ‰˘Û¯ÚˆÌÈÎfi
‰fiÓÙÈ #12 ‰ÂÓ Â›¯Â Ù˘È΋ ÌÔÚÊÔÏÔÁ›· ¿Óˆ Ï¿ÁÈÔ˘ ÙÔ̤· ÂÓÒ Î·Ù·ÁÚ¿ÊËÎ·Ó ‰È·ÛÙ‹Ì·Ù· ÌÂٷ͇ fiÏˆÓ ÙˆÓ
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘. ¢È·ÈÛÙÒıËÎÂ, ·ÎfiÌË, fiÙÈ ÙÔ ÎÔÙÈÎfi ÙÌ‹Ì· ÙˆÓ ¿Óˆ ΢ÓÔ‰fiÓÙˆÓ ‹Ù·Ó ·ÚÎÂÙ¿ Ô͇·È¯ÌÔ, ÂÓÒ Ô ÚÔÁfiÌÊÈÔ˜ #14 ‹Ù·Ó ˘ÂÎÊ˘Á̤ÓÔ˜. MÂÏÂÙ‹ıËÎ·Ó ÔÈ ·˘¯ÂÓÈΤ˜ Ô˘ÏÈΤ˜ ηÌ‡Ï˜ Î·È ·Ú·ÙËÚ‹ıËΠ·ÓÈÛÔÚÚÔ›· ÌÂٷ͇ ÙˆÓ ‰ÔÓÙÈÒÓ #12 ηÈ
#22. øÛÙfiÛÔ, ηٿ ÙË Û˘˙‹ÙËÛË ·ÔÊ·Û›ÛÙËΠfiÙÈ Ë ·ÓÈÛÔÚÚÔ›· ·˘Ù‹ ‰ÂÓ ‹Ù·Ó ÂÓÔ¯ÏËÙÈ΋ ·ÈÛıËÙÈο fiÙ·Ó ÌÈÏÔ‡Û ‹ ¯·ÌÔÁÂÏÔ‡ÛÂ. H Û‡ÁÎÏÂÈÛ‹ Ù˘ ‹Ù·Ó II˘ Ù¿Í˘
ηٿ Angle Î·È Î·Ù·ÁÚ¿ÊËΠηٷÎfiÚ˘ÊË ÚfiÙ·ÍË 3,6
¯ÈÏ. (EÈÎ. 1, 2). K·Ù¿ ÙËÓ ÂͤٷÛË Ù˘ ÎÚÔÙ·ÊÔÁÓ·ıÈ΋˜
‰È¿ÚıÚˆÛ˘ ‰ÂÓ ‰È·ÈÛÙÒıËΠη̛· ¤Ó‰ÂÈÍË ¿ıËÛ˘.
82
– Treatment plan
The patient was already aware of the available treatment
options (orthodontic treatment, ceramic veneers or direct
resin bonding) and selected direct resin bonding to
restore upper teeth (#13 through #23) to their aesthetic
potential. She was already under orthodontic treatment 8
years ago and did not wish to undergo the same procedure. At the same time, she refused the solution of
ceramic veneers due firstly to their cost and secondly to
the minimal intervention on tooth structure offered by
resin veneers. Models of the patients existing dentition
status were subsequently mounted in a semi-adjustable
articulator, where the six teeth were waxed up to ideal
length, occlusion, and contour (Fig. 1). This wax-up was
captured in an impression (Fig. 3) and used in a second
appointment so as to mock-up the planned restorations
with resins intraoral in order to give patient a clinical
impression of the final result. The clinical mock-up was
made without bonding, in order to be easily removed after
the completion of the diagnostic clinical appointment.
This step allowed the practitioner to check every tooth’s
position, length and occlusion. The class II bite relationship, allowed the dentist to restore all teeth to the ideal
shape and length without occlusal interventions. All necessary alterations in the mock up were made in order to
have the maximum aesthetic result. The procedure finished when both dentist and patient were satisfied by the
outcome. This step is regarded as invaluable in patients
with sensitive aesthetic expectations since it facilitates
Hellenic Stomatological Review 57: 79-90, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
EÈÎ. 2:. EÓ‰ÔÛÙÔÌ·ÙÈΤ˜ fi„ÂȘ ÙˆÓ ‰ÔÓÙÈÒÓ #13-23 (A. ¶ÚÔÛÙÔÌȷ΋, fiÌÔÚË). EÈÏÔÁ‹ ·fi¯ÚˆÛ˘ ÁÈ· ÙÔ ‰fiÓÙÈ #11. (B. •ËÚÔÁÚ·ÊÈ΋
·ÂÈÎfiÓÈÛË ÛÙËÓ ÔÔ›· Ê·›ÓÂÙ·È ÙÔ ÛÙÚÒÌ· ÎÔÙÈ΋˜ ‰È·Ê¿ÓÂÈ·˜), (C. EÓ‰ÔÛÙÔÌ·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÚËÙÈÓÒÓ Û¯ÂÙÈο Ì ÙËÓ ·fi‰ÔÛË Ù˘ ÂÈϯı›۷˜ ·fi¯ÚˆÛ˘), (D. Xڈ̷ÙÈÎfi˜ ¯¿ÚÙ˘ ÙÔ˘ Ê˘ÛÈÎÔ‡ ‰ÔÓÙÈÔ‡)
Fig. 2: Intraoral views of teeth #13-23 (A. facial, lateral). Color selection of tooth #11. (B. xerographic view showing the incisal translucent
layer), (C. Intraoral testing of different types of resins at the basic color selected), (D. chromatic map on the natural tooth)
™ÙËÓ Ï¿ÁÈ· ÌÂÙ·ÙfiÈÛË Î·È ÚÔ˜ ÙȘ ‰‡Ô Ï¢ڤ˜ ·Ú·ÙËÚ‹ıËΠ΢ÓÔ‰ÔÓÙÈ΋ ÚÔÛÙ·Û›·, ÂÓÒ ÛÙËÓ ÚÔÔÏ›ÛıËÛË, ÌfiÓÔ Ù· ‰fiÓÙÈ· #11 Î·È #41 ‹Ù·Ó Û Â·Ê‹. AÔÛ˘Ó·ÚÌÔÁ‹ ÙˆÓ ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ ·Ú·ÙËÚ‹ıËΠÙfiÛÔ ÛÙȘ
Ï¿ÁȘ ÎÈÓ‹ÛÂȘ fiÛÔ Î·È ÛÙËÓ ÚfiÛıÈ· ÌÂÙ·ÙfiÈÛË.
– ™¯¤‰ÈÔ ıÂÚ·›·˜
H ·ÛıÂÓ‹˜ ÂÓËÌÂÚÒıËΠÁÈ· Ù· Èı·Ó¿ Û¯¤‰È· ıÂÚ·›·˜
(ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›·, fi„ÂȘ ÔÚÛÂÏ¿Ó˘ ‹ fi„ÂȘ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘) Î·È ÙÂÏÈο Â¤ÏÂÍ ÙËÓ Ù¯ÓÈ΋ Ù˘ ¿ÌÂÛ˘
Û˘ÁÎfiÏÏËÛ˘ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ ˆ˜ ÙÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÙˆÓ ¿Óˆ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ (#13 ¤ˆ˜ #23). OÈ ÏfiÁÔÈ
‹Ù·Ó fiÙÈ Â›¯Â ‹‰Ë ÂÊ·ÚÌÔÛÙ› ÔÚıÔ‰ÔÓÙÈ΋ ıÂÚ·›· ÚÈÓ
·fi 8 ¤ÙË, ÂÓÒ ‰ÂÓ ÂÈı˘ÌÔ‡Û ӷ ÚԂ› ÛÙË Ï‡ÛË ÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ Î·Ù·Ú¯‹Ó ÏfiÁˆ ÎfiÛÙÔ˘˜ ·ÏÏ¿
Î·È ÂÂÌ‚·ÙÈÎfiÙËÙ·˜ ÛÙÔ˘˜ Ô‰ÔÓÙÈÎÔ‡˜ ÈÛÙÔ‡˜.
EÎÌ·Á›· ÌÂϤÙ˘ Ù˘ ·Ú¯È΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ÊÚ·ÁÌÔ‡ ·Ó·ÚÙ‹ıËÎ·Ó Û ËÌÈÚÔÛ·ÚÌÔ˙fiÌÂÓÔ ·ÚıÚˆÙ‹Ú·
Î·È Ù· ¤ÍÈ ÚfiÛıÈ· ‰fiÓÙÈ· ÎÂÚÒıËÎ·Ó ÛÙÔ ÂÈı˘ÌËÙfi ‡Hellenic Stomatological Review 57: 79-90, 2013
patient feedback regarding the anticipated result and the
related aesthetic goals. When all relevant information and
details were discussed and determined, a polyvinylsiloxane impression of the palatal surfaces of the anterior teeth,
canine and premolars was performed in order to
formulate the final treatment plan organized for a next
appointment.
– Technical procedure:
Determination of the tooth shade was performed early
afternoon under controlled room illumination and a relevant
chromatic map was designed (Fig. 2). For all teeth the
required preparation design was a simple facial beveling
for concealing the transition line between the natural tooth
structures and the resin materials upon placement and
polymerization. The bevels were also extended through the
interproximal areas in order to enhance bonding and allow
the gap closure by resin. The incisal edge of teeth #13 and
#23 was reduced. To ensure the control of moisture
83
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
„Ô˜, Û¯‹Ì· Î·È Î·Ù¿ÏÏËÏË Û‡ÁÎÏÂÈÛË (EÈÎ. 1). A˘Ùfi ıˆÚÂ›Ù·È ¿ÏψÛÙ ˆ˜ ··Ú·›ÙËÙÔ ÛÙ¿‰ÈÔ Û οı ÂÚ›ÙˆÛË ·ÈÛıËÙÈ΋˜ ·Ú¤Ì‚·Û˘2-4. TÔ Î¤ÚˆÌ· ·ÔÙ˘ÒıËÎÂ
Û ̋ÙÚ· ÛÈÏÈÎfiÓ˘ (EÈÎ. 3) Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠÛÙË
‰Â‡ÙÂÚË Û˘Ó¿ÓÙËÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· Ú·ÁÌ·ÙÔÔÈËı›
ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ÚÔÛÔÌÔ›ˆÛË (‰È·ÁÓˆÛÙÈÎfi ÂÓ‰ÔÛÙÔÌ·ÙÈÎfi mock-up) Ì ۇÓıÂÙË ÚËÙ›ÓË ÙˆÓ ·ÔηٷÛÙ¿ÛˆÓ
ÙÔ˘ ÎÂÚÒÌ·ÙÔ˜. A˘Ùfi ıˆڋıËΠ··Ú·›ÙËÙÔ ÏfiÁˆ Ù˘
ȉȷ›ÙÂÚ˘ ¢·ÈÛıËÛ›·˜ Ù˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙÔ ÙÂÏÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·.
KÏÈÓÈο, Ë ÚÔÛÔÌÔ›ˆÛË ·˘Ù‹ ¤ÁÈÓ ÙÔÔıÂÙÒÓÙ·˜ ηÈ
‰È·ÌÔÚÊÒÓÔÓÙ·˜ ÙË ÚËÙ›ÓË, ¯ˆÚ›˜ Ó· ÚÔËÁËı› ·‰ÚÔÔ›ËÛË Î·È Û˘ÁÎfiÏÏËÛË. M ÙÔÓ ÙÚfiÔ ·˘Ùfi ‰È·ÛÊ·Ï›ÛÙËÎÂ Ë Â‡ÎÔÏË ·Ê·›ÚÂÛË ÙÔ˘ ˘ÏÈÎÔ‡ ÌÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ Û˘Ó‰ڛ·˜. ¶·Ú¿ÏÏËÏ· ÂÎÙÈÌ‹ıËÎÂ Ë ı¤ÛË ÙˆÓ ‰ÔÓÙÈÒÓ, ÙÔ Ì‹ÎÔ˜ Î·È Ë Û‡ÁÎÏÂÈÛ‹ ÙÔ˘˜.
H IIË Û˘ÁÎÏÂÈÛȷ΋ Ù¿ÍË Î·Ù¿ Angle Â¤ÙÚ„ ÙË ÙÂÏÈ΋
‰È·ÁÓˆÛÙÈ΋ ‰È·ÌfiÚʈÛË ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ÛÙÔ ÂÈı˘ÌËÙfi Û¯‹Ì· Î·È Ì‹ÎÔ˜ ¯ˆÚ›˜ Û˘ÁÎÏÂÈÛȷΤ˜ ·ÚÂÌ‚ÔϤ˜. ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó fiϘ ÔÈ ··Ú·›ÙËÙ˜ ·ÏÏ·Á¤˜
Î·È ‰fiıËÎ·Ó fiϘ ÔÈ Û¯ÂÙÈΤ˜ ‰È¢ÎÚÈÓ›ÛÂȘ ÚÔÎÂÈ̤ÓÔ˘
Ó· ·ÔÊ·ÛÈÛıÔ‡Ó ÔÈ ÙÂÏÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ. H ‰È·ÁÓˆÛÙÈ΋ ·˘Ù‹ ‰È·‰Èηۛ· ÔÏÔÎÏËÚÒıËΠfiÙ·Ó ÙfiÛÔ Ë ·ÛıÂÓ‹˜
fiÛÔ Î·È Ô Ô‰ÔÓÙ›·ÙÚÔ˜ ¤ÌÂÈÓ·Ó ÈηÓÔÔÈË̤ÓÔÈ ·fi ÙÔ ·ÔÙ¤ÏÂÛÌ·. T¤ÏÔ˜, ÂÏ‹ÊıËΠ¤Ó· Ó¤Ô «ÎÏÂȉ› ÛÈÏÈÎfiÓ˘»
Ù˘ ÙÚÔÔÔÈË̤Ó˘ ·˘Ù‹˜ ηٿÛÙ·Û˘, ÚÔÎÂÈ̤ÓÔ˘
Ó· ¯ÚËÛÈÌÔÔÈËı› ÛÙËÓ ÙÂÏÈ΋ Û˘Ó‰ڛ·.
– T¯ÓÈ΋ ‰È·‰Èηۛ·:
H ·fi¯ÚˆÛË ÙˆÓ ‰ÔÓÙÈÒÓ ÂÈϤ¯ıËΠӈڛ˜ ÙÔ ·fiÁÂ˘Ì·
Ì ÂÏÂÁ¯fiÌÂÓÔ ÊˆÙÈÛÌfi ‰ˆÌ·Ù›Ô˘ Î·È Û¯Â‰È¿ÛÙËΠ¯ÚˆÌ·ÙÈÎfi˜ ¯¿ÚÙ˘ ÁÈ· οı ‰fiÓÙÈ (EÈÎ. 2). °È· fiÏ· Ù· ‰fiÓÙÈ·,
Ë ··ÈÙÔ‡ÌÂÓË ·Ú·Û΢‹ ‹Ù·Ó ·ÏÒ˜ Ì›· ÚÔÛÙÔÌȷ΋
ÏÔÍÔÙfiÌËÛË, ÒÛÙ ӷ Á›ÓÂÈ ÈÔ ÔÌ·Ï‹ Ë ÁÚ·ÌÌ‹ ÌÂÙ¿‚·Û˘ ·fi ÙÔ Ê˘ÛÈÎfi ‰fiÓÙÈ ÚÔ˜ ÙË Û‡ÓıÂÙË ÚËÙ›ÓË. H ÏÔÍÔÙfiÌËÛË ÂÂÎÙ¿ıËΠÛÙȘ fiÌÔÚ˜ ÂÚÈÔ¯¤˜ ÁÈ· Ó· ÂÓÈÛ¯˘ı› Ë Û˘ÁÎfiÏÏËÛË Ù˘ ÚËÙ›Ó˘ Î·È Ó· ÏËÚˆıÔ‡Ó Ù·
‰È·ÛÙ‹Ì·Ù· ÌÂٷ͇ ÙˆÓ ‰ÔÓÙÈÒÓ. TÔ ÎÔÙÈÎfi ¿ÎÚÔ ÙˆÓ
‰ÔÓÙÈÒÓ #13 Î·È #23 ÌÂÈÒıËÎÂ Î·È ·ÔÛÙÚÔÁÁ˘Ï‡ÙËÎÂ.
TÔÔıÂÙ‹ıËΠ‰È·Ê·Ó‹˜ Ù·ÈÓ›· ÎÂÏÔ˘ÏÔ˝ÙË, ¯ˆÚ›˜ ÛÊ‹Ó·
(ÁÈ· Ó· ÌËÓ ÚÔÎÏËı› ·ÈÌÔÚÚ·Á›·) Î·È ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ
ÂȉÈ΋ ÚËÙ›ÓË ·ÔÌfiÓˆÛ˘ ÙˆÓ Ô˘ÏÈÎÒÓ ÈÛÙÒÓ. EÓ·ÏÏ·ÎÙÈο, ÚÔÙ›ÓÂÙ·È Ë ÙÔÔı¤ÙËÛË ÌÈÎÚ‹˜ ÔÛfiÙËÙ·˜ ÔÔÈ·Û‰‹ÔÙ ·ÏÈ¿˜ ÚËÙ›Ó˘ ‹ ÚËÙ›Ó˘ ·ÔÌfiÓˆÛ˘ ԇψÓ,
Ë ÔÔ›· Î·È ÛÙÔÈ‚¿˙ÂÙ·È Ì ÙÚfiÔ Ô˘ Ó· Û˘ÁÎÚ·Ù› ¤Ó·
ÙÌËÌ·ÙÈÎfi ÌÂÙ·ÏÏÈÎfi ÙÔ›¯ˆÌ· οıÂÙ· ÛÙËÓ ÂÚÈÔ¯‹ ÂÚÁ·Û›·˜ (EÈÎ. 4). ¶ÚÈÓ ÙËÓ ÙÔÔı¤ÙËÛË Ù˘ ·ÔηٷÛÙ·ÙÈ΋˜
ÚËÙ›Ó˘, ·‰ÚÔÔÈ‹ıËÎ·Ó ÔÈ ÂÈÊ¿ÓÂȘ Ì 37% ʈÛÊÔÚÈÎfi Ô͇ ÁÈ· 30 ‰Â˘ÙÂÚfiÏÂÙ· Î·È ÍÂχıËÎ·Ó Ì ÛÚ¤È ÓÂÚÔ‡-·¤Ú·. MÂÙ¿, ¯ÚËÛÈÌÔÔÈ‹ıËÎÂ Ô ÂÈÏÂÁ̤ÓÔ˜ Û˘ÁÎÔÏÏËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ (Xp Bond, Dentsply Int.), Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹.
™ÙȘ ÂÚÈÔ¯¤˜ Ô˘ ··ÈÙ‹ıËΠÌfiÓÔ ÚËÙ›ÓË ·‰·Ì·ÓÙ›Ó˘
(fiˆ˜ ÛÙȘ fiÌÔÚ˜ Î·È ÎÔÙÈΤ˜ ÂÈÊ¿ÓÂȘ), ¯ÚËÛÈÌÔÔÈ‹ıËΠ̛· ÌÈÎÚfiÎÔÎÎË ÚËÙ›ÓË (B1 Body type, Renamel
Microfill, Cosmedent, USA). MfiÓÔ ÛÙÔ ÎÔÙÈÎfi ÙÌ‹Ì· ÙÔ˘
#21, fiÔ˘ ÎÚ›ıËΠ··Ú·›ÙËÙË Ë ÂÓ›Û¯˘ÛË Ù˘ ·ÓÙÔ¯‹˜
Ù˘ ·ÔηٿÛÙ·Û˘ ÏfiÁˆ Ù˘ ·‡ÍËÛ˘ ÙÔ˘ Ì‹ÎÔ˘˜ ÙÔ˘
84
EÈÎ. 3: EÓ‰ÔÛÙÔÌ·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙÔ˘ «ÎÏÂȉÈÔ‡ ÛÈÏÈÎfiÓ˘» Ô˘ ¤¯ÂÈ ÚÔ·„ÂÈ ·fi ÙË ‰È·ÁÓˆÛÙÈ΋ ÂÓ‰ÔÛÙÔÌ·ÙÈ΋ ÚÔÛÔÌÔ›ˆÛË
Fig. 3: Intraoral check of silicone key derived from introral diagnostic mock-up
through the direct resin buildup, swabs were used. The cellouloid tape was placed without a wedge (in order to avoid
bleeding) using blocking resin as a barrier material. Alternatively, a small amount of an old resin material photopolymerized in place or blocking resin, can also be used for
holding a partial metallic tape placed vertically in the working
area and blocking the gap in the form needed (Fig. 4).
Prior to the restorative procedure, 30 seconds of etching
with 37% phosphoric acid, followed by thorough rinsing
with water spray, was applied. Then, an adhesive system
(Xp Bond, Dentsply Int.) was applied according to
manufacturer’s directions of use.
Where only enamel type resin was needed (like interproximal and inscisal areas) a microfill resin (B1 Body type)
(Renamel Microfill, Cosmedent, USA) was used. Only in
the incisal part of the tooth #21, where reinforcement was
needed in order to augment the length of the tooth, the
nanofill B1 Body type (Renamel Nano, Cosmedent, USA)
was placed (Fig. 2). Different sizes of resin brushes (No.
1,3, Cosmedent, USA) and special very thin instruments
(IPCL, IPCT, Cosmedent, USA) were used in order to
shape the material in the interproximal areas (Fig. 4).
For the tooth #12, pink opaque shade (Renamel Pink
Opaque, Cosmedent, USA) was used to cover the underlying discoloration by forming a thin uniformed layer. The
shade was placed twice in order to better cover the
discoloration of this specific tooth. Then, a 0.3 mm layer of
nanofill B1 shade resin was placed and photopolymerized. Finally, a microfill B1 shade 0.2mm layer covered the
whole veneer.
All layers were photopolymerized with a led lamp for
20sec (TechnoGaz, Italy). The last layer was photopolymerized for 40sec for better polymerization and thus
better polishing effect according to manufacturers directions of use.
– Finishing and polishing
Finishing followed the stratification technique, in order to
accomplish contouring, shaping and smoothing of the
restorations and to remove excess at the tooth-restoration
Hellenic Stomatological Review 57: 79-90, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
‰ÔÓÙÈÔ‡, ÙÔÔıÂÙ‹ıËΠӷÓfiÎÔÎÎË ÚËÙ›ÓË (B1 Body type,
Renamel Nano, Cosmedent, USA) (EÈÎ. 2).
K·Ù¿ ÙË ‰È·‰Èηۛ· Ù˘ ‰È·ÛÙڈ̿وÛ˘ Î·È ÂȉÈο ÁÈ·
ÙË ‰È·ÌfiÚʈÛË ÙÔ˘ ˘ÏÈÎÔ‡ ÛÙȘ fiÌÔÚ˜ ÂÈÊ¿ÓÂȘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂȉÈο ÈӤϷ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂÁÂıÒÓ (NÔ
1, 3, Cosmedent, USA) Î·È Ôχ ÏÂÙ¿ ÂÚÁ·Ï›· ÙÔÔı¤ÙËÛ˘ ÚËÙ›Ó˘ (IPCL, IPCT, Cosmedent, USA) (EÈÎ. 4).
TÔ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ ‰fiÓÙÈ #12 ÚÔÂÙÔÈÌ¿ÛÙËΠÁÈ· ÙÔÔı¤ÙËÛË fi„˘ Ì ·Ú·Û΢‹ Ù˘ ÚÔÛÙÔÌȷ΋˜ ÙÔ˘ ÂÈÊ¿ÓÂÈ·˜ Û ‚¿ıÔ˜ 0,5mm. MÂÙ¿ Ù· ÛÙ¿‰È·
Ù˘ ·‰ÚÔÔ›ËÛ˘ Î·È Û˘ÁÎfiÏÏËÛ˘ fiˆ˜ ·Ó·Ê¤ÚÔÓÙ·È
·Ú·¿Óˆ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰‡Ô ÔÌÔÈfiÌÔÚÊ· ÏÂÙ¿
ÛÙÚÒÌ·Ù· ˘ÁÚ‹˜ ÚËÙ›Ó˘ Û ·fi¯ÚˆÛË ÚÔ˙ ·‰È·Ê¿ÓÂÈ·˜ (Renamel Pink Opaque, Cosmedent, USA) ÚÔÎÂÈ̤ÓÔ˘ Ó· Î·Ï˘Êı› Ë ˘ÔΛÌÂÓË ‰˘Û¯ÚˆÌ›·. K¿ı ÛÙÚÒÌ·
interfaces. For gross removal and contouring of composite restorations, a 15-40 microns finishing diamond was
used. This step was followed by using a tungsten 16blade carbide bur with plenty of water for teeth restored so
as to modify the restorations to the proper geometric
outline form, including the proper line angles, primary and
secondary anatomy. Polishing took place after finishing
for giving the surfaces high luster and enamel-like texture.
Using a low-speed handpiece, with a complete sequence
of aluminum oxide discs (Flexidiscs, Cosmedent, USA),
circular movements and without water-cooling, resulted
in smooth surface’s appearance. In this stage, minor modifications in tooth occlusal contacts were made taking
into consideration the patient’s Angle class II malocclusion. For the palatal surfaces, due to anatomical features,
EÈÎ. 4: TÔÔı¤ÙËÛË Ù¯ÓËÙÔ‡ ÙÔȯÒÌ·ÙÔ˜ A. TÌËÌ·ÙÈÎfi ÌÂÙ·ÏÏÈÎfi ÙÔ›¯ˆÌ· ÙÔÔıÂÙË̤ÓÔ Î¿ıÂÙ· Î·È ÛÙ·ıÂÚÔÔÈË̤ÓÔ Ì ÚËÙ›ÓË ·ÔÌfiÓˆÛ˘ ԇψÓ. B. T·ÈÓ›· ÎÂÏÔ˘ÏÔ˝ÙË ÙÔÔıÂÙË̤ÓË ÛÙÔ ·˘¯ÂÓÈÎfi fiÚÈÔ Î·È ÛÙ·ıÂÚÔÔÈË̤ÓË Ì ÚËÙ›ÓË C. KÔÓÙÈÓ‹ fi„Ë ÙÔ˘ ÎÔÙÈÎÔ‡ ¿ÎÚÔ˘ ÙÔ˘ ÂÚÁ·Ï›Ԣ ÙÔÔı¤ÙËÛ˘ ÚËÙÈÓÒÓ D. EÚÁ·Ï›· Ôχ ÏÂÙÔ‡ ÎÔÙÈÎÔ‡ ¿ÎÚÔ˘ ÁÈ· ÙËÓ ÙÔÔı¤ÙËÛË ÚËÙ›Ó˘ ÛÙȘ fiÌÔÚ˜ Î·È ˘ÔÔ˘ÏÈΤ˜ ÂÚÈÔ¯¤˜.
Fig. 4: Placement of matrix A. Partial metallic matrix placed vertically and stabilized in place with blocking resin. B. Celluloid tape placed
around the cervical margin and blocked with resin. C. Close up view of the working edge of the instrument. D. Extra thin instruments for
resin placement in the interproximal areas.
Hellenic Stomatological Review 57: 79-90, 2013
85
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
˘ÁÚ‹˜ ÚËÙ›Ó˘ ʈÙÔÔÏ˘ÌÂÚ›ÛÙËΠÁÈ· 10 sec. ™ÙË Û˘Ó¤¯ÂÈ·, ÙÔÔıÂÙ‹ıËΠÛÙÚÒÌ· Ó·ÓfiÎÔÎ΢ ÚËÙ›Ó˘ (B1)
Û ¿¯Ô˜ 0.3mm. MÂÙ¿ ÙÔÓ ÊˆÙÔÔÏ˘ÌÂÚÈÛÌfi ÙÔ˘ ÛÙÚÒÌ·ÙÔ˜ ·˘ÙÔ‡ ÙÔÔıÂÙ‹ıËΠÛÙÚÒÌ· ÌÈÎÚfiÎÔÎ΢ ÚËÙ›Ó˘ (B1), ̤¯ÚÈ Ó· Ú·ÁÌ·ÙÔÔÈËı› ÂÏ·ÊÚÈ¿ ˘ÂÚÏ‹ÚˆÛË ÙÔ˘ ‰ÔÓÙÈÔ‡ Ì ÛÎÔfi ÙËÓ Â¿ÚÎÂÈ· ˘ÏÈÎÔ‡ ÌÂÙ¿
ÙËÓ ÙÂÏÈ΋ ‰È·ÌfiÚʈÛË Î·È Ï›·ÓÛË Ù˘ ·ÔηٿÛÙ·Û˘,
ηı’ fiÏÔ ÙÔ Ì‹ÎÔ˜ Ù˘ ÎÔÙÈ΋˜ ÂÈÊ¿ÓÂÈ·˜.
ŸÏ· Ù· ÛÙÚÒÌ·Ù· ÚËÙ›Ó˘ Ô˘ ÙÔÔıÂÙ‹ıËÎ·Ó ÊˆÙÔÔÏ˘ÌÂÚ›ÛÙËÎ·Ó ÌÂ Ï˘¯Ó›· LED ÁÈ· 20 sec (TechnoGaz,
Italy). TÔ ÙÂÏÈÎfi ÛÙÚÒÌ· ʈÙÔÔÏ˘ÌÂÚ›ÛÙËΠÁÈ· 40 sec
Û‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ÙÔ˘ ηٷÛ΢·ÛÙ‹ ÁÈ· ÙËÓ Â›Ù¢ÍË ÌÂÁ·Ï‡ÙÂÚÔ˘ ‚¿ıÔ˘˜ ÔÏ˘ÌÂÚÈÛÌÔ‡ Î·È ÙÂÏÈο ÌÂÁ·Ï‡ÙÂÚ˘ ÂÈÊ·ÓÂȷ΋˜ ÛÙÈÏÓfiÙËÙ·˜.
– ¢È·ÌfiÚʈÛË Î·È Ï›·ÓÛË
K·Ù¿ ÙÔ ÛÙ¿‰ÈÔ Ù˘ ‰È·ÌfiÚʈÛ˘ ·Ô‰fiıËΠÙÔ Î·Ù¿ÏÏËÏÔ Û¯‹Ì·, ηÌ˘ÏfiÙËÙ· Î·È Ï›· ÂÈÊ¿ÓÂÈ· ÛÙȘ ·ÔηٷÛÙ¿ÛÂȘ Î·È ·Ê·ÈÚ¤ıËÎ·Ó Ù˘¯fiÓ ÂÚ›ÛÛÂȘ ˘ÏÈÎÔ‡.
°È· ÙËÓ ·‰Ú‹ ·Ê·›ÚÂÛË ÂÚÈÛÛÂÈÒÓ Î·È ‰È·ÌfiÚʈÛ˘
Ù˘ ·ÔηٿÛÙ·Û˘, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·Ì¿ÓÙÈ· ̤Û˘ ·‰ÚfiÙËÙ·˜ (15-40 microns). °È· ÙËÓ ·fi‰ÔÛË ÏÂÙÔÌÂÚÂÈÒÓ fiˆ˜ ÔÈ ÎÔÙÈΤ˜ ÁˆÓ›Â˜ Î·È ¿ÏÏ· ÚˆÙÔÁÂÓ‹
Î·È ‰Â˘ÙÂÚÔÁÂÓ‹ ·Ó·ÙÔÌÈο ÛÙÔȯ›· ¯ÚËÛÈÌÔÔÈ‹ıËηÓ
ÛÙË Û˘Ó¤¯ÂÈ· ÏÂÙfiÎÔÎη ‰È·Ì¿ÓÙÈ· Ì ηٷÈÔÓÈÛÌfi ÓÂÚÔ‡. ™ÙÔ ÛÙ¿‰ÈÔ Ù˘ Ï›·ÓÛ˘ Ô˘ ·ÎÔÏÔ‡ıËÛ ·˘Ùfi Ù˘
‰È·ÌfiÚʈÛ˘, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Û ¯ÂÈÚÔÏ·‚‹ ¯·ÌËÏÒÓ Û˘¯ÓÔًوÓ, ‰›ÛÎÔÈ ·fi ÔÍ›‰È· ·ÏÔ˘ÌÈÓ›Ô˘
(Flexidiscs, Cosmedent, USA) Û ‰È·‰Ô¯È΋ ÛÂÈÚ¿ ·‰ÚfiÙËÙ·˜, Ì ΢ÎÏÈΤ˜ ÎÈÓ‹ÛÂȘ Î·È ¯ˆÚ›˜ ηٷÈÔÓÈÛÌfi ÓÂÚÔ‡. ™Â ·˘Ùfi ÙÔ ÛÙ¿‰ÈÔ, ÂÏ¿¯ÈÛÙ˜ ÙÚÔÔÔÈ‹ÛÂȘ ¯ÚÂÈ¿ÛÙËÎ·Ó Ì ‚¿ÛË ÙȘ Û˘ÁÎÏÂÈÛȷΤ˜ Â·Ê¤˜ ÙˆÓ ‰ÔÓÙÈÒÓ,
ÂÍ·ÈÙ›·˜ Ù˘ II˘ Ù¿Í˘ ÌÂٷ͇ ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÊÚ·ÁÌÒÓ.
°È· ÙȘ ˘ÂÚÒȘ ÂÈÊ¿ÓÂȘ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ì ‹Ș
ÎÈÓ‹ÛÂȘ ΢ÂÏÏÔÂȉ‹ Î·È ÊÏÔÁÔÂȉ‹ Ï·ÛÙȯ¿ÎÈ· Ï›·ÓÛ˘ (Flexicups, Flexipoints, Cosmedent, USA). ™ÙÔ ÙÂÏÈÎfi
ÛÙ¿‰ÈÔ, ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó Ù·Èӛ˜ Ï›·ÓÛ˘ ÙˆÓ fiÌÔÚˆÓ
ÂÈÊ·ÓÂÈÒÓ (Flexistrips, Cosmedent), ÚÔÎÂÈ̤ÓÔ˘ ÙÔ Ô‰ÔÓÙÈÎfi Ó‹Ì· Ó· ‰È¤Ú¯ÂÙ·È ¯ˆÚ›˜ Ó· ·ÚÂÌÔ‰›˙ÂÙ·È ÛÙ·
ÌÂÛÔ‰fiÓÙÈ· ‰È·ÛÙ‹Ì·Ù· Î·È Ó· ·ÔÊ¢¯ıÔ‡Ó ÛÙÔ Ì¤ÏÏÔÓ
Ù˘¯fiÓ ·ÔÎÔÏÏ‹ÛÂȘ ‹ ηٿÁÌ·Ù· ÙˆÓ ·ÔηٷÛÙ¿ÛˆÓ.
¶¿ÛÙ· Ï›·ÓÛ˘ (Enamelize, Cosmedent, USA) ¯ÚËÛÈÌÔÔÈ‹ıËΠ۠fiϘ ÙȘ ÂÈÊ¿ÓÂȘ, Ì ÙË ‚Ô‹ıÂÈ· ÂȉÈÎÔ‡
ÙÛfi¯ÈÓÔ˘ ‰›ÛÎÔ˘ Ô˘ ÂÚȤ¯ÂÙ·È ÛÙÔ ÚÔ·Ó·ÊÂÚı¤Ó Û‡ÛÙËÌ· Ï›·ÓÛ˘, Î·È ÚÔÛ¤‰ˆÛ ÙËÓ ÙÂÏÈ΋ ÛÙÈÏÓfiÙËÙ·
ÛÙȘ ·ÔηٷÛÙ¿ÛÂȘ.
AÊÔ‡ Ù· ‰fiÓÙÈ· ÂÍÂÙ¿ÛÙËÎ·Ó ÏÂÙÔÌÂÚÒ˜ Î·È ‰ÂÓ ˘‹ÚÍ·Ó ÚÔÙÂÈÓfiÌÂÓ˜ ·ÏÏ·Á¤˜ Ô‡Ù ·fi ÙÔÓ Ô‰ÔÓÙ›·ÙÚÔ
Ô‡Ù ·fi ÙËÓ ·ÛıÂÓ‹, ÂÏ‹ÊıËÛ·Ó ÙÂÏÈΤ˜ ʈÙÔÁڷʛ˜
ÂÓÒ ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ Û˘Ó‰ڛ· Â·Ó·ÍÈÔÏfiÁËÛ˘ ÌÂÙ¿ ·fi Ì›· ‚‰ÔÌ¿‰·. EÂȉ‹ ηٿ ÙËÓ ÚÒÙË Â‚‰ÔÌ¿‰·
·fi ÙËÓ ÙÔÔı¤ÙËÛË Ù˘ ÚËÙ›Ó˘ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ë Ì¤ÁÈÛÙË ·ÔÚÚfiÊËÛË ÓÂÚÔ‡ ·fi ÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ3, 4, ÚÔÙ›ÓÂÙ·È Ë ÙÂÏÈ΋ Ï›·ÓÛË Ó· Á›ÓÂÙ·È ÛÙË Û˘Ó‰ڛ· Â·ÓÂͤٷÛ˘ ÌÂÙ¿ ·fi Ì›· ‚‰ÔÌ¿‰·5. ™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi, Ë Î·Ù¿ ‰Â‡ÙÂÚÔ ÛÎÔfi ÛٛςˆÛË
ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ÚÔÛ¤‰ˆÛ ÌÂÁ·Ï‡ÙÂÚË ÂÌÊ·ÓÒ˜
ÛÙÈÏÓfiÙËÙ· (EÈÎ. 5). ¢fiıËÎ·Ó ÛÙËÓ ·ÛıÂÓ‹ ÁÚ·Ù¤˜ Ô86
composite polishing cups and points have been used
gently in order to polish the specific areas, without losing
the anatomy and surface morphology (Flexicups, Flexipoints, Cosmedent, USA). Finally, for all teeth, plastic
interproximal strips (Flexistrips, Cosmedent) were used
so as to achieve the ideal polished surface in this stainsusceptible zone. In this point, it is considered very important to thoroughly examine the convenience of the
dental floss in passing through the interproximal areas in
order to avoid debonding or fractures of the restorations.
A polishing paste (Enamelize, Cosmedent, USA) applied
to all surfaces with a special polishing buffering disk
included in the previous mentioned polishing system,
added gloss to the final restorations.
Once the teeth were in detail examined and no alterations
were suggested from the patient, photos were taken for
self-evaluation and a recall appointment was set after a
week. As most of the water sorption can be observed
during the first week of resin placement3, 4, the final
polishing procedures can be performed in a second visit
in order to get a more esthetic view5. In this case, this
delayed finishing/polishing procedures over the veneers
resulted in a glossier surface (Fig. 5). Information on
maintenance procedures were given in written to the
patient with special care on habits during anterior biting.
Recall appointment was set after six months7.
DISCUSSION
Restoring teeth using direct composite veneers can be
quite a challenging procedure for a clinician. Achieving
natural colour blending, masking dark teeth and providing
a natural finish require meticulous placement with the appropriate composite opacities and shades, the proper
layering technique and finishing with specific systems.
Critical self-evaluation, especially using digital photography, documentation, and follow-up visits are critical to
ensure an esthetic outcome3, 4.
Oral maintenance of the veneers in biologically esthetically and operating accepted conditions depends on the
oral hygiene habits of the patient. Patients should be informed in advance that shade and texture of the material will
change over time and periodic maintenance is required.
In long term evaluation of resin restorations, three types of
resin composite discolorations have been described: a)
external discolorations owing to the accumulation of plaque and surface stains; b) surface or subsurface color
alterations, implying a superficial degradation or a slight
penetration and reaction of staining agents within the
superficial layer of resin composites (adsorption); and c)
body or intrinsic discolorations owing to physicochemical
reactions in the deeper portions of the restoration. External and surface discolorations are closely related to hygiene, diet and smoking habits7. Intrinsic colour instability
and staining due to smoke is also a well-known problem
with resin composites. Smokers should be informed
preoperatively for the potential staining and the need for
frequent recalls and may be presented with the alternative
Hellenic Stomatological Review 57: 79-90, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
EÈÎ. 5: TÔ ¯·ÌfiÁÂÏÔ Ù˘ ·ÛıÂÓÔ‡˜ (A. ¶ÚÈÓ, B. MÂÙ¿) Î·È Ï‹„Ë Ù˘ Û˘ÁÎÏÂÈÛȷ΋˜ ηٿÛÙ·Û˘ Ù˘ ·ÛıÂÓÔ‡˜ (C. ¶ÚÈÓ, D. MÂÙ¿)
Fig. 5: Smile (A. before B. after) and occlusion of the patient (C. before, D. after)
‰ËÁ›Â˜ Û¯ÂÙÈο Ì ÙËÓ Û˘ÓÙ‹ÚËÛË ÙˆÓ ·ÔηٷÛÙ¿ÛˆÓ,
Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙËÓ ·ÔÊ˘Á‹ ÈÛ¯˘Ú‹˜ ‰‹Í˘ Ì ٷ
ÚfiÛıÈ· ‰fiÓÙÈ· Î·È ·ÔÊ˘Á‹ Ï‹„˘ ¯ÚˆÌÔÁfiÓˆÓ Ô˘ÛÈÒÓ Î·Ù’ ÂÍ·ÎÔÏÔ‡ıËÛË. ¶ÚÔÁÚ·ÌÌ·Ù›ÛÙËÎÂ Û˘Ó‰ڛ·
Â·ÓÂͤٷÛ˘ ÌÂÙ¿ ·fi ¤ÍÈ Ì‹Ó˜7.
™YZHTH™H
H ·ÔηٿÛÙ·ÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ì ¿ÌÂÛ˜ fi„ÂȘ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ·ÔÙÂÏ› Û˘¯Ó¿ ÚfiÎÏËÛË ÁÈ· ÙÔÓ ÎÏÈÓÈÎfi Ô‰ÔÓÙ›·ÙÚÔ. O ηٿÏÏËÏÔ˜ Û˘Ó‰˘·ÛÌfi˜ ·Ô¯ÚÒÛˆÓ
ÛÙ· Û‡ÓıÂÙ· ˘ÏÈο, Ë ÛˆÛÙ‹ ‰È·ÛÙڈ̿وÛË, Ï›·ÓÛË
Î·È ÛٛςˆÛË ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ¤Ó· ·fiÏ˘Ù· ÚԂϤ„ÈÌÔ ÙÂÏÈÎfi ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·. £ÂˆÚÂ›Ù·È fï˜
ȉȷ›ÙÂÚ˘ ÛËÌ·Û›·˜ Ë ‰È·‰Èηۛ· Ù˘ Û˘Ó¯ԇ˜ ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ·ÈÛıËÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜ ̤ۈ „ËÊȷ΋˜
ʈÙÔÁÚ·ÊÈ΋˜ ÙÂÎÌËÚ›ˆÛ˘ Î·È Î·Ù·ÁÚ·Ê‹˜ Î·È Û˘¯Ó‹˜ Â·Ó·ÍÈÔÏfiÁËÛ˘3, 4.
H ‰È·Ù‹ÚËÛË ÙˆÓ fi„ÂˆÓ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ÒÛÙ ӷ ·Ú·Ì¤ÓÔ˘Ó ‚ÈÔÏÔÁÈο, ·ÈÛıËÙÈο Î·È ÏÂÈÙÔ˘ÚÁÈο ·Ô‰ÂÎÙ¤˜, ‚·Û›˙ÂÙ·È Û ÌÂÁ¿ÏÔ ‚·ıÌfi ÛÙȘ Û˘Ó‹ıÂȘ ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜ ÙˆÓ ·ÛıÂÓÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÎÚ›ÓÂÙ·È
ÛÎfiÈÌË Ë ÂÓË̤ڈۋ ÙÔ˘˜ Û¯ÂÙÈο Ì ÙËÓ Èı·Ó‹ ·ÏÏ·Á‹ ÛÙË ¯ÚÔÈ¿ Î·È ÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ ˘ÏÈÎÒÓ Ì ÙËÓ ¿ÚÔHellenic Stomatological Review 57: 79-90, 2013
option of a more colour stable ceramic restoration5. On
the other hand, tannins, caffeine, tartaric acid and phenols, as secondary metabolites found in coffee, tea and
red wine, are predominantly responsible for staining, as
well as secondarily the turmeric solution, orange juice and
cola. The presence of sugar in coffee and tea increases
the color difference compared to coffee or tea without sugar for light-polymerized composite materials7. Of course,
the degree of staining differs among composite brands
thus manufacturers’ recommendations should be followed during placement and photopolymerization steps.
Also, the surface roughness and gloss of composite
materials changes with brushing time, with hybrid composite resins being more prone to surface changes than
microfilled ones8. Evaluation of prior anterior resin restorations can be a guide for the clinician to estimate the
potential occurrence of stains and discolorations.
During recall appointments, there are two main ways to
remove superficial stains from resin composites: repolishing or repair1. The recommended interval between oral
health appointments should be determined specifically
for each patient on the basis of an assessment of his oral
habits and general dental condition. During an oral health
interview, the clinician should ensure that comprehensive
87
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
‰Ô ÙÔ˘ ¯ÚfiÓÔ˘. ™Â Ì·ÎÚÔÚfiıÂÛÌË ·ÍÈÔÏfiÁËÛË ·ÔηٷÛÙ¿ÛÂˆÓ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘, ÙÚÂȘ Ù‡ÔÈ ·ԯڈ̷ÙÈÛÌÒÓ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ÚÔÙ›ÓÂÙ·È Ó· ·ÍÈÔÏÔÁÔ‡ÓÙ·È: 1) Â͈ÙÂÚÈΤ˜ ‰˘Û¯ÚˆÌ›Â˜ ÏfiÁˆ Ù˘ Û˘ÛÛÒÚ¢Û˘
Ͽη˜ Î·È ÂÈÊ·ÓÂÈ·ÎÒÓ ¯ÚˆÛÙÈÎÒÓ, 2) ÂÈÊ·ÓÂȷΤ˜ ‹
˘ÔÂÈÊ·ÓÂȷΤ˜ ·ÏÏ·Á¤˜, ˘ÔÓÔÒÓÙ·˜ ÌÈ· ÂÈÊ·ÓÂȷ΋
˘Ô‚¿ıÌÈÛË ‹ ÌÈÎÚԉțۉ˘ÛË Î·È ·ÓÙ›‰Ú·ÛË ¯ÚˆÛÙÈÎÒÓ
·Ú·ÁfiÓÙˆÓ ÂÓÙfi˜ ÙÔ˘ ÂÈÊ·ÓÂÈ·ÎÔ‡ ÛÙÚÒÌ·ÙÔ˜ Ù˘
Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ (ÚÔÛÚÚfiÊËÛË) Î·È 3) ÂÓ‰ÔÁÂÓ›˜ ·ԯڈ̷ÙÈÛÌÔ‡˜ ‹ ·ԯڈ̷ÙÈÛÌÔ‡˜ ÙÔ˘ ΢ڛˆ˜ ÛÒÌ·ÙÔ˜ Ù˘ ÚËÙ›Ó˘ ÏfiÁˆ Ê˘ÛÈÎÔ¯ËÌÈÎÒÓ ·ÓÙȉڿÛˆÓ
ÛÙ· ‚·ı‡ÙÂÚ· ÛÙÚÒÌ·Ù· ÙÔ˘ ˘ÏÈÎÔ‡. OÈ Â͈ÙÂÚÈΤ˜ ηÈ
ÂÈÊ·ÓÂȷΤ˜ ‰˘Û¯ÚˆÌ›Â˜ Â›Ó·È ÛÙÂÓ¿ Û˘Ó‰Â‰Â̤Ó˜ ÌÂ
ÙȘ Û˘Ó‹ıÂȘ ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜, ‰È·ÙÚÔÊ‹˜ Î·È Î·Ó›ÛÌ·ÙÔ˜7. EÁÁÂÓ‹˜ ¯ÚˆÌ·ÙÈ΋ ·ÛÙ¿ıÂÈ· Î·È ¯ÚÒÛË Ô˘ ÔÊ›ÏÂÙ·È ÛÙÔÓ Î·Ófi Â›Ó·È Â›Û˘ ¤Ó· ·Ó·ÁÓˆÚÈṲ̂ÓÔ
Úfi‚ÏËÌ· ÙˆÓ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ. OÈ Î·ÓÈÛÙ¤˜ ÚÔÙ›ÓÂÙ·È Ó· ÂÓËÌÂÚÒÓÔÓÙ·È ÚÔÂÂÌ‚·ÙÈο ÁÈ· ÙËÓ ÂӉ¯fiÌÂÓË ¯ÚÒÛË ÙˆÓ ·ÔηٷÛÙ¿ÛÂÒÓ ÙÔ˘˜ ηıÒ˜ Î·È ÁÈ·
ÙËÓ ·Ó¿ÁÎË Û˘¯ÓÒÓ Â·ÓÂÍÂÙ¿ÛˆÓ. ™ÙȘ ÂÚÈÙÒÛÂȘ
·˘Ù¤˜, ÌÔÚ› ÂÓ·ÏÏ·ÎÙÈο Ó· ÚÔÙ·ı› Ë Ï‡ÛË ÌÈ·˜ ÎÂÚ·ÌÈ΋˜ ·ÔηٿÛÙ·Û˘ Ô˘ ·Ú¤¯ÂÈ ÛÙ·ıÂÚfiÙËÙ·
¯ÚÒÌ·ÙÔ˜5. Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ¯ËÌÈΤ˜ Ô˘Û›Â˜ fiˆ˜
ÔÈ Ù·Ó›Ó˜, Ë Î·Ê½ÓË Î·È ÔÈ Ê·ÈÓfiϘ, ˆ˜ ‰Â˘ÙÂÚÔÁÂÓ›˜
ÌÂÙ·‚Ôϛ٘ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ Î·Ê¤, ÙÔ ÙÛ¿È Î·È ÙÔ
ÎfiÎÎÈÓÔ ÎÚ·Û›, Â›Ó·È Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ˘‡ı˘Ó˜ ÁÈ· ÙËÓ
¯ÚÒÛË ÙˆÓ ÔÏ˘ÌÂÚÒÓ ˘ÏÈÎÒÓ, ÂÓÒ Ô˘Û›Â˜ fiˆ˜ Ë ÙÔ˘ÚÌ·Ï›ÓË, ÔÈ Ê˘ÛÈÎÔ› ¯˘ÌÔ› Î·È Ù· ·Ó·„˘ÎÙÈο Ù‡Ô˘ ÎfiÏ·,
‰Â˘ÙÂÚ¢fiÓÙˆ˜. AÍ›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ·ÚÔ˘Û›· ˙¿¯·Ú˘ ÛÙÔÓ Î·Ê¤ Î·È ÙÔ ÙÛ¿È ·˘Í¿ÓÂÈ ÙË ‰È·ÊÔÚ¿ ÛÙÔ
¯ÚÒÌ· Û ۇÁÎÚÈÛË Ì ηʤ ‹ ÙÛ¿È ¯ˆÚ›˜ ˙¿¯·ÚË ÁÈ· Ù·
ʈÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓ· Û‡ÓıÂÙ· ˘ÏÈο7. º˘ÛÈο, Ô ‚·ıÌfi˜
Ù˘ ¯ÚÒÛ˘ ‰È·Ê¤ÚÂÈ ÌÂٷ͇ ÙˆÓ Û‡ÓıÂÙˆÓ ÚËÙÈÓÒÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÂÙ·ÈÚÈÒÓ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÚÔÙ›ÓÂÙ·È Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ Ô‰ËÁÈÒÓ ¯Ú‹Û˘ ÙˆÓ Î·Ù·Û΢·ÛÙÒÓ Î·Ù¿
ÙËÓ ÙÔÔı¤ÙËÛË Î·È ÊˆÙÔÔÏ˘ÌÂÚÈÛÌfi ÙÔ˘˜. EÈÚfiÛıÂÙ·, Ë ·‰ÚfiÙËÙ· Î·È ÛÙÈÏÓfiÙËÙ· ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ¤¯ÂÈ ·Ó·ÊÂÚı› fiÙÈ ÌÂÙ·‚¿ÏÏÂÙ·È ÏfiÁˆ ‚Ô˘ÚÙÛ›ÛÌ·ÙÔ˜ Ì ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘, Ì ÙȘ ˘‚ÚȉÈΤ˜ ÚËÙ›Ó˜
Ó· Â›Ó·È ÈÔ ÂÈÚÚÂ›˜ ÛÙȘ ÌÂÙ·‚ÔϤ˜ ·˘Ù¤˜ Û ۯ¤ÛË
Ì ÙȘ ÌÈÎÚfiÎÔÎΘ8. H ·ÍÈÔÏfiÁËÛË ÚÔ¸·Ú¯fiÓÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ ÛÙÔÓ ›‰ÈÔ ·ÛıÂÓ‹ ÌÔÚ› Ó· ·ÔÙÂϤÛÂÈ Ô‰ËÁfi ·ÍÈÔÏfiÁËÛ˘ Ù˘ ÔÚ›·˜ Ì›·˜
Ó¤·˜ ·ÔηٿÛÙ·Û˘ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÌÊ¿ÓÈÛË ¯ÚˆÛÙÈÎÒÓ Î·È ‰˘Û¯ÚˆÌÈÒÓ ‹ ÙÔ ‚·ıÌfi ·ÔÙÚÈ‚‹˜ Ù˘.
™ÙȘ Â·ÓÂÍÂÙ¿ÛÂȘ, Ë ·Ê·›ÚÂÛË ¯ÚˆÛÙÈÎÒÓ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙˆÓ Û˘Óı¤ÙˆÓ ÚËÙÈÓÒÓ ÌÔÚ› Ó· Á›ÓÂÈ Â›Ù Ì Â·Ó·ÛٛςˆÛË Â›Ù Ì ÂȉÈfiÚıˆÛË Ù˘ ›‰È·˜ Ù˘ ·ÔηٿÛÙ·Û˘1. TÔ ÚÔÙÂÈÓfiÌÂÓÔ ‰È¿ÛÙËÌ· ÌÂٷ͇ ÙˆÓ Â·ÓÂÍÂÙ¿ÛÂˆÓ Ú¤ÂÈ Ó· ηıÔÚ›˙ÂÙ·È Ì ‚¿ÛË ÙËÓ ·ÙÔÌÈ΋
·ÍÈÔÏfiÁËÛË Ù˘ Ô‰ÔÓÙÈ΋˜ ηٿÛÙ·Û˘ ÙÔ˘ ÂοÛÙÔÙ ·ÛıÂÓÔ‡˜. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È fiÙ·Ó Ï·Ì‚¿ÓÂÙ·È Ï‹Ú˜ Ô‰ÔÓÙÈ·ÙÚÈÎfi/È·ÙÚÈÎfi ÈÛÙÔÚÈÎfi Î·È ¤¯Ô˘Ó ‰ˆı› ÔÈ Î·Ù¿ÏÏËϘ Ô‰ËÁ›Â˜ ÚfiÏ˄˘ Î·È ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜. T· ‰Â‰Ô̤ӷ Ô˘ ¤¯Ô˘Ó Û˘ÁÎÂÓÙÚˆı› ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËı› ÙÔ Î·Ù¿ÏÏËÏÔ ¯ÚÔÓÈÎfi
‰È¿ÛÙËÌ· ̤¯ÚÈ ÙËÓ ÂfiÌÂÓË Â›Û΄Ë, ÙËÓ ÈηÓfiÙËÙ·
ÙÔ˘ ·ÛıÂÓÔ‡˜ ‹ ÙËÓ ÂÈı˘Ì›· ÙÔ˘ Ó· ÂÈÛÎÂÊı› ÙÔÓ Ô‰Ô88
dental/medical history is taken, examinations are conducted and initial preventive advice is given. This will allow
the dentist and the patient to discuss factors that can
affect resin restorations as mentioned above. All relevant
information will be used to assess the appropriate recall
interval, the patient’s ability or desire to visit the dentist at
the recommended interval and any financial costs
consequent to the recall visits. So far there is little existing
evidence to support the practice of every 6-months’
dental appointment, but most clinicians do so3-6.
As the concept of minimally invasive dentistry expands
amongst dentists, it is very important to proceed to
restorations repair before replacing them, extending the
longevity of dental restorations and reducing detrimental
effects on teeth, thereby serving the interests of patients1.
Restorations on central incisors and small unilateral restorations generally show the best esthetic performance.
Loss of anatomical form due to wear is the main reason for
esthetic failure. Minor failure requiring repair or refinishing
is presented mainly as wear, marginal discoloration or
marginal fracture and can be easily carried out in recall
appointments9.
It should be noted that veneers on non-vital teeth generally show higher risk of failure than veneers placed on
vital teeth which is an important parameter to consider
when choosing a treatment plan. This may be attributed
to the relatively low bond strength achieved in non vital
teeth than vital ones9 and should be taken under consideration when finalizing the treatment plan.
Generally, direct anterior restorations seem to have a high
successful rate of survival9. In a retrospective evaluation,
estimating 5-year survival rates, almost 80% for direct
composite resin buildups were found10. This finding
corresponds to the outcome of a prospective clinical
evaluation of 87 direct composite buildups over 5 years
with a survival rate of 89%11.
Finally, the results of a retrospective study showed that
the choice of material (direct composite resin vs porcelain) when constructing maxillary anterior veneers does
not significantly affect the patient’s perception of cosmetic
improvement. However, given the choice and information, patients seemed to prefer the composite veneer
option as a more conservative technique12.
The following conclusions should finally be suggested
concerning the case: 1) Even in difficult occlusal status
such as II anterior bites, direct bonding is suggested as a
minimally interventional approach in closing diastemas or
altering the shape of teeth in the anterior region, 2) Direct
intraoral diagnostic resin-up can give a better view on the
clinical outcome in demanding aesthetic situations, 3)
The appropriate use of materials and techniques can
guarantee a good aesthetic clinical outcome, 4) Careful
maintenance from the patient and the dentist through
recall appointments can assure a long lasting aesthetic
effect.
Hellenic Stomatological Review 57: 79-90, 2013
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
ÓÙ›·ÙÚÔ ÛÙ· Û˘ÓÈÛÙÒÌÂÓ· ‰È·ÛÙ‹Ì·Ù· Î·È Ù˘¯fiÓ ÔÈÎÔÓÔÌÈΤ˜ ‰·¿Ó˜ Ô˘ ı· ÚÔ·„Ô˘Ó ·fi ÙȘ Â·ÓÂÍÂÙ¿ÛÂȘ. AÓ Î·È ‰ÂÓ ˘¿Ú¯Ô˘Ó Û˘ÁÎÂÎÚÈ̤ӷ ÛÙÔȯ›· Û¯ÂÙÈο Ì ÙÔ ı¤Ì· ·˘Ùfi, ÔÈ ÂÚÈÛÛfiÙÂÚÔÈ ÎÏÈÓÈÎÔ› ÚÔÙ›ÓÔ˘Ó
ÙËÓ Â·ÓÂͤٷÛË Î¿ı 6 Ì‹Ó˜3-6.
H ÂȉÈfiÚıˆÛË ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Î·Ù¿ ÙȘ Û˘Ó·ÓÙ‹ÛÂȘ Â·Ó·ÍÈÔÏfiÁËÛ˘ Î·È ÂϤÁ¯Ô˘ ‰È·Ê˘Ï¿ÛÛÔ˘Ó ÙËÓ
·Ú¯‹ Ù˘ ÂÏ¿¯ÈÛÙ˘ ·Ú¤Ì‚·Û˘ ÂÂÎÙ›ÓÔÓÙ·˜ ÙË Ì·ÎÚÔ‚ÈfiÙËÙ· Ù˘ Û˘ÓÔÏÈ΋˜ ·ÔηٿÛÙ·Û˘ Î·È ÌÂÈÒÓÔÓÙ·˜ ÙȘ ÔÈÎÔÓÔÌÈΤ˜ ÂÈÙÒÛÂȘ ÁÈ· ÙÔ˘˜ ·ÛıÂÓ›˜1. OÈ ·ÔηٷÛÙ¿ÛÂȘ ÛÙÔ˘˜ ÎÂÓÙÚÈÎÔ‡˜ ÙÔÌ›˜ Î·È ÁÂÓÈÎfiÙÂÚ·
ÔÈ ÌÈÎÚ¤˜ Û ¤ÎÙ·ÛË ·ÔηٷÛÙ¿ÛÂȘ, ÂÌÊ·Ó›˙Ô˘Ó ÙËÓ
ηχÙÂÚË ·ÈÛıËÙÈ΋ Ì·ÎÚÔÚfiıÂÛÌ·, ÂÓÒ Ë ·ÒÏÂÈ· Ù˘
·Ó·ÙÔÌÈÎfiÙËÙ·˜ ÏfiÁˆ ·ÔÙÚÈ‚‹˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ô Î‡ÚÈÔ˜ ÏfiÁÔ˜ ·ÔÙ˘¯›·˜ ÙÔ˘˜. H ·ÔÙÚÈ‚‹ Ù˘ ÂÈÊ¿ÓÂÈ·˜,
Ô ÔÚÈ·Îfi˜ ·ԯڈ̷ÙÈÛÌfi˜ ‹ Ù· ÌÈÎÚÔÛ·Û›Ì·Ù· ÛÙ· fiÚÈ· Ù˘ ¤ÌÊڷ͢, ·ÔÙÂÏÔ‡Ó ÙȘ Û˘¯ÓfiÙÂÚ˜ ·Èٛ˜ ÂȉÈfiÚıˆÛ˘ ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ·˘ÙÒÓ9.
AÍ›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÔÈ fi„ÂȘ Û ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· ÂÌÊ·Ó›˙Ô˘Ó ÁÂÓÈο ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ
·ÔÙ˘¯›·˜ Û ۯ¤ÛË Ì fi„ÂȘ Ô˘ ÙÔÔıÂÙÔ‡ÓÙ·È Û ‰fiÓÙÈ· Ì ˙ˆÓÙ·Ófi ÔÏÊfi. A˘Ùfi ›Ûˆ˜ Ó· ·ÔÙÂÏ› Ì›· ÛËÌ·ÓÙÈ΋ ·Ú¿ÌÂÙÚÔ Î·Ù¿ ÙÔ Û¯Â‰È·ÛÌfi ÙÔ˘ ۯ‰›Ô˘ ıÂÚ·›·˜. Œ¯ÂÈ ‰Â ·Ô‰Ôı› ÛÙË Û¯ÂÙÈο ¯·ÌËÏ‹ ·ÓÙÔ¯‹ ÙÔ˘
Û˘ÁÎÔÏÏËÙÈÎÔ‡ ‰ÂÛÌÔ‡ Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Û ‰fiÓÙÈ· ¯ˆÚ›˜ ˙ˆÓÙ·Ófi ÔÏÊfi9.
°ÂÓÈο ˆÛÙfiÛÔ, ÔÈ ¿ÌÂÛ˜ ·ÔηٷÛÙ¿ÛÂȘ ÚÔÛı›ˆÓ
‰ÔÓÙÈÒÓ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ˘„ËÏfi ÔÛÔÛÙfi ÂÈ‚›ˆÛ˘9.
™Â Ì›· ·Ó·‰ÚÔÌÈ΋ ÌÂϤÙË ‚Ú¤ıËΠfiÙÈ ÙÔ ÔÛÔÛÙfi 5-ÂÙÔ‡˜ ÂÈ‚›ˆÛ˘ ¿ÌÂÛˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ÊÙ¿ÓÂÈ Û¯Â‰fiÓ ÙÔ 80%10. TÔ ·ÔÙ¤ÏÂÛÌ· ·˘Ùfi ÌÔÚ› Ó· Û˘ÁÎÚÈı› Ì ‰Â‰Ô̤ӷ ÚÔÔÙÈ΋˜ ÎÏÈÓÈ΋˜ ÌÂϤÙ˘ 87 ¿ÌÂÛˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ Ô˘
·ÍÈÔÏÔÁ‹ıËÎ·Ó Û ‰È¿ÛÙËÌ· 5 ÂÙÒÓ, Ì ÙËÓ ÂÈ‚›ˆÛ‹
ÙÔ˘˜ Ó· ÊÙ¿ÓÂÈ Û ÔÛÔÛÙfi 89%11. T¤ÏÔ˜, Ù· ·ÔÙÂϤÛÌ·Ù· Ì›·˜ ·Ó·‰ÚÔÌÈ΋˜ ÌÂϤÙ˘ ¤‰ÂÈÍ·Ó fiÙÈ Ë ÂÈÏÔÁ‹
ÙÔ˘ ˘ÏÈÎÔ‡ (¿ÌÂÛË Û‡ÓıÂÙË ÚËÙ›ÓË vs ÔÚÛÂÏ¿ÓË) ηٿ
ÙËÓ Î·Ù·Û΢‹ fi„ÂˆÓ ÛÙ· ÚfiÛıÈ· ‰fiÓÙÈ· Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ‰ÂÓ ÂËÚ¿˙ÂÈ ÛËÌ·ÓÙÈο ÙËÓ ·ÓÙ›ÏË„Ë ÙÔ˘ ·ÛıÂÓÔ‡˜ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÈÛıËÙÈ΋ ‚ÂÏÙ›ˆÛ‹ ÙÔ˘. øÛÙfiÛÔ,
Ï·Ì‚¿ÓÔÓÙ·˜ ˘’ fi„Ë ÙËÓ ÂÈÏÔÁ‹ Î·È ÙȘ ÏËÚÔÊÔڛ˜
Ô˘ ÙÔ˘˜ ‰›ÓÔÓÙ·È, ÔÈ ·ÛıÂÓ›˜ Ê·›ÓÂÙ·È Ó· ÚÔÙÈÌÔ‡Ó
ÙËÓ ÂÈÏÔÁ‹ fi„ÂˆÓ Û‡ÓıÂÙ˘ ÚËÙ›Ó˘ ¤Ó·ÓÙÈ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ fi„ˆÓ12.
™˘ÌÂÚ·ÛÌ·ÙÈο, ı· ÌÔÚÔ‡Û·Ó Ó· ·Ó·ÊÂÚıÔ‡Ó Ù· ·ÎfiÏÔ˘ı·: 1) AÎfiÌË Î·È Û ‰‡ÛÎÔϘ Û˘ÁÎÏÂÈÛȷΤ˜ ηٷÛÙ¿ÛÂȘ (.¯. IIË Ù¿ÍË) Ë Ù¯ÓÈ΋ Ù˘ ¿ÌÂÛ˘ Û˘ÁÎfiÏÏËÛ˘ ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› ˆ˜ χÛË ÂÏ¿¯ÈÛÙ˘ ·Ú¤Ì‚·Û˘ ÁÈ· ÎÏ›ÛÈÌÔ ‰È·ÛÙËÌ¿ÙˆÓ ‹ ÌÂÌÔӈ̤Ó˜ fi„ÂȘ ÛÙ·
ÚfiÛıÈ· ‰fiÓÙÈ·, 2) Ë ¿ÌÂÛË ‰È·ÁÓˆÛÙÈ΋ Ù¯ÓÈ΋ (ÂÓ‰ÔÛÙÔÌ·ÙÈÎfi mock-up) Û˘Ó›ÛÙ·Ù·È ÁÈ· ·ÛıÂÓ›˜ Ì ȉȷ›ÙÂÚ˜ ·ÈÛıËÙÈΤ˜ ··ÈÙ‹ÛÂȘ, 3) Ë Î·Ù¿ÏÏËÏË ¯Ú‹ÛË ÙˆÓ ˘ÏÈÎÒÓ Î·È Ù¯ÓÈÎÒÓ Û˘ÁÎfiÏÏËÛ˘ Î·È ‰È·ÛÙڈ̿وÛ˘
ÌÔÚ› Ó· ÂÁÁ˘Ëı› ¤Ó· ÚԂϤ„ÈÌÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·, 4) Ë ÚÔÛÂÎÙÈ΋ Û˘ÓÙ‹ÚËÛË ÙfiÛÔ ·fi ÙÔÓ ·ÛıÂÓ‹ fiÛÔ Î·È ·fi ÙÔÓ ÎÏÈÓÈÎfi Ô‰ÔÓÙ›·ÙÚÔ, ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ ¤Ó· Ì·ÎÚ¿˜ ‰È·ÚΛ·˜ ·ÈÛıËÙÈÎfi Î·È ÏÂÈÙÔ˘ÚÁÈÎfi ·ÔÙ¤ÏÂÛÌ·.
Hellenic Stomatological Review 57: 79-90, 2013
REFERENCES
1. Horvath S, Schulz CP: Minimally invasive restoration of a
maxillary central incisor with a partial veneer. Eur J Esthet
Dent 2012; 7 (1): 6-16.
2. De Araujo EM, Baratieri LN, Monteiro S, Vieira LC, de Andrada
MA: Direct adhesive restoration of anterior teeth: Part 3. Procedural considerations. Pract Proceed Aesthet Dent 2003; 15
(6): 433-7.
3. Dietschi D, Ardu S, Krejci I: A new shading concept based on
natural tooth color applied to direct composite restorations.
Quintessence Int 2006; 37 (2): 91-102.
4. Dietschi D: Optimising aesthetics and facilitating clinical application of free-hand bonding using the “natural layering
concept”. Br Dent J 2008; 204: 181-185.
5. Vargas M: Conservative aesthetic enhancement of the anterior dentition using a predictable direct resin protocol. Pract
Proced Aesthet Dent 2006; 18 (8): 501-507.
6. Zorba YO, Bayindir YZ, Barutcugil C: Direct laminate veneers
with resin composites: two case reports with five-year followups. J Contemp Dent Pract 2010; 11 (4): 56-62.
7. Guler AU, Yilmaz F, Kulunk T, Guler E, Kurt S: Effects of different drinks on stainability of resin composite provisional
restorative materials. J Prosthet Dent 2005; 94: 118-24.
8. Heintze SD, Forjanic, Ohmiti K, Rousson V: Surface deterioration of dental materials after simulated tooth brushing in
relation to brushing time and load. Dent Mater 2010; 26 (4):
306-319.
9. Kubo S, Kawasaki A, Hayashi Y: Factors associated with the
longevity of resin composite restorations. Dent Mater 2011;
30 (3): 374-383.
10. Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ,
Ding P: Recontouring teeth and closing diastemas with direct
composite buildups: a clinical evaluation of survival and
quality parameters. J Dent 2010 Dec; 38 (12): 1001-9.
11. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G:
The 5-year clinical performance of direct composite additions to correct tooth form and position. II. Marginal qualities.
Clin Oral Investigations 1997; 1: 19-26.
12. Nalbandian S, Millar BJ: The effect of veneers on cosmetic
improvement. Br Dent J 2009; 207 (2): 72-3.
Corresponding author:
Antoniadou Maria
e-mail: [email protected]
89
¶·ÚÔ˘Û›·ÛË ¶ÂÚÈÛÙ·ÙÈÎÔ‡
Case Report
BIB§IO°PAºIA
1. Horvath S, Schulz CP: Minimally invasive restoration of a
maxillary central incisor with a partial veneer. Eur J Esthet
Dent 2012; 7 (1): 6-16.
2. De Araujo EM, Baratieri LN, Monteiro S, Vieira LC, de Andrada
MA: Direct adhesive restoration of anterior teeth: Part 3. Procedural considerations. Pract Proceed Aesthet Dent 2003; 15
(6): 433-7.
3. Dietschi D, Ardu S, Krejci I: A new shading concept based on
natural tooth color applied to direct composite restorations.
Quintessence Int 2006; 37 (2): 91-102.
4. Dietschi D: Optimising aesthetics and facilitating clinical
application of free-hand bonding using the “natural layering
concept”. Br Dent J 2008; 204: 181-185.
5. Vargas M: Conservative aesthetic enhancement of the
anterior dentition using a predictable direct resin protocol.
Pract Proced Aesthet Dent 2006; 18 (8): 501-507.
6. Zorba YO, Bayindir YZ, Barutcugil C: Direct laminate veneers
with resin composites: two case reports with five-year followups. J Contemp Dent Pract 2010; 11 (4): 56-62.
7. Guler AU, Yilmaz F, Kulunk T, Guler E, Kurt S: Effects of
different drinks on stainability of resin composite provisional
restorative materials. J Prosthet Dent 2005; 94: 118-24.
8. Heintze SD, Forjanic, Ohmiti K, Rousson V: Surface deterioration of dental materials after simulated tooth brushing in
relation to brushing time and load. Dent Mater 2010; 26 (4):
306-319.
9. Kubo S, Kawasaki A, Hayashi Y: Factors associated with the
longevity of resin composite restorations. Dent Mater 2011;
30 (3): 374-383.
10. Wolff D, Kraus T, Schach C, Pritsch M, Mente J, Staehle HJ,
Ding P: Recontouring teeth and closing diastemas with direct
composite buildups: a clinical evaluation of survival and
quality parameters. J Dent 2010 Dec; 38 (12): 1001-9.
11. Peumans M, Van Meerbeek B, Lambrechts P, Vanherle G:
The 5-year clinical performance of direct composite
additions to correct tooth form and position. II. Marginal
qualities. Clin Oral Investigations 1997; 1: 19-26.
12. Nalbandian S, Millar BJ: The effect of veneers on cosmetic
improvement. Br Dent J 2009; 207 (2): 72-3.
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
M. AÓÙˆÓÈ¿‰Ô˘
e-mail: [email protected]
90
Hellenic Stomatological Review 57: 79-90, 2013
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
OÏÈ΋ AÔηٿÛÙ·ÛË ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘
Ì ÔÏÔÎÂÚ·ÌÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ
E. E˘·ÁÁ¤ÏÔ˘*, I. T˙Ô‡Ù˙·˜**, ¶. Zˆ›‰Ë˜***
Full Fixed Mandibular Restoration
with Monolithic Zirconia All Ceramic Material
E. Evangelou*, I, Tzoutzas**, P. Zoidis***
¶EPI§HæH
SUMMARY
OÈ ÔÏÔÎÂÚ·ÌÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È
Â‰Ò Î·È Ï›Á˜ ‰ÂηÂٛ˜ ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋, ÚÔÛʤÚÔÓÙ·˜ ¿ÚÈÛÙ· ·ÈÛıËÙÈο ·ÔÙÂϤÛÌ·Ù·. Y¿Ú¯Ô˘Ó
·ÚÎÂÙ¿ Û˘ÛÙ‹Ì·Ù· ηٷÛ΢‹˜ ÔÏÔÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ Ù· ÔÔ›· ÚÔÛʤÚÔ˘Ó ÔÏϤ˜ ‰˘Ó·ÙfiÙËÙ˜ Â·ÓÔÚıˆÙÈ΋˜ ·ÔηٿÛÙ·Û˘ ÛÙÔ Û‡Á¯ÚÔÓÔ Ô‰ÔÓÙ›·ÙÚÔ. ŒÓ· Û‡Á¯ÚÔÓÔ ÔÏÔÎÂÚ·ÌÈÎfi Û‡ÛÙËÌ· Ì ·ÚÎÂÙ¿ ηϤ˜ ȉÈfiÙËÙ˜ ·ÔÙÂÏ› Ë ÌÔÓÔÊ·ÛÈ΋ ÌÔÚÊ‹ ÙÔ˘ ÔÍÂȉ›Ô˘ Ù˘ ZÈÚÎÔÓ›·˜.
™ÙËÓ ÂÚÁ·Û›· ·˘Ù‹ ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÎÏÈÓÈÎfi ÂÚÈÛÙ·ÙÈÎfi Á˘Ó·›Î·˜ 51 ÂÙÒÓ, Ë ÔÔ›· ÚÔÛ‹Ïı ÛÙËÓ KÏÈÓÈ΋ ™˘ÓÔÏÈ΋˜ AÓÙÈÌÂÙÒÈÛ˘ AÛıÂÓÒÓ Ù˘ O‰ÔÓÙÈ·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ AıËÓÒÓ, ÌÂ
ÙËÓ ÂÈı˘Ì›· Ó· ·ÔηٷÛÙ‹ÛÂÈ ÙËÓ Î¿Ùˆ Ù˘ ÁÓ¿ıÔ. H ·ÛıÂÓ‹˜ ·ÚÔ˘Û›·˙ ÛÂÈÚ¿ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Î·È
·ÈÛıËÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Î·È ÂÈÚfiÛıÂÙ· ·ÏÏÂÚÁ›· Û fiÏ· Ù· ̤ٷÏÏ· ÂÎÙfi˜ ·fi ÙÔ ¯Ú˘Ûfi Î·È ÙÔÓ
¿ÚÁ˘ÚÔ. ø˜ ÂÎ ÙÔ‡ÙÔ˘, Ë ·ÛıÂÓ‹˜ ÂÈı˘ÌÔ‡Û ӷ
Ï¿‚ÂÈ ·ÔηٷÛÙ¿ÛÂȘ ¯ˆÚ›˜ ÙËÓ ‡·ÚÍË ÌÂÙ¿ÏÏÔ˘. ŒÙÛÈ Î·Ù·ÛÙÚÒıËΠÙÔ Û¯¤‰ÈÔ ıÂÚ·›·˜, ÙÔ
ÔÔ›Ô ÂÚÈÏ¿Ì‚·Ó ÙËÓ Î·Ù·Û΢‹ ÔÏÔÎÂÚ·ÌÈÎÒÓ
·ÔηٷÛÙ¿ÛÂˆÓ Ì ÙËÓ Â›Î·ÈÚË Ù¯ÓÔÏÔÁ›· ÙˆÓ
All-Ceramic restorations have been used with success for dental restorations up to date, providing
excellent esthetic results. There are several systems
available for the construction of all-ceramic crowns
and bridges. One of the most sophisticated systems
is the Monolithic Zirconia all ceramic material.
This present clinical case concerns a 51-year old female patient who presented to the Undergraduate
Dental Clinic of the National and Kapodistrian University of Athens, with the desire to restore her mandibular teeth. The patient had several functional and
esthetic problems as well as allergy to metals, except
for gold and silver, requesting metal free restorations.
As a result, the treatment plan consisted of a full fixed
mandibular restoration, using the Monolithic Zirconia
all ceramic system as a veneering material.
* O‰ÔÓÙ›·ÙÚÔ˜, AfiÊÔÈÙË EK¶A
** AÓ. K·ıËÁËÙ‹˜ O‰ÔÓÙÈ΋˜ ¯ÂÈÚÔ˘ÚÁÈ΋˜ EK¶A
*** §¤ÎÙÔÚ·˜ ¶ÚÔÛıÂÙÈ΋˜ EK¶A
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 91-99, 2013
·ÚÂÏ‹ÊıË 21/1/2014 - ÂÎÚ›ıË 31/1/2014
Key Words: All-ceramic restorations, Monolithic Zirkonia
INTRODUCTION
The first all-ceramic restoration was constructed in 1889 by
* Dentist, UOA graduate
** Associate professor, Dental Surgery, UOA
*** Lecturer, Prosthodontics, UOA
Hellenic Stomatological Review 57: 91-99, 2013
paper received 21/1/2014 - accepted 31/1/2014
91
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
ÛÙÂÊ·ÓÒÓ ·fi ÙË ÌÔÓÔÊ·ÛÈ΋ ÌÔÚÊ‹ ÙÔ˘ OÍÂȉ›Ô˘
Ù˘ ZÈÚÎÔÓ›·˜.
§¤ÍÂȘ ÎÏÂȉȿ: OÏÔÎÂÚ·ÌÈΤ˜ ·ÔηÛÙ·ÛÙ¿ÛÂȘ,
OÍ›‰ÈÔ Ù˘ ZÈÚÎÔÓ›·˜
EI™A°ø°H
H ÚÒÙË ÔÏÔÎÂÚ·ÌÈ΋ ·ÔηٿÛÙ·ÛË ¯ÚÔÓÔÏÔÁÂ›Ù·È ÙÔ
1889 Î·È Î·Ù·Û΢¿ÛÙËΠ·fi ÙÔÓ Charles H. Land Ì ÙËÓ
Ù¯ÓÈ΋ ÙÔ˘ ʇÏÏÔ˘ Ï·Ù›Ó·˜ Î·È Ë ·ÔηٿÛÙ·ÛË ·˘Ù‹
ÔÓÔÌ¿ÛÙËΠÛÙÂÊ¿ÓË Jacket1. Afi ÙfiÙ ÏfiÁˆ ÙˆÓ Û˘Ó¯ÒÓ ÂÍÂÏ›ÍÂˆÓ ÛÙÔ ¯ÒÚÔ, Ù· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù· ·ÔÙÂÏÔ‡Ó ·Ó·fiÛ·ÛÙÔ ÎÔÌÌ¿ÙÈ ÛÙÔ ¯ÒÚÔ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÂÎÙÂÓÒ˜ ÁÈ· ÙËÓ Î·Ù·Û΢‹
ÎÂÚ·ÌÈÎÒÓ fi„ˆÓ, ÂÓı¤ÙˆÓ, ÂÂÓı¤ÙˆÓ, ÛÙÂÊ·ÓÒÓ Î·È ÁÂÊ˘ÚÒÓ2. M¤¯ÚÈ ÚfiÛÊ·Ù· ˘‹Ú¯·Ó ·ÚÎÂÙ¿ ÌÂÈÔÓÂÎÙ‹Ì·Ù· ÛÙË ¯Ú‹ÛË ÙÔ˘˜, fiˆ˜ Ë Â˘ıÚ·˘ÛÙfiÙËÙ·, Ë ÂÚÁ·ÛÙËÚȷ΋ ‰˘ÛÎÔÏ›· ηıÒ˜ Î·È Ô ·˘ÍË̤ÓÔ˜ ¯ÚfiÓÔ˜ Ô˘ ¯ÚÂÈ·˙fiÙ·Ó ÁÈ· Ó· ηٷÛ΢·ÛÙÔ‡Ó2. M ÙË Û˘Ó¯‹ ·Ó¿Ù˘ÍË
ÛÙÔ ¯ÒÚÔ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÎÏÈÓÈ΋˜ Ú¿Í˘ Î·È Ù¯ÓÔÏÔÁ›·˜, Ë Î·Ù·Û΢‹ ÙÔ˘˜ ηı›ÛÙ·Ù·È fiÏÔ Î·È ÈÔ ·Ï‹ ηÈ
Ë Ì˯·ÓÈ΋ ÙÔ˘˜ ·ÍÈÔÈÛÙ›· Û˘Ó¯Ҙ ·Ó·Ù‡ÛÛÂÙ·È2.
TÔ ˙ÈÚÎfiÓÈÔ Â›Ó·È ¤Ó· Ï·ÌÂÚfi ÁÎÚÈ-Ï¢Îfi ̤ٷÏÏÔ3, ÂÓÒ
ÙÔ ÔÍ›‰ÈÔ Ù˘ ZÈÚÎÔÓ›·˜ (ZrO2) Â›Ó·È ¤Ó· ˘ÏÈÎfi Ô˘ Û˘Ó‰˘¿˙ÂÈ Ôχ ηϤ˜ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜. MÔÚ› Ó· ˘¿ÚÍÂÈ Û ÔÏϤ˜ Ê¿ÛÂȘ, ·Ó¿ÏÔÁ· Ì ÙËÓ ÚÔÛı‹ÎË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ÛÙÔȯ›ˆÓ fiˆ˜ Ô ¿Û‚ÂÛÙÔ˜ (CaO) ‹ Ë M·ÁÓËÛ›· (MgO). H ‰ÔÌ‹ Ù˘ ZÈÚÎÔÓ›·˜ ‰ÂÓ ÂÈÙÚ¤ÂÈ ÙËÓ
ÌÂÙ¿‰ÔÛË ÚˆÁÌÒÓ Ì¤Û· ÛÙË Ì¿˙· Ù˘ Î·È ¤ÙÛÈ ¤¯ÂÈ ·ÓÙÔ¯‹ ÛÙÔÓ ÂÊÂÏ΢ÛÌfi Î·È ÛÙËÓ Î¿Ì„Ë. E›Û˘, ¤¯ÂÈ ˘„ËÏ‹
ÛÎÏËÚfiÙËÙ·, ·ÓÙÔ¯‹ ÛÙË ‰È¿‚ÚˆÛË, Â›Ó·È ‚ÈÔÛ˘Ì‚·Ùfi ˘ÏÈÎfi, ·ÎÙÈÓÔÛÎÈÂÚfi Î·È ÙÔ ¯ÚÒÌ· Ù˘ ÚÔÛÔÌÔÈ¿˙ÂÈ Ì ÂΛÓÔ ÙÔ˘ Ê˘ÛÈÎÔ‡ ‰ÔÓÙÈÔ‡3, 4, 5. MÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÛÙÂÊ¿ÓˆÓ ‹ ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÁÂÊ˘ÚÒÓ ÙÂÛÛ¿ÚˆÓ, ˆ˜ Î·È ¤ÍÈ ÙÂÌ·¯›ˆÓ5. H ·‰È·Ê¿ÓÂÈ·
ÙÔ˘ ˘Ú‹Ó· Ù˘ ˙ÈÚÎÔÓ›·˜ fï˜, ÙËÓ Î·ıÈÛÙ¿ ÏÈÁfiÙÂÚÔ ·ÈÛıËÙÈ΋ Û ۯ¤ÛË Ì ٷ ¿ÏÏ· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù·.
™ÙËÓ ¶ÚÔÛıÂÙÈ΋, Ë ZÈÚÎÔÓ›· ¤Î·Ó ÙËÓ ÂÌÊ¿ÓÈÛ‹ Ù˘ ÌÂ
ÙÔ Û‡ÛÙËÌ· In Ceram Zirkonia® (Vita Zanhfabrick, Bad
Sackingen, Germany), ÂÓÒ Ì ÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ CADCAM, ÔÈ È‰ÈfiÙËÙ¤˜ Ù˘ ‚ÂÏÙÈÒÓÔÓÙ·Ó Û˘Ó¯Ҙ3,6. AÚ¯Èο,
ÔÈ ·ÔηٷÛÙ¿ÛÂȘ ·fi ZÈÚÎÔÓ›·, ·ÔÙÂÏÔ‡ÓÙ·Ó ·fi ¤Ó·
˘Ú‹Ó·, ¿Óˆ ÛÙÔÓ ÔÔ›Ô «ÎÙÈ˙fiÙ·Ó» Ë ·ÔηٿÛÙ·ÛË.
A˘Ùfi fï˜ ›¯Â ˆ˜ ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁÂ›Ù·È ÌÈ· ÌÂÛfiÊ·ÛË ÌÂٷ͇ ÎÂÚ·ÌÈÎÔ‡ Î·È ZÈÚÎÔÓ›·˜, Ë ÔÔ›· ·ÔÙÂÏÔ‡Û ÙÔ ·‰‡Ó·ÌÔ ÛËÌÂ›Ô ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ·˘ÙÒÓ,
·ÊÔ‡ ÁÈÓfiÙ·Ó ·ÔÊÏÔ›ˆÛË ÙÔ˘ ÎÂÚ·ÌÈÎÔ‡ ·fi ÙÔÓ ˘Ú‹Ó· Î·È ÔÈ ·ÔηٷÛÙ¿ÛÂȘ Ô‰ËÁÔ‡ÓÙ·Ó Û ηٿÁÌ·Ù·4. TË
χÛË Û ·˘Ùfi ÙÔ Úfi‚ÏËÌ· ‹Úı ӷ ‰ÒÛÂÈ Ë ÌÔÓÔÊ·ÛÈ΋
ÌÔÚÊ‹ ÙÔ˘ ÔÍÂȉ›Ô˘ Ù˘ ZÈÚÎÔÓ›·˜, fiÔ˘ Ë ·ÔηٿÛÙ·ÛË ·ÔÙÂÏÂ›Ù·È ÂÍ’ ÔÏÔÎÏ‹ÚÔ˘ ·fi ZÈÚÎÔÓ›·7.
¶APOY™IA™H ¶EPI™TATIKOY
AÛıÂÓ‹˜ ËÏÈΛ·˜ 51 ÂÙÒÓ, ÚÔÛ‹Ïı ÛÙËÓ KÏÈÓÈ΋ ™˘ÓÔÏÈ΋˜ AÓÙÈÌÂÙÒÈÛ˘ AÛıÂÓÒÓ, ÛÙËÓ O‰ÔÓÙÈ·ÙÚÈ΋ ™¯ÔÏ‹
92
Charles H. Land, and it is known as the «jacket» crown1.
Since then, all ceramic restorations have become an
integral part of dentistry and are used as veneers, inlays,
onlays, and crown and bridge restorations2. Until recently,
there were many disadvantages concerning their use,
such as brittleness, low fracture toughness, and complex
laboratory construction2. However, with the advent of Zirconia materials, their construction became simpler and
their mechanical properties greatly improved2.
Zirconium is a shiny grey-white metal3 and Zirconia Oxide
(ZrO2) is a material that offers good mechanical properties. It may exist in several crystal phases, depending in
the addition of components like calcia (CaO) or Magnesia
(MgO). The structure of Zirconia has the ability to inhibit
cracks. Thus, it presents tensile strength and flexural stability. Furthermore, it presents fracture toughness, high
hardness, excellent chemichal resistance, biocompatibility and color, simulating the color of the original teeth3, 4, 5.
It can be used for the construction of single crowns, or for
the construction of crown and bridge restorations up to five
or six units5. However, its opaque core makes Zirconia
restorations less esthetic than the other All-ceram systems5.
The first Zirconia system available was In Ceram Zirkonia® (Vita Zanhfabrick, Germany), while with the development of the CAD-CAM system; its properties were
continuously improved6.
First, the crowns of Zirconia consisted of a core, on which
the restoration was «built». However, this has always been
the drawback of these restorations, since the ceramic
material was torn off from the Zirconium core and as a
result, it led to fractures4. The solution came with the advent of the Monolithic Zirconia; in which the crowns consisted of just one monolithic body of Zirconia witch incorporated the core and the built up in one body7.
CLINICAL REPORT PRETREATMENT
A female patient, 51 years old, married, has presented for
treatment to the Undergraduate Dental Clinic of National
and Kapodistrian University of Athens, with the desire to
restore her mandible having functional and esthetic
problems. The vertical dimension was reduced and the
incisal edges of the lower anterior teeth were severely
worn since they had to antagonize the upper anterior
ceramometal restorations. The patient had allergy to
metals, except for silver and gold, and was seeking for
metal free restorations.
Intraoral examination revealed:
- Generalized, moderate periodontitis
- Maxillary teeth had been recently restored (2 years ago).
Teeth #12, #11, #21, #22 and #23 had fixed metalceramic crowns witch supported a maxillary flexible
removable partial denture made from Valplast (Valplast
International Corporation, Westbury, NY, USA).
- Mandibular teeth #47, #46 and #36, had been extracted
and the teeth #48 and #37 had carious lesions. Teeth
Hellenic Stomatological Review 57: 91-99, 2013
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
ÙÔ˘ EK¶A, Ì ÙËÓ ÂÈı˘Ì›· Ó· ·ÔηٷÛÙ‹ÛÂÈ Û˘ÓÔÏÈο
ÙÔ ÛÙfiÌ· Ù˘, ÙÔ ÔÔ›Ô fiˆ˜ ·Ó¤ÊÂÚÂ, ·ÚÔ˘Û›·˙ ÏÂÈÙÔ˘ÚÁÈο Î·È ·ÈÛıËÙÈο ÚÔ‚Ï‹Ì·Ù·. ¢È·ÈÛÙÒıËΠÌÂȈ̤ÓË Î¿ıÂÙË ‰È¿ÛÙ·ÛË Î·ıÒ˜ Î·È ·ÔÙÚÈ‚‹ ÙˆÓ ÚÔÛı›ˆÓ
‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘, ηıÒ˜ ·˘Ù¿ ·ÓÙ·ÁˆÓ›˙ÔÓÙ·Ó
ÙȘ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÙˆÓ ÚfiÛıÈˆÓ ¿Óˆ ‰fiÓÙÈÒÓ. H ·ÛıÂÓ‹˜, ηٿ ÙË Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ‰‹ÏˆÛ fiÙÈ ¤¯ÂÈ ·ÏÏÂÚÁ›· Û fiÏ· Ù· ̤ٷÏÏ· ÂÎÙfi˜ ·fi ÙÔ
¯Ú˘Ûfi Î·È ÙÔÓ ¿ÚÁ˘ÚÔ. ŒÙÛÈ ˙‹ÙËÛ ÔÔÈ·‰‹ÔÙ ·ÔηٿÛÙ·ÛË, ·ÚΛ ·˘Ù‹ Ó· ÌËÓ ÂÌÂÚȤ¯ÂÈ Î·ıfiÏÔ˘ ̤ٷÏÏÔ.
K·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó Ù· ÂÍ‹˜:
- °ÂÓÈÎÂ˘Ì¤ÓË ¯ÚfiÓÈ· ÂÚÈÔ‰ÔÓÙ›Ùȉ· ̤Û˘ ‚·Ú‡ÙËÙ·˜,
‚Ú·‰Â›·˜ ÂͤÏÈ͢
#45, #44, #43, #42, #41, #31, #32, #33, #34 and #35
presented intense cervical attritions. Furthermore, all of the
mandibular teeth were stained, due to the fact that the
patient was a smoker. (Fig. 1-4)
TREATMENT PLAN
The treatment plan consisted of: full mouth periodontal
treatment, caries removal for tooth #48, endodontic treatment for #48 followed by a core build up restoration, using
a fiberglass post and posterior composite resin. The Mandibular restoration consisted of a fixed prosthodontic reconstruction made of Zirconia, using the Brux-Zir® system. In
- O ¿Óˆ Ô‰ÔÓÙÈÎfi˜ ÊÚ·ÁÌfi˜ ‹Ù·Ó Û ÈηÓÔÔÈËÙÈ΋ ηٿÛÙ·ÛË, ·ÊÔ‡ ›¯Â ·ÔηٷÛÙ·ı› ‰‡Ô ¯ÚfiÓÈ· ÚÈÓ, Ì ·Î›ÓËÙ˜ ·ÔηٷÛÙ¿ÛÂȘ ÛÙ· #12, #11, #21, #22 ηÈ
#23. T· ˘fiÏÔÈ· ‰fiÓÙÈ· ›¯·Ó ÂÍ·¯ı› Î·È ·ÔηٷÛÙ·ı› Ì ÌÂÚÈ΋ Ô‰ÔÓÙÔÛÙÔȯ›· ηٷÛ΢·Ṳ̂ÓË ÂÍ’ ÔÏÔÎÏ‹ÚÔ˘ ·fi ·ÎÚ˘ÏÈÎfi Ù‡Ô˘ Valplast (Valplast
International Corporation, Westbury, NY, USA).
- ™ÙÔÓ Î¿Ùˆ Ô‰ÔÓÙÈÎfi ÊÚ·ÁÌfi Ù· ‰fiÓÙÈ· #47, #46 ηÈ
#36 ›¯·Ó ÂÍ·¯ı› ÛÙÔ ·ÚÂÏıfiÓ Î·È Ù· #48 Î·È #37 ›¯·Ó ÙÂÚˉÔÓÈΤ˜ ‚Ï¿‚˜. ™Ù· ‰fiÓÙÈ· # 45, #44, #43,
#42, #41, #31, #32, #33, #34 Î·È #35 ˘‹Ú¯·Ó Ôχ ¤ÓÙÔÓ˜ ·ÔÙÚÈ‚¤˜ ÎÔÙÈο Î·È Ì·ÛËÙÈο. E›Û˘, fiÏ· Ù·
‰fiÓÙÈ· ›¯·Ó ¯ÚˆÛÙÈΤ˜ ÂÍ’ ·ÈÙ›·˜ ÙÔ˘ ÁÂÁÔÓfiÙÔ˜ fiÙÈ Ë ·ÛıÂÓ‹˜ ‹Ù·Ó ηÓ›ÛÙÚÈ·. (EÈÎ. 1-4).
EÈÎ. 1: AÚ¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÚÔÛÙÔÌȷο
Fig. 1: Initial Clinical Picture buccal view
™XE¢IO £EPA¶EIA™
TÔ Û¯¤‰ÈÔ ıÂÚ·›·˜ ÂÚÈÂÏ¿Ì‚·ÓÂ: ÂÚÈÔ‰ÔÓÙÈ΋ ıÂÚ·›· ÛÙÔ Û‡ÓÔÏÔ ÙÔ˘ ÊÚ·ÁÌÔ‡, ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›·
ÛÙÔ #48, ÙÔÔı¤ÙËÛË Û ·˘Ùfi ¿ÍÔÓ· ˘·ÏÔÓËÌ¿ÙˆÓ Î·È ·Ó·Û‡ÛÙ·Û‹ ÙÔ˘ Ì ۇÓıÂÙË ÚËÙ›ÓË ÔÈÛı›ˆÓ Î·È ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË fiÏ˘ Ù˘ οو ÁÓ¿ıÔ˘ Ì Á¤Ê˘Ú˜
Î·È ÛÙÂÊ¿Ó˜ ·fi ÌÔÓÔÊ·ÛÈÎfi OÍ›‰ÈÔ Ù˘ ZÈÚÎÔÓ›·˜, ÌÂ
ÙÔ Û‡ÛÙËÌ· Brux-Zir®. ™˘ÁÎÂÎÚÈ̤ӷ ı· ηٷÛ΢¿˙ÔÓÙ·Ó, Ì›· Á¤Ê˘Ú· ÙÚÈÒÓ ÙÂÌ·¯›ˆÓ Ì ÛÙËÚ›ÁÌ·Ù· Ù· #37
Î·È #35 Î·È ÁÂʇڈ̷ ÙÔ #36, Ì›· Á¤Ê˘Ú· ¤ÓÙ ÙÂÌ·¯›ˆÓ Ì ÛÙËÚ›ÁÌ·Ù· Ù· #48, #45 Î·È #44 Î·È ÁÂÊ˘ÚÒÌ·Ù· Ù· #47 Î·È #46 Î·È ÂÊÙ¿ ÌÔÓ‹ÚÂȘ ÛÙÂÊ¿Ó˜ ÛÙ· #34,
#33, #32, #31, #41, #42 Î·È #43.
EÈÎ. 2: AÚ¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÁψÛÛÈο
Fig. 2: Initial Clinical Picture lingual view
£EPA¶EIA
AÊÔ‡ ÔÏÔÎÏËÚÒıËÎÂ Ë ÂÚÈÔ‰ÔÓÙÈ΋ ıÂÚ·›·, Ë ÂÓ‰Ô‰ÔÓÙÈ΋ ıÂÚ·›· ÙÔ˘ #48, Ë ÙÔÔı¤ÙËÛË Û ·˘Ùfi ¿ÍÔÓ·
˘·ÏÔÓËÌ¿ÙˆÓ Î·È Ë ·Ó·Û‡ÛÙ·Û‹ ÙÔ˘ Ì ۇÓıÂÙË ÚËÙ›ÓË
ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ, ¤ÁÈÓ ϋ„Ë ÙˆÓ ·Ú¯ÈÎÒÓ ·ÔÙ˘ˆÌ¿ÙˆÓ Ì ÌË ·ÓÙÈÛÙÚÂÙfi ˘‰ÚÔÎÔÏÏÔÂȉ¤˜ (Jeltrate Plus;
Dentsply Caulk, Milford, Del) Î·È ÌÂÙ·ÏÏÈÎfi ‰ÈÛοÚÈÔ ÂÌÔÚ›Ô˘. T· ·Ú¯Èο ·ÔÙ˘ÒÌ·Ù· ÛÙ¿ÏıËÎ·Ó ÛÙÔ ÂÚÁ·ÛÙ‹ÚÈÔ Ì ÙËÓ Ô‰ËÁ›· ηٷÛ΢‹˜ ·Ú¯ÈÎÒÓ ÂÎÌ·Á›ˆÓ
ÌÂϤÙ˘. K·Ù·Û΢¿ÛÙËΠÂÓ‰ÔÛÙÔÌ·ÙÈο ÚfiÛıÈÔ˜ ·ÔÚÔÁÚ·ÌÌ·ÙÈÛÙ‹˜ Ì ·˘ÙÔÔÏ˘ÌÂÚÈ˙fiÌÂÓË ·ÎÚ˘ÏÈ΋
ÚËÙ›ÓË (GC Pattern Resin, GC Dental Products Gorp,
Hellenic Stomatological Review 57: 91-99, 2013
EÈÎ. 3: AÚ¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÚÈÔ¯‹˜ #37
Fig. 3: Initial Clinical Picture #37 Area
93
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
Tokyo, Japan) ÁÈ· ÙË Ï‹„Ë ÛÙ·ıÂÚ‹˜ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓ˘ ηٷÁÚ·Ê‹˜ Ù˘ ÎÂÓÙÚÈ΋˜ Û¯¤Û˘ ÛÙËÓ ·˘ÍË̤ÓË Î¿ıÂÙË ‰È¿ÛÙ·ÛË Ô˘ ÂÚfiÎÂÈÙÔ Ó· Â·ÎÔÏÔ˘ı‹ÛÂÈ. H
ηٷÁÚ·Ê‹ Ù˘ ÎÂÓÙÚÈ΋˜ Û¯¤Û˘ ÛÙËÓ ·˘ÍË̤ÓË Î¿ıÂÙË ‰È¿ÛÙ·ÛË Ú·ÁÌ·ÙÔÔÈ‹ıËΠ̠ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ·ÔÚÔÁÚ·ÌÌ·ÙÈÛÙ‹ Î·È ÏÂÙfiÚÚ¢ÛÙ˘ ÛÈÏÈÎfiÓ˘ ηٷÁÚ·Ê‹˜ (Blue mousse, Parkell Inc., Edgewood, NY, USA).
T· ÂÎÌ·Á›· ·Ó·ÚÙ‹ıËÎ·Ó Û ËÌÈÚÔÛ·ÚÌÔ˙fiÌÂÓÔ ·ÚıÚˆÙ‹Ú· (Denar Mark II, Whip Mix Corporation, Fort
Collins, CO, USA) Î·È ·ÎÔÏÔ‡ıËÛ ‰È·ÁÓˆÛÙÈÎfi Τڈ̷
ÛÙËÓ ·˘ÍË̤ÓË Î¿ıÂÙË ‰È¿ÛÙ·ÛË. ™ÙË Û˘Ó¤¯ÂÈ· ·ÎÔÏÔ‡ıËÛ ·ÓÙÈÁÚ·Ê‹ Ù˘ ‰È·ÁÓˆÛÙÈ΋˜ Û‡ÓÙ·Í˘, ηٷÛ΢‹
ηÈÓÔ‡ÚÈˆÓ ÂÎÌ·Á›ˆÓ ÌÂϤÙ˘ Î·È Î·Ù·Û΢‹ Ì‹ÙÚ·˜
Omnivac, ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷÛ΢·ÛÙÔ‡Ó ÌÂÙ·‚·ÙÈΤ˜
·ÔηٷÛÙ¿ÛÂȘ ÂÓ‰ÔÛÙÔÌ·ÙÈο ·fi ÂÓ „˘¯ÚÒ ÔÏ˘ÌÂÚÈ˙fiÌÂÓË ·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË (Lang Dental Manufacturing
Co., Inc., Wheeling, IL.) (EÈÎ. 5,6).
AÎÔÏÔ‡ıˆ˜, ¤ÁÈÓ·Ó ÔÈ ·Ú¯ÈΤ˜ ·Ú·Û΢¤˜ ÛÙ· #48,
#45, #44, #35 Î·È #37, Î·È Î·Ù·Û΢¿ÛÙËÎ·Ó ÔÈ Ô›ÛıȘ ÌÂÙ·‚·ÙÈΤ˜ Á¤Ê˘Ú˜ Û ÎÂÓÙÚÈ΋ Û¯¤ÛË Î·È ·˘ÍË̤ÓË Î¿ıÂÙË ‰È¿ÛÙ·ÛË, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÙÔÓ ÚfiÛıÈÔ ·ÔÚÔÁÚ·ÌÌ·ÙÈÛÙ‹. H ·ÛıÂÓ‹˜ ÚÔÛ‹Ïı ͷӿ ÙËÓ ÂfiÌÂÓË Ì¤Ú·, ÁÈ· Ó· ÔÏÔÎÏËÚˆıÔ‡Ó ÔÈ ·Ú·Û΢¤˜ ÛÙ·
EÈÎ. 4: AÚ¯È΋ ÎÏÈÓÈ΋ ÂÈÎfiÓ·˜ ÂÚÈÔ¯‹˜ #48
Fig. 4: Initial Clinical Picture #48 Area
particular, it was decided to fabricate a three unit fixed
bridge, using #37 and #35 as abutments and #36 as pontic, a five unit fixed bridge using #48, #45 and #44 as abutments and #46 and #47 as pontics and seven single
crowns for teeth #34, #33, #32, #31, #41, #42 and #43.
TREATMENT
EÈÎ. 5: EÎÌ·ÁÂ›Ô ¿Óˆ ÁÓ¿ıÔ˘
Fig. 5: Maxillary Cast
EÈÎ. 6: ¢È¿Ê·ÓË Ì‹ÙÚ· Omnivac
Fig. 6: Omnivac Matrix
94
After the completion of the full mouth periodontal treatment,
the endodontic treatment for tooth #48, took place. The
post and core restoration consisted of a fiberglass post and
a posterior composite resin built up respectively. Initial
maxillary and mandibular irreversible hydrocolloid impressions (Jeltrate Plus; Dentsply Caulk, Milford, Delaware)
were taken and sent to the dental laboratory. A deprogrammer was fabricated from autopolymerized acrylic resin (GC Pattern Resin, GC Dental Products Gorp, Tokyo,
Japan) in order to obtain accurate and reliable centric relation records, since vertical dimension had to be increased.
The centric relation was recorded in the increased vertical
dimension with the use of the deprogrammer and a dimensionally stable, fast-setting elastomeric bite registration material (Blue mousse, Parkell Inc., Edgewood, NY,
USA). The casts were mount on a semi-adjustable articulator (Denar Mark II, Whip Mix Corporation, Fort Collins,
CO, USA) in the increased vertical dimension using these
bite registration records. A full mandibular diagnostic wax
up was performed, it was duplicated, new casts were fabricated and an Omnivac matrix was made in order to
fabricate temporary restorations intraorally.
Initial preparations were made for the posterior teeth #48,
#45, #44, #35 and #37, and temporary bridges were
constructed intraorally using cold cure autopolymerizing
acrylic resin (Lang Dental Manufacturing Co., Inc., Wheeling, IL.) in the increased vertical dimension, using the laboratory matrix on the anterior teeth. Having good repeatable
and stable posterior contacts, patient left the clinic, and
returned the next day for the preparation of the anterior teeth
and the fabrication of the anterior temporary crowns (Fig. 7).
Hellenic Stomatological Review 57: 91-99, 2013
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
ÚfiÛıÈ· οو ‰fiÓÙÈ· Î·È Ó· ηٷÛ΢·ÛÙÔ‡Ó ÔÈ ÌÂÙ·‚·ÙÈΤ˜ ÛÙÂÊ¿Ó˜ ÙˆÓ ÚÔÛı›ˆÓ ·fi ÂÓ „˘¯ÚÒ ÔÏ˘ÌÂÚÈ˙fiÌÂÓË ·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË (EÈÎ. 7).
™ÙËÓ ›‰È· Â›ÛÎÂ„Ë Î·Ù·Û΢¿ÛÙËΠӤԘ ÚfiÛıÈÔ˜ ·ÔÚÔÁÚ·ÌÌ·ÙÈÛÙ‹˜, ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙȘ ÌÂÙ·‚·ÙÈΤ˜ ÙˆÓ
ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ Ù˘ οو ÁÓ¿ıÔ˘. MÈ· ‚‰ÔÌ¿‰· ÌÂÙ¿, Ë ·ÛıÂÓ‹˜ ÚÔÛ‹Ïı Ì ÛÙ·ıÂÚ‹ Î·È Â·Ó·Ï·Ì‚·ÓfiÌÂÓË Û‡ÁÎÏÂÈÛË Ì ·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ ·fi ÙËÓ ÎÚÔÙ·ÊÔÁÓ·ıÈ΋ ¿ÚıÚˆÛË, ÁÈ· ÙȘ ÙÂÏÈΤ˜ ·Ú·Û΢¤˜ ηÈ
ÙË Ï‹„Ë ÙÔ˘ ÙÂÏÈÎÔ‡ ·ÔÙ˘ÒÌ·ÙÔ˜. AÊÔ‡ ÙÔÔıÂÙ‹ıËÎ·Ó Ù· Ó‹Ì·Ù· ·ÒıËÛ˘ Ô‡ÏˆÓ (Ultrapak, Ultradent
Product Inc., South Jordan, Utah, USA) Ì ÙËÓ Ù¯ÓÈ΋
ÙÔ˘ ‰ÈÏÔ‡ Ó‹Ì·ÙÔ˜, ÔÏÔÎÏËÚÒıËÎ·Ó ÔÈ ÙÂÏÈΤ˜ ·Ú·Û΢¤˜ Ì ‚¿ıÚÔ ÙÔÍÔÂȉԇ˜ Ù‡Ô˘ (Chamfer) Î·È Ï‹ÊıËΠÙÔ ÙÂÏÈÎfi ·ÔÙ‡ˆÌ· ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÌÂÙ·ÏÏÈÎfi ‰ÈÛοÚÈÔ ÂÌÔÚ›Ô˘ (EÈÎ. 8-10). °È· ÙË Ï‹„Ë ÙÔ˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÛÈÏÈÎfiÓ˜ ÚÔÛı‹Î˘ ˘„ËÏÔ‡ Î·È ¯·ÌËÏÔ‡
ÈÍÒ‰Ô˘˜ (Extrude; Kerr Corp, Orange, Calif. USA) Ì ÙËÓ
Ù¯ÓÈ΋ Ù˘ Ù·˘Ùfi¯ÚÔÓ˘ ‰ÈÏ‹˜ Ì›Í˘.
H ÂÈÏÔÁ‹ ÙÔ˘ ¯ÚÒÌ·ÙÔ˜ ¤ÁÈÓ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¯ÚˆÌ·ÙÈÎfi Ô‰ËÁfi Vitapan 3D Master (Vita Zahnfabrik GmbH,
Bad Sackingen, Germany) (EÈÎ. 11). TÔ ÙÂÏÈÎfi ·ÔÙ‡ˆÌ·
ÛÙ¿ÏıËΠÛÙÔ Ô‰ÔÓÙÔÙ¯ÓÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ Ì ÙËÓ Ô‰ËÁ›·
ηٷÛ΢‹˜ ÂÎÌ·Á›Ԣ ÂÚÁ·Û›·˜ ·fi ˘¤ÚÛÎÏËÚË Á‡„Ô
(Jade Stone; Whip Mix Corp, Louisville, KY, USA). AÎÔÏÔ‡ıËÛ ԉËÁ›· ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÂÚÁ·ÛÙËÚÈ·ÎÒÓ ÌÂÙ·‚·ÙÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ ·fi ÂÓ ıÂÚÌÒ ÔÏ˘ÌÂÚÈ˙fiÌÂÓË
·ÎÚ˘ÏÈ΋ ÚËÙ›ÓË, ·ÓÔÌÔÈfiÙ˘ˆÓ Ì ÙȘ ÙÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂȂ‚·ÈÒÛÔ˘Ó ÙËÓ ·ÈÛıËÙÈ΋
Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÛÙËÓ Ó¤· ı¤ÛË ıÂÚ·›·˜ (EÈÎ.12).
¢˘Ô ‚‰ÔÌ¿‰Â˜ ·ÚÁfiÙÂÚ·, Ì ÙËÓ ·ÛıÂÓ‹ ·fiÏ˘Ù· ¢¯·ÚÈÛÙË̤ÓË ÙfiÛÔ Û ·ÈÛıËÙÈÎfi fiÛÔ Î·È Û ÏÂÈÙÔ˘ÚÁÈÎfi
Â›‰Ô, ÔÈ ÙÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ·fi OÍ›‰ÈÔ Ù˘ ZÈÚÎÔÓ›·˜ ·Ú·‰fiıËÎ·Ó ÛÙËÓ ·ÛıÂÓ‹. AÚ¯Èο, ¤ÁÈÓ ¤ÏÂÁ¯Ô˜ Î·È Ú‡ıÌÈÛË Ù˘ Û‡ÁÎÏÂÈÛ˘ Ì ÂÎÏÂÎÙÈÎfi ÙÚÔ¯ÈÛÌfi
¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ÂȉÈο ‰È·Ì¿ÓÙÈ· ÎÔ‹˜ ˙ÈÚÎÔÓ›·˜
(Kommet, USA) (EÈÎ. 15). ™ÙË Û˘Ó¤¯ÂÈ· ÔÈ ·ÔηٷÛÙ¿ÛÂȘ ÛÙ¿ÏıËÎ·Ó ÛÙÔ Ô‰ÔÓÙÔÙ¯ÓÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ ÁÈ· ÙËÓ
ÙÂÏÈ΋ ÂÊ˘¿ÏˆÛË (EÈÎ. 16). OÈ ÙÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ
˙ÈÚÎÔÓ›·˜ ·‰ÚÔÔÈ‹ıËÎ·Ó ÂÛˆÙÂÚÈο Ì ·ÌÌÔ‚ÔÏ‹ ÁÈ·
‚ÂÏÙ›ˆÛË ÙˆÓ È‰ÈÔÙ‹ÙˆÓ Û˘ÁÎfiÏÏËÛ˘ Î·È ÎÔÏÏ‹ıËηÓ
ÛÙÔ ÛÙfiÌ· Ì ÚËÙÈÓÒ‰Ë ÎÔÓ›· ‰ÈÏÔ‡ ÔÏ˘ÌÂÚÈÛÌÔ‡
(Panavia F, Kuraray America Inc., New York, NY, USA).
(EÈÎ. 17). AÎÔÏÔ‡ıËÛ·Ó Â·ÓÂÍÂÙ¿ÛÂȘ ‰‡Ô ̤Ú˜ Î·È ¤Ó·
Ì‹Ó· ÌÂÙ¿ (EÈÎ. 18-22).
EÈÎ. 7: AÚ¯ÈΤ˜ ·Ú·Û΢¤˜ ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ
Fig. 7: Initial anterior tooth preparations
The same day, a new anterior deprogrammer was fabricated in order to fit with the new temporary anterior teeth.
A week later the patient presented with stable occlusion,
no TMJ symptoms, and was decided to proceed to the
final tooth preparations. Final tooth preparations were
made using a Chamfer finish line diamond. Retraction
cord was placed (Ultrapak, Ultradent Product Inc., South
Jordan, Utah, USA) and the final impression was performed using vinyl polysiloxane impression material (Extrude; Kerr Corp, Orange, Calif. USA) and a metal tray (Fig.
8-10). Impressions were poured in high strength die stone
(Jade Stone; Whip Mix Corp, Louisville, KY, USA) and the
master cast was fabricated.
EÈÎ. 8: TÂÏÈΤ˜ Ô‰ÔÓÙÈΤ˜ ·Ú·Û΢¤˜
Fig. 8: Final tooth preparations
™YM¶EPA™MATA-™YZHTH™H
TÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi ·ÚÔ˘ÛÈ¿˙ÂÈ ÎÏÈÓÈÎfi ÂӉȷʤÚÔÓ ·fi ÏÂ˘Ú¿˜ ۯ‰›Ô˘ ıÂÚ·›·˜, Ô‰ÔÓÙÈÎÒÓ ·Ú·Û΢ÒÓ, ÙÂÏÈÎÔ‡ ·ÔÙ˘ÒÌ·ÙÔ˜ Î·È ÙÂÏÈ΋˜ Û˘ÁÎfiÏÏËÛ˘.
TÔ Û¯¤‰ÈÔ ıÂÚ·›·˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÂӉȷʤÚÔÓ fi¯È ÌfiÓÔ
ÂÂȉ‹ ¤¯ÂÈ ·ÔηٷÛÙ·ı› fiÏË Ë Î¿Ùˆ ÁÓ¿ıÔ˜ Ì ۇÛÙËÌ· ÌÔÓÔÊ·ÛÈ΋˜ ZÈÚÎÔÓ›·˜ ·ÏÏ¿ Î·È ÂÂȉ‹ ·ÊÔÚ¿
ÛÙËÓ Î·Ù·Û΢‹ ÁÂÊ˘ÚÒÓ 3 Î·È 5 ÙÂÌ·¯›ˆÓ ·fi ·˘Ùfi ÙÔ
˘ÏÈÎfi8. EÎÙÂٷ̤Ó˜, ·ÔηٷÛÙ¿ÛÂȘ ·fi ZÈÚÎÔÓ›· ·ÔÙÂÏÔ‡Û·Ó Úfi‚ÏËÌ· ηٿ ÙÔ ·ÚÂÏıfiÓ Î·ıÒ˜ ÂÌÊ¿ÓÈ˙·Ó
Hellenic Stomatological Review 57: 91-99, 2013
EÈÎ. 9: TÂÏÈΤ˜ Ô‰ÔÓÙÈΤ˜ ·Ú·Û΢¤˜
Fig. 9: Final tooth preparations
95
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
Tooth color selection was made using the Vitapan 3D
Master shade guide (Vita Zahnfabrik GmbH, Bad Sackingen, Germany) (Fig. 11). Heat cured, temporary restorations were fabricated from the master cast, in order to
ensure esthetics and function in the new vertical dimension would be comfortable and repeatable. (Fig. 12-14).
EÈÎ. 10: TÂÏÈÎfi ·ÔÙ‡ˆÌ·
Fig. 10: Final impression
EÈÎ. 14: EÚÁ·ÛÙËÚȷο ÌÂÙ·‚·ÙÈο ÁψÛÛÈο
Fig. 14: Heat Cured Temporary Restorations, lingual view
EÈÎ. 11: EÈÏÔÁ‹ ¯ÚÒÌ·ÙÔ˜ (C2)
Fig. 11: Tooth Color Selection (C2)
EÈÎ. 15: ¢È·Ì¿ÓÙÈ· ÎÔ‹˜ ZÈÚÎÔÓ›·˜
Fig. 15: Zirconia adjustment diamond burs
EÈÎ. 12: EÓ £ÂÚÌÒ ÂÚÁ·ÛÙËÚȷο ÌÂÙ·‚·ÙÈο
Fig. 12: Heat cured temporary restorations
Two weeks later, the final Monolithic Zirconia restorations
were delivered. Occlusal adjustments were made prior to
cementation using Zirconia and Lithium Disilicate adjustment diamond burs (Kommet, USA) (Fig. 15). The
restorations were sent back to the laboratory for the final
glazing. The zirconia restorations were internally etched
with sandblasting to improve adhesiveness, and were
cemented with dual cure resin cement (Panavia F, Kuraray America Inc., New York, NY, USA) (Fig. 17). Two
recall appointments were made after delivery, two days
and a month after (Fig. 18)
CONCLUSIONS-DISCUSSION
EÈÎ. 13: EÚÁ·ÛÙËÚȷο ÌÂÙ·‚·ÙÈο ÚÔÛÙÔÌȷο
Fig. 13: Heat Cured Temporary Restorations, buccal view
96
This clinical case presented highly sensitive in terms of
treatment planning, tooth preparation, final impression,
and final cementation.
Treatment planning has been clinically interesting, not only
because it involved the restoration of the entire mandible
Hellenic Stomatological Review 57: 91-99, 2013
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
EÈÎ. 19: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÚÔÛÙÔÌȷο
Fig. 19: Final Restorations buccal view
EÈÎ. 16: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ
Fig. 16: Final Restorations
EÈÎ. 20: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÚÔÛÙÔÌȷο
Fig. 20: Final Restorations buccal view
EÈÎ. 17: TÂÏÈ΋ Û˘ÁÎfiÏÏËÛË ·ÔηٷÛÙ¿ÛˆÓ
Fig. 17: Zirconia restorations finally cemented
EÈÎ. 21: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÁψÛÛÈο
Fig. 21: Final restorations lingual view
EÈÎ. 18: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÚÔÛÙÔÌȷο
Fig. 18: Final restoration buccal view
ηٿÁÌ·Ù· Ì ÌÂȈ̤ӷ ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ Ì ÙÔ ¤Ú·ÛÌ· ÙˆÓ ÂÙÒÓ9. OÈ ÂÓ ÏfiÁˆ ·ÔηٷÛÙ¿ÛÂȘ ÌÔÓÔÊ·ÛÈ΋˜ ZÈÚÎÔÓ›·˜ Ê·›ÓÂÙ·È ˆ˜ ·ÔÙÂÏÔ‡Ó ÙË Ï‡ÛË ÛÙÔ Úfi‚ÏËÌ·7, 10.
OÈ ·Ú·Û΢¤˜ ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘ ÚfiÎÂÈÙ·È Ó· ‰Â¯ıÔ‡Ó ·ÔηٷÛÙ¿ÛÂȘ ZÈÚÎÔÓ›·˜ ÔÈΛÏÔ˘Ó, ·fi ‚¿ıÚÔ ÂÒ˜ Ù‡Ô˘ ÊÙÂÚÔ‡, ÂχıÂÚ˘ ·fiÏË͢11, 12. H ÙÔÍÔÂȉ‹˜ ·Ú·Û΢‹ Ù‡Ô˘ Chamfer ·ÔÙÂÏ› ÙË Ï‡ÛË ÂÈÏÔÁ‹˜ ηıÒ˜
ÂÍ·ÛÊ·Ï›˙ÂÈ Ù·˘Ùfi¯ÚÔÓ· ÙË ‰ÔÌÈ΋ ·ÓÙÔ¯‹ Ù˘ ·ÔηٿHellenic Stomatological Review 57: 91-99, 2013
EÈÎ. 22: TÂÏÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ÁψÛÛÈο - 2 Ì‹Ó˜ ÌÂÙ¿
Fig. 22: Final restorations lingual view - 2 months recall
97
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
ÛÙ·Û˘ ‰›ÓÔÓÙ·˜ Â·ÚΤ˜ ¿¯Ô˜ ÛÙÔ ÎÂÚ·ÌÈÎfi ˘ÏÈÎfi ηÈ
ÙËÓ ·ÛÊ·Ï‹ ·ÔÎÔ‹ Ù˘ Ô‰ÔÓÙÈ΋˜ Ô˘Û›·˜ ‰È·ÛÊ·Ï›˙ÔÓÙ·˜ ÙËÓ ÂÈ‚›ˆÛË ÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÔÏÊÔ‡. T· ·Ú·¿Óˆ
·ÔÎÙÔ‡Ó ÌÂÁ·Ï‡ÙÂÚË ÛËÌ·Û›· ηıÒ˜ ·ÊÔÚÔ‡Ó ÛÙËÓ ·Ú·Û΢‹ ÙfiÛÔ ÔÈÛı›ˆÓ fiÛÔ Î·È ÚÔÛı›ˆÓ ‰ÔÓÙÈÒÓ.
H ‰È·‰Èηۛ· Ù˘ ÙÂÏÈ΋˜ ·ÔÙ‡ˆÛ˘, ÚÔ··ÈÙ› ηı·Ú¤˜ Ô‰ÔÓÙÈΤ˜ ·Ú·Û΢¤˜ Ì ÙË ¯Ú‹ÛË Ó‹Ì·ÙÔ˜ ·ÒıËÛ˘13 Î·È ÙË ¯Ú‹ÛË Ù˘ Ù¯ÓÈ΋˜ ÙÔ˘ ‰ÈÏÔ‡ Ó‹Ì·ÙÔ˜ ÚÔÎÂÈ̤ÓÔ˘ ÙÔ ÙÂÏÈÎfi ·ÔÙ‡ˆÌ· Ó· Â›Ó·È ·ÎÚÈ‚¤˜14. ŒÙÛÈ
Ó‹Ì· #00 ÙÔÔıÂÙÂ›Ù·È ÛÙÔ ‚¿ıÔ˜ Ù˘ Ô˘ÏÔ‰ÔÓÙÈ΋˜ Û¯ÈÛÌ‹˜ Û fiÏ· Ù· ‰fiÓÙÈ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ı› Ë ·ÈÌÔÚÚ·Á›·, Î·È ·ÎÔÏÔ˘ı› Ó‹Ì· #2 ÁÈ· ÙÔ˘˜ ÁÔÌÊ›Ô˘˜ # 1 ÁÈ·
ÙÔ˘˜ ÚÔÁfiÌÊÈÔ˘˜ Î·È #0 ÁÈ· ÙÔ˘˜ ÙÔÌ›˜, ÚÔÎÂÈ̤ÓÔ˘
Ó· ¤¯Ô˘Ì ·ÛÊ·Ï‹ Î·È Â·Ú΋ ·ÒıËÛË ÙˆÓ ÈÛÙÒÓ Î·È
Û·Ê‹ ·ÔÎ¿Ï˘„Ë Ù˘ ÁÚ·ÌÌ‹˜ ·Ú·Û΢‹˜.
H ÙÂÏÈ΋ Û˘ÁÎfiÏÏËÛË ·ÔÙÂÏ› ÌÈ· ÂÍ·ÈÚÂÙÈο ¢·›ÛıËÙË
ÎÏÈÓÈ΋ ‰È·‰Èηۛ· ηıÒ˜ ··ÈÙÂ›Ù·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ Ù˘
˘ÁÚ·Û›·˜. OÈ ·ÔηٷÛÙ¿ÛÂȘ ZÈÚÎÔÓ›·˜ ‰ÂÓ ··ÈÙÔ‡Ó ÂÂÍÂÚÁ·Û›· Ì Y‰ÚÔÊıÔÚÈÎfi Ô͇, ·ÏÏ¿ Ë ÂÈÊ¿ÓÂÈ· Û˘ÁÎfiÏÏËÛ˘ ÌÔÚ› Ó· ·˘ÍËı› Ì ÂÛˆÙÂÚÈ΋ ·‰ÚÔÔ›ËÛË
Ì ·ÌÌÔ‚ÔÏ‹15. ¶·Ú¿ÁÔÓÙ·˜ ÛÈÏ·Ó›Ô˘ ÌÔÚ› Ó· ÂÊ·ÚÌÔÛÙ› ÂÛˆÙÂÚÈο ÙˆÓ ÛÙÂÊ·ÓÒÓ ÁÈ· 1 min Ô ÔÔ›Ô˜ ÛÙË Û˘Ó¤¯ÂÈ· ÛÙÂÁÓÒÓÂÙ·È Ì ·ÂÚÔÛ‡ÚÈÁÁ·16. AÎÔÏÔ˘ı› Ë ÂÊ·ÚÌÔÁ‹ ÚËÙÈÓÒ‰Ô˘˜ ÎÔÓ›·˜ (Panavia F, Kuraray
America Inc., New York, NY, USA) Î·È Ë Û˘ÁÎfiÏÏËÛË ÙˆÓ
·ÔηٷÛÙ¿ÛÂˆÓ Ù˘ ÌÔÓÔÊ·ÛÈ΋˜ ZÈÚÎÔÓ›·˜17, 18.
™ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ ÂÚÈÛÙ·ÙÈÎfi, ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ·
‹Ù·Ó ÂÍ·ÈÚÂÙÈÎfi Î·È Ë ·ÛıÂÓ‹˜ ·fiÏ˘Ù· ÈηÓÔÔÈË̤ÓË. H
‰È·ı¤ÛÈÌË ‚È‚ÏÈÔÁÚ·Ê›· Ô˘ ·ÊÔÚ¿ ÛÙË Ì·ÎÚÔ‚ÈfiÙËÙ·
ÙˆÓ ÂÓ ÏfiÁˆ ÂÎÙÂÙ·Ì¤ÓˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Â›Ó·È ÂÚÈÔÚÈṲ̂ÓË. H ·ÛıÂÓ‹˜ Â›Ó·È ÚÔÁÚ·ÌÌ·ÙÈṲ̂ÓË Û ÂÙ‹ÛȘ
Â·ÓÂÍÂÙ¿ÛÂȘ Ì ÛÎÔfi ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ Ì·ÎÚÔ‚ÈfiÙËÙ·˜
ÙˆÓ ÂÓ ÏfiÁˆ ·ÔηٷÛÙ¿ÛÂˆÓ Î·È ÙËÓ ÙÚÔÊÔ‰ÔÛ›· Ù˘
‰ÈÂıÓÔ‡˜ ‚È‚ÏÈÔÁÚ·Ê›·˜ Ì ٷ ·ÔÙÂϤÛÌ·Ù·.
BIB§IO°PAºIA
1. Helvey G: A History of Dental Ceramics. Comp Cont Educ
Dent 2010; 31 (4): 310-311.
2. Griggs A J: Recent Advantages in Materials for All-Ceramic
Restorations. Dent Clin North Am 2007; 51 (3): 713-727.
3. Volpato C, Garbelotto L, Fredel M, Bondioli F: Application of
Zirconia in Dentistry: Biological, Mechanical and Optical
Considerations. In: Sikalidis C. Advances in Ceramics Electric and Magnetic Ceramics, Bioceramics, Ceramics and
Enviroment. KÚÔ·Ù›·. InTech. 2011: 397-420.
4. ™Ôω¿ÙÔ˜ N, KÔÓÙ·ÎÈÒÙ˘ °, °Ô‡ÛÈ·˜ H, XÚÈÛÙfiÔ˘ÏÔ˜ ¶, MÂÏ·ÎfiÔ˘ÏÔ˜ I: ZÈÚÎÔÓ›·. I‰ÈfiÙËÙ˜, KÏÈÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ηÈ
¶·ÚÔ˘Û›·ÛË KÏÈÓÈÎÒÓ ¶ÂÚÈÙÒÛˆÓ. ™ÙÔÌ·ÙÔÏÔÁ›· 2009;
66 (1): 3-16.
5. McLaren E, Giordano R: Zirconica-Based Ceramics: Materials Properties, Esthetics, and Layering Techniques of a New
Veneering Porcelain, VM9. QDT 2005: 99-111.
6. Hamza T, Ezzat H, Ei-Hossary M, Katamish H, Shokry T,
Rosenstiel S: Accuracy of ceramic restorations made with
two CAD/CAM systems. J Prosthet Dent 2013 ;109 (2): 83-7.
7. Thalji G, Cooper L: Implant-Supported Fixed Dental Rehabilitation with Monolithic Zirconia: A Clinical Case Report. J Esthet
Restor Dent 2014 2. doi: 10.1111/jerd.12078.
8. Lüthy H, Filser F, Loeffel O, Schumacher M, Gauckler LJ,
98
with Zirconia, but for the fact that it involved 3 and 5 unit
Monolithic Zirconia restorations8. Long span restorations
has always been a problem when using Zirconia, with a
reduced success rate over the years9. Monolithic Zirconia
seems to be the solution to this problem7, 10.
Margin preparation for Zirconia restorations varies from
shoulder to feather edge11, 12. Chamfer tooth preparation is
the finish line of choice since it results in restoration’s
structural strength providing for conservative tooth preparation removal at the same time. The above become
more important since anterior teeth are involved in the
treatment. These lower anteriors are preparation sensitive, since over preparation leads to root canal.
Final impression making requires clean tooth preparation,
and the use of retraction cord13 (Ultrapak, Ultradent
Product Inc., South Jordan, Utah, USA) using the double
cord technique14. Retraction cord #00 is packed at the
bottom of the sulcus for all teeth to control bleeding. Cord
#2 is used for molars, #1 for premolars and #0 for
anterior teeth in order to have sufficient tissue retraction
and full exposure of the preparation finish line.
The final cementation of all ceramic restorations is
technique sensitive and must always be done with caution,
since it requires complete moisture control. Zirconia
restorations do not require HF acid treatment, but sandblasting can enhance adhesion instead15. Silane coupling
agent is applied internally in the restoration for 1 minute
and then dried using the air syringe16. Dual cure adhesive
resin cement is used (Panavia F, Kuraray America Inc.,
New York, NY, USA) for the final cementation of Zirconia
restorations17, 18.
The esthetic result has been excellent, and the patient
completely satisfied.
Literature concerning Monolithic Zirconia restorations is
scarce, especially for such long span restorations. Yearly
recall appointments are scheduled for this patient in order
to record the longevity of the restoration and provide
literature with the results.
REFERENCES
1. Helvey G: A History of Dental Ceramics. Comp Cont Educ
Dent 2010; 31 (4): 310-311.
2. Griggs A J: Recent Advantages in Materials for All-Ceramic
Restorations. Dent Clin North Am 2007; 51 (3): 713-727.
3. Volpato C, Garbelotto L, Fredel M, Bondioli F: Application of
Zirconia in Dentistry: Biological, Mechanical and Optical
Considerations. In: Sikalidis C. Advances in Ceramics Electric and Magnetic Ceramics, Bioceramics, Ceramics and
Enviroment. KÚÔ·Ù›·. InTech. 2011: 397-420.
4. ™Ôω¿ÙÔ˜ N, KÔÓÙ·ÎÈÒÙ˘ °, °Ô‡ÛÈ·˜ H, XÚÈÛÙfiÔ˘ÏÔ˜ ¶, MÂÏ·ÎfiÔ˘ÏÔ˜ I: ZÈÚÎÔÓ›·. I‰ÈfiÙËÙ˜, KÏÈÓÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ηÈ
¶·ÚÔ˘Û›·ÛË KÏÈÓÈÎÒÓ ¶ÂÚÈÙÒÛˆÓ. ™ÙÔÌ·ÙÔÏÔÁ›· 2009;
66 (1): 3-16.
5. McLaren E, Giordano R: Zirconica-Based Ceramics: Materials Properties, Esthetics, and Layering Techniques of a New
Veneering Porcelain, VM9. QDT 2005: 99-111.
6. Hamza T, Ezzat H, Ei-Hossary M, Katamish H, Shokry T,
Rosenstiel S: Accuracy of ceramic restorations made with
two CAD/CAM systems. J Prosthet Dent 2013; 109 (2): 83-7.
Hellenic Stomatological Review 57: 91-99, 2013
EӉȷʤÚÔ˘Û· KÏÈÓÈ΋ ¶ÂÚ›ÙˆÛË
Clinical Case Report
Hammerle CH: Strength and reliability of four unit all ceramic
posterior bridges Dent Mater 2005; 21 (10): 930-7.
9. Al-Amleh B, Lyons K, Swain M: Clinical trials in zirconia: a
systematic review. J Oral Rehabil 2010; 37 (8): 641-52.
10. Martinez-Rus F, Ferreiroa A, Ozcan M, Bartolome J, Pradies
G: Fracture resistance of crowns cemented on titanium and
zirconia implant abutments: a comparison of monolithic
versus manually veneered all-ceramic systems. Int J Oral
Maxillofac Implants 2012; 27 (6): 1448-55.
11. Baltzer A: All-ceramic single-tooth restorations: choosing the
material to match the preparation--preparing the tooth to
match the material. Int J Comput Dent 2008; 11 (3-4): 241-56.
12. Scmitt J, Wichmann M, Hoist S, Reich S: Restoring severely
compromised anterior teeth with zirconia crowns and featheredged margin preparations: a 3-year follow-up of a prospective clinical trial. Int J Prosthodont 2010; 23 (2): 107-9.
13. Benson B, Bomberg T, Hatch R, Hoffman W: Tissue
displacement methods in fixed prosthodontics. J Prosthet
Dent 1986; 55 (2): 175-81.
14. Cloyd S, Puri S: Using the double cord packing technique of
tissue retraction for making crown impressions Dent Today
1999; 18 (1): 54-9.
15. Elsaka S: Influence of surface treatments on the surface
properties of different zirconia cores and adhesion of zirconiaveneering ceramic systems. Dent Mater 2013; 29: 239-51.
16. Fagi G, Vichi A, Ferrari: Influence of surface pretreatment on
the short-term bond strength of resin composite to a zirconiabased material. Am J Dent 2012; 25 (2): 73-8.
17. Turker S, Ozcan M, Mandali G, Damla I, Bugurman B,
Valandro L: Bond strength and stability of 3 luting systems on
a zirconia-dentin complex. Gen Dent 2013; 61: 10-3.
18. Koizumi H, Nakayama D, Komine F, Blatz M, Matsumura H:
Bonding of resin-based luting cements to zirconia with and
without the use of ceramic priming agents. J Adhes Dent
2012; 14 (4): 385-92.
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
E. E˘·ÁÁ¤ÏÔ˘
e-mail: [email protected]
Û.Û.: H ÎÏÈÓÈ΋ ÂÚÁ·Û›· Ô˘ ÂÚÈÁÚ¿ÊÂÙ·È ÛÙÔ ¿ÚıÚÔ ·˘Ùfi ¤¯ÂÈ
Ú·ÁÌ·ÙÔÔÈËı› ·fi ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜. OÈ Û˘ÁÁÚ·Ê›˜
‰ËÏÒÓÔ˘Ó fiÙÈ ‰ÂÓ ¤¯Ô˘Ó ηӤӷ ÔÈÎÔÓÔÌÈÎfi fiÊÂÏÔ˜ ·fi
ÙË ¯Ú‹ÛË Î·È ÂÚÈÁÚ·Ê‹ ˘ÏÈÎÒÓ, ‚ÔËıËÙÈÎÒÓ Ì¤ÛˆÓ
Î·È ÂÙ·ÈÚÂÈÒÓ ÛÙÔ ¿ÚıÚÔ ·˘Ùfi.
Hellenic Stomatological Review 57: 91-99, 2013
7. Thalji G, Cooper L: Implant-Supported Fixed Dental Rehabilitation with Monolithic Zirconia: A Clinical Case Report. J
Esthet Restor Dent 2014 2. doi: 10.1111/jerd.12078.
8. Lüthy H, Filser F, Loeffel O, Schumacher M, Gauckler LJ,
Hammerle CH: Strength and reliability of four unit all ceramic
posterior bridges Dent Mater 2005; 21 (10): 930-7.
9. Al-Amleh B, Lyons K, Swain M: Clinical trials in zirconia: a
systematic review. J Oral Rehabil 2010 Aug; 37 (8): 641-52.
10. Martinez-Rus F, Ferreiroa A, Ozcan M, Bartolome J, Pradies
G: Fracture resistance of crowns cemented on titanium and
zirconia implant abutments: a comparison of monolithic
versus manually veneered all-ceramic systems. Int J Oral
Maxillofac Implants 2012; 27 (6): 1448-55.
11. Baltzer A: All-ceramic single-tooth restorations: choosing the
material to match the preparation--preparing the tooth to
match the material. Int J Comput Dent 2008; 11 (3-4): 241-56.
12. Scmitt J, Wichmann M, Hoist S, Reich S: Restoring severely
compromised anterior teeth with zirconia crowns and featheredged margin preparations: a 3-year follow-up of a prospective clinical trial. Int J Prosthodont 2010; 23 (2): 107-9.
13. Benson B, Bomberg T, Hatch R, Hoffman W: Tissue
displacement methods in fixed prosthodontics. J Prosthet
Dent 1986; 55 (2): 175-81.
14. Cloyd S, Puri S: Using the double cord packing technique of
tissue retraction for making crown impressions Dent Today
1999; 18 (1): 54-9.
15. Elsaka S: Influence of surface treatments on the surface
properties of different zirconia cores and adhesion of zirconiaveneering ceramic systems. Dent Mater 2013; 29: 239-51.
16. Fagi G, Vichi A, Ferrari M: Influence of surface pretreatment
on the short-term bond strength of resin composite to a
zirconia-based material. Am J Dent 2012; 25 (2): 73-8.
17. Turker S, Ozcan M, Mandali G, Damla I, Bugurman B,
Valandro L: Bond strength and stability of 3 luting systems on
a zirconia-dentin complex. Gen Dent 2013; 61: 10-3.
18. Koizumi H, Nakayama D, Komine F, Blatz M, Matsumura H:
Bonding of resin-based luting cements to zirconia with and
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Corresponding author:
E. Evangelou
e-mail: [email protected]
e.n.: The clinical work described in this paper is performed
by the authors. Authors declare no financial interest
whatsoever on dental products and companies mentioned
in this article.
99
BÈ‚ÏÈÔÁÚ·ÊÈ΋ AÓ·ÛÎfiËÛË
Literature Review
∑ÈÚÎÔÓ›·: ™‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÂÓfi˜ ÔÏ˘Û˘˙ËÙË̤ÓÔ˘ ˘ÏÈÎÔ‡.
¢ÔÌ‹, ÂÊ·ÚÌÔÁ¤˜ Î·È ÎÏÈÓÈÎÔ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ›
∂. Δ˙·Ó·Î¿Î˘*, π. Δ˙Ô‡Ù˙·˜**, ∂. ∫ÔÓÙÔÓ·Û¿ÎË***
Zirconia: Contemporary views of a much talked material:
Structure, applications and clinical considerations
E. Tzanakakis*, I. Tzoutzas**, E. Kontonasaki***
¶EPI§HæH
SUMMARY
T· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ·, Â˘Ú‡Ù·ÙË ı¤ÛË ÛÙËÓ Â·ÓÔÚıˆÙÈ΋ Ô‰ÔÓÙÈ·ÙÚÈ΋ η٤¯Ô˘Ó Ù· ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜. H ˙ÈÚÎÔÓ›· (ηı·Úfi ÔÍ›‰ÈÔ ZrO2), ÚÔ¤Ú¯ÂÙ·È
·fi ÙÔ˘˜ ÔχÙÈÌÔ˘˜ Ï›ıÔ˘˜ ˙ÈÚÎÔÓ›ÙË Î·È ‚·‰‰ÂÏÂ˚ÙË. H ¯Ú‹ÛË Ù˘ ˙ÈÚÎÔÓ›·˜ ÛÙȘ ‚ÈÔ˚·ÙÚÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ÍÂΛÓËÛ ˆ˜ ˘ÏÈÎfi ÛÙËÓ ÔÏÈ΋ ·ÚıÚÔÏ·ÛÙÈ΋
ÎÂÊ·Ï‹˜ ÌËÚÈ·›Ô˘ ÔÛÙÔ‡. H ˙ÈÚÎÔÓ›· ÎÚ˘ÛÙ·ÏÏÒÓÂÙ·È Û ΢‚È΋, ÙÂÙÚ·ÁˆÓÈ΋ Î·È ÌÔÓÔÎÏÈÓ‹ ÌÔÚÊ‹ ·Ó¿ÏÔÁ· Ì ÙË ıÂÚÌÔÎÚ·Û›·. °È· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ÙˆÓ
‚¤ÏÙÈÛÙˆÓ Ì˯·ÓÈÎÒÓ È‰ÈÔًوÓ, ··ÈÙÂ›Ù·È Ë ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ÙÂÙÚ·ÁˆÓÈ΋˜ Ê¿Û˘ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, Ë ÔÔ›· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Ì ‰È¿ÊÔÚ· ÔÍ›‰È· .¯. ˘ÙÙÚ›Ô˘ Î·È ‰ËÌËÙÚ›Ô˘ (Y2O3, CeO2).
™ÙËÓ O‰ÔÓÙÈ·ÙÚÈ΋ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÙÚÂȘ Ù‡ÔÈ
˙ÈÚÎÔÓ›·˜, Ë Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ÙÂÙÚ·ÁˆÓÈ΋
˙ÈÚÎÔÓ›·, Ë ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›· Î·È Ë
·ÏÔ˘Ì›Ó· ÂÓÈÛ¯˘Ì¤ÓË Ì ˙ÈÚÎÔÓ›·. T· ÎÂÚ·ÌÈο ÙÔ˘
ÚÒÙÔ˘ Ù‡Ô˘, ·ÚÔ˘ÛÈ¿˙Ô˘Ó ˘„ËϤ˜ Ì˯·ÓÈΤ˜ È-
In recent years, zirconia ceramics hold a remarkable place in restorative dentistry. Zirconia (pure ZrO2),
is derived from the gemstones zirconite and baddeleyite. The use of zirconia in biomedical applications started in total hip femoral head replacement.
Zirconia crystallizes in cubic, tetragonal and monoclinic form depending on temperature. For ceramics with the optimum mechanical properties the
stabilization of the tetragonal phase at room
temperature is a prerequisite, and is performed with
various stabilizing oxides e.g. cerium and yttrium
(Y2O3, CeO2). Three types of zirconia are used in
Dentistry, the fully stabilized tetragonal zirconia, the
partially stabilized zirconia and the alumina -reinforced zirconia. Fully stabilized tetragonal zirconia
ceramics exhibit high mechanical properties, but
present two main drawbacks: uncontrolled growth
of the monoclinic phase, which can lead to prema-
* O‰ÔÓÙ›·ÙÚÔ˜, ¶ÚÔÛıÂÙÔÏfiÁÔ˜ À¢ μÈÔ¸ÏÈÎÒÓ ∂∫¶∞
** O‰ÔÓÙ›·ÙÚÔ˜, ∞Ó. ∫·ıËÁËÙ‹˜ O‰ÔÓ. ÃÂÈÚÔ˘ÚÁÈ΋˜ ∂∫¶∞
*** O‰ÔÓÙ›·ÙÚÔ˜, E. K·ıËÁ‹ÙÚÈ· ¶ÚÔÛıÂÙÔÏÔÁ›·˜ ∞ΛÓËÙ˘
¶ÚÔÛıÂÙÈ΋˜ ∞¶£
ÂÏÏËÓÈο ÛÙÔÌ·ÙÔÏÔÁÈο ¯ÚÔÓÈο 57: 101-137, 2013
·ÚÂÏ‹ÊıË 2/1/2014 - ÂÎÚ›ıË 13/1/2014
* Prosthodontist, MSc Phd cand Biomaterials UOA
** Associate Professor Operative Dentistry UOA
*** Assistant Professor AUTH
Hellenic Stomatological Review 57: 101-137, 2013
paper received 2/1/2014 - accepted 13/1/2014
101
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰ÈfiÙËÙ˜, Ì ‚·ÛÈÎfiÙÂÚ· ÌÂÈÔÓÂÎÙ‹Ì·Ù¿ ÙÔ˘˜ ÙË ÌË
ÂÏÂÁ¯fiÌÂÓË ·Ó¿Ù˘ÍË Ù˘ ÌÔÓÔÎÏÈÓÔ‡˜ Ê¿Û˘ Ô˘
ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ ÙÔ ˘ÏÈÎfi Û ÚÒÈÌË ·ÛÙÔ¯›·, ηÈ
ÙËÓ ·˘ÍË̤ÓË ·‰È·Ê¿ÓÂÈ·. ™ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ¤¯Ô˘Ó
¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙËÓ Î·Ù·Û΢‹ ·Î›ÓËÙˆÓ ÔÏÔÎÂÚ·ÌÈÎÒÓ ÛÙÂÊ·ÓÒÓ Î·È ÁÂÊ˘ÚÒÓ, ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ, ÁÂÊ˘ÚÒÓ ÛÙËÚÈ˙fiÌÂÓ˜ Û ¤ÓıÂÙ· ‹ Ù‡Ô˘
Maryland, ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Î·È ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈÎÒÓ
ÎÔÏÔ‚ˆÌ¿ÙˆÓ. OÈ ÚÒÙ˜ 3ÂÙ›˜ Î·È 5ÂÙ›˜ ÎÏÈÓÈΤ˜
ÌÂϤÙ˜ Â›Ó·È ÂÓı·ÚÚ˘ÓÙÈΤ˜ ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿
ÙÔ˘ ˘ÏÈÎÔ‡ ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ, Ì ΢ڛ·Ú¯Â˜
ÂÈÏÔΤ˜ ÙËÓ ·ÔÎfiÏÏËÛË ÙˆÓ ·ÔηٷÛÙ¿ÛˆÓ,
ÙËÓ ·ÔÊÏÔ›ˆÛË ÙˆÓ ÂÈÎ·Ï˘ÙÈÎÒÓ ÎÂÚ·ÌÈÎÒÓ ·ÏÏ¿ Î·È ÙË ıÚ·‡ÛË ÙˆÓ Û˘Ó‰¤ÛÌˆÓ Ì ÌÈÎÚ¤˜ ‰È·ÛÙ¿ÛÂȘ. TÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ˘¿Ú¯Ô˘Ó Ì·ÎÚfi¯ÚÔÓ˜
ÌÂϤÙ˜ ÂÈ‚›ˆÛ˘ ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ˙ÈÚÎÔÓ›·˜,
ηıÈÛÙ¿ ÂÏÏÈ‹ ÙËÓ ÙÂÎÌËÚ›ˆÛË ÁÈ· ÙËÓ Î·ıÔÏÈ΋ ‹
ÌÂÚÈ΋ ·Ô‰Ô¯‹ ÙÔ˘ ˆ˜ ·ÍÈfiÈÛÙ˘ ÂÓ·ÏÏ·ÎÙÈ΋˜
χÛ˘ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ˙ÈÚÎÔÓ›·, ˙ÈÚÎfiÓÈÔ, ÌÔÓÔÎÏÈÓ‹˜ Ê¿ÛË, ȉÈfiÙËÙ˜,
ÂÊ·ÚÌÔÁ¤˜.
EI™A°ø°H
TȘ ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ¤¯Ô˘Ó Â¤ÏıÂÈ ÛËÌ·ÓÙÈΤ˜ ·ÏÏ·Á¤˜ ÛÙÔ ¯ÒÚÔ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÂÈÛÙ‹Ì˘. H ‚·ı‡ÙÂÚË
‰ÈÂÚ‡ÓËÛË Ê·ÈÓÔÌ¤ÓˆÓ Î·È Ì˯·ÓÈÛÌÒÓ Ô˘ ·ÊÔÚÔ‡Ó
ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÛÙÔÌ·ÙÔÁÓ·ıÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ¤‰ˆÛ·Ó ÒıËÛË Û ÔÏÏ¿ ÂÈÛÙËÌÔÓÈο ‰›·, ÛÙËÓ ÚfiÏË„Ë,
ÛÙË ıÂÚ·›· ·ÏÏ¿ Î·È ÛÙËÓ ¤ÌÊ˘ÙË ·Ó¿ÁÎË ÙÔ˘ ·ÓıÚÒÔ˘ ÁÈ· ηχÙÂÚË ·ÈÛıËÙÈ΋. ™ÙÔÓ ÙÔ̤· Ù˘ ıÂÚ·›·˜,
‚·ÛÈÎfi˜ ÛÙfi¯Ô˜ Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ Â›Ó·È Ë ·ÔηٿÛÙ·ÛË
Î·È Ë ‰È·Ù‹ÚËÛË ÙÔ˘ ıÂÚ·¢ÙÈÎÔ‡ ·ÔÙÂϤÛÌ·ÙÔ˜. ™ÙÔ
¯ÒÚÔ ·˘Ùfi ȉȷ›ÙÂÚÔ ÚfiÏÔ Î·Ù¤¯Ô˘Ó Ù· ˘ÏÈο ·ÔηٿÛÙ·Û˘ Ù· ÔÔ›· ˆ˜ ÙÌ‹Ì· ÙˆÓ Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ‚ÈÔ¸ÏÈÎÒÓ
‚Ú›ÛÎÔÓÙ·È Û ‰È·Ú΋ ÂͤÏÈÍË Î·È ¤Ú¢ӷ. AÔÙ¤ÏÂÛÌ· ÌÂÏÂÙÒÓ Î·È Ì·ÎÚÔ¯ÚfiÓÈˆÓ ÂÈÚ·Ì¿ÙˆÓ Â›Ó·È Ô ¤ÏÂÁ¯Ô˜ Ù˘
·ÍÈÔÈÛÙ›·˜ ÙˆÓ Ô‰ÔÓÙÈ·ÙÚÈÎÒÓ ˘ÏÈÎÒÓ. ™‹ÌÂÚ· ˘¿Ú¯Ô˘Ó ˘ÏÈο Ù· ÔÔ›· ¤‰ˆÛ·Ó ÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· ˘ËÚÂۛ˜
ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ·Ú¿ÁÔÓÙ·È Î·È
Ó· ıˆÚÔ‡ÓÙ·È ·ÍÈfiÈÛÙ·. ŒÓ·˜ ÌÂÁ¿ÏÔ˜ ÂÚ¢ÓËÙÈÎfi˜
¯ÒÚÔ˜ ÂÚÈÎÏ›ÂÈ Ó¤· ˘ÏÈο Ù· ÔÔ›· Û˘ÓÙ›ıÂÓÙ·È ÛÙËÚÈ˙fiÌÂÓ· Û ˘¿Ú¯Ô˘Û˜ ‚·ÛÈΤ˜ ‰Ô̤˜ Î·È ·ÔÙÂÏÔ‡Ó ÙËÓ ÂͤÏÈÍ‹ ÙÔ˘˜, ›Ù ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Û ‰È·ÊÔÚÂÙÈΤ˜ ÂÊ·ÚÌÔÁ¤˜ ¿ÏÏˆÓ ÂÈÛÙËÌÒÓ. ŒÓ· ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·Ú¿‰ÂÈÁÌ· Â›Ó·È Ù· ·ÓıÚ·ÎÔÓ‹Ì·Ù·, Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ‰È¿ÊÔÚ˜ ÂÊ·ÚÌÔÁ¤˜ ÁÈ· Ì˯·ÓÈ΋ ‹ ıÂÚÌÈ΋ ÂÓ›Û¯˘ÛË Û‡ÓıÂÙˆÓ ˘ÏÈÎÒÓ1 Î·È ÛÙËÓ ·˘ÙÔÎÈÓËÙÔ‚ÈÔÌ˯·Ó›·.
™ÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ‰ÔÎÈÌ¿ÛÙËÎ·Ó Û·Ó ˘ÏÈÎfi ÚÔηٷÛ΢·ÛÌ¤ÓˆÓ ·ÍfiÓˆÓ. ™ÙÔ ¯ÒÚÔ ÙˆÓ Ó¤ˆÓ ˘ÏÈÎÒÓ Á›ÓÔÓÙ·È ÌÂϤÙ˜ ÁÈ· Ó· ÂÍ·¯ıÔ‡Ó Û˘ÌÂÚ¿ÛÌ·Ù· Û¯ÂÙÈο ÌÂ
ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ‹ ÌË ·Ï·ÈÔÙ¤ÚˆÓ ˘ÏÈÎÒÓ. T· Ô‰Ô102
ture failure, and increased opacity. In dentistry they
have been used for the construction of all ceramic
crowns and fixed partial dentures, aesthetic posts,
inlay-supported or Maryland type partial dentures,
as dental implants and abutments. The first 3- and 5year clinical studies are encouraging for the behavior of the material in the oral environment, with main
complications being the restoration decementation,
the chipping of the ceramic veneer and the fracture
of connectors with small dimensions. The fact that
there are no long-term studies on the clinical survival of zirconia restorations makes incomplete the
documentation of the material for its total or partial
acceptance as a viable alternative to the classic
metal-ceramic restorations
Key Words: zirconia, zirconium, monoclinic, properties,
applications.
INTRODUCTION
In recent decades there have been significant changes in
the field of dental science. A deeper investigation of
phenomena and mechanisms related to the function of
the stomatognathic system promoted many scientific
fields such as prevention and treatment, and satisfied the
innate human need for better aesthetics. The main
treatment goal in dentistry, is to restore and maintain the
therapeutic effect. Under this perspective, special role for
many years hold restorative materials which as part of
dental biomaterials are constantly evolving. Scientific
results and long-term experiments are needed to test the
reliability of dental materials. Today, there are materials
that have provided services for many years in dentistry
and continue to be considered reliable. A large research
area in dental materials includes newly synthesized materials relying on existing basic structures that consist either
evolutionary products is, or existing products that have
been tested in different applications. Typical examples
are the carbon fibers, which are used in various applications for mechanical or thermal reinforcement composites1 and the automotive industry. In dentistry they have
been used as prefabricated posts. A lot of new studies
continuously provide evidence-based knowledge concerning the need for replacement of older or current materials. Dental materials follow the rules dictated by their
chemical composition and differ in physical, chemical,
optical and mechanical properties. The deep knowledge
of materials’ properties is the most important prerequisite
for their correct application.
In the field of restorative dentistry ceramic materials hold
important position. A basic property but at the same time
disadvantage of ceramics is their brittle nature which
makes them brittle when they are deformed by more than
0,1%2. This led researchers to attempt to strengthen the
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÓÙÈ·ÙÚÈο ˘ÏÈο ·ÎÔÏÔ˘ıÔ‡Ó ÙÔ˘˜ ηÓfiÓ˜ Ô˘ ˘·ÁÔÚ‡ÂÈ Ë ¯ËÌÈ΋ ÙÔ˘˜ Û‡ÓıÂÛË Î·È ‰È·Ê¤ÚÔ˘Ó ÌÂٷ͇ ÙÔ˘˜
ÛÂ Ê˘ÛÈΤ˜, ¯ËÌÈΤ˜, ÔÙÈΤ˜ Î·È Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜. H
‚·ıÈ¿ ÁÓÒÛË ÙˆÓ È‰ÈÔÙ‹ÙˆÓ ÙˆÓ ˘ÏÈÎÒÓ Â›Ó·È Ë ‚·ÛÈÎfiÙÂÚË ÚÔ¸fiıÂÛË ÁÈ· ÙË ÛˆÛÙ‹ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜.
™ÙÔ ¯ÒÚÔ Ù˘ Â·ÓÔÚıˆÙÈ΋˜ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ÛËÌ·ÓÙÈ΋
ı¤ÛË Î·Ù¤¯ÂÈ Ë ¯Ú‹ÛË ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ˘ÏÈÎÒÓ. B·ÛÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ·ÏÏ¿ Î·È ÌÂÈÔÓ¤ÎÙËÌ· ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Â›Ó·È
Ë „·ı˘Ú‹ ÙÔ˘˜ ʇÛË, Ô˘ Ù· ηıÈÛÙ¿ ‡ıÚ·˘ÛÙ· fiÙ·Ó
·Ú·ÌÔÚʈıÔ‡Ó Û ÔÛÔÛÙfi ÌÂÁ·Ï‡ÙÂÚÔ ÙÔ˘ 0,1%2.
A˘Ùfi Ô‰‹ÁËÛ ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜ ÛÙËÓ ÚÔÛ¿ıÂÈ· ÂÓ›Û¯˘Û˘ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Ì ٤ÙÔÈÔ ÙÚfiÔ ÒÛÙ ӷ ÌËÓ Ô‰ËÁÔ‡ÓÙ·È Û ıÚ·‡ÛË Î·È Ó· ‰È·ÙËÚÔ‡Ó fiϘ ÙȘ ¿ÏϘ ȉÈfiÙËÙ˜ Ô˘ Ù· ηıÈÛÙÔ‡Ó ÌÔÓ·‰Èο. H ÂͤÏÈÍË ÙˆÓ ˘ÏÈÎÒÓ
·˘ÙÒÓ ˘‹ÚÍ ڷÁ‰·›· Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Î·È ÙÔ ˙ËÙÔ‡ÌÂÓÔ ‹Ù·Ó Ë ·˘ÍË̤ÓË ·ÓÙÔ¯‹ Î·È Ë ‚ÂÏÙȈ̤ÓË ·ÈÛıËÙÈ΋ ÙÔ˘˜. O ÌÂÙ·ÏÏÈÎfi˜ ÛÎÂÏÂÙfi˜ ÙˆÓ ·Î›ÓËÙˆÓ ÚÔÛıÂÙÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ ÂÍ·ÎÔÏÔ˘ı› ̤¯ÚÈ Û‹ÌÂÚ·
Ó· ·ÔÙÂÏ› ÌÈ· ·ÍÈfiÈÛÙË Ï‡ÛË ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙˆÓ
ÎÂÚ·ÌÈÎÒÓ ˘ÏÈÎÒÓ. ¶·ÚfiÏ· ·˘Ù¿ Ë ·Ó¿ÁÎË ÁÈ· ηχÙÂÚË
·ÈÛıËÙÈ΋ ·fi‰ÔÛË ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ, Ô‰‹ÁËÛ Û ÚÔÛ¿ıÂȘ ·ÓÙÈηٿÛÙ·Û˘ ÙÔ˘ ·‰È·Ê·ÓÔ‡˜ ÌÂÙ·ÏÏÈÎÔ‡ ˘Ú‹Ó·, Ô ÔÔ›Ô˜ ‰˘Û¯ÂÚ·›ÓÂÈ ÙË ¯ÚˆÌ·ÙÈ΋ ·fi‰ÔÛË ÙÔ˘ Ê˘ÛÈÎÔ‡ ‰ÔÓÙÈÔ‡. M ·˘Ùfi ÙÔ ÛÎÂÙÈÎfi ·Ó·Ù‡¯ıËÎ·Ó Ù· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù· ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ Ì ÔÏϤ˜ Î·È ‰È·ÊÔÚÂÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ
ÛÙËÓ Û‡ÛÙ·ÛË ÙˆÓ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ˘ÏÈÎÒÓ3, 4. H ÈÔ ÚfiÛÊ·ÙË ·fi ·˘Ù¤˜ Â›Ó·È Ë ¯Ú‹ÛË ÎÂÚ·ÌÈÎÒÓ ˙ÈÚÎÔÓ›·˜
(ZrO2), ˘ÏÈÎÔ‡ Ô˘ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÛÙË ‚ÈÔÌ˯·Ó›·,
ÛÙËÓ ËÏÂÎÙÚÔÓÈ΋ ·ÏÏ¿ Î·È ÛÙÔÓ ÙÔ̤· Ù˘ È·ÙÚÈ΋˜ ˆ˜ ˘ÏÈÎfi Ù˘ ÔÚıÔ‰È΋˜5. H ˙ÈÚÎÔÓ›· Û‹ÌÂÚ· η٤¯ÂÈ È‰È·›ÙÂÚË ı¤ÛË ÛÙÔÓ ÙÔ̤· Ù˘ Ô‰ÔÓÙÈ·ÙÚÈ΋˜ ηıÒ˜ ¤¯ÂÈ ·ÍÈÔÔÈËı› ÙfiÛÔ ÛÙÔÓ ÙÔ̤· Ù˘ ·ÔηٿÛÙ·Û˘ Û ‰È¿ÊÔÚ˜ ηٷÛ΢¤˜ -΢ڛˆ˜ ˆ˜ ˘ÏÈÎfi ˘Ú‹Ó· ·Î›ÓËÙˆÓ ÔÏÔÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ-, fiÛÔ Î·È Ì ÙË ÌÔÚÊ‹
‚ÈÔ¸ÏÈÎÔ‡ ÔÛÙÂÔÂÓۈ̷ÙÔ‡ÌÂÓˆÓ Ô‰ÔÓÙÈÎÒÓ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ. OÈ ·ÔηٷÛÙ¿ÛÂȘ Ì ˙ÈÚÎÔÓ›· ÂÌÊ·Ó›˙ÔÓÙ·È
ÛÙÔÓ Ô‰ÔÓÙÈ·ÙÚÈÎfi ¯ÒÚÔ ÌÂÙ¿ ÙÔ 2000 Ì ¢ڇÙÂÚË ·Ô‰Ô¯‹ ÌÂÙ¿ ÙÔ 20105.
I™TOPIKH ANA¢POMH
TÔ ˙ÈÚÎfiÓÈÔ Â›Ó·È ÁÓˆÛÙfi ˆ˜ ÔχÙÈÌÔ˜ Ï›ıÔ˜ ·fi ·Ú¯·ÈÔÙ¿ÙˆÓ ¯ÚfiÓˆÓ. TÔ Ì¤Ù·ÏÏÔ ˙ÈÚÎfiÓÈÔ Ì ·ÙÔÌÈÎfi ·ÚÈıÌfi
40, ¤¯ÂÈ ¿ÚÂÈ ÙËÓ ÔÓÔÌ·Û›· ÙÔ˘ ·fi ÙËÓ ·Ú·‚È΋ ϤÍË
zargon Ô˘ ÛËÌ·›ÓÂÈ ¯Ú˘Ûfi Û ¯ÚÒÌ· Î·È ÚÔ¤Ú¯ÂÙ·È ·fi ÙȘ ÂÚÛÈΤ˜ ϤÍÂȘ zar (¯Ú˘Ûfi˜) Î·È gun (¯ÚÒÌ·). TÔ
‰ÈÔÍ›‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘ (ZrO2), ÙÔ ÔÔ›Ô ÔÓÔÌ¿˙ÂÙ·È ˙ÈÚÎÔÓ›· ·Ó·Î·Ï‡ÊıËΠ·fi ÙÔÓ °ÂÚÌ·Ófi ¯ËÌÈÎfi Martin
Heirich Klaproth ÙÔ 1789, Ô ÔÔ›Ô˜ ÙÔ ¯·Ú·ÎÙ‹ÚÈÛ ˆ˜ ͯˆÚÈÛÙfi ÛÙÔÈ¯Â›Ô ¯ˆÚ›˜ ·ÎfiÌË Ó· ÙÔ ¤¯ÂÈ ÛÙË ‰È¿ıÂÛ‹
ÙÔ˘ Û ηı·Ú‹ ÌÂÙ·ÏÏÈ΋ ÌÔÚÊ‹6.
H ˙ÈÚÎÔÓ›· ÚԤ΢„ ·fi ÙËÓ fiÙËÛË ÔÚÈÛÌ¤ÓˆÓ ÔχÙÈÌˆÓ Ï›ıˆÓ Î·È ¯ÚËÛÈÌÔÔÈ‹ıËΠÁÈ· ÔÏÏ¿ ¯ÚfiÓÈ· Ì ÔÍ›‰È· Û¿ÓÈˆÓ Á·ÈÒÓ ˆ˜ ¯ÚˆÛÙÈÎÒÓ ÁÈ· ÙËÓ ÎÂÚ·ÌÈ΋7.
™ÙË Ê‡ÛË ˘¿Ú¯ÂÈ Û ÌÔÚÊ‹ ÂÓfi˜ Û¿ÓÈÔ˘ ÂÙÚÒÌ·ÙÔ˜
Î·È Ë ÔÓÔÌ·Û›· ÚÔ¤Ú¯ÂÙ·È ·fi ÙÔÓ Joseph Baddeley8
Ô˘ ·Ó·Î¿Ï˘„ ÙÔ ÚÒÙÔ ¤Ùڈ̷ ÛÙË Sri Lanka ÙÔ
Hellenic Stomatological Review 57: 101-137, 2013
ceramics so as to avoid fracture and keep all the other
qualities that make them unique. The development of
these materials has been rapid in recent years and the
aim was to increase the strength and improve the aesthetics. The metal core of fixed prosthetic restorations continues to this day to be the most reliable solution to support
ceramics. However, the need for better aesthetic performance of ceramic restorations led to efforts to replace the
opaque metal core, which makes difficult to adapt the
color of the natural tooth. For these reasons, all-ceramic
systems were developed in dentistry with many different
approaches3. The most recent approach is the use of
zirconia ceramic (ZrO2),- materials that have been used in
industry, in electronics and in medicine as a material of
orthopedics4. Zirconia today holds a special position in
the field of dentistry as it has exploited both in the field of
restorative dentistry - mainly as a core material of ceramic
restorations, as well as a biomaterial of osseointegrated
dental implants. It began to spread in the dental field since
2000 with wider acceptance after 20105.
HISTORY
Zirconium is known as a gemstone since ancient times.
The zirconium metal with atomic number 40, has taken its
name from the Arabic word zargon which means gold in
color and comes from the Persian words zar (gold) and gun
(color). The zirconium dioxide called zirconia ZrO2 was
discovered by the German chemist Martin Heirich Klaproth
in 1789, who described it as a separate item without even
have it in pure metallic form6 (Encyclopedia Britannica).
Zirconia was isolated by firing certain gems and used for
many years with rare earth oxides as pigments for
ceramics7. In nature ZrO2 (Zirconia) is present in the form
of a rare rock and derives its name from Joseph Baddeley8
who discovered the first rock in Sri Lanka in 1892. The
isolation of the pure oxide (ZrO2) was achieved in 1824 by
the Swedish chemist Jons Jakob Barzelius by heating a
mixture of potassium chloride and zirconium. In pure
metallic form it was introduced in 19249.
Another rock is also zirconitis (ZrSiO4) found in rounded or
prismatic brown crystals. Transparent and blue varieties
used as gems are produced by heating natural zirconitis.
Therefore, because the source of zirconium by vaddeleyitis
from South Africa was insufficient for industrial production,
manufacturers utilized the sand rich of zirconitis8.
In 1899 Walther Nerst (Nobel Chemistry 1920) observed
that the mixed oxide 15% by weight Y2O3-ZrO2 behaved as
an oxygen ion conductor (O2-) at elevated temperatures.
The industrial application of the solid oxide electrolyte fuel
cells (SOFC) began with the discovery and the use of
stabilized cubic zirconia as a semiconductor. Before 1975,
its use was restricted to a very limited refractory uses, today
it is used in a very wide range of applications in industry,
household appliances, medicine and dentistry10. Since
1980 zirconia ceramics became popular due to their very
low thermal conductivity and specific crystal structure,
since major difficulties in their processing have overcome11.
103
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
1892. H ·ÔÌfiÓˆÛË ÙÔ˘ ηı·ÚÔ‡ ÔÍÂȉ›Ô˘ ZrO2 ‹ ˙ÈÚÎÔÓ›·˜ ÂÂÙ‡¯ıË ÙÔ 1824 ·fi ÙÔÓ ™Ô˘Ë‰fi XËÌÈÎfi Jons
Jakob Barzelius Ì ÙËÓ ı¤ÚÌ·ÓÛË ÂÓfi˜ Ì›ÁÌ·ÙÔ˜ Î·Ï›Ô˘
Î·È ¯ÏˆÚȉ›Ô˘ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘. ™Â ηı·Ú‹ ÌÂÙ·ÏÏÈ΋ ÌÔÚÊ‹ ·ÚÔ˘ÛÈ¿ÛÙËΠÙÔ 19249.
ŒÓ· ¿ÏÏÔ ¤Ùڈ̷ Â›Ó·È Î·È Ô ˙ÈÚÎÔÓ›Ù˘ (ZrSiO4) Ô˘
‚Ú›ÛÎÂÙ·È Û ÚÈÛÌ·ÙÈÎÔ‡˜ ‹ Û ÛÙÚÔÁÁ˘ÏÂ̤ÓÔ˘˜ ÎÚ˘ÛÙ¿ÏÏÔ˘˜ ηʤ ¯ÚÒÌ·ÙÔ˜. ¢È·Ê·Ó›˜ Î·È ÌÏ ÔÈÎÈϛ˜
Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÔχÙÈÌÔÈ Ï›ıÔÈ ·Ú¿ÁÔÓÙ·È ·fi ÙË ı¤ÚÌ·ÓÛË ÙÔ˘ Ê˘ÛÈÎÔ‡ ˙ÈÚÎÔÓ›ÙË. EÂȉ‹ ÏÔÈfiÓ Ë
ËÁ‹ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘ ·fi ÙÔÓ ‚·‰‰ÂÏÂ˚ÙË Ù˘ NÔÙ›Ô˘ AÊÚÈ΋˜ ‰ÂÓ Â·ÚÎÔ‡Û ÁÈ· ÙË ‚ÈÔÌ˯·ÓÈ΋ ·Ú·ÁˆÁ‹, ·ÍÈÔÔÈ‹ıËÎÂ Ë ¿ÌÌÔ˜ ÏÔ‡ÛÈ· Û ˙ÈÚÎÔÓ›ÙË8.
TÔ 1899 Ô Walther Nerst (Nobel XËÌ›·˜ 1920) ·Ú·Ù‹ÚËÛ fiÙÈ ÙÔ ÌÈÎÙfi ÔÍ›‰ÈÔ 15% Î.‚. Y2O3-ZrO2 Û˘ÌÂÚÈÊÂÚfiÙ·Ó ˆ˜ ·ÁˆÁfi˜ ÈfiÓÙˆÓ O-2 Û ˘„ËϤ˜ ıÂÚÌÔÎڷۛ˜. H
‚ÈÔÌ˯·ÓÈ΋ ÂÊ·ÚÌÔÁ‹ ÛÙȘ ΢„¤Ï˜ η˘Û›ÌÔ˘ ÛÙÂÚÂÔ‡
ËÏÂÎÙÚÔχÙË (High temperature solid oxide fuel cells ‹
SOFC) ÍÂΛÓËÛ Ì ÙËÓ ·Ó·Î¿Ï˘„Ë ·˘Ù‹ Î·È ÙË ¯Ú‹ÛË
Ù˘ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ΢‚È΋˜ ˙ÈÚÎÔÓ›·˜ ˆ˜ ËÌÈ·ÁˆÁÔ‡. ¶ÚÈÓ ÙÔ 1975 Ë ¯Ú‹ÛË ÙÔ˘ ‹Ù·Ó ÂÚÈÔÚÈṲ̂ÓË Û ˘Ú›Ì·¯Â˜ ÂÊ·ÚÌÔÁ¤˜, ÂÓÒ Û‹ÌÂÚ· η٤¯ÂÈ ¤Ó· Â˘Ú‡Ù·ÙÔ
Ê¿ÛÌ· ÂÊ·ÚÌÔÁÒÓ ÛÙË ‚ÈÔÌ˯·Ó›·, Û ÔÈÎȷΤ˜ Û˘Û΢¤˜, Î·È ÛÙËÓ È·ÙÚÈ΋ Î·È Ô‰ÔÓÙÈ·ÙÚÈ΋10. Afi ÙÔ 1980 fï˜
Ù· ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜ ·Ó·Ù‡¯ıËÎ·Ó ÂÍ·ÈÚÂÙÈο ÏfiÁˆ
ÙÔ˘ Ôχ ÌÈÎÚÔ‡ Û˘ÓÙÂÏÂÛÙ‹ ·ÁˆÁÈÌfiÙËÙ·˜ Î·È Ù˘ ȉȷ›ÙÂÚ˘ ÎÚ˘ÛÙ·ÏÏÈ΋˜ ÙÔ˘˜ ‰ÔÌ‹˜, ·ÊÔ‡ ÍÂÂÚ¿ÛÙËηÓ
Ù· ÚÔ‚Ï‹Ì·Ù· ηٿ ÙËÓ Î·ÙÂÚÁ·Û›· ÙÔ˘˜11.
TÔ 1969 ÚÔÙ›ÓÂÙ·È Ë ¯Ú‹ÛË ‰ÈÔÍÂȉ›Ô˘ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘
ÛÙËÓ È·ÙÚÈ΋ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ÛÙËÓ ÔÚıÔ·È‰È΋ ˆ˜
ÂÓ·ÏÏ·ÎÙÈÎÔ‡ ˘ÏÈÎÔ‡ ÁÈ· ÔÏÈ΋ ·ÚıÚÔÏ·ÛÙÈ΋ ÎÂÊ·Ï‹˜
ÌËÚÈ·›Ô˘ ÛÙË ı¤ÛË ÙÔ˘ ÙÈÙ·Ó›Ô˘ Î·È Ù˘ ·ÏÔ˘Ì›Ó·˜12. ™ÙË
Û˘Ó¤¯ÂÈ· ÚÔÙ¿ıËΠˆ˜ Ó¤Ô ˘ÏÈÎfi ÙÔ 1989 ÁÈ· ÙËÓ ÔÏÈ΋
·ÚıÚÔÏ·ÛÙÈ΋ ÈÛ¯›Ô˘. ŒÎÙÔÙ ÂÚÈÛÛfiÙÂÚ˜ ·fi
600.000 ÎÂʷϤ˜ ¤¯Ô˘Ó ÙÔÔıÂÙËı› ·ÁÎfiÛÌÈ·13, 14.
M¤¯ÚÈ Û‹ÌÂÚ· Ù· ÎÂÚ·ÌÈο ÎÚ¿Ì·Ù· ˙ÈÚÎÔÓ›·˜ ·ÔÙÂÏÔ‡Ó Ù· ÈÛ¯˘ÚfiÙÂÚ· ÌÔÓÔÊ·ÛÈο ÎÂÚ·ÌÈο ÔÍ›‰È· Ô˘
¤¯Ô˘Ó ·Ú·¯ı›10. EÓÙÔ‡ÙÔȘ, ÙÔ 2002 ‹Ù·Ó Ë ¯ÚÔÓÈ¿ ηٿ
ÙËÓ ÔÔ›· Ë ˙ÈÚÎÔÓ›· ˆ˜ ˘ÏÈÎfi Ù˘ ÔÚıÔ·È‰È΋˜ ‰¤¯ÙËÎÂ
‰ÚÈ̇ٷÙË ÎÚÈÙÈ΋ ηıÒ˜ ¤Ó·˜ ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÎÂÊ·ÏÒÓ ÌËÚÈ·›Ô˘ ÔÛÙÔ‡ (400) Ì ÙÔ ÂÌÔÚÈÎfi fiÓÔÌ·
Prozyr Zirconia14 ·¤Ù˘¯·Ó Û in vivo ÏÂÈÙÔ˘ÚÁ›· ÙÔ 2001.
TËÓ ›‰È· ¯ÚÔÓÈ¿ Ë ÂÙ·ÈÚ›· St. Gobain Desmarquest, Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ηٷÛ΢·ÛÙ‹˜ ÌËÚÈ·›ˆÓ ÎÂÊ·ÏÒÓ ˙ÈÚÎÔÓ›·˜, ·Ó·ÎÔ›ÓˆÛ ÙËÓ ·Ó¿ÎÏËÛË Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÚÙ›‰ˆÓ ÏfiÁˆ ·ÔÎÏ›ÛÂˆÓ ÛÙË ıÂÚÌÈ΋ ηÙÂÚÁ·Û›· ηٿ ÙËÓ
·Ú·ÁˆÁ‹ ÙÔ˘˜. A˘Ù¤˜ ÔÈ ·ÚÙ›‰Â˜ Û˘Û¯ÂÙ›ÛÙËÎ·Ó ÌÂ
ÌÂÁ¿ÏÔ ·ÚÈıÌfi in vivo ηٷÁÌ¿ÙˆÓ15. AÓ Î·È Ë ¯Ú‹ÛË ˙ÈÚÎÔÓ›·˜ Û˘Ó¯›˙ÂÙ·È Û ÂÈÏÂÁ̤Ó˜ ·ÁÔÚ¤˜, fiˆ˜ Ë I·ˆÓ›·, Ë ·fiÛ˘ÚÛË Ù˘ Desmarquest ¤ÊÂÚ ·ÒÏÂÈ· Ù˘ ÂÌÈÛÙÔÛ‡Ó˘ Ù˘ ˙ÈÚÎÔÓ›·˜ ˆ˜ ·ÍÈfiÈÛÙÔ˘ ˘ÏÈÎÔ‡ ÛÙËÓ
E˘ÚÒË Î·È ÙȘ Eӈ̤Ó˜ ¶ÔÏÈÙ›˜15.
¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÈÂÚ¢ӋıËÎ·Ó Ù· ·›ÙÈ· ÙˆÓ ·ÔÙ˘¯ÈÒÓ, ÛÙË Û˘Ó¤¯ÂÈ· ‰È·ÊÔÚÔÔÈ‹ıËÎ·Ó ÔÈ ÚԉȷÁڷʤ˜
‰È·ÛÙ¿ÛÂˆÓ ÁÈ· ÙȘ ÎÂʷϤ˜, ·fi ÙÔ 2000 ¤ˆ˜ Û‹ÌÂÚ· ÂÁηٷÏ›ÂÙ·È Ë ¯Ú‹ÛË Ù˘ ˙ÈÚÎÔÓ›·˜ ÛÙËÓ ÔÚıÔ·È‰È΋.
°›ÓÔÓÙ·È ·ÚfiÏ· ·˘Ù¿ ÚÔÛ¿ıÂȘ ÁÈ· ηıȤڈÛË ¿ÏÏˆÓ Û‡ÓıÂÙˆÓ ˘ÏÈÎÒÓ ˙ÈÚÎÔÓ›·˜-·ÏÔ˘Ì›Ó·˜ ÛÙËÓ ÔÚıÔ104
In 1969 scientists proposed the use of zirconium dioxide
in medicine and more specifically in orthopedics as an
alternative material for replacing the femoral heads in
place of the alumina and titanium12. Consequently, it was
proposed as a new material in 1989 for total hip arthroplasty. Since then, more than 600,000 zirconia heads are
installed worldwide13, 14.
Hitherto zirconia ceramic alloys are the strongest single
phase oxide ceramics ever produced10. However in 2002
zirconia materials were heavily criticized in orthopedics.
The reason was that a substantial number of femoral
heads (400) under the brand name Prozyr Zirconia14 failed
in function in 2001. Despite the fact that the causes of
failures were investigated since then and the dimensional
specifications for the heads were differentiated, from 2000
to today clinicians abandoned the use of zirconia in
orthopedics. Nevertheless many efforts were made to
introduce other composites of zirconia - alumina in orthopedics, which retain the advantages of zirconia and do
not present the serious drawback of aging and low
temperature degradation16. Unlike its use in dentistry has
increased with an annual sales increase of 12%14.
Zirconium as an element of the periodic table belongs to
the IVB transition metals group. Characteristic of this
group is that ions in conventional oxidation state have
completed some subshell d17.The transition elements are
used in many alloys and often form colored compounds.
Their atoms have an unsupplemented inner cortex (layer)
which has electron vacancies. At ambient temperature, it
has a closed hexagonal crystal structure and physical and
chemical properties similar to the titanium18.
MATERIAL PRODUCTION
Zirconium is strong, lustrous and corrosion resistant with
atomic number 40 and atomic weight 91,229. It is abundant
in nature, it ranks 18th in the amount of crust and its
concentration is 130 mg/kg in the cortex and 0.026mg/L at
sea19. Pure zirconium is present in crystalline form as white
and malleable metal, and amorphous as a dark blue powder. There is no free pure zirconium in nature and it exists
only as oxide or in combination with silicas9. The zircon is
the main commercial source of zirconium and is found
primarily in Australia, South Wales, Brazil, India and South
Africa20. The annual world production of zirconium is
900.000 tonnes19.
Zirconium has many similarities with the element Hf
(Hafnium), which is attached to various minerals and their
separation becomes difficult21. As a metal has many uses
and applications in photographic flashes, surgical instruments and as a hardener of alloys in nuclear reactors18.
Zirconium dioxide presents a white crystalline form called
zirconia. Minerals that contain it are zircon (ZrSiO4) (Fig.1)
and baddeleyte (ZrO2) (Fig. 2). Zirconia is oxidation
resistable and does not react with acids and bases at
room temperature with the exception of hydrogen fluoride
(HF). It reacts with carbon, nitrogen and hydrogen at
temperatures above 2200ÆC14.
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
·È‰È΋, Ô˘ ‰È·ÙËÚÔ‡Ó Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· Ù˘ ˙ÈÚÎÔÓ›·˜
Î·È ‰ÂÓ ¤¯Ô˘Ó ÙÔ ÛÔ‚·Úfi ÌÂÈÔÓ¤ÎÙËÌ· Ù˘ Á‹Ú·ÓÛ˘16.
AÓÙ›ıÂÙ· Ë ¯Ú‹ÛË Ù˘ ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ·˘Í‹ıËΠ̠ÂÙ‹ÛÈ· ·‡ÍËÛË ˆÏ‹ÛÂˆÓ 12%14.
¶POE§EY™H - ¶APA°ø°H ZIPKONIOY - ZIPKONIA™
TÔ ˙ÈÚÎfiÓÈÔ ˆ˜ ÛÙÔÈ¯Â›Ô ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ›Ó·Î· ·Ó‹ÎÂÈ
ÛÙ· ̤ٷÏÏ· ÌÂÙ¿ÙˆÛ˘ ÛÙËÓ IVB ÔÌ¿‰·. X·Ú·ÎÙËÚÈÛÙÈÎfi ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜ Â›Ó·È fiÙÈ Ù· ÈfiÓÙ· ÙÔ˘˜ ÛÂ Û˘ÓËıÈṲ̂ÓË Î·Ù¿ÛÙ·ÛË ÔÍ›‰ˆÛ˘ ¤¯Ô˘Ó ÌÂÚÈο Û˘ÌÏËڈ̤ÓÔ ÙÔÓ ˘ÔÊÏÔÈfi d17. T· ÛÙÔȯ›· ÌÂÙ¿ÙˆÛ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÔÏÏ¿ ÎÚ¿Ì·Ù· Î·È Û˘¯Ó¿ Û¯ËÌ·Ù›˙Ô˘Ó
¤Á¯ÚˆÌ˜ ÂÓÒÛÂȘ. T· ¿ÙÔÌ¿ ÙÔ˘˜ ‰È·ı¤ÙÔ˘Ó Î¿ÔÈÔ ÌË
Û˘ÌÏËڈ̤ÓÔ ÂÛˆÙÂÚÈÎfi ÊÏÔÈfi (ÛÙÈ‚¿‰·) Ô˘ ¤¯ÂÈ ÎÂÓ¤˜ ı¤ÛÂȘ ËÏÂÎÙÚÔÓ›ˆÓ. ™Â ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜
¤¯ÂÈ ÎÏÂÈÛÙ‹ ÂÍ·ÁˆÓÈ΋ ÎÚ˘ÛÙ·ÏÏÈ΋ ‰ÔÌ‹ Î·È Ê˘ÛÈΤ˜
Î·È ¯ËÌÈΤ˜ ȉÈfiÙËÙ˜ ·ÚfiÌÔȘ Ì ÙÔ ÙÈÙ¿ÓÈÔ18.
TÔ ˙ÈÚÎfiÓÈÔ Â›Ó·È ÈÛ¯˘Úfi, ÛÙÈÏÓfi Î·È ÂÍ·ÈÚÂÙÈο ·ÓıÂÎÙÈÎfi
ÛÙË ‰È¿‚ÚˆÛË Ì ·ÙÔÌÈÎfi ·ÚÈıÌfi 40 Î·È ·ÙÔÌÈÎfi ‚¿ÚÔ˜
91,229. Y¿Ú¯ÂÈ ¿ÊıÔÓÔ ÛÙË Ê‡ÛË, η٤¯ÂÈ ÙËÓ 18Ë ı¤ÛË
Û ÔÛfiÙËÙ· ÛÙÔ ÊÏÔÈfi Ù˘ Á˘ Î·È ÔÈ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙÔ˘
Â›Ó·È 130 mg/kg ÛÙÔ ÊÏÔÈfi Î·È 0.026Ìg/l ÛÙË ı¿Ï·ÛÛ·19.
TÔ Î·ı·Úfi ˙ÈÚÎfiÓÈÔ ˘¿Ú¯ÂÈ Û ÎÚ˘ÛÙ·ÏÏÈ΋ ÌÔÚÊ‹ ˆ˜
Ï¢Îfi Î·È ÂÏ·Ùfi ̤ٷÏÏÔ Î·È Û ¿ÌÔÚÊË ˆ˜ ÛÎÔ‡Ú· ÌÏÂ
ÛÎfiÓË. ¢ÂÓ ˘¿Ú¯ÂÈ ÂχıÂÚÔ Î·ı·Úfi ˙ÈÚÎfiÓÈÔ ÛÙË Ê‡ÛË
·Ú¿ ÌfiÓÔ ˆ˜ ÔÍ›‰ÈÔ ‹ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘ÚÈÙÈο ÔÍ›‰È·9. O ˙ÈÚÎÔÓ›Ù˘ Â›Ó·È Ë Î‡ÚÈ· ÂÌÔÚÈ΋ ËÁ‹ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘ Î·È ‚Ú›ÛÎÂÙ·È ÚˆÙ›ÛÙˆ˜ Û A˘ÛÙÚ·Ï›·, NfiÙÈ· O˘·Ï›·, BÚ·˙ÈÏ›·, IÓ‰›· Î·È NfiÙÈ· AÊÚÈ΋20. H ÂÙ‹ÛÈ· ·ÁÎfiÛÌÈ· ·Ú·ÁˆÁ‹ ˙ÈÚÎÔÓ›Ô˘ Â›Ó·È 900.000 ÙfiÓÔÈ19.
TÔ ˙ÈÚÎfiÓÈÔ ¤¯ÂÈ ÔÏϤ˜ ÔÌÔÈfiÙËÙ˜ Ì ÙÔ ÛÙÔÈ¯Â›Ô Hf
(ÕÊÓÈÔ), Ì ÙÔ ÔÔ›Ô ‚Ú›ÛÎÂÙ·È Ì·˙› Û ‰È¿ÊÔÚ· ÔÚ˘ÎÙ¿
Î·È Ô ‰È·¯ˆÚÈÛÌfi˜ ÙÔ˘˜ ηı›ÛÙ·Ù·È ‰˘Û¯ÂÚ‹˜21. ø˜ ̤ٷÏÏÔ ¤¯ÂÈ ·ÚÎÂÙ¤˜ ¯Ú‹ÛÂȘ Î·È ÂÊ·ÚÌÔÁ¤˜ Û ʈÙÔÁÚ·ÊÈο ÊÏ·˜, ¯ÂÈÚÔ˘ÚÁÈο ÂÚÁ·Ï›·, ˆ˜ ÛÎÏËÚ˘ÓÙ‹˜ ÎÚ·Ì¿ÙˆÓ Î·È Û ˘ÚËÓÈÎÔ‡˜ ·ÓÙȉڷÛÙ‹Ú˜18.
TÔ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ˙ÈÚÎÔÓ›Ô˘ ¤¯ÂÈ Ï¢΋ ÎÚ˘ÛÙ·ÏÏÈ΋ ÌÔÚÊ‹ Î·È ÔÓÔÌ¿˙ÂÙ·È ˙ÈÚÎÔÓ›·. Ÿˆ˜ ·ÓÙ›ÛÙÔȯ· Î·È ÛÙÔ Î·ı·Úfi ˙ÈÚÎfiÓÈÔ ‰ÂÓ ˘Ê›ÛÙ·Ù·È Î·ı·Ú‹ ˙ÈÚÎÔÓ›· ÛÙË Ê‡ÛË.
T· ÔÚ˘ÎÙ¿ ÛÙ· ÔÔ›· ÂÌÂÚȤ¯ÂÙ·È fiˆ˜ ÚԷӷʤÚıËÎ·Ó Â›Ó·È Ô ˙ÈÚÎÔÓ›Ù˘ (ZrSiO4) (EÈÎ. 1) Î·È Ô ‚·‰‰ÂÏ½Ù˘
(ZrO2) (EÈÎ. 2). H ˙ÈÚÎÔÓ›· Â›Ó·È ÛÙ·ıÂÚ‹ ÛÙËÓ ÔÍ›‰ˆÛË
Î·È ‰ÂÓ ·ÓÙȉڿ Ì Ôͤ· Î·È ‚¿ÛÂȘ ÛÙË ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ Ì ÂÍ·›ÚÂÛË ÙÔ ˘‰ÚÔÊıfiÚÈÔ (HF). AÓÙȉڿ Ì ÙÔÓ
¿Óıڷη, ÙÔ ¿˙ˆÙÔ Î·È ÙÔ ˘‰ÚÔÁfiÓÔ Û ıÂÚÌÔÎڷۛ˜ ¿Óˆ ÙˆÓ 2200ÆC14.
EÈÎ. 1: ZÈÚÎÔÓ›Ù˘ (ηʤ ¯ÚÒÌ·ÙÔ˜, ÚÈÛÌ·ÙÈÎfi˜)
Fig. 1: Zirkonitis (brown color, prismatic)
www.en.wikipedia.org/wiki.zircon
EÈÎ. 2: B·‰‰ÂÏÂ˚Ù˘
Fig. 2: Baddeleyte
www.en.wikipedia.org/wiki.baddeleyte
EÈÎ. 3: AÏÏÔÙÚÔÈΤ˜ ÌÔÚʤ˜ ˙ÈÚÎÔÓ›·˜ ·) ΢‚È΋ (c-phase)
‚) ÙÂÙÚ·ÁˆÓÈ΋ (t-phase) Á) ÌÔÓÔÎÏÈÓ‹˜ (m-phase)
·fi ¶ÂÙÚfiÔ˘ÏÔ˜ 200111
Fig. 3: Allotropic forms of zirconia a) cubic b) tetragonal
c) monoclinic
from Petropoulos 200111
Microstructure
MIKPO¢OMH - ATOMIKH ¢IEY£ETH™H - KPY™TA§§IKE™ MOPºE™
H ˙ÈÚÎÔÓ›· ·ÚÔ˘ÛÈ¿˙ÂÈ ÙÔ Ê·ÈÓfiÌÂÓÔ ÙÔ˘ ÔÏ˘ÌÔÚÊÈÛÌÔ‡ ‰ËÏ·‰‹ ÎÚ˘ÛÙ·ÏÏÒÓÂÙ·È Ì ÙÚÂȘ ‰È·ÊÔÚÂÙÈÎÔ‡˜
ÙÚfiÔ˘˜. OÈ ÙÚÂȘ ÎÚ˘ÛÙ·ÏÏÈΤ˜ ÌÔÚʤ˜ Ù˘ ˙ÈÚÎÔÓ›·˜
›ӷÈ: ·) Ë Î˘‚È΋, ¤Ó· ¢ı‡ ϤÁÌ· Ì ÙÂÙÚ¿ÁˆÓ˜ Ï¢ڤ˜ ‚) Ë ÙÂÙÚ·ÁˆÓÈ΋, ¤Ó· ¢ı‡ ϤÁÌ· Ì ÔÚıÔÁÒÓÈÔ
Û¯‹Ì· Î·È Ë Á) Ë ÌÔÓÔÎÏÈÓ‹˜, ¤Ó· ·Ú·ÌÔÚʈ̤ÓÔ ϤÁÌ· Û ۯ‹Ì· ·Ú·ÏÏËÏÂÈ¤‰Ô˘ (EÈÎ. 3).
Hellenic Stomatological Review 57: 101-137, 2013
Zirconia exhibits the phenomenon of polymorphism and
is crystallized in three different ways. The three crystallographic forms of zirconia are: a) the cubic, a rectangular
grid with straight sides b) the tetragonal, a rectangular
grid with a straight shape, and c) the monoclinic, a deformed grid parallelepiped-shaped (Fig. 3).
Each crystallographic form has different properties.
During heating, changes of the zirconia crystal structure
take place. The monoclinic is stable at room temperature
105
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
K¿ı ÎÚ˘ÛÙ·ÏÏÈ΋ ÌÔÚÊ‹ ¤¯ÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ȉÈfiÙËÙ˜.
K·Ù¿ ÙË ı¤ÚÌ·ÓÛË Ù˘ ˙ÈÚÎÔÓ›·˜ ·Ú·ÙËÚÔ‡ÓÙ·È ·ÏÏ·Á¤˜ ÙˆÓ ÎÚ˘ÛÙ·ÏÏÈÎÒÓ ‰ÔÌÒÓ. H ÌÔÓÔÎÏÈÓ‹˜ Â›Ó·È ÛÙ·ıÂÚ‹ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ Î·È ‰È·ÙËÚÂ›Ù·È Ì¤¯ÚÈ ÙÔ˘˜
1170ÆC, ¤¯ÂÈ ÌÂȈ̤Ó˜ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ Û ۯ¤ÛË ÌÂ
ÙËÓ ÙÂÙÚ·ÁˆÓÈ΋ Î·È ÂËÚ¿˙ÂÈ ÙË Û˘ÓÔ¯‹ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ
ÎÚ˘ÛÙ¿ÏÏˆÓ Î·È ÙËÓ ˘ÎÓfiÙËÙ·. H ÙÂÙÚ·ÁˆÓÈ΋ ›ӷÈ
ÛÙ·ıÂÚ‹ ÌÂٷ͇ 1170ÆC Î·È 2370ÆC Î·È ÚÔÛ‰›‰ÂÈ ÛÙÔ ˘ÏÈÎfi ‚ÂÏÙȈ̤Ó˜ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜. H ΢‚È΋ ›ӷÈ
ÛÙ·ıÂÚ‹ Û ıÂÚÌÔÎڷۛ˜ ¿Óˆ ÙˆÓ 2370ÆC ̤¯ÚÈ ÙÔ ÛËÌÂ›Ô Ù‹Í˘22 Î·È ¤¯ÂÈ Ì¤ÙÚȘ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜. K·Ù¿
ÙË ‰È¿ÚÎÂÈ· Ù˘ „‡Í˘ ÙÔ˘ ˘ÏÈÎÔ‡ ÙÔ Ê·ÈÓfiÌÂÓÔ ·ÓÙÈÛÙÚ¤ÊÂÙ·È Î·È Û ıÂÚÌÔÎÚ·Û›· 950ÆC ÍÂÎÈÓ¿ÂÈ Ë ÌÂÙ·ÙÚÔ‹ Ù˘ ÙÂÙÚ·ÁˆÓÈ΋˜ Û ÌÔÓÔÎÏÈÓ‹7, 8. H ÌÂÙ·‚ÔÏ‹
Ê¿ÛÂˆÓ ·ÎÔÏÔ˘ıÂ›Ù·È Î·È ·fi ÌÂÙ·‚ÔÏ‹ fiÁÎÔ˘ ÙÔ˘ ˘ÏÈÎÔ‡. K·Ù¿ ÙËÓ ÌÂÙ·ÙÚÔ‹ Ù˘ ÙÂÙÚ·ÁˆÓÈ΋˜ Û ÌÔÓÔÎÏÈÓ‹ (t->m) ·Ú·ÙËÚÂ›Ù·È ·‡ÍËÛË ÙÔ˘ fiÁÎÔ˘ ηٿ 4,5% ÂÚ›Ô˘ ÂÓÒ Ù˘ ΢‚È΋˜ Û ÙÂÙÚ·ÁˆÓÈ΋ (c->t) 2,31%23.
ŒÓ·˜ ‰È·ÊÔÚÂÙÈÎfi˜ ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi˜ (c—>t) ÌÔÚ› Ó·
ÚÔηϤÛÂÈ ÙË ‰ËÌÈÔ˘ÚÁ›· ÌÈ·˜ ‰È·ÊÔÚÂÙÈ΋˜ t Ê¿Û˘.
A˘Ù‹ Ë Ê¿ÛË t, ÁÓˆÛÙ‹ ˆ˜ t’, ıˆÚÂ›Ù·È fiÌÔÈ· Ù˘ t, ·ÏÏ¿
Ì ÂÚÈÛÛfiÙÂÚË ÂÚÈÂÎÙÈÎfiÙËÙ· Û ‡ÙÙÚÈÔ, ÌÈÎÚfiÙÂÚÔ Ì¤ÁÂıÔ˜ ÎÚ˘ÛÙ¿ÏÏˆÓ Î·È È‰È·›ÙÂÚË ·ÓÙ›ÛÙ·ÛË ÛÙË ÌÂÙ·ÙÚÔ‹ Ù˘ Û ʿÛË m24. O ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi˜ ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ Ê·›ÓÂÙ·È Ó· ÂÚÈÔÚ›˙ÂÈ ÙȘ ÁÓˆÛÙ¤˜ ·ÚÓËÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ ·Ó¿Ù˘Í˘ Ù˘ Ê¿Û˘ m, ηٿ ÙË Á‹Ú·ÓÛË Ù˘
˙ÈÚÎÔÓ›·˜ ÛÂ ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜.
A˘Ù¤˜ ÔÈ ÌÂÙ·ÙÚÔ¤˜ ÙÔ˘ ϤÁÌ·ÙÔ˜ Â›Ó·È Ì·ÚÙÂÓÛÈÙÈÎÔ‡
Ù‡Ô˘ Î·È ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ·fi ÙÚ›· ÛËÌ›·. ¶ÚÒÙÔ, ÙËÓ
¤ÏÏÂÈ„Ë ‰È¿¯˘Û˘ (ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÌfiÓÔ Û˘ÓÙÔÓÈṲ̂Ó˜
·ÏÏ·Á¤˜ ÛÙȘ ı¤ÛÂȘ ÙÔ˘ ϤÁÌ·ÙÔ˜ ¯ˆÚ›˜ ÌÂٷΛÓËÛË ·ÙfïÓ). ¢Â‡ÙÂÚÔ, fiÙÈ ÔÈ ÌÂÙ·ÙÚÔ¤˜ ·˘Ù¤˜ Û˘Ì‚·›ÓÔ˘Ó
ηٿ ÙË ‰È¿ÚÎÂÈ· ÌÂÙ·‚ÔÏ‹˜ Û ¤Ó· ıÂÚÌÔÎÚ·ÛÈ·Îfi ‰È¿ÛÙËÌ· ·Ú¿ Û ̛· Û˘ÁÎÂÎÚÈ̤ÓË ıÂÚÌÔÎÚ·Û›· Î·È ÙÚ›ÙÔ
Ë ·Ú·ÌfiÚʈÛË ÙÔ˘ Û¯‹Ì·ÙÔ˜25. TÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi
ÚÒÙË ÊÔÚ¿ ·Ú·ÙËÚ‹ıËΠÛÙ· ÎÚ¿Ì·Ù· Ûȉ‹ÚÔ˘-¯·ÏÎÔ‡ Ì ÙË ÌÂÙ·ÙÚÔ‹ ÙÔ˘ ÔÛÙÂÓ›ÙË Û ̷ÚÙÂÓÛ›ÙË Î·È ÙËÓ
·ÓÙ›ÛÙÔÈ¯Ë ÂÍ·ÈÚÂÙÈ΋ ‚ÂÏÙ›ˆÛË ÙˆÓ Ì˯·ÓÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ ÙÔ˘ ÎÚ¿Ì·ÙÔ˜26.
O•EI¢IA ™TA£EPO¶OIH™H™ ºA™EøN
H ˙ÈÚÎÔÓ›· ÁÈ· Ó· ÌÔÚ¤ÛÂÈ Ó· Ì·˜ ·Ú¤¯ÂÈ ÙȘ ··ÈÙÔ‡ÌÂÓ˜ ȉÈfiÙËÙ˜ ÚÔ¸Ôı¤ÙÂÈ ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ t-Ê¿Û˘ Û ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜. H ÌÔÓÔÎÏÈÓ‹˜ ÌÔÚÊ‹ Ù˘ ˙ÈÚÎÔÓ›·˜ ·ÔÙÂÏÔ‡Û ÂÌfi‰ÈÔ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ·ÓıÂÎÙÈÎÔ‡ ÎÂÚ·ÌÈÎÔ‡ Ô˘ ı· ÌÔÚÔ‡Û ӷ ¯ÚËÛÈÌÔÔÈËı› Û ‰È¿ÊÔÚ˜ ÂÊ·ÚÌÔÁ¤˜. OÈ ÂÓ·ÏÏ·Á¤˜ fiÁÎÔ˘
ÏfiÁˆ ÌÂÙ·ÙÚÔ‹˜ Ê¿ÛÂˆÓ ÂÈÛ¿ÁÔ˘Ó Ù¿ÛÂȘ Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚˆÁ̤˜ ÛÙË Ì¿˙· ÙÔ˘ ˘ÏÈÎÔ‡ ÌÂÈÒÓÔÓÙ·˜ ÙȘ Ì˯·ÓÈΤ˜ ·ÓÙÔ¯¤˜ ÙÔ˘ ˘ÏÈÎÔ‡26. OÈ ÚÔÛ¿ıÂȘ ÙˆÓ ¯ËÌÈÎÒÓ
Ì˯·ÓÈÎÒÓ ÍÂΛÓËÛ·Ó Á‡Úˆ ÛÙÔ 1972 fiÙ·Ó ·Ó·Î¿Ï˘„·Ó
fiÙÈ Î·Ù¿ ÙË ‰ËÌÈÔ˘ÚÁ›· ÎÚ·Ì¿ÙˆÓ ˙ÈÚÎÔÓ›·˜ Ì ÚÔÛı‹ÎË ÔÍÂȉ›ˆÓ ¯·ÌËÏfiÙÂÚÔ˘ Ûı¤ÓÔ˘˜ (CaO, MgO, La2O3,
Y2O3) ¢ÓÔÔ‡ÓÙ·Ó Ë Î˘‚È΋ Î·È Ë ÙÂÙÚ·ÁˆÓÈ΋ ÌÔÚÊ‹23.
H ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ˙ÈÚÎÔÓ›·˜ Á›ÓÂÙ·È Ì ÙËÓ ·ÓÙÈηٿÛÙ·ÛË ÙÔ˘ Zr4+ ·fi ÙÔ Y3+ ÛÙÔ ϤÁÌ·. TÔ ·Ú·¿Óˆ Ô‰ËÁ› ÙÔ Û¯ËÌ·ÙÈÛÌfi ÎÂÓÒÓ ÂÓ‰ÔÏÂÁÌ·ÙÈÎÒÓ ı¤ÛÂˆÓ Èfi106
and kept up to 1170ÆC, has reduced mechanical properties compared to the tetragonal and influences the consistency of the ceramic crystal and density. The tetragonal
is constant between 1170ÆC and 2370ÆC and gives the
material improved mechanical properties. The cubic is
stable at temperatures in excess of 2370ÆC until the
melting point22 and has moderate mechanical properties.
During the cooling of the material the phenomenon is
reversed, and at the temperature 950ÆC the conversion of
the tetragonal to monoclinic form starts7, 8. This phase
transformation is followed by a change in volume of the
material. During the conversion of the tetragonal to
monoclinic (t-> m) phase a volume increase of about
4.5% is observed, while the respective volume change for
the transformation of cubic to tetragonal (c-> t) is 2,31%29.
A different transformation (c -> t) can cause the creation
of a different t phase. This is known as t’, it is considered
like t, but contains more yttrium, attains smaller crystal
size and presents higher resistance to t->m phase transformation24. This type of transformation appears to limit
the known negative consequences of the m phase development, during aging of zirconia at room temperature.
First, there is lack of diffusion (they include coordinated
changes in the positions of the crystal matrix without
atomic moving). Second, they take place in a temperature
range instead of a specific temperature and third, there is
distortion of the shape25.This phenomenon was first
observed in the iron - copper alloys by converting ostenite
to martensite and the corresponding outstanding improvement of the mechanical properties of the alloy26 .
PHASE STABILIZATION OXIDES
Zirconia in order to provide the required properties needs
the stabilization of the t- phase at ambient temperature.
The presence of monoclinic zirconia is an obstacle to the
creation of a durable ceramic that could be used in
various applications. The volume variation due to the
phase transformation creates cracks in the mass of the
material by reducing its mechanical strength26. Efforts of
chemical engineers began around 1972 when they
discovered that alloying with lower valence oxides (CaO,
MgO, La2O3, Y2O3) favored the cubic and quadratic form23.
The stabilization of t zirconia is achieved by the replacement of Zr4 + ions from Y3 + in the matrix. The above leads
to the formation of oxygen voids inside the crystal matrix
which are known as oxygen vacancies and their mobility
in the matrix causes ionic conductivity. In essence, with
the addition of Y3 + lattice defects are generated.
The phases formed are now similar to those of pure
zirconia with the difference that the impurity - ion stabilizers replace Zr +4 ions create intracellular positions of
oxygen ions in order to maintain neutrality when it comes
to trivalent stabilizer (Fig. 4).
A total of three mechanisms are taking place for the
stabilization of the t- phase and the most common
impurities or stabilizers are cerium dioxide (CeO2) and
yttrium trioxide (Y2O3): a) trivalent ions which create
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÓÙˆÓ Ô͢ÁfiÓÔ˘ Ô˘ ·ÔÙÂÏÔ‡Ó ÙÔ˘˜ ÊÔÚ›˜ Ù˘ ·ÁˆÁÈÌfiÙËÙ·˜, Ë ÎÈÓËÙÈÎfiÙËÙ¿ ÙÔ˘˜ ÛÙÔ ϤÁÌ· ·ÔÙÂÏ› ÙËÓ
ÈÔÓÙÈ΋ ·ÁˆÁÈÌfiÙËÙ·. ™ÙËÓ Ô˘Û›· Ì ÙËÓ ÚÔÛı‹ÎË ÙÔ˘
Y3+ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ·Ù¤ÏÂȘ ÛÙÔ ϤÁÌ·.
OÈ Ê¿ÛÂȘ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡ÓÙ·È ϤÔÓ Â›Ó·È ·Ó¿ÏÔÁ˜ ÌÂ
·˘Ù¤˜ Ù˘ ηı·Ú‹˜ ˙ÈÚÎÔÓ›·˜ Ì ÙË ‰È·ÊÔÚ¿ fiÙÈ Ù· ÈfiÓÙ·
ÚfiÛÌÈ͢-ÛÙ·ıÂÚÔÔÈËÙÒÓ ·ÓÙÈηıÈÛÙÔ‡Ó Ù· Zr+4 ÈfiÓÙ·
Î·È ‰ËÌÈÔ˘ÚÁÔ‡Ó ÙÔ Û¯ËÌ·ÙÈÛÌfi ÎÂÓÒÓ ÂÓ‰ÔÏÂÁÌ·ÙÈÎÒÓ
ı¤ÛÂˆÓ ÈfiÓÙˆÓ Ô͢ÁfiÓÔ˘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·ÙËÚËı› Ë
Ô˘‰ÂÙÂÚfiÙËÙ·, fiÙ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÙÚÈÛıÂÓ‹ ÛÙ·ıÂÚÔÔÈËÙ‹ (EÈÎ. 4).
™˘ÓÔÏÈο ÙÚÂȘ Ì˯·ÓÈÛÌÔ› ÏÂÈÙÔ˘ÚÁÔ‡Ó ÁÈ· ÙË ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ t-Ê¿Û˘ Î·È ÔÈ ϤÔÓ Û˘Ó‹ıÂȘ ÚÔÛÌ›ÍÂȘÛÙ·ıÂÚÔÔÈËÙ¤˜ Â›Ó·È ÙÔ ‰ÈÔÍ›‰ÈÔ ÙÔ˘ ‰ËÌËÙÚ›Ô˘ (CeO2)
Î·È ÙÔ ÙÚÈÔÍ›‰ÈÔ ÙÔ˘ ˘ÙÙÚ›Ô˘ (Y2O3): ·) ÙÚÈÛıÂÓ‹ ÈfiÓÙ· Ù·
ÔÔ›· ‰ËÌÈÔ˘ÚÁÔ‡Ó Ô¤˜ Ô͢ÁfiÓÔ˘ Fe+3, Ga+3, Y+3 ‚) ÙÂÙÚ·ÛıÂÓ‹ ÈfiÓÙ· Ì ÌÈÎÚfiÙÂÚÔ ‹ ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ (Ti+4,
Ce+4) Á) ÚÔÛÌ›ÍÂȘ ÊÔÚÙ›Ô˘ ·ÓÙÈÛÙ¿ıÌÈÛ˘23. ™ËÌ·ÓÙÈ΋
¿ÓÙˆ˜ ¤Ú¢ӷ ¤¯ÂÈ Á›ÓÂÈ ÛÙ· ÎÂÚ·ÌÈο Ô˘ ÛÙËÚ›˙ÔÓÙ·È
ÛÙË ˙ÈÚÎÔÓ›·. Œ¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ‰È·ÊÔÚÂÙÈΤ˜ ̤ıÔ‰ÔÈ
Û‡ÓıÂÛ˘ Î·È ÁÈ· ÙË ÛÙ·ıÂÚÔÔ›ËÛ‹ Ù˘ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Ù· ÔÍ›‰È· Ì·ÁÓËÛ›Ô˘, ·Û‚ÂÛÙ›Ô˘, ‰ËÌËÙÚ›Ô˘ Î·È ˘ÙÙÚ›Ô˘ (MgO, CaO, CeO2, Y2O3) ηıÒ˜ Î·È ÔÍ›‰È· Û¿ÓÈˆÓ Á·ÈÒÓ27.
T· Ó¤· ·˘Ù¿ ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜ Î·È ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ë
ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›· (PSZ) ¯·Ú·ÎÙËÚ›ÛÙËÎ·Ó ·fi ÙÔ˘˜ Garvie Î·È Û˘Ó28 ˆ˜ «ÎÂÚ·ÌÈÎfi˜ ¯¿Ï˘‚·˜» ÁÈ·Ù› ÂÌÊ·Ó›˙Ô˘Ó ·ÚÎÂÙ¤˜ ÔÌÔÈfiÙËÙ˜ Ì ÙÔ ¯¿Ï˘‚·
ηıÒ˜ ¤¯Ô˘Ó ÙÚÂȘ ·ÏÏÔÙÚÔÈΤ˜ ÌÔÚʤ˜, Ì·ÚÙÂÓÛÈÙÈÎÔ‡
Ù‡Ô˘ ÌÂÙ·ÙÚÔ‹ Ê¿Û˘, Î·È ÌÂÙ·‚ÏËÙ¤˜ Ê¿ÛÂȘ.
MOPºE™ ENI™XYMENH™ ZIPKONIA™ A¶O METATPO¶H
ºA™H™
O fiÚÔ˜ ÂÓÈÛ¯˘Ì¤Ó· ÎÂÚ·ÌÈο ÂÌÂÚȤ¯ÂÈ ÌÈ· ¢Ú›· Ù¿ÍË
˘ÏÈÎÒÓ Î·È ÌÈÎÚÔ‰ÔÌÒÓ29. H ÂÓÈÛ¯˘Ì¤ÓË ˙ÈÚÎÔÓ›· ¯ˆÚ›˙ÂÙ·È Û ÙÚÂȘ ‚·ÛÈΤ˜ ηÙËÁÔڛ˜. ™ÙȘ ‰˘Ô ÚÒÙ˜ ·ÔÙÂÏÂ›Ù·È ·fi ˘ÏÈο ÙÔ˘Ï¿¯ÈÛÙÔÓ ‰˘Ô Ê¿ÛÂˆÓ Ì ÙËÓ ÙÂÙÚ·ÁˆÓÈ΋ ˙ÈÚÎÔÓ›· Ó· ·ÔÙÂÏ› ÙË ÌÈÎÚfiÙÂÚË Ê¿ÛË ÂÓÒ
Ë ÙÚ›ÙË Î·ÙËÁÔÚ›· ÂÚÈÏ·Ì‚¿ÓÂÈ Î·Ù¿ ·ÚÈÔ ÏfiÁÔ ÌÔÓÔÊ·ÛÈ΋ t-˙ÈÚÎÔÓ›·23. ™˘ÓÂÒ˜ ‰È·ÎÚ›ÓÔ˘ÌÂ: 1. Ù· ÎÂÚ·ÌÈο
ÂÓÈÛ¯˘Ì¤Ó· Ì ˙ÈÚÎÔÓ›·, 2. T· ÎÂÚ·ÌÈο Ì ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ÙÂÙÚ·ÁˆÓÈ΋ ˙ÈÚÎÔÓ›· Î·È 3. T· ÎÂÚ·ÌÈο
Ì Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ÙÂÙÚ·ÁˆÓÈ΋ ˙ÈÚÎÔÓ›·.
1. KEPAMIKA ENI™XYMENA ME ZIPKONIA
™Â ·˘Ù¿ Ù· ˘ÏÈο ·Ú·ÙËÚÂ›Ù·È ‰È¿¯˘ÛË ÎÚ˘ÛÙ¿ÏÏˆÓ ˙ÈÚÎÔÓ›·˜ ̤۷ Û ̛· ¿ÏÏË ÎÚ˘ÛÙ·ÏÏÈ΋ Ì‹ÙÚ·. E›Ó·È Ù· ÏÈÁfiÙÂÚÔ ÌÂÏÂÙË̤ӷ, ·ÏÏ¿ Î·È Ì ÌÈÎÚfiÙÂÚÔ ÂÌÔÚÈÎfi ÂӉȷʤÚÔÓ ÂÓÈÛ¯˘Ì¤Ó· ÎÂÚ·ÌÈο. X·Ú·ÎÙËÚÈÛÙÈο ·Ú·‰Â›ÁÌ·Ù· Â›Ó·È Ë ÂÓÈÛ¯˘Ì¤ÓË Ì ˙ÈÚÎÔÓ›· ·ÏÔ˘Ì›Ó·
(Zirconia toughened alumina ‹ ZTA) Î·È Ô ÂÓÈÛ¯˘Ì¤ÓÔ˜ ÌÂ
˙ÈÚÎÔÓ›· ÌÔ˘Ï›Ù˘ (3Al2O3.2SiO2 ‹ ZTM)31 Y¿Ú¯Ô˘Ó ‚¤‚·È· Î·È ¿Ú· ÔÏÏÔ› ¿ÏÏÔÈ Û˘Ó‰˘·ÛÌÔ› ˘ÏÈÎÒÓ ·ÏÔ˘Ì›Ó·˜ Î·È ˙ÈÚÎÔÓ›·˜, fiÔ˘ ÙÔ ÔÛÔÛÙfi Ù˘ ˙ÈÚÎÔÓ›·˜ ›ӷÈ
ÌÂÁ·Ï‡ÙÂÚÔ ·fi ·˘Ùfi Ù˘ ·ÏÔ˘Ì›Ó·˜ ÔfiÙ ϤÔÓ ÚÔ·ÙÂÈ ÌÈ· ¿ÏÏË ÛÂÈÚ¿ ˘ÏÈÎÒÓ Ë ÂÓÈÛ¯˘Ì¤ÓË Ì ·ÏÔ˘Ì›Ó·
Hellenic Stomatological Review 57: 101-137, 2013
EÈÎ. 4 : H ‰ËÌÈÔ˘ÚÁ›· ÔÒÓ Ô͢ÁfiÓÔ˘ (oxygen vacancies) ÙÔ˘
ÎÚ˘ÛÙ¿ÏÏÔ˘ Ù˘ ˘ÙÙÚ›·˜ ÛÙËÓ YSZ Û ΢‚È΋ ÎÚ˘ÛÙ·ÏÏÈ΋ ‰ÔÌ‹
Fig. 4: Oxygen vacancies of yttria crystal in cubic YSZ’s crystal
www.wikipedia.org/wiki/yttria-stabilised_zirconia
oxygen vacancies Fe +3, Ga +3, Y +3 b) tetravalent ions with
smaller or larger atomic volume (Ti +4, Ce +4) c) compensation load impurities29. Considerable research has been
done, however, in ceramics based on zirconia. Many
different methods of synthesis and stabilization have been
proposed and many oxides have beem tested suvh as
magnesium, calcium, cerium and yttrium (MgO, CaO,
CeO2, Y2O3) as well as rare earth oxides27.
These new zirconia ceramics and specifically the partially
stabilized zirconia (PSZ) were characterized by Garvie as
“ceramic steel” because they show several similarities
with steel as having three allotropic forms, martensinic
type phase transformation and variable phases28.
FORMS OF REINFORCED ZIRCONIA CERAMICS
The term reinforced ceramics includes a wide class of
materials and microstructures29. Reinforced zirconia is
divided into three main categories. In the first two, materials consist of at least two phases with the t-phase to be
the smallest one, while the third category includes primarily monophase t- zirconia29. Therefore we distinguish: 1.
Zirconia reinforced ceramics, 2. Ceramics with partially
stabilized tetragonal zirconia and 3. Ceramics with fully
stabilized tetragonal zirconia.
1. ZIRCONIA REINFORCED CERAMICS
In these materials zirconia crystals diffuseinto another
crystal matrix. they are the least studied but with the less
commercial interest reinforced ceramics. Typical examples are alumina reinforced with zirconia (Zirconia toughened alumina or ZTA) and zirconia reinforced mullite
(3Al2O3.2SiO2 or ZTM)31. There are many other combinations of alumina and zirconia, where the proportion of
zirconia is greater than that of alumina and constitute
107
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
˙ÈÚÎÔÓ›· (AZT)28. T· Û˘ÁÎÂÎÚÈ̤ӷ ÎÂÚ·ÌÈο ÌÔÚÔ‡Ó Ó·
ÏÂÈÙÔ˘ÚÁ‹ÛÔ˘Ó ˆ˜ ˘ÏÈο ·ÎfiÌ· Î·È ¯ˆÚ›˜ ÙËÓ ·ÚÔ˘Û›·
οÔÈÔ˘ ÛÙ·ıÂÚÔÔÈËÙ‹ ηıÒ˜ Ë ÛÙ·ıÂÚfiÙËÙ· Ù˘ t-Ê¿Û˘ ÂϤÁ¯ÂÙ·È ·fi ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ, ÙË ÌÔÚÊÔÏÔÁ›· ÙÔ˘ Î·È ı¤ÛË ÙÔ˘ (ÂÚÈÎÚ˘ÛÙ·ÏÏÈο ‹ ÂÓ‰ÔÎÚ˘ÛÙ·ÏÏÈο)22. O˘ÛÈ·ÛÙÈο ÚfiÎÂÈÙ·È ÁÈ· ¤Ó· Ê·ÈÓfiÌÂÓÔ ·Ó¿ÏÔÁÔ
Ù˘ ÌÂÙ·ÙfiÈÛ˘ ÙÔ˘ ıÂÚÌÔÎÚ·ÛÈ·ÎÔ‡ ‰È·ÛÙ‹Ì·ÙÔ˜ ¤Ó·Ú͢ Ù˘ Ì·ÚÙÂÓÛÈÙÈ΋˜ ÌÂÙ·ÙÚÔ‹˜ οو ·fi ÙË ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘31. H ÚÔÛı‹ÎË ˙ÈÚÎÔÓ›·˜ ÌÔÚ› Ó·
Á›ÓÂÈ Â›Ù Û ÌÔÚÊ‹ ηı·Ú‹˜ ˙ÈÚÎÔÓ›·˜ ‹ ˆ˜ PSZ Û ÛÎfiÓË ·ÏÔ˘Ì›Ó·˜. M ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ÂÓÈÛ¯‡ÂÙ·È ÙfiÛÔ Ë ‰˘ÛıÚ·˘ÛÙfiÙËÙ· (Kic) fiÛÔ Î·È Ë ·ÓÙÔ¯‹ ο̄˘ ÙÔ˘ ˘ÏÈÎÔ‡,
·ÚΛ Ô ÎfiÎÎÔ˜ Ù˘ ηı·Ú‹˜ ˙ÈÚÎÔÓ›·˜ Ó· Â›Ó·È Ù˘ Ù¿Í˘
ÙˆÓ 1-2 Ìm Î·È Ù˘ ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ˙ÈÚÎÔÓ›·˜
2-5 Ìm Û ÔÛÔÛÙfi ¤ˆ˜ 15%32. TÔ ÔÚ҉˜ ÙˆÓ ÌÈÎÙÒÓ
ÎÂÚ·ÌÈÎÒÓ ZTA ÊÙ¿ÓÂÈ ÙÔ 8-11% Î·È Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ
ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ÙÂÙÚ·ÁˆÓÈ΋˜
˙ÈÚÎÔÓ›·˜ Ì ˘ÙÙÚ›· (Y-TZP). A˘Ùfi ÂÍËÁ› ÂÓ Ì¤ÚÂÈ Î·È ÙȘ
¯·ÌËÏfiÙÂÚ˜ Ì˯·ÓÈΤ˜ ·ÓÙÔ¯¤˜ Û ۯ¤ÛË Ì ÙËÓ ˙ÈÚÎÔÓ›·
Y-TZP22. H ηٷÛ΢‹˜ ÎÂÚ·ÌÈÎÒÓ Ù¤ÙÔÈÔ˘ Ù‡Ô˘ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· Á›ÓÂÈ Â›Ù Ì Ù¯ÓÈ΋ «slip-cast» ›Ù Ì ÂÎÙÚÔ¯ÈÛÌfi
Û «Ì·Ï·Îfi ÛÙ¿‰ÈÔ» ÙÔ˘ ˘ÏÈÎÔ‡ (soft machining)23.
T· ÎÂÚ·ÌÈο ZTA Ê·›ÓÔÓÙ·È ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓ· ÁÈ· ‚ÈÔ˚·ÙÚÈΤ˜ ÂÊ·ÚÌÔÁ¤˜. EÏ¿¯ÈÛÙ· ›¯·Ó ‰ËÌÔÛÈ¢ı› ̤¯ÚÈ
ÚfiÛÊ·Ù· ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘˜ ˆ˜ ÎÂÚ·ÌÈÎÒÓ ‚ÈÔ¸ÏÈÎÒÓ33.
TÔ ÁÂÁÔÓfi˜ fï˜ fiÙÈ Ë ÚÔÛı‹ÎË ·ÏÔ˘Ì›Ó·˜ ÛÙË ˙ÈÚÎÔÓ›· ÂÌÔ‰›˙ÂÈ ÙË Á‹Ú·ÓÛË ÙÔ˘ ˘ÏÈÎÔ‡ ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÌÂÈÒÓÂÈ ‰Ú·ÛÙÈο ÙËÓ ÎÈÓËÙÈ΋ Ù˘ ı· Ú¤ÂÈ Ó· ‰›ÓÂÈ ÂÏ›‰Â˜
ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÂÓfi˜ ÈÛ¯˘ÚÔ‡ ‚ÈÔ¸ÏÈÎÔ‡ ··ÏÏ·Á̤ÓÔ˘ ·fi ÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ Á‹Ú·ÓÛ˘14. §›Á˜ ¤Ú¢Ó˜ ¤¯Ô˘Ó Á›ÓÂÈ ÛÙÔ Ê·ÈÓfiÌÂÓÔ Ù˘ Á‹Ú·ÓÛ˘ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ
·ÏÔ˘Ì›Ó·˜-˙ÈÚÎÔÓ›·˜. º·›ÓÂÙ·È fï˜ fiÙÈ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi Á‹Ú·ÓÛ˘ ·Ú·ÙËÚÂ›Ù·È ·ÚfiÏ· ·˘Ù¿, ÂÍ·ÚÙÒÌÂÓÔ
·fi Ù· ¯·Ú·ÎÙËÚÈÛÙÈο ÌÈÎÚÔ‰ÔÌ‹˜ ÙˆÓ ‰‡Ô Ê¿ÛÂˆÓ ÙÔ˘
˘ÏÈÎÔ‡34. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ Ô ‚·ıÌfi˜ ÌÂÙ·ÙÚÔ‹˜ Ê¿Û˘
ÛÙ· ÎÂÚ·ÌÈο ZTA ÂÍ·ÚÙ¿Ù·È ·fi ÙË ıÂÚÌÔÎÚ·Û›·, ÙË
‰È¿ÚÎÂÈ· Î·È ÙËÓ ›ÂÛË Ô˘ ˘Ê›ÛÙ·Ù·È ÙÔ ˘ÏÈÎfi Î·È Â›Ó·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁÔ˜ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙÔ˘ ÎfiÎÎÔ˘35. TÔ
ÏÂÔÓ¤ÎÙËÌ· Ù˘ ηχÙÂÚ˘ ·ÓÙ›ÛÙ·Û˘ ÛÙË Á‹Ú·ÓÛË
Û‹ÌÂÚ· ·ÌÊÈÛ‚ËÙ›ٷÈ36.
T· Û‡ÓıÂÙ· ÎÂÚ·ÌÈο ˘ÏÈο Ù‡Ô˘ ZTA ‰È·ÎÚ›ÓÔÓÙ·È ÛÂ
‰È¿ÊÔÚÔ˘˜ Ù‡Ô˘˜ ¤¯ÔÓÙ·˜ Ô Î·ı¤Ó·˜ ‰È·ÊÔÚÂÙÈ΋ Û‡ÓıÂÛË, ÔÛfi Î·È Â›‰Ô˜ ÛÙ·ıÂÚÔÔÈËÙ‹, ηıÒ˜ Î·È ÚÔÛı‹ÎË ¿ÏÏˆÓ ÔÍÂȉ›ˆÓ Î·È ÎÚ˘ÛÙ·ÏÏÈÎÒÓ Ê¿ÛˆÓ. EӉȷʤÚÔÓ Ê·›ÓÂÙ·È Ó· ¤¯ÂÈ Ë ZTA Ì ÚÔÛı‹ÎË ¯ÚˆÌ›·˜
(Cr2O3), Ë ÔÔ›· ÂÈÙ˘Á¯¿ÓÂÈ ·‡ÍËÛË Ù˘ ‰˘ÛıÚ·˘ÛÙfiÙËÙ·˜ ‰È·ÙËÚÒÓÙ·˜ ÛÙÔ ›‰ÈÔ Â›Â‰Ô ÙË ÛÎÏËÚfiÙËÙ· ÙÔ˘
˘ÏÈÎÔ‡37. º·›ÓÂÙ·È Ì¿ÏÈÛÙ· fiÙÈ ÙÔ ˘ÏÈÎfi ·˘Ùfi ¤¯ÂÈ ‹‰Ë ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÌÂϤÙ˘ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋38.
H Ù˘È΋ ÂÈÎfiÓ· ÙˆÓ ZTA Û ËÏÂÎÙÚÔÓÈÎfi ÌÈÎÚÔÛÎfiÈÔ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔ˘˜ ÂÓÈÛ¯˘ÙÈÎÔ‡˜ t-ÎÚ˘ÛÙ¿ÏÏÔ˘˜ ˙ÈÚÎÔÓ›·˜
‰ÈÂÛ·Ṳ́ÓÔ˘˜ Û ̋ÙÚ· ÎÚ˘ÛÙ¿ÏÏˆÓ ·ÏÔ˘Ì›Ó·˜. ™ÙËÓ
Ô‰ÔÓÙÈ·ÙÚÈ΋ ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÙÔ VITA In-Ceram® ZIRCONIA (VITA, Germany) ÙÔ ÔÔ›Ô ·ÔÙÂÏÂ›Ù·È ·fi 30%
Á˘·Ï› Î·È 70% ÔÏ˘ÎÚ˘ÛÙ·ÏÏÈÎfi ÎÂÚ·ÌÈÎfi. TÔ ˙ÈÚÎfiÓÈÔ ˆ˜
ÛÙÔÈ¯Â›Ô ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ ›Ó·Î· ·Ó‹ÎÂÈ ÛÙ· ̤ٷÏÏ· ÌÂÙ¿ÙˆÛ˘ ÛÙËÓ IVB ÔÌ¿‰·. X·Ú·ÎÙËÚÈÛÙÈÎfi ·˘Ù‹˜ Ù˘ ÔÌ¿108
another group of materials ie the alumina reinforced
zirconia (AZT). These ceramics can serve as materials even without the presence of a stabilizers, as as the stability
of the t- phase is controlled by the grain size, morphology
and location (inter- or intra-granularly)22. Essentially it is a
phenomenon analogous to the displacement of the
temperature range of the martensitic transformation starting below room temperature31. The addition of zirconia
can be made either in the form of pure zirconia or PSZ
alumina powder. In this way both the fracture toughness
(Kic) and the flexural strength of the material are
enhanced, provided that the grain size of the pure zirconia
is 1-2 Ìm and that of the partially stabilized zirconia is 2-5
Ìm in proportion up to 15%32. The porosity of mixed ZTA
ceramics reaches 8-11% and is higher in fully stabilized
tetragonal zirconia ceramics with yttria (Y- TZP). This
partly explains the lower mechanical strength with respect
to zirconia Y-TZP22. The construction of the ceramic
restoration may be either with “slip-cast” technique or
milling in “green phase” of the material (soft machining)23.
The ZTA ceramics seem promising material for biomedical purposes. Few issues have been published until
recently for its use as a ceramic biomaterial33. Yet the fact
that the addition of alumina in zirconia prevents aging of
the material, or at least drastically reduces the kinetics,
should give hope for a strong biomaterial aging free14.
Few studies have been published on the phenomenon of
aging in alumina-zirconia composites. However, it seems
that a small percentage of aging observed, depends on
the characteristics of the microstructure of the two phases
of the material34. More particularly the degree of transformation in ZTA phases depends on the temperature,
duration and pressure on the material and is inversely
proportional to the grain size35. However, the advantage of
higher resistance to aging today is questioned36.
The ZTA composites are divided into several types having
each a different composition, amount and type of stabilizer as well as the addition of other oxides and crystalline
phases. Interest seems to have the cromia doped ZTA
which achieves increased toughness while maintaining
the same level of hardness of the material37. This material
has already been studied for use in dentistry38.
The typical image of ZTA ceramics with electron microscope includes the t- zirconia crystals dispersed in a
matrix of alumina crystals. In-Ceram Zirconia (In-Ceram®
ZIRCONIA, VITA, Germany) used in dentistry consists of
30% glass and 70 % zirconia polycrystalline alumina
ceramic with a ratio of about 70:30 by volume. According
to Chai et al, In Ceram Zirconia comes from adding 33 %
partially stabilized zirconia with 12% CeO2 to 67% In
Ceram alumina39.
2. CERAMICS WITH PARTIALLY STABILIZED ZIRCONIA
(PSZ)
This category is the most studied and exploited commercially. Features complex microstructure and magnesiastabilized materials are the strongest reinforced ceraHellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰·˜ Â›Ó·È fiÙÈ Ù· ÈfiÓÙ· ÙÔ˘˜ ÛÂ Û˘ÓËıÈṲ̂ÓË Î·Ù¿ÛÙ·ÛË ÔÍ›‰ˆÛ˘ ¤¯Ô˘Ó ÌÂÚÈο Û˘ÌÏËڈ̤ÓÔ ÙÔÓ ˘ÔÊÏÔÈfi d17.
T· ÛÙÔȯ›· ÌÂÙ¿ÙˆÛ˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÔÏÏ¿
ÎÚ¿Ì·Ù· Î·È Û˘¯Ó¿ Û¯ËÌ·Ù›˙Ô˘Ó ¤Á¯ÚˆÌ˜ ÂÓÒÛÂȘ. T· ¿ÙÔÌ¿ ÙÔ˘˜ ‰È·ı¤ÙÔ˘Ó Î¿ÔÈÔ ÌË Û˘ÌÏËڈ̤ÓÔ ÂÛˆÙÂÚÈÎfi ÊÏÔÈfi (ÛÙÈ‚¿‰·) Ô˘ ¤¯ÂÈ ÎÂÓ¤˜ ı¤ÛÂȘ ËÏÂÎÙÚÔÓ›ˆÓ. ™Â
ıÂÚÌÔÎÚ·Û›· ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ¤¯ÂÈ ÎÏÂÈÛÙ‹ ÂÍ·ÁˆÓÈ΋ ÎÚ˘ÛÙ·ÏÏÈ΋ ‰ÔÌ‹ Î·È Ê˘ÛÈΤ˜ Î·È ¯ËÌÈΤ˜ ȉÈfiÙËÙ˜ ·ÚfiÌÔȘ Ì ÙÔ ÙÈÙ¿ÓÈÔ18 Ì ·Ó·ÏÔÁ›· ÂÚ›Ô˘ 70:30 ηٿ fiÁÎÔ. O Chai ·Ó·Ê¤ÚÂÈ fiÙÈ ÙÔ ˘ÏÈÎfi In Ceram Zirconia ÚÔ¤Ú¯ÂÙ·È ·fi ÙËÓ ÚÔÛı‹ÎË 33% ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ˙ÈÚÎÔÓ›·˜ Ì 12% CeO2 Û 67% In Ceram alumina39.
2. KEPAMIKA ME MEPIKø™ ™TA£EPO¶OIHMENH
ZIPKONIA (PARTIALLY STABILIZED ZIRCONIA H PSZ)
H ηÙËÁÔÚ›· ·˘Ù‹ Â›Ó·È Ë ϤÔÓ ÌÂÏÂÙË̤ÓË Î·È ·ÍÈÔÔÈË̤ÓË ÂÌÔÚÈο. ¢È·ı¤ÙÂÈ ÔχÏÔÎË ÌÈÎÚÔ‰ÔÌ‹ ηÈ
ÛÙËÓ ÂÚ›ÙˆÛË ˘ÏÈÎÒÓ Ì ÛÙ·ıÂÚÔÔÈËÙ‹ Ì·ÁÓËÛ›· Â›Ó·È ·fi Ù· ÈÛ¯˘ÚfiÙÂÚ· ÂÓÈÛ¯˘Ì¤Ó· ÎÂÚ·ÌÈο23. ™Â ·˘Ù¿
Ù· ÎÂÚ·ÌÈο Ë ÙÂÙÚ·ÁˆÓÈ΋ t-Ê¿ÛË Û¯ËÌ·Ù›˙ÂÙ·È Û ̋ÙÚ· ÛÙ·ıÂÚÔÔÈË̤Ó˘ ΢‚È΋˜ c-Ê¿Û˘. A˘Ùfi ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÚÔÛÌ›ÍÂȘ ‰È¿ÊÔÚˆÓ ÔÍÂȉ›ˆÓ (CaO, MgO,
La2O3, Y2O3) ÛÂ Û˘ÁÎÂÓÙÚÒÛÂȘ ¯·ÌËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜
Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÁÈ· ÙËÓ Ï‹ÚË ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ΢‚È΋˜ Ê¿Û˘. ŒÙÛÈ Ë t-Ê¿ÛË ‚Ú›ÛÎÂÙ·È ˆ˜ ›˙ËÌ· ÛÙÔ ÂÛˆÙÂÚÈÎfi ÙˆÓ ÎfiÎÎˆÓ Ì¤Û· Û ÌÈ· Ì‹ÙÚ· c-ÛÙ·ıÂÚÔÔÈË̤Ó˘ Ê¿Û˘. H t-Ê¿ÛË Â›Ó·È Û Ï‹ÚË Û˘ÓÔ¯‹ Ì ÙÔ˘˜ ΢‚ÈÎÔ‡˜ ÎÚ˘ÛÙ¿ÏÏÔ˘˜ Î·È ¤¯ÂÈ ÌÔÚÊ‹ ·ÙÚ·ÎÙÔÂȉ‹ Û Â›Â‰Ô Ó·ÓÔ̤ÙÚˆÓ. ¶ÈÔ ·Ï¿ Ù· ÎÂÚ·ÌÈο ·˘Ù¿ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ Â›Ó·È ÔÏ˘Ê·ÛÈο Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó
Û ÌÈÎÚ‹ Û˘ÁΤÓÙÚˆÛË ÌÔÓÔÎÏÈÓ‹ Î·È ÙÂÙÚ·ÁˆÓÈ΋ Ê¿ÛË
Û ˘fiÛÙڈ̷ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ΢‚È΋˜ ˙ÈÚÎÔÓ›·˜.
A˘Ù‹ Ë ÌÂÙ·ÛÙ·ı‹˜ ηٿÛÙ·ÛË Ù˘ t-Ê¿Û˘ ‰È·ÙËÚ›ٷÈ
¯¿ÚË ÛÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÛÙ·ıÂÚÔÔÈËÙÒÓ. H ÌÂÙ·ÙÚÔ‹
Ù˘ Û m-Ê¿ÛË, Ë ÔÔ›· ı· Ô‰ËÁÔ‡Û Û ·‡ÍËÛË fiÁÎÔ˘
ÙÔ˘ ˘ÏÈÎÔ‡ ÂÌÔ‰›˙ÂÙ·È ·fi ÙȘ Û˘ÌÈÂÛÙÈΤ˜ Ù¿ÛÂȘ Ô˘
·ÛÎÔ‡ÓÙ·È Û ·˘ÙÔ‡˜ ÙÔ˘˜ ÎfiÎÎÔ˘˜ ·fi ÙÔ˘˜ ÁÂÈÙÔÓÈÎÔ‡˜ ÙÔ˘˜40. T· ‰È·ÁÚ¿ÌÌ·Ù· Ê¿ÛÂˆÓ ‰Â›¯ÓÔ˘Ó Ì›· Ì›ÍË
΢‚È΋˜, ÙÂÙÚ·ÁˆÓÈ΋˜ ‹ Î·È ÌÔÓÔÎÏÈÓÔ‡˜ Ê¿Û˘ Î·È ÁÈ·
Ó· ·Ú·¯ı› ÌÈ· ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›·
(PSZ) ¯ÚÂÈ¿˙ÔÓÙ·È ‰‡Ô ÚÔ¸Ôı¤ÛÂȘ. K·Ù·Ú¯‹Ó Ë Û˘ÁΤÓÙÚˆÛË ÙÔ˘ ÛÙ·ıÂÚÔÔÈËÙ‹ Ó· Â›Ó·È ÌÈÎÚfiÙÂÚË ·fi
fiÛË ¯ÚÂÈ¿˙ÂÙ·È ÁÈ· ÙËÓ Ï‹ÚË ÛÙ·ıÂÚÔÔ›ËÛË Ù˘ ΢‚È΋˜ Ê¿Û˘ Î·È Î·Ù¿ ‰Â‡ÙÂÚÔÓ Ë Î˘‚È΋ Ê¿ÛË Ó· ıÂÚÌ·Óı› ÒÛÙ ӷ ·Ó·Ù˘¯ı› ¤Ó· ‰ÈÊ·ÛÈÎfi ÎÂÚ·ÌÈÎfi32.
H PSZ ¯·Ú·ÎÙËÚ›ÛÙËΠ·fi ÙÔ˘˜ Garvie Î·È Nicholson28
ˆ˜ «ÎÂÚ·ÌÈÎfi˜ ¯¿Ï˘‚·˜» ·ÊÔ‡ ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÚfiÎÂÈÙ·È ÁÈ· ˘ÏÈÎfi ˘„ËÏ‹˜ Ì˯·ÓÈ΋˜ ·ÓÙÔ¯‹˜ Î·È ÛÎÏËÚfiÙËÙ·˜
Ì ÙÔ ÌÔÓ·‰ÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÂÓ›Û¯˘Û‹˜ ÙÔ˘ ·fi ÙË
ÌÂÙ·ÙÚÔ‹ Ê¿Û˘ (Transformation toughening). H ÌÔÓ·‰È΋ ·˘Ù‹ ȉÈfiÙËÙ· «ÌÂÙ·ÛÙ¿ıÂÈ·» Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ¯·ı› fiÙ·Ó ÔÈ ÎfiÎÎÔÈ Â›Ó·È Ôχ ÌÈÎÚÔ›, ÔfiÙ ‰ÂÓ ÌÂÙ·ÙÚ¤ÔÓÙ·È,
ηıÒ˜ Î·È fiÙ·Ó Â›Ó·È Ôχ ÌÂÁ¿ÏÔÈ, ‰Â ‰È·ÙËÚÔ‡ÓÙ·È ˆ˜
ÌÂÙ·ÙÚÂfiÌÂÓÔÈ ÎÚ‡ÛÙ·ÏÏÔÈ, ÁÈ·Ù› ηı›ÛÙ·ÓÙ·È ‰˘Ó·Ù¤˜
·˘ÙfiÌ·Ù˜ ÌÂÙ·ÙÚÔ¤˜ ÙÔ˘˜ Û ÌÔÓÔÎÏÈÓ‹ Ê¿ÛË Î·Ù¿
ÙËÓ „‡ÍË ÙÔ˘˜ Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘41, 42.
I‰È·›ÙÂÚË ÚÔÛÔ¯‹ ¯ÚÂÈ¿˙ÂÙ·È Û ‰‡Ô ‚·ÛÈο ÛÙ¿‰È· ·Hellenic Stomatological Review 57: 101-137, 2013
mics23. In these ceramics t-phase is formed in the matrix of
stabilized cubic c-phase. This is achieved with blends of
various oxides (CaO, MgO, La2O3, Y2O3) at concentrations lower than those needed to fully stabilize the cubic
phase. Thus, the t- phase is precipitated inside the grains
in a matrix c- stationary phase. T-phase is fully consistent
with the cubic crystals and has a fusiform shape at nanometer level. Simply these ceramics at room temperature
are multiphasic and include a short concentration of
monoclinic and tetragonal phase in cubic stabilized
zirconia substrate. This metastable state of the t- phase is
maintained thanks to the presence of stabilizers. The
transformation to the m- phase which would increase the
volume of the material is prevented by the compressive
stresses exerted on those grains from the adjacent
ones40.The phase diagrams show a mixing of cubic, tetragonal or monoclinic phase. To produce a partially stabilized zirconia (PSZ) two conditions are needed. First, the
concentration of the stabilizer should be less than needed
to fully stabilize the cubic phase and, secondly, the cubic
phase should be heated to develop a biphasic ceramic32.
PSZ was characterized by Garvie and Nicholson as
“ceramic steel”, since it was observed that this material is
of high mechanical strength and toughness with the
unique characteristics coming from the phase transformation (Transformation toughening). This unique property (metastability) may be lost when the grains are very
small, so they do not transform, and when they are too
large, so they are not stable as converted crystals, because they automatically convert to monoclinic phase during
cooling to ambient room temperature41, 42.
Particular care is needed in two main production steps of
such ceramics. First of all sintering must be carried out at
high temperatures (1680ÆC and 1800ÆC) and then the
velocity and the temperature range time of cooling cycles
must be tightly controlled. During the cooling step, at
about 1100ÆC, the tetragonal phase is developed, whose
volume fraction is decisive for the break strength of the
material31, 43.
There are two main types of partially stabilized zirconia
(PSZ) according to stabilizers and microstructure. The
first is a coarse structure containing 8% MgO and grain
size of 50-100 Ìm and is called Mg-PSZ. The second by
adding Y2O3 leading to a very fine ceramic structure with a
grain size <1Ìm. A commercial brand for Mg-PSZ is Denzir-M (Dentronic AB, Sweden)44. Two main disadvantages
of Denzir are the porosity and the large grain size (30-60
Ìm) which makes the material unsuitable for biomedical
purposes, as well as the presence of impurities such as
SiO2 which reduce the magnesium content of Mg
(through the creation of Mg-silicates) and spontaneous
cause aging of the material (t->m transformation)22.
3. YTTRIUM STABILIZED TETRAGONAL ZIRCONIA
(TZP) POLYCRYSTALS, Y-TZP AND CERIA STABILIZED
TETRAGONAL ZIRCONIA POLYCRYSTALS, Ce-TZP)
These constitute the single phase polycrystalline t-zirco109
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ú·ÁˆÁ‹˜ Ù¤ÙÔÈÔ˘ ›‰Ô˘˜ ÎÂÚ·ÌÈÎÒÓ. ¶ÚÒÙ· ·fi fiÏ· Ë
˘ÚÔÛ˘Ûۈ̿وÛË Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È Û ˘„ËϤ˜ ıÂÚÌÔÎڷۛ˜ (1680ÆC Î·È 1800ÆC) Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ë Ù·¯‡ÙËÙ· Î·È Ù· ıÂÚÌÔÎÚ·Ûȷο ‰È·ÛÙ‹Ì·Ù· ÙÔ˘
·ÎÏÔ˘ „‡Í˘ Ú¤ÂÈ Ó· ÂϤÁ¯ÔÓÙ·È ·˘ÛÙËÚ¿. K·Ù¿ ÙÔ
ÛÙ¿‰ÈÔ Ù˘ „‡Í˘, Á‡Úˆ ÛÙÔ˘˜ 1100ÆC, ·Ó·Ù‡ÛÛÂÙ·È Ë
ÙÂÙÚ·ÁˆÓÈ΋ Ê¿ÛË, Ù˘ ÔÔ›·˜ ÙÔ ÎÏ¿ÛÌ· Û fiÁÎÔ Â›Ó·È
ηıÔÚÈÛÙÈÎfi ÁÈ· ÙËÓ ·ÓÙÔ¯‹ ıÚ·‡Û˘ ÙÔ˘ ˘ÏÈÎÔ‡30, 43.
¢‡Ô Â›Ó·È ÔÈ Î‡ÚÈÔÈ Ù‡ÔÈ ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘
˙ÈÚÎÔÓ›·˜ (PSZ) ·Ó¿ÏÔÁ· Ì ÙÔ˘˜ ÛÙ·ıÂÚÔÔÈËÙ¤˜ Î·È ÙË
ÌÈÎÚÔ‰ÔÌ‹ ÙÔ˘˜. O ÚÒÙÔ˜ Ì ·‰ÚfiÎÔÎÎË ‰ÔÌ‹ Â›Ó·È ÌÂ
ÂÚÈÂÎÙÈÎfiÙËÙ· 8% MgO Î·È Ì¤ÁÂıÔ˜ ÎfiÎÎÔ˘ 50-100 Ìm
Î·È ÔÓÔÌ¿˙ÂÙ·È Mg-PSZ. O ‰Â‡ÙÂÚÔ˜ Ì ÚÔÛı‹ÎË Y2O3
Ô˘ Ô‰ËÁ› Û ˘ÂÚÏÂÙfiÎÔÎη ÎÂÚ·ÌÈο Ì ̤ÁÂıÔ˜
ÎfiÎÎÔ˘ <1Ìm. ŒÓ· ÂÌÔÚÈÎfi Û··ÛÌ· ˙ÈÚÎÔÓ›·˜ MgPSZ Â›Ó·È ÙÔ Denzir-M (Dentronic AB, Sweden)44. ¢‡Ô Â›Ó·È Ù· ‚·ÛÈο ÚÔ‚Ï‹Ì·Ù· ÙˆÓ ˘ÏÈÎÒÓ: ·)ÙÔ ÔÚ҉˜
Î·È ‚) ÙÔ ÌÂÁ¿ÏÔ Ì¤ÁÂıÔ˜ ÎfiÎÎÔ˘ (30-60 Ìm) Ù· ÔÔ›·
ÌÔÚ› Ó· ÚÔηϤÛÔ˘Ó ·ÏÏÔ›ˆÛË ˘ÏÈÎÔ‡ ÒÛÙ ӷ ›ӷÈ
·Î·Ù¿ÏÏËÏÔ ϤÔÓ Û ‚ÈÔ˚·ÙÚÈΤ˜ ÂÊ·ÚÌÔÁ¤˜. E›Û˘ Ë
·ÚÔ˘Û›· ÚÔÛÌ›ÍÂˆÓ SiO2 ÔÈ Ôԛ˜ ÌÂÈÒÓÔ˘Ó ÙËÓ ÂÚÈÂÎÙÈÎfiÙËÙ· Û ̷ÁÓ‹ÛÈÔ Mg (Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ˘ÚÈÙÈÎÒÓ ÂÓÒÛÂˆÓ ÙÔ˘ Mg) Î·È ÚÔηÏÔ‡Ó ·˘ıfiÚÌËÙË Á‹Ú·ÓÛË ÙÔ˘ ˘ÏÈÎÔ‡ (t-m transformation)22.
3. KPY™TA§§OI TETPA°øNIKH™ ZIPKONIA™ (YTTRIUM
STABILIZED TETRAGONAL ZIRCONIA POLYCRYSTALS,
Y-TZP AND CERIA STABILIZED TETRAGONAL ZIRCONIA POLYCRYSTALS, Ce-TZP)
T· ÎÂÚ·ÌÈο ·˘Ù‹˜ Ù˘ ηÙËÁÔÚ›·˜ ·ÔÙÂÏÔ‡ÓÙ·È ·fi
ÌÔÓÔÊ·ÛÈ΋ ÔÏ˘ÎÚ˘ÛÙ·ÏÏÈ΋ t-˙ÈÚÎÔÓ›· Î·È ‹‰Ë ·fi ÙÔ
1977 ÁÓÒÚÈ˙·Ó fiÙÈ Ì ÌÈÎÚ¤˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ˘ÙÙÚ›Ô˘
ÌÔÚ› Ó· ηٷÛ΢·ÛÙ› ÌÈÎÚfiÎÔÎÎË ˙ÈÚÎÔÓ›· Î·È Ó· ÂÚȤ¯ÂÈ ¤ˆ˜ Î·È 98% t- Ê¿ÛË. H ˘„ËÏ‹ ·ÓÙÔ¯‹ (700 MPa
ÛÙËÓ Î¿Ì„Ë) Û˘Ì›ÙÂÈ Ì ˘„ËÏfi ÔÛÔÛÙfi ÙÂÙÚ·ÁˆÓÈ΋˜
Ê¿Û˘ Î·È Ë ¯·ÌËÏ‹ (50-100 MPa) Ì ·ÓÙ›ÛÙÔȯ· ˘„ËÏfi
ÔÛÔÛÙfi ÌÔÓÔÎÏÈÓÔ‡˜ Ê¿Û˘45. OÈ Ì¤ÁÈÛÙ˜ ÙÈ̤˜ ·ÓÙÔ¯‹˜ ÂÌÊ·Ó›˙ÔÓÙ·È fiÙ·Ó ÙÔ ÎÚ›ÛÈÌÔ Ì¤ÛÔ Ì¤ÁÂıÔ˜ ÎfiÎÎÔ˘
Â›Ó·È ÌÈÎÚfiÙÂÚÔ ÙÔ˘ 0,3 Ìm46. K¿Ùˆ ·fi ÙÔ 0,2 Ìm ÌÂÁ¤ıÔ˘˜ ÎfiÎÎÔ˘ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi˜ Ô ÌÂÙ·Û¯ËÌ·ÙÈÛÌfi˜ Ê¿ÛÂˆÓ Î·È Û˘ÓÂÒ˜ ¤¯Ô˘Ì ¯·ÌËÏfiÙÂÚË ‰˘ÛıÚ·˘ÛÙfiÙËÙ·23. TÔ ÔÛÔÛÙfi Ù˘ ÙÂÙÚ·ÁˆÓÈ΋˜ Ê¿Û˘ Ô˘ ‰È·ÙËÚÂ›Ù·È Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘ ÂÍ·ÚÙ¿Ù·È ·fi ÙË ıÂÚÌÔÎÚ·Û›· ·Ú·Û΢‹˜, ÙÔ ÔÛÔÛÙfi ÙÔ˘ ÛÙ·ıÂÚÔÔÈËÙ‹
(Y2O3, CeO2), ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎÎˆÓ Î·ıÒ˜ Î·È ÙÔ ‚·ıÌfi Ù˘ Û˘Ì›ÂÛ˘ Ô˘ ÂÍ·ÛÎÂ›Ù·È Û ·˘ÙÔ‡˜ ·fi ÙÔ
ϤÁÌ·23. OÈ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ TZP ÂÍ·ÚÙÒÓÙ·È ·fi ·˘Ù¤˜ ÙȘ ·Ú·Ì¤ÙÚÔ˘˜7.
™Ù· ÎÂÚ·ÌÈο 3Y-TZP (3mol% Y2O3) Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÛÙË Ô‰ÔÓÙÈ·ÙÚÈ΋, ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚfiÏÔ ÛÙȘ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ¤¯ÂÈ ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ23. ¶¤Ú·Ó ÂÓfi˜
ÎÚ›ÛÈÌÔ˘ ÌÂÁ¤ıÔ˘˜ ÎfiÎÎÔ˘, Ô˘ ΢ڛˆ˜ ÂÍ·ÚÙ¿Ù·È ·fi
ÙË Û˘ÁΤÓÙÚˆÛË ÔÍÂȉ›Ô˘ ÙÔ˘ ˘ÙÙÚ›Ô˘ (Y2O3), Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·˘ÙfiÌ·ÙË ÌÂÙ·ÙÚÔ‹ ·fi ÙÂÙÚ·ÁˆÓÈ΋ Û ÌÔÓÔÎÏÈÓ‹ Ê¿ÛË. H ÌÂÙ·ÙÚÔ‹ ·ÚÂÌÔ‰›˙ÂÙ·È Û Ôχ ÏÂÙfiÎÔÎΘ ‰Ô̤˜. EÏ¿ÙÙˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÎfiÎÎˆÓ ‹
·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ ÛÙ·ıÂÚÔÔÈËÙÈÎÒÓ ÔÍÂÈ110
nia ceramics. Since 1977 it was found that adding small
concentrations of yttrium on zirconia powder micrograin
zirconia material can be produced, containing up to 98%
t- phase. The high strength (700 MPa flexural strength)
coincides with high tetragonal phase and the low one (50100 MPa) with high amount of monoclinic phase45. The
maximum strength values occur when the critical average
grain size is less than 0.3Ìm46. Below 0.2 Ìm grain size
phase transformation is not possible and fracture toughness is lowered22. The proportion of the tetragonal phase
at room temperature depends on the preparation temperature, the percentage of stabilizers (Y2O3, CeO2), the
grain size and the degree of compression exerted on
them by the grid22. The mechanical properties of TZP
depend on these parameters7. In 3Y- TZP (3mol% Y2O3)
used in dentistry, grain size plays the most important role
in mechanical properties22. Beyond a critical grain size,
which mainly depends on the concentration of yttrium
dioxide, an automatic transformation from tetragonal to
monoclinic phase can be observed. The conversion is
restricted in very fine structures. Reduction in the grain
size or increasing the concentration of the stabilizing oxides may reduce the transformation rate. Specifically drastic reduction in the grain size results in loss of metastability while increasing the concentration of the stabilizing
oxide more than 3,5% Y2O3 in Y-TZP probably allow
nucleation of stable cubic phase. Therefore in order to
achieve a metastable tetragonal phase at room temperature, the grain size must be less than 0.8 Ìm and the
proportion of the stabilizer oxide not exceeding 3mol%45.
Also the sintering conditions affect both the stability and
the final strength of the final product since they determine
the grain size47. It appears that changing the sintering
conditions from 1550ÆC to 1450ÆC develops cubic phase
which reduces Y from the adjacent crystals, causing
nucleation of t-m transformation sites and dramatically
reduces the resistance to aging of the material48.
A feature of Y-TZP ceramics is the formation of compressive layers on their surface. Tetragonal surface granules
are not limited by the crystal matrix and therefore can be
converted automatically into monoclinic because of the
abrasive procedures provoking compressive stresses at a
depth of some microns in the subsurface. This surface
hardening and transformation phase plays a role in
improving the mechanical properties and wear resistance
of the material, but the thickness of the converted surface
limits them. This phenomenon can be disastrous in the
mechanical behavior of the material, if the conversion
phase on the surface causes a surface cracking, followed
by detachment of surface grains and proceed to the bulk
of the material7.
Many factors play a role in controlling the mechanical
behavior of Y-TZP ceramics. The size and shape of the
grains, the type and amount of stabilizer, the size and
distribution of the internal stresses and the presence of
residual stresses (prestresses)49. One of the disadvantages of 3Y-TZP ceramics is the sensitivity to thermal
shocks. In such case there is depletion of yttrium from
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰›ˆÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÏ·ÙÙÒÛÂÈ ÙÔ Ú˘ıÌfi ÌÂÙ·ÙÚÔ‹˜.
™˘ÁÎÂÎÚÈ̤ӷ ‰Ú·ÛÙÈ΋ Ì›ˆÛË ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÎfiÎÎˆÓ Ô‰ËÁ› Û ·ÒÏÂÈ· Ù˘ «ÌÂÙ·ÛÙ·ıÂÚfiÙËÙ·˜» ÂÓÒ ·‡ÍËÛË Ù˘ Û˘ÁΤÓÙÚˆÛ˘ ÙˆÓ ÛÙ·ıÂÚÔÔÈËÙÈÎÒÓ ÔÍÂȉ›ˆÓ ¿Óˆ ·fi 3,5% Y2O3 ÛÙÔ Y-TZP Èı·ÓÒ˜ Ó· ÂÈÙÚ¤„ÂÈ ‰ËÌÈÔ˘ÚÁ›· ˘Ú‹ÓˆÓ ÛÙ·ıÂÚ‹˜ ΢‚È΋˜ Ê¿Û˘. EÔ̤ӈ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙ¢¯ı› ÙÂÙÚ·ÁˆÓÈ΋ ÌÂÙ·ÛÙ·ı‹˜ Ê¿ÛË Û ıÂÚÌÔÎÚ·Û›· ‰ˆÌ·Ù›Ô˘, ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ
ÎfiÎÎˆÓ Ú¤ÂÈ Ó· Â›Ó·È ÌÈÎÚfiÙÂÚÔ ·fi 0,8 Ìm Î·È ÙÔ ÔÛÔÛÙfi ÙÔ˘ ÛÙ·ıÂÚÔÔÈËÙÈÎÔ‡ ÔÍÂȉ›Ô˘ Ó· ÌËÓ ÍÂÂÚÓ¿
Ù· 3mol%.45.
E›Û˘ ÔÈ Û˘Óı‹Î˜ ˘ÚÔÛ˘Ûۈ̿وÛ˘ ÂËÚ¿˙Ô˘Ó
ÙfiÛÔ ÙË ÛÙ·ıÂÚfiÙËÙ· fiÛÔ Î·È ÙËÓ ÙÂÏÈ΋ ·ÓÙÔ¯‹ ÙÔ˘ ÙÂÏÈÎÔ‡ ÚÔ˚fiÓÙÔ˜, ηıÒ˜ ηıÔÚ›˙Ô˘Ó ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ47. º·›ÓÂÙ·È fiÙÈ ÛÂ Û˘Óı‹Î˜ ˘ÚÔÛ˘Ûۈ̿وÛ˘
1550ÆC ·ÓÙ› ÁÈ· 1450ÆC ·Ó·Ù‡ÛÛÂÙ·È Î˘‚È΋ Ê¿ÛË Ë ÔÔ›· ÌÂÈÒÓÂÈ ÙÔ Y ·fi ÙÔ˘˜ ÁÂÈÙÔÓÈÎÔ‡˜ ÎÚ˘ÛÙ¿ÏÏÔ˘˜,
ÚÔηÏ› ˘Ú‹Ó˜ ÌÂÙ·ÙÚÔ‹˜ t-m ÌÂÈÒÓÔÓÙ·˜ ‰Ú·Ì·ÙÈο ÙËÓ ·ÓÙ›ÛÙ·ÛË ÙÔ˘ ˘ÏÈÎÔ‡ ÛÙË Á‹Ú·ÓÛË48.
X·Ú·ÎÙËÚÈÛÙÈÎfi ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP Â›Ó·È Ô Û¯ËÌ·ÙÈÛÌfi˜ ıÏÈÙÈÎÒÓ ˙ˆÓÒÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ¿ ÙÔ˘˜. OÈ ÂÈÊ·ÓÂÈ·ÎÔ› ÙÂÙÚ·ÁˆÓÈÎÔ› ÎfiÎÎÔÈ ‰ÂÓ ÂÚÈÔÚ›˙ÔÓÙ·È ·fi ÙÔ ϤÁÌ· Î·È ÁÈ· ÙÔ ÏfiÁÔ ·˘Ùfi ÌÔÚÔ‡Ó Ó· ÌÂÙ·ÙÚ·Ô‡Ó ·˘ÙÔÌ¿Ùˆ˜ Û ÌÔÓÔÎÏÈÓ›˜ ÂÍ·ÈÙ›·˜ ·ÔÙÚÈÙÈÎÒÓ ‰È·‰ÈηÛÈÒÓ Ô˘ ÚÔηÏÔ‡Ó ıÏÈÙÈΤ˜ Ù¿ÛÂȘ Û ‚¿ıÔ˜ ÔÚÈÛÌ¤ÓˆÓ Ìm ˘ÔÂÈÊ·ÓÂȷο. A˘Ù‹ Ë ÂÈÊ·ÓÂȷ΋ ÌÂÙ·ÙÚÔ‹
Ê¿ÛÂˆÓ Î·È ÛÎÏ‹Ú˘ÓÛË ·›˙ÂÈ ÚfiÏÔ ÛÙË ‚ÂÏÙ›ˆÛË ÙˆÓ
Ì˯·ÓÈÎÒÓ È‰ÈÔÙ‹ÙˆÓ Î·È Ù˘ ·ÓÙ›ÛÙ·Û˘ ÛÙË ÊıÔÚ¿ ÙÔ˘
˘ÏÈÎÔ‡, ÙÔ ¿¯Ô˜ fï˜ Ù˘ ÌÂÙ·ÙÚ·›۷˜ ÂÈÊ¿ÓÂÈ·˜
ÙȘ ÂÚÈÔÚ›˙ÂÈ. TÔ Ê·ÈÓfiÌÂÓÔ ·˘Ùfi ÌÔÚ› Ó· ·Ԃ› ηٷÛÙÚÔÊÈÎfi ÛÙË Ì˯·ÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ˘ÏÈÎÔ‡, ·Ó Ë
ÌÂÙ·ÙÚÔ‹ Ê¿ÛÂˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· ÚÔηϤÛÂÈ ÌÈ· ÂÈÊ·ÓÂȷ΋ ÚˆÁÌ‹, ·ÎÔÏÔ˘ıÔ‡ÌÂÓË ·fi ·fiÛ·ÛË ÂÈÊ·ÓÂÈ·ÎÒÓ ÎfiÎÎˆÓ Î·È ÚÔ¯ˆÚ‹ÛÂÈ ÛÙË Ì¿˙· ÙÔ˘ ˘ÏÈÎÔ‡7.
¶ÔÏÏÔ› ·Ú¿ÁÔÓÙ˜ ÂϤÁ¯Ô˘Ó ÙË Ì˯·ÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿
ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP. TÔ Ì¤ÁÂıÔ˜ Î·È Û¯‹Ì· ÙÔ˘ ÎfiÎÎÔ˘,
Ô Ù‡Ô˜ Î·È ÙÔ ÔÛfi ÙÔ˘ ÛÙ·ıÂÚÔÔÈËÙ‹, ÙÔ Ì¤ÁÂıÔ˜ ηÈ
Ë Î·Ù·ÓÔÌ‹ ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ Ù¿ÛÂˆÓ Î·È Ë ·ÚÔ˘Û›· ÙˆÓ
˘ÔÏÂÈÌÌ·ÙÈÎÒÓ Ù¿ÛˆÓ49. ŒÓ· ·fi Ù· ÌÂÈÔÓÂÎÙ‹Ì·Ù·
ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP Â›Ó·È Ë Â˘·ÈÛıËÛ›· ÛÙÔ˘˜ ıÂÚÌÈ-
grain boundaries resulting in cubic phase appearance
which affects the consistency of the material. To address
the phenomenon it was proposed the reduction of the
grain size to nanometer scale and the addition of other
stabilizers in order to improve its performance. It has been
proposed that adding Cerium (Ce) and Alumina another
Ce- stabilized alumina TZP ceramic can be created49. The
fully stabilized zirconia is less elastic than the partially
stabilized and less resistant to thermal shocks from MgPSZ. At temperatures above 900ÆC is prone to deformation50. One major limitation of Y-TZP in their use in dentistry concerns the optical properties and especially the
opacity and the intense white color. For this reason,
various additive oxides have been tested in order to
change the color of Y-TZP. It seems that the addition of
CeO2 and ErO2 improves the color without significantly
affecting the mechanical properties51. Indeed the system
Procera AllZirkon (Nobel Biocare) has four different colors. Recently new systems are developed with transparent zirconia (grain size 3nm) made with a particular
zirconium, yttrium and oxygen ions condensation technique, in a gaseous phase. This kind of material is designed
for the fabrication of full contour zirconia restorations
without the need of a veneering material.
3.1. PHYSICAL PROPERTIES OF YTZP
The properties of YTZP are dependent on yttria
percentage and on grain size. The density of YTZP is 6.056.07 gr/cm3, and thermal conductivity of 2.2W /m*K32. The
resistance to thermal shocks is approaching 400ÆC, and
the dielectric constant from 16 to 18. It has zero porosity,
white color and a maximum working temperature of
1500ÆC. The melting point is extremely high (2750ÆC).
Coefficient of thermal expansion is 10,3*10-6/ÆC. Table 1
shows comparatively the physical, thermal and electrical
properties of the three types of zirconia.
3.2. OPTICAL PROPERTIES
The phenomena that determine the color and shape of a
Table 1. Physical properties of zirconia toughened ceramics
Property
ZTA
Mg-PSZ
Y-TZP
white
yellow
white
Density (gr/cm )
4.1
5.7
6.0
Average grain size (Ìm)
0.5
50
0.35-0.7
25
2
2
9
10.5
10.5
Maximum temperature ÆC
1000
900
1200
Thermal shock resistance ÆC
250
260
300
Color
3
Thermal conductivity (W/m*K)
-6
-1
Coefficient of thermal expansion (*10 K )
(http://www.bce-special-ceramics.com/highperformanceceramics/comparison.php)
Hellenic Stomatological Review 57: 101-137, 2013
111
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÎÔ‡˜ ·ÈÊÓȉȷÛÌÔ‡˜. ™Â Ù¤ÙÔÈ· ÂÚ›ÙˆÛË ·Ú·ÙËÚ›ٷÈ
ÂÍ¿ÓÙÏËÛË ÙÔ˘ ˘ÙÙÚ›Ô˘ ·fi Ù· fiÚÈ· ÙˆÓ ÎfiÎÎˆÓ Ì ·ÔÙ¤ÏÂÛÌ· ÙË ‰ËÌÈÔ˘ÚÁ›· ΢‚È΋˜ Ê¿Û˘ Ë ÔÔ›· ÂËÚ¿˙ÂÈ ÙË Û˘ÓÔ¯‹ ÙÔ˘ ˘ÏÈÎÔ‡. °È· ÙËÓ ·ÓÙÈÌÂÙÒÈÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ ÚÔÙ¿ıËÎÂ Ë ÛÌ›ÎÚ˘ÓÛË ÙˆÓ ÎfiÎÎˆÓ Û Â›‰Ô
Ó·ÓÔ̤ÙÚˆÓ ÁÈ· ‚ÂÏÙ›ˆÛË Ù˘ Â›‰ÔÛ˘ Î·È Ë ÚÔÛı‹ÎË
¿ÏÏˆÓ ÛÙ·ıÂÚÔÔÈËÙÒÓ. Œ¯ÂÈ ÚÔÙ·ı› Ë ÚÔÛı‹ÎË ‰ËÌËÙÚ›Ô˘ (Ce) Î·È ·ÏÔ˘Ì›Ó·˜ ÁÈ· ÙË ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ ¿ÏÏÔ˘ ÛÙ·ıÂÚÔÔÈË̤ÓÔ˘ ÎÂÚ·ÌÈÎÔ‡ Ce-TZP Ì ·ÏÔ˘Ì›Ó·49. H Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›· Â›Ó·È ÏÈÁfiÙÂÚÔ
ÂÏ·ÛÙÈ΋ ·fi ÙË ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË Î·È ÏÈÁfiÙÂÚÔ
·ÓıÂÎÙÈ΋ ÛÙÔ˘˜ ıÂÚÌÈÎÔ‡˜ ·ÈÊÓȉȷÛÌÔ‡˜ ·fi ÙËÓ MgPSZ. ™Â ıÂÚÌÔÎڷۛ˜ ¿Óˆ ÙˆÓ 900ÆC Â›Ó·È ÂÈÚÚÂ‹˜
ÛÙËÓ ·Ú·ÌfiÚʈÛË50.
ŒÓ·˜ ‚·ÛÈÎfi˜ ÂÚÈÔÚÈÛÌfi˜ ÙˆÓ Y-TZP ÛÙËÓ ¯Ú‹ÛË ÙÔ˘˜
ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ·ÊÔÚ¿ ÙȘ ÔÙÈΤ˜ ȉÈfiÙËÙ˜ Î·È ÂȉÈο
ÙËÓ ·‰È·Ê¿ÓÂÈ· Î·È ÙÔ ¤ÓÙÔÓ· Ï¢Îfi ¯ÚÒÌ· ÙÔ˘˜. °È· ÙÔ
ÏfiÁÔ ·˘Ùfi ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ‰È¿ÊÔÚ· ÚfiÛıÂÙ· ÔÍÂȉ›ˆÓ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂÙ·‚ÏËı› ÙÔ ¯ÚÒÌ· ÙˆÓ Y-TZP.
º·›ÓÂÙ·È ˆ˜ Ë ÚÔÛı‹ÎË Î·È CeO2 Î·È ErO2 ‚ÂÏÙÈÒÓÂÈ ÙË
¯ÚˆÌ·ÙÈ΋ ·fi¯ÚˆÛË ¯ˆÚ›˜ ÛËÌ·ÓÙÈ΋ Â›ÙˆÛË ÛÙȘ
Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜51. M¿ÏÈÛÙ· ÙÔ Û‡ÛÙËÌ· Procera
AllZirkon (Nobel Biocare, Switzerland) ¤¯ÂÈ ‹‰Ë Ù¤ÛÛÂÚȘ
‰È·ÊÔÚÂÙÈÎÔ‡˜ ¯ÚˆÌ·ÙÈÛÌÔ‡˜. ¶ÚfiÛÊ·Ù· ·Ó·Ù‡ÛÛÔÓÙ·È Û˘ÛÙ‹Ì·Ù· Ó¤·˜ ‰È·Ê·ÓÔ‡˜ ˙ÈÚÎÔÓ›· Ì ̤ÁÂıÔ˜
ÎfiÎÎˆÓ 3 nm Ô˘ ηٷÛ΢¿˙ÂÙ·È Ì ÌÈ· ȉȷ›ÙÂÚË Ù¯ÓÈ΋ Û˘Ì‡ÎÓˆÛ˘ ÈfiÓÙˆÓ ˙ÈÚÎÔÓ›Ô˘, ˘ÙÙÚ›Ô˘ Î·È Ô͢ÁfiÓÔ˘
Û ·¤ÚÈ· Ê¿ÛË Ô˘ ÚÔÔÚ›˙ÂÙ·È ÁÈ· ·ÔηٷÛÙ¿ÛÂȘ ˙ÈÚÎÔÓ›·˜ Ï‹ÚÔ˘˜ ·Ó·ÙÔÌ›·˜ ¯ˆÚ›˜ ÂÈÎ·Ï˘ÙÈÎfi ˘ÏÈÎfi52.
3.1. ºY™IKE™ I¢IOTHTE™ TZP
OÈ È‰ÈfiÙËÙ˜ ÙÔ˘ YTZP ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔ ÔÛÔÛÙfi Ù˘
˘ÙÙÚ›·˜ ηıÒ˜ Î·È ·fi ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ. H ˘ÎÓfiÙËÙ· Â›Ó·È 6.05-6.07 gr/cm3 Î·È Ë ıÂÚÌÈ΋ ·ÁˆÁÈÌfiÙËÙ·
2.2W/m*K32. H ·ÓÙ›ÛÙ·ÛË ÛÙÔ˘˜ ıÂÚÌÈÎÔ‡˜ ·ÈÊÓȉȷÛÌÔ‡˜ ÏËÛÈ¿˙ÂÈ ÙÔ˘˜ 400ÆC, Î·È Ë ‰ÈËÏÂÎÙÚÈ΋ ÛÙ·ıÂÚ¿
16-18. Œ¯ÂÈ ÌˉÂÓÈÎfi ÔÚ҉˜, Ï¢Îfi ¯ÚÒÌ· Î·È Ì¤ÁÈÛÙË
ıÂÚÌÔÎÚ·Û›· ¯Ú‹Û˘ Ù˘ ÙÔ˘˜ 1500ÆC. TÔ ÛËÌÂ›Ô Ù‹Í˘
Ù˘ Â›Ó·È ÂÍ·ÈÚÂÙÈο ˘„ËÏfi (2750ÆC). O ™˘ÓÙÂÏÂÛÙ‹˜
ıÂÚÌÈ΋˜ ‰È·ÛÙÔÏ‹˜ (™.£.¢.) Â›Ó·È 10,3*10-6/ÆC. ™ÙÔÓ ¶›Ó·Î· 1 Ê·›ÓÔÓÙ·È Û˘ÁÎÚÈÙÈο ÔÈ Ê˘ÛÈΤ˜, ıÂÚÌÈΤ˜ Î·È ËÏÂÎÙÚÈΤ˜ ȉÈfiÙËÙ˜ ÙˆÓ ÙÚÈÒÓ Î·ÙËÁÔÚÈÒÓ ˙ÈÚÎÔÓ›·˜.
3.2. O¶TIKE™ I¢IOTHTE™
T· Ê·ÈÓfiÌÂÓ· Ô˘ ÚÔÛ‰ÈÔÚ›˙Ô˘Ó ¯ÚˆÌ·ÙÈο Î·È Û¯ËÌ·ÙÈο ¤Ó· Ê˘ÛÈÎfi ÛÒÌ· Â›Ó·È Ë ·ÔÚÚfiÊËÛË, Ë ·ÓÙ·Ó¿ÎÏ·ÛË, Ë ‰È¿‰ÔÛË, Ë ‰È¿ıÏ·ÛË Î·È Ë ‰È¿¯˘ÛË4, Ù· ÔÔ›·
ηıÔÚ›˙ÔÓÙ·È ‚·ÛÈο ·fi ÙËÓ Â›‰Ú·ÛË ÌÂٷ͇ Ù˘ ÂÈΛÌÂÓ˘ ËÏÂÎÙÚÔÌ·ÁÓËÙÈ΋˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ Î·È ÙˆÓ ËÏÂÎÙÚÔÓ›ˆÓ ÂÓÙfi˜ ÙÔ˘ ˘ÏÈÎÔ‡. H ÂÈΛÌÂÓË ËÏÂÎÙÚÔÌ·ÁÓËÙÈ΋ ·ÎÙÈÓÔ‚ÔÏ›·, Ë ÔÔ›· ¤¯ÂÈ ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ Û˘¯ÓÔÙ‹ÙˆÓ Î·È Ì‹ÎˆÓ Î‡Ì·ÙÔ˜, ÌÔÚ› Ó· ‰ÈÂÁ›ÚÂÈ ¤Ó· ËÏÂÎÙÚfiÓÈÔ Î¿ÓÔÓÙ·˜ ÙÔ Ó· ÌÂÙ·ÎÈÓËı› ·fi ÙÔ ·Ú¯ÈÎfi ÙÔ˘ ÂÓÂÚÁÂÈ·Îfi Â›Â‰Ô Û ¤Ó· ‰È·ÊÔÚÂÙÈÎfi Â›‰Ô. K¿ı ˘ÏÈÎfi ·ÓÙȉڿ Ì ‰È·ÊÔÚÂÙÈÎfi ÙÚfiÔ Û οı ̋ÎÔ˜ ·̷ÙÔ˜. O ‚·ıÌfi˜ ·ÔÚÚfiÊËÛ˘ Ù˘ ËÏÂÎÙÚÔÌ·ÁÓËÙÈ΋˜ ·ÎÙÈÓÔ‚ÔÏ›·˜ ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â›‰Ô˜ ÙÔ˘ ¯ËÌÈÎÔ‡ ‰ÂÛÌÔ‡
112
material is the absorption, reflection, transmission, refraction and diffusion3, which are basically determined by the
interaction between the electromagnetic radiation and
electrons within the material. The external electromagnetic
radiation, which has a large range of frequencies and
wavelengths, can excite an electron by being moved from
its original energy level to a different level. Each material
reacts differently to each wavelength. The degree of absorption of electromagnetic radiation depends on the type of
chemical bonding and the availability of free electrons.
Ceramic materials may entrap some wavelengths of
radiation and can be transparent only in a small range.
The zirconia ceramics have special optical properties. In
the absence of glass due to the high density of the
material they present high opacity. Beyond that, depending on the type of material the color can change. They
have a high refractive index (2.1-2.2), a low coefficient of
absorption and high opacity in the optical and infrared
spectrum54. These properties are due to the fact that the
dispersed grains (particles) of material are slightly larger
than the wavelength of light and the different reflective
index of the matrix material. For this reason, in dentistry
are used to cover discolorations of the substrate55. Factors
affecting the color of the zirconia materials are the grain
size, the distribution of grain sizes, the compression
method and different additives in each material. The
density and homogeneity of the material with minimum
porosity (<0.05%) provides a constant opacity of the
material. Nevertheless factors affecting the color or
transparency of zirconia ceramics were tested without
showing that they degrade the mechanical properties55.
The Ce-TZP are yellow and in powder form, from yellow to
brown. When changing the valence of Ce from +4 to +3 then
it turns gray. For this reason it is not used as such for
dental use36. Y-TZP ceramics are white, although the products resulting from the production of isostatic compression in the absence of oxygen have originally black color.
But when they are subjected to a heat treatment at
1000ÆC-1200ÆC and the presence of oxygen, they
gradually acquire white color56. The Mg-PSZ are yellow
while the ZTA are white.
3.3. MECHANICAL PROPERTIES
There is no doubt that the zirconia ceramics have better
mechanical properties than other ceramics such as
alumina7. The excellent performance of zirconia ceramics
in mechanical testing is primarily due to the dense
structure, the microgranules and the absence of defects8.
The mechanical properties are affected by the purity of
the material, the density, the porosity, the particle size, the
crystalline structure (t-c-m phases), the geometrical
characteristics and the surface characteristics (Table 2).
There is particular interest in the flexural strength which
depends on the purity of the material density, the critical
particle size, the amount of t- phase and the sintering
method.
They present flexural strength around 500MPa40, 129, while
particularly high values of 900-1200 MPa have been
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
¶›Ó·Î·˜ 1. º˘ÛÈΤ˜ ȉÈfiÙËÙ˜ ÂÓÈÛ¯˘Ì¤ÓˆÓ ÎÂÚ·ÌÈÎÒÓ Ì ˙ÈÚÎÔÓ›·
I‰ÈfiÙËÙ·
ZTA
Mg-PSZ
Y-TZP
Ï¢Îfi
K›ÙÚÈÓÔ
§Â˘Îfi
¶˘ÎÓfiÙËÙ· (gr/cm )
4.1
5.7
6.0
M¤ÛÔ Ì¤ÁÂıÔ˜ ÎfiÎÎÔ˘ (Ìm)
0.5
50
0.35-0.7
£ÂÚÌÈ΋ ·ÁˆÁÈÌfiÙËÙ· (W/m*K)
25
2
2
9
10.5
10.5
M¤ÁÈÛÙË ıÂÚÌÔÎÚ·Û›· ÆC
1000
900
1200
AÓÙ›ÛÙ·ÛË ÛÙ· ıÂÚÌÈο ÛÙÚ˜ÆC
250
260
300
XÚÒÌ·
3
-6
-1
™£¢ (*10 K )
(http://www.bce-special-ceramics.com/highperformanceceramics/comparison.php)
Table 2. Mechanical properties of zirconia
Property/Material
Y-TZP
Ce-TZP
ZTA
Mg-PSZ
Density (gr/cm )
6.05
6.15
4.15
5.75
Hardness (HV30)
1350
900
1600
1020
Bending strength (MPa)
1000
350
500
800
Compression strength (MPa)
2000
-
-
2000
Modulus of elasticity (GPa)
205
215
380
205
3
Î·È ÙËÓ ‰È·ıÂÛÈÌfiÙËÙ· ÂχıÂÚˆÓ ËÏÂÎÙÚÔÓ›ˆÓ. T· ÎÂÚ·ÌÈο ˘ÏÈο ÌÔÚÔ‡Ó Ó· ÂÁÎψ‚›˙Ô˘Ó ÔÚÈṲ̂ӷ Ì‹ÎË Î‡Ì·ÙÔ˜ Ù˘ ·ÎÙÈÓÔ‚ÔÏ›·˜ Î·È Ó· Â›Ó·È ‰È·Ê·Ó‹ ÌfiÓÔ Û ¤Ó·
ÌÈÎÚfi ‡ÚÔ˜ ·˘ÙÒÓ55.
T· ÎÂÚ·ÌÈο Ù˘ ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ȉȷ›ÙÂÚ˜ ÔÙÈΤ˜ ȉÈfiÙËÙ˜. §fiÁˆ Ù˘ ·Ô˘Û›·˜ Á˘·ÏÈÔ‡ Î·È ÂÍ·ÈÙ›·˜ Ù˘ ÌÂÁ¿Ï˘ ˘ÎÓfiÙËÙ·˜ ÙÔ˘ ˘ÏÈÎÔ‡ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¤ÓÙÔÓË ·‰È·Ê¿ÓÂÈ·. Afi ÂΛ Î·È ¤Ú· ·Ó¿ÏÔÁ· Ì ÙÔÓ Ù‡Ô ÙÔ˘ ˘ÏÈÎÔ‡ ÙÔ ¯ÚÒÌ· ÌÂÙ·‚¿ÏÏÂÙ·È. Œ¯Ô˘Ó ˘„ËÏfi ‰Â›ÎÙË ·Ó¿ÎÏ·Û˘ (2.1-2.2), ¯·ÌËÏfi Û˘ÓÙÂÏÂÛÙ‹ ·ÔÚÚfiÊËÛ˘ ηÈ
˘„ËÏ‹ ·‰È·Ê¿ÓÂÈ· ÛÙÔ ÔÙÈÎfi Î·È ˘¤Ú˘ıÚÔ Ê¿ÛÌ·54. OÈ
ȉÈfiÙËÙ˜ ·˘Ù¤˜ ÔÊ›ÏÔÓÙ·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ‰ÈÂÛ·Ṳ́ÓÔÈ ÎfiÎÎÔÈ (particles) ÙÔ˘ ˘ÏÈÎÔ‡ Â›Ó·È ÂÏ¿¯ÈÛÙ· ÌÂÁ·Ï‡ÙÂÚÔÈ ·fi ÙÔ Ì‹ÎÔ˜ ·̷ÙÔ˜ ÙÔ˘ ʈÙfi˜ Î·È ÛÙÔ ‰È·ÊÔÚÂÙÈÎfi ‰Â›ÎÙ˘ ·Ó¿ÎÏ·Û˘ Ù˘ Ì‹ÙÚ·˜ ÙÔ˘ ˘ÏÈÎÔ‡.
°È· ÙÔ ÏfiÁÔ ·˘Ùfi ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ¯ÚËÛÈÌÔÔÈ›ٷÈ
ÁÈ· Ó· ηχ„ÂÈ ‰˘Û¯ÚˆÌ›Â˜ ÙÔ˘ ˘ÔÛÙÚÒÌ·ÙÔ˜55. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ¯ÚÒÌ· ÙˆÓ ˘ÏÈÎÒÓ Ù˘
˙ÈÚÎÔÓ›·˜ Â›Ó·È ÙÔ Ì¤ÁÂıÔ˜ ÙÔ˘ ÎfiÎÎÔ˘, Ë Î·Ù·ÓÔÌ‹ ÙˆÓ
ÌÂÁÂıÒÓ ÙˆÓ ÎfiÎΈÓ, Ë Ì¤ıÔ‰Ô˜ Û˘Ì›ÂÛ˘ Î·È Ù· ‰È·ÊÔÚÂÙÈο ÚfiÛıÂÙ· οı ˘ÏÈÎÔ‡. H ˘ÎÓfiÙËÙ· Î·È ÔÌÔÈÔÁ¤ÓÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡ Ì ÂÏ¿¯ÈÛÙÔ ÔÚ҉˜ (<0,05%)
·Ú¤¯ÂÈ ÌÈ· ÛÙ·ıÂÚ‹ ·‰È·Ê¿ÓÂÈ· ÛÙÔ ˘ÏÈÎfi. ¶·ÚfiÏ·
·˘Ù¿ ¤¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› Î·È ·Ú¿ÁÔÓÙ˜ Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔ ¯ÚÒÌ· ‹ ÙË ‰È·Ê¿ÓÂÈ· Ù˘ ˙ÈÚÎÔÓ›·˜ ¯ˆÚ›˜ Ó·
Hellenic Stomatological Review 57: 101-137, 2013
recorded for the Y-TZP7 ceramics. The value of 900 MPa
results from technical sintering without pressure and the
value of 1200 MPa is achieved by fusing at high pressure
(HiP)40. The performance of ZTA ceramics in bending tests
gives smaller values of 400-450 MPa39.
Young’s modulus is relatively low, allowing large deformation of the material up to failure, a unique property in brittle
materials. This allows a significant absorption of stresses
that responds excellent during fatigue tests7. In the literature
there is a wide range of zirconia fracture toughness values
that vary from 4-19 MPa m-1/2. Comparison of these values is
difficult as they result from different techniques and are
influenced by the particle size, density and percentage of
impurities of each particular ceramic57. However, the Y TZP
fracture toughness is higher than other ceramics such as
alumina.
3.4. APPLICATIONS IN INDUSTRY - OTHER
APPLICATIONS
Zirconia is primarily used in industry. A particularly
important application of cubic zirconia YSZ (Y-16 %) is in
fuel cells. Zirconia is used as an electrolyte with very thin
coating thickness, which is responsible for the low resistance to electrical leakage and lower operating temperature of the cell58. However, as mentioned above, the cubic
113
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ê·›ÓÂÙ·È fiÙÈ ˘Ô‚·ıÌ›˙Ô˘Ó ÙȘ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜55.
T· ÎÂÚ·ÌÈο Ce-TZP Â›Ó·È Î›ÙÚÈÓ· Î·È Û ÌÔÚÊ‹ ÛÎfiÓ˘
·fi ΛÙÚÈÓÔ ¤ˆ˜ ηʤ. M¿ÏÈÛÙ· fiÙ·Ó ÌÂÙ·‚¿ÏÏÂÈ Ûı¤ÓÔ˜
ÙÔ Ce ·fi +4 Û +3 ÙfiÙ Á›ÓÂÙ·È ÁÎÚÈ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ‰Â
¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ·˘ÙÔ‡ÛÈ· ÁÈ· Ô‰ÔÓÙÈ·ÙÚÈ΋ ¯Ú‹ÛË36.
T· ÎÂÚ·ÌÈο Y-TZP Â›Ó·È ÏÂ˘Î¿, ·Ó Î·È Ù· ÚÔ˚fiÓÙ· Ô˘
ÚÔ·ÙÔ˘Ó ·fi ·Ú·ÁˆÁ‹ ÈÛÔÛÙ·ÙÈ΋˜ Û˘Ì›ÂÛ˘ ÛÂ
·Ô˘Û›· Ô͢ÁfiÓÔ˘ ¤¯Ô˘Ó ·Ú¯Èο Ì·‡ÚÔ ¯ÚÒÌ·. EÓ Û˘Ó¯›· fï˜ ˘fiÎÂÈÓÙ·È Û ıÂÚÌÈ΋ ÂÂÍÂÚÁ·Û›· ÛÙÔ˘˜
1000ÆC-1200ÆC Î·È ·ÚÔ˘Û›· Ô͢ÁfiÓÔ˘, ·ÔÎÙÒÓÙ·˜
ÛÙ·‰È·Î¿ ¤Ó· ¿ÛÚÔ ¯ÚÒÌ·56. T· ÎÂÚ·ÌÈο Mg-PSZ ›ӷÈ
ΛÙÚÈÓÔ˘ ¯ÚÒÌ·ÙÔ˜ ÂÓÒ Ù· ZTA Â›Ó·È ÏÂ˘Î¿.
3.3. MHXANIKE™ I¢IOTHTE™
¢ÂÓ ˘¿Ú¯ÂÈ Î·Ì›· ·ÌÊÈ‚ÔÏ›· fiÙÈ Ù· ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ηχÙÂÚ˜ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ·fi ¿ÏÏ· ÎÂÚ·ÌÈο
fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· Ë ·ÏÔ˘Ì›Ó·7. H ÂÍ·ÈÚÂÙÈ΋ ·fi‰ÔÛË
ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ˙ÈÚÎÔÓ›·˜ ÛÙȘ Ì˯·ÓÈΤ˜ ‰ÔÎÈ̤˜ ÔÊ›ÏÂÙ·È ÚÒÙÈÛÙ· ÛÙËÓ ˘ÎÓ‹ ‰ÔÌ‹, ÛÙÔ˘˜ ÌÈÎÚÔÎfiÎÎÔ˘˜ ηÈ
ÛÙËÓ ·Ô˘Û›· ·ÙÂÏÂÈÒÓ8. OÈ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ÂËÚ¿˙ÔÓÙ·È ·fi ÙË Î·ı·ÚfiÙËÙ· ÙÔ˘ ˘ÏÈÎÔ‡, ÙËÓ ˘ÎÓfiÙËÙ·, ÙÔ
ÔÚ҉˜, ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ, ·fi ÙËÓ ÎÚ˘ÛÙ·ÏÏÈ΋
‰ÔÌ‹ (t-c-m Ê¿ÛÂȘ), ·fi Ù· ÁˆÌÂÙÚÈο ¯·Ú·ÎÙËÚÈÛÙÈο
Î·È Ù· ÂÈÊ·ÓÂȷο ¯·Ú·ÎÙËÚÈÛÙÈο (¶›Ó·Î·˜ 2). I‰È·›ÙÂÚ·
Ì·˜ ÂӉȷʤÚÂÈ Ë ·ÓÙÔ¯‹ ÛÂ Î¿Ì„Ë Ë ÔÔ›· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ Î·ı·ÚfiÙËÙ·, ˘ÎÓfiÙËÙ· ÙÔ˘ ˘ÏÈÎÔ‡, ÙÔ ÎÚ›ÛÈÌÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÎfiÎΈÓ, ÙÔ ÔÛfi Ù˘ t-Ê¿Û˘ Î·È ÙË Ì¤ıÔ‰Ô
˘ÚÔÛ˘Ûۈ̿وÛ˘8. H ·ÓÙÔ¯‹ ÛÙËÓ Î¿Ì„Ë ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP Î˘Ì·›ÓÂÙ·È Á‡Úˆ ÛÙ· 500MPa40, 128, ÂÓÒ ¤¯Ô˘Ó
ηٷÁÚ·Ê› Î·È È‰È·›ÙÂÚ· ˘„ËϤ˜ ÙÈ̤˜ Ù˘ Ù¿Í˘ ÙˆÓ
900-1200 MPa7. H ÙÈÌ‹ ÙˆÓ 900 MPa ÚÔ·ÙÂÈ ·fi ÙËÓ
Ù¯ÓÈ΋ ˘ÚÔÛ˘Ûۈ̿وÛ˘ ¯ˆÚ›˜ ›ÂÛË Î·È Ë ÙÈÌ‹ ÙˆÓ
1200 MPa ÂÈÙ˘Á¯¿ÓÂÙ·È Î·Ù¿ ÙËÓ Û‡ÓÙËÍË Û ˘„ËÏ‹ ›ÂÛË (HiP)40, 57. H Â›‰ÔÛË ÙˆÓ ZTA ÛÙȘ ‰ÔÎÈ̤˜ ο̄˘ ‰›ÓÂÈ ÌÈÎÚfiÙÂÚ˜ ÙÈ̤˜ 400-450 MPa39.
TÔ Ì¤ÙÚÔ ÂÏ·ÛÙÈÎfiÙËÙ·˜ Â›Ó·È Û¯ÂÙÈο ¯·ÌËÏfi ÂÈÙÚ¤ÔÓÙ·˜ ÌÂÁ¿ÏË ·Ú·ÌfiÚʈÛË ÙÔ˘ ˘ÏÈÎÔ‡ ̤¯ÚÈ ÙË ıÚ·‡ÛË
ÙÔ˘, ÌÔÓ·‰È΋ ȉÈfiÙËÙ· ÛÙ· „·ı˘Ú¿ ˘ÏÈο. A˘Ùfi ÂÈÙÚ¤ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ ·ÔÚÚfiÊËÛË Ù¿ÛÂˆÓ Ô˘ ·ÓÙ·ÔÎÚ›ÓÂÙ·È ¿ÚÈÛÙ· ÛÙȘ ‰ÔÎÈ̤˜ ÎfiˆÛ˘8. ™ÙË ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯ÂÈ ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÙÈÌÒÓ ‰˘ÛıÚ·˘ÛÙfiÙËÙ·˜ ÁÈ·
ÙË ˙ÈÚÎÔÓ›· Î·È ÔÈΛÏÂÈ ·fi 4-19MPa m-1/2. H Û‡ÁÎÚÈÛË
·˘ÙÒÓ ÙˆÓ ÙÈÌÒÓ Â›Ó·È ‰‡ÛÎÔÏË Î·ıÒ˜ ÚÔ·ÙÔ˘Ó ·fi
‰È·ÊÔÚÂÙÈΤ˜ Ù¯ÓÈΤ˜ Î·È ÂËÚ¿˙ÔÓÙ·È ·fi ÙÔ Ì¤ÁÂıÔ˜
zirconia has low toughness which can lead to cracking in
long term use. For this reason more recently it has been
proposed to add alumina in cubic zirconia electrolytes to
improve the hardness and fracture toughness (Kic) but in
a small proportion, as the addition of alumina has a
negative impact on the electrical conductivity59.
Another application of zirconia is in high performance or
pressure chromatography (HPLC). Due to the high
pressure, the HPLC is rapid (results in some minutes) and
due to fine grain adsorbents materials that are used
provide high separation efficiency. The main reason is the
excellent chemical and thermal stability, which remains
even at temperatures above 300ÆC for a long time60.
Silica (SiO2) was the first of the materials used as gate
dielectric materials for the manufacture of integrated
circuits. But as it was necessary to gradually reduce the
size of the devices, the size of the membranes had to
respectively decrease and in order to create current
leakage the use of materials with higher dielectric constant
was proposed. Partially stabilized zirconia (YSZ) is one of
the materials that can remain thermodynamically stable in
contact with silicon even at 1000ÆC and therefore is quite
promising as gate dielectric material to replace SiO261.
Cubic zirconia is used in oxygen sensors which have a
wide range of industrial applications. Such sensors are
used to control the oxygen content in exhaust gases or
molten metals. In automotive industry is known as oxygen
sensors (Ï)-type62. Combining the high durability and the
improved conductivity compared to that of fully stabilized
zirconia ceramics, Y-TZP ceramics are excellent for use
as electrolytes in electrochemical applications such reactors, oxygen pumps and fuel cells63. The chemical
stability, high melting point, electrical and optical properties makes them ideal components for high resistance
to wear and for connecting optical fibers64. There is a wide
variety of applications of zirconia in its various forms,
which are summarized in Table 39.
ZIRCONIA CERAMICS IN DENTISTRY
Although there are many types of systems in the industry
of ceramics containing zirconia65, three are currently
available for use in dentistry. These are fully stabilized
tetragonal zirconia, partially stabilized zirconia and zirconia -reinforced alumina.
¶›Ó·Î·˜ 2. ªË¯·ÓÈΤ˜ ȉÈfiÙËÙ˜ ˙ÈÚÎÔÓ›·˜
I‰ÈfiÙËÙ·/YÏÈÎfi
Y-TZP
Ce-TZP
ZTA
Mg-PSZ
3
¶˘ÎÓfiÙËÙ· (gr/cm )
6.05
6.15
4.15
5.75
™ÎÏËÚfiÙËÙ· (HV30)
1350
900
1600
1020
AÓÙÔ¯‹ ÛÙËÓ Î¿Ì„Ë (MPa)
1000
350
500
800
AÓÙÔ¯‹ ÛÙË Û˘Ì›ÂÛË (MPa)
2000
-
-
2000
M¤ÙÚÔ ÂÏ·ÛÙÈÎfiÙËÙ·˜ (GPa)
205
215
380
205
114
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Table 3. Major Zirconia industrial applications
Valve and pump parts
Cable guides
Cutting tools
Friction and dispersal means
Oxygen Sensors
Fuel cells membranes
Thermal Barriers
Fiber optic accessories
ÎfiÎΈÓ, ˘ÎÓfiÙËÙ· Î·È ÔÛÔÛÙfi ÚÔƯ͈̂Ó57. ¶¿ÓÙˆ˜ Ë
‰˘ıÚ·˘ÛÙfiÙËÙ· ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP Â›Ó·È ˘„ËÏfiÙÂÚË
Û ۯ¤ÛË Ì ¿ÏÏ· ÎÂÚ·ÌÈο fiˆ˜ Ë ·ÏÔ˘Ì›Ó·.
3.4. EºAPMO°E™ ™TH BIOMHXANIA - A§§E™
EºAPMO°E™
H ˙ÈÚÎÔÓ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÌÔÚʤ˜
Ù˘ ÛÙË ‚ÈÔÌ˯·Ó›·. MÈ· ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÂÊ·ÚÌÔÁ‹
Ù˘ ΢‚È΋˜ ˙ÈÚÎÔÓ›·˜ YSZ (Y-16%) Â›Ó·È ÛÙȘ ΢„¤Ï˜
η˘Û›ÌÔ˘. H ˙ÈÚÎÔÓ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È ˆ˜ ËÏÂÎÙÚÔχÙ˘
Î·È Ì¿ÏÈÛÙ· Ì ȉȷ›ÙÂÚ· ÏÂÙfi ¿¯Ô˜ Â›ÛÙÚˆÛ˘ ÂÈÙ˘Á¯¿ÓÂÙ·È ¯·ÌËÏ‹ ·ÓÙ›ÛÙ·ÛË, ËÏÂÎÙÚÈ΋ ‰È·ÚÚÔ‹ ηÈ
¯·ÌËÏfiÙÂÚË ıÂÚÌÔÎÚ·Û›· ÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ΢„¤Ï˘58.
ŸÌˆ˜, fiˆ˜ ÚԷӷʤÚıËÎÂ, Ë Î˘‚È΋ ˙ÈÚÎÔÓ›· ¤¯ÂÈ ¯·ÌËÏ‹ ‰˘ÛıÚ·˘ÛÙfiÙËÙ· Ú¿ÁÌ· Ô˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ
Û ‰ËÌÈÔ˘ÚÁ›· ÚˆÁÌÒÓ Û ̷ÎÚfi¯ÚÔÓË ÏÂÈÙÔ˘ÚÁ›·.
°È· ÙÔ ÏfiÁÔ ·˘Ùfi ÚfiÛÊ·Ù· ÚÔÙ¿ıËÎÂ Ë ÚÔÛı‹ÎË ·ÏÔ˘Ì›Ó·˜ Û ËÏÂÎÙÚÔχÙ˜ ΢‚È΋˜ ˙ÈÚÎÔÓ›·˜ ÒÛÙ ӷ
‚ÂÏÙȈı› Ë ÛÎÏËÚfiÙËÙ· Î·È Ë ‰˘ıÚ·˘ÛÙfiÙËÙ· Kic ·ÏÏ¿
Û ÌÈÎÚfi ÔÛÔÛÙfi ηıÒ˜ Ë ÚÔÛı‹ÎË ·ÏÔ˘Ì›Ó·˜ ¤¯ÂÈ
·ÚÓËÙÈ΋ Â›ÙˆÛË ÛÙËÓ ËÏÂÎÙÚÈ΋ ·ÁˆÁÈÌfiÙËÙ·59.
MÈ· ¿ÏÏË ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÎÂÚ·ÌÈÎÒÓ ˙ÈÚÎÔÓ›·˜ Â›Ó·È ÛÙË
¯ÚˆÌ·ÙÔÁÚ·Ê›· ˘„ËÏ‹˜ ·fi‰ÔÛ˘ ‹ ›ÂÛ˘ (HPLC).
§fiÁˆ Ù˘ ˘„ËÏ‹˜ ȤÛˆ˜, Ë HPLC Â›Ó·È Ù·¯‡Ù·ÙË (·Ú¤¯ÂÈ ·ÔÙ¤ÏÂÛÌ· Û ÌÂÚÈο ÏÂÙ¿ Ù˘ ÒÚ·˜) Î·È ÂÂȉ‹
¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÏÂÙfiÎÔÎη ˘ÏÈο ÚÔÛÚfiÊËÛ˘ (Ï›Á· Ìm) ·Ú¤¯ÂÈ ÌÂÁ¿ÏË ÈηÓfiÙËÙ· ‰È·¯ˆÚÈÛÌÔ‡. O ·ÚÈÔ˜ ÏfiÁÔ˜ Â›Ó·È Ë ÂÍ·ÈÚÂÙÈ΋ ¯ËÌÈ΋ Î·È ıÂÚÌÈ΋ ÛÙ·ıÂÚfiÙËÙ· Ù˘, Ë ÔÔ›· ·Ú·Ì¤ÓÂÈ ·ÎfiÌ· Î·È Û ıÂÚÌÔÎڷۛ˜ ¿Óˆ ÙˆÓ 300ÆC ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·60.
To ‰ÈÔÍ›‰ÈÔ ˘ÚÈÙ›Ô˘ (SiO2) ˘‹ÚÍ ·fi Ù· ÚÒÙ· ˘ÏÈο
Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ ‰ÈËÏÂÎÙÚÈο ˘ÏÈο ‡Ï˘ ÁÈ·
ÙËÓ Î·Ù·Û΢‹ ÔÏÔÎÏËÚˆÌ¤ÓˆÓ Î˘Îψ̿وÓ. K·ıÒ˜ fï˜ ¯ÚÂÈ¿ÛÙËΠӷ ÌÂȈı› ÛÙ·‰È·Î¿ ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ
Û˘Û΢ÒÓ, ÌÂÈÒıËΠ·ÓÙ›ÛÙÔȯ· ÙÔ Ì¤ÁÂıÔ˜ ÙˆÓ ÌÂÌ‚Ú·ÓÒÓ Î·È ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ËÌÈÔ˘ÚÁËı› ‰È·ÚÚÔ‹ Ú‡̷ÙÔ˜ ÚÔÙ¿ıËÎÂ Ë ¯Ú‹ÛË ˘ÏÈÎÒÓ Ì ÌÂÁ·Ï‡ÙÂÚË ‰ÈËÏÂÎÙÚÈ΋ ÛÙ·ıÂÚ¿.
H ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›· (YSZ) Â›Ó·È ¤Ó· ·fi Ù· ˘ÏÈο Ô˘ ÌÔÚÔ‡Ó Ó· ·Ú·Ì¤ÓÔ˘Ó ıÂÚÌÔ‰˘Ó·ÌÈο ÛÙ·ıÂÚ¿ Û Â·Ê‹ Ì ˘Ú›ÙÈÔ ·ÎfiÌ· Î·È Û 1000ÆC,
Î·È Û˘ÓÂÒ˜ ·ÚÎÂÙ¿ ˘ÔÛ¯fiÌÂÓÔ ‰ÈËÏÂÎÙÚÈÎfi ˘ÏÈÎfi ‡Ï˘ ÁÈ· Ó· ·ÓÙÈηٷÛÙ‹ÛÂÈ ÙÔ SiO261.
H ΢‚È΋ ˙ÈÚÎÔÓ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Û ·ÈÛıËÙ‹Ú˜ Ô͢ÁfiÓÔ˘ ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ¤Ó· ÌÂÁ¿ÏÔ Ê¿ÛÌ· ‚ÈÔÌ˯·ÓÈÎÒÓ
ÂÊ·ÚÌÔÁÒÓ. T¤ÙÔÈÔÈ ·ÈÛıËÙ‹Ú˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ·
ÙÔÓ ¤ÏÂÁ¯Ô ÂÚÈÂÎÙÈÎfiÙËÙ·˜ Ô͢ÁfiÓÔ˘ Û η˘Û·¤ÚÈ· ‹
Hellenic Stomatological Review 57: 101-137, 2013
Most manufactured zirconia ceramics for dental clinical
use are those of partially stabilized tetragonal zirconia,
which, depending on the laboratory manufacturing
process are divided into two categories. The first one,
where milling and machining is performed during the socalled «green stage», the partially sintered form. In this
category, high performance systems are: CEREC 3 and in
lab DCS Precident, Procera, Lava, Cercon Smart
Ceramics, Everest, Denzir, DentaCad and Evolution D4D.
As a disadvantage is considered the fact that the
frameworks must be done larger by 20-25% in order to
counteract the contraction that occurs during the final
stage of sintering. Unlike, the cutting and milling in this
form of zirconia is faster and cutting tools that serve this
purpose suffer less wear66. In the second category the
milling and construction are completed in the fully sintered format after burning down and compression (Hot Isostatic Pressing or HiP) of zirconia. The main representatives of this technique are the systems DC-Zirkon (DCS
Dental AG), Everest-ZH (Kavo), Denzir (Cadesthetics
AB)67, 23. This technique is advantageous in that the final
versions of the frameworks do not undergo dimensional
changes. On the other hand cutting and processing is
extremely difficult and time consuming because of the
high hardness of the material66. Even today there is no
consensus among researchers regarding the choice of
method of manufacturing zirconia frameworks concerning which is less damaging to the final product, and that
is the reason that both the aforementioned techniques still
exist68. Table 4 contains the major CAD-CAM system for
zirconia materials processing.
ZIRCONIA CERAMICS APPLICATIONS IN DENTISTRY
Dental prosthetic restorations should serve the function
and patient comfort and maintain their integrity over time70.
The selection of appropriate materials therefore must be
driven by the success and survival of restorations. Zirconia
ceramics are used in a wide range of applications in
dentistry. Therefore together with metal-ceramic and other
systems add an alternative approach in reconstructions
where strength has to be combined with increased demands for aesthetics.
SINGLE TOOTH RESTORATIONS
The most frequently used individual dental restorations in
115
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Û ÙËÁ̤ӷ ̤ٷÏÏ·. ™ÙËÓ ·˘ÙÔÎÈÓËÙÔ‚ÈÔÌ˯·Ó›· ÂÊ·ÚÌÔÁ‹ Â›Ó·È ÁÓˆÛÙÔ› ˆ˜ ·ÈÛıËÙ‹Ú˜ Ͽ̉· (Ï)62.
™˘Ó‰˘¿˙ÔÓÙ·˜ ÙËÓ ˘„ËÏ‹ ·ÓÙÔ¯‹ Î·È ÙËÓ ‚ÂÏÙȈ̤ÓË ·ÁˆÁÈÌfiÙËÙ· ·fi ÂΛÓË Ù˘ Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘
˙ÈÚÎÔÓ›·˜ Ù· ÎÂÚ·ÌÈο Y-TZP Â›Ó·È ÂÍ·ÈÚÂÙÈο ÁÈ· ¯Ú‹ÛË
Û·Ó ËÏÂÎÙÚÔχÙ˜ Û ÂÊ·ÚÌÔÁ¤˜ fiˆ˜ ËÏÂÎÙÚÔ¯ËÌÈÎÔ›
·ÓÙȉڷÛÙ‹Ú˜, ·ÓÙϛ˜ Ô͢ÁfiÓÔ˘ Î·È Î˘„¤Ï˜ η˘Û›ÌÔ˘64. H ¯ËÌÈ΋ ÛÙ·ıÂÚfiÙËÙ·, ÙÔ ˘„ËÏfi ÛËÌÂ›Ô Ù‹Í˘, ÔÈ
ËÏÂÎÙÚÈΤ˜ Î·È ÔÙÈΤ˜ ȉÈfiÙËÙ¤˜ ÙÔ˘˜ Ù· ηıÈÛÙ¿ ȉ·ÓÈο
ÁÈ· ÂÍ·ÚÙ‹Ì·Ù· ˘„ËÏ‹˜ ·ÓÙ›ÛÙ·Û˘ ÛÙËÓ ÊıÔÚ¿ Î·È ÁÈ·
Û‡Ó‰ÂÛË ÔÙÈÎÒÓ ÈÓÒÓ. Y¿Ú¯ÂÈ Ì›· ÌÂÁ¿ÏË ÔÈÎÈÏ›· ÂÊ·ÚÌÔÁÒÓ Ù˘ ˙ÈÚÎÔÓ›·˜ Û ‰È¿ÊÔÚ˜ ÌÔÚʤ˜ Ù˘, ÔÈ Ôԛ˜ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 39.
Table 4A. Current zirconia “green stage”
CAD-CAM systems
System
Material
synthesis
Cercon
PSZ
DC-Zirkon
PSZ
IPS e.max ZirCAD
PSZ
LAVA Frame
PSZ
ProceraAllCeram
alumina
KEPAMIKA ZIPKONIA™ ™THN O¢ONTIATPIKH
ProceraAllZirkon
PSZ
¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ˘¿Ú¯Ô˘Ó ÔÏÏÔ› Ù‡ÔÈ ÎÂÚ·ÌÈÎÒÓ
ÂÊ·ÚÌÔÁÒÓ ÛÙË ‚ÈÔÌ˯·Ó›· Ô˘ ÂÚȤ¯Ô˘Ó ˙ÈÚÎÔÓ›·65,
ÙÚÂȘ Â›Ó·È Û‹ÌÂÚ· ‰È·ı¤ÛÈÌÔÈ ÁÈ· ¯Ú‹ÛË ÛÙËÓ O‰ÔÓÙÈ·ÙÚÈ΋. A˘ÙÔ› Â›Ó·È Ë Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ÙÂÙÚ·ÁˆÓÈ΋ ˙ÈÚÎÔÓ›·, Ë ÌÂÚÈÎÒ˜ ÛÙ·ıÂÚÔÔÈË̤ÓË ˙ÈÚÎÔÓ›· Î·È Ë
·ÏÔ˘Ì›Ó· ÂÓÈÛ¯˘Ì¤ÓË Ì ˙ÈÚÎÔÓ›·.
T· ÂÚÈÛÛfiÙÂÚ· ηٷÛ΢·˙fiÌÂÓ· ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜
Û ÎÏÈÓÈ΋ ¯Ú‹ÛË Â›Ó·È ·˘Ù¿ Ù˘ Ï‹Úˆ˜ ÛÙ·ıÂÚÔÔÈË̤Ó˘ ÙÂÙÚ·ÁˆÓÈ΋˜ ˙ÈÚÎÔÓ›·˜, Ù· ÔÔ›· ·Ó¿ÏÔÁ· Ì ÙËÓ
ÂÚÁ·ÛÙËÚȷ΋ ‰È·‰Èηۛ· ηٷÛ΢‹˜ ÙÔ˘˜ ‰È·ÎÚ›ÓÔÓÙ·È Û ‰‡Ô ηÙËÁÔڛ˜. H ÚÒÙË ÂÎÙÂÏ› ÙÔÓ ÂÎÙÚÔ¯ÈÛÌfi Ù˘ ÚÒÙ˘ ‡Ï˘ ηٿ ÙÔ ÏÂÁfiÌÂÓÔ «green stage»,
‰ËÏ·‰‹ ÛÙË ÌÂÚÈÎÒ˜ Û˘ÓÙËÁ̤ÓË ÌÔÚÊ‹ Ù˘. ™Â ·˘Ù‹ ÙË
ηÙËÁÔÚ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÔÈΛϷ ·ÍÈfiÏÔÁ· Û˘ÛÙ‹Ì·Ù· ˘„ËÏ‹˜ ·fi‰ÔÛ˘: CEREC 3 Î·È in lab DCS Precident, Procera, Lava, Cercon Smart Ceramics, Everest,
Denzir, DentaCad Î·È Evolution D4D. MÂÈÔÓ¤ÎÙËÌ· ıˆÚÂ›Ù·È ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÛÎÂÏÂÙÔ› Ô˘ ηٷÛ΢¿˙ÔÓÙ·È
Ì ·˘Ù‹Ó ÙËÓ Ù¯ÓÈ΋ Â›Ó·È ÌÂÁÂı˘Ì¤ÓÔÈ Î·Ù¿ 20-25% ÁÈ·
Ó· ·ÓÙÈÚÚÔ‹ÛÔ˘Ó ÙË Û˘ÛÙÔÏ‹ Ô˘ Â¤Ú¯ÂÙ·È Î·Ù¿ ÙÔ
ÙÂÏÈÎfi ÛÙ¿‰ÈÔ Ù˘ ˘ÚÔÛ˘Ûۈ̿وÛ˘. AÓÙ›ıÂÙ· Ô ÂÎÙÚÔ¯ÈÛÌfi˜ Û ·˘Ù‹ ÙË ÌÔÚÊ‹ Ù˘ ˙ÈÚÎÔÓ›·˜ Â›Ó·È Ù·¯‡ÙÂÚÔ˜ Î·È Ù· ÎÔÙÈο ÂÚÁ·Ï›· Ô˘ Â͢ËÚÂÙÔ‡Ó ·˘Ùfi
ÙÔ ÛÎÔfi ˘Ê›ÛÙ·ÓÙ·È ÌÈÎÚfiÙÂÚË ÊıÔÚ¿66. H ‰Â‡ÙÂÚË ·ÊÔÚ¿ ÙÔÓ ÂÎÙÚÔ¯ÈÛÌfi Î·È Î·Ù·Û΢‹ Ù˘ ÛÙËÓ Ï‹Úˆ˜
Û˘ÓÙËÁ̤ÓË ÌÔÚÊ‹ Ù˘ fiÙ·Ó ¤¯ÂÈ ÚÔËÁËı› Ë ¤„ËÛË
οو ·fi Û˘Ì›ÂÛË (Hot Isostatic Pressing ‹ HiP) Ù˘
˙ÈÚÎÔÓ›·˜. K‡ÚÈÔÈ ÂÎÚfiÛˆÔÈ ·˘Ù‹˜ Ù˘ Ù¯ÓÈ΋˜ ›ӷÈ
Ù· Û˘ÛÙ‹Ì·Ù· DC-Zirkon (DCS Dental AG), Everest-ZH
(Kavo), Denzir (Cadesthetics AB)22. H Û˘ÁÎÂÎÚÈ̤ÓË Ù¯ÓÈ΋ ÏÂÔÓÂÎÙ› ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÙÂÏÈΤ˜ ÌÔÚʤ˜ ÙˆÓ
VitaYZ
PSZ
Table 4B. Current fully-sintered zirconia
CAD-Cam systems
System
Material synthesis
Denzir
PSZ
Digizon
PSZ
Everst ZH blanks
PSZ
clinical practice are the total coverage crowns, mainly
because of their excellent clinical reliability over other
more conservative restorations (inlays,onlays etc)71. The
removal of tooth structure when preparing the tooth to
receive a dental prostheses must be as conservative as
possible and any construction should be made at the
lowest possible volume, without violating the biological
principles and the principles of mechanical strength of the
structure4.
The instructions, however, for making teeth that will receive crowns with zirconia core differ slightly from those of
classical metal-ceramic crowns72. The minimum height of
clinical crown of the tooth preparation should be at least
4mm73. Particularly, incisal or occlusal reduction of the
tooth abutment should be 1.5 to 2mm and 1.2 to 1.5 mm
in the axial walls. In cervical areas finish line should be
slightly subgingivally and its width should be 0,8-1,2 mm74,
¶›Ó·Î·˜ 3. ∫‡ÚȘ ÂÊ·ÚÌÔÁ¤˜ Î·È ¯Ú‹ÛÂȘ ∑ÈÚÎÔÓ›· ÛÙË ‚ÈÔÌ˯·Ó›·
TÌ‹Ì·Ù· ‚·Ï‚›‰ˆÓ Î·È ·ÓÙÏÈÒÓ
O‰ËÁÔ› ηψ‰›ˆÓ
KÔÙÈο ÂÚÁ·Ï›·
M¤Û· ÙÚÈ‚‹˜ Î·È ‰È·ÛÔÚ¿˜
AÈÛıËÙ‹Ú˜ O͢ÁfiÓÔ˘
MÂÌ‚Ú¿Ó˜ ΢„ÂÏÒÓ Î·˘Û›ÌÔ˘
£ÂÚÌÈÎÔ› ÌÔÓˆÙ¤˜
EÍ·ÚÙ‹Ì·Ù· ÔÙÈÎÒÓ ÈÓÒÓ
116
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÛÎÂÏÂÙÒÓ ‰ÂÓ ˘Ê›ÛÙ·ÓÙ·È ÌÂÙ·‚ÔϤ˜ ‰È·ÛÙ¿ÛˆÓ, Ë ·ÔÎÔ‹ Î·È ÂÂÍÂÚÁ·Û›· fï˜ Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏË
Î·È ¯ÚÔÓÔ‚fiÚ· ÏfiÁˆ Ù˘ ˘„ËÏ‹˜ ÛÎÏËÚfiÙËÙ·˜ ÙÔ˘ ˘ÏÈÎÔ‡66. EÍ·ÎÔÏÔ˘ı› ·ÎfiÌ· Î·È Û‹ÌÂÚ· Ó· ÌËÓ ˘¿Ú¯ÂÈ ÔÌÔʈӛ· ÌÂٷ͇ ÂÚ¢ÓËÙÒÓ Û fiÙÈ ·ÊÔÚ¿ ÙËÓ ÂÈÏÔÁ‹
ÌÂıfi‰Ô˘ ηٷÛ΢‹˜ ÛÎÂÏÂÙÒÓ ˙ÈÚÎÔÓ›·˜ Ë ÔÔ›· ı· Â›Ó·È ÏÈÁfiÙÂÚÔ Î·Ù·ÛÙÚÂÙÈ΋ ÁÈ· ÙÔ ÙÂÏÈÎfi ÚÔ˚fiÓ, ÁÈ·˘Ùfi
ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· Û˘Ó˘¿Ú¯Ô˘Ó Î·È ÔÈ ‰‡Ô ÚÔ·Ó·ÊÂÚı›Û˜ Ù¯ÓÈΤ˜68. ™ÙÔÓ ¶›Ó·Î· 4 ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ù· ÛËÌ·ÓÙÈÎfiÙÂÚ· Û˘ÛÙ‹Ì·Ù· CAD-CAM ÁÈ· ÂÂÍÂÚÁ·Û›· ˘ÏÈÎÒÓ ˙ÈÚÎÔÓ›·˜.
¶›Ó·Î·˜ 4A. ™‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù·
CAD-CAM “green stage”
™‡ÛÙËÌ·
™‡ÓıÂÛË
˘ÏÈÎÔ‡
Cercon
PSZ
DC-Zirkon
PSZ
IPS e.max ZirCAD
PSZ
LAVA Frame
PSZ
ProceraAllCeram
alumina
ProceraAllZirkon
PSZ
VitaYZ
PSZ
75
. The inclination of the axial walls should be 5-6Æ73. Some
clinicians suggest 2,0 to 2,5 mm incisal/occlusal
reduction for better aesthetics and anatomical shape76.
On the other hand, there are of course minimally invasive
preparation techniques such as edge knife (knife-edge)
which seem to be an alternative technique in anterior
teeth, without reducing the strength of the structure77.
Unlike the feather-edge preparations, deep retentive
grooves and complex occlusal morphology of the
abutment should be avoided because it is extremely
difficult to reproduce78, 79. The specifications for the
laboratory part of the construction for the core thickness is
0,5 mm for posterior teeth and to 0,3 mm for the anterior77
(Fig. 5). A different approach to design the framework for
zirconia crowns is the technique of a zirconia collar80. The
Ce-TZP/Al is the hardest ceramic material currently
available for prosthetic restorations. The thickness of the
core Ce-TPZ/Al frameworks can be reduced to 0,3 mm,
compared to 0,5 mm of Y-TZP.
¶›Ó·Î·˜ 4B. ™‡Á¯ÚÔÓ· Û˘ÛÙ‹Ì·Ù·
Cad-Cam “Ï‹ÚÔ˘˜ Û˘Ûۈ̿وÛ˘”
™‡ÛÙËÌ·
™‡ÓıÂÛË ˘ÏÈÎÔ‡
Denzir
PSZ
Digizon
PSZ
Everst ZH blanks
PSZ
EºAPMO°E™ KEPAMIKøN ZIPKONIA™ ™THN O¢ONTIATPIKH ø™ E¶ANOP£øTIKøN Y§IKøN
OÈ Ô‰ÔÓÙÈΤ˜ ÚÔÛıÂÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ Ú¤ÂÈ Ó· Â͢ËÚÂÙÔ‡Ó ÙËÓ ÏÂÈÙÔ˘ÚÁ›·, ÙËÓ ¿ÓÂÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ηÈ
ÙËÓ ‰È·Ù‹ÚËÛË Ù˘ ·ÎÂÚ·ÈfiÙËÙ¿˜ ÙÔ˘˜ Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘70. H ÂÈÏÔÁ‹ ÏÔÈfiÓ ÙˆÓ Î·Ù¿ÏÏËÏˆÓ ˘ÏÈÎÒÓ Ú¤ÂÈ
Ó· Á›ÓÂÙ·È Ì ÁÓÒÌÔÓ· ÙËÓ ÂÈÙ˘¯›· Ù˘ ·ÔηٿÛÙ·Û˘.
T· ÎÂÚ·ÌÈο ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ·ÍÈÔÔÈËı› Û ÌÈ· ·ÚÎÂÙ¿
ÌÂÁ¿ÏË Áο̷ ÂÊ·ÚÌÔÁÒÓ ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋. ™˘ÓÂÒ˜
Ì·˙› Ì ٷ ̤ٷÏÏ· Î·È ¿ÏÏ· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù·
ÚÔÛı¤ÙÔ˘Ó ÌÈ· ÂÓ·ÏÏ·ÎÙÈ΋ ÚÔÛ¤ÁÁÈÛË Û ηٷÛ΢¤˜ fiÔ˘ Ë ·ÓÙÔ¯‹ Û˘Ó‰˘¿˙ÂÙ·È Ì ·˘ÍË̤Ó˜ ··ÈÙ‹ÛÂȘ
ÁÈ· ·ÈÛıËÙÈ΋.
Hellenic Stomatological Review 57: 101-137, 2013
Fig. 5: Zirconia crown. Visible are the extended dimensions of
zirconia core
After three years of clinical studies81 zirconia crowns seem
to have satisfactory levels of success, to the point that the
zirconia core is considered as a reliable alternative material to the metal framework82. To reduce the rate of ceramic chipping, a ceramic veneering material with suitable
thermal expansion coefficient compatible with that of
zirconia was tested and the three-year follow-up showed
excellent behavior83. Also, after two years follow-up it was
found that the use of core material reinforced with alumina
zirconia by 25% (In Ceram Zirconia-VITA) is equally
reliable for the manufacture of posterior teeth crowns with
Cercon Zirconia84. Similar encouraging results for the InCeram Zirconia have been published in a three year study85. However, for a more accurate assessment of the
clinical behavior and complications of the use of allceramic crowns with zirconia core, a significant number of
at least five-year studies86 should be completed and be
able to support the use of zirconia ceramics as reliable
alternative to conventional metal-prostheses85.
117
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
MONHPEI™ O¢ONTIKE™ A¶OKATA™TA™EI™
TÔ ÌÂÁ·Ï‡ÙÂÚÔ fiÁÎÔ ÌÂÌÔÓˆÌ¤ÓˆÓ ·ÔηٷÛÙ¿ÛˆÓ
ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË ·ÔÙÂÏÔ‡Ó ÔÈ ÛÙÂÊ¿Ó˜ ÔÏÈ΋˜ Î¿Ï˘„˘ ÂÍ·ÈÙ›·˜ ΢ڛˆ˜ Ù˘ ÂÍ·ÈÚÂÙÈ΋˜ ÎÏÈÓÈ΋˜ ·ÍÈÔÈÛÙ›·˜ ÙÔ˘˜ Û ۯ¤ÛË Ì ¿ÏϘ ÂÚÈÛÛfiÙÂÚÔ Û˘ÓÙËÚËÙÈΤ˜ ÌÔÓ‹ÚÂȘ ·ÔηٷÛÙ¿ÛÂȘ71. H ·Ê·›ÚÂÛË ÙˆÓ Ô‰ÔÓÙÈÎÒÓ ÈÛÙÒÓ Î·Ù¿ ÙËÓ ·Ú·Û΢‹ ÙˆÓ ‰ÔÓÙÈÒÓ ÁÈ· ÙËÓ ˘Ô‰Ô¯‹ ÚÔÛıÂÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ Ú¤ÂÈ Ó· ‚Ú›ÛÎÂÙ·È Ì¤Û·
ÛÙ· Ï·›ÛÈ· ÙˆÓ ÚԉȷÁÚ·ÊÒÓ Î¿ı ηٷÛ΢‹˜, ÒÛÙÂ
Ó· Á›ÓÂÙ·È Î·Ù¿ ÙÔÓ ÂÏ¿¯ÈÛÙÔ ‰˘Ó·Ùfi fiÁÎÔ, ¯ˆÚ›˜ Ó· ·Ú·‚È¿˙ÔÓÙ·È ÔÈ ‚ÈÔÏÔÁÈΤ˜ ·Ú¯¤˜ Ù˘ ÂÊ·ÚÌÔÁ‹˜ Î·È ÔÈ
Ì˯·ÓÈΤ˜ ·Ú¯¤˜ Ù˘ ·ÓÙÔ¯‹˜ Ù˘ ηٷÛ΢‹˜4.
OÈ Ô‰ËÁ›Â˜ ¿ÓÙˆ˜ ÁÈ· ÙËÓ ·Ú·Û΢‹ ‰ÔÓÙÈÒÓ Ô˘ ı· ˘ԉ¯ıÔ‡Ó ÛÙÂÊ¿ÓË Ì ˘Ú‹Ó· ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ÌÈÎÚ¤˜
‰È·ÊÔÚ¤˜ ·fi ·˘Ù¤˜ ÙˆÓ ÎÏ·ÛÈÎÒÓ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈÎÒÓ
ÛÙÂÊ·ÓÒÓ72. TÔ ÂÏ¿¯ÈÛÙÔ ‡„Ô˜ ÎÏÈÓÈ΋˜ ̇Ï˘ ÙÔ˘ ˘fi
·Ú·Û΢‹ ‰ÔÓÙÈÔ‡ Ú¤ÂÈ Ó· Â›Ó·È 4mm73. ¶ÈÔ Û˘ÁÎÂÎÚÈ̤ӷ ¯ÚÂÈ¿˙ÂÙ·È 1,5 ¤ˆ˜ 2mm ÎÔÙÈ΋ ‹ Ì·ÛËÙÈ΋ Ù·›ӈÛË ÙÔ˘ ÛÙËÚ›ÁÌ·ÙÔ˜ Î·È 1,2 ¤ˆ˜ 1,5mm ·Ê·›ÚÂÛË ÛÙ·
·ÍÔÓÈο ÙÔȯÒÌ·Ù·. ™ÙȘ ·˘¯ÂÓÈΤ˜ ·ÔÏ‹ÍÂȘ Ë ÔÚÈÔı¤ÙËÛË Ú¤ÂÈ Ó· Á›ÓÂÙ·È ÂÏ·ÊÚÒ˜ ÂÓ‰ÔÛ¯ÈÛÌÈο Î·È ÙÔ Â‡ÚÔ˜ ÙÔÍÔÂȉԇ˜ ·fiÏË͢ ÛÙ· ·˘¯ÂÓÈο fiÚÈ· 0,8 ¤ˆ˜
1,2mm73, 74. H ÎÏ›ÛË ÙˆÓ ·ÍÔÓÈÎÒÓ ÙÔȯˆÌ¿ÙˆÓ Ú¤ÂÈ Ó·
Â›Ó·È 5-6Æ73. OÚÈṲ̂ÓÔÈ ÎÏÈÓÈÎÔ› Ô‰ÔÓÙ›·ÙÚÔÈ Û˘ÓÈÛÙÔ‡Ó 2,0
¤ˆ˜ 2,5mm ÎÔÙÈ΋/Ì·ÛËÙÈ΋ Ù·›ӈÛË ÁÈ· ηχÙÂÚË ÔÙÈ΋ ·fi‰ÔÛË Î·È ·Ó·ÙÔÌÈ΋ ÌÔÚÊ‹76. Afi ÙËÓ ¿ÏÏË
ÏÂ˘Ú¿ ˘¿Ú¯Ô˘Ó ‚¤‚·È· Î·È ÔÈ ÂÏ¿¯ÈÛÙ· ÂÂÌ‚·ÙÈΤ˜
Ù¯ÓÈΤ˜ ·Ú·Û΢‹˜ fiˆ˜ ·˘Ù‹˜ ÙÔ˘ ¿ÎÚÔ˘ Ì·¯·›Ú·˜
(knife-edge) Ô˘ Ê·›ÓÂÙ·È Ó· ·ÔÙÂÏÔ‡Ó ÂÓ·ÏÏ·ÎÙÈ΋ Ù¯ÓÈ΋ Û ÚfiÛıÈ· ‰fiÓÙÈ·, ¯ˆÚ›˜ Ó· ÌÂÈÒÓÂÙ·È Ë ·ÓÙÔ¯‹
Ù˘ ηٷÛ΢‹˜77. AÓÙ›ıÂÙ· Ù· fiÚÈ· ¿ÎÚÔ˘ ÊÙÂÚÔ‡
(feather-edge), ÔÈ ‚·ıȤ˜ Û˘ÁÎÚ·ÙËÙÈΤ˜ ·‡Ï·Î˜ Î·È Ë
Û‡ÓıÂÙË Ì·ÛËÙÈ΋ ÌÔÚÊÔÏÔÁ›· ÙÔ˘ ÎÔÏÔ‚ÒÌ·ÙÔ˜ ı·
Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È, ‰ÈfiÙÈ Â›Ó·È ÂÍ·ÈÚÂÙÈο ‰‡ÛÎÔÏÔ
Ó· ·Ó··Ú·¯ıÔ‡Ó78, 79. OÈ ÚԉȷÁڷʤ˜ Ô˘ ·ÊÔÚÔ‡Ó
ÛÙÔ ÂÚÁ·ÛÙËÚÈ·Îfi ̤ÚÔ˜ Ù˘ ηٷÛ΢‹˜ ÁÈ· ÙÔ ¿¯Ô˜
ÙÔ˘ ˘Ú‹Ó· Â›Ó·È 0,5mm ÁÈ· Ù· Ô›ÛıÈ· ‰fiÓÙÈ· Î·È ¤ˆ˜
0,3mm ÁÈ· Ù· ÚfiÛıÈ·77 (EÈÎ. 5). M›· ‰È·ÊÔÚÂÙÈ΋ Û¯Â-
EÈÎ. 5: OÏÔÎÏËڈ̤ÓË ÛÙÂÊ¿ÓË ˙ÈÚÎÔÓ›·˜ Ì ۷Ê›˜ ÙȘ ‰È·ÛÙ¿ÛÂȘ ÙÔ˘ ÛÎÂÏÂÙÔ‡ ˙ÈÚÎÔÓ›·˜
118
The use of all-ceramic crowns as abutments for removable prostheses rarely appears in the dental literature. The
design of these crowns should provide retentive undercuts and slots87. Zirconia crowns have been used in removable prosthodontics as crowns for the support of partial
dentures87 or as primary crowns in dual crown systems
(telescopic substructures)88.
One potential disadvantage arises from the fact that with
this type of restorations, zirconia is in some parts
completely exposed to the oral environment, without the
necessary ceramic veneer coverage. This constitutes a
danger to the integrity of the restorations over time, considering the role of water in aging of zirconia89. The manufacturers, however, recommend polishing of the exposed
zirconia ceramics with extremely fine abrasives87.
ALL CERAMIC FIXED PARTIAL DENTURESSPECIFICATIONS
A fixed partial denture (FPD) prosthesis consists of
abutments and pontics, which are connected together by
connectors. The connector is a relatively thin, vulnerable
point of the prosthetic construction90. During the loading
of fixed partial dentures, connectors reach critical stresses before these stresses reach the thicker parts of the
prostheses. For this reason, the connectors are manufactured in appropriate dimensions to withstand occlusal
loads4. Especially for zirconia restorations connectors
design seems to be crucial for the flexural strength and
reliability of zirconia fixed partial dentures66. Increasing the
dimensions of the connector reduces stress concentration at critical points of the structure impacting positively
on the strength of ceramic construction90. It is suggested
the height of 4mm is sufficient for posterior teeth FPD’s
and even greater if it is placed in areas of increased loads
(bruxism or increased vertical overlap). A similar design is
not always possible due to biological constraints (clinical
crown height, interdental spaces). Some researchers
suggest connector dimensions 3x3 mm and 0.5 mm core
thickness with positive laboratory results91, while others
increase dimensions up to 4x4 mm92. However, to avoid
connector fractures (Fig. 6) and therefore zirconia core
FPD’s clinical failures there is need for proper planning
and proportional connector geometry to resist the loads
sustained during function (Fig. 7). Of particular importance are the minimum diameter of the connector (dmin) and
the radius of curvature in cross section. Clinically the
design should take into account the material properties,
the anatomical constraints, and the possibility of oral
hygiene and aesthetic expectations66.
Proper design of connector offers longevity to the
prosthetic restorations. Increasing the connector height
from 3 to 4mm significantly reduced the stress concentration93 (Fig. 8). According to Studart94 3-unit FPD’s should
have a connector cross-sectional area of 5,7 mm2, 4-unit
12,6 mm2 and 5-unit 18,8 mm2. Forces that have a special
role in connector fractures are the tensile forces
developed during function of the FPD during chewing.
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
‰È·ÛÙÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÛÎÂÏÂÙÔ‡ ˙ÈÚÎÔÓ›·˜ ÁÈ· ÌÔÓ‹ÚÂȘ ÛÙÂÊ¿Ó˜ Â›Ó·È Ë Ù¯ÓÈ΋ Ù˘ ·Ú·ÌÔÓ‹˜ ÂÓfi˜ ÎÔÏÏ¿ÚÔ˘ ˙ÈÚÎÔÓ›·˜80. TÔ ÎÂÚ·ÌÈÎfi Ce-TZP/Al Â›Ó·È ÙÔ ÛÎÏËÚfiÙÂÚÔ ÎÂÚ·ÌÈÎfi ˘ÏÈÎfi Û‹ÌÂÚ· ‰È·ı¤ÛÈÌÔ ÁÈ· ÚÔÛıÂÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ. TÔ ¿¯Ô˜ ÙÔ˘ ˘Ú‹Ó· ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Ce-TZP/Al ÛÎÂÏÂÙÒÓ ÌÔÚ› Ó· ÌÂȈı› ÛÙÔ 0,3 mm,
Û ۇÁÎÚÈÛË Ì 0,5 mm ÙˆÓ ÎÂÚ·ÌÈÎÒÓ Y-TZP.
MÂÙ¿ ·fi ÙÚÈÂÙ›˜ ÎÏÈÓÈΤ˜ ÌÂϤÙ˜81 ÔÈ ÛÙÂÊ¿Ó˜ Ê·›ÓÂÙ·È Ó· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈηÓÔÔÈËÙÈο ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜,
Û ÛËÌÂ›Ô Ô˘ Ó· ıˆÚÂ›Ù·È Ë ˙ÈÚÎÔÓ›· ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋
χÛË ÛÙÔ ÌÂÙ·ÏÏÈÎfi ÛÎÂÏÂÙfi82. °È· ÙË Ì›ˆÛË ÙÔ˘ ÔÛÔÛÙÔ‡ Ù˘ ·ÔÊÏÔ›ˆÛ˘ ‰ÔÎÈÌ¿ÛÙËΠ¤Ó· ÂÈÎ·Ï˘ÙÈÎfi
ÎÂÚ·ÌÈÎfi Ì ÙÔÓ Î·Ù¿ÏÏËÏÔ Û˘ÓÙÂÏÂÛÙ‹ ıÂÚÌÈ΋˜ ‰È·ÛÙÔÏ‹˜ Û˘Ì‚·Ùfi Ì ÂΛÓÔÓ Ù˘ ˙ÈÚÎÔÓ›·˜ Î·È Û ÙÚÈÂÙ‹
·Ú·ÎÔÏÔ‡ıËÛË ¤‰ÂÈÍ ÂÍ·ÈÚÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿83. E›Û˘ Û ‰ÈÂÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË ‰È·ÈÛÙÒıËΠfiÙÈ Ë ¯Ú‹ÛË
˘ÏÈÎÔ‡ ˘Ú‹Ó· ·ÏÔ˘Ì›Ó·˜ ÂÓÈÛ¯˘Ì¤Ó˘ Ì ˙ÈÚÎÔÓ›· ηٿ
25% (In Ceram Zirconia-VITA, Germany) Â›Ó·È ÂÍ›ÛÔ˘ ·ÍÈfiÈÛÙË ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÛÙÂÊ·ÓÒÓ ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ
Ì ÙËÓ Cercon Zirconia84. ¶·ÚfiÌÔÈ· ÂÓı·ÚÚ˘ÓÙÈο ·ÔÙÂϤÛÌ·Ù· ÁÈ· ÙÔ In-Ceram Zirconia ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› ηÈ
Û ÙÚÈÂÙ‹ ÌÂϤÙË85. ¶¿ÓÙˆ˜ ÁÈ· Ó· ˘¿ÚÍÂÈ ÔÚıfiÙÂÚË ·ÍÈÔÏfiÁËÛË Ù˘ ÎÏÈÓÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ÙˆÓ ÂÈÏÔÎÒÓ ·fi ÙË ¯Ú‹ÛË ÔÏÔÎÂÚ·ÌÈÎÒÓ ÛÙÂÊ·ÓÒÓ Ì ˘Ú‹Ó·
˙ÈÚÎÔÓ›·˜ ı· Ú¤ÂÈ Ó· ÔÏÔÎÏËÚˆı› ÛËÌ·ÓÙÈÎfi˜ ·ÚÈıÌfi˜ ÂÓÙ·ÂÙÒÓ ÌÂÏÂÙÒÓ86 Î·È Ó· ÌÔÚ¤ÛÂÈ Ó· ÛÙËÚȯı› Ë
¿Ô„Ë fiÙÈ ·ÔÙÂÏÔ‡Ó ·ÍÈfiÈÛÙË ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙȘ
Û˘Ì‚·ÙÈΤ˜ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈΤ˜ ÚÔÛıÂÙÈΤ˜ ÂÚÁ·Û›Â˜85.
H ¯Ú‹ÛË ÙˆÓ ÔÏÔÎÂÚ·ÌÈÎÒÓ ÛÙÂÊ·ÓÒÓ ÁÈ· ÛÙËÚ›ÁÌ·Ù· ÎÈÓËÙÒÓ ÚÔÛı¤ÛÂˆÓ Û¿ÓÈ· ÂÌÊ·Ó›˙ÂÙ·È ÛÙËÓ Ô‰ÔÓÙÈ·ÙÚÈ΋ ‚È‚ÏÈÔÁÚ·Ê›·. O ۯ‰ȷÛÌfi˜ ·˘ÙÒÓ ÙˆÓ ÛÙÂÊ·ÓÒÓ
Ú¤ÂÈ Ó· ·Ú¤¯ÂÈ ÙȘ ·Ó¿ÏÔÁ˜ Û˘ÁÎÚ·ÙËÙÈΤ˜ ˘ÔÛηʤ˜, Ô‰ËÁ¿ Â›‰· Î·È ˘Ô‰Ô¯¤˜ ÂÊ·Ù‹ÚˆÓ87. Œ¯ÂÈ ·Ó·ÊÂÚı› Ë ¯Ú‹ÛË ÛÙÂÊ·ÓÒÓ ˙ÈÚÎÔÓ›·˜ ÛÙËÓ ÎÈÓËÙ‹ ÚÔÛıÂÙÈ΋ ηıÒ˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ˆ˜ ÛÙÂÊ¿Ó˜ ‰ÔÓÙÈÒÓ ÛÙËÚÈÁÌ¿ÙˆÓ ÌÂÚÈÎÒÓ Ô‰ÔÓÙÔÛÙÔȯÈÒÓ87 ‹ ˆ˜ ÚˆÙÔÁÂÓ›˜ ÛÙÂÊ¿Ó˜ ÛÂ Û˘ÛÙ‹Ì·Ù· ‰ÈÏÒÓ ÛÙÂÊ·ÓÒÓ (ÙËÏÂÛÎÔÈΤ˜ ÎÈÓËÙ¤˜ ηٷÛ΢¤˜)88.
ŒÓ· Èı·Ófi ÌÂÈÔÓ¤ÎÙËÌ· ÚÔ·ÙÂÈ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ
Û ·˘ÙÔ‡ ÙÔ˘ Ù‡Ô˘ ÙȘ ÛÙÂÊ¿Ó˜, ÙÔ ˘ÏÈÎfi Ù˘ ˙ÈÚÎÔÓ›·˜
ÙÔ˘ ˘Ú‹Ó· Â›Ó·È Û ÔÚÈṲ̂ӷ ÛËÌ›· ÂÓÙÂÏÒ˜ ÂÎÙÂıÂÈ̤ÓÔ ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ ¯ˆÚ›˜ ÎÂÚ·ÌÈ΋ Î¿Ï˘„Ë. H
¤ÎıÂÛË ·˘Ù‹ ·ÔÙÂÏ› ΛӉ˘ÓÔ ÁÈ· ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ
·ÔηٷÛÙ¿ÛÂˆÓ Û ‚¿ıÔ˜ ¯ÚfiÓÔ˘ ηıÒ˜ Â›Ó·È ·ԉ‰ÂÈÁ̤ÓË Ë Û˘Ì‚ÔÏ‹ Ù˘ ·ÚÔ˘Û›·˜ ÓÂÚÔ‡ ÛÙËÓ ÂÈÙ¿¯˘ÓÛË ÙÔ˘ Ê·ÈÓÔ̤ÓÔ˘ Ù˘ Á‹Ú·ÓÛ˘ Ù˘ ˙ÈÚÎÔÓ›·˜89. OÈ
ηٷÛ΢·ÛÙ¤˜ ¿ÓÙˆ˜ Û˘ÓÈÛÙÔ‡Ó ÙË Ï›·ÓÛË Ù˘ ÂÎÙÂıÂÈ̤Ó˘ ˙ÈÚÎÔÓ›·˜ Ì ÂÍ·ÈÚÂÙÈο ÏÂÙfiÎÔÎη ÎÂÚ·ÌÈο
ÏÂÈ·ÓÙÈο ̤۷87.
Fig. 6: Extended dimensions of zirconia core
Fig.7: Crack of zirconia core in a 4 unit bridge
O§OKEPAMIKE™ °EºYPE™ - ¶PO¢IA°PAºE™
M›· ·Î›ÓËÙË ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË ·ÔÙÂÏÂ›Ù·È ·fi
Ù· ÛÙËÚ›ÁÌ·Ù· Î·È Ù· ÁÂÊ˘ÚÒÌ·Ù·, Ù· ÔÔ›· Û˘Ó‰¤ÔÓÙ·È
ÌÂٷ͇ ÙÔ˘˜ Ì ÙÔ˘˜ Û˘Ó‰¤ÛÌÔ˘˜. O Û‡Ó‰ÂÛÌÔ˜ ·ÔÙÂÏ› ¤Ó· Û¯ÂÙÈο ÏÂÙfi, ¢¿ÏˆÙÔ ÛËÌÂ›Ô ÌÈ·˜ ÌË ÔÌÔÈfiÌÔÚÊÔ˘ Û¯‹Ì·ÙÔ˜ ηٷÛ΢‹˜90. K·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘
ÊfiÚÙÈÛ˘ ÌÈ·˜ Á¤Ê˘Ú·˜ Ô Û‡Ó‰ÂÛÌÔ˜ ÊÙ¿ÓÂÈ Û ÎÚ›ÛÈ̘
Hellenic Stomatological Review 57: 101-137, 2013
Fig. 8: The previous apperture in backscattered electron image
(BEI 20X) (Tzoutzas and Tzanakakis 2010)
119
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ù¿ÛÂȘ ÚÈÓ ·fi Ù· ·¯‡ÙÂÚ· ÛËÌ›· Ù˘ ηٷÛ΢‹˜.
°È· ÙÔ ÏfiÁÔ ·˘Ùfi ÔÈ Û‡Ó‰ÂÛÌÔÈ Î·Ù·Û΢¿˙ÔÓÙ·È Û ηٿÏÏËϘ ‰È·ÛÙ¿ÛÂȘ ÒÛÙ ӷ ·ÓÙ¤¯Ô˘Ó Ù· Ì·ÛËÙÈο
ÊÔÚÙ›·4. EȉÈο ÁÈ· ÙȘ ·ÔηٷÛÙ¿ÛÂȘ ˙ÈÚÎÔÓ›·˜ Ô Û¯Â‰È·ÛÌfi˜ ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ Ê·›ÓÂÙ·È Ó· Â›Ó·È Î·ıÔÚÈÛÙÈÎfi˜
ÁÈ· ÙËÓ ·ÓÙÔ¯‹ ÛÙË ıÚ·‡ÛË Î·È ÙËÓ ‚ȈÛÈÌfiÙËÙ· ÙˆÓ ÁÂÊ˘ÚÒÓ Ì ÛÎÂÏÂÙfi ˙ÈÚÎÔÓ›·˜66. A˘Í¿ÓÔÓÙ·˜ ÙȘ ‰È·ÛÙ¿ÛÂȘ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ ÌÂÈÒÓÂÙ·È Ë Û˘ÁΤÓÙÚˆÛË Ù¿ÛˆÓ
Û ÎÚ›ÛÈÌ· ÛËÌ›· Ù˘ ‰ÔÎÔ‡ ÂȉÚÒÓÙ·˜ ıÂÙÈο ÛÙËÓ ·ÓÙÔ¯‹ Ù˘ ÔÏÔÎÂÚ·ÌÈ΋˜ ηٷÛ΢‹˜90. ¶ÚÔÙ›ÓÂÙ·È Ì¿ÏÈÛÙ· ÙÔ ‡„Ô˜ ÙˆÓ 4mm ˆ˜ Â·ÚΤ˜ ÁÈ· Á¤Ê˘Ú˜ ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ ‹ ·ÎfiÌË ÌÂÁ·Ï‡ÙÂÚÔ ·Ó ÚfiÎÂÈÙ·È ÁÈ· ÂÚÈÙÒÛÂȘ ·˘ÍË̤Ó˘ ÊfiÚÙÈÛ˘ fiˆ˜ Û ‚ÚÔ˘ÍÈÛÙ¤˜ ‹
·˘ÍË̤ÓË Î·Ù·ÎfiÚ˘ÊË ÚfiÙ·ÍË. ŒÓ·˜ ·ÚfiÌÔÈÔ˜ ۯ‰ȷÛÌfi˜ ‰ÂÓ Â›Ó·È ¿ÓÙ· ÂÊÈÎÙfi˜ ÏfiÁˆ ‚ÈÔÏÔÁÈÎÒÓ ÂÚÈÔÚÈÛÌÒÓ (‡„Ô˜ ÎÏÈÓÈ΋˜ ̇Ï˘, ÌÂÛÔ‰fiÓÙÈ· ‰È·ÛÙ‹Ì·Ù·).
OÚÈṲ̂ÓÔÈ ÂÚ¢ÓËÙ¤˜ ÚÔÙ›ÓÔ˘Ó ‰È·ÛÙ¿ÛÂȘ Û˘Ó‰¤ÛÌÔ˘
3x3 mm Î·È ¿¯Ô˜ ÛÎÂÏÂÙÔ‡ 0.5mm Ì ıÂÙÈο ÂÚÁ·ÛÙËÚȷο ·ÔÙÂϤÛÌ·Ù·91, ÂÓÒ ¿ÏÏÔÈ Û˘ÓÈÛÙÔ‡Ó ÌÂÁ·Ï‡ÙÂÚ˜ ‰È·ÛÙ¿ÛÂȘ Ù˘ Ù¿Í˘ ÙˆÓ 4x4 mm92. ¶¿ÓÙˆ˜ ÁÈ· Ó·
·ÔʇÁÔÓÙ·È Î·Ù¿ÁÌ·Ù· Û˘Ó‰¤ÛÌˆÓ Î·È Û˘ÓÂÒ˜ ÎÏÈÓÈΤ˜ ·ÔÙ˘¯›Â˜ ÁÂÊ˘ÚÒÓ Ì ˘Ú‹Ó· ˙ÈÚÎÔÓ›·˜, ¯ÚÂÈ¿˙ÂÙ·È
ηٿÏÏËÏÔ˜ ۯ‰ȷÛÌfi˜ Î·È ·Ó¿ÏÔÁË ÁˆÌÂÙÚ›· Û˘Ó‰¤ÛÌÔ˘ ÁÈ· Ó· ·ÓÙ·ÔÎÚÈı› Ô Û‡Ó‰ÂÛÌÔ˜ ÛÙ· ÊÔÚÙ›· Ô˘
˘Ê›ÛÙ·Ù·È Î·Ù¿ ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ (EÈÎ. 6). I‰È·›ÙÂÚË ÛËÌ·Û›· ÂÎÙfi˜ Ù˘ ÂÏ¿¯ÈÛÙ˘ ‰È·Ì¤ÙÚÔ˘ ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘
(dmin) ¤¯ÂÈ Î·È Ë ·ÎÙ›Ó· ηÌ˘ÏfiÙËÙ·˜ ÛÙË ‰È·ÙÔÌ‹ ÙÔ˘˜.
(EÈÎ. 7). Afi ÎÏÈÓÈ΋˜ ¿Ԅ˘ ÛÙÔ Û¯Â‰È·ÛÌfi Ú¤ÂÈ Ó·
Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë ÔÈ È‰ÈfiÙËÙ˜ ÙÔ˘ ˘ÏÈÎÔ‡, ÔÈ ·Ó·ÙÔÌÈÎÔ› ÂÚÈÔÚÈÛÌÔ›, Ë ‰˘Ó·ÙfiÙËÙ· ÛÙÔÌ·ÙÈ΋˜ ˘ÁÈÂÈÓ‹˜ ηÈ
·ÈÛıËÙÈΤ˜ ÚÔÛ‰Ô˘66.
O ÛˆÛÙfi˜ ۯ‰ȷÛÌfi˜ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ ÌÈ·˜ ·Î›ÓËÙ˘ ·ÔηٿÛÙ·Û˘ ÚÔÛ‰›‰ÂÈ Ì·ÎÚÔ‚ÈfiÙËÙ· ÛÙËÓ Î·Ù·Û΢‹. A˘Í¿ÓÔÓÙ·˜ ÙÔ ‡„Ô˜ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ Û ÔÏÔÎÂÚ·ÌÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ ·fi 3 Û 4mm ÌÂÈÒÓÂÙ·È ÛËÌ·ÓÙÈο Ë Û˘ÁΤÓÙÚˆÛË Ù¿ÛÂˆÓ ÛÙÔ˘˜ Û˘Ó‰¤ÛÌÔ˘˜93 (EÈÎ.
8). ™‡Ìʈӷ Ì ÙÔÓ Studart94 Ë ·ÔηٿÛÙ·ÛË ÙÚÈÒÓ ÙÂÌ·¯›ˆÓ Ú¤ÂÈ Ó· ¤¯ÂÈ ‰È·ÙÔÌ‹ Û˘Ó‰¤ÛÌÔ˘ ÂÌ‚·‰fi 5,7
mm2,ÙˆÓ ÙÂÛÛ¿ÚˆÓ 12,6 mm2 Î·È ÙˆÓ ¤ÓÙ 18,8 mm2.
¢˘Ó¿ÌÂȘ Ô˘ ¤¯Ô˘Ó ȉȷ›ÙÂÚÔ ÚfiÏÔ ÛÙ· ηٿÁÌ·Ù· Û˘Ó‰¤ÛÌˆÓ Â›Ó·È ÔÈ ÂÊÂÏ΢ÛÙÈΤ˜ ‰˘Ó¿ÌÂȘ Ô˘ ·Ó·Ù‡ÛÛÔÓÙ·È Î·Ù¿ ÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ Á¤Ê˘Ú·˜ Ì ÙËÓ Â›‰Ú·ÛË
ÙˆÓ Ì·ÛËÙÈÎÒÓ ‰˘Ó¿ÌÂˆÓ ÛÙË ÛÙÔÌ·ÙÈ΋ ÎÔÈÏfiÙËÙ·. H
̤ÁÈÛÙË ÂÊÂÏ΢ÛÙÈ΋ ÊfiÚÙÈÛË ·Ú·ÙËÚÂ›Ù·È ÛÙËÓ Ô˘ÏÈ΋
ÂÈÊ¿ÓÂÈ· ÙˆÓ Û˘Ó‰¤Û̈Ó93 ÁÈ’ ·˘Ùfi Î·È ÚÔÙ¿ıËÎÂ Ë ÌË
Î¿Ï˘„Ë Ù˘ Ô˘ÏÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ Û˘Ó‰¤ÛÌÔ˘ ÌÂ Î·Ï˘ÙÈ΋ ÔÚÛÂÏ¿ÓË95. H ÂÎÙÂıÂÈ̤ÓË ÂÈÊ¿ÓÂÈ· ˙ÈÚÎÔÓ›·˜ fï˜ ‰ËÌÈÔ˘ÚÁ› ÚÔ‚ÏËÌ·ÙÈÛÌÔ‡˜ ˆ˜ ÚÔ˜ ÙË Á‹Ú·ÓÛË
‹ ·ÎÚÈ‚¤ÛÙÂÚ· ÙÔÓ ÂÎÊ˘ÏÈÛÌfi ÙˆÓ Ì˯·ÓÈÎÒÓ È‰ÈÔًوÓ
Û ˘ÁÚfi ÂÚÈ‚¿ÏÏÔÓ (LTD-low temperature degradation)
ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ89. IηÓÔÔÈËÙÈο ÔÛÔÛÙ¿ ÂÈÙ˘¯›·˜ ¤¯Ô˘Ó ‚ÚÂı› Û ÙÚÈÂÙ‹ ·Ú·ÎÔÏÔ‡ıËÛË ÁÂÊ˘ÚÒÓ
˙ÈÚÎÔÓ›·˜ ÙÚÈÒÓ Î·È ÙÂÛÛ¿ÚˆÓ ÙÂÌ·¯›ˆÓ Ì ÌÔÓ·‰ÈÎfi ÌÂÈÔÓ¤ÎÙËÌ· ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÔÊÏÔ›ˆÛ˘ ÙÔ˘ ÂÈÎ·Ï˘ÙÈÎÔ‡ ÎÂÚ·ÌÈÎÔ‡96.
¶·Ú¿ ÙËÓ ·Ú¯È΋ ‰˘ÛÈÛÙ›· ÙˆÓ ÎÏÈÓÈÎÒÓ Ô‰ÔÓÙÈ¿ÙÚˆÓ
ˆ˜ ÚÔ˜ ÙËÓ ·ÎÚ›‚ÂÈ· ÔÚȷ΋˜ ÂÊ·ÚÌÔÁ‹˜ ÙˆÓ ÔÏÔÎÂÚ·ÌÈÎÒÓ ÁÂÊ˘ÚÒÓ, Û‹ÌÂÚ· ÂÎÙÈÌ¿Ù·È fiÙÈ ‰ÂÓ ˘Ê›ÛÙ·Ù·È ‰È·120
The maximum tensile loads are observed in the gingival
surface of connectors93 and for this reason non ceramic
coverage of the connector’s gingival surface has been
proposed95. The exposed zirconia surface, however, raises concerns regarding aging or rather degradation of
mechanical properties in humid environment (LTD-low
temperature degradation) in the oral environment89.
Satisfactory success rates have been reported in studies
with three year follow-ups of zirconia 3- and 4-unit FPD’s,
without significant complications apart from only a small
percentage of ceramic chipping96.
Despite the initial skepticism of clinicians as to the
accuracy of fit of all-ceramic FPD’s, currently it is estimated
that there is no difference in quality between the application
of classic metal-ceramic and modern CAD-CAM zirconia
restorations97. Laboratory studies have identified the clinically acceptable fit accuracy of 3- and 4-units zirconia
FPD’s fabricated on CAD-CAM systems98, 99, 100.
INLAY RETAINED FIXED PARTIAL DENTURES
A special category of conservative dental restorations are
the posterior teeth 3-unit inlay retained FPD’s. Of particular interest are those that replace the first molar and are
retained on inlay design cavities in the second premolar
and second molar, which can be one alternative prosthetic treatment plan of a missing molar or premolar101. It
is reported that when preparing an abutment for ceramic
crown a 67-73% of the coronal tooth substance is removed102. Therefore more tooth substance is removed on
conventional FPD’s than on inlay retained FPD’s104. An
alternative technique in which buccal and palatal (lingual)
flanges are added in both sides of the inlays seems to
improve the prognosis of such special prosthetic construction103. Nevertheless, large amounts of failure of such
structures are observed (13% to 37 months)104 and made
clinicians cautious to their widespread use, despite the
promising strength of such zirconia core constructions in
laboratory tests104.
MARYLAND FIXED PARTIAL DENTURES
Zirconia frameworks have been used for the construction
of micromechanical retention FPD’s, which are an alternative approach in several clinical cases where we need a
minimally invasive prosthetic rehabilitation. Both single
wing and double wing designs were tested. Double wing
design appears to have greater resistance to detachment
in laboratory tests106. These constructions have as complications detachments107 or fractures of the joints. A new
modified surface for bonding gives new prospects for
wider use of such special structures108.
ZIRCONIA POSTS
Castable posts of noble metals are considered as the
reference method in restoring endodontically treated
teeth with extensive loss of dental hard substances109. The
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
EÈÎ. 6: EÍ·ÈÚÂÙÈο ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ Û‡Ó‰ÂÛÌÔÈ(>4x4mm) ÛÂ
ÛÎÂÏÂÙfi Á¤Ê˘Ú·˜ ˙ÈÚÎÔÓ›·˜ ÙÂÛÛ¿ÚˆÓ ÙÂÌ·¯›ˆÓ
need for more aesthetic posts was driven from the fact
that the color of a ceramic crown is affected by the color of
the underlying coronal build-up, leading to the search for
more esthetic materials110, 111. The use of zirconia as a
structural material for posts began in 1993 as an alternative solution and was subsequently extended.
The type of restoration on an endodontically treated tooth
when a post method is selected depends on several
factors. Today the choices are divided into cast posts and
a wide range of prefabricated ones. In the second case,
the restoration of the removed tooth substance in the
coronal part is made with a restoring material. Following
this classification manufacturers have released systems
of prefabricated or customized zirconia posts111.
According to some authors fiberglass posts have lower
probability of root fracture than zirconia posts. The latter
are not removed when a failure occurs. Toksavul found
similar strengths in three different post systems and
concluded that zirconia posts are reliable as aesthetic
posts in cases when all-ceramic crowns are used to
restore endodontically treated teeth111.
However, regardless of type and technique, zirconia
posts have been heavily criticized for the fact that may
cause -due to their high rigidity- root fractures more often
than fiberglass posts113. There is also an inherent difficulty
in bonding zirconia to both adhesive cement and build-up
material, but the most important problem is considered
the difficulty to remove a zirconia post when endodontic
re-treatment is required. It is also almost impossible to
grind a cemented zirconia post113, 114.
MONOLITHIC ZIRCONIA
EÈÎ.7: K¿Ù·ÁÌ· ÛÎÂÏÂÙÔ‡ ˙ÈÚÎÔÓ›·˜ Û Á¤Ê˘Ú· ÙÂÛÛ¿ÚˆÓ ÙÂÌ·¯›ˆÓ (T˙Ô‡Ù˙·˜ I., T˙·Ó·Î¿Î˘ E. 2010)
The need to reduce and eliminate chipping failures led to the
entrance of a new technique to form full contour restorations
with the exclusive use of zirconia material. To differentiate
from other materials the term monolithic zirconia is widely
used for this new generation materials. The opacity of the
material appears to be significantly reduced due to the
decrease in the grain size of the material (nm scale). Also
due to the high strength of the material very thin restorations
can be made(0.6-0.8 mm). These require minimum tooth
preparation, almost the same that is needed to construct a
full cast crown made of gold, noble or basic alloys.
Beyond that, there are some drawbacks and weaknesses
of the new material that might impede the wide spreading.
First, the aesthetic restorations can be individualized as
limited only to external dyes and colors specified by the
manufacturer. This of course depends on the patient
selection, the skill of the laboratory and the accuracy of
color matching. Also the high hardness of the material
creates suspicions of the possible abrasion of the enamel
antagonist53, 54.
OTHER APLLIANCES
EÈÎ. 8: H ÚÔËÁÔ‡ÌÂÓË ÂÈÎfiÓ· Û ÏÂÙÔ̤ÚÂÈ· Ì ÙË ¯Ú‹ÛË ÚÔ‚ÔÏ‹˜ ÔÈÛıÔÛΉ·˙fiÌÂÓˆÓ ËÏÂÎÙÚÔÓ›ˆÓ ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ηٿÁÌ·ÙÔ˜. (BEI 20X) (T˙Ô‡Ù˙·˜ & T˙·Ó·Î¿Î˘ 2010)
Hellenic Stomatological Review 57: 101-137, 2013
Ceramic orthodontic brackets were one of the innovations
in clinical orthodontics in the late 80s. The first ceramic
had low toughness and the material used was alumina114.
121
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÊÔÚ¿ ÛÙËÓ ÔÈfiÙËÙ· ÂÊ·ÚÌÔÁ‹˜ ÌÂٷ͇ ÎÏ·ÛÈÎÒÓ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈÎÒÓ Î·Ù·Û΢ÒÓ Î·È Û‡Á¯ÚÔÓˆÓ CAD-CAM
ηٷÛ΢ÒÓ ˙ÈÚÎÔÓ›·˜97. EÚÁ·ÛÙËÚȷΤ˜ ÌÂϤÙ˜ ÂÍ·ÎÚ›‚ˆÛ·Ó ÙËÓ ÎÏÈÓÈο ·Ô‰ÂÎÙ‹ ÔÚȷ΋ ÂÊ·ÚÌÔÁ‹ ÁÂÊ˘ÚÒÓ
˙ÈÚÎÔÓ›·˜ ÙÚÈÒÓ Î·È ÙÂÛÛ¿ÚˆÓ ÙÂÌ·¯›ˆÓ ηٷÛ΢·Ṳ̂Ó˜ Ì ۇÁ¯ÚÔÓ· CAD-CAM Û˘ÛÙ‹Ì·Ù·98 ,99, 100.
°EºYPE™ ™THPIZOMENE™ ™E EN£ETA/INLAY
RETAINED FPDS
M›· ȉȷ›ÙÂÚË Î·ÙËÁÔÚ›· Û˘ÓÙËÚËÙÈÎÒÓ ÚÔÛıÂÙÈÎÒÓ ·ÔηٷÛÙ¿ÛÂˆÓ ·ÔÙÂÏÔ‡Ó ÔÈ ÙÚÈÒÓ ÙÂÌ·¯›ˆÓ Á¤Ê˘Ú˜
ÔÈÛı›ˆÓ ‰ÔÓÙÈÒÓ ÛÙËÚÈ˙fiÌÂÓ˜ Û ¤ÓıÂÙ·. I‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÔÙÂÏÔ‡Ó ÂΛӘ Ô˘ ·ÓÙÈηıÈÛÙÔ‡Ó ÙÔÓ
ÚÒÙÔ ÁÔÌÊ›Ô Î·È ÛÙËÚ›˙ÔÓÙ·È Û ÎÔÈÏfiÙËÙ˜ ÂÓı¤ÙˆÓ
ÛÙÔÓ ‰Â‡ÙÂÚÔ ÚÔÁfiÌÊÈÔ Î·È ÁÔÌÊ›Ô ·ÓÙ›ÛÙÔȯ·, ÔÈ Ôԛ˜ ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ¤Ó· ·fi ÂÓ·ÏÏ·ÎÙÈο Û¯¤‰È· ıÂÚ·›·˜ ·ÔηٿÛÙ·Û˘ ÂÓfi˜ ÂÏÏ›ÔÓÙÔ˜ ÁÔÌÊ›Ô˘ ‹ ÚÔÁÔÌÊ›Ô˘101. AӷʤÚÂÙ·È fiÙÈ Î·Ù¿ ÙËÓ ·Ú·Û΢‹
ÂÓfi˜ ÛÙËÚ›ÁÌ·ÙÔ˜ ÁÈ· ÔÏÔÎÂÚ·ÌÈ΋ ÛÙÂÊ¿ÓË ·Ê·ÈÚ›ٷÈ
ÙÔ 67-73% Ù˘ Ô‰ÔÓÙÈ΋˜ Ô˘Û›·˜ Ù˘ ̇Ï˘102. ™˘ÓÂÒ˜
ÂÚÈÛÛfiÙÂÚË Ô‰ÔÓÙÈ΋ Ô˘Û›· ·Ê·ÈÚÂ›Ù·È Û ‰fiÓÙÈ·-ÛÙËÚ›ÁÌ·Ù· Ì ‰‡Ô ÂÍˆÌ˘ÏÈΤ˜ ·Ú·Û΢¤˜ ÔÏÈ΋˜ Î¿Ï˘„˘ ·Ú¿ Û ÌÈ· Á¤Ê˘Ú· ÛÙËÚÈ˙fiÌÂÓË Û ¤ÓıÂÙ·104. M›·
ÂÓ·ÏÏ·ÎÙÈ΋ Ù¯ÓÈ΋ ηٿ ÙËÓ ÔÔ›· ÚÔÛÙ›ıÂÓÙ·È ÙÂÚ‡ÁÈ· ·ÚÂȷο Î·È ˘ÂÚÒÈ· (ÁψÛÛÈο) Âη٤ڈıÂÓ ÙˆÓ
ÂÓı¤ÙˆÓ-ÛÙËÚÈÁÌ¿ÙˆÓ Ê·›ÓÂÙ·È Ó· ‚ÂÏÙÈÒÓÂÈ ÙËÓ ÚfiÁÓˆÛË Ù¤ÙÔÈˆÓ ÂȉÈÎÒÓ ÚÔÛıÂÙÈÎÒÓ Î·Ù·Û΢ÒÓ103. ¶·ÚfiÏ· ·˘Ù¿, Ù· ÌÂÁ¿Ï· ÔÛÔÛÙ¿ ·ÔÙ˘¯›·˜ Ù¤ÙÔÈˆÓ Î·Ù·Û΢ÒÓ (13% Û 37 Ì‹Ó˜)105 Ì·˜ ηıÈÛÙÔ‡Ó ÂÈÊ˘Ï·ÎÙÈÎÔ‡˜ ÛÙËÓ Â˘Ú›· ¯Ú‹ÛË ÙÔ˘˜, ·Ú¿ ÙËÓ ÔÏÏ¿ ˘ÔÛ¯fiÌÂÓË ˘„ËÏ‹ ·ÓÙÔ¯‹ ÙÔ˘ ÛÎÂÏÂÙÔ‡ ˙ÈÚÎÔÓ›·˜ Û ÂÚÁ·ÛÙËÚȷΤ˜ ‰ÔÎÈ̷ۛ˜ Ù¤ÙÔÈˆÓ Î·Ù·Û΢ÒÓ104.
°EºYPE™ TY¶OY MARYLAND
OÈ ÛÎÂÏÂÙÔ› ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙËÓ Î·Ù·Û΢‹ ÁÂÊ˘ÚÒÓ ÌÈÎÚÔÌ˯·ÓÈ΋˜ Û˘ÁÎÚ¿ÙËÛ˘, ÔÈ Ôԛ˜
·ÔÙÂÏÔ‡Ó ÌÈ· ÂÓ·ÏÏ·ÎÙÈ΋ ÚÔÛ¤ÁÁÈÛË Û ·ÚÎÂÙ¤˜ ÎÏÈÓÈΤ˜ ÂÚÈÙÒÛÂȘ Ô˘ ¯ÚÂÈ¿˙ÂÙ·È ÌÈ· ÂÏ¿¯ÈÛÙ· ·ÚÂÌ‚·ÙÈ΋ ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË. Œ¯Ô˘Ó ‰ÔÎÈÌ·ÛÙ› ÙfiÛÔ
ÌÔÓÔÙ¤Ú˘ÁÔÈ fiÛÔ Î·È ‰ÈÙ¤Ú˘ÁÔÈ Û¯Â‰È·ÛÌÔ›, ÂÎ ÙˆÓ ÔÔ›ˆÓ ÔÈ ‰ÈÙ¤Ú˘ÁÔÈ Ê·›ÓÂÙ·È Ó· ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ¯‹ ÛÙËÓ ·ÔÎfiÏÏËÛË ÂÚÁ·ÛÙËÚȷο106. OÈ Î·Ù·Û΢¤˜ ·˘Ù¤˜ ¤¯Ô˘Ó ˆ˜ Û˘Ó‹ıÂȘ ÂÈÏÔΤ˜ ÙȘ ·ÔÎÔÏÏ‹ÛÂȘ107 ‹
Ù· ηٿÁÌ·Ù· ÙˆÓ Û˘Ó‰¤Û̈Ó. MÈ· Ó¤· ÙÚÔÔÔÈË̤ÓË ÂÈÊ¿ÓÂÈ· ÁÈ· Û˘ÁÎfiÏÏËÛË ‰›ÓÂÈ Ó¤Â˜ ÚÔÔÙÈΤ˜ ÁÈ· ¢ڇÙÂÚË ¯Ú‹ÛË Ù¤ÙÔÈˆÓ ÂȉÈÎÒÓ Î·Ù·Û΢ÒÓ108.
A•ONE™ EN¢OPPIZIKOI
OÈ ¯˘ÙÔ› ÂÓ‰ÔÚÚÈ˙ÈÎÔ› ¿ÍÔÓ˜ ·fi ¢ÁÂÓ‹ ̤ٷÏÏ· ıˆÚÔ‡ÓÙ·È ˆ˜ ̤ıÔ‰Ô˜ ·Ó·ÊÔÚ¿˜ ÛÙËÓ ·ÔηٿÛÙ·ÛË ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓˆÓ ‰ÔÓÙÈÒÓ Ì ÂÎÙÂٷ̤ÓË ·ÒÏÂÈ· ÛÎÏËÚÒÓ Ô‰ÔÓÙÈÎÒÓ Ô˘ÛÈÒÓ109. H ·Ó¿ÁÎË ÁÈ· ¿ÍÔÓ˜
Ì ηχÙÂÚË ·ÈÛıËÙÈ΋ ·fi‰ÔÛË Û ÂÚÈÙÒÛÂȘ fiÔ˘ Ë
¯ÚˆÌ·ÙÈ΋ ÈÛÙfiÙËÙ· ÌÈ·˜ ÔÏÔÎÂÚ·ÌÈ΋˜ ÛÙÂÊ¿Ó˘ ÂËÚ¿˙ÂÙ·È ·fi ÙÔ ¯ÚÒÌ· Ù˘ ˘ÔΛÌÂÓ˘ Ì˘ÏÈ΋˜ ·Ó·Û‡122
Then zirconia115 was used as an alternative ceramic with
some disadvantages. The intense white color was not
particularly aesthetic and high opacity inhibits photopolymerization of the adhesive substrate114. On the other hand,
zirconia brackets exhibited excellent resistance to abrasion116, greater resistance to deformation and less retention of dental plaque74.
In direct comparison with the metal brackets show reduced efficacy of tooth movement, greater wear of enamel
due to frequent detachment74 and greater wear of the
opposite dental barrier117. Zirconia brackets are however,
an alternative solution115. Other structures of zirconia for
dental use that have been released are some types of
precision attachments for which so far there is no available literature on their efficacy and clinical performance74.
A number of new cutters and surgical instruments based
on zirconia have been also released74.
IMPLANT ABUTMENTS
Almost in all implant brands on the market, there is a
number of prefabricated and customized abutments for
implant restorations, made of titanium alloys, gold or nonprecious metals and ceramic materials118. First ceramic
abutments were made of alumina and came into production in 1993, which despite their excellent aesthetic performance were criticized for certain failures (abutment
fractures)119, 120. Then in order to reduce the risk of failure
zirconia abutments were tested122.
Zirconia abutments can be prefabricated or customized.
The selection of prefabricated is reliable and practical, but
customized ones with the help of CAD-CAM technology
can be designed for optimum aesthetics and integration
of soft tissues74. There is need for more randomized clinical trials to evaluate the benefits of using zirconia abutments. In general having only a few research data,
findings may be summarized as follows121:
a) In frontal areas zirconia abutments function without
complications (four years studies), without knowing
their reliability for posterior restorations.
b) The biocompatibility of zirconia is similar to that of titanium at periimplant soft tissues and the accumulation
of dental plaque is less than that of titanium.
In a clinical study after four years there was no abutment
fracture, but only loosening of abutment screw in a small
percentage and ceramic chipping123. Other advantages
are considered the radiolucency of the abutments which
is similar to metals and allows a reliable assessment of the
fit accuracy through a radiographic imaging12, the less
discoloration of tissues in relation to basic alloys and even
the less bacterial adhesion to the surface of zirconia124.
COMPLICATIONS OF ZIRCONIA RESTORATIONS
1. CERAMIC CHIPPING
Complication rates of zirconia FPD’s survival, show that
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÛÙ·Û˘ Ô‰‹ÁËÛ ÛÙËÓ ·Ó·˙‹ÙËÛË ˘ÏÈÎÒÓ Ô˘ ·¤‰È‰·Ó
ηχÙÂÚË ·ÈÛıËÙÈ΋110, 111. H ¯Ú‹ÛË Ù˘ ˙ÈÚÎÔÓ›·˜ ˆ˜ ˘ÏÈÎÔ‡ ηٷÛ΢‹˜ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ ÍÂΛÓËÛ ÙÔ 1993
ˆ˜ ÂÓ·ÏÏ·ÎÙÈ΋ χÛË Î·È ÂÂÎÙ¿ıËΠÛÙË Û˘Ó¤¯ÂÈ·.
H ÂÈÏÔÁ‹ ÙÔ˘ ›‰Ô˘˜ Ù˘ ·ÔηٿÛÙ·Û˘ ÂÓfi˜ ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤ÓÔ˘ ‰ÔÓÙÈÔ‡ fiÙ·Ó ÂÈÏÂÁ› Ó· ÙÔÔıÂÙËı› ÂÓ‰ÔÚÚÈ˙ÈÎfi˜ ¿ÍÔÓ·˜ ÂÍ·ÚÙ¿Ù·È ·fi ·ÚÎÂÙÔ‡˜ ·Ú¿ÁÔÓÙ˜. ™‹ÌÂÚ· ÔÈ ÂÈÏÔÁ¤˜ ¯ˆÚ›˙ÔÓÙ·È Û ¯˘ÙÔ‡˜ ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓÔ˘˜ ¿ÍÔÓ˜ Î·È Û ¤Ó· ÌÂÁ¿ÏÔ Ê¿ÛÌ· ÚÔηٷÛ΢·ÛÌ¤ÓˆÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ. ™ÙÔ˘˜ ‰Â‡ÙÂÚÔ˘˜, Ë
·ÔηٿÛÙ·ÛË Ù˘ ·Ê·ÈÚÂı›۷˜ Ô‰ÔÓÙÈ΋˜ Ô˘Û›·˜ ÛÙÔ
Ì˘ÏÈÎfi ̤ÚÔ˜ Á›ÓÂÙ·È Ì ¤Ó· ˘ÏÈÎfi ·Ó·Û‡ÛÙ·Û˘. AÎÔÏÔ˘ıÒÓÙ·˜ ·˘Ù‹ ÙËÓ Ù·ÍÈÓfiÌËÛË Î·Ù¿ ·ÚfiÌÔÈÔ ÙÚfiÔ ¤¯Ô˘Ó
΢ÎÏÔÊÔÚ‹ÛÂÈ Û˘ÛÙ‹Ì·Ù· ÚÔηٷÛ΢·Ṳ̂ӈÓ, ·ÏÏ¿
Î·È ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓˆÓ ÂÓ‰ÔÚÚÈ˙ÈÎÒÓ ·ÍfiÓˆÓ ˙ÈÚÎÔÓ›·˜111.
™‡Ìʈӷ Ì ÔÚÈṲ̂ÓÔ˘˜ Û˘ÁÁÚ·Ê›˜ ÔÈ ¿ÍÔÓ˜ ˘·ÏÔÓËÌ¿ÙˆÓ ¤¯Ô˘Ó ÌÈÎÚfiÙÂÚË Èı·ÓfiÙËÙ· ηٷÛÙÚÔÊÈÎÒÓ Î·Ù·ÁÌ¿ÙˆÓ Û ۯ¤ÛË Ì ÙÔ˘˜ ¿ÍÔÓ˜ ˙ÈÚÎÔÓ›·˜, Î·È ÔÈ ÙÂÏÂ˘Ù·›ÔÈ ‰ÂÓ ·Ê·ÈÚÔ‡ÓÙ·È fiÙ·Ó Û˘Ì‚Â› ·ÔÙ˘¯›·. O
Toksavul112 ‚ڋΠ·ÚfiÌÔȘ ·ÓÙÔ¯¤˜ Û 3 ‰È·ÊÔÚÂÙÈο ›‰Ë ·ÍfiÓˆÓ Î·È Î·Ù¤ÏËÍ fiÙÈ ÔÈ ¿ÍÔÓ˜ ˙ÈÚÎÔÓ›·˜ Â›Ó·È ·ÍÈfiÈÛÙÔÈ ˆ˜ ÚÔ˜ ÙÔ ·ÈÛıËÙÈÎfi ·ÔÙ¤ÏÂÛÌ· Û ÂÚÈÙÒÛÂȘ
ÔÏÔÎÂÚ·ÌÈÎÒÓ ÛÙÂÊ·ÓÒÓ Ô˘ ηχÙÔ˘Ó ÂÓ‰Ô‰ÔÓÙÈο ıÂÚ·Â˘Ì¤Ó· ‰fiÓÙÈ· Ì ÂÍ·ÈÚÂÙÈ΋ ηٷÛÙÚÔÊ‹ ̇Ï˘111.
°ÂÓÈο ¿ÓÙˆ˜, ·ÓÂÍ·Úًو˜ Ù‡Ô˘ Î·È Ù¯ÓÈ΋˜, ÔÈ ¿ÍÔÓ˜ ˙ÈÚÎÔÓ›·˜ ¤¯Ô˘Ó ˘ÔÛÙ› ¤ÓÙÔÓË ÎÚÈÙÈ΋ ÁÈ· ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ê·›ÓÂÙ·È Ó· ÚÔηÏÔ‡Ó ÂÍ·ÈÙ›·˜ Ù˘ ÌÂÁ¿Ï˘ ·Î·Ì„›·˜ ÙÔ˘˜ Û˘¯Ó¿ ηٿÁÌ·Ù· ÚÈ˙ÒÓ ÈÔ Û˘¯Ó¿ ·fi
ÙÔ˘˜ ¿ÍÔÓ˜ ˘·ÏÔÓËÌ¿ÙˆÓ113. Y¿Ú¯ÂÈ Â›Û˘ ÌÈ· ÂÁÁÂÓ‹˜
‰˘ÛÎÔÏ›· Û˘ÁÎfiÏÏËÛ˘ Ù˘ ˙ÈÚÎÔÓ›·˜ ÙfiÛÔ Ì ÙËÓ Û˘ÁÎÔÏÏËÙÈ΋ ÎÔÓ›· fiÛÔ Î·È Ì ÙÔ ˘ÏÈÎfi ·Ó·Û‡ÛÙ·Û˘, ·ÏÏ¿
ÙÔ ϤÔÓ ÛËÌ·ÓÙÈÎfi Úfi‚ÏËÌ· ıˆÚÂ›Ù·È Ë ‰‡ÛÎÔÏË ·Ê·›ÚÂÛË ÙÔ˘ ¿ÍÔÓ· ˙ÈÚÎÔÓ›·˜ Û ÂÚ›ÙˆÛË Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Â·Ó¿ÏË„Ë Ù˘ ÂÓ‰Ô‰ÔÓÙÈ΋˜ ıÂÚ·›·˜ ηıÒ˜ ›ӷÈ
·‰‡Ó·ÙÔ Ó· ÙÚÔ¯ÈÛÙ› ¤Ó·˜ Û˘ÁÎÔÏÏË̤ÓÔ˜ ¿ÍÔÓ·˜113, 114.
MONO§I£IKH ZIPKONIA
H ·Ó¿ÁÎË ÁÈ· ÙË Ì›ˆÛË Î·È ÂÍ¿ÏÂÈ„Ë ÙˆÓ ·ÛÙÔ¯ÈÒÓ Ù˘ ÂÈÎ·Ï˘ÙÈ΋˜ ÔÚÛÂÏ¿Ó˘ ÛÙȘ ηٷÛ΢¤˜ ˙ÈÚÎÔÓ›·˜ Ô‰‹ÁËÛ ÛÙËÓ Â›ÛÔ‰Ô ÌÈ·˜ Ó¤·˜ Ù¯ÓÈ΋˜ ‰È·ÌfiÚʈÛ˘ ·Î›ÓËÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Ï‹ÚÔ˘˜ Ô‰ÔÓÙÈ΋˜ ·Ó·ÙÔÌ›·˜ Ì ·ÔÎÏÂÈÛÙÈ΋ ¯Ú‹ÛË ˘ÏÈÎÔ‡ ˙ÈÚÎÔÓ›·˜53. °È· ÙË
‰È·ÊÔÚÔÔ›ËÛË ·fi Ù· ¿ÏÏ· ˘ÏÈο ˙ÈÚÎÔÓ›·˜ ·Ô‰fiıËÎÂ
Ô ¯·Ú·ÎÙËÚÈÛÌfi˜ ÌÔÓÔÏÈıÈ΋ ˙ÈÚÎÔÓ›· ÁÈ· ·˘Ù‹ ÙË Ó¤· ÁÂÓÈ¿ ˘ÏÈÎÒÓ. H ·‰È·Ê¿ÓÂÈ· ÙÔ˘ ˘ÏÈÎÔ‡ Ê·›ÓÂÙ·È Ó· ÌÂÈÒÓÂÙ·È ·ÈÛıËÙ¿ ÏfiÁˆ Ù˘ Ì›ˆÛ˘ ÙÔ˘ ÌÂÁ¤ıÔ˘˜ ÙˆÓ ÎfiÎΈÓ
ÙÔ˘ ˘ÏÈÎÔ‡ (Ù˘ Ù¿Í˘ ÙˆÓ nm)54. E›Û˘ ÏfiÁˆ Ù˘ ÌÂÁ¿Ï˘ ·ÓÙÔ¯‹˜ ÙÔ˘ ˘ÏÈÎÔ‡ ηٷÛ΢¿˙ÔÓÙ·È Ôχ ÏÂÙ¿
¿¯Ë ·ÔηٷÛÙ¿ÛÂˆÓ 0,6-0,8¯ÈÏ. Ô˘ ··ÈÙÔ‡Ó ÂÏ¿¯ÈÛÙË Ô‰ÔÓÙÈ΋ ·Ú·Û΢‹ fiÛË ÂÚ›Ô˘ ··ÈÙ›ÙÔ ÁÈ· ÙËÓ
ηٷÛ΢‹ ÌÈ·˜ ÔÏÈ΋˜ ¯˘Ù‹˜ ÛÙÂÊ¿Ó˘ ·fi ÎÚ¿Ì·Ù·
¯Ú˘ÛÔ‡, ¢ÁÂÓÒÓ ‹ ‚·ÛÈÎÒÓ ÎÚ·Ì¿ÙˆÓ.
Afi ÂΛ Î·È ¤Ú· ˘¿Ú¯Ô˘Ó ÔÚÈṲ̂ӷ ÌÂÈÔÓÂÎÙ‹Ì·Ù· ηÈ
·‰˘Ó·Ì›Â˜ ÙÔ˘ Ó¤Ô˘ ˘ÏÈÎÔ‡ Ô˘ Èı·Ófi Ó· ÂÌÔ‰›ÛÔ˘Ó
ÙËÓ Â˘Ú›· ÂÍ¿ψۋ ÙÔ˘. K·Ù·Ú¯‹Ó Ë ·ÈÛıËÙÈ΋ ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ‰ÂÓ ÌÔÚ› Ó· ÂÍ·ÙÔÌÈ΢ٛ ηıÒ˜ ÂÚÈÔÚ›˙ÂÙ·È Û Â͈ÙÂÚÈΤ˜ ÌfiÓÔ ¯ÚˆÛÙÈΤ˜ Î·È ÛÙ· ¯ÚÒHellenic Stomatological Review 57: 101-137, 2013
the most frequent technical complication is the loss of the
ceramic veneering layer (chipping)66, 125. There are many
factors, such as the proper design of the zirconia framework to support the porcelain veneering layer, the appropriate processing in the dental laboratory, and further
improvements in mechanical properties and application
techniques of porcelain veneering that affect chipping
rates125.
Each manufacturer recommends treating the surface of
the zirconia framework (eg sandblast and heat treatments) before veneering with porcelain. However, the
effect of surface treatments on the bonding strength of
porcelain to zirconia is still controversial. There are differences in thermal expansion coefficients and firing temperatures between commercial veneering ceramics for
zirconia. This implies that different products have different
powder compositions. Compatibility of the coefficients of
thermal expansion needs improvement, which will likely
include the optimization of powder synthesis126.
However, there is no clear evidence demonstrating the
presence of chemical bonds between zirconia and
ceramic veneer, although there is one report126 that suggests the existence of such bond. Therefore it is assumed
that micromechanical adhesion plays a major role in
integrating zirconia and porcelain.
2. CONNECTOR FRACTURE
Another serious complication that leads to failure restorations is the fracture of the frame. Most often is observed
to the connectors. The first few failures led to the introduction of stricter criteria for the minimum dimensions of
frame and connectors and the use of shorter span restorations5 (Fig. 6). Of particular importance is the design of
the connectors where sharp endings can lead inevitably
to stress concentration points and failure. (Fig. 7-8)
3. RESTORATION DEBONDING/DECEMENTATION
The loss of retention (adhesive cement fracture) of one
tooth abutment or the entirely decementation of a dental
prosthesis is an important technical complication that
affects its survival. It is of course possible to re-cement the
prosthesis without any other complication, but sometimes
other biological complications such as secondary caries
or loss of pulp vitality require immediate replacement of
the prosthesis. The loss of retention is a very low complication rate in single crowns or FPDs127. Nevertheless, the
investigation and understanding of the causes leading to
decementation of prostheses can lead to more reliable
restorations.
Cementation is the last clinical step for the construction of
a prosthetic restoration. Provided that the preceding
steps have been executed perfectly, final cementation
completes a reliable prosthetic restoration. The bonding
surfaces must produce the maximum quality of bond so
that there is a long-term prosthetic survival and the possibility of microleakage is minimized. Apart from the surface
of the dental abutment, the inner surface of the prosthesis
123
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
Ì·Ù· Ô˘ ηıÔÚ›˙ÔÓÙ·È ·fi ÙÔÓ Î·Ù·Û΢·ÛÙ‹. A˘Ùfi ‚¤‚·È· ÂÍ·ÚÙ¿Ù·È ·fi ÙËÓ ÂÈÏÔÁ‹ ÂÚÈÛÙ·ÙÈÎÔ‡, ÙËÓ ÂȉÂÍÈfiÙËÙ· ÙÔ˘ ÂÚÁ·ÛÙËÚ›Ô˘ Î·È ÙËÓ ·ÎÚ›‚ÂÈ· Ù˘ ¯ÚˆÌ·ÙÔÏË„›·˜. AÎfiÌË Ë ÌÂÁ¿ÏË ÛÎÏËÚfiÙËÙ· ÙÔ˘ ˘ÏÈÎÔ‡ ‰ËÌÈÔ˘ÚÁ› ˘Ô„›Â˜ ÁÈ· Èı·Ó‹ ·ÔÙÚÈ‚‹ Ù˘ ·‰·Ì·ÓÙ›Ó˘
ÙÔ˘ ·ÓÙ·ÁˆÓÈÛÙ‹.
A§§E™ KATA™KEYE™/OP£O¢ONTIKH
T· ÎÂÚ·ÌÈο ÔÚıÔ‰ÔÓÙÈο ·Á·ÏÈ· (brackets) ·ÔÙ¤ÏÂÛ·Ó ÌÈ· ·fi ÙȘ ηÈÓÔÙƠ̂˜ ÛÙËÓ ÎÏÈÓÈ΋ ÔÚıÔ‰ÔÓÙÈ΋
ÛÙ· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ’80. T· ÚÒÙ· ÎÂÚ·ÌÈο ›¯·Ó ¯·ÌËÏ‹ ‰˘ÛıÚ·˘ÛÙfiÙËÙ· Î·È ÙÔ ˘ÏÈÎfi Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠ‹Ù·Ó Ë ·ÏÔ˘Ì›Ó·115. ™ÙË Û˘Ó¤¯ÂÈ· Ë ˙ÈÚÎÔÓ›·116
¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ÂÓ·ÏÏ·ÎÙÈÎfi ÎÂÚ·ÌÈÎfi Ì ·ÚÎÂÙ¿ fï˜ ÌÂÈÔÓÂÎÙ‹Ì·Ù·. TÔ ¤ÓÙÔÓ· Ï¢Îfi ¯ÚÒÌ· ‰ÂÓ ‹Ù·Ó ȉȷ›ÙÂÚ· ·ÈÛıËÙÈÎfi Î·È Ë ˘„ËÏ‹ ·‰È·Ê¿ÓÂÈ· ÂÌfi‰È˙ ÙÔÓ
ʈÙÔÔÏ˘ÌÂÚÈÛÌfi ÙÔ˘ Û˘ÁÎÔÏÏËÙÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜115. Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ ÂÌÊ¿ÓÈ˙ ÂÍ·ÈÚÂÙÈ΋ ·ÓÙ›ÛÙ·ÛË ÛÙËÓ ·ÔÙÚÈ‚‹116, ÌÂÁ·Ï‡ÙÂÚË ·ÓÙÔ¯‹ ÛÙËÓ ·Ú·ÌfiÚʈÛË Î·È ÏÈÁfiÙÂÚË Û˘ÁÎÚ¿ÙËÛË Ô‰ÔÓÙÈ΋˜ ÌÈÎÚԂȷ΋˜ Ͽη˜75.
™Â ¿ÌÂÛË Û‡ÁÎÚÈÛË Ì ٷ ÌÂÙ·ÏÏÈο brackets ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂȈ̤ÓË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÌÂٷΛÓËÛ˘ ‰ÔÓÙÈÒÓ, ÌÂÁ·Ï‡ÙÂÚË ÊıÔÚ¿ Ù˘ ·‰·Ì·ÓÙ›Ó˘ ÏfiÁˆ ÙˆÓ Û˘¯ÓÒÓ ·ÔÎÔÏÏ‹ÛˆÓ75 Î·È ÌÂÁ·Ï‡ÙÂÚË ·ÔÙÚÈ‚‹ ÙÔ˘ ·ÓÙ›ıÂÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÊÚ·ÁÌÔ‡117. AÔÙÂÏÔ‡Ó ¿ÓÙˆ˜ ÌÈ·
ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÛÙËÓ ÔÚıÔ‰ÔÓÙÈ΋115.
ÕÏϘ ηٷÛ΢¤˜ ˙ÈÚÎÔÓ›·˜ ÁÈ· Ô‰ÔÓÙÈ·ÙÚÈ΋ ¯Ú‹ÛË
Ô˘ ¤¯Ô˘Ó ΢ÎÏÔÊÔÚ‹ÛÂÈ Â›Ó·È ÔÚÈṲ̂ÓÔÈ Ù‡ÔÈ Û˘Ó‰¤ÛÌˆÓ ·ÎÚȂ›·˜ ÁÈ· ÙÔ˘˜ ÔÔ›Ô˘˜ ˆ˜ ÙÒÚ· ‰ÂÓ ˘¿Ú¯ÂÈ
‰È·ı¤ÛÈÌË ‚È‚ÏÈÔÁÚ·Ê›· ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ηÈ
ÙËÓ ÎÏÈÓÈ΋ ÙÔ˘˜ ·fi‰ÔÛË. E›Û˘ ¤¯ÂÈ Î·Ù·Û΢·ÛÙ›
ÛÂÈÚ¿ Ó¤ˆÓ ÎÔÙÈÎÒÓ Î·È ¯ÂÈÚÔ˘ÚÁÈÎÒÓ ÂÚÁ·Ï›ˆÓ Ì ‚¿ÛË ÙË ˙ÈÚÎÔÓ›·75.
most often needs some form of treatment to strengthen
the cement-substrate bond. The specificity of zirconia
framework restorations lies in the fact that due to its high
hardness and crystallinity, it remains almost unaffected by
any processing128.
There have been several experimental attempts to improve the bond between zirconia and various cements with
different results. There is still a wide field of research until
the introduction of a protocol for cementing zirconia restorations that may eliminate the unpleasant complication of
restoration decementation.
CLINICAL CASES
1) Zirconia crown replacing an old metal-ceramic crown
on # 11# (Fig. 9-12)
2) Monolithic zirconia restorations (Fig.13 a-d and Fig.14 a-d).
Fig. 9a: Image of cracked metal-ceramic crown in #21
¢IAB§ENNO°ONIA ™THPI°MATA EMºYTEYMATøN
™Â οı ÔÏÔÎÏËڈ̤ÓÔ Û‡ÛÙËÌ· ÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘ ÂÌÊ˘ÙÂ˘Ì¿ÙˆÓ Û¯Â‰fiÓ fiÏˆÓ fiÛˆÓ Î˘ÎÏÔÊÔÚÔ‡Ó
ÛÙËÓ ·ÁÔÚ¿, ˘¿Ú¯ÂÈ ÌÈ· ÛÂÈÚ¿ ÚÔηٷÛ΢·ÛÌ¤ÓˆÓ Î·È
ÂÍ·ÙÔÌÈÎÂ˘Ì¤ÓˆÓ ÛÙËÚÈÁÌ¿ÙˆÓ ÁÈ· ÂÈÂÌÊ˘ÙÂ˘Ì·ÙÈΤ˜ ·ÔηٷÛÙ¿ÛÂȘ, ηٷÛ΢·ÛÌ¤ÓˆÓ ·fi ÎÚ¿Ì·Ù· ÙÈÙ·Ó›Ô˘, ¯Ú˘ÛÔ‡ ‹ ÌË Â˘ÁÂÓÒÓ ÌÂÙ¿ÏÏˆÓ Î·È ÎÂÚ·ÌÈÎÒÓ ˘ÏÈÎÒÓ118. T· ÚÒÙ· ÎÂÚ·ÌÈο ÛÙËÚ›ÁÌ·Ù· ·fi ·ÏÔ˘Ì›Ó· ÂÌÊ·Ó›ÛÙËÎ·Ó ÛÙËÓ ·Ú·ÁˆÁ‹ ÙÔ 1993, Ù· ÔÔ›· fï˜ ·Ú¿ ÙËÓ ÂÍ·ÈÚÂÙÈ΋ ·ÈÛıËÙÈ΋ ÙÔ˘˜ ·fi‰ÔÛË ‰¤¯ÙËÎ·Ó ÎÚÈÙÈ΋ ÁÈ· ÔÚÈṲ̂Ó˜ ·ÔÙ˘¯›Â˜ (ηٿÁÌ·Ù· ÎÔÏÔ‚ˆÌ¿ÙˆÓ)119, 120. ™ÙË Û˘Ó¤¯ÂÈ· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂȈı› Ô Î›Ó‰˘ÓÔ˜ ıÚ·‡ÛÂˆÓ ‰ÔÎÈÌ¿ÛÙËÎ·Ó ÛÙËÚ›ÁÌ·Ù· ·fi ˙ÈÚÎÔÓ›·122.
T· ÛÙËÚ›ÁÌ·Ù· ˙ÈÚÎÔÓ›·˜ ÌÔÚ› Ó· Â›Ó·È ÚÔηٷÛ΢·Ṳ̂ӷ ‹ ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó·. H ÂÈÏÔÁ‹ ÙˆÓ ÚÔηٷÛ΢·ÛÌ¤ÓˆÓ Â›Ó·È ·ÍÈfiÈÛÙË Î·È Ú·ÎÙÈ΋, ·ÏÏ¿ Ù· ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó· Ì ÙË ‚Ô‹ıÂÈ· Ù˘ Ù¯ÓÔÏÔÁ›·˜ CAD-CAM ÌÔÚÔ‡Ó
Ó· ۯ‰ȷÛÙÔ‡Ó ÁÈ· ȉ·ÓÈ΋ ·ÈÛıËÙÈ΋ Î·È ÂÓۈ̿وÛË
ÙˆÓ Ì·Ï·ÎÒÓ ÈÛÙÒÓ75. Y¿Ú¯ÂÈ fï˜ ·Ó¿ÁÎË ÂÚÈÛÛfiÙÂÚˆÓ Ù˘¯·ÈÔÔÈËÌ¤ÓˆÓ ÎÏÈÓÈÎÒÓ ÌÂÏÂÙÒÓ ÁÈ· Ó· ·ÍÈÔÏÔÁËıÔ‡Ó Ù· ÔʤÏË ·fi ÙË ¯Ú‹ÛË ÛÙËÚÈÁÌ¿ÙˆÓ ˙ÈÚÎÔÓ›·˜. ™Â
124
Fig. 9b: Image of cracked metal-ceramic crown in #21(visible
metal collar in cervical area)
DISCUSSION AND CONCLUSIONS
Zirconia - ceramic systems have already gained a significant position in restorative approaches with all-ceramic
restorations. The first 3-year and 5-year studies were very
encouraging for the behavior of the material in the oral
environment, while there is a large research effort to
further reduce and eliminate problems encountered in its
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
ÁÂÓÈΤ˜ ÁÚ·Ì̤˜ ¤¯ÔÓÙ·˜ Ï›Á· ÂÚ¢ÓËÙÈο ‰Â‰Ô̤ӷ Ù·
Û˘ÌÂÚ¿ÛÌ·Ù· ÌÔÚÔ‡Ó Ó· Û˘ÓÔ„ÈÛÙÔ‡Ó ˆ˜ ÂÍ‹˜121:
·) ™Â ÚfiÛıȘ ÂÚÈÔ¯¤˜ Ù· ÛÙËÚ›ÁÌ·Ù· ˙ÈÚÎÔÓ›·˜ ÏÂÈÙÔ˘ÚÁÔ‡Ó ¯ˆÚ›˜ ÂÈÏÔΤ˜ (ÌÂϤÙ˜ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ),
¯ˆÚ›˜ Ó· ÁÓˆÚ›˙Ô˘Ì ÙËÓ ·ÍÈÔÈÛÙ›· ÙÔ˘˜ ÁÈ· ÙȘ ·ÔηٷÛÙ¿ÛÂȘ ÔÈÛı›ˆÓ ÂÚÈÔ¯ÒÓ ÙÔ˘ ÊÚ·ÁÌÔ‡.
‚) H ‚ÈÔÛ˘Ì‚·ÙfiÙËÙ· Ù˘ ˙ÈÚÎÔÓ›·˜ Â›Ó·È ·Ó¿ÏÔÁË Ì ·˘Ù‹Ó ÙÔ˘ ÙÈÙ·Ó›Ô˘ ÛÙÔ˘˜ ÂÚÈÂÌÊ˘ÙÂ˘Ì·ÙÈÎÔ‡˜ Ì·Ï·ÎÔ‡˜ ÈÛÙÔ‡˜ Î·È Ë Û˘ÁΤÓÙÚˆÛË Ô‰ÔÓÙÈ΋˜ ÌÈÎÚԂȷ΋˜ Ͽη˜ ÌÈÎÚfiÙÂÚË ·fi ·˘Ù‹Ó ÙÔ˘ ÙÈÙ·Ó›Ô˘.
™Â ÎÏÈÓÈ΋ ÌÂϤÙË Â›Û˘ ÙÂÛÛ¿ÚˆÓ ÂÙÒÓ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠοٷÁÌ· ÛÙËÚ›ÁÌ·ÙÔ˜, ·Ú¿ ÌfiÓÔ ·ÔÎÔ¯ÏÈÒÛÂȘ ÛÂ
ÌÈÎÚfi ÔÛÔÛÙfi ÛÙËÚÈÁÌ¿ÙˆÓ Î·È ·ÔÊÏÔÈÒÛÂȘ ÂÈÎ·Ï˘ÙÈÎÒÓ ÎÂÚ·ÌÈÎÒÓ123. ÕÏÏ· ÏÂÔÓÂÎÙ‹Ì·Ù· ıˆÚÔ‡ÓÙ·È Ë
·ÎÙÈÓԉȷÂÚ·ÙfiÙËÙ· ÙˆÓ ÛÙËÚÈÁÌ¿ÙˆÓ Ô˘ Â›Ó·È ·Ó¿ÏÔÁË ÙˆÓ ÌÂÙ¿ÏÏˆÓ Î·È ÂÈÙÚ¤ÂÈ ·ÍÈfiÈÛÙË ·ÍÈÔÏfiÁËÛË Ù˘
ÂÊ·ÚÌÔÁ‹˜ ̤۷ ·fi ÌÈ· ·ÎÙÈÓÔÁÚ·ÊÈ΋ ·ÂÈÎfiÓÈÛË12, fiˆ˜ Â›Û˘ Ô ÌÈÎÚfiÙÂÚÔ˜ ·ԯڈ̷ÙÈÛÌfi˜ ÙˆÓ ÈÛÙÒÓ ÛÂ
Û¯¤ÛË Ì ٷ ‚·ÛÈο ÎÚ¿Ì·Ù· Î·È ·ÎfiÌË Ë ÌÈÎÚfiÙÂÚË ÚÔÛÎfiÏÏËÛË ‚·ÎÙËÚ›ˆÓ ÛÙËÓ ÂÈÊ¿ÓÂÈ· Ù˘ ˙ÈÚÎÔÓ›·˜124.
Fig. 10: Zirconia core try-in
E¶I¶§OKE™ A¶OKATA™TA™EøN ME KAPAMIKA
ZIPKONIA™
Fig. 11: Final prosthesis
1) A¶Oº§OIø™H KEPAMIKøN E¶IKA§Y¶TIKøN Y§IKøN
T· ÔÛÔÛÙ¿ ÂÈÏÔÎÒÓ Î·È ÂÈ‚›ˆÛ˘ ·ÔηٷÛÙ¿ÛˆÓ
˙ÈÚÎÔÓ›·˜ Î·È ÌÂÙ·ÏÏÔÎÂÚ·ÌÈ΋˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÈÔ Û˘¯Ó‹
Ù¯ÓÈ΋ ÂÈÏÔ΋ ÁÈ· ÙȘ ·ÔηٷÛÙ¿ÛÂȘ ˙ÈÚÎÔÓ›·˜ ›ӷÈ
Ë ·ÒÏÂÈ· Ù˘ ÂÈÎ·Ï˘ÙÈ΋˜ ÔÚÛÂÏ¿Ó˘ (chipping)66,
125
. Y¿Ú¯Ô˘Ó ÔÏÏÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÙËÓ ÂËÚ¿˙Ô˘Ó fiˆ˜ Ô Î·Ù¿ÏÏËÏÔ˜ ۯ‰ȷÛÌfi˜ ÙÔ˘ ÔÏÔÎÂÚ·ÌÈÎÔ‡ ÛÎÂÏÂÙÔ‡ ÁÈ· ÙËÓ ˘ÔÛÙ‹ÚÈÍË Ù˘ ÂÈÎ¿Ï˘„˘ ÔÚÛÂÏ¿Ó˘,
ÙÔ ÌÂÁ¿ÏÔ ¿¯Ô˜ Ù˘ ÂÈÎ·Ï˘ÙÈ΋˜ ÔÚÛÂÏ¿Ó˘, Ô Î·Ù¿ÏÏËÏÔ˜ ¯ÂÈÚÈÛÌfi˜ ÛÙÔ Ô‰ÔÓÙÔÙ¯ÓÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ, ηÈ
ÔÈ ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙÈÒÛÂȘ ÛÙȘ Ì˯·ÓÈΤ˜ ȉÈfiÙËÙ˜ Î·È ÙȘ
Ù¯ÓÈΤ˜ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÂÈÎ¿Ï˘„˘ ÔÚÛÂÏ¿Ó˘125.
K¿ı ηٷÛ΢·ÛÙ‹˜ Û˘ÓÈÛÙ¿ ÂÂÍÂÚÁ·Û›· Ù˘ ÂÈÊ¿ÓÂÈ·˜ ÛÎÂÏÂÙÔ‡ ˙ÈÚÎÔÓ›·˜ (fiˆ˜ ·ÌÌÔ‚ÔÏ‹ Î·È ıÂÚÌÈΤ˜
ÂÂÍÂÚÁ·Û›Â˜) ÚÈÓ ·fi ÙËÓ ÂÈÎ¿Ï˘„Ë Ì ÔÚÛÂÏ¿ÓË.
øÛÙfiÛÔ, Ë Â›‰Ú·ÛË ÙˆÓ ıÂÚÌÈÎÒÓ ÂÂÍÂÚÁ·ÛÈÒÓ ÁÈ· ÙËÓ
·‡ÍËÛË ÙÔ˘ ‰ÂÛÌÔ‡ Û‡Ó‰ÂÛ˘ Ù˘ ÔÚÛÂÏ¿Ó˘ Ì ÙË ˙ÈÚÎÔÓ›· Â›Ó·È ·ÎfiÌ· ·ÌÊÈÏÂÁfiÌÂÓË. Y¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜
ÛÙÔ˘˜ ıÂÚÌÈÎÔ‡˜ Û˘ÓÙÂÏÂÛÙ¤˜ ‰È·ÛÙÔÏ‹˜ Î·È ıÂÚÌÔÎڷۛ˜ fiÙËÛ˘ ÌÂٷ͇ ÙˆÓ ÂÌÔÚÈο ÚÔ˚fiÓÙˆÓ ÂÈÎ¿Ï˘„˘ ÔÚÛÂÏ¿ÓË ÁÈ· ÙË ˙ÈÚÎÔÓ›·. A˘Ùfi Û˘ÓÂ¿ÁÂÙ·È fiÙÈ Ù·
‰È·ÊÔÚÂÙÈο ÚÔ˚fiÓÙ· ¤¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ Û˘Óı¤ÛÂȘ
ÛÎfiÓ˘. BÂÏÙ›ˆÛË ¯ÚÂÈ¿˙ÂÙ·È ÙË Û˘Ì‚·ÙfiÙËÙ· ·fi ÙÔ˘˜
Û˘ÓÙÂÏÂÛÙ¤˜ ıÂÚÌÈ΋˜ ‰È·ÛÙÔÏ‹˜, Î·È ·˘Ùfi ‚ÂÏÙ›ˆÛË Î·Ù¿ ¿Û· Èı·ÓfiÙËÙ· ı· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙË ‚ÂÏÙÈÛÙÔÔ›ËÛË
Ù˘ ÛÎfiÓ˘ Û‡ÓıÂÛ˘126.
øÛÙfiÛÔ, ‰ÂÓ ˘¿Ú¯Ô˘Ó Û·Ê›˜ ÂӉ›ÍÂȘ Ô˘ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ¯ËÌÈÎÒÓ ‰ÂÛÌÒÓ ÌÂٷ͇ ˙ÈÚÎÔÓ›·˜
Î·È ÂÈÎ¿Ï˘„Ë ÎÂÚ·ÌÈο, ·Ó Î·È ˘¿Ú¯ÂÈ Ì›· ·Ó·ÊÔÚ¿126
Ô˘ ·Ó·Ê¤ÚÂÈ ¤Ó·Ó Ù¤ÙÔÈÔ ‰ÂÛÌfi. ™˘ÓÂÒ˜ ˘ÔÙ›ıÂÙ·È fiÙÈ Ë Ì˯·ÓÈ΋ ÚfiÛÊ˘ÛË ‰È·‰Ú·Ì·Ù›˙ÂÈ ÙÔ Ì›˙ÔÓ· ÚfiÏÔ
ÛÙËÓ ÂÓۈ̿وÛË Ù˘ ÔÚÛÂÏ¿Ó˘ ÛÙË ˙ÈÚÎÔÓ›·.
Hellenic Stomatological Review 57: 101-137, 2013
Fig. 12: Absence of metal allows light transmission through
zirconia prosthesis
use. Alongside the emergence of new zirconia materials
such as as monolithic zirconia has solved the ceramic
chipping disadvantage.
There are plenty more applications of zirconia in dentistry,
few of which have scientific and long-term evidence-based
documentation. Some studies report cases with extreme
applications of zirconia such as bars, precision attachments etc. Clinicians should be particularly cautious in
accepting new undocumented applications that may be
proposed by companies or dental laboratories.
Some suspicions persist by clinicians as to the restorations behavior over time that should not be considered
groundless. The great strength of the core material does
not always guarantee longevity as there is always the risk of
a sharp change in the behavior of the material due to aging.
125
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
2) KATA°MATA ™YN¢E™MøN
M›· ¿ÏÏË ÛÔ‚·Ú‹ ÂÈÏÔ΋ Ô˘ Ô‰ËÁ› ÙȘ ·ÔηٷÛÙ¿ÛÂȘ Û ·ÛÙÔ¯›· Â›Ó·È ÙÔ Î¿Ù·ÁÌ· ÙÔ˘ ÛÎÂÏÂÙÔ‡. ¶ÈÔ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ Û˘Ó‰¤ÛÌÔ˘˜. OÈ ÚÒÙ˜ ÎÈfiÏ·˜
·ÔÙ˘¯›Â˜ Ô‰‹ÁËÛ·Ó ÛÙËÓ Î·ıȤڈÛË ·˘ÛÙËÚfiÙÂÚˆÓ
ÎÚÈÙËÚ›ˆÓ ÁÈ· ÙȘ ‰È·ÛÙ¿ÛÂȘ ÛÎÂÏÂÙÔ‡ Î·È Û˘Ó‰¤Û̈Ó
Î·È ÛÙËÓ ˘ÈÔı¤ÙËÛË ÈÔ ÂÚÈÔÚÈÛÌ¤ÓˆÓ Û ¤ÎÙ·ÛË ·ÔηٷÛÙ¿ÛˆÓ5 (EÈÎ. 6). I‰È·›ÙÂÚË ÛËÌ·Û›· ¤¯ÂÈ Î·È Ô Û¯Â‰È·ÛÌfi˜ ÙˆÓ Û˘Ó‰¤ÛÌˆÓ fiÔ˘ Ú¤ÂÈ Ó· ·ÔʇÁÔÓÙ·È
Ô͇·È¯Ì˜ ·ÔÏ‹ÍÂȘ Ô˘ Ô‰ËÁÔ‡Ó ·Ó·fiÊ¢ÎÙ· Û ÛËÌ›· Û˘ÁΤÓÙÚˆÛ˘ Ù¿ÛÂˆÓ (EÈÎ. 7&8).
3) A¶OKO§§H™H ¶PO™£ETIKøN EP°A™IøN
H ·ÒÏÂÈ· Û˘ÁÎÚ¿ÙËÛ˘ (οٷÁÌ· Û˘ÁÎÔÏÏËÙÈ΋˜ ÎÔÓ›·˜)
ÂÓfi˜ ÛÙËÚ›ÁÌ·ÙÔ˜ ·fi Ì›· ÚÔÛıÂÙÈ΋ ÂÚÁ·Û›· ‹ Ë ÂÍÔÏÔÎÏ‹ÚÔ˘ ·ÔÎfiÏÏËÛË ÌÈ·˜ ÚÔÛıÂÙÈ΋˜ ÂÚÁ·Û›·˜ ·fi Ù· Ô‰ÔÓÙÈο ÎÔÏÔ‚ÒÌ·Ù· ·ÔÙÂÏ› Ì›· ÛËÌ·ÓÙÈ΋ Ù¯ÓÈ΋ ÂÈÏÔ΋ Ô˘ ÂËÚ¿˙ÂÈ ÙËÓ ÂÈ‚›ˆÛ‹ Ù˘. E›Ó·È ‚¤‚·È· ‰˘Ó·Ù‹ Ë ¿ÌÂÛË Â·Ó·Û˘ÁÎfiÏÏËÛË Ù˘ ÂÚÁ·Û›·˜ ¯ˆÚ›˜ οÔÈ·
¿ÏÏË ÂÈÏÔ΋, ·ÏÏ¿ ÔÚÈṲ̂Ó˜ ÊÔÚ¤˜ ¿ÏϘ ‚ÈÔÏÔÁÈΤ˜ ÂÈÏÔΤ˜ fiˆ˜ ‰Â˘ÙÂÚÔÁÂÓ‹˜ ÙÂÚˉfiÓ· ‹ ·ÒÏÂÈ· ˙ˆÙÈÎfiÙËÙ·˜ ÂÈ‚¿ÏÏÔ˘Ó ÙËÓ ¿ÌÂÛË ·ÓÙÈηٿÛÙ·Û‹ Ù˘. H ·ÒÏÂÈ· Û˘ÁÎÚ¿ÙËÛ˘ Â›Ó·È Ôχ ¯·ÌËÏ‹˜ Û˘¯ÓfiÙËÙ·˜ ÂÈÏÔ΋ ÛÙȘ ÌÔÓ¤˜ ÛÙÂÊ¿Ó˜ ‹ Á¤Ê˘Ú˜127. ¶·ÚfiÏ· ·˘Ù¿ Ë ‰ÈÂÚ‡ÓËÛË ÙˆÓ ·ÈÙ›ˆÓ Ô˘ Ô‰ËÁÔ‡Ó ÛÙËÓ ·ÔÎfiÏÏËÛË ÙˆÓ
ÚÔÛıÂÙÈÎÒÓ ÂÚÁ·ÛÈÒÓ ÌÔÚ› Ó· ‚ÔËı‹ÛÂÈ ÙËÓ ¤Ú¢ӷ ÁÈ·
ÂÚÈÛÛfiÙÂÚÔ Ì·ÎÚÔ‚ÈfiÙÂÚ˜ ·ÔηٷÛÙ¿ÛÂȘ.
H ‰È·‰Èηۛ· Ù˘ ÙÂÏÈ΋˜ Û˘ÁÎfiÏÏËÛ˘ ·ÔÙÂÏ› ÙÔ ÙÂÏÂ˘Ù·›Ô ÎÏÈÓÈÎfi ÛÙ¿‰ÈÔ Î·Ù·Û΢‹˜ ÌÈ·˜ ÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘. M ÙËÓ ÚÔ¸fiıÂÛË fiÙÈ Ù· ÚÔËÁÔ‡ÌÂÓ· ÛÙ¿‰È· ¤¯Ô˘Ó ÂÎÙÂÏÂÛÙ› ȉ·ÓÈο, Ë Û˘ÁÎfiÏÏËÛË ¤Ú¯ÂÙ·È ˆ˜ ÂÈÛÙ¤Á·ÛÌ· ÁÈ· ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÌÈ·˜ ·ÍÈfiÈÛÙ˘ ÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘. OÈ ÚÔ˜ Û˘ÁÎfiÏÏËÛË ÂÈÊ¿ÓÂȘ
Ú¤ÂÈ Ó· ·Ô‰ÒÛÔ˘Ó ÙË Ì¤ÁÈÛÙË ÔÈfiÙËÙ· ‰ÂÛÌÔ‡ ¤ÙÛÈ ÒÛÙ ӷ ˘¿Ú¯ÂÈ ÌÈ· Ì·ÎÚÔ¯ÚfiÓÈ· ÂÈ‚›ˆÛË Ù˘ ÚÔÛıÂÙÈ΋˜ ·ÔηٿÛÙ·Û˘ Î·È Ó· ÂÏ·¯ÈÛÙÔÔÈËı› ÙÔ Ê·ÈÓfiÌÂÓÔ
Ù˘ ÌÈÎÚԉțۉ˘Û˘. EÎÙfi˜ ·fi ÙËÓ ÂÈÊ¿ÓÂÈ· ÙÔ˘ Ô‰ÔÓÙÈÎÔ‡ ÎÔÏÔ‚ÒÌ·ÙÔ˜, Ë ÂÛˆÙÂÚÈ΋ ÂÈÊ¿ÓÂÈ· Ù˘ ÚÔÛıÂÙÈ΋˜ ÂÚÁ·Û›·˜ ˘Ê›ÛÙ·Ù·È ÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÊÔÚ¤˜ οÔÈ·
ÌÔÚÊ‹˜ ÂÂÍÂÚÁ·Û›· ÚÔÎÂÈ̤ÓÔ˘ Ó· ÈÛ¯˘ÚÔÔÈËı› Ô ‰ÂÛÌfi˜ Ì ÙÔ Ô‰ÔÓÙÈÎfi ÎÔÏfi‚ˆÌ·. H ȉȷÈÙÂÚfiÙËÙ· ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ Ì ÛÎÂÏÂÙfi ˙ÈÚÎÔÓ›·˜ ¤ÁÎÂÈÙ·È ÛÙÔ ÁÂÁÔÓfi˜
fiÙÈ ÏfiÁˆ Ù˘ ˘„ËÏ‹˜ ÛÎÏËÚfiÙËÙ·˜ Î·È ÎÚ˘ÛÙ·ÏÏÈÎfiÙËÙ·˜
Ù˘ ˙ÈÚÎÔÓ›· ·Ú·Ì¤ÓÔ˘Ó Û¯Â‰fiÓ ·ÓÂËÚ¤·ÛÙ˜ ·fi ÔÔÈ·‰‹ÔÙ ÂÊ·ÚÌÔ˙fiÌÂÓË ÂÂÍÂÚÁ·Û›·128. Œ¯Ô˘Ó Á›ÓÂÈ
ÔÏϤ˜ ÂÈÚ·Ì·ÙÈΤ˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘
‰ÂÛÌÔ‡ ÌÂٷ͇ ˙ÈÚÎÔÓ›·˜ Î·È ‰È¿ÊÔÚˆÓ ÎÔÓÈÒÓ Ì ‰È·ÊÔÚÂÙÈο ·ÔÙÂϤÛÌ·Ù·. Y¿Ú¯ÂÈ ·ÎfiÌË Â˘Ú‡ ÂÚ¢ÓËÙÈÎfi
‰›Ô ̤¯ÚÈ ÙËÓ Î·ıȤڈÛË Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÚˆÙÔÎfiÏÏÔ˘
Û˘ÁÎfiÏÏËÛ˘ ÙˆÓ ·ÔηٷÛÙ¿ÛÂˆÓ ˙ÈÚÎÔÓ›·˜ Ô˘ ÂӉ¯Ô̤ӈ˜ Ó· ÂÍ·Ï›„ÂÈ ÙË ‰˘Û¿ÚÂÛÙË ÂÈÏÔ΋ ·ÔÎfiÏÏËÛ˘ ÌÈ·˜ ·ÔηٿÛÙ·Û˘ ·fi ÙÔ Ô‰ÔÓÙÈÎfi ÛÙ‹ÚÈÁÌ·.
K§INIKA ¶EPI™TATIKA
1) MÔÓ‹Ú˘ ÛÙÂÊ¿ÓË Ì ÛÎÂÏÂÙfi ˙ÈÚÎÔÓ›·˜ ÁÈ· ·ÓÙÈηٿÛÙ·ÛË ·Ï·È¿˜ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈ΋˜ ÛÙÂÊ¿Ó˘ Û ·ÈÛıËÙÈ΋ ÂÚÈÔ¯‹ #11(EÈÎ. 9-12)
2) ™ÙÂÊ¿ÓË ÌÔÓÔÏÈıÈ΋˜ ˙ÈÚÎÔÓ›·˜ (EÈÎ. 13 ·-‰ &14 ·-‰)
126
13a
13b
13c
13d
Fig. 13a-d: Monolithic zirconia crown a) buccal view b) occlusal
view c) appliance of surface contamination inhibitor (Ivoclean,
Ivoclar)
Hellenic Stomatological Review 57: 101-137, 2013
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
14a
EÈÎ. 9·: AÚ¯È΋ ÂÈÎfiÓ· ıÚ·˘Ṳ̂Ó˘ ÌÂÙ·ÏÏÔÎÂÚ·ÌÈ΋˜ ÛÙÂÊ¿Ó˘ #21
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Hellenic Stomatological Review 57: 101-137, 2013
Fig. 14a-d: Monolithic zirconia crown one month post final cementation (buccal and occlusal view)
127
μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
EÈÎ. 12: H ·Ô˘Û›· ÌÂÙ¿ÏÏÔ˘ ÂÈÙÚ¤ÂÈ ‰È¿¯˘ÛË ÊˆÙfi˜ ̤۷ ·fi ÙËÓ ÚÔÛıÂÙÈ΋ ·ÔηٿÛÙ·ÛË
™YZHTH™H-™YM¶EPA™MATA
T· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù· ˙ÈÚÎÔÓ›·˜ Ôχ ÁÚ‹ÁÔÚ· ÂÎÙfiÈÛ·Ó ¿ÏÏ· ÔÏÔÎÂÚ·ÌÈο Û˘ÛÙ‹Ì·Ù· Î·È ¤¯Ô˘Ó ‹‰Ë ·ÔÎÙ‹ÛÂÈ ¤Ó· ÌÂÁ¿ÏÔ ÌÂÚ›‰ÈÔ Ù˘ ·ÁÔÚ¿˜ ÙˆÓ ÔÏÔÎÂÚ·ÌÈÎÒÓ ·ÔηٷÛÙ¿ÛˆÓ. OÈ ÚÒÙ˜ 3ÂÙ›˜ Î·È 5ÂÙ›˜ ÌÂϤÙ˜ ‹Ù·Ó ȉȷ›ÙÂÚ· ÂÓı·ÚÚ˘ÓÙÈΤ˜ ÁÈ· ÙË Û˘ÌÂÚÈÊÔÚ¿
ÙÔ˘ ˘ÏÈÎÔ‡ ÛÙÔ ÛÙÔÌ·ÙÈÎfi ÂÚÈ‚¿ÏÏÔÓ Î·È Á›ÓÂÙ·È ÌÂÁ¿ÏË
ÂÚ¢ÓËÙÈ΋ ÚÔÛ¿ıÂÈ· ÁÈ· ÙËÓ ÂÚ·ÈÙ¤Úˆ Ì›ˆÛË Î·È ÂÍ¿ÏÂÈ„Ë ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ Ô˘ ÚԤ΢„·Ó ηٿ ÙË ¯Ú‹ÛË Ù˘. ¶·Ú¿ÏÏËÏ· Ë ÂÌÊ¿ÓÈÛË Ó¤ˆÓ ˘ÏÈÎÒÓ ÌÔÓÔÏÈıÈ΋˜
˙ÈÚÎÔÓ›·˜ ¤‰ˆÛ χÛË ÛÙȘ ·ÔÎÔÏÏ‹ÛÂȘ ÙÔ˘ ÂÈÎ·Ï˘ÙÈÎÔ‡ ÎÂÚ·ÌÈÎÔ‡.
Y¿Ú¯ÂÈ ÏËıÒÚ· ϤÔÓ ÂÊ·ÚÌÔÁÒÓ Ù˘ ˙ÈÚÎÔÓ›·˜ ÛÙËÓ
Ô‰ÔÓÙÈ·ÙÚÈ΋, ÂÏ¿¯ÈÛÙ˜ ·fi ÙȘ Ôԛ˜ ¤¯Ô˘Ó ÂÈÛÙËÌÔÓÈ΋ Î·È ‚È‚ÏÈÔÁÚ·ÊÈ΋ ÙÂÎÌËÚ›ˆÛË. ¶ÔÏϤ˜ ÊÔÚ¤˜ Ì¿ÏÈÛÙ· ·Ó·Ê¤ÚÔÓÙ·È ˆ˜ ·Ó·ÊÔÚ¤˜ ÂÚÈÙÒÛÂˆÓ ·ÎÚ·›Â˜ ÂÊ·ÚÌÔÁ¤˜ Ù˘ ˙ÈÚÎÔÓ›·˜ fiˆ˜ Û‡Ó‰ÂÛÌÔÈ ·ÎÚȂ›·˜, ‰ÔÎÔ› Î.¿. OÈ ÎÏÈÓÈÎÔ› Ú¤ÂÈ Ó· Â›Ó·È È‰È·›ÙÂÚ· ÂÈÊ˘Ï·ÎÙÈÎÔ› ÛÙËÓ ·Ô‰Ô¯‹ Ó¤ˆÓ ·ÙÂÎÌËÚ›ˆÙˆÓ ÂÊ·ÚÌÔÁÒÓ Ô˘
ÌÔÚ› Ó· ÚÔÙ·ıÔ‡Ó ·fi ÂÙ·ÈÚ›˜ ‹ Ô‰ÔÓÙÔÙ¯ÓÈο
ÂÚÁ·ÛÙ‹ÚÈ·.
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ÂÁÁ˘ÒÓÙ·È ¿ÓÙÔÙ ̷ÎÚÔ‚ÈfiÙËÙ· ηıÒ˜ ˘¿Ú¯ÂÈ Ô Î›Ó‰˘ÓÔ˜ Ù˘ ·fiÙÔÌ˘ ÌÂÙ·‚ÔÏ‹˜ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÙÔ˘
˘ÏÈÎÔ‡ (Á‹Ú·ÓÛË)130. TÔ ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ˘ÏÈÎfi ‰Â ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ ÔÚıÔ·È‰È΋ ÚÔ‚ÏËÌ¿ÙÈÛ ÔÏÏÔ‡˜ ÎÏÈÓÈÎÔ‡˜ Ô‰ÔÓÙÈ¿ÙÚÔ˘˜.
Afi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿ Ë ·Ó¿Ù˘ÍË Î·È ÂͤÏÈÍË ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ Û¯Â‰È·ÛÌÔ‡ Î·È ÎÔ‹˜ Ì ÙË ‚Ô‹ıÂÈ· ËÏÂÎÙÚÔÓÈÎÒÓ
˘ÔÏÔÁÈÛÙÒÓ (CAD-CAM) ¤¯ÂÈ ÂÈÎÂÓÙÚˆı› ÛÙÔ ˘ÏÈÎfi Ù˘
˙ÈÚÎÔÓ›·˜ Î·È ¤¯ÂÈ ÙÂÏÂ˘Ù·›· ‚ÂÏÙȈı› Ë ÔÈfiÙËÙ· ÔÚȷ΋˜
ÂÊ·ÚÌÔÁ‹˜, ÛËÌÂ›Ô ¤ÓÙÔÓ˘ ÎÚÈÙÈ΋˜ ÛÙ· ÚÒÙ· Û˘ÛÙ‹Ì·Ù·84. T· ÎÂÚ·ÌÈο ·ÏÔ˘Ì›Ó·˜ Î·È Ù· ÌÂÙ·ÏÏÈο ÎÚ¿Ì·Ù·
Ê·›ÓÂÙ·È Ó· ÌËÓ ·ÔÙÂÏÔ‡Ó ϤÔÓ ÙÔ Â›ÎÂÓÙÚÔ Ù˘ ÂͤÏÈ128
The fact that the material is not used any longer in clinical
orthopedics raise doubts among dental professionals.
On the other hand the growth and development of
computer-aided design and cutting systems (CAD-CAM)
have been focused on zirconia and have recently
improved the fit accuracy, a point of criticism in the early
systems. The alumina ceramics and metal alloys appear
to no longer constitute the focus of development for CADCAM systems, and their commercial use is descending.
Zirconia is a subject of basic research for the last ten years
in dentistry at many levels. The three main axes of research investigation are its bond to the veneering
porcelain, luting with contemporary cements and the
improvement of its optical and mechanical properties.
Alongside areas of research and development are related
to similar materials such as composites of zirconia and
alumina. Some attempts are currently in progress in the
laser’s field, for cutting and processing zirconia with
preliminary promising results.
There are several issues on zirconia with the main
disadvantage being the matastability of its structure and
the non-controlled development of monoclinic phase that
can lead to premature failures. However there is not
enough long-term clinical documentation for total or partial acceptance of zirconia as a viable and reliable
alternative to the classical metal-ceramic restorations.
Finally, the application of zirconia as a biomaterial for
dental implants does not seem to have nowdays the initial
enthusiastic acceptance. Today, there are only a few
manufacturers of zirconia implants. However, until now,
the research done on zirconia implants is a small fraction
of the widespread research on titanium alloy implants.
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Literature Review
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Corresponding author:
E. Tzanakakis
e-mail: [email protected]
e.n.: The clinical work described in this paper is performed
by the authors. Authors declare no financial interest
whatsoever on dental products and companies mentioned
in this article.
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μÈ‚ÏÈÔÁÚ·ÊÈ΋ ∞Ó·ÛÎfiËÛË
Literature Review
121. Nakamura K, Kanno T, Milleding P, Ortengren U: Zirconia
as a dental implant abutment material: a systematic review
Int J Prosthodont 2010 Jul-Aug; 23 (4): 299-309.
122. Holst S, Blatz MB, Hegenbarth E, Wichmann M, Eitner S:
Prosthodontic considerations for predictable singleimplant esthetics in the anterior maxilla. J Oral Maxillofac
Surg 2005; 63 (9 Suppl 2): 89-96.
123. Glauser R et al: Experimental zirconia abutments for
implant supported single tooth restorations in esthetically
demanding regions:4-year results of a prospective clinical
study Int J Prosthodont 2004; 17: 285-290.
124. Scarano A, Piattelli M, Caputi S, Favero G, Piattelli A: Bacterial adhesion on commercially pure titanium and zirconium oxide disks: an in vivo human study. J Periodontol
2004; 75 (2): 292-6.
125. Raigrodski AJ, Hillstead MB, Meng KG, Chung KH: Survival
and complications of zirconia-based fixed dental prostheses:
a systematic review. J Prosthet Dent 2012; 107: 170-7.
126. Fischer J, Grohman P, Stawarczyk B: Effect of zirconia
surface treatments on the shear strength of zirconia
/veneering ceramic composites. Dent Mater J 2008; 27:
448-54.
127. Hill E, Lott J: A clinically focused discussion of luting
materials Australian Dent J 2011; 56: (1 suppl): 67-76.
128. Amaral R, Ozcan M, Valandro L, Balducci I, Bottino M: Effect
of conditioning methods on the microtensile bond strength
of phosphate monomer-based cement on zirconia ceramic
dry and aged conditions J Biomed Res PartB Appl
Biomater 2008; 85 B: 1-9.
129. Siarampi E, Kontonasaki E, Papadopoulou L, Kantiranis N,
Zorba T, Paraskevopoulos KM, Koidis P: Flexural strength
and the probability of failure of cold isostatic pressed
zirconia core ceramics. J Prosthet Dent 2012; 108 (2): 84-95.
130. Vatali A, Siarampi E, Kontonasaki E, Kantiranis N, Zorba T,
Vouroutzis N, Paraskevopoulos KM, Koidis P: Effect of In
Vitro Ageing on a Cold Isostatic-Pressed Zirconia Ceramic
for All Ceramic Restorations. Key Engineer Mater 2012;
493-494 : 604-608.
¢È‡ı˘ÓÛË ÁÈ· ÂÈÎÔÈÓˆÓ›·:
E. T˙·Ó·Î¿Î˘
e-mail: [email protected]
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Hellenic Stomatological Review 57: 101-137, 2013
137