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DIRECT AND INDIRECT DENTAL RESTORATIONS:
CLINICAL STATUS AND EVALUATION
Eshmurodova Farangiz Bakhrom kizi
2nd year clinical ordinator of the Department of Therapeutic Dentistry
of the Tashkent State Dental Institute
Fari199@icloud.com
https://doi.org/10.5281/zenodo.14050248
ARTICLE INFO
ABSTRACT
Qabul qilindi: 1-noyabr 2024 yil
Ma’qullandi: 5-noyabr 2024 yil
Nashr qilindi: 7-noyabr 2024 yil
To restore teeth after endodontic treatment, direct or
indirect restoration is used, but no common approaches are
defined.
KEY WORDS
endodontically
treated
teeth,
direct and indirect restoration,
photocomposites,
ceramic
materials, clinical evaluation.
Objective.
Clinical evaluation of direct and indirect restoration of lateral group teeth after
endodontic treatment in different follow-up periods.
Materials and methods.
In a prospective randomized study, 79 individuals were examined in
which 170 molars with class 2 cavities were restored (the Black method) after endodontic
treatment. In 38 patients, 89 teeth (52.4 %) were restored by direct method from a
photocomposite, in 41 patients, 81 indirect restoration from a ceramic material was performed
using digital technologies. The condition of the restorations was assessed after 6 and 12 months
according to clinical criteria.
Research result
. Within 6 months, according to clinical criteria, violations were detected in 6
direct (6.7%) and 1 indirect restoration (1.2%). After 12 months, among direct restorations, 2 of
them were found to be destroyed (2.2%), anatomical shape disorders were found in 6
restorations (6.7%), marginal fit was found in 5 (5.6%), marginal staining was found in 9
restorations (10.1%), and contact point defects were found in 11 cases (12.4%). These violations
occurred in 13 updates (14.6%). At the same time, the anatomical shape and edge fit were
violated only in 1 indirect restoration (1.2%), edge staining, as well as defects of the contact
point, were detected in 2 restorations (2.5%). In General, there were 2 indirect restorations with
violations (2.5%). According to the results of two surveys, 19 direct restorations (21.3%) and 3
indirect restorations (3.7%) were detected with violations.
Conclusions.
After endodontic treatment, it is advisable to restore the lateral teeth with ceramic
materials using an indirect method.
Teeth damaged by caries most often require the use of photocomposites. In the current dental
materials market for the renovation of anterior and posterior teeth, there is a wide selection
of restoration materials and adhesive systems that can be combined with photocomposites to
ensure sufficient consolidation of the material ів with hard tissues [1,2]. Renewal of teeth,
apparently, can be carried out by a direct method in one step or by an indirect method with a
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1-JILD, 12-SON (YOʻITJ)
prepared restoration on a model in a laboratory in two or more stages [3, 4]. One of the most
important officials is the importance of the method of materials for renewal and the position
of the rejuvenated tooth to the vocal group, posterior, frontal or posterior, and the stage of its
restoration. Tooth crowns suffer the most due to the presence of advanced caries, which is
subject to endodontic treatment. The method of this treatment, apparently, is a clear
obturation of the root canals after their previous instrumental processing [5]. During the
process of preparation of pathologically changed hard tissues, as well as during the creation of
free access to the mouths of the root canals, it is necessary to remove up to half the volume of
the crown of the teeth, oscrema, and femoral group. As a result of such approaches, the walls
of the prepared carious lesions in the molars and premolars become thin and brittle, and are
easily broken under the influx of the great chewing agent [4,6]. In addition, caries often affects
the cusps, which are the supporting structures of the back teeth. In clinical practice, there are
significant considerations for the treatment of teeth, including after endodontic tooth
extraction, direct restoration with photocomposite materials or indirect restoration with
photocomposite in other materials [7]. At the same time, the use of non-direct upgrades made
from ceramic materials using digital technologies is becoming increasingly widespread, but
they are, however, quite expensive [3,8]. Nutritional stagnation of the direct or indirect
method of identifying endodontically fused teeth of the butt group is quite controversial, until
now there is no single point of view.
Clinical evaluation of direct and indirect restoration of teeth in the lateral group after
endodontic treatment at different levels of care.
Materials and methods
. In a prospective randomized study, 79 individuals were exposed to
the disease from 25 to 50 patients, of which 36 men (45.6% of the total population) and 43
women (54.4%). The type of skin patient was separated according to the informed consent to
participate in the investigation. In a group of patients, 170 molars were renovated, sealed, and
170 molars were renovated using different approaches, in which endodontic treatment was
carried out in order to reduce caries. In the teeth there was a 2
nd
grade birth after Black.
Before renewal, patients were assessed for empty mouth hygiene using the simplified hygiene
index OHI-S and underwent occupational hygiene tests [9]. The patients were divided into
two groups: in 38 individuals (48.1% of the total number of cases), the first group had 89
molars (52.4% of the total number of hundred teeth) were renewed by the direct method
using additional photocomposite material, in 41 individuals (51.9%) of the other group, in 81
molars (47.6%) the renewal was prepared by the indirect method from ceramic material.
After cleaning the teeth, which encouraged laziness, the color shades of future restorations
were determined using a standard scale. In patients of the first group, after extensive
approaches to endodontically treated molars, empty parts were prepared that were suitable
for direct restoration under photo composite material [2,4]. Then, a total etching of the hard
fabrics of the walls and bottom of the empty tanks was carried out with 37% phosphoric acid
gel, and a 5th generation adhesive system was applied with a light infusion for its hardening.
The photocomposite material was introduced into balls with light polymerization of the skin
in the “soft start” mode, the contact surface of the teeth was replenished using the cured
matrix system. Next, the occlusal contacts were checked, finishing and polishing were carried
out. In patients of the other group, the molars after endodontic treatment were prepared for
indirect restoration of the molars, such as: thickness of the walls of the empty is not less than
1 mm, overhanging edges day, cut between the bottom and walls of the vines are close to
straight [3] .
After this, the patient’s dental rows were simultaneously scanned using a high-precision
intraoral optoelectronic scanner CEREC AC Connect Omnicam, Dentsply Sirona, to capture a
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1-JILD, 12-SON (YOʻITJ)
digital image and model an indirect ceramic restoration. ї. The prepared empty space near the
tooth was covered with a time-sensitive onlay made from a besacrylic composite with the
help of a silicone template for the model, which was made on a Formlabs Form 2 3D printer,
Formlabs, with photopolymer resin. The extracted scans were analyzed using the Exocad
software product, a permanent ceramic model was modeled and it was produced from a
ceramic CAD block based on lithium disilicate on an inLab MC X5 milling bench, Dentsply
Sirona. The technical stages of processing and pre-clinical preparation of the prepared update
were carried out in the laboratory. At the next tooth, which had undergone restoration, the
time pad was removed, the hard tissues of the walls and bottom were completely etched with
37% orthophosphoric acid gel, the surface of the indirect ceramic restoration, which may
adhere to hard tissues were etched with 9% hydrofluoric acid gel, then silane was applied to
the surface and, with the help of universal self-adhesive composite cement, the indirect
ceramic restoration was fixed with with the exhaust stream of a light-emitting diode
photopolymerizer, directed between the lines outside its perimeter . They thoroughly
polished between the indirect contacts and checked the occlusal contacts.
The div of direct and indirect restorations was assessed on the day after preparation for a
period of 6 and 12 months according to clinical criteria, including “the integrity of the
renewal”, “anatomical shape”, “shape” Prilyagannya", "Crajove Zabarvlennya", "Stan Contact
Point" , as well as according to aesthetic criteria, texture, “color consistency” and “surface
roughness”. Using the visual-instrumental method, the severity or presence of impairments
was identified and recorded according to specified criteria. The contact point site was
assessed for the stagnation of flocs. Considering that in one update there could be a decal
damage, the skin term recorded a number of damage according to the skin clinical criterion
and a number of restorations with identified damage. They also meant that there would be a
lot of renewal without water damage, so that at the administrative station. In cases where
damage was detected based on clinical criteria, over the course of the patient’s life,
restoration defects were corrected or other renovations were carried out, but precautions
were taken for these updates. Since the damage to the updated one was determined by
aesthetic criteria, it was corrected and followed by caution.
For statistical processing of the results of the index assessment of empty hygiene, we used
variation statistics in the MS Excel XP program with a significant difference for p<0.05.
Indicators of clear signs that will become renewed presented absolute and definitive
meanings.
Results.
In the first group, the hygiene index OHI-S increased to 1.4±0.15 points, in the other
group ‒ 1.28±0.17 points, then the level of oral hygiene In patients of both groups, the results
were not statistically significantly different from each other (p>0.05). The day after the
restoration was completed in patients of both groups, no damage was discovered. After 6
months, 79 patients were treated (100%), of which there were 170 new cases (100%). At the
time of clinical evaluation, it was established that 2 updates (2.2% of the total number of
patients in this group) were frequent daily, The ruins of the bathtub stuck to about half the
volume of skin renewal . In another 2 restorations (2.2%), the anatomical shape was damaged,
there were defects in the areas of the contact surface of the restorations, and the contact
points between the restorations and the existing teeth were damaged. According to Zagal,
according to the current situation, damage to contact points was detected in 4 cases (4.5%). It
was also recorded that the marginal fit to the enamel of the renewed teeth was damaged
down to the enamel-dentin interface in 2 renovations (2.2%), and in 4 restorations (4.5%)
there was evidence of marginal wear at the enamel interface. Also, according to the current
clinical criteria, 6 direct renewals (6.7%) of the damaged teeth were revealed. According to
aesthetic criteria, 3 restorations (3.4%) did not match the hard tissues of the teeth behind the
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1-JILD, 12-SON (YOʻITJ)
color between the acceptable ones, and 4 restorations (4.5%) had increased surface
roughness.
In patients of the other group, all indirect teeth retained their integrity and anatomical shape,
all contact points between the new and adjacent teeth were still valuable and functional , less
than 1 restoration cost (1.2% of the cost per of this group) it was revealed that the regional
adhesion between the enamel and the regional fermentation was damaged. Thus, the present
damage was observed in 1 direct update (1.2%). Due to the aesthetic criteria, only a
discrepancy in color was established between the acceptable limits in 2 restorations (2.5%).
In the term of 12
months, the total percentage was 79 percent (100%), but the overall total amount of the total
amount was 163 (95.9% of the total amount). The number of direct renewals in the first
group changed to 83 (93.3% of the output rate in patients of this group). Frequently, 2
renovations (2.2% of the total number of quilted restorations), 6 renovations (6.7%) of small
damage to the anatomical shape were found. In 11 cases (12.4 %) there were other defects of
contact points, including the loss of renewal, hairiness and damage to the anatomical shape.
The defective edge fitting of the photocomposite was installed in 5 restorations (5.6%),
Significantly less damage in this term was detected in indirect restorations, of which 80 were
stitched (98.8% of the cob bone), in patients of the other group. All restorations were less
frequent, with less than 1 (1.2% of the total restoration) damage to the anatomical shape of
the contact surface. Contact points between the new and existing teeth were inferior in 2
cases (2.5%). At the perimeter of the 1st restoration (1.2%), defects in the edge fit of the
enamel were revealed; beyond the perimeter of the 2nd restoration (2.5%), the presence of
marginal burr was detected. All damages according to the established criteria were observed
only in 2 indirect restorations (2.5%). Overall, there were more aesthetic damages, wrinkles,
lack of consistency in color between acceptable boundaries - in 5 renovations (6.2%), the hair
was moved up - in 2 restorations (2.5%).
During the follow-up of 6 and 12 months in patients of the first group, 19 teeth renewal
(21.3% of the cob) with damage due to the passage of teeth were identified. final criteria,
especially in another group - only 3 (3.7 %), then 6.3 times less. Subject to current criteria,
indirect ceramic restorations also overcame direct photocompositing restorations. Without
damage, then, according to the results of the river investigation, in the first group there were
70 direct restorations (78.7% of the cob volume), in patients of the other group - 78 indirect
restorations renewal (96.3%). Such indicators coincide, incredibly, with the crust of indirect
ceramic restorations of endodontically annealed primary teeth.
Natural teeth after edodontic treatment are completely restored with ceramic materials using
the indirect method using digital technologies. For such approaches, damage is considered
lower than for direct renewal from photocomposite materials.
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YANGI O'ZBEKISTON ILMIY
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1-JILD, 12-SON (YOʻITJ)
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