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Svetootverzhdaemye composites and their efficiency at replacement of defects of a coronal part of a tooth.

Svetootverzhdaemye composites take an in the lead place among plombirovochnyh materials in modern restoration stomatology [3, 4, 12, 13, 16, 20, 21, 22, 23, 27, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 43, 47, 49, 51, 59, 61, 62, 63, 64, 65, 66, 67, 69, 74, 75, 76, 77, 88, 93, 94, 95, 96, 97, 101, 105, 108, 109, 110, 112, 119, 123, 124, 128, 129, 130, 132, 134, 139, 141, 142, 145, 153, 156, 159, 165].

C their occurrence quality and long duration of restorations has sharply improved at sealing of carious cavities.

Modern svetootverzhdaemye composit materials allow to restore functional and aesthetic parametres of a tooth immediately in an oral cavity in one visiting that is convincingly shown in Makeevoj I.M., Chilikina V. N's monographies [63, 124]. It is promoted by development of adhesive technics and materials [2, 15, 19, 25, 29, 46, 62, 63, 71, 80, 87, 98, 105, 124, 138, 155, 160, 164, 165]. Nevertheless, after restoration of a teeth by composit materials probably development of such phenomena, as a seal discoloration, occurrence regional prokrashivanija on border of "a tooth-composite tissue», disturbance of a regional adhering. In this connection research works on experimental and clinical studying of composites proceed at sealing of defects of a tooth [14, 20, 31, 32, 39, 45, 51, 78, 82, 89, 90, 91, 105, 106, 120, 126, 128, 132, 133, 137, 140, 154, 155, 156, 159, 160, 162, 167, 170].

SHelemeteva So-called informs, that domestic researches of quality of restorations in terms till 3 years have shown, that to 8,6 % from them replacement demand, and about 30 % require correction of colour and polishing. Foreign researches with terms of observation till 10 years also are more devoted basically to quality of sealing of cavities of II class on Black. The condition of the restored teeth in the remote terms depends as on a used material and "age" of restoration, and in a larger measure from observance

9 doctor of principles of work with composit materials and keepings by the patient of references [128].

By results of own clinical inspection of the big group of patients of Shelemeteva G. N has drawn conclusions, that the major factor influencing quality of seals in remote terms, technology strict observance is: in control group of 98 % of seals of composit materials light otverzhdenija are estimated unsatisfactorily whereas in investigated group where all seals have been imposed by one doctor with technology observance, 16 % of seals are recognised by unsatisfactory; quality of seals in the remote terms is influenced by following factors: a correct choice of a material, observance of a technique of application, frequency rate of polishing, observance of rules of hygiene of an oral cavity. The composit material «Silux Plus» (a class mikrofilov) provides the longest conservation of aesthetic parametres at independent or combined use for carrying out of restoration of a face-to-face teeth; The basic disadvantage of a hybrid composite «Prisma TRN» in terms over 5 years is absence of shine of a surface, a discoloration, loss of a transparency and regional prokrashivanie seals. Kompomernyj the material «Dyract» as a whole possesses good tsvetostabilnostju, however takes place local prokrashivanie and augmentation of volume of seals. 20 % of seals from «Dyract» have been lost in terms over 5 years; the regional adhering of seals worsens eventually: at carrying out of electrometric research every year data elektrometrii increase on 1 mka.

Patients is less critical concern an estimation of quality of seals, than the doctor - the stomatologist: according to patients, only 46 seals were subject to replacement (9,2 %) whereas it was necessary to replace 80 seals (17 %). The Most frequent reasons on which patients address for replacement of seals, rasping defects (skoly, an appreciable discoloration) are.

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Adilhanjan V. A pays attention to features of sealing depulpirovannyh of a teeth: depulpirovanie a tooth leads to depression acid-resistant ™ and structural resistance of an enamel, the quantity having chopped off firm tissues of a coronal part of a tooth [3] as a result increases. Fastness depression depulpirovannyh teeth to mechanical loads considers a number of authors as a consequence of appreciable loss of firm tissues in the course of pulp cavity disclosing. According to other researchers, pulp excision does not lead to structural and functional changes in a tooth enamel). For the prevention of such complications as the crack of an enamel and a crown fracture, it is recommended external (an artificial crown) strengthening depulpirovannyh teeth. However many authors specify in risk of fracture of a root of a tooth at unjustified or illiterate use shtiftovyh designs.

Adilhanjan V. A on the basis of clinical research, and also as a result of bench prochnostnyh researches has stated an estimation of quality of restoration depulpirovannyh teeth with application of various methods.

It is established, that the most widespread method of restoration of a coronal part of a teeth after endodonticheskogo treatments irrespective of a group accessory is seal applying (65,5 % of cases), and sealing without overlapping of walls of a tooth or cutting edge is applied in 53,5 % of cases; the greatest number of satisfactory results in the remote terms is received for the teeth restored by a seal with a peg and overlapping of walls of a tooth - in control group - 68 %, in investigated group - 88 %; in 98 % of cases at skolah the composit seals blocking walls of a tooth, the antagonist of composit restoration were the teeth restored by ceramic-metal crowns; character of defect of a teeth depends on a method of restoration of a coronal part: for metallokeramiki is skol ceramic facing and a local ulitis, for seals without overlapping of walls of a tooth is an invoice, for tselnokompozitnyh seals with overlapping of cutting edges and tooth walls is

And skoly a material in area aproksimalnoj a surface and hillocks. It is established, that regional permeability of seals of control group without visible defects makes 5,8 yo 0,4 mka, that is

Unsatisfactory whereas in investigated group this indicator makes 3,2 yo 0,2 mka, that also on 0,3 mka exceeds a norm threshold; intact premolar tooths possess durability at compression in 130 yo 0,2 MPA whereas for intact molar tooths this size has made 160 yo 2,6 MPA. Durability of the premolar tooth restored without overlapping of walls, makes only 21,3 yo 1,8 MPA, the molar tooth was blasted at augmentation of a load to 59,3 yo 2,0 MPA; peg or composite presence in area ustev root channels does not render positive influence on fastness of a tooth without overlapping of walls plombirovochnym a material and makes less than 40 % of durability from an intact tooth for molar tooths and less than 20 % of durability from an intact tooth for a premolar tooth.

Amanatidi G. E has devoted the research to a clinico-laboratory choice of a material for sealing of defects of firm tissues of a tooth in prisheechnoj to area [4]. He, also as many other things clinicians, confirms, that in the remote terms the doctor faces such phenomena, as frequent abaissement of seals, occurrence regional prokrashivanija on border «tooth tissues - a composite», disturbance of a regional adhering and postoperative sensitivity. Domestic researches of quality of the seals filling defect of firm tissues in prisheechnoj of area of teeth have shown, that in terms over 5 years of 20 % of seals of area are estimated "unsatisfactorily or lost. According to Patjukova V.V., the condition of seals in the remote terms depends on observation term, from performance by the doctor of principles of preparing and work with plombirovochnymi materials, from observance by the patient of references on hygiene of an oral cavity.

However Amanatidi G. E considers as the most important factor a correct choice plombirovochnogo a material. On the basis of contemporary records and

Amanatidi G. E's own 12 clinical researches have been defined service life and quality of seals of V class depending on plombirovochnogo a material. It is established, that till 2th years the considerable quantity of seals from a material «Spectrum TPCH» is estimated unsatisfactorily - 35,3 %; at an estimation of seals from kompomera "Dajrekt" 20 % of unsatisfactory results are received.

In laboratory conditions the module of elasticity of tissues of a teeth in prisheechnoj areas is defined in not blasting way. It is established, that the module of elasticity of firm tissues of premolar tooths in prisheechnoj areas makes 18 Open Companies yo 1 800 MPA.

Dynamics of the module of elasticity plombirovochnyh materials in various terms is defined and the interrelation of the module of elasticity and water absorption of materials is established. It is established, that the module of elasticity of materials stekloionomernoj and kompomernoj the nature changes depending on endurance in water - from 30 000 to 23 037 MPA ("Dajrekt"), the stablest value of the module of elasticity is received for materials "unirest" (from 19 000 to 19 087 MPA) and "FiltekFlou" (from 13 200 to 14 174 MPA).

References for choice plombirovochnyh materials on the basis of comparison of the received data are given. It is established, that for maintenance of high quality of sealing of defects of a teeth prisheechnoj areas the material should possess not only the module of elasticity corresponding to the module of elasticity of a tooth, but also adhesion to firm tissues of a tooth not less than 6 MPA.

Amanatidi G. E does conclusions that at studying of quality of seals from composit and kompomernyh materials the estimation was "unsatisfactorily received by 25 % of seals of control group and 19 % of seals of investigated group; at studying of a teeth with the lost seals of V class of control group it is established, that adequate preparing of cavities has not been spent to 100 % of cases, in 98 % of cases have not been eliminated suprakontakty; presence of direct dependence between quality of seals is established

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Control both investigated groups and level of hygienic care of an oral cavity; presence of direct dependence between presence of a direct occlusion, parafunctions and loss of seals in the nearest terms after sealing is established; the module of elasticity of firm tissues of a teeth of group of premolar tooths in prisheechnoj the areas, defined by not blasting method. Makes 18 000 yo 1 800 MPA; the optimum module of elasticity and adhesion to tooth tissues the composit material light otverzhdenija "unirest", the worst indicators at stekloionomernogo cement «Kemfil superior» possesses; necessary factors of maintenance of quality of seals prisheechnoj areas are: creation of resistance and retentsionnoj cavity forms, carrying out protravlivanija, a choice of a material with the module of elasticity approached to 18 000 MPA and adhesion not less 6 MPA.

Nikolaev A.I., Tsepov L.M. also specify in the most serious disadvantage of universal composites - high polimerizatsionnuju usadku (at various materials it fluctuates from 3 to 5 %) [75, 76, 77, 78, 79, 80]. polimerizatsionnaja usadka is one of the most serious problems of practical therapeutic stomatology. All stomatologists - of practice faced so-called postoperative sensitivity when, after applying of a seal from a composite, the patient has pains in a tooth from temperature stimuluses, morbidity at nakusyvanii on a seal, and sometimes through any time the pulpitis or a periodontitis develops.

Other negative effect polimerizatsionnoj usadki which stomatologists face often enough, is «polimerizatsionnyj stress» - occurrence of strains on border of a seal with a tooth in the course of polymerisation.

Authors recognise, that the problem of an optimum parity aesthetic and prochnostnyh characteristics of universal microhybrid composites is not solved till now.

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If to state the general estimation to universal composites, that, according to Nikolaev A.I. And Tsepova L.M., it is possible to estimate these materials on good"and above, that is aesthetic properties - on«4», durability - on«4», handling characteristics - on«4»etc. Authors ascertain what to frame an ideal universal composite to any firm-manufacturer yet it was not possible and now three more groups of composit materials are issued: the microfilled composites for aesthetic restoration of a face-to-face teeth; condensed composites for sealing of a chewing teeth; liquid (fluid) composites which are fast auxiliary materials and at correct application allow to improve quality of work considerably.

In a complex all four groups of materials, that is the microhybrid, microfilled, condensed and liquid composites in combination C adgezivom make restoration system.

Nikolaev A.I. And Tsepov L.M. have wide experience and give an application appreciation in clinical practice of new restoration system of company ZM ESPE. These materials have the general name «Filtek». Company ZM ESPE delivers on the Russian market: a universal microhybrid composite «Filtek Z250»; a condensed composite «Filtek Р60»; mikrofilnyj a composite for aesthetic restorations «Filtek Al 10»; zhidkotekuchy a composite «Filtek Flow».

Nikolaev A.I., Tsepov L.M. have carried out the analysis of the remote results of treatment of caries of a teeth in a number of municipal stomatologic establishments in which, despite wide development of the paid stomatologic help, the overwhelming majority of the population [41, 42 is treated, 68]. It is established, that at application of traditional techniques and plombirovochnyh materials in half a year to standard demands (the anatomic form of a seal, a regional adhering, caries "relapse" on seal edge, the condition of contact point for cavities of II class on Back, etc.) did not satisfy approximately 30 % of seals, in a year - more than 50 %, through

15 two years - almost 75 % of the examined seals. And these indicators essentially did not differ at cement, plastic, metal and composit seals. But if cement seals did not meet demands on 3-4 positions at seals from composites disturbance of a regional adhering was more often observed, caries "relapse" on seal edge, and also development of carious process on others, not sealed up earlier, tooth sites.

In other article Nikolaev A.I. And Tsepov L.M. assert, that all composit plombirovochnye materials are subject polimerizatsionnoj usadke, reaching 2-5 % of volume. The reason of this process is reduction of distances between molecules of a monomer in the course of polymerisation with 3-4 to 1,54 angstrem. At thick enough layer of a composite usadka can lead to a disruption of communication between a seal and a cavity wall - debondingu, to painful sensations after sealing, to occurrence of cracks of an enamel, otlomu hillocks and to other undesirable phenomena.

As is known, composites chemical otverzhdenija shrink to the centre of a seal and, partially, - towards tissues with more heat, i.e. towards a tooth pulp. Usadka svetootverzhdaemyh materials goes in a direction to a light source.

C the reduction purpose polimerizatsionnoj usadki composites and prevention of harmful consequences of this phenomenon raise the maintenance of an inorganic excipient in composites, apply system dentinal and enamel adgezivov, at sealing use various techniques and techniques. polimerizatsionnoj usadki svetootverzhdaemogo a composite authors consider as one of the most simple and widespread ways of reduction of harmful consequences its level-by-level entering into a cavity and same its level-by-level polymerisation.

According to Nikolaev A.I. And Tsepova L.M., a problem of a choice of a material for sealing of defects of a teeth remains actual, for example in

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prisheechnyh cavities as the structure of firm tissues of a tooth and affinity of a pulp exclude possibility of creation of a cavity of sufficient depth and necessary retentsionnyh points. For maintenance of quality of sealing prisheechnyh cavities of a teeth in the nearest and remote terms it is necessary not only to spend preparing with creation refractory and retentsionnoj forms, but also correctly to choose plombirovochnyj a material taking into account the elasticity module (in the foreign literature - the module the Ship's boy). The elasticity module defines a parity between a load and deformation. In an ideal the seal at a load should be deformed, and after load elimination to be restored in full conformity with deformation of firm tissues of a tooth. At a combination of good adhesion plombirovochnogo a material to tissues of a tooth and corresponding module of elasticity probably to provide high quality of a seal in the nearest and remote terms.

Dadaljan D.V. gives special attention to definitive processing of restoration (grinding and polishing) - to the closing stage in creation of a smooth surface of a composite [39].

Imperfect definitive processing leads to formation on a surface of a composite of microbic scurf and bracing of pigments, a consequence of that is the inflammation of a regional gum, and development of caries round a seal. Formation, structure and rate of development of a debris differ at different individuals as depend on structure of a saliva, activity of immune protection and other factors among which quality of a surface of a composite has the paramount importance.

Microorganisms of an oral cavity not only form scurf on surfaces of fabric and artificial formations, but also activly co-operate with them, subjecting to a destruction both materials, and tissues adjoining to them. In this connection creations of such materials or a way of their processing which would interfere with the very first obligatory condition are obviously important also perspective

17 creations of a debris - adhesions of microorganisms on stomatologic materials.

Dadaljan D.V. on the basis of questioning studies methods and the materials used by stomatologists of Russia at a stage of definitive processing of restoration of teeth. It is established, that firm "ЗМ" system (42 %) has appeared the most widespread system for definitive processing of restoration. Hermetic of a surface of a composit seal is applied only by 48 % of doctors.

On the basis of data of clinical inspection the comparative estimation of quality of a surface of restoration of a teeth from kompomera, composites chemical and light otverzhdenija is spent. It is taped, that in the remote terms the composit material light otverzhdenija «Spectrum», covered with hermetic «Fortify Plus» has shown the best results.

On the basis of data of a scanning submicroscopy character of structure of a surface of a composit material depending on degree of definitive processing and hermetic use is studied. On poluchenym to data the surface svetootverzhdaemogo a composit material has well developed structure with set of apertures, pores and glybchatyh freely laying particles. As a result of drawing of hermetic the surface becomes monolithic, almost completely disappear freely located on a surface glybchatye particles.

On the basis of the given laboratory researches degree of formation of a debris is defined at various methods of definitive processing plombirovochnyh materials. It is established, that a surface plombirovochnogo a material, processed by hermetic «Fortify Plus» it is least subject to microbic adhesion in comparison with a raw surface and a surface processed by other methods.

Giving due to positive properties of composites of Mamedova L.A., Podojnikova M. N, do not hide, that the last possess

18 raised wearability, polimerizatsionnoj usadkoj (2,7 - to 4 % from volume), as a result forms defects between a tooth and a seal that frames conditions for penetration of bacteria and development of secondary caries [69].

In this connection scientists within last 30 years along with improvement of already available composites continued search of such composit material which would be strong, aesthetic, convenient in application, and also did not give to usadke. As a result of long-term researches essentially new class of composites ORMOKER (an abbreviation - Ornanicheski the Modified CERAMICS) has been framed.

To Mamedova L.A., Podojnikova M. N specify their basic difference from earlier known composit materials which consists in matrix structure. Prominent feature of a matrix is siloksanovaja a network which organic groups are built in. In comparison with a matrix of a molecule traditional the Encore-gma ormokera have considerably larger molecular weight. Preliminary polymerisation ormokera in the course of manufacture considerably reduces polimerizatsionnuju usadku (1,62-1,88 %) and allocation of residual monomers. Presence in a matrix more than 50 % of inorganic components raises fastness of materials to istiraniju under the influence of nutrition, a teeth, etc.

Ormokery meet all demands shown to materials for restoration of chewing group of teeth: they high-strength, wearproof, are easily condensed. One more ideal property ormokerov is depth svetootverzhdenija to 4 mm, that considerably reduces time of restoration of a tooth.

Among ormokerov the following is most known: Solitaire (Kulzer), Prodigy condensable (Kerr), Admira (Voco), Ariston rns (Vivadent), Definite (Degussa), Filtec Р-60 (ZM), Pyramid (Bisco), etc.

Authors have spent restoration of a chewing teeth at 328 patients, from them with use Solitaire - at 148, Prodigy condensable - at 122, Definite -

19 at 58 patients also have established high efficiency ormokerov and still observed small percent of negative results.

Al Waning, Ami Smidt, Hans van Pelt result a clinical example of the restoration executed by a composite chemical otverzhdenija Concise, at repeated visit through impressing 19-year-old term [165]. The restoration surface became slightly rough, it becomes perceptible also istiranie cutting edge, but it is necessary to recognise good result of functioning of a seal within 19 years (the material is widely used till now by stomatologists). Authors remind, that mikrofilnye plombirovochnye materials have appeared after standard composites and offered steadier glossy shine of a surface. However such materials have appeared incapable to resist to appreciable exercise stresses. For this reason hybrid composites have been entered into practice, but after the additive of particles of the larger size again has declared itself effect of the roughness which were becoming perceptible earlier at standard composites.

For roughness indemnification have been framed so-called melkodispersnye hybrids, or microhybrid materials which systems with even smaller diameter of particles of an excipient have followed. The purpose of noted improvements was to frame a universal composite with firmness of shine after polishing, characteristic for mikrofilnyh composites. In universal restoration material Fitek Supreme of manufacture ZM ESPE considerably new technology has been applied to achievement of this purpose. Instead of razmola till the suitable size of a particle of an inorganic excipient synthesise in accuracy of the demanded diameter. Though nanotehnologija, in itself, also it is not new, changes management of process natural klasteringa (i.e. has undergone formations of larger particles from fine) which occurs at a stage, the following ambassador of manufacture of particles of the small size, and also the control of a parity of these klasterov to number of individual particles

20 excipients in an admixture. The standard small size nanochastits an excipient and klasterov has caused the highest durability of a composite and firmness of glossy shine. It is not less important, that this again synthesised particle of an excipient practically does not give visual opacity to a composite. As a result svetoprelomlenie and a shade it is possible to supervise completely addition of pigments in composite Pasta.

Thus the new universal restoration composite having 4 different degrees svetoprelomlenija, dentinal (dentine), the basic (body), enamel (enamel) and transparent (translucent), existing in 30 shades was born. Al Waning from co-workers. Give it an appreciation.

Maksimovskij J.M., Ulyanov of TV., of Zablotskaja N.V. draw attention to fluid composites [67]. C occurrence of fluid composites with the improved physical and biomechanical properties doctors have received wider choice in the decision of aesthetic problems. Raised reliability at faster application, reduction of quantity of components and work stages, the good remote results - offers Heraeus Kulzer at work with new zhidkotekuchim composite Flow Line. For a reliable retention of a seal, prevention of regional permeability and preventive maintenance of secondary caries of the restored tooth quality and correct application of adhesive system before cavity filling plombirovochnym a material have great value. Its chemical compound also has the big practical value as allows to approach competently to a choice of this or that bondingovoj systems on which in 90 % of cases the success of work depends.

Before authors there was a problem of application new nizkomodulnogo composite Flow Line in a combination with dentino-bondingovoj system Gluma Comfort Bond «Heraeus Kulzer». C this purpose they used the above-stated materials on therapeutic reception and have noted their advantages and the disadvantages bound to indications of application and technology of work with the specified composite.

Timofeeva V. N in the work «the Condition of seals from composit materials at persons with various susceptibility to caries» expresses opinion, that the basic criterion of an estimation of efficiency operativnoyovosstanovitelnogo treatments of caries of a teeth is fastness and service life of seals [105]. The remote service life of composit materials which for today are widely applied, is not established. At the same time it is known, that in a year from 9,4 % to 17,1 % of seals from these materials have an unsatisfactory condition. It is established, that the clinical condition of seals and their durability depend on many factors: from a kind plombirovochnogo a material, adhesive system, a technique of preparing of a carious cavity and its sealing and other factors.

By the author 122 patients at the age from 18 till 35 years have been surveyed and the clinical condition of 264 seals from composit materials chemical and light otverzhdenija with service life from 6 months till 5 years is estimated. Considering, that the surveyed patients had various fastness to caries of a teeth, that, according to an index Wick (level of intensity of caries), all surveyed have been conditionally divided into 2 groups, the first group sostavli 35 persons with low and average Wick (from 0 to 0,30), the second - 87 persons with high and very high Wick (from 0,31 and above).

Clinical condition of seals at all surveyed estimated on regional integrity, presence of secondary caries and regional permeability. Disturbance of regional integrity of seals considered, if visually and instrumentalno dredging on the seal edge, extending on dentino-enamel borders was defined. The diagnosis secondary caries was put according to the definition given by E.V.Bohr and E.Helvig from co-workers., i.e. at detection of carious process near to a seal. Regional permeability of seals defined an electrometric method on G.G.Ivanovoj.

At surveyed with high level Wick about seals of II class in 4 times is more often taped secondary caries, and regional permeability in 1,8 times above, than at persons with low and an average level Wick.

Dr. Nien NGO is the initiative supporter of the concept of the minimum intervention (MI) and pays special attention to studying of the interactions arising between restoration materials and tissues of a tooth, using various technologies of microscopy and a microanalysis [153].

In restoration stomatology time of revolutionary changes comes: the surgical concept «dilate to prevent», can be replaced with concepts of conservative regenerative medicine with principle MI which can be realised at use of the newest stomatologic materials - stekloionomerov. The author propagandises an increasing role of preventive actions.

Application plombirovochnyh materials with a high indicator of fluorescence in ultra-violet radiation can become the possible decision of aesthetic problems svetokompozitov. The line of materials Diamond DRM Laboratories Inc also concerns such materials. (USA) about which write Kobrin V. G and Filippovich S.B. [49].

However, the effect of fluorescence is not the unique characteristic of materials of line Diamond. Now practically all stomatologic materials are framed on the basis of organic matrixes Bis-GMA and UDMA. More steadfast treating of these pitches finds out amorphous internal structure (like glass), that is the reason of high fragility, susceptibility to high deterioration of a surface and a discoloration.

Alternative to application of the specified pitches is use as an organic matrix of liquid crystal pitches, such, as PCDMA (it is known on company Jeneric/Pentron materials) and PEX (DRM). The last possess very strong crystalline structure after

23 polymerisations (diamondlike - from here and the name of line Diamond), elasticity at microlevel and rigidity at macrolevel. Such qualities allow to reach high durability, fastness to deleting and strongly expressed hydrorepellent ability.

Last researches have shown podtverzhdennost organic pitches Bis-GMA and UDMA to hydrolysis, in particular on a live teeth. And it is possible even to meet statements that adhesion of materials on the basis of pitches Bis-GMA and UDMA within 5 years decreases to level in 3-5 MPA against initial from above 20 MPA, at the expense of disappearance of a hybrid layer.

Side. Century I surveys in detail processes usadki in polymeric materials and, in particular, in composites [20]. Usadka a material begins with the first certificates of polymerisation and there pass some stages:

- Rather slow change of volume in a liquid or plastic condition, that is without change of a modular condition of substance;

- Fast change of volume in geleobraznom or an elastic condition with transition in a firm body;

- Slow change of volume in a firm condition owing to proceeding process of structurization and temperature changes.

To a point geleobrazovanija the material does not possess prochnostnymi properties, usadka is compensated by plastic properties, and internal strains are absent. The narrow interval geleobrazovanija marks material transition in a new qualitative condition: there is kogezionnaja a durability proceeding usadka causes deformations and internal strains. In a critical zone there can be a formation of cracks in a material or a regional cleft. At the further augmentation of durability growth of internal strains starts to lag behind, and then owing to relaksatsionnyh processes internal strains fall to some minimum (and already safe) sizes. However then strains can

Again to begin growth owing to absorption by a material of the water which always are available in an oral cavity.

The author recommends a set of actions for depression of deforming circumstances with reference to composites:

- The high volume maintenance of an excipient and good plasticity;

- The prolonged operating time of a composite chemical otverzhdenija and a high transparency of the basic layer svetootverzhdaemogo a composite;

- Use effective a dentine-enamel of adhesive system;

- Application of linings from stekloionomernyh cements in cavities of the big sizes;

- Level-by-level applying of a seal with polymerisation separately each layer;

- Use of a way of a flare of a photopolymeric seal through a wall of a carious cavity;

- Application of glaze or hermetic for definitive furnish of a seal.

Except these universal rules naturally there is a considerable quantity of techniques of performance of each step or procedure which depend on individual possibilities, skills and preferences of the stomatologist. Here it is necessary to carry both selection of instruments, and preparation of a cavity for sealing, and presence of assortment of materials, and power of photopolymerization reactor etc.

Hannig M., Boff V, Hoehnk H-D., Muehlbauer E.A. The purposes of the research have put working out of technology of sealing of cavities of II class with the proximal edges located in the field of a dentine (CbC - technics: a composite bound with kompomerom) [139].

The estimation of mechanical properties has found out, as experimental kompomer with low viscosity offered by authors, and a composite resin with low viscosity possess similar modules of plasticity. Composites for restoration of a chewing teeth were characterised by higher value as durabilities on compression, and durabilities on a flexure and the plasticity module in comparison with materials of low viscosity.

The SEM-analysis of the proximal edges located in a dentine spent after sealing, has found out more than 95 % of faultless marginal adaptation among all samples.

Load influence in laboratory conditions has not caused appreciable deterioration of marginal adaptation: after a series of thermal and occlusal loads excellent marginal integrity has remained at 94 % of samples with the marginal sites located in the field of a dentine. The boundary area on section kompomera and a composite has shown existence of communication strong and steady against loads; it was not possible to find out any lumens in boundary area.

In our country working out of composite materials is conducted from the beginning of 80th years. Barer G. M, Andreeva A.G., Vedeev A.I., Okrachkova S.V., Polikarpova A.P. for this time frames such materials, as "Kompodent", "Folakor", etc. [12]. However demands of practising doctors to plombirovochnym to materials raise every day and consequently last years in A/O DIAS together with GosNiI-medpolimer and MMSI new materials for restoration are developed and tested in experiment and clinic. One of them is composit svetootverzhdaemyj a material for sealing of all groups of a teeth "Esterfill-photo". In an out-patient department of chair of hospital therapeutic stomatology, within 3 months, under observation was ON patients by whom 136 teeth is sealed up that has allowed to receive the nearest results of treatment.

The analysis of results of application "Esterfill-photo" spent on following indicators: toxic influence on a tooth pulp; seal abaissement; disturbance of a regional adhering; otlom seal parts; a seal discoloration; reaction of a mucosa in the field of contact with plombirovochnym a material

As a result of the spent clinical tests it has been noted: seal abaissement (on II class), at one patient; disturbance of the regional

26 adherings are taped at two patients with seals on FASHIONS, that, possibly, has been bound to disturbance of rules of applying and seal polymerisation; seal bracing to firm tissues of a tooth good, otloma seals on the contact and lost surfaces it was not observed. The approved material possesses colourfastness (for 3 months of observations), however, at non-observance by patients of rules of hygiene of an oral cavity the seal surface became matte-sulphur, that, possibly, is bound to absorption of food dyes (2 cases); mucosa changes at contact to a seal did not observe; during tests there were no cases of toxic influence on a pulp.

It is necessary to notice, that the majority consistence rastsvetoj a dentine is viscous, fluid; the material strongly enough sticks to istrumentam and does not possess necessary elasticity that complicates dense utrombovyvanie it in cavities and modelling from it seals.

The received results testify, that given plombirovochnyj the material can be used in clinical practice of the stomatologist, be a choice material, undoubtedly, is perspective. For improvement of its quality and elimination of noted disadvantages the further experimental and clinical researches are required.

Professor Boer describes a technique of sealing by the composites, corresponding to the operative concept of application of materials replacing an amalgam: jashchikoobraznoe preparing, «technics full protravlivanija», a steel matrix and wooden klinyshek, simplicity of drawing of a material and svetootverzhdenie is immediate from a chewing surface, i.e. simple enough application [62]. Reached quality is not less important. It is necessary to notice however, that quality of a regional adhering of the seals of II class imposed thus is not faultless. After a thermal and mechanical load in vitro, within 6-18 months in vivo, from 60 to 90 % of regional areas of seals negermetichny; and in the field of a dentine - 80-100 %. The similar unsatisfactory marginal

27 adaptation is caused by the described operative technics. And fluid or packed composites, and also difficult adhesive systems here will change nothing. The seals established by a described method will have not tight edges. There can be regional pigmentations.

Boer V. M reminds of «the Zurich school» works with composites [19]. Long since sealing by composites was defined by the theory «referred polimerizatsionnoj usadki». It is based on a postulate, that composites at polymerisation always shrink in a light source direction. For prevention of danger of backlog of a material from walls during polymerisation a part of the seal having immediate contact to a wall of a cavity, polimerizuetsja so that light polimerizatsionnoj lamps got through corresponding firm tissues of a tooth. Hence, usadka to this part of a seal should be referred to a wall and on border between a tooth tissue and a composite the load decreases. Danger of formation of microcracks considerably decreases.

The same author explains a technique of polymerisation SOFT-START. The given principle is easily applied, when during the first 10-15 seconds of polymerisation the light guide keeps away on 2-3 sm from otverzhdaemogo a material. As intensity decreases proportionally to a distance square, as a result of this reception it is possible to reach proportional reduction of quantity of light. It would be more reliable to define precisely necessary excision by means of the measuring device. Thus followed reach initial value a minimum 100 мВт/см2. After the mentioned 10-15 seconds the light guide is brought as it is possible more close to otverzhdaemoj for a surface for full otverzhdenija.

The majority of the methods of diagnostics of defects of a regional adhering offered till now plom either are insufficiently exact and objective, or are too difficult for use in stomatologic clinic [22]. In Volhovskoj S.M.'s work for the purpose of diagnostics of disturbance of a regional adhering and early revealing of secondary caries used

28

The advanced electrometric method developed by Ivanovoj G. G and Leontevym V. K which is now the unique objective method quite accessible to clinic.

The author observed 386 seals from composit materials "Stomadent" chemical otverzhdenija, "Stomadent" light otverzhdenija, Spectrum, Dyract A.R./, 204 from which have been put immediately during research, and 182 are put earlier. Seals were distributed depending on a material, a class of a carious cavity and the diagnosis. Following parametres were clinically estimated: the anatomic form of a seal, a discoloration on scientific edge of a seal, presence of relapse of caries.

The most significant influence on electrometric indicators on border of seals without visible defects rendered a kind plombirovochnogo a material and age of restoration. Indicators elektrometrii it is authentic vozrasli eventually irrespective of a kind plombirovochnogo a material. The greatest average value elektroprovodnosti and, hence, the greatest regional permeability of seals are noted at chemically otverzhdaemogo "Stomadenta". The least indicators characterising the greatest tightness of border of a seal, - at composit material Dyract of A.R. rising of electrometric indications at seals in cavities I, II and IV classes, the least - at seals III, V classes is noted. It has not been taped dependences of electrometric indicators of seals depending on the diagnosis. Any defect it was not revealed at seals with indicators elektroprovodnosti less than 1,0 MicA. Thus, communication between frequency of occurrence of clinical defects on border of a seal and value regional elektroprovodnosti has been shown.

The application technique zhidkotekuchego a composit material at elimination of defects of a regional adhering of seals led to improvement of a regional adhering of seals that has been confirmed by depression of indicators elektroprovodnosti on defective sites of borders of seals before appointments,

29 corresponding qualitative regional adaptations (with 5,32 mka to 1,35 mka). These indicators did not worsen at the subsequent observation over seals.

Thus, proof and qualitative correcting of regional defects of seals that has been confirmed by objective data elektrometrii has been reached. The given technique allows to prolong considerably term of qualitative functioning of seals with regional defects [32].

The big resonance in world stomatology was received by publications and performances George Mayer [30]. Within the limits of the thesis for a doctor's degree (the Dr. Franc the Role, 1993) at patients (selected the accident method) had been surveyed seals in the field of a lateral teeth, amalgamovye and composit. The clinical estimation of seals on the accepted parametres is spent. Besides, with the consent of patients, the most bad seals have been removed. «It was followed by accident: only under 4 from 180 composit seals it has not been taped caries. Owing to presence of secondary caries it was required carrying out of a vital extirpation, in many cases treatment concerning Caries profunda was necessary, some teeth should be ekstragirovany», - has informed prof. Mayer.

Caries has been found out and almost under each amalgam restoration (partly in the same patients), however in so weak degree that there was no necessity for a vital extirpation. Residual caries it was possible to remove and impose a new seal easily.

The microflora found under composit seals, differed the big variety anaerobov. The spectrum was close to the spectrum which is found out in infected root channels. Though it is not enough quantity of observations for global generalisations, Mayer considers possible to state them the following estimation: «Shift of a spectrum of microbes from a debris towards an anaerobic microflora is bound not so much with the years seals, and is faster with actually material. The applied material has possibly certain influence on a microflora getting or remaining under restorations. In a teeth of lateral area,

zo being under a masticatory stress, under composites it is necessary to expect much more appreciable carious destructions, than under similar amalgam restorations », - speaks Maejr.

Cast gold seals or galvanic vkladki which however at cost and spent time are not comparable with an amalgam can be possible alternatives, in its opinion, completely ceramic vkladki, such, as impress-inlejz.

In the specified publication, for example, it is informed, that at one kompomera with high quality of a regional adhering before a load, after a load of edge a minimum on 2/3 have been opened, and in a dentine - a minimum on 4/5. Value for all other investigated composites were similar also. After a load at the best one third of length of edge had a good adhering, and in seals from Ariston, Definite and Solitaire - less than 10 %. At carrying out of experimental researches in the field of a dentinal step only at use of combinations Р60? Scotchbond

Multipurpose and Tetric Ceram? Syntax classic it is possible to speak about how many nibud deserving a mention bondinge. If at use of a substitute of an amalgam according to available to demands (simple processing) the simple adhesive system, how show researches is used accordingly, it is possible to expect only bad results.

The abresion of antagonists is, according to Mayer, secondary. It sums up: «seals of a lateral teeth Carrying an occlusion differ dramaticheski frequent disturbance of a regional adhering and formation of clefts. It is bound with usadkoj polymer, vpityvaniem and water return, and especially to microflexures of a teeth during a masticatory stress. Regional clefts become more and more so substrate in the form of molecules in the beginning can get, and then and bacteria». For comparison Mayer adds: «At amalgam restorations of the such does not occur. Edges with a current of years become on the contrary more dense. It name self-hermetic sealing or, on - simple, they rust».

Reduction of formation of clefts (polimerizatsionnaja usadka), rising of fastness to wear process and invoices, and also simplification of a method of processing should be the purpose of the further researches first of all. According to Mayer, the future belongs to the modified polymeric materials which like amalgams suppress growth of bacteria. Difference consists in it from fluorine allocation stekloionomernymi cements which supports a remineralization, but does not possess any bacteriostatic effect.

Boldyrev J.A., Gerasimovich I.S. remind, that restoration of a teeth can be carried out as immediately in a mouth of the patient (so-called direct restorations), and in laboratory conditions, with application of manufacturing of restoration on models, or by means of computer processing of special preparation [21].

Direct restorations are carried out by the doctor-stomatologist immediately in an oral cavity, with application of restoration and adhesive systems. Positive sides of direct restoration consist in the following: possibility to carry out manipulation in one visiting that spares time of the doctor and the patient; possibility of correction of colour immediately in an oral cavity; smaller working costs; absence of necessity for work of the tooth technician that allows to raise profitability of work.

Disadvantages of direct restoration mainly are what are bound to its carrying out in an oral cavity at the patient. It causes difficulties at a reconstruction of all anatomic details of a chewing surface, contact point. At direct restoration cases of hit of a saliva and thereof adhesion disturbance are not excluded. Cases of incomplete polymerisation owing to bad conditions for light guide leading are possible also.

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Scientific source BAHAREV LEONID JUREVICH. the Bodily machinery and clinical efficiency of intrastomatic and laboratory restorations of a teeth. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2004. 2004

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