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Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme

Yıl 2026, Cilt: 35 Sayı: 1 , 190 - 198 , 16.04.2026
https://doi.org/10.34108/eujhs.1814521
https://izlik.org/JA83LY64ZE

Öz

Nanoteknolojinin diş hekimliğine entegrasyonu yeni bir dönemi başlatmıştır. Nanopartiküllerin eklenmesiyle dental malzemelerin daha üstün özelliklere kavuşmasını hedefleyen çalışmalar yapılmaktadır. Ancak henüz nanopartiküllerin etki mekanizması ve malzemeye etkisi tam olarak ortaya konulmamıştır. Bu sistematik derlemenin amacı, geleneksel cam iyonomer simanlara gümüş nanopartikül ilavesinin antimikrobiyal performansa etkisini nanopartikül konsantrasyonu, morfolojisi ve boyutuna bağlı olarak değerlendirmektir. 2015–2025 yılları arasında PubMed, Scopus ve Web of Science veri tabanlarında yayımlanmış çalışmalar taranmıştır. Dahil edilen çalışmalar gümüş nanopartikül içeren geleneksel cam iyonomer simanların mikroorganizmalar üzerindeki inhibisyon etkisini inceleyen in vitro araştırmaları kapsamaktadır. Çalışmaların büyük çoğunluğunda, antimikrobiyal etkinliğin konsantrasyon ile doğru orantılı olduğu, ancak düşük ilave oranlarının dahi yüksek antimikrobiyal etki oluşturduğu belirlenmiştir. Ayrıca küçük boyutlu ve homojen dağılmış nanopartiküllerin, kümelenmiş veya düzensiz partiküllere kıyasla daha güçlü antimikrobiyal etki gösterdiği saptanmıştır. Klinik uygulamalara yönelik optimal oranların belirlenebilmesi için sitotoksisite ve uzun dönem çalışmalara ihtiyaç duyulmaktadır.

Etik Beyan

Gerekli Değil

Destekleyen Kurum

Yok

Proje Numarası

Proje yok

Teşekkür

Yok

Kaynakça

  • Lemos JA, Palmer SR, Zeng L, et al. The biology of Streptococcus mutans. Microbiol Spectr. 2019;7(1): GPP3-0051-2018. doi: 10.1128/microbiolspec.GPP3-0051-2018.
  • Pitts NB, Zero DT, Marsh PD, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030. doi:10.1038/nrdp.2017.30.
  • Mazurel D, Brandt BW, Boomsma M, et al. Streptococcus mutans and caries: a systematic review and meta-analysis. J Dent Res. 2025;104(6):594-603. doi:10.1177/00220345241303880.
  • Nicholson JW. Adhesion of glass-ionomer cements to teeth: a review. Int J Adhes Adhes.2016;69:33-38. doi: 10.1016/j.ijadhadh.2016.03.012.
  • Hoshika S, Ting S, Ahmed Z, et al. Effect of conditioning and 1 year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin. Dent Mater. 2021;37(1):106-112. doi: 10.1016/j.dental.2020.10.016.
  • Zubaer A, Akter RS, Salahuddin AA, Ayubur RM, Hidehiko S, Shuhei H. Effect of conditioning and 3-year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin. J Dent Sci. 2025;20(2):1229-1235. doi: 10.1016/j.jds.2022.01.004.
  • Cabral MF, Martinho RL, Guedes-Neto MV, Rebelo MA, Pontes DG, Cohen-Carneiro F. Do conventional glass ionomer cements release more fluoride than resin-modified glass ionomer cements? Restor Dent Endod. 2015;40(3):209–215. doi:10.5395/rde.2015.40.3.209.
  • Islam MS, Padmanabhan V, Koniali G, et al. Fluoride release, recharge, and mass stability of restorative dental materials: an in vitro study. Dent J. 2025;13(10):438. doi:10.3390/dj13100438.
  • Oliveira RC, Camargo LB, Novaes TF, et al. Survival rate of primary molar restorations is not influenced by hand mixed or encapsulated GIC: 24 months RCT. BMC Oral Health. 2021;21(1):371. doi:10.1186/s12903-021-01710-0.
  • Almuhaiza M. Glass-ionomer cements in restorative dentistry: a critical appraisal. J Contemp Dent Pract. 2016;17(4):331-336. doi:10.5005/jp-journals-10024-1850.
  • Singh S, Kulkarni G, Kumar RSM, et al. Comparative evaluation of the biological response of conventional and resin modified glass ionomer cement on human cells: a systematic review. Restor Dent Endod. 2024;49(4):e41. doi:10.5395/rde.2024.49.e41.
  • Tüzüner T, Dimkov A, Nicholson JW. The effect of antimicrobial additives on the properties of dental glass-ionomer cements: a review. Acta Biomater Odontol Scand. 2019;5(1):9–21. doi:10.1080/23337931.2018.1539623.
  • Farrugia C, Camilleri J. Antimicrobial properties of conventional restorative filling materials and advances in antimicrobial properties of composite resins and glass ionomer cements-A literature review. Dent Mater. 2015;31(4):e89-99. doi:10.1016/j.dental.2014.12.005.
  • Kelten OS, Hepdeniz OK, Tuncer Y, Kankaya DA, Gurdal O. Effect of surface characteristic of different restorative materials containing glass ionomer on Streptococcus mutans biofilm. Niger J Clin Pract. 2020;23(7):957-964. doi: 10.4103/njcp.njcp_538_19.
  • Bohinc K, Tintor E, Kovačević D, et al. Bacterial adhesion on glass–ionomer cements and micro/nano hybrid composite dental surfaces. Coatings. 2021;11(2):235. doi:10.3390/coatings11020235.
  • Ge KX, Quock R, Chu CH, Yu OY. The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis. Dent Mater. 2023;39(12):e1-e17. doi:10.1016/j.dental.2023.10.008.
  • Bayda S, Adeel M, Tuccinardi T, Cordani M, Rizzolio F. The history of nanoscience and nanotechnology: from chemical-physical applications to nanomedicine. Molecules. 2019;25(1):112. doi:10.3390/molecules25010112.
  • Dipalma G, Inchingolo AD, Guglielmo M, et al. Nanotechnology and its application in dentistry: a systematic review of recent advances and innovations. J Clin Med. 2024;13(17):5268. doi:10.3390/jcm13175268.
  • Yin IX, Zhang J, Zhao IS, Mei ML, Li Q, Chu CH. The antibacterial mechanism of silver nanoparticles and its application in dentistry. Int J Nanomedicine.2020;15:2555-2562. doi:10.2147/IJN.S246764.
  • Nie P, Zhao Y, Xu H. Synthesis, applications, toxicity and toxicity mechanisms of silver nanoparticles: A review. Ecotoxicol Environ Saf.2023;253:114636. doi: 10.1016/j.ecoenv.2023.114636.
  • Bruna T, Maldonado-Bravo F, Jara P, Caro N. Silver nanoparticles and their antibacterial applications. Int J Mol Sci. 2021;22(13):7202. doi:10.3390/ijms22137202.
  • Bapat RA, Chaubal TV, Joshi CP, et al. An overview of application of silver nanoparticles for biomaterials in dentistry. Mater Sci Eng C Mater Biol Appl. 2018;91:881-898. doi: 10.1016/j.msec.2018.05.069.
  • Paiva L, Fidalgo TKS, da Costa LP, et al. Antibacterial properties and compressive strength of new one-step preparation silver nanoparticles in glass ionomer cements. J Dent. 2018;69:102-109. doi: 10.1016/j.jdent.2017.12.003.
  • Guo T, Wang D, Gao SS. The antibiofilm effect and mechanism of silver nanowire-modified glass ionomer cement against multi-species oral biofilm. BMC Oral Health. 2025;25(1):160. doi:10.1186/s12903-025-05536-y.
  • Enan ET, Ashour AA, Basha S, Felemban NH, Gad El-Rab SMF. Antimicrobial activity of biosynthesized silver nanoparticles, amoxicillin, and glass-ionomer cement against Streptococcus mutans and Staphylococcus aureus. Nanotechnology. 2021;32(21). doi:10.1088/1361-6528/abe577.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. doi:10.1136/bmj. n71.
  • Horsley T, Dingwall O, Sampson M. Checking reference lists to find additional studies for systematic reviews. Cochrane Database Syst Rev. 2011;2011(8):MR000026. doi: 10.1002/14651858.MR000026.pub2.
  • Guo T, Yang M, Wang D, Zheng J, Gao SS. Antibiofilm and mechanical properties of silver nanowire-modified glass ionomer cement. J Dent. 2023;135:104569. doi: 10.1016/j.jdent.2023.104569.
  • Ashour AA, Felemban MF, Felemban NH, et al. Comparison and advanced antimicrobial strategies of silver and copper nanodrug-loaded glass ionomer cement against dental Caries microbes. Antibiotics. 2022;11(6):756. doi:10.3390/antibiotics11060756.
  • El-Wassefy NA, El-Mahdy RH, El-Kholany NR. The impact of silver nanoparticles integration on biofilm formation and mechanical properties of glass ionomer cement. J Esthet Restor Dent. 2018;30(2):146-152. doi:10.1111/jerd.12353.
  • Wassel MO, Allam GG. Anti-Bacterial effect, fluoride release, and compressive strength of a glass ionomer containing silver and titanium nanoparticles. Indian J Dent Res. 2022;33(1):75-79. doi: 10.4103/ijdr.IJDR_117_20.
  • Porter GC, Tompkins GR, Schwass DR, Li KC, Waddell JN, Meledandri CJ. Anti-biofilm activity of silver nanoparticle-containing glass ionomer cements. Dent Mater. 2020;36(8):1096-1107. doi: 10.1016/j.dental.2020.05.001.
  • Imran M, Mallick R, Vadlamani R, Dhar A. Assessment of the antimicrobial efficacy and mechanical properties of glass ionomer cement incorporating silver nanoparticles in varying concentrations for pediatric dental applications. J Pharm Bioallied Sci. 2024;16:S3689-S3691. doi: 10.4103/jpbs.jpbs_1202_24.
  • Siddiqui A, Gul A, Khan H, Anjum F, Hussain T. Bio-inspired synthesis of silver nanoparticles using Salsola imbricata and its application as antibacterial additive in glass ionomer cement. Nanotechnology. 2024;35(35). doi:10.1088/1361-6528/ad50e4.

Antimicrobial Efficacy of Silver Nanoparticle-Modified Conventional Glass Ionomer Cements: A Systematic Review

Yıl 2026, Cilt: 35 Sayı: 1 , 190 - 198 , 16.04.2026
https://doi.org/10.34108/eujhs.1814521
https://izlik.org/JA83LY64ZE

Öz

The integration of nanotechnology into dentistry has initiated a new era in dental materials research. Numerous studies have aimed to enhance the properties of dental materials through the incorporation of nanoparticles; however, the underlying mechanisms of action and their effects on material performance have not yet been fully elucidated. The aim of this systematic review was to evaluate the effect of silver nanoparticle incorporation into conventional glass ionomer cements on antimicrobial performance, with particular emphasis on nanoparticle concentration, morphology, and size. Studies published between 2015 and 2025 were systematically searched in the PubMed, Scopus, and Web of Science databases. Eligible studies included experimental and in vitro investigations assessing the inhibitory effects of silver nanoparticle–modified conventional glass ionomer cements against microorganisms. The majority of the included studies reported that antimicrobial efficacy was positively correlated with nanoparticle concentration; however, even low incorporation levels were found to yield substantial antimicrobial effects. In addition, smaller and homogeneously dispersed nanoparticles demonstrated stronger antimicrobial activity compared with aggregated or irregularly distributed particles. Further studies addressing cytotoxicity and long-term outcomes are required to determine optimal incorporation ratios for clinical applications.

Etik Beyan

Gerekli Değil

Destekleyen Kurum

Yok

Proje Numarası

Proje yok

Teşekkür

Yok

Kaynakça

  • Lemos JA, Palmer SR, Zeng L, et al. The biology of Streptococcus mutans. Microbiol Spectr. 2019;7(1): GPP3-0051-2018. doi: 10.1128/microbiolspec.GPP3-0051-2018.
  • Pitts NB, Zero DT, Marsh PD, et al. Dental caries. Nat Rev Dis Primers. 2017;3:17030. doi:10.1038/nrdp.2017.30.
  • Mazurel D, Brandt BW, Boomsma M, et al. Streptococcus mutans and caries: a systematic review and meta-analysis. J Dent Res. 2025;104(6):594-603. doi:10.1177/00220345241303880.
  • Nicholson JW. Adhesion of glass-ionomer cements to teeth: a review. Int J Adhes Adhes.2016;69:33-38. doi: 10.1016/j.ijadhadh.2016.03.012.
  • Hoshika S, Ting S, Ahmed Z, et al. Effect of conditioning and 1 year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin. Dent Mater. 2021;37(1):106-112. doi: 10.1016/j.dental.2020.10.016.
  • Zubaer A, Akter RS, Salahuddin AA, Ayubur RM, Hidehiko S, Shuhei H. Effect of conditioning and 3-year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin. J Dent Sci. 2025;20(2):1229-1235. doi: 10.1016/j.jds.2022.01.004.
  • Cabral MF, Martinho RL, Guedes-Neto MV, Rebelo MA, Pontes DG, Cohen-Carneiro F. Do conventional glass ionomer cements release more fluoride than resin-modified glass ionomer cements? Restor Dent Endod. 2015;40(3):209–215. doi:10.5395/rde.2015.40.3.209.
  • Islam MS, Padmanabhan V, Koniali G, et al. Fluoride release, recharge, and mass stability of restorative dental materials: an in vitro study. Dent J. 2025;13(10):438. doi:10.3390/dj13100438.
  • Oliveira RC, Camargo LB, Novaes TF, et al. Survival rate of primary molar restorations is not influenced by hand mixed or encapsulated GIC: 24 months RCT. BMC Oral Health. 2021;21(1):371. doi:10.1186/s12903-021-01710-0.
  • Almuhaiza M. Glass-ionomer cements in restorative dentistry: a critical appraisal. J Contemp Dent Pract. 2016;17(4):331-336. doi:10.5005/jp-journals-10024-1850.
  • Singh S, Kulkarni G, Kumar RSM, et al. Comparative evaluation of the biological response of conventional and resin modified glass ionomer cement on human cells: a systematic review. Restor Dent Endod. 2024;49(4):e41. doi:10.5395/rde.2024.49.e41.
  • Tüzüner T, Dimkov A, Nicholson JW. The effect of antimicrobial additives on the properties of dental glass-ionomer cements: a review. Acta Biomater Odontol Scand. 2019;5(1):9–21. doi:10.1080/23337931.2018.1539623.
  • Farrugia C, Camilleri J. Antimicrobial properties of conventional restorative filling materials and advances in antimicrobial properties of composite resins and glass ionomer cements-A literature review. Dent Mater. 2015;31(4):e89-99. doi:10.1016/j.dental.2014.12.005.
  • Kelten OS, Hepdeniz OK, Tuncer Y, Kankaya DA, Gurdal O. Effect of surface characteristic of different restorative materials containing glass ionomer on Streptococcus mutans biofilm. Niger J Clin Pract. 2020;23(7):957-964. doi: 10.4103/njcp.njcp_538_19.
  • Bohinc K, Tintor E, Kovačević D, et al. Bacterial adhesion on glass–ionomer cements and micro/nano hybrid composite dental surfaces. Coatings. 2021;11(2):235. doi:10.3390/coatings11020235.
  • Ge KX, Quock R, Chu CH, Yu OY. The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis. Dent Mater. 2023;39(12):e1-e17. doi:10.1016/j.dental.2023.10.008.
  • Bayda S, Adeel M, Tuccinardi T, Cordani M, Rizzolio F. The history of nanoscience and nanotechnology: from chemical-physical applications to nanomedicine. Molecules. 2019;25(1):112. doi:10.3390/molecules25010112.
  • Dipalma G, Inchingolo AD, Guglielmo M, et al. Nanotechnology and its application in dentistry: a systematic review of recent advances and innovations. J Clin Med. 2024;13(17):5268. doi:10.3390/jcm13175268.
  • Yin IX, Zhang J, Zhao IS, Mei ML, Li Q, Chu CH. The antibacterial mechanism of silver nanoparticles and its application in dentistry. Int J Nanomedicine.2020;15:2555-2562. doi:10.2147/IJN.S246764.
  • Nie P, Zhao Y, Xu H. Synthesis, applications, toxicity and toxicity mechanisms of silver nanoparticles: A review. Ecotoxicol Environ Saf.2023;253:114636. doi: 10.1016/j.ecoenv.2023.114636.
  • Bruna T, Maldonado-Bravo F, Jara P, Caro N. Silver nanoparticles and their antibacterial applications. Int J Mol Sci. 2021;22(13):7202. doi:10.3390/ijms22137202.
  • Bapat RA, Chaubal TV, Joshi CP, et al. An overview of application of silver nanoparticles for biomaterials in dentistry. Mater Sci Eng C Mater Biol Appl. 2018;91:881-898. doi: 10.1016/j.msec.2018.05.069.
  • Paiva L, Fidalgo TKS, da Costa LP, et al. Antibacterial properties and compressive strength of new one-step preparation silver nanoparticles in glass ionomer cements. J Dent. 2018;69:102-109. doi: 10.1016/j.jdent.2017.12.003.
  • Guo T, Wang D, Gao SS. The antibiofilm effect and mechanism of silver nanowire-modified glass ionomer cement against multi-species oral biofilm. BMC Oral Health. 2025;25(1):160. doi:10.1186/s12903-025-05536-y.
  • Enan ET, Ashour AA, Basha S, Felemban NH, Gad El-Rab SMF. Antimicrobial activity of biosynthesized silver nanoparticles, amoxicillin, and glass-ionomer cement against Streptococcus mutans and Staphylococcus aureus. Nanotechnology. 2021;32(21). doi:10.1088/1361-6528/abe577.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71. doi:10.1136/bmj. n71.
  • Horsley T, Dingwall O, Sampson M. Checking reference lists to find additional studies for systematic reviews. Cochrane Database Syst Rev. 2011;2011(8):MR000026. doi: 10.1002/14651858.MR000026.pub2.
  • Guo T, Yang M, Wang D, Zheng J, Gao SS. Antibiofilm and mechanical properties of silver nanowire-modified glass ionomer cement. J Dent. 2023;135:104569. doi: 10.1016/j.jdent.2023.104569.
  • Ashour AA, Felemban MF, Felemban NH, et al. Comparison and advanced antimicrobial strategies of silver and copper nanodrug-loaded glass ionomer cement against dental Caries microbes. Antibiotics. 2022;11(6):756. doi:10.3390/antibiotics11060756.
  • El-Wassefy NA, El-Mahdy RH, El-Kholany NR. The impact of silver nanoparticles integration on biofilm formation and mechanical properties of glass ionomer cement. J Esthet Restor Dent. 2018;30(2):146-152. doi:10.1111/jerd.12353.
  • Wassel MO, Allam GG. Anti-Bacterial effect, fluoride release, and compressive strength of a glass ionomer containing silver and titanium nanoparticles. Indian J Dent Res. 2022;33(1):75-79. doi: 10.4103/ijdr.IJDR_117_20.
  • Porter GC, Tompkins GR, Schwass DR, Li KC, Waddell JN, Meledandri CJ. Anti-biofilm activity of silver nanoparticle-containing glass ionomer cements. Dent Mater. 2020;36(8):1096-1107. doi: 10.1016/j.dental.2020.05.001.
  • Imran M, Mallick R, Vadlamani R, Dhar A. Assessment of the antimicrobial efficacy and mechanical properties of glass ionomer cement incorporating silver nanoparticles in varying concentrations for pediatric dental applications. J Pharm Bioallied Sci. 2024;16:S3689-S3691. doi: 10.4103/jpbs.jpbs_1202_24.
  • Siddiqui A, Gul A, Khan H, Anjum F, Hussain T. Bio-inspired synthesis of silver nanoparticles using Salsola imbricata and its application as antibacterial additive in glass ionomer cement. Nanotechnology. 2024;35(35). doi:10.1088/1361-6528/ad50e4.
Toplam 34 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Çocuk Diş Hekimliği, Diş Malzemeleri ve Ekipmanı
Bölüm Derleme
Yazarlar

Feyza Nur Altan 0009-0009-5629-4697

Zeynep Aslı Güçlü 0000-0003-0453-0167

Proje Numarası Proje yok
Gönderilme Tarihi 31 Ekim 2025
Kabul Tarihi 24 Şubat 2026
Yayımlanma Tarihi 16 Nisan 2026
DOI https://doi.org/10.34108/eujhs.1814521
IZ https://izlik.org/JA83LY64ZE
Yayımlandığı Sayı Yıl 2026 Cilt: 35 Sayı: 1

Kaynak Göster

APA Altan, F. N., & Güçlü, Z. A. (2026). Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme. Sağlık Bilimleri Dergisi, 35(1), 190-198. https://doi.org/10.34108/eujhs.1814521
AMA 1.Altan FN, Güçlü ZA. Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme. Sağlık Bilimleri Dergisi. 2026;35(1):190-198. doi:10.34108/eujhs.1814521
Chicago Altan, Feyza Nur, ve Zeynep Aslı Güçlü. 2026. “Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme”. Sağlık Bilimleri Dergisi 35 (1): 190-98. https://doi.org/10.34108/eujhs.1814521.
EndNote Altan FN, Güçlü ZA (01 Nisan 2026) Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme. Sağlık Bilimleri Dergisi 35 1 190–198.
IEEE [1]F. N. Altan ve Z. A. Güçlü, “Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme”, Sağlık Bilimleri Dergisi, c. 35, sy 1, ss. 190–198, Nis. 2026, doi: 10.34108/eujhs.1814521.
ISNAD Altan, Feyza Nur - Güçlü, Zeynep Aslı. “Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme”. Sağlık Bilimleri Dergisi 35/1 (01 Nisan 2026): 190-198. https://doi.org/10.34108/eujhs.1814521.
JAMA 1.Altan FN, Güçlü ZA. Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme. Sağlık Bilimleri Dergisi. 2026;35:190–198.
MLA Altan, Feyza Nur, ve Zeynep Aslı Güçlü. “Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme”. Sağlık Bilimleri Dergisi, c. 35, sy 1, Nisan 2026, ss. 190-8, doi:10.34108/eujhs.1814521.
Vancouver 1.Feyza Nur Altan, Zeynep Aslı Güçlü. Gümüş Nanopartikülle Modifiye Edilmiş Geleneksel Cam İyonomer Simanların Antimikrobiyal Etkinliği: Sistematik Derleme. Sağlık Bilimleri Dergisi. 01 Nisan 2026;35(1):190-8. doi:10.34108/eujhs.1814521