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IPS e.max.CAD瓷块与复合树脂高嵌体修复后牙大面积缺损疗效观察

2020-01-13易明坤张野

中国美容医学 2020年12期
关键词:修复疗效

易明坤 张野

[摘要]目的:观察IPS e.max.CAD瓷块与复合树脂高嵌体修复大面积缺损后牙的疗效及安全性。方法:选取2018年1月-2018年9月笔者医院口腔科诊治的82例后牙大面积缺损患者为研究对象,根据非随机临床同期对照研究及患者自愿原则分为瓷块组(n=41)、复合树脂组(n=41),其中瓷块组接受IPS e.max.CAD瓷块高嵌体修复,而复合树脂组进行复合树脂高嵌体修复,修复体均粘接12个月进行复诊,比较两组修复效果、患者满意度及不良反应发生情况。结果:瓷块组修复体形态、修复体颜色、边缘颜色、边缘密合度及繼发龋的分级相较于复合树脂组明显优,差异有统计学意义(P<0.05);瓷块组患者满意度明显高于复合树脂组,差异有统计学意义(P<0.05);两组总不良反应发生率比较,无显著性差异(P>0.05),但与复合树脂组比较,瓷块组对颌牙磨耗、牙龈炎发生率略高(P>0.05)。结论:与复合树脂高嵌体相比较,IPS e.max.CAD瓷块高嵌体对大面积缺损后牙的修复效果明显优,但后者修复期间更易出现对颌牙磨损及牙龈炎,IPS e.max.CAD瓷块高嵌体修复或许更适于对美学效果要求较高且牙周状况较好的患者。

[关键词]大面积缺损;后牙;高嵌体;修复;疗效

[中图分类号]R783.4    [文献标志码]A    [文章编号]1008-6455(2020)12-0154-04

Effects of IPS e.max.CAD Ceramic Blocks and Composite Resin Onlay in Repair of Massive Defect of Posterior Teeth

YI Ming-kun,ZHANG Ye

(Department of Pediatric Dentistry,Xiangyang Stomatological Hospital,Xiangyang 441003,Hubei,China)

Abstract: Objective To observe the effects and safety of IPS e.max.CAD ceramic blocks and composite resin onlay in repair of massive defect of posterior teeth. Methods Eighty-two patients with massive defect of posterior teeth diagnosed and treated in stomatology department of the hospital between January and September 2018 were selected as the subjects. They were divided into the ceramic block group (n=41) and the composite resin group (n=41) according to the principle of non-randomized clinical concurrent control trial and voluntariness. The ceramic block group was treated with IPS e.max.CAD ceramic block onlay while the composite resin group was treated with composite resin onlay. The restorations were bonded for 12 months and reexamined.The effect of repair,patients satisfaction and adverse reactions were compared between the two groups. Results The morphology and color of restorations, color of the margin, margin fitness and the grade of secondary caries in the ceramic block group were significantly better than those in the composite resin group (P<0.05). The satisfaction of patients in the ceramic block group was significantly higher than that of the composite resin group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P>0.05). However, the incidence rates of wear of paired jaw teeth and gingivitis in the ceramic block group were slightly higher than those in the composite resin group (P>0.05). Conclusion Compared with composite resin onlays, the effect of IPS e.max.CAD ceramic block onlay is obviously better in repair of massive defect of posterior teeth. However, wear of paired jaw teeth and gingivitis are prone to occur during the latter repair. IPS e .max.CAD ceramic block onlay restoration may be more suitable for patients having higher aesthetic requirements and better periodontal conditions.

3  讨论

早期临床上主要借助于全冠修复以确保后牙大面积缺损患者患牙的抗折性,全冠修复的成功率虽高,但对牙体硬组织破坏多、费用高且易出现全冠脱落等现象[7-8];近年来,临床实践证实嵌体可于模型上完成,其精细雕刻的时间及视野充足,且可在高温高压下成形及抛光,利于患牙邻面外形、邻面与边缘密合度接触关系的恢复,提高后牙大面积缺损患者的修复效果,以往研究证实高嵌体修复对牙齿大面积缺损患者的效果明显优于全冠修复[9-10]。目前,复合树脂、瓷块是口腔嵌体的常用材料,刘小舟等[11]研究指出,复合树脂、陶瓷嵌体在近中-牙合面-远中(MOD)缺损患者应用中,对牙体组织修复体界面应力分布的影响相当,但复合树脂嵌体修复MOD缺损患者,牙体组织修复体界面剪切应力以及拉伸应力相较于陶瓷嵌体小,而目前国内关于两种高嵌体修复材料对后牙大面积缺损患者的临床疗效差异及适用性尚处于探索阶段。

本次分析结果显示:瓷块组较复合树脂组明显优,表现为前者的修复体形态、修复体颜色、边缘颜色、边缘密合度及继发龋的A级占比明显高,且瓷块组患者满意度明显高于复合树脂组,表明IPS e.max.CAD瓷块高嵌体治疗后牙大面积缺损患者的修复效果较复合树脂高嵌体明显优良,瓷块高嵌体修复利用全瓷修复技术,对冠修复体的细节把握更为精准,修复体几乎无需调磨,其可直接烧结或上釉烧结后,修复体表面更为光滑,修复体边缘密合度较到位,此外,该嵌体材料具备自然光泽,更为美观的修复效果[12-13],因此,患者满意度更高。而复合树脂耐磨性及抗压强度相较于IPS e.max.CAD瓷块低,且树脂材料易老化变色[14],因而复合树脂高嵌体对后牙大面积缺损的修复效果(尤其是美学修复方面)逊于IPS e.max.CAD瓷块高嵌体。

本次研究虽显示两组总不良反应无明显差异,但瓷块组对颌牙磨耗、牙龈炎发生率略高于复合树脂组,说明两种高嵌体修复材料的整体安全性相当,IPS e.max.CAD瓷块高嵌体修复过程中更易引发对颌牙磨耗以及牙龈炎发生,尽管IPS e.max.CAD瓷块有良好的抗压强度,但仍存在硬度大的特点,长期佩戴过程中易损伤对颌牙,此外,其材料强度较大对牙龈刺激较大,出现牙龈炎几率相对更高[15];而复合树脂高嵌体性能优良且硬度适中,在一定程度上对颌牙起到保护作用,同时复合树脂高嵌体修复过程中不仅能很好地恢复与牙龈的接触关系,且与牙面移行、不易形成悬突,减少对牙龈刺激。此外,除组织面外整个嵌体模型均可高度抛光,减少菌斑的附着且易于口腔清洁[16],初步提示复合树脂高嵌体在后牙大面积缺损修复中可保护对颌牙、减轻对牙龈的刺激。

基于以上分析,本次研究初步证实了IPS e.max.CAD瓷块修复后牙大面积缺损效果明显优于复合树脂高嵌体,但前者易引发对颌牙磨耗及牙龈炎,临床上可依据患者牙周状况择优选择修复方案。但本研究依然存在随诊时间较短、对象主要来源本院等不足,未来有待进一步完善研究。

[参考文献]

[1]于海悦,麻丹丹,林小育,等.CAD/CAM高嵌体修复根管治疗后磨牙大面积缺损的临床研究[J].实用口腔医学杂志,2017,33(1):41-44.

[2]Soares PV,Santos-Filho PCF,Martins LRM,et al.Influence of restorative technique on the biomechanical behavior of endodontically treated maxillary premolars.Part I: Fracture resistance and fracture mode[J].J Prosthet Dent,2008,99(1):30-37.

[3]張倩倩,陈昕,赵雨薇,等.3D打印在口腔美学修复中的应用[J].华西口腔医学杂志,36(6):656-661.

[4]孙雪丹.IPS e.max CAD LT低度透明瓷块修复后牙缺损的临床效果观察[J]. 口腔医学,2013,33(4):251-253.

[5]范晓川,黄晓峰.复合树脂分层修复前牙缺损2例[J].实用口腔医学杂志,2018,34(3):418-420.

[6]Hickel R,Roulet JF,Bayne S,et al.Recommendations for conducting controlled clinical studies of dental restorative materials[J].Clin Oral Investig,2015,57(5):300-302.

[7]王丽,高锦瑜,王星.铸瓷高嵌体修复磨牙大面积牙体缺损的临床效果[J]. 临床医学研究与实践,2017,2(6):122-123.

[8]Wang S,Zhao Z,Yang Y,et al.A high-strength mineralized collagen bone scaffold for large-sized cranial bone defect repair in sheep[J].Regen Biomater,2018,5(5):283.

[9]田斌,曹文瑾,杨晓林.椅旁CAD/CAM系统制作玻璃陶瓷高嵌体修复后牙牙体大面积缺损的效果[J].宁夏医科大学学报,2017,39(6):705-707.

[10]周进茹,陈西文,朱智敏.全瓷冠与高嵌体用于修复邻牙合面缺损根管治疗后下颌磨牙抗折强度对比研究[J].中国实用口腔科杂志,2017,10(1):26-30.

[11]刘小舟,贾兴亚,张忠提.复合树脂、陶瓷嵌体对MOD缺损牙体组织修复体界面应力及其分布的影响[J].山东医药,2018,58(32):17-20.

[12]强卫林,李雨轩,刘刚,等.3种边缘设计铸瓷高嵌体修复不同程度缺损无髓磨牙的3年对比研究[J].华西口腔医学杂志,2018,36(5):35-39.

[13]Goujat A,Abouelleil H,Colon P,et al.Mechanical properties and internal fit of 4 CAD-CAM block materials[J].J Prosthet Dent,2018,119(3):384-389.

[14]赵莉,庄友梅,陈晓涛.树脂超瓷嵌体与复合树脂充填用于根管治疗后牙体大面积缺损修复的临床疗效对比[J].广西医学,2018,40(20):46-49.

[15]陈勤超.三种材料的高嵌体修复大面积后牙缺损的效果评价[J].中华老年口腔医学杂志,2018,16(2):102-106.

[16]黄方芳,陈雷,潘微,等.CAD/CAM全瓷嵌体与复合树脂嵌体修复后牙Ⅱ类洞的临床效果及预后观察[J].广西医科大学学报,2018,35(9):96-98.

[收稿日期]2019-10-21

本文引用格式:易明坤,张野.IPS e.max.CAD瓷块与复合树脂高嵌体修复后牙大面积缺损疗效观察[J].中国美容医学,2020,29(12):154-157.

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