金属熔附烤瓷冠桥应用于种植义齿修复的特点

讨论烤瓷熔附冠桥作种植义齿的上部修复体的技术特点,说明在临床应用的有效性。方法：以数千例ＣＤＩＣ种植义齿烤瓷熔附冠桥修复的临床经验的基础上,阐述烤瓷熔附冠昨体边缘,咬Ｈｅ合处理,金属基底制作等方面的技术特点以及生物力学问题。     

固定义齿修复前牙缺失的临床失败病例分析

目的:研究金属烤瓷桥及粘接桥修复前牙缺失的失败病例,分析两种修复方式的优缺点及适应症。方法:收集门诊前牙缺失、固定义齿修复病例,分成烤瓷冠桥修复组和粘接桥修复组。检查记录修复后即刻效果及修复半年后、修复2年后的临床失败病例情况,进行对比分析。结果:烤瓷冠桥组失败病例主要为牙龈变色、崩瓷、牙龈炎、基牙牙髓炎、根尖病变等;粘接桥组失败病例主要为修复体松动、脱落、继发龋等。结论:两种固定义齿修复前牙缺失各有优缺点、适应症,临床应谨慎选择使用。     

51件金属烤瓷修复体失败原因讨论

金属烤瓷冠因其强度高、质硬耐磨、色泽稳定、美观和适应范围广等优点 ,在临床上得到广泛应用。本文通过对 1 993～ 1 999年间在我科出现的 51例失败病例进行讨论 ,以供临床参考。临床资料从有完整临床资料的病例中 ,复查 1 993～ 1 999年间的1 1 56例共 1 32 0件金属烤瓷冠修复体。其中 41例患者的 51件修复体失败 ,占总件数的 3.9%。一年内失败者有 1 9件 ,1～ 2年者 1 4件 ,2～ 3年者 8件 ,3年以上者 1 0件。其中烤瓷冠 40件 ,烤瓷桥 1 1件。详情见表 1。表 1　 51件金属烤瓷修复体失败原因时间松动脱落崩瓷基牙病变 牙龈变色色泽不协调 …     

牙列重度磨损修复治疗36例报告

目的:探讨用金属烤瓷修复体修复牙列重度磨损伴牙列缺损病例进行重建的临床效果。方法:对36例重度磨损病例采用金属烤瓷冠桥进行重建修复治疗,治疗前、后测定咀嚼效率,并进行比较分析。结果:应用金属烤瓷冠桥进行重建修复有效地恢复了患者的关系及颌面垂直距离,原有的TMD症状得到改善或消失,咀嚼效率明显提高。结论:金属烤瓷修复体是牙列重度磨损后咬合重建的有效治疗方法。     

347例烤瓷熔附金属修复体的随访分析

目的：总结烤瓷熔附金属修复体的临床疗效。方法：对1999年3-2001年3月期间，资料记录完整和随访的347例共886个牙位的烤瓷熔附金属修复体的临床资料进行调查分析。结果：0．5－2年的成功率为97．85％，失败的主要原因为崩瓷，冠脱落，龈红肿或龈萎缩，食物嵌塞等。结论：为了提高修复的成功率和远期疗效，应严格掌握适应证，规范牙体制备，技工制作，临床试合，特别注意非正中He的调试，并应嘱患者避免咬过硬的食物和正确的刷牙方式。     

三种烤瓷桥临床修复六年的回顾分析

目的 追踪观察金沉积基底冠熔结镍铬桥体烤瓷桥、金合金烤瓷桥和镍铬合金烤瓷桥的临床效果,为评价不同烤瓷桥临床修复的远期效果提供参考.方法 制作金沉积基底冠熔结镍铬桥体烤瓷桥(A组)35件,同期分别制作金合金烤瓷桥(B组)和镍铬合金烤瓷桥(c组)各35件,临床检查105件修复体的边缘密合性,随访复查修复体的基牙继发龋和修复体折裂、折断、脱落情况.结果 105件修复体平均随访6年.A组边缘密合性好(100%),明显好于B组(91%)与C组(77%)(P<0.01).6年内A组基牙继发龋率为0%(0/35),B组基牙继发龋率为6%(2/35),c组基牙继发龋率为14%(5/35).A组中有1例在修复2年后饰面瓷崩瓷,占3%;随访期内B组无崩瓷现象;C组1例在修复4年后饰面瓷崩瓷,占3%,3种修复体崩瓷率差异无统计学意义(P>0.05).其余修复体均无桥架松动、折断以及修复体脱落.结论 金沉积基底冠熔结镍铬桥体烤瓷桥有良好的边缘密合度,强度可满足临床要求,有临床应用价值.但其与常规铸造合金烤瓷桥一样,需谨慎使用,提倡用于无髓基牙烤瓷桥修复.     

数字化金属激光烧结烤瓷桥在修复失败再治疗中的临床研究

目的 研究数字化金属激光烧结（DMLS）烤瓷桥对牙列缺损固定桥修复失败再治疗的临床修复效果。方法 选择我院就诊的后牙牙列缺损固定桥失败患者24例72个单位修复体,拆除原修复体后,针对病因完善治疗基牙后,随机分为2组,研究组患者采用数字化激光烧结烤瓷桥修复,对照组采用传统铸造烤瓷桥修复。根据改良式Ryge标准分别评价2组修复体的就位情况、边缘适合性、基牙颊侧冠边缘色泽,并在患者修复后3个月和6个月复查修复体完整性及修复体周围牙龈状况等评价分级,对2组修复体评价结果统计分析。结果 研究组修复体在就位的准确性、基牙边缘适合性及3个月和6个月后基牙牙龈状况均优于对照组,2组差异有统计学意义（P<0.05）。2组修复体基牙冠颊侧边缘色泽,3个月和6个月的完整性差异无统计学意义（P>0.05）。结论 数字化激光烧结的金属烤瓷桥在临床就位、边缘适合性及修复后牙龈状况方面优于传统铸造金属烤瓷桥,值得临床推广应用。     

铸造桩核加金瓷全冠修复龈下牙体缺损

目的 探讨铸造桩核加烤瓷熔附金属全冠修复涉及龈牙牙体缺损的临床疗效。方法 对63例69只涉及龈下缺损的患牙采用铸造桩核加烤瓷熔附金属全冠进行修复。铸造桩核与烤瓷熔附金属全冠先后取模制作完成,结果 患牙经治疗6-12月后检查69只,良好62只,占89.86%,一般6只,占8.70%,失败1只,占1.44%。结论 铸造桩核加烤瓷熔附金属全冠修复龈下的牙体缺损是一种较理想的修复方法。     

口腔修复工艺学问答(九)

九、烤瓷与硬质冠桥树脂修复技术 147、烤瓷修复有几种、各有何工艺特点? (1)烤瓷全冠:是烤瓷修复的最初形式,先用纯的铂金箔作成坯,烧附烤瓷于其上,修复体制成后,再将铂箔剥去,完成烤瓷全冠。 (2)烤瓷—金属熔合全冠:是最广泛、实用的烤瓷复修技术,主要以高强度的金属与低熔烤瓷熔合,形成烤瓷—金属熔合全冠。其工艺特点是先铸造成冠     

金属烤瓷修复体的失败原因分析及预防措施

目的研究金属烤瓷修复体失败的原因,探求解决方法和预防措施。方法制作金属烤瓷修复体889件。对其中失败的41件,从临床因素、技师制作因素等方面综合分析失败原因,提出新的治疗方案。结果41件失败的金属烤瓷修复体中,瓷崩裂22件,龈缘变色10件,色泽不协调3件,冠桩脱落3件,基牙折断1件,食物嵌塞2件。根据失败原因,采取相应补救措施,41件修复体均得到有效修复。结论严格选择金属烤瓷修复适应证,规范临床和技工室操作,学习色度学的知识,有助于提高金属烤瓷修复体的成功率。     

The relationship between failure and design in conventional bridgework from general dental practice

A total of 142 failed bridges constructed in general dental practice were assessed for design factors that might relate to failure. The overall mean age of the bridges at failure was 6.2 years; anterior and complex bridgework had a mean age of about 5 years, compared with 7.5 years for posterior bridges. The lifespan of the bridgework was significantly correlated with the number of retainers but not with the number of units. Bridges with one or two retainers had an average lifespan of just over 7 years, whilst those with three or more retainers had been in service for, on average, only 4 years. The practical difficulties of constructing multi-abutment bridgework could account for this difference. One hundred and ninety-one of the 346 retainers were porcelain bonded to semi non-precious metal crowns, and had a mean lifespan of 3.7 years, whilst those that were gold based lasted at least twice as long. Post crowns as retainers survived on average for 6.2 years.     

Survival of resin-bonded porcelain veneer crowns placed with and without metal reinforcement

OBJECTIVES: The purpose of this retrospective case study of dental records was to compare the long-term failure rates and modes for resin-bonded sintered feldspathic porcelain veneer crowns (RBPVCs) either containing or without metal substructure reinforcement. METHODS: Two prosthodontists placed 62 RBPVCs fabricated with, and 167 without, metal reinforcement in 143 older adolescent and adult patients treated in a private practice. Clinical judgement determined the type of crown design placed. Preparation margins were generally finished on enamel, and all crowns occluded with opposing teeth. Observations included the patients, operators, crown designs and failure modes. Chi-square or Fisher's exact tests and life table survival statistics were used to evaluate the findings (alpha = 0.05). RESULTS: Over five years, failures occurred in 14.5% of RBPVCs fabricated with, and in 18.6% without, metal reinforcement. Cumulative survival estimates were 74.3 +/- 8.5(Standard Error)% and 72.9 +/- 4.8(SE)%, respectively (P = 0.96). Mandibular posterior crowns comprised 27.1% of the placements, but 47.5% of the failures. Bulk fracture of porcelain occurred in 7.0% of the crowns, all without metal reinforcement. Minor porcelain fractures and debonding were less frequent in both types of crowns. Persistent pulpitis occurred in 3.5% of all teeth. CONCLUSIONS: There was a significant risk of failure for sintered porcelain RBPVCs placed as posterior restorations. Although metal reinforcement was able to reduce the risk of bulk fracture of porcelain, other causes of failure were less affected.     

老年患者后牙残根残冠的保存与修复治疗

目的:研究老年患者后牙残根残冠行桩核全冠修复的效果.方法:对103例60岁以上老人的174颗后牙残根残冠进行根充治疗,制作桩核后行金瓷或金属全冠修复,对修复体的卫生、使用情况及基牙牙周健康状况进行为期5年的随访观察.结果:发现3颗全冠和2颗桩核脱落,6颗基牙因松动拔除,13颗基牙出现较重的牙周炎症,4颗基牙发生根面龋,另有4颗基牙动度明显增加,93%的义齿使用良好.结论:后牙桩核全冠修复,不仅能恢复口腔功能,可促进老年患者的健康.但口腔卫生至关重要.     

Outcome of Endodontic Treatment through Existing Full Coverage Restorations: An Endodontic Practice Case Series

IntroductionThis case series assessed the outcome of nonsurgical endodontic treatment completed through retained full coverage restorations (FCRs) in a board-certified endodontist private practice. The number of cases completed by the first author was 153.MethodsAll cases were performed following a standardized protocol for treatment and restoration depending on the type of FCR. Number of cases that showed up for 2- to 4-year follow-up was 127, with 83% recall rate. The age range of patients was 33–95 years, with mean age of 54.734 years. The mean recall time was 2.448 years. FCRs and their distribution were as follows: 4 anterior teeth, 14 premolars, and 109 molars. There were 103 nonsurgical root canal treatments and 24 retreatments. Patients who presented for recall had 74 porcelain fused to metal crowns, 17 zirconia crowns, 15 abutments of porcelain fused to metal bridges, 14 lithium disilicate crowns, 5 gold crowns, 1 full metal crown, and 1 gold onlay.ResultsThere were no endodontically related failures. Six cases failed; 3 were due to vertical root fractures, 1 was due to horizontal root fracture, and 2 were due to extensive recurrent caries causing restorative failure. The percentage of healed cases following the American Association of Endodontists outcome criteria adopted in 2004 with intact retained FCR was 95.3%.ConclusionsThe results suggest predictable favorable outcomes for nonsurgical endodontic treatment through FCR following the proposed protocol for diagnosis, treatment, and restoration.     

Current types of ceramics available or in use

For years, dental profession tried, to find an ideal material and technique, for improving esthetic and functions. The use of porcelain fused to metal crowns, offered the opportunity to build up esthetic crowns on anterior and posterior teeth; however the metal substructure of porcelain fused to metal crown prevent us in many cases to achieve an ideal esthetic, as far as translucency is concerned. The ceramic built up on an alumina core, and the new castable ceramics seam to eliminate this problem, but the laboratory procedures are time consuming and complex, and their mechanical strength are still questionnable.     

Fracture resistance of implant-supported screw- versus cement-retained porcelain fused to metal single crowns: SEM fractographic analysis.

OBJECTIVES: The present in vitro study aimed at evaluating the fracture resistance of both implant-supported screw- and cement-retained porcelain fused to metal (PFM) single crowns. A scanning electron microscope (SEM) evaluation of the mode of failure of the specimens was also performed. METHODS: Forty PFM premolar-shaped identical single crowns were realized. The restorations were divided into two groups: cement-retained (group 1) and screw-retained (group 2) prostheses. Compressive loading tests and SEM fractographic analyses were performed. The data were statistically analysed by means of the Student's t-test, with a confidence interval of 95%. RESULTS: The mean fracture load value was 1657 (+/-725) N in group 1 and 1281 (+/-747) N in group 2; the statistical analysis pointed out no significant differences between the two groups (p=0.115). The mean work at maximum load value was 0.775 (+/-0.619) J in group 1 and 0.605 (+/-0.526) J in group 2; the statistical analysis pointed out no significant differences between the two groups (p=0.355). All the samples were affected by cohesive fractures of the porcelain. Screw-retained crowns showed microcracks at the level of the occlusal access to the screw and extensive fractures in the whole thickness of the ceramics. On the contrary, cement-retained restorations were affected by less wide paramarginal fractures of the porcelain. SIGNIFICANCE: A stronger implant-prosthetic connection was noticed in cemented restorations group than in screw-retained single crowns. Even though negatively influenced by the presence of the occlusal access to the screw, the metal-ceramics bond can be considered predictable in both the implant-prosthetic connection systems analysed.     

烤瓷冠桥修复后1年的牙周情况分析

目的：观察烤瓷冠桥修复体对牙周组织的影响。方法：对126例患的336颗牙分别经镍铬合金烤瓷、贵金属烤瓷和铸造全瓷冠桥修复后1年进行复查，观察修复前后牙龈色泽、牙龈指数、菌斑指数、和牙周探诊深度的变化。结果：有14％的镍铬合金烤瓷修复后1年牙龈发生变色，贵金属烤瓷和铸造全瓷对牙龈色泽影响很少或没有；镍铬合金烤瓷和贵金属烤瓷修复后牙龈指数与术前有显性差异；铸造全瓷组术前和术后无明显差异；3组术前、术后的菌斑指数、牙周探诊深度无明显差异。结论：铸造全瓷牙修复对牙周组织的影响较少。     

Assessment of clinical proceedings adopted by dental professionals regarding the employment of ceramic fused to metal crowns

The current features of ceramic fused to metal crowns were evaluated by means of a questionnaire composed by 20 questions concerning the use of this type of restoration in the daily dental practice of professionals from Aracaju, Bauru and post-graduation students in the area of dental prosthesis. The conclusions were as follows: 1. Ceramic fused to metal crowns are the most employed restorations in Dentistry. 2. Most dentists regard ceramic fused to metal crowns as successful restorations, indicating ceramic occlusal surfaces for most of the patients. 3. Even though most professionals use nickel-chromium alloys in ceramic fused to metal crowns for their patients, they prefer the use of noble and semi-noble alloys for restorations in their own mouths. 4. The majority of the interviewees employ ceramic fused to metal crowns for rehabilitation of anterior teeth (57.23%). Nevertheless, this was due to the fact that 78% of the dentists from Aracaju preferred this type of restoration, whereas in Bauru most professionals and students make use of ceramic crowns. 5. Most professionals apply zinc phosphate cement for the placement of ceramic fused to metal crowns. Most of them prefer to use Vita porcelain (34.34%), compared to 13.86% for the Noritake and Dulceram Plus porcelains. 6. The most desired improvement for ceramic fused to metal crowns was the possibility of easy repair.     

Retrospective assessment of 546 all-ceramic anterior and posterior crowns in a general practice

STATEMENT OF PROBLEM: There is need to determine whether following a consistent procedural protocol in a private dental practice will result in high success rates for all-ceramic anterior and posterior crowns fabricated from aluminous porcelain veneered to high-alumina content-supporting cores. Aluminous porcelain is known to have poor tensile strength and fracture resistance when subjected to shear forces. PURPOSE: This study examined the long-term survivability of alumina core, all-ceramic crowns in both anterior and posterior locations. MATERIAL AND METHODS: Following a consistent protocol over 6 years, 546 all-ceramic, In-Ceram crowns (32.4% anterior [n = 177] and 67.6% posterior [n = 369]) were consecutively luted with glass ionomer resin hybrid cement and periodically observed by the same dentist who prepared and cemented them. RESULTS: The overall success rate was 99.1% (n = 541) with a 0.9% (n = 5) failure rate. The success-to-failure ratio for anterior all-ceramic crowns was 98.9% to 1.1% (n = 175:2); the posterior crown ratio was 99.2% to 0.8% (n = 366:3). CONCLUSION: Following a consistent protocol of careful tooth preparation and crown cementation resulted in high success rates for anterior and posterior all-ceramic crowns. Glass ionomer resin hybrid cement appeared to be a reliable luting agent. All-ceramic alumina core crowns are durable and provide optimum esthetic choices for anterior and posterior locations.     

A survey of crown and fixed partial denture failures: length of service and reasons for replacement

The mean length of service of all restorations observed in this study was 8.3 years. Caries was the most common cause of failure, affecting 22.0% of the units failed and leading to the necessity for replacement of 24.3% of the units observed. Mechanical problems accounted for 69.5% of the failed units as opposed to 28.5% for oral disease. Resin veneer metal crowns provided the longest service of all crown types observed (13.9 years) and failed most frequently because of worn or lost veneers. The complete veneer metal crown had a life span of 6.1 years and was most likely to fail because of caries or defective margins. Ceramic-metal crowns also showed a relatively short period of service at 6.5 years, needing replacement primarily because of porcelain failure or poor esthetics. The resin-veneer metal crown also provided the longest service as a retainer, with a mean length of service of 14.7 years. This was closely followed by the partial veneer retainer (14.3 years), while the ceramic-metal retainer had the shortest life span (6.3 years). No apparent relationship was found between the span of prosthesis and its length of service. The six-unit canine-to-canine fixed partial denture exhibited the greatest longevity of the prostheses studied (10.4 years), while the two-unit cantilever fixed partial denture provided a mean of only 3.7 years of service before replacement was required.