CAD/CAM高嵌体修复根管治疗后磨牙大面积缺损的临床研究

目的:分析CAD/CAM高嵌体修复磨牙根管治疗后牙冠大面积缺损的疗效分析.方法:选择260颗牙体重度龋损累及牙髓的磨牙,经完善的根管治疗后采用CAD/CAM椅旁技术进行全瓷高嵌体修复.分别在修复后6、12、18个月进行随访,参考美国公共健康会(USPHS)标准对其临床效果进行观察.结果:在260颗患牙中,CAD/CAM高嵌体修复磨牙根管治疗后牙冠大面积缺损成功率为98％,其中3例发生修复体脱落,2例发生修复体折裂.结论:CAD/CAM高嵌体修复技术可以作为磨牙根管治疗后牙体大面积缺损修复的手段.     

可切削复合瓷修复对青少年恒磨牙萌出及建牙合过程影响研究

目的    研究可切削复合瓷修复对青少年恒磨牙萌出、建牙合过程的影响。方法    选择2017年10—12月在大连市口腔医院牙体牙髓病科及儿童口腔科就诊的14 ~ 17岁单侧第一磨牙大面积龋坏并累及牙髓且其他3颗第一磨牙无龋坏的患者60例,完成根管治疗后随机分为3组,分别行复合树脂充填修复术（树脂充填组）、聚合瓷嵌体或高嵌体修复术（聚合瓷组）及可切削复合瓷嵌体或高嵌体修复术（CAD/CAM组）。完成修复即刻及1年后分别制取数字化印模,复查并测量患牙、对颌牙及对侧同名牙牙尖至龈缘顶点高度变化。结果　与同名对照牙相比,树脂充填组牙尖高度变化最大,聚合瓷组次之,CAD/CAM组变化最小,差异具有统计学意义（P < 0.01）。结论    采用可切削复合瓷修复青少年恒磨牙大面积牙体缺损,对牙齿萌出及建牙合过程的影响小于传统的修复方式。     

C形根磨牙根管治疗后CAD／CAM高嵌体修复的临床研究

目的观察CAD／CAM全瓷高嵌体修复根管治疗后C形根管下颌第二磨牙的临床效果。方法选择C形根管下颌第二磨牙24例,进行完善根管治疗,进行CAD／CAM全瓷高嵌体修复。术后即刻、6月／3及18月,参考美国公共健康会（USPHS）标准,对其临床效果进行观察。结果CAD／CAM全瓷高嵌体成功率高于90％。结论CAD／CAM全瓷高嵌体修复C形根管下颌第二磨牙根管治疗后效果良好,值得在临床推广。     

高嵌体结合即刻牙本质封闭技术修复磨牙中重度缺损的临床观察

目的:评价高嵌体结合即刻牙本质封闭技术修复磨牙中重度缺损的临床疗效.方法:选择我科2017年1月～2018年10月根管治疗后1～3个轴壁缺损的126例患者,141颗磨牙,采用CAD/CAM高嵌体结合即刻牙本质封闭技术修复,术后6、12、24个月复查,对其进行临床疗效评价.结果:共118例患者,130颗磨牙高嵌体完成24...     

椅旁CAD/CAM高嵌体修复老年磨牙大面积缺损的临床观察

目的：探究数字化椅旁计算机辅助设计/计算机辅助制造（CAD/CAM）高嵌体对老年磨牙大面积缺损患者的修复效果。方法：选取2016年7月～2020年6月本院收治的75例（75颗缺损牙）老年磨牙大面积缺损患者,行根管治疗后采用椅旁CAD/CAM进行高嵌体修复。评价修复后12、24个月的修复效果,并于修复后24个月调查患者满意度,检测修复前和修复后12、24个月的龈沟液内肿瘤坏死因子-α(TNF-α)和基质金属蛋白酶8(MMP-8)水平。结果：修复后12、24个月的修复合格率分别为97.33%、93.33%,修复后24个月患者在修复体颜色、外形及舒适度三方面的满意率分别为98.67%、97.33%、100%。修复后12、24个月的患牙龈沟液内TNF-α及MMP-8水平较修复前下降（P<0.05）。结论：CAD/CAM技术制作的高嵌体对于老年磨牙大面积缺损的修复效果良好,患者满意度高,可作为老年磨牙大面积缺损的有效治疗方案。     

数字化口腔修复（5）--全瓷OD高嵌体（附病例报告）

目的：观察计算机辅助设计与制造（computer aided design and manufacture,CAD／CAM）二矽酸锂牙合面－远中（occlusul－distal,OD）高嵌体修复磨牙残冠的临床疗效。方法：临床病例为经过完善根管治疗后大面积缺损的磨牙残冠,采用CAD／CAM二矽酸锂OD高嵌体修复,按照改良的美国公共卫生署（United States Public Health Service, USPHS）标准进行1年的临床疗效评价。结果：患牙OD高嵌体无脱落,折断、劈裂等现象。临床指标均达到A级标准。结论：CAD／CAM二矽酸锂OD高嵌体修复后牙牙体大面积缺损具有良好的临床效果。     

数字化口腔修复（3）-CAD／CAM二氧化锆钉MOD高嵌体修复（附病例报告）

目的：观察CAD／CAM二氧化锆钉MOD高嵌体修复后牙残冠的临床疗效。方法：临床病例为3颗大面积缺损的磨牙残冠患者,经过完善的根管治疗后,采用CAD／CAM二氧化锆钉MOD高嵌体修复,按照改良的USPHS标准分别进行6个月和1年的临床疗效评价。结果：各时段复查结果表明：3颗患牙无脱落,折断、劈裂等不良现象。临床指标均达到A级。结论：CAD／CAM二氧化锆钉MOD高嵌体修复后牙牙体大面积缺损具有良好的临床效果,远期疗效有待进一步观察。     

CAD/CAM全瓷高嵌体与全瓷冠抗折性能的比较

目的 比较第一恒磨牙CAD/CAM全瓷高嵌体与CAD/CAM全瓷冠修复体的抗折裂强度。方法 30颗上颌第一恒磨牙随机分为3组,每组10颗：其中A组为CAD/CAM高嵌体组, B组为CAD/CAM全冠组, C组为10颗天然第一恒磨牙对照组。在LLOYD万能试验机上进行抗折裂载荷实验,采用方差分析进行统计学处理。结果 A组、B组和C组的抗折裂载荷值分别是（1 623.00±431.86） N、（1 351.00±474.02） N和（2 280.3±914.19） N,第一恒磨牙利用CAD/CAM制作高嵌体修复体与全瓷冠修复体的抗折裂能力均低于天然牙,经方差分析, C组抗折裂值最大（P<0.05）, A组和B组间差异无统计学意义（P>0.05）。结论 用CAD/CAM制作高嵌体修复体与全瓷冠修复体的抗折强度相当,提示在临床上可以考虑采用更加微创的牙体预备方法来修复牙体缺损。     

CAD/CAM全瓷高嵌体修复根管治疗后牙体缺损的临床评价

目的:采用瓷睿刻计算机辅助设计与制作(CAD/CAM)系统制作全瓷高嵌体修复根管治疗后的后牙牙体缺损,观察其1年期床疗效。方法::选取46例根管治疗后的后牙,使用瓷睿刻(CEREC)系统,IPS e.max CAD材料,制作全瓷高嵌体,双固化树脂水门汀粘结。修复后1年,采用改良USPHS标准对修复体、牙体、牙周等各方面指标进行评价,同时评价患者满意度。结果:87 ％的修复体各项检查标准都达到了USPHS 标准A类,患者满意率92％。CEREC 全瓷高嵌体1年期疗效确切。结论:使用瓷睿刻(CEREC)系统制作的 IPS e.max CAD全瓷高嵌体可作为根管治疗后后牙牙体缺损的有效修复方案。     

CAD/CAM全瓷高嵌体微创修复根管治疗后牙体缺损的效果评价

目的：探讨CEREC计算机辅助设计与制作（computer aided design and computer aided manufacturing , CAD/CAM）全瓷高嵌体微创修复根管治疗后的后牙牙体缺损的临床疗效。方法选择126例大面积缺损的后牙,经过完善的根管治疗后,采用CEREC CAD/CAM全瓷高嵌体修复缺损牙冠,修复后即刻对患者进行满意度调查,术后即刻及1年后随访,均按照改良的美国公共卫生部（United States Public Health Service ,USPHS）标准对修复体进行临床评价。结果患者满意度在91%以上。根据改良USPHS标准,术后即刻及1年后复查时修复体边缘适合性达到A级分别为92.1％和91.3%（c2=0.052,P=0.820）,外形达A级前后两次均为97.6%,表面质地达到A级分别为95.2%和93.7%（c2=0.303,P=0.582）,颜色匹配达到A级分别为80.2%和81.7%（c2=0.103,P=0.748）。仅出现1例瓷破裂。结论 CEREC CAD/CAM全瓷高嵌体修复后牙牙体缺损效果良好,远期效果有待观察。     

Volumetric and dimensional accuracy assessment of CAD-CAM–manufactured dental prostheses from different materials

Statement of problemIn computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the CAD of the prosthesis represents the clinical prerequisite design to restore the treated tooth. However, how closely the CAM prosthesis shape matches the CAD, particularly in relation to different materials, is unclear.PurposeThe purpose of this in vitro study was to evaluate onlays designed and manufactured with the same CAD-CAM system but manufactured with different materials.Material and methodsA single standard tessellation language (STL) model was used to produce 6 composite resin onlays, 6 leucite glass-ceramic onlays, and 6 lithium disilicate glass-ceramic onlays. The onlays were digitized by using an X-ray microtomographic protocol with a metrological calibration. The CAD model was then compared with the scans of the different onlays. An analysis by region of interest was then carried out to assess the accuracy and reliability of the dimensional accuracy.ResultsThe composite resin and the lithium disilicate glass-ceramic had the best dimensional accuracy. The leucite glass-ceramic exhibited a lack of trueness linked to consistent overmilling. The composite resin had less peripheral chipping than the glass-ceramics.ConclusionsThe composite resin and the lithium disilicate glass-ceramic material exhibited satisfactory dimensional accuracy. Milling the glass-ceramic before crystallization considerably improved dimensional accuracy.     

下颌磨牙牙体严重缺损伴Ⅱ度根分叉病变的综合治疗

目的 探讨通过浓缩生长因子+引导性组织再生术+植骨术+椅旁计算机辅助设计和制作系统修复下颌磨牙牙体大面积缺损伴Ⅱ度根分叉病变的的临床效果.方法 对符合实验条件的40颗下颌磨牙,随机分为实验组(CGF+GBR+植骨术)和对照组(GBR+植骨术),6周复诊行CAD/CAM高嵌体修复.术后6个月,12个月对患牙进行修复体评价...     

两种肩台形态对全瓷高嵌体边缘适合性的影响

目的研究肩台形态对CERE Cinlab牙科计算机辅助设计一计算机辅助制造（computer aided design／computeraided manufacturing,CAD／CAM）系统制作的氧化锆全瓷高嵌体边缘适合性的影响。方法选取2颗离体第一磨牙行高嵌体牙体预备,1颗制备直角肩台,1颗制备凹形肩台。2颗牙分别用二次印模法取模,分别翻制5个相同尺寸的超硬石膏代型,并采用CAD／CAM技术制作5个全瓷高嵌体。然后用树脂加强型玻璃离子粘固,在体视显微镜下观察并测量冠边缘与代型边缘之间的间隙。结果直角肩台全瓷高嵌体的边缘间隙为（57．58±14．94）μm,凹形肩台全瓷高嵌体的边缘间隙为（61．98±12．84）μm,均在适合范围内。两种肩台全瓷高嵌体的边缘间隙大小差异无统计学意义（t=4．88,P〈0．01）.结论直角肩台和凹形肩台均可以满足全瓷高嵌体的边缘适合性要求。     

Marginal and internal fit of heat pressed versus CAD/CAM fabricated all-ceramic onlays after exposure to thermo-mechanical fatigue

Objectives

The aim of the study was to evaluate the marginal and internal fit of heat-pressed and CAD/CAM fabricated all-ceramic onlays before and after luting as well as after thermo-mechanical fatigue.

Materials and methods

Seventy-two caries-free, extracted human mandibular molars were randomly divided into three groups (n = 24/group). All teeth received an onlay preparation with a mesio-occlusal–distal inlay cavity and an occlusal reduction of all cusps. Teeth were restored with heat-pressed IPS-e.max-Press* (IP, *Ivoclar-Vivadent) and Vita-PM9 (VP, Vita-Zahnfabrik) as well as CAD/CAM fabricated IPS-e.max-CAD* (IC, Cerec 3D/InLab/Sirona) all-ceramic materials. After cementation with a dual-polymerising resin cement (VariolinkII*), all restorations were subjected to mouth-motion fatigue (98 N, 1.2 million cycles; 5 °C/55 °C). Marginal fit discrepancies were examined on epoxy replicas before and after luting as well as after fatigue at 200× magnification. Internal fit was evaluated by multiple sectioning technique. For the statistical analysis, a linear model was fitted with accounting for repeated measurements.

Results

Adhesive cementation of onlays resulted in significantly increased marginal gap values in all groups, whereas thermo-mechanical fatigue had no effect. Marginal gap values of all test groups were equal after fatigue exposure. Internal discrepancies of CAD/CAM fabricated restorations were significantly higher than both press manufactured onlays.

Conclusions

Mean marginal gap values of the investigated onlays before and after luting as well as after fatigue were within the clinically acceptable range. Marginal fit was not affected by the investigated heat-press versus CAD/CAM fabrication technique. Press fabrication resulted in a superior internal fit of onlays as compared to the CAD/CAM technique.

Clinical relevance

Clinical requirements of 100 μm for marginal fit were fulfilled by the heat-press as well as by the CAD/CAM fabricated all-ceramic onlays. Superior internal fit was observed with the heat-press manufacturing method. The impact of present findings on the clinical long-term behaviour of differently fabricated all-ceramic onlays warrants further investigation.     

Adhesive cementation of chairside CAD/CAM inlays and onlays

Chairside CAD/CAM restorations offer aesthetic, functional, biocompatible, and long-term successful alternatives to traditional materials and techniques, and can be fabricated in one appointment. Adhesive cementation is key for the long-term clinical success of CAD/CAM inlays and onlays. The clinical use of a newly developed composite resin cement for adhesive cementation of CAD/CAM inlays/onlays has been described.     

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??Objective    To explore whether IPS e.max CAD onlays with more sound tissue preserved had enough fracture resistance and better restoration effect compared with all-ceramic crowns when mandibular molars were in mesio-occlusal cavities after endodontic treatment. Methods    From August to October of 2015?? totally 32 extracted mandibular molars were collected in West China Hospital of Stomatology. All teeth were divided into four groups after being made pairs??which were G1??G2??G3 and G4. Subsequently??mesio-occlusal cavities were prepared with the same dimension??and endodontic treatment was conducted in all specimens. According to the restoration type and whether being exposed to thermomechanical cycles or not??the next process was as follows. G1??IPS e.max CAD crowns??no thermomechanical cycles??to simulate immediate state after restoration??G2??IPS e.max CAD crowns??with 1.2 million dynamic loadings and 1000 thermal cycles??to simulate 5-year functional state after restoration??G3??IPS e.max CAD onlays??no thermomechanical cycles??G4??IPS e.max CAD onlays??with 1.2 million dynamic loadings and 1000 thermal cycles. After that??all the specimens were loaded to failure??and failure modes were inspected and recorded. Results    The immediate fracture resistance of crowns and onlays was ??2269.49 ± 281.68??N and ??2357.91 ± 342.64??N??respectively??and there was no significant difference between them??P < 0.05??. After thermomechanical cycles??although the fracture resistance of both crowns and onlays decreased ???1738.30 ± 230.21??N and??2096.75 ± 216.75??N???they were higher than the mean masticatory force??100-250 N??and the maximum biting force??200-540 N??. The fracture resistance of onlays was higher than that of crowns and there was a significant difference between them??P < 0.05??. Conclusion    For mandibular molars with mesio-occlusal defect??both onlays and crowns achieve excellent immediate flexural strength. After thermomechanical cycles to simulate 5-year functional movement??they still have sufficient fracture resistance and onlays show better result than crowns.