Nd:YAP激光联合自酸蚀粘接和树脂修复治疗牙本质敏感的临床研究

目的 探讨Nd：YAP激光联合自酸蚀粘接系统对牙本质敏感的临床疗效。方法 选取108颗需要树脂充填的牙本质敏感患牙,随机分为实验组和对照组。实验组使用Nd：YAP激光处理牙面后,联合自酸蚀粘接系统和树脂充填修复;对照组直接使用自酸蚀粘接系统和树脂充填修复,分别在治疗后6个月和12个月对牙敏感性,充填体固位性,充填体边缘密合性和总体疗效进行评估。结果 治疗后12个月随访,实验组牙齿敏感度改善情况、充填体固位性、充填体边缘密合度均优于对照组,差异有统计学意义（P<0.05）;实验组总体疗效高于对照组,差异有统计学意义（P<0.05）。结论 Nd：YAP激光联合自酸蚀粘接系统对改善牙本质敏感疗效明显,充填体固位力和边缘密合度优,适合用于需要充填的牙本质敏感患者。     

上颌第二前磨牙根管治疗后复合树脂直接粘接修复2．5年的效果

本文报道1例采用复合树脂直接粘接修复技术修复根管治疗后上颌第二前磨牙MOD洞的病例。患牙因慢性牙髓炎施行一疗次根管治疗．牙体缺损呈MOD洞．采用复合树脂直接粘接技术进行修复。临床操作中充分发挥牙本质粘接作用．利用髓腔固位,并以复合树脂覆盖颊舌牙尖。经1年和25年复查修复效果良好．患牙能正常行使咀嚼功能．修复体和剩余牙体组织均完好,没有边缘着色和继发龋形成。本病例提示复合树脂直接粘接技术是修复根管治疗后牙体缺损的一个有效方法。     

不同牙本质处理剂的临床效果评价

复合树脂材料以其较好的粘接性能和色泽已广泛应用于口腔临床上的粘接、牙体修复、美容等。酸蚀技术能显著提高牙釉质与材料的粘接强度业已得到公认,但对牙本质的处理效果尚有争议。寻求较好的牙本质表面处理剂是有待解决的课题之一。本文旨在通过临床研究探讨各种牙本质表面处理剂应用价值。     

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1牙体粘接修复术1.1定义借助于牙体硬组织表面处理,使材料与牙体粘接的方法。1.2牙釉质的粘接目前对釉质的粘接主要采用酸蚀技术,即通过酸蚀刻釉质表层,获得树脂修复体的微机械固位,从而增强复合树脂与釉质的粘接强度。     

FL-BOND粘接系统在楔状缺损修复中的临床观察

目的:对比研究FL-BOND自酸蚀粘接系统和全酸蚀粘接系统与光固化复合树脂修复牙颈部楔状缺损的临床疗效。方法:对218例楔状缺损患者420个患牙随机分成2组,分别采用FL-BOND自酸蚀粘接系统与全酸蚀粘接系统对牙颈部楔状缺损进行光固化复合树脂修复,治疗后6,12,24月复查,对2组病例的治疗效果进行比较分析。结果:两组病例一次成功率比较,无统计学差异。但FL-BOND系统在防止牙本质过敏方面明显优于全酸蚀粘接系统。结论:FL-BOND系统与光固化复合树脂修复楔状缺损有良好的防止牙本质过敏作用。     

光固化复合树脂在后牙牙体治疗中的应用

报道光固化复合树脂应用于后牙牙体治疗病例80例106颗牙,年龄15-72岁,使用材料为古莎斯拉菲勒树脂,采用酸蚀粘结技术直接修复,其中龋合并牙间隙过大者34颗,残根残冠25颗,牙冠襞裂21颗,窝洞充填26颗。牙体预备时主张做附加固位形,严重缺损者要选用钢丝支架、根管桩或固位钉并常规减颊舌(腭)径,降低(牙合)面,观察5月-3年,效果满意。作者认为复合树脂硬度不如合金,常规充填首选银汞合金。但对伴有牙间隙过大的牙体缺损修复、窝洞充填,残根残冠的保存修复,无法备固位形的牙体缺损修复及特殊要求者树脂具有独特价值,值得推广应用。     

自酸蚀粘接系统和复合树脂修复牙体缺损的疗效比较

目的:比较自酸蚀粘接系统和复合树脂修复牙体缺损的效果。方法:随机抽取201颗患牙随机分为2组,治疗组101颗,采用自酸蚀底料的可乐丽菲露SEBOND及AP-X复合树脂修复牙体缺损;对照组100颗,应用Durafill釉质粘接剂及Charisma复合树脂修复。治疗后随访观察1、3、6个月,所得结果用四格表χ2检验。结果:治疗组修复体成功率达98%,而对照组则为90%,两组疗效有显著差异(P<0.05)。结论:应用自酸蚀粘接系统和复合树脂修复牙体缺损,可以获得较好的固位性能和边缘封闭性,值得在临床上推广。     

复合树脂充填不同角度楔形缺损效果的三维有限元分析

目的:研究复合树脂对下颌第一前磨牙4种角度楔形缺损的修复效果。方法:在前期建立的深1 mm,夹角分别为30°、60°、90°、120°的下颌第一前磨牙颊颈部楔形缺损有限元模型上,通过赋予牙本质参数和复合树脂参数,获得模拟复合树脂充填修复模型、模拟完整牙体实验模型和未修复的楔形缺损模型,分别经100 N轴向加载后,利用三维有限元分析法进行应力分析。结果:由牙本质充填模拟的完整牙体其应力分布状况与复合树脂充填体相似,均为近中侧高于远中侧,各种角度楔缺的Von Mises应力集中点均位于修复体外表面近中侧边缘;复合树脂修复体部分的Von Mises应力最大值低于模拟牙本质修复体。30°楔缺时树脂修复模型在平面O上承受较大应力的范围略大于完整牙体;在60°楔缺时树脂修复模型在平面O上承受较大应力的范围略小于完整牙体;在90°和120°楔缺时树脂修复模型在平面O上承受较大应力的范围明显小于完整牙体。30°、60°、90°、和120°4种楔形缺损角度情况下,树脂修复组和完整牙体组在直线L上的Von Mises应力分布接近(P>0.05),均明显小于未充填的楔缺模型(P<0.05)。结论:复合树脂充填对于4种夹角角度的楔形缺损均具有保护作用,可使患牙内部的应力分布情况恢复正常,更好的阻断了牙体内部的应力集中现象。     

复合树脂直接粘接修复Ⅴ.后牙直接粘接修复

后牙承担着较大的咀嚼咬合力,修复后牙龋坏或牙体缺损时,要均衡考虑材料的机械强度和耐磨性.银汞合金充填修复术操作简便,材料的机械性能好,被广泛应用于后牙龋损修复已有百余年,取得了良好的临床效果,但存在牺牲部分正常牙体组织以获得固位和颜色不符合美观要求等缺点.20世纪70年代以来,复合树脂开始应用于牙体缺损修复,但多用于前牙区对美学要求高的病例.早期由于粘接系统和复合树脂性能的不足,临床上出现继发龋或粘接失败的病例很多,加之耐磨性差,较少用于后牙.     

复合树脂充填材料的研发策略和进展

复合树脂充填材料是牙体直接粘接修复的首选材料,其良好的性能可以满足临床牙体修复治疗的要求,恢复结构和功能并兼具微创和美观。为进一步提高临床疗效,改善复合树脂材料性能的局限性是根本的解决策略。本文总结目前的研究进展,重点阐述改良复合树脂材料的性能,研发新型复合树脂包括抗菌复合树脂、再矿化生物活性树脂和自修复复合树脂的进展,为新型复合树脂充填材料的研究趋势提供新思路。     

Controversies in posterior composite resin restorations

The use of posterior composites is riddled with so many controversies that the puzzled practitioner must step warily among them. This modality is a minefield, where one careless movement can bring disaster. All composite restorations are subject to three big destructive forces--moisture, polymerization shrinkage, and clinical wear--forces that can eventually produce both microleakage and deterioration of the silane coupling agent linking filler particles to resin matrix. Despite the extreme technique sensitivity of posterior composite resins, knowledge of resin technology, sound operative dentistry principles and foresight in case selection can be effective in producing durable cosmetic restorations. Posterior composite resin restorations bonded to enamel and dentin reputedly strengthen teeth in both conventional and adhesive types of preparations provided polymerization shrinkage can be controlled. It is imperative that a knowledge of occlusal contacts be used to influence cavity outline, confining the trauma or occlusal forces away from the tooth-resin interface and helping to minimize occlusal wear. With the increased use of posterior resins, the trend in cavity preparations should break away from the traditional Black preparation toward the adhesive type preparation. If the Black Class II preparation is used, it is suggested that bevels be confined to the facial and lingual margins of the proximal box. Prewedging helps to maintain a conservative Class II preparation. Shade selection must be made prior to rubber dam isolation for greater accuracy and to help prevent postinsertion discoloration. The enamel should be pumiced to present a clean substrate for acid etching. The smear layer should be removed. The type of pulp protection applied before acid etching is dependent on the material used. After etching, the enamel should be washed with a 1 per cent potassium chloride solution. It is a more universally chemically stable solution than additive-laden local water supplies. The potassium chloride solution lowers the electrostatic forces on the enamel that would interfere with the flow of enamel bonding agents. Furthermore, tests have shown that the use of potassium chloride washes increase the strength of the enamel body by 40 per cent. Because of the depth of most posterior cavities, an incremental filling technique must be used to ensure a thorough polymerization of the resin and to forestall a massive polymerization shrinkage. When finished and contoured, the margins of the restoration should be re-etched, washed, and dried and then covered with an application of unfilled resin to discourage microleakage. Traditional operative dentistry technique must become flexible enough to meet the new demands of resin technology.(ABSTRACT TRUNCATED AT 400 WORDS)     

Regional bond strengths of resins to human root dentine

Objectives: The demand for restoration of root dentine defects such as cervical erosion and root caries has significantly increased recently, but there is limited information on the performance of the adhesive resins to radicular dentine. The purpose of this study was to measure the regional tensile bond strength (TBS) of composite bonded to human root and coronal dentine, and to observe the interface between resin and root dentine by SEM.

Methods: Human extracted cuspid teeth were used to measure TBS with a new microtensile bond test. Enamel and cementum were removed from the labial tooth surfaces to form a long cavity preparation into dentine from the mid-crown to the apex of the root within the same tooth. All Bond 2 (all etch technique) or Imperva Bond (no etch) was bonded to dentine surfaces and covered with Protect Liner resin composite. The resin-bonded teeth were serially sliced into 16 sections at right angles to the long axis of the tooth, and the bonded surfaces were trimmed to give a bonded surface area of 1 mm² for TBS testing.

Results: All Bond 2 bond strengths to coronal and apical dentine showed high values (23.5 MPa) but the bond strength was significantly lower on cervical root dentine. Imperva Bond produced a relatively high tensile bond strength to all regional areas. SEM showed that the thickness of the resin-infiltrated layer formed by All Bond 2 in root dentine was less than coronal areas. Resin infiltration with Imperva Bond was always less than 0.5 μm. The results suggest that high TBS values can be obtained with minimal resin infiltration in root dentine.     

复合树脂嵌体的研究进展及应用现状

复合树脂嵌体也称间接性树脂修复,是由含有双甲基丙烯酸酯基类的复合树脂在体外固化制作而成。体外固化过程释放了复合树脂嵌体的聚合收缩应力,使修复体的聚合收缩局限在粘接层内;同时提高了复合树脂的聚合程度,提升了其机械性能。同样,由于复合树脂嵌体有体外操作过程,因此在解剖形态方面更佳,有着相比直接树脂充填更良好的邻面接触和面形态。相比瓷嵌体,复合树脂嵌体有着修补方便,不磨耗对牙等特点。随着复合树脂材料及树脂粘接材料的更新,复合树脂嵌体的性能如抗折裂强度、边缘微渗漏、硬度及耐磨性等方面得以提高,复合树脂嵌体在临床方面的应用逐渐广泛,不仅限于牙体严重缺损活髓牙的修复,在完成牙髓治疗后的牙齿、隐裂牙、重度磨损牙等疾患中均有应用。本文就近年来复合树脂嵌体的性能研究及临床应用现状作一综述。     

Clinical management of non-carious enamel defects

Enamel defects not caused by decay may occur singly or may be generalized over the entire tooth surface. In the past, treatment of these aesthetic problems required large cavity preparations or full crown coverage of the affected teeth. Now, with the advent of various resin restorative materials capable of bonding to enamel, new techniques are being developed which are less radical. By etching the surface of the enamel with varying concentrations of dilute phosphoric acid, sufficient porosity is produced to allow the resin to adhere to it. Thus, by removing a minimal amount of tooth structure, the affected area can be masked with a thin layer of resin material after the surface has been properly prepared. If the fault in the enamel is generalized, the whole surface of the tooth may be restored using this technique, effectively covering the tooth with an aesthetic veneer. The new resin filling materials offer good colour stability as well as resistance to abrasive wear. Tests have revealed that this mode of treatment has a successful retention rate of over 92 per cent after 5 years. Lightly discoloured or stained defects of the enamel may be treated by bleaching the affected area with no adverse effect on the pulp tissue. Those teeth not improved by bleaching can be conservatively managed by veneering their surfaces with smooth finishing plastic materials.     

Compomers, reattachment method expand restoration capabilities.

The purpose of this article is to review one new material and one new technique being used in restorative dentistry today. Compomers, new fluoride-releasing resin restorative materials, are compared to conventional glass ionomers in terms of classification, physical properties, and clinical usage. Compomers are not true glass ionomer materials since the acid/base setting reaction, charactheristic of conventional glass ionomers, does not occur. As a consequence, their physical properties of translucency, coefficient of thermal expansion, and strength more closely resemble composite resins than conventional glass ionomers. These differences in physical properties have clinical implications in their usage. In terms of new techniques, clinical and laboratory data now exist to support the method of reattachment of fractured tooth fragments using only dentin bonding agents, in cases where the tooth fragment is available. This method can restore up to 50 percent of the original strength of intact teeth. The technique advocates the use of acid etching and enamel and dentin bonding, without any tooth preparation. In vitro studies have achieved total (100 percent) restoration of intact teeth by bonding a porcelain veneer to the tooth after the reattachment.     

Restoring the incisal edge

Restorative dentistry evolves with each development of new material and innovative technique. Selection of improved restorative materials that simulate the physical properties and other characteristics of natural teeth, in combination with restorative techniques such as the proximal adaptation and incremental layering, provide the framework that ensures the optimal development of an esthetic restoration. These advanced placement techniques offer benefits such as enhanced chromatic integration, polychromatism, ideal anatomical form and function, optimal proximal contact, improved marginal integrity and longer lasting directly placed composite restorations. The purpose of this article is to give the reader a better understanding of the complex restorative challenge in achieving true harmonization of the primary parameters in esthetics (that is, color, shape and texture) represented by the replacement of a single anterior tooth. The case presented demonstrates the restoration of a Class IV fracture integrating basic adhesive principles with these placement techniques and a recently developed nanoparticle hybrid composite resin system (Premise, Kerr/Sybron, Orange, CA). The clinical presentation describes preoperative considerations, tooth preparation, development of the body layer, internal characterization with tints, development of the artificial enamel layer, shaping and contouring, and polishing of a Class IV composite restoration. The clinical significance is that anterior tooth fractures can be predictably restored using contemporary small particle hybrid composite resin systems with the aforementioned restorative techniques. These placement techniques when used with proper attention to preparation design, adhesive protocol and finishing and polishing procedures, allow the clinician to successfully restore form, function and esthetics to the single anterior tooth replacement.     

Fluoride uptake from restorative dental materials by human enamel.

The purpose of the study was to determine the uptake in vitro of fluoride from restorative materials by tooth enamel and whether prior etching of the enamel causes a change of uptake. The outermost layer of the labial surface of extracted canines was removed by grinding and the enamel was covered with five different fluoride-containing materials; a silicate, a composite resin, an amalgam, a silicophosphate, and a polycarboxylate luting cement. The material was either removed immediately or after storing the tooth in distilled water. The fluoride content was determined using a sensitive physical method based on the 19F (p,alpha gamma) 16 O reaction. In addition, the fluoride content of enamel after etching for different periods of time and of etched enamel which had been in contact with silicate cement was determined. The mean fluoride content of uncovered interior enamel was 226 parts/10(6). All materials, except the composite, increased clearly the fluoride content of the underlyaing enamal. Etching of interior enamel also increased the fluoride values. No difference could be shown in fluoride uptake from silicate and composite resin between etched and unetched enamel.     

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提要：全瓷修复因其优良的美观效果及生物相容性等诸多优点,成为口腔修复的发展趋势之一。各类全瓷修复体通过黏结性树脂黏结于牙体表面,合理有效的瓷表面处理技术是影响瓷与树脂黏结的首要因素。本文就牙科陶瓷几种表面处理方法的研究及其在口腔修复中的应用做一综述。     

Reattachment of a severely traumatized maxillary central incisor, one-year clinical evaluation: a case report

Traumatic fracture of anterior teeth is one of the common dilemmas facing the dentist during daily practice. Classical treatment of a fractured tooth involving the pulp includes the use of post and core with or without a crown, or extraction of the remaining part of the fractured tooth and replacement with a three-unit fixed partial denture or an implant. With the improvement of adhesive systems, reattachment of the fractured tooth fragment became possible as a mode of treatment that immediately improves the esthetic quality of the restored tooth. This article presents a clinical technique for the restoration of a fractured maxillary central incisor, by reattaching the labial enamel fragment using a metallic post and resin composite restoration. One-year clinical evaluation revealed successful results for this technique.     

Primarily Research

Abstract: Composite materials have become an integral part of the wide range of filling materials currently available. Conditioning is necessary to achieve adequate bonding of the composite material to enamel and dentin. Normally, this is done by applying acid preparations to the dental surfaces. These acids have an etching effect that causes surface roughening. The increasing application of lasers in dentistry has introduced another possibility. Laser irradiation can cause roughening of enamel and dentin surfaces. Another interesting alternative is the so-called kinetic cavity preparation technique. This method also results in distinct surface roughening. The purpose of the present study, was to compare the described methods. Tensile bond strength tests and shear bond tests were carried out to examine the adhesion of a composite material to surfaces treated with these methods. Laser irradiation with certain devices and the air-abrasive technique yielded results similar to those with acid etching.