CAD/CAM Procera氧化锆全瓷在后牙固定桥中的应用

吉林大学口腔医学院从2005年开始全面引进CAD/CAM氧化锆全瓷修复体系,并大量用于后牙固定桥的制作,现将修复效果作一评价。1材料与方法1.1临床病例资料选择吉林大学口腔医院修复科2005年3月至2006年7月,全身状况良好,能自愿配合修复治疗及随诊患者27例,后牙固定桥修复体31件,其中3单位固定桥19件,4单位固定桥(双基牙)9件,5单位固定桥(三基牙)3件。男性11例,女性16例,年龄22~41岁,平均30.5岁。1.2牙体预备切削车针直径为0.9~1.0mm,咬合面预备1.5~2.0mm,非咬合面1.0~1.5mm,肩台为全肩台,宽度≥1mm,边缘为直角肩台(内线角圆钝)或深无角肩台,…     

计算机辅助设计与制作氧化锆全瓷冠桥的临床应用

目的 评价运用牙科计算机辅助设计与制作(CAD-CAM)氧化锆全瓷固定冠桥修复体的临床应用效果.方法 选择2010年1月至5月接受氧化锆全瓷冠桥修复的患者113例,共计167件修复体,通过计算机印模采集系统获取工作模型及对(牙合)牙咬合记录的三维数据,将两者虚拟拼合后,采用inLab V3.85软件的Reduced程序...     

Cercon全瓷在口腔固定修复中的应用初探

目的对Cereon全瓷的制作I艺及临床效果进行评估。方法对5例患者共15牙单位的冠、桥使用Cer- con全瓷系统进行修复,并进行修复后1,3,6,12月的临床追踪观察。结果Ce~全瓷修复体美观自然,无折断、开裂、崩瓷、变色,牙酿组织无红肿、压痛。结论Ce~全瓷系统是目前较理想的口腔固定修复材料。     

Empress 2高强度全瓷冠桥的临床制作

烤瓷修复体由于缺乏自然牙的活力和易产生牙龈颈缘黑线，促进了不需金属底层结构的全瓷修复的发展。本文介绍一种新研制的高强度、高韧性的热压铸玻璃陶瓷Empress2在口腔美容修复中的应用，它不仅能制作嵌体、贴面、单冠，而且能够制作三单位前牙全瓷冠桥。这种全瓷修复体具有极佳的生物相容性和美学性能。冠边缘适合性好，能够被临床常用的氢氟酸或二氢氟铵酸蚀剂酸蚀，以增强陶瓷表面与树脂粘接剂的结合力。     

氧化锆全瓷修复体颜色再现的影响因素

全瓷修复体因其良好的机械性能及美学效果广泛应用于口腔修复。其中高强度的氧化锆材料备受关注。氧化锆材料机械性能优良,但美学效果相比其他全瓷材料稍有逊色。为使氧化锆材料呈现更好的美学修复效果,部分学者不断研究各种影响氧化锆材料颜色的因素并寻找改善其美学效果的方法。影响氧化锆全瓷修复体颜色的因素较多,本文旨在材料因素、加工因素、临床因素三方面对氧化锆全冠修复体颜色的影响作一综述。     

CAD/CAM氧化锆全瓷冠桥随访4年的临床分析

目的:回顾分析评价CAD/CAM氧化锆全瓷冠桥的修复效果.方法:为267位患者制做CAD/CAM氧化锆全瓷冠或桥681件,随访了205例患者的562件全瓷冠桥,随访时间2-6年.对修复体的崩瓷、全瓷冠的颜色与修复体的边缘密合度进行评价.结果:CAD/CAM氧化锆全瓷冠的崩瓷率3.31%,与修复体部位有明显相关性(P＜0.01),不同技术员完成的CAD/C氧化锆全瓷冠的颜色效果有明显不同(P＜0.001),不同颜色预备体的修复体后颜色效果没有明显差异(P＞0.05),CAD/CAM全瓷冠颜色达到好以上90.8%,CAD/CAM全瓷修复体的边缘密合度达到好的99.2%,长桥边缘密合度欠佳,修复体松动脱落0.35%,随访期间没有发现CAD/CAM全瓷修复体基底冠或桥支架折断.结论:CAD/CAM全瓷冠颜色接近天然牙,特别是预备体变色时是115床旨选的美学修复体,CAD/CAM全瓷冠边缘密合度好,整体崩瓷率可接受,但长桥边缘密合度需进一步提高,且磨牙的崩瓷率须进一步研究降低.     

CAD/CAM氧化锆全瓷在口腔修复领域的应用

回顾全瓷修复的发展历史．其美观逼真的修复效果早已被广大医生和患者所认可。而其强度一直是人们关注的焦点。目前全瓷材料的种类较多,如白榴石、锂基瓷、氧化铝、氧化锆等,制作方法也各有不同,如渗透陶瓷、热压铸造陶瓷、瓷沉积、计算机辅助设计与计算机辅助制作（CAD／CAM）等,其强度也越来越高,修复适应证也越来越广。在所有全瓷修复材料中,以CAD／CAM二氧化锆全瓷的抗弯强度最高㈣。CAD／CAM修复技术是将光电子技术、计算机技术及自控机械加工技术合并用于口腔修复的新技术。该技术起于20世纪70年代。但应用范围有限,效果也不尽人意。随着电子计算机技术与修复材料的迅速发展。有关该技术的研究越来越多㈤．其在口腔修复中的应用也越来越广。我国从2004年开始在临床上应用CAD／CAM氧化锆全瓷修复技术。     

氧化锆全瓷修复材料研究进展

全瓷修复体具有与天然牙非常接近的物理特性、吸光度和透光性,生物相容性好,是一种理想的口腔修复体。本文就全瓷修复材料近年来的发展历史、典型全瓷修复材料的特点,尤其是在生物学性能、力学性能和全瓷修复材料的医用基础研究前景等方面进行综述。结合口腔修复材料的发展趋势,应该适当普及掌握基础理论,进一步促进全瓷修复材料广泛应用于口腔临床。     

IPS Empress2全瓷冠桥的初步临床研究

目的 探讨ＩＰＳ Ｅｍｐｒｅｓｓ２全瓷桥及冠修复效果。方法 分别制作ＩＰＳ Ｅｍｐｒｅｓｓｌ全瓷冠５０例、ＩＰＳ Ｅｍｐｒｅｓｓ２全瓷冠５０件和全瓷桥１６件,及金合金基底烤资桥１６件,比较ＩＰＳ Ｅｍｐｒｅｓｓ１和ＩＰＳ Ｅｍｐｒｅｓｓ２全瓷冠及体折断情况,随访３～１２个月。结果 ＩＰＳ Ｅｍｐｒｅｓｓ２全瓷冠的颜色、形态、基牙龋患率、修复体的边缘密合度、边缘着色与ＩＰＳ Ｅｍｐｒｅｓｓ１无统计学     

Cerec2 CAD/CAM全瓷修复体的临床研究

目的：采用Cerec2 CAD／CAM系统制作各类修复体，并对其近期临床效果进行评价。方法：本研究共选取65名患者，用Cerec2 CAD／CAM系统按照标准程序制作各类全瓷修复体106个，其中贴面32个，嵌体4个，高嵌体33个，全冠30个，种植全冠2个，连桩全冠5个。记录修复体加工时间，修复后一周复诊时，填写修复体满意度调查表。并由两位医师每半年按照改良的USPHS标准对修复体进行评价。结果：修复体的加工时间平均在20min以内，其中贴面所需时间最少，嵌体需要时间最长。患者的总体满意率达到93％。83％的修复体各项检查标准都达到了USPHS标准的A类。结论：Cerec CAD／CAM系统操作独立，简单，制作修复体快捷。整个修复过程一次就诊就能完成。研究显示Cerec全瓷修复体有着广泛的应用范围。     

计算机辅助设计与制作氧化锆桩核在前牙修复中的应用

目的评价计算机辅助设计与制作(computer-aided design and manufacturing,CAD/CAM)氧化锆桩核在前牙残根、残冠修复中的应用效果。方法收集前牙大面积缺损患者68例共75颗患牙,CAD/CAM氧化锆桩核和全瓷冠修复,随访6～24个月,从修复体的稳定性、美观效果及牙周健康状况3个方面进行评价。结果 75颗全瓷冠修复体,2颗桩核与根部之间出现松动,牙冠与桩核之间不松动;1颗出现冠松动,桩核与根部无松动。X线片未见根尖周病变,也未出现根折、桩折。修复体与邻牙及对侧、对颌同名天然牙的电脑比色数值(Shade值)差值为0的占41颗,差值为1～2的占34颗,差值为3及以上的为0颗。修复体外形美观,无边缘着色,牙龈形态与颜色正常。6～24个月累计成功率为96%(72/75)。结论 CAD/CAM氧化锆桩核应用于前牙修复近期效果满意。     

CAD/CAM氧化锆全瓷冠和金属烤瓷冠的临床应用及对牙周组织影响

目的:探讨CAD/CAM氧化锆、银钯合金和钴铬合金烤瓷全冠的修复效果及对牙周影响.方法:随机选择全冠修复患者46例49颗受试牙,采用3种材料进行修复(CAD/CAM氧化锆、银钯合金、钴铬合金).修复前、后进行GCF含量、TNF-α、IL-6检测,并对修复效果进行评价.采用SPSS 18.0软件包对数据进行统计学分析.结果:对照各组修复后效果,修复体颜色匹配和牙龈状况指标CAD/CAM氧化锆全瓷冠组均显著优于其他2组(P＜0.05).各组修复后GCF含量、TNF-α和IL-6检测结果,CAD/CAM氧化锆全瓷冠组均显著优于其他2组(P.＜0.01).结论:CAD/CAM氧化锆全瓷冠修复体修复效果好,且对患者牙周组织的破坏较小,优于银钯和钴铬合金烤瓷全冠修复体.     

CAD/CAM一体化氧化锆桩核的临床评价

目的:观察CAD/CAM一体化氧化锆桩核在修复前牙残冠、残根中的临床效果。方法:本研究对45颗残冠、残根使用自凝塑料在口中制作桩核模型,应用CAD/CAM技术切削出一体化氧化锆桩核,运用一体化氧化锆桩和全瓷冠修复所有残冠、残根,经3年的临床跟踪,观察其临床效果。结果:观察期间失访2例患者,因此只对剩余43件修复体进行复查,其中中切牙28例,侧切牙7例,尖牙8例。2例患牙在第6个月时出现牙龈炎。1例右上中切牙氧化锆桩核修复体在第12个月后出现I-II°松动,1例右上侧切牙桩核修复体在第18个月后松动脱落。24个月和30个月时分别有1例患牙出现根折。所有复诊患者在36个月的临床观察中均未见桩核折断、边缘着色和继发性根尖周炎,并且所有修复体均获得满意美观效果。结论:CAD/CAM一体化氧化锆桩具有良好的美学效果和生物相容性,近期临床效果满意。     

饰面瓷厚度对氧化锆全瓷冠抗压缩破坏力的影响

目的：研究饰面瓷厚度对氧化锆全瓷冠抗压缩破坏力的影响。方法：常规 CAD-CAM制作氧化锆筒状基底冠25个,厚度均为0．5 mm,随机分为 A、B、C、D、E 5组,饰面瓷厚度依次为0．5、1．0、1．5、2．0、2．5 mm。万能材料试验机测试各组试件抗压缩破坏力值。采用 SPSS13．0统计软件对测试结果进行统计分析。用扫描电镜（SEM）观察试件断裂面微观结构。结果：A ～E 组试件抗压缩破坏力值依次为：（1279．96±42．85）N、（2235．44±50．14）N、（2216．38±48．97）N、（2169．22±60．40）N、（2028．70±47．37）N。A 组、E 组氧化锆全瓷修复体的抗压缩破坏力值均低于其他3组（P ＜0．01）;其余组间抗压缩破坏力值无统计学差异（P ＞0．05）。扫描电子显微镜观察发现,A 组、E 组氧化锆全瓷修复体基底瓷－饰面瓷结合界面处不平坦,较为疏松;饰瓷层出现气孔及微裂纹增多、增大。结论：饰面瓷厚度低于1．0 mm 及高于2．0 mm 时,修复体的微观结构可能会受到影响,从而氧化锆全瓷冠整体抗压缩破坏力的性能受影响,建议临床应用时严格控制饰面瓷厚度。     

CAD/CAM玻璃陶瓷全冠在后牙义齿修复中的运用

目的:研究CAD/CAM全瓷冠在后牙义齿修复中的应用。方法:35例患者47个后牙经完善根管治疗后,使用CAD/CAM氧化锆全冠修复。结果:随访3~18个月,45个牙冠修复体的固位、边缘密合度、牙周状况均良好,1个冠咬合面出现隐裂,1个牙冠修复体出现松动。结论:CAD/CAM氧化锆全冠在后牙义齿修复中能够提供较好的固位及美学效果。     

Comparative fracture strength analysis of Lava and Digident CAD/CAM zirconia ceramic crowns

PURPOSE

All-ceramic crowns are subject to fracture during function. To minimize this common clinical complication, zirconium oxide has been used as the framework for all-ceramic crowns. The aim of this study was to compare the fracture strengths of two computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia crown systems: Lava and Digident.

MATERIALS AND METHODS

Twenty Lava CAD/CAM zirconia crowns and twenty Digident CAD/CAM zirconia crowns were fabricated. A metal die was also duplicated from the original prepared tooth for fracture testing. A universal testing machine was used to determine the fracture strength of the crowns.

RESULTS

The mean fracture strengths were as follows: 54.9 ± 15.6 N for the Lava CAD/CAM zirconia crowns and 87.0 ± 16.0 N for the Digident CAD/CAM zirconia crowns. The difference between the mean fracture strengths of the Lava and Digident crowns was statistically significant (P<.001). Lava CAD/CAM zirconia crowns showed a complete fracture of both the veneering porcelain and the core whereas the Digident CAD/CAM zirconia crowns showed fracture only of the veneering porcelain.

CONCLUSION

The fracture strengths of CAD/CAM zirconia crowns differ depending on the compatibility of the core material and the veneering porcelain.     

Load-bearing capacity of CAD/CAM 3D-printed zirconia,CAD/CAM milled zirconia,and heat-pressed lithium disilicate ultra-thin occlusal veneers on molars

ObjectivesThe load-bearing capacity of ultra-thin occlusal veneers made of 3D-printed zirconia were compared to the ones obtained by fabricating these reconstructions by CAD/CAM milling zirconia or heat-pressing lithium-disilicate.MethodsOn 60 extracted human molars, the occlusal enamel was removed and extended into dentin. Occlusal veneers of 0.5 mm thickness were digitally designed. The specimens were divided into 3 groups (n = 20 each) differing in the restorative material and the fabrication technique of the occlusal veneer. (1) 3DP: 3D-printed zirconia (Lithoz); (2): CAM: milled zirconia (Ceramill Zolid FX); (3) HPR: heat-pressed lithium disilicate (IPS e.max Press). After conditioning procedures, the restorations were adhesively bonded onto the conditioned tooth. Thereafter, all specimens were aged in a chewing simulator by exposure to cyclic fatigue and temperature variations. Subsequently the specimens were statically loaded and the load which was necessary to decrease the maximum load by 20% and initiate a crack (F_initial) and the load which was needed to fracture the specimen (F_max) were measured. Differences between the groups were compared applying the Kruskal-Wallis (KW) test and the Wilcoxon-Mann-Whitney-Test (WMW: p < 0.05).ResultsThe median F_initial values for the groups 3DP, CAM and HPR were 1’650 N, 1’250 N and 500 N. The differences between all three groups were statistically significant (KW: p < 0.0001). The median F_max values amounted to 2’026 N for the group 3DP, 1’500 N for the group CAM and 1’555 N for the group HPR. Significant differences were found between 3DP and CAM (WMW: p = 0.0238).SignificanceRegarding their load-bearing capacity, 3D-printed or milled zirconia as well as heat-pressed lithium disilicate can be recommended as restorative material for ultra-thin occlusal veneers to prosthetically compensate for occlusal tooth wear. Despite statistically significant differences between the restoration materials, all load-bearing capacities exceeded the clinically expected normal bite forces.     

椅旁CAD/CAM系统与技工室制作全锆冠的临床比较研究

目的:比较CEREC AC椅旁CAD/CAM系统与技工室WIELAND系统制作氧化锆全锆冠的临床修复效果.方法:采用CEREC AC椅旁CAD-CAM系统制作磨牙区全锆冠,并与技工室WIELAND系统制作的全锆冠进行修复体外观形态、边缘密合度、牙龈情况和颜色匹配方面的比较.用满意度评价修复体的各项临床指标,用统计学方法比较两组的差异.结果:各项指标中颜色匹配效果满意度稍低(12/20比14/20);在修复体外观形态、边缘密合度、牙龈情况等方面满意度高(18/20).两组试验数据统计结果P＞ 0.05.提示两种加工方式制作的修复体的临床效果差异无统计学意义.结论:CEREC AC椅旁CAD/CAM系统与技工室WIELAND系统制作的氧化锆全锆冠的临床效果评价无明显差异.CEREC AC椅旁CAD/CAM系统还可以为患者提供更为快捷的服务.     

Gap comparison between single crown and three-unit bridge zirconia substructures

PURPOSE

To compare marginal and internal gaps of zirconia substructure of single crowns with those of three-unit fixed dental prostheses.

MATERIALS AND METHODS

Standardized Co-Cr alloy simulated second premolar and second molar abutments were fabricated and subsequently duplicated into type-III dental stone for working casts. After that, all zirconia substructures were made using Lava™ system. Marginal and internal gaps were measured in 2 planes (mesial-distal plane and buccal-palatal plane) at 5 locations: marginal opening (MO), chamfer area (CA), axial wall (AW), cusp tip (CT) and mid-occlusal (OA) using Replica technique.

RESULTS

There were significant differences between gaps at all locations. The mean ± SD of marginal gap in premolar was 43.6 ± 0.4 µm and 46.5 ± 0.5 µm for single crown and 3-unit bridge substructure respectively. For molar substructure the mean ± SD of marginal gap was 48.5 ± 0.4 µm and 52.6 ± 0.4 µm for single crown and 3-unit bridge respectively. The largest gaps were found at the occlusal area, which was 150.5 ± 0.5 µm and 154.5 ± 0.4 µm for single and 3-unit bridge premolar substructures respectively and 146.5 ± 0.4 µm and 211.5 ± 0.4 µm for single and 3-unit bridge molar substructure respectively.

CONCLUSION

Independent-samples t-test showed significant differences of gap in zirconia substructure between single crowns and three-unit bridge (P<.001). Therefore, the span length has the effect on the fit of zirconia substructure that is fabricated using CAD/CAM technique especially at the occlusal area.     

CAD/CAM systems available for the fabrication of crown and bridge restorations

Dental biomaterials are widely used in all areas of routine dental practice. There are mainly two methods for their application. Firstly, dental biomaterials are placed into living tissues, such as teeth, to fill the space. Secondly, dental devices such as crown and bridge restorations and dentures are fabricated using various materials to restore the morphology and function of the dentition. Crown and bridge restorations are one of the main treatment methods used by general practitioners to achieve lifelike restoration of form and function. The recent introduction of osseointegrated implants has expanded the application of crown and bridge restorations for partially edentulous patients. Mechanical durability and precision fit are mandatory requirements for crowns and bridges. The development of various casting alloys and precise casting systems has contributed to the successful use of metal-based restorations. However, patient requests for more aesthetic and biologically 'safe' materials has led to an increased demand for metal-free restorations. There is also a growing demand to provide all-ceramic restorations more routinely. New materials such as highly sintered glass, polycrystalline alumina, zirconia based materials and adhesive monomers, will assist dentists to meet this demand. In addition, new fabrication systems combined with computer-assisted fabrication systems (dental CAD/CAM) and various networks are now available. Dental technology was centred on lost-wax casting technology but we now face a revolution in crown and bridge fabrication. This article reviews the history and recent status of dental CAD/CAM, the application of CAD/CAM fabricated tooth-coloured glass ceramic crowns, and the application of all-ceramic crowns and bridges using CAD/CAM fabricated zirconia based frameworks.