采用分光光度计比较种植支持式氧化锆全瓷和贵金属金瓷修复的牙冠颜色

目的 应用一种小型分光光度计对上前牙区种植支持式氧化锆全瓷修复与贵金属金瓷修复的牙冠颜色进行比较,为临床选择修复材料提供参考依据。方法 纳入 18例（男 7例,女 11例）行口腔种植修复后复查患者的上前牙区种植支持式单冠 29颗进行研究,其中氧化锆全瓷修复单冠 11颗,贵金属金瓷修复单冠 18颗。采用小型反射型分光光度计型比色仪 SpectroShadeTM采集图片并输入计算机,应用相关软件测量每个种植牙冠体 1/3与对照天然牙的CIE L﹡a﹡b﹡颜色差异。应用统计学软件 SPSS 17.0进行统计分析。结果 氧化锆全瓷修复和贵金属金瓷修复的牙冠明度均高于天然牙,全瓷修复引起的明度差异（ 4.5±3.2）大于金瓷修复引起的明度差异（ 1.0±2.6）,具有统计学意义（ P=0.004）;色相差异和饱和度差异均无统计学意义。全瓷修复和金瓷修复与天然牙的颜色差异（ 7.0±2.8和4.0±1.9）均高于人眼的分辨阈值（ 3.7）,且前者差异大于后者,具有统计学意义（ P=0.002）。氧化锆全瓷和贵金属金瓷两种修复方式的临床主观评分无统计学差异（ P=0.977）。上前牙天然牙色由前向后明度渐低,色相变红黄。结论 就本试验所选用的修复材料而言,分光光度计测量显示氧化锆全瓷修复与天然牙的牙冠颜色差异大于贵金属金瓷修复与天然牙的颜色差异,但两种修复方式的临床效果无明显区别。     

牙本质及树脂粘结剂颜色对瓷贴面修复颜色匹配的影响

目的：瓷贴面已成为一种备受青睐的恢复前牙形态和色泽的修复方法。但瓷贴面的厚度限制和高半透明性使其在颜色匹配上容易受到多种因素影响。本文目的是研究牙本质颜色及树脂粘结剂颜色对瓷贴面修复颜色匹配的最终影响。方法和材料：预先选择色号（A1）作为上颌中切牙修复的目标色．用数码分光光度比色计（SpectroShade．MHT）测量其牙色参数（L＊a—b）．用可以代表较大范围的牙色度分布的9种天然牙本质颜色（NaturalDieMaterial,IvoclarVivadent）制作上颌中切牙树脂复制品,然后运用瓷贴面的标准牙体预备方法在树脂牙上进行预备。用7种不同色度的树脂粘结剂（VariolinkVeneers,IvoclarVivadent）将制作好的瓷贴面（IPSEmpressEsthetic．A1．0．6mmthick．IovclarVivadent）粘贴在树脂牙上。测量粘固后贴面的L＊a～b值,计算与目标色（A1）之间的△E值。△E〉3．3即被认定为可被肉眼察觉的显著性颜色不匹配。结果：7种不同色度的树脂粘结剂对贴面最终颜色均没有显著的影响．因为每一个试样组测出来的△E值几乎都是相同的。另一方面．天然牙本质的颜色对最终的颜色匹配有明显的影响。在63个试样组（9种不同颜色牙本质的树脂代型和7种色度的树脂粘结剂组合）中没有一组达到可接受的颜色匹配。结论：薄的瓷贴面不能遮住下面牙本质的颜色．即使是运用了不同色度的树脂粘结剂。联合运用遮色瓷也许能够提高最终的配色效果。     

前牙区单个牙即刻种植即刻修复牙龈诱导后的美学评价

目的:分析评估前牙区单颗种植体经过即刻种植即刻修复牙龈诱导成形后的红色美学和白色美学结果,并分析红色美学与白色美学之间的相关性。方法:32例患者在前牙区行单颗牙即刻种植,术后使用临时基台和临时修复体进行牙龈诱导重塑,4个月后完成恒久修复,使用红色美学分值PES对种植体周围软组织进行红色美学分析,使用白色美学分值WES对种植修复体进行白色美学分析。结果:32颗种植体均获得良好的骨结合并完成种植修复。红色美学分值和白色美学分值PES/WES总均值为(16.37±2.64),红色美学分值PES的均值为(8.37±1.52),白色美学分值WES的均值(8.00±1.37)。红色美学分值PES的五个变量中的近中龈乳头(1.91±0.28)的分值最高,而根部凸度/软组织颜色和质地(1.46±0.51)的分值最低。在白色美学分值WES这5个变量中的牙冠形态(1.77±0.43)的分值最高,而牙冠的表面质地(1.37±0.49)的分值最低。种植体的红色美学分值PES和白色美学分值WES呈显著正相关(r=0.592,P<0.001)。结论:即刻种植时采用即刻修复牙龈诱导技术,可使种植修复获得理想的美学效果;种植体单冠的白色美学与红色美学相关。     

不同金属基底和遮色瓷厚度对金瓷修复体色彩的影响

目的　对比不同金属基底和遮色瓷厚度对金瓷修复体色彩的影响,力求找出能有效遮住底层冠金属色的 最佳遮色瓷厚度。方法　制作贵金属合金、金沉积与镍铬合金片,分别以其为基底依次制作遮色瓷厚度为0·05、 0·1、0·2、0·3、0·4、0·5 mm的试件。用CR-321色差计对试件测色,计算色差并进行统计分析。结果　以镍铬合金与 贵金属合金为基底的瓷修复体遮色瓷厚度为0·3 mm时可以完全遮住底色,色差值小于1·5 NBS;金沉积为基底的 修复体遮色瓷厚度为0·1 mm即可完全遮住底色,色差值小于1·5 NBS。结论　对于不同的金属基底材料,有不同 的遮色瓷厚度要求;随遮色瓷厚度的增加,以镍铬合金与贵金属合金为基底的修复体彩度增加,金沉积为基底的修 复体彩度略有下降。     

种植支持式固定义齿被动就位的临床检测方法

种植支持式固定义齿的长期成功率与其被动就位状态密切相关,因而被动就位的临床检测在种植修复治疗中十分重要。现有证据表明完全的被动就位状态仍无法实现,而一定程度的失配是临床可接受的。被动就位的检测主要涉及被动性与适合性两个方面。被动性检测方法主要是螺钉阻力实验,而适合性检测方法主要包括交替指压法、直视法、探诊法、影像学方法、单螺钉实验法及指示材料法。每种检测方法均有其优势及局限性,本文将就被动就位的定义以及临床常用检测方法进行综述,以期为临床诊疗提供参考。     

一个种植体支持的两个单位冠桥——上颌前牙区种植修复的美学选择

在上颌前牙区进行种植时．由于种植体周围软组织形态不协调而带来的美学并发症很常见．特别是两个邻牙缺失植入两个种植体时。本文建议在上前牙两个邻牙缺失的情况下．仅植入一颗种植体．并通过两个临床病例阐述此治疗理念。其主要优势在于能更好地保存牙间乳头和龈缘轮廓,避免因植入两颗相邻种植体后出现种植体之间牙槽骨的吸收。     

插销式分体桩冠修复[牙合]龈距离过短的磨牙残冠疗效

目的探讨插销式分体桩冠修复[牙合]龈距离过短的磨牙残冠的临床效果。方法30颗[牙合]龈距离过短的磨牙残冠进行插销式分体桩冠修复。用硅橡胶取模,取其接近牙长轴方向的根管作为主桩制作桩核冠,分叉较大的根管制作插销,插入冠部预留的孔道辅助固位。结果30颗磨牙残冠修复体经24个月随访观察,固位稳定。除1例出现轻度牙龈炎,1例插销封闭树脂脱落外,其余的修复体边缘密合,无明显牙龈炎,咀嚼功能正常,无明眵松动。患牙咀嚼有力、感觉舒适、无不良反应。结论插销式分体桩冠修复[牙合]龈距离过短的磨牙残冠能获得良好的固位及烤瓷冠美观效果,但远期效果需进一步观察。     

上颌单前牙即刻种植修复和延期种植修复的美学效果比较

目的:比较上颌单前牙即刻种植即刻修复和延期种植延期修复的美学效果。方法:收集42例上颌单前牙种植修复病例,A组行即刻种植即刻修复(20例),B组行延期种植延期修复(22例)。采集永久修复后6个月复查的口内数码照片,用红白美学指数对其评分。统计分析以比较2组病例得分有无差异。结果:A组的种植体留存率(95.0%)和B组的种植体留存率(100%)相当,差别无统计学意义。A组红色美学指数(PES)得分(12.05±0.97)和白色美学指数(WES)得分(8.00±1.41)均高于B组PES(10.50±1.57),WES(6.95±1.21),差别具有统计学意义。A组PES≥12的病例所占比例(68.4%)高于B组(22.7%),差别具有统计学意义。结论:即刻种植即刻修复组的短期美学效果较延期种植延期修复组更好,且两者的种植体留存率没有显著差别。     

单个前牙种植体即刻种植和即刻修复的牙龈美学效果评价

目的:评价种植体即刻种植即刻修复的牙龈美学效果及患者对美观的满意度.方法:观察28例患者28枚ITI种植体在单个前牙种植体即刻种植即刻临时冠修复,对种植义齿周围的牙龈美观状况及相应的软组织健康状况进行观察,并对患者满意度进行调查,托槽弓丝固定3个月,6个月后行永久烤瓷冠修复.结果:12个月时所有种植体都发生了骨结合现象,种植义齿周围的软组织外形正常,牙问乳头外形大小与菌斑附着,龈炎并不相关.患者对即刻种植修复的美学效果均非常满意.结论:在严格掌握适应证的前提下,单个前牙即刻种植修复比延期修复可获得更佳的软组织外形,尤其是牙间乳头外形大小达到更理想的美学效果.     

数字化技术在种植支持式全口固定义齿修复中的运用1例

终末牙列的种植支持式全口固定义齿修复由于余留牙及颌骨解剖条件因素而较为复杂。本临床病例通过数字化技术辅助信息的采集与拟合、数字化设计、数字化导板辅助植入及数字化印模技术和CAD/CAM技术在最终修复的运用,讨论总结了数字化技术在终末牙列种植支持式全口固定义齿修复中的运用流程、特点和应用优势。     

The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial

The aim of this study was to test the color-change effect of all-ceramic restorations compared with porcelain-fused-to-metal (PFM) restorations on marginal peri-implant soft tissue. Thirty patients were randomly divided into 2 groups of 15 subjects each. The all-ceramic group received all-ceramic crowns on aluminum oxide-based abutments, while the PFM group received crowns on titanium or gold abutments. A reflectance spectrophotometer was used to measure the color difference (deltaE(Implant)) between the midfacial peri-implant mucosa before and after restoration insertion. The color difference (deltaE(Tooth-implant)) between the midfacial peri-implant mucosa and the gingival margin of the corresponding neighboring tooth was tested. The mucosal thickness was measured midfacially around the implant (MT(Implant)) and neighboring tooth (MT(Tooth)). deltaE(Implant) values were similar for the all-ceramic (7.4 +/- 2.7) and PFM groups (7.6 +/- 2.8). The all-ceramic group induced significantly less visible mucosal color change (3.4 +/- 1.4) compared to the PFM group (5.2 +/- 2.3). The MT(Implant) value of the all-ceramic group was 3.4 +/- 0.8 mm, while that of the PFM group was 2.9 +/- 0.9 mm, which was not significantly different. Significant differences were found when comparing MT(Implant) (3.1 +/- 0.9) and MT(Tooth) (1.2 +/- 0.3) values for test and control groups. All-ceramic restorations revealed a better color match to the neighboring teeth than PFM restorations.     

Marginal discoloration of all-ceramic restorations cemented adhesively versus nonadhesively

BackgroundThe authors conducted a systematic review to correlate the clinical incidence of marginal discoloration of all-ceramic restorations with the mode of cementation (adhesive versus nonadhesive).Types of Studies ReviewedThe authors conducted a literature search by using electronic databases, relevant references, database citations and journal hand searches for clinical studies of marginal discoloration of all-ceramic restorations with a mean follow-up time of at least five years. The search period spanned January 1990 through February 2011. The authors reported and compared summary estimates and five-year event rates.ResultsThe authors selected 16 studies for final analysis from an initial yield of 346 articles. The mean observation time ranged between five and 10 years. The majority of studies used adhesive luting procedures for definitive cementation. In only one study did investigators report regarding the incidence of marginal discoloration of both adhesively and nonadhesively cemented all-ceramic restorations, and the difference between the luting types in terms of discoloration was not statistically significant (P = .5).Clinical ImplicationsThe results of this systematic review showed that there is a lack of studies with findings regarding marginal discoloration rates of nonadhesively luted all-ceramic restorations. Unacceptable marginal discoloration rates of adhesively luted all-ceramic prostheses were relatively low even at 10 years of service.     

Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study

Purpose: The aim of this clinical research on implant‐supported restorations is to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri‐implant soft tissue. Material and methods: Twenty patients received an endosseous dental implant in the anterior maxilla. At the time of each definitive prosthesis delivery, an all‐ceramic crown has been tried on gold, titanium and zirconia abutment. After the insertion of each single abutment, the peri‐implant soft tissue color has been measured through a spectrophotometer. Also, the thickness of the facial peri‐implant soft tissue was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a specific tissue area and to collect the data before the statistical analysis in Lab^* color space. The normality of the quantitative variables was verified by means of the Shapiro–Wilk test. Simple linear correlation between quantitative variables was evaluated by using Pearson's coefficient. The results on the performance of the abutment materials with regard to the color measurements and the overall measurement ΔE were described by computing the least‐square means. The significance of differences among types of abutment was verified by means of the Scheffe test for multiple comparisons. Results: For all the abutments used, the color of the peri‐implant soft tissue appeared to be significantly different from the one of the contra‐lateral tooth (ΔE>8.5). Significantly higher (P<0.05) difference were present with the use of titanium abutments (11 ± 0.4) when compared with the results of gold (8.9 ± 0.4) and zirconia (8.5 ± 0.4) abutments. No correlation has been demonstrated between soft tissue thickness and degree of color difference (P>0.25). Conclusions: Within the limitation of the present study, the peri‐implant soft tissue color appears to be different from the soft tissue color around natural teeth, no matter which type of restorative material is selected. When titanium abutment was selected, significantly higher differences were present than those obtained with gold or zirconia abutments. The thickness of the peri‐implant soft tissue did not appear to be a crucial factor in the abutment impact on the soft tissue color. To cite this article:
Bressan E, Paniz G, Lops D, Corazza B, Romeo E, Favero G. Influence Of abutment material on the gingival color of implant supported all‐ceramic restorations: a prospective multicenter study
Clin. Oral Impl. Res. 22 , 2011; 631–637.
doi: 10.1111/j.1600‐0501.2010.02008.x     

Shade-match perception of porcelain-fused-to-metal restorations: a comparison between dentist and patient

BACKGROUND: Patient satisfaction with the shade match of restorations has not been appraised carefully in the dental literature. This study compared patients' and a prosthodontist's satisfaction with the shade o f existing porcelain-fused-to-metal, or PFM, restorations. METHODS: The authors selected a convenience sample of 212 patients for this study. Patients and a prosthodontist were asked independently, under standardized conditions, to express their satisfaction with the shade match of the patient's restoration. Kendall's tau-b statistic was used to measure the strength of the association between the shade satisfaction rating of the patient and that of the prosthodontist. The authors also examined patient satisfaction with respect to sex, treatment location and clinician. RESULTS: The prosthodontist was less satisfied than the patient with the shade match in a significant number of cases. The authors found no difference in patient satisfaction with respect to sex. They did find that patients were more satisfied with the shade match of restorations placed by a prosthodontist or placed under the supervision of a prosthodontist than they were with restorations placed by general practitioners. CONCLUSIONS: Patients were more satisfied with the shade match of their PFM restorations than was the prosthodontist. Patients also were more satisfied with restorations placed by a prosthodontist or placed under the supervision of a prosthodontist in a hospital or academic setting. Clinical Implications. Patient satisfaction with shade match is important when constructing or replacing a restoration, and the level of satisfaction might be different from that of the clinician. When selecting restoration shades, clinicians should take into consideration the opinions of their patients.     

Eliminating coronal discoloration when cementing all-ceramic restorations over metal posts and cores.

Opaque procelain was fused over metal posts and cores. This procedure permitted the definitive all-ceramic restorations to possess a more uniform shade between teeth restored with metal posts and cores and adjacent vital teeth.     

Conventional visual vs spectrophotometric shade taking for porcelain-fused-to-metal crowns: a clinical comparison

This study tested the shade match of single porcelain-fused-to-metal restorations with the adjacent dentition when the restorations were fabricated according to data from conventional visual shade matching or from a new spectrophotometric system. The samples of a Vita Classic shade guide were measured with the spectrophotometer to determine the CIE L*a*b* color parameters. Three clinicians independently selected the best match to a maxillary right or left incisor needing a restoration in 10 patients. The 10 incisors were then measured using a reflectance spectrophotometer. CIE L*a*b* coordinates were directly recorded on the spectrophotometer's detector area using a standard light source. Resulting conventional and spectrophotometric restorations were tested intraorally for best match with the adjacent incisor using conventional shade matching versus spectrophotometric measuring. Total color difference was calculated, and all groups were statistically analyzed. Initial shade evaluation matched for all three visual shade selections in two cases. In six cases only two evaluators matched, and in the remaining two cases all three visual selections differed. In contrast, in nine of 10 cases all three spectrophotometric shade selections matched. Additionally, in nine of 10 cases delta E values of visually assessed tooth shades were higher than spectrophotometrically assessed delta E values. Resulting delta E values for conventional crowns compared to spectrophotometric crowns were significantly higher. Finally, in nine of 10 cases spectrophotometric crowns were preferred over conventional crowns for definitive cementation when evaluated visually. Spectrophotometric shade analysis and communication can be used efficiently for fabrication of porcelain-fused-to-metal restorations.     

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摘要：目的    分析采用氧化锆全瓷冠修复对患牙牙周组织的影响。方法    选择2008 年 6月至2009年3月在沈阳市口腔医院修复科就诊的需行全冠修复的患者38例（患牙52颗）,采用氧化锆全瓷冠修复患牙。于修复前及修复后1年行牙周状况检查。分别取患牙修复前、后的龈沟液（gingival crevicular fluid,GCF）,进行GCF量测定,并对GCF内肿瘤坏死因子（tumor necrosis factor-α,TNF-α）和白细胞介素-6（interleukin-6,IL-6）含量进行比较分析。结果    修复体边缘的深度符合临床要求,修复后患牙的牙周指标（探诊深度、龈沟出血指数、菌斑指数）、GCF量、GCF内TNF-α及IL-6含量与修复前比较,差异无统计学意义（P > 0.05）。结论    氧化锆全瓷冠修复后1年内对患牙牙周组织无明显不利影响。     

贵金属烤瓷与氧化锆全瓷修复对种植体周围组织影响的临床比较

目的评价贵金属烤瓷、氧化锆全瓷单冠修复对种植体周围组织的影响。方法选择2008年6月—2010年12月间完成种植单冠修复的患者78例共120颗种植体,贵金属烤瓷修复与氧化锆全瓷修复各60颗。分别于修复后12个月复诊,检测种植体周围边缘骨吸收量(MBL)、牙周探诊深度(PD)、改良菌斑指数(mPLI)、改良龈沟出血指数(mSBI)、龈乳头指数等临床指标,以及调查患者对种植义齿的满意度。结果贵金属烤瓷与氧化锆全瓷修复在MBL、PD、mPLI、mSBI、龈乳头指数以及患者满意度方面的差异均无统计学意义(P>0.05)。结论贵金属烤瓷与氧化锆全瓷修复对种植体周围组织的影响无差异,均能取得较好的临床修复效果,长期效果有待于进一步观察。     

烤瓷冠修复后牙龈着色病因分析一例

由使用不良修复材料、错误的牙体预备和粗糙的修复体制作等原因所致的牙龈病损在临床上十分常见[1-3].银汞充填物悬突引起的牙龈变色也较多[3-4].扫描电子显微镜(SEM)和X线能谱分析(energy dispersive X-ray analysis,EDX)显示,部分修复材料的残屑可以进入牙龈结缔组织内,在牙龈组织内可检测到Hg、Ag、Cu、Sn、Zn等元素[5-7].在因贱金属烤瓷修复引起的牙龈炎患者的牙龈组织内也可检测到Ni和Cr等元素.