数字化辅助一体化纤维桩核及树脂基陶瓷冠修复冠折年轻恒牙1例

桩核修复是临床常见的牙体缺损修复方式,临床常用桩核主要有玻璃纤维预成桩树脂核和个性化一体式桩核。在个性化桩核的材料选择上,由于金属的美观缺陷及氧化锆的弹性模量限制,兼具个性化、机械性能及美学优势的一体化玻璃纤维桩核作为一种新型桩核形式被临床所应用。本文报告1例CAD/CAM一体化纤维树脂桩核及树脂基陶瓷冠修复年轻恒牙冠折的临床病例。     

3种纤维桩修复残冠的临床观察

目的:探讨临床常用的3种玻璃纤维桩在残根残冠修复治疗中的临床效果。方法:148例患者共计161颗残根残冠经完善的根管治疗后采用玻璃纤维桩堆塑树脂核行全冠修复,观察其疗效。结果:经过2年的临床观察,纤维桩核修复成功率为91.93%,10例失败源于桩或冠松脱,其中FibraPost玻璃纤维桩桩核松脱率最低。3例失败表现为桩核折断。结论:纤维桩树脂核可作为理想的残根残冠修复方式,纤维桩表面固位设计以及纤维桩与根管的密合度都可以增强其抗脱位能力。     

两种桩核修复上前牙漏斗状残根的临床研究

目的：观察金银钯合金铸造桩核和预成玻璃纤维桩联合复合树脂核修复上前牙漏斗状残根的临床效果。方法：选取2008年1月-2009年12月期间共81颗已经完善根管治疗的漏斗状上前牙残根,其中36颗用铸造桩核冠修复,45颗用纤维桩树脂核冠修复,冠部修复体均为烤瓷冠,随访2年,比较临床效果。结果：铸造桩核组成功率80．56％,纤维桩树脂核组成功率82．22％,两组修复成功率差异无统计学意义（P〉0．05）。结论：两种桩核修复上前牙漏斗状残根,临床效果基本相同。纤维桩由于就诊次数少、更有利于再修复而更被推荐使用。     

纤维桩钉在前牙残根残冠保存修复中的应用

前牙残根残冠，传统的金属桩核和烤瓷冠修复存在美观差、弹性模量大，易导致根折及金属离子析出致牙龈染色等缺点。随着新型牙科纤维桩的出现，前牙残根残冠的美容保存修复有了材料学基础。我们对高强度DT Light Post纤维桩在前牙残根残冠保存修复中的临床应用进行了分析。     

玻璃纤维桩在老年人残根残冠修复治疗中的临床研究

目的：探讨玻璃纤维桩在老年人残根、残冠修复治疗中的临床效果。方法：临床选择53例残根残冠的老年患者，68颗患牙。经完善的根管治疗后，采用玻璃纤维制作复合树脂桩核，再以烤瓷冠修复，并经过0．5—2．0年临床疗效的追踪观察。结果：68颗患牙66颗无异常，1颗基牙牙龈炎，1颗纤维桩脱落，修复成功率为97．06％，修复效果满意。结论：玻璃纤维桩在老年患者残根残冠的修复治疗中，能达到良好的修复效果。     

玻璃纤维桩修复前牙残根的疗效观察

目的探讨玻璃纤维桩和树脂核联合全冠在前牙残根修复中的临床效果。方法以玻璃纤维桩和树脂核联合全冠修复前牙残根21颗,修复完成后两年进行随访检查。结果有1颗残根修复后一年玻璃纤维桩松动,失败率4．76％,其余病例义齿冠保持完好,纤维桩无松动、脱落,X线片示牙根和纤维桩无折断,牙周和根尖无阴影。结论应用玻璃纤维桩和树脂核联合全冠修复前牙残根是一种效果良好的修复方法。     

3种纤维桩用于后牙牙体缺损修复的临床观察

目的研究3种纤维桩用于后牙牙体缺损修复的临床效果。方法需进行后牙缺损修复的患者76例共90颗患牙,分为3组,每组30颗,分别采用碳纤维桩、玻璃纤维桩和石英纤维桩行修复治疗,全冠粘接后12个月复查。结果碳纤维桩、玻璃纤维桩和石英纤维桩修复后牙牙体缺损1年成功率分别为96.7%、100.00%和93.3%。结论 3种纤维桩用于后牙牙体缺损修复短期内均可以满足临床要求,但仍需对其进行长期临床观察。     

三种桩核系统修复后牙体组织抗疲劳强度体外研究

目的:比较两种纤维根管桩核系统和金属铸造桩核修复后牙体组织的抗疲劳强度和破坏模式。方法:2 4个离体上颌中切牙常规根管治疗术后截除牙冠,随机等分成A、B、C三组,A组用AESTHETI -PLUS石英纤维桩、复合树脂核系统及烤瓷冠修复,B组用C- POST碳纤维桩、复合树脂核系统及烤瓷冠修复,C组用Cr -Co铸造金属桩核进行桩核及烤瓷冠修复,包埋于底座后进行抗疲劳强度的测试,最多测试次数约10 0万次或试件破坏,记录试件破坏时的加载次数以及试件破坏的模式。结果:三种桩核系统修复后的离体牙中均有发生根折,但根折的部位不同,A组另有2个离体牙出现树脂核与牙本质分离,B组另有1例出现树脂核与牙本质分离,而C组除2例根折外,其余6个离体牙未出现明显的牙体组织或修复体的破坏。结论:Cr Co铸造金属桩核系统是一种较为成熟的桩核系统,AESTHETI- PLUS石英纤维桩和C POST碳纤维桩核系统具有一定的临床应用前景,但临床使用纤维桩时仍应考虑其他因素对修复效果的影响。     

CAD/CAM一体化玻璃纤维桩核抗折力的体外实验研究

目的比较CAD/CAM一体化玻璃纤维桩核与预成纤维桩和铸造金合金桩核修复体的抗折力。方法27颗离体上中切牙截冠根充后随机分为3组,分别采用一体化玻璃纤维桩核、预成纤维桩和铸造金合金桩核加铸造金属冠进行修复。使用万能力学试验机测试样本的抗折力并观察损坏模式。结果一体化玻璃纤维桩核组的抗折力为246.9±43.8N,显著高于预成玻璃纤维桩组（174.89±37.5N）,而与铸造金合金桩核组（290.1±84.2N）无显著差异。各组样本的损坏模式主要为牙颈部的损伤。结论CAD/CAM一体化玻璃纤维桩核修复上中切牙的抗折力与铸造金合金桩核近似,高于预成玻璃纤维桩。     

碳纤维桩的性能及应用

桩冠或桩核加冠修复，是根管充填治疗后牙齿临床冠外形重建的最主要手段之一。桩核加冠修复技术自1880年问世以来，逐步得到改善，可以说它的发展是伴随着科学技术的进步而得以实现的。近几十年铸造合金桩核加冠及预成金属桩加核加冠，成了牙体缺损修复的主流方式，但其自身存在的诸多缺点，不得不使研究人员致力于开发一种性能更为出众的桩核产品，聚碳纤维酯桩，便是近十年来的一种新产品。尽管诞生才10年，但它在欧美发达国家已越来越多的应用于临床，这种修复系统在我国还未普及，国内也未见有关聚碳纤维酯桩核修复系统的实验及长期临床应用的报道。因此，有必然在我国介绍并推广这种修复系统。     

Dental fiber-post resin base material: a review

Teeth that have short clinical crown, which are not alone enough to support the definitive restoration can be best treated using the post and core system. The advantages of fiber post over conventional metallic post materials have led to its wide acceptance. In addition to that the combination of aesthetic and mechanical benefits of fiber post has provided it with a rise in the field of dentistry. Also the results obtained from some clinical trials have encouraged the clinicians to use the fiber posts confidently. Fiber posts are manufactured from pre-stretched fibers impregnated within a resin matrix. The fibers could that be of carbon, glass/silica, and quartz, whereas Epoxy and bis-GMA are the most widely used resin bases. But recently studies are also found to be going on for polyimide as possible material for the fiber post resin base as a substitute for the conventional materials.     

Fabricating fiber-reinforced composite posts

Endodontic posts do not increase the strength of the remaining tooth structure in endodontically treated teeth. On the contrary, depending on the post design employed (tapered versus parallel-sided), the root can be weakened relative to the amount of tooth removed during preparation. In many cases, if there has been a high degree of damage to the clinical crown, conservative preparation for an anatomic tapered (biomimetic) post with the incorporation of a ferrule on solid tooth structure is necessary to protect the reaming root structure as well as for the long-term retention of the composite resin core and the definitive restoration. Adhesively luted endodontic posts reinforced with glass or quartz fiber lead to better homogeneous tension distribution when loaded than rigid metal or zirconium oxide ceramic posts. Fiber-reinforced posts also possess advantageous optical properties over metal or metal oxide post systems. The clinician should realize that there are admittedly substantial differences in the mechanical loading capacity of the different fiber-reinforced endodontic posts and should be aware of such differences in order to research and select a suitable post system for use.     

两种纤维桩用于修复磨牙缺损的临床效果观察

目的比较两种纤维桩修复磨牙缺损的临床效果。方法选取磨牙残根残冠患者84例共120颗患牙,经过完善的根管治疗后,随机分为2组,A组42例患者共58颗患牙,置入石英纤维桩;B组42例患者共62颗患牙,采用玻璃纤维桩。两组患者均采用全冠恢复牙冠外形。随访36个月,观察2组患牙的修复效果,并用SPSS13.0软件对2组修复体的成功率进行χ2检验。结果 A组成功率96.6%,B组成功率为93.5%,差异无统计学意义（P〉0.05）。A组无桩折断发生,B组3颗患牙发生桩折断,2组桩折断的发生率差异无统计学意义（P〉0.05）。结论石英纤维桩与玻璃纤维桩对磨牙缺损均能取得良好的修复效果。     

Randomized controlled clinical pilot trial of titanium vs. glass fiber prefabricated posts: preliminary results after up to 3 years

PURPOSE: This randomized parallel-group clinical pilot study aimed to compare the clinical outcome of prefabricated rigid titanium to glass fiber endodontic posts when luted with self-adhesive universal resin cement. MATERIALS AND METHODS: Ninety-eight patients in need of postendodontic restoration were assessed for eligibility. Ninety-one patients met the selection criteria and were randomized and allocated to 2 intervention groups. Forty-five participants were treated using a titanium post and 46 participants received a glass fiber post, each in combination with composite core buildups for postendodontic restoration. All posts had a diameter of 1.4 mm and a length of 13 mm and were cemented 8 mm within the root canal with self-adhesive universal resin cement. A circumferential ferrule of 2 mm was always provided. Surgical crown lengthening was necessary in 13 cases. Patients were observed in intervals of 3, 6, 12, 24, and 36 months after post placement. RESULTS: After 24 to 36 months (mean +/- SD: 27.9 +/- 5.6) of observation following post placement, 1 tooth was extracted because of changes of the prosthetic treatment plan. No failures were observed among the 88 patients with follow-up data. CONCLUSIONS: Both titanium and glass fiber reinforced composite posts result in successful treatment outcomes after 2 years. The material combination used seems to be appropriate in the short term for cementing endodontic posts, irrespective of the post material.     

An up to 3-Year Controlled Clinical Trial Comparing the Outcome of Glass Fiber Posts and Composite Cores with Gold Alloy-Based Posts and Cores for the Restoration of Endodontically Treated Teeth

Purpose: This controlled clinical trial aimed to compare the 3-year outcomes of glass fiber posts and composite cores with gold alloy-based posts and cores for the restoration of endodontically treated teeth. Materials and Methods: One hundred forty-four patients in need of 205 restorations on endodontically treated teeth were selected and followed for 7 to 37 months (mean: 21 ± 9 months). The teeth were primarily stratified based on the remaining tissue available to restore the tooth core with or without a post. Then, randomization allocated the teeth to either test group 1 (prefabricated glass fiber posts), test group 2 (custom-made glass fiber posts), or test group 3 (composite cores without posts). The control group consisted of gold alloy-based posts and cores. All posts/cores were covered with all-ceramic single crowns. Failures were either absolute, such as root fractures or irreparable fractures of the post/core, or relative, such as loss of post retention or reparable fractures of the core. Success and survival probability lifetime curves, corrected for clustering, were drawn for the entire data set. Results: The recall rate at 3 years was 97.1%. Absolute failures consisted of two root fractures and one endodontic failure, while relative failures included three instances of retention loss of the post/core and one post fracture. Because of the low number of events, no statistical tests were performed. The success and survival probabilities over all groups together at 3 years amounted to 91.7% and 97.2%, respectively. Conclusions: After being followed for up to 3 years, both cast gold and composite post and core systems performed well clinically. Longer follow-up times are needed to detect possible significant differences. Int J Prosthodont 2011;24:363-372.     

国产陶瓷预成根管桩临床应用的初步评价

目的初步评价新型氧化锆陶瓷预成根管桩修复牙体缺损的临床效果。方法临床收集61例上颌中切牙或尖牙病例,均采用非金属桩+树脂核+全冠修复,其中27例用新型氧化锆陶瓷预成根管桩,34例使用目前临床常用的石英纤维桩。对上述病例修复1年后进行复查。结果 2组患牙均无粘膜过敏反应,且牙齿松动度、牙周探诊深度,X线检查均在正常范围,未出现预成根管桩松动脱落的病例,存留率均为100%。结论新型氧化锆陶瓷预成根管桩和树脂核直接修复前牙缺损初期疗效满意。     

牙本质肩领对纤维桩修复效果影响的研究进展

在众多的桩核修复材料中,纤维桩以其优良的物理性能、机械性能和美学特性得到越来越多的临床应用,牙本质肩领的设计形态对于纤维桩修复后的固位、稳定、牙根抗折性能等方面具有重要意义,本文就牙本质肩领对纤维桩修复效果影响的研究进展作一综述.     

三种纤维桩弯曲强度的试验评价

目的比较碳纤维桩、玻璃纤维桩和石英纤维桩3种纤维桩的弯曲强度,为临床修复选择提供依据。方法采用万能实验机检测碳纤维桩、玻璃纤维桩和石英纤维桩在垂直方向加力直至断裂的最大载荷值,每种纤维桩6个样本,计算各纤维桩的弯曲强度。结果碳纤维桩、玻璃纤维桩和石英纤维桩的弯曲强度分别为（734.28±24.53）MPa（、529.17±31.18）MPa（、864.36±20.64）MPa。3种纤维桩的弯曲强度差异有统计学意义（F=176.187,P=0.007）。两两比较显示：石英纤维桩和碳纤维桩间的弯曲强度差异有统计学意义（P=0.000）,碳纤维桩和玻璃纤维桩间的弯曲强度差异有统计学意义（P=0.000）。结论弯曲强度由高到低分别为石英纤维桩、碳纤维桩、玻璃纤维桩。     

Adhesive restoration of anterior endodontically treated teeth: influence of post length on fracture strength

Objectives

This study aims to evaluate the fracture resistance of endodontically treated anterior teeth restored with crowns made of composite or ceramic and retained without the use of a post (endocrowns) or with posts of 5 mm (short) and 10 mm in length (long).

Material and methods

Forty-eight intact maxillary incisors were selected for the study. After endodontic treatment, the crowns were sectioned 2 mm coronally to the cementoenamel junction provided with a ferrule of 2 mm. The roots were randomly divided into six groups (n?=?8) according to the post length and type of coronary restoration. The crowns were fabricated with the chairside economical restoration of esthetic ceramics system. Group 1 was restored with a 10-mm glass fiber post, composite core, and a full-coverage ceramic crown (LPCer); group 2, with a 5-mm glass fiber post, composite core, and a full-coverage ceramic crown (SPCer); group 3, with a 10-mm glass fiber post, composite core, and a full-coverage composite crown (LPCpr); group 4, with a 5-mm glass fiber post, composite core, and a full-coverage composite crown (SPCpr); and groups 5 (EndoCer) and 6 (EndoCpr) were restored with ceramic and composite endocrowns, respectively. The teeth were then thermomechanically loaded in a chewing machine. After fatigue, the specimens were loaded to fracture. Data were analyzed with ANOVA and chi-square test. Mode of failure was defined as repairable or non-repairable.

Results

Presence of post, post length, and crown material had no significant effect on the fracture resistance. Groups restored with endocrowns presented a higher number of repairable fractures in respect to the other groups.

Conclusions

Presence of a post had no effect on the restorations’ fracture strength.

Clinical relevance

Although this in vitro study has some limitations in respect to its clinical relevance, the restoration of largely destroyed anterior teeth with the use of an endocrown or a short glass fiber post might have advantages over a large glass fiber post.