聚合瓷遮色铸造桩在前牙美学修复中应用1例

大面积牙体缺损需进行铸造桩核冠修复,铸造桩核因金属本身颜色缺陷,会影响修复体最终美学效果,前牙美学修复区更甚.本文介绍一种采用CERAMAGE聚合瓷遮色金属桩核,从而改善前牙全瓷修复体色彩呈现效果的方法,为大面积缺损患牙的美学修复提供改进方法.     

瓷修复技术的临床应用Ⅴ.全瓷桩核的临床应用

桩核系统是修复牙体缺损的重要方式,目前临床常用铸造金属桩核,然而金属桩核自身的颜色以及金属腐蚀变色可影响修复后的美学效果.随着患者对美观要求的不断提高,非金属桩核得到广泛应用.全瓷材料具有良好的生物相容性与抗腐蚀性,更有其他材料无法比拟的光学特性,因而全瓷桩核在口腔修复中的应用越来越普遍.本讲座将介绍全瓷桩核的性能、临床选择、制作方法以及常见问题及处理.     

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。     

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.     

一体化氧化锆桩核的研究进展

采用金属桩核和纤维桩树脂核修复残根残冠已很普遍,但由于金属桩核的颜色问题和纤维桩的抗折性差,其应用受到限制。氧化锆桩核具有较高弹性模量,在应力状态下形变较小,利于应力在桩和牙根之间传递,较纤维桩少发生桩折断且不影响全瓷冠修复的美学效果和MRI等影像学结果等特性,使其在临床上受到重视。本文对一体化氧化锆桩核的特性、应用范围、加工制作要求和临床粘接应用作一概述。     

复合树脂粘结修复操作规范及评定标准(建议稿)

1.复合树脂粘结修复的适应证1.1前牙Ⅰ、Ⅲ、Ⅳ和Ⅴ类洞的修复.1.2前牙形态与色泽异常牙的美学修复(四环素牙、氟斑牙、无髓变色牙、畸形牙、扭转牙).1.3前牙小间隙的关闭.1.4制作桩核冠的桩核(树脂核).1.5后牙Ⅰ、Ⅱ和Ⅴ类洞的修复.1.6容易隔离、咬合接触不紧、修复体没有承受全部(牙合)力的患牙.1.7对(牙合)牙存在不同金属修复体的更换.1.8意向性修复.     

新型树脂类桩核临床应用效果观察

目的临床观察树脂类桩核的使用效果.方法 182颗患牙随机分为两组,分别采用新型树脂类桩核和金属铸造桩核联合烤瓷冠修复,追踪观察临床效果.结果所有病例追踪2～5年,随访期内新型树脂类桩核有14颗失败,金属铸造桩核组有8颗失败,经χ^2检验,P＞0.05,两组病例失败率差异无统计学意义.结论新型树脂类桩核具有较好的美学效果,但其抗折能力较金属铸造桩核低,临床应用应严格掌握适应证.     

氧化锆及其成品桩系统的特点及临床应用

对于已完善治疗的残冠残根,临床上最常采用的修复方式是桩核冠修复体.常用的桩核系统包括铸造金属桩核、纤维树脂桩核以及氧化锆桩等.金属桩核在过去曾广泛应用于临床,但其主导地位逐渐为纤维桩核所取代.虽然氧化锆桩过高的硬度和弹性模量使其在作为桩核修复体的临床应用上受到争议,并也因此影响了它的应用和推广,其拥有的良好理化特性、机械性能、尤其是优良的生物相容性和美学特性,仍使许多人对其欲罢不能.本文将从物理性能、抗折强度、粘接性能、美学效果以及临床应用等方面对氧化锆材料及成品桩系统进行综述,以期能让关注者对氧化锆及其桩核系统有一个较为全面的了解和认识,并能结合临床实际完善其应用技术,探索其可能的适应证范围.     

玻璃纤维桩树脂预成型后再粘结对增强喇叭口根管固位力的研究

玻璃纤维桩因其美学性能好,弹性模量与牙本质相近,修复后根折发生率低于金属铸造桩,在临床残根残冠修复中得到越来越普遍的应用。由于牙体缺损未及时治疗、继发龋、多次桩核冠修复等原因使根管口呈喇叭型,此类病例用玻璃纤维桩修复容易发生桩核冠的脱落。本实验将玻璃纤维桩用树脂预成型后再粘结至喇叭型根管与常规玻璃纤维桩修复方法的固位力进行对比,     

052.瓷层和粘固剂层厚度对于不同类型不透明桩核色泽修饰的影响

[英]/Vichi A…∥J Prosthet Dent.-2000,83(4).-412～417 　　由于较薄的粘固剂层往往不能达到满意的遮色效果,造成了色泽深暗的桩核进行全瓷冠修复时的美学效果不佳.本研究选择了2种商品化的非金属桩核(碳纤维和氧化锆)及1种实验性的美学桩核,在体外研究其全瓷冠瓷层厚度及粘固剂层厚度对修复体整体色泽的影响. 　　 出版日期：2001年3月20日 请看PDF全文     

Custom ceramic posts and cores: an overview of rationale and a new use for a proven technology

Endodontically treated teeth pose a unique restorative challenge. This challenge is magnified in the esthetic zone when an all-ceramic crown is the desired final restoration. When choosing a treatment modality, the dentist must consider the physical properties of post and core materials and couple those considerations with the patient's demand for life-like restorative results. As computer-aided design/computer-aided manufacturing (CAD/ CAM) technology enters the mainstream of dentistry, an ideal passive custom ceramic post and core may be constructed chairside or ordered from a dental laboratory. CAD/CAM offers unmatched precision and versatility for the construction of dental posts and cores. This type of post and core construction allows the dentist to avoid the pitfalls of poor fitting prefabricated posts, separate core materials, and delays in making the final crown restoration by constructing them chairside and avoiding the laboratory time involved in casting a custom metal post.     

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目前牙齿美学修复是口腔临床中的热点。在对前牙美学缺陷患者的修复治疗中,最重要的是要检查获取患者全部相关的牙齿美学信息,分析患者美学缺陷中的问题,最后做出正确的美学修复设计。本文讨论有关前牙美学修复中前牙美学分析和美学设计中常用的方法、4个重要的美学参数以及露龈笑的病因和治疗。     

An alternative method for fabricating a custom-made metal post with a ceramic core

Abstract –  The restoration of anterior non-vital teeth with metal posts and cores and all-ceramic restorations may lead to compromised esthetics because of the semitranslucence of ceramics and the metallic color of the underlying post and cores. This article presents a technique that combines the optical properties of ceramic cores with the mechanical properties of custom-made cast metal posts. The technique involves heat pressing of the core from leucite-enriched glass-ceramic to the underlying custom-made metal post and may provide additional esthetic benefit for anterior teeth especially with little remaining coronal dentin and with small root volume.     

The effect of post length and core material on root fracture with respect to different post materials

Abstract

Objective. The aim of this study was to evaluate the effect of different core materials and post length on the fracture strength of different posts (CAD/CAM zirconia post (ZR post)) and an individually formed glass fiber reinforced composite post (FRC post). Materials and methods. One hundred maxillary central incisors received endodontic treatment and were divided into two groups according to the post length: (1) 10 mm in length and (2) 15 mm in length (n = 50/per group). Then the specimens were randomly assigned into five sub-groups (n = 10/per group) as follows: One-piece milled zirconia post and core (group Zr), zirconia post with resin core (Biscore, Bisco) (group Zr/R), zirconia post with resin composite core (Admira, Voco) (group Zr/RC), FRC post with resin core (group F/R) and FRC post with resin composite core (group F/RC). The posts were cemented with a self-adhesive luting agent according to the manufacturer's instructions by using endo tips and light-cured for 40 s using a halogen light curing unit. Metal crowns were made for each specimen, cemented and loaded to failure. Fracture loads (N) and modes of failure were recorded. The data were analyzed using three-way analysis of variance (ANOVA) followed by Tukey's post-hoc test (p < 0.001). Results. Fracture strength of roots was significantly affected by the type of post material (p < 0.05) and post length (p < 0.05), but not by the type of core materials used (p = 0.078). Conclusion. Longer zirconia posts with zirconia- or resin-based cores can be recommended as an alternative to FRC posts with resin-based cores. The fracture patterns observed in teeth restored with fiber posts were more favorable than teeth restored with zirconia posts. Clinical significance. A higher restoring success rate can be achieved by fiber posts rather than zirconia posts, since the failure mode for these posts would be restorable. Additionally, post length is a more critical factor in teeth restored with one-piece milled zirconia posts than in those restored with fiber posts.     

Effect of length and diameter of tapered posts on the retention

The force transmission of tapered unthreaded posts along the root has been reported to be homogenous but their retentive strength was found to be lower compared with those of parallel unthreaded or other kinds of threaded posts. The purpose of this in vitro study was to investigate the effect of length and diameter on the retentive strength of sandblasted tapered prefabricated titanium posts (Erlangen post system). Posts with constant taper angle but with three different lengths (9, 12, 15 mm) and apical diameters (0.5, 0.9, 1.1 mm) were cemented using zinc phosphate cement into the prepared and roughened post spaces of 90 intact anterior teeth. The post retention concerning length and diameter, being independent from each other, was measured by a tensile force test. The retentive strength was found to be proportional to the length as well as to the diameter of the posts. The mean minimum strength (181 +/- 14 N) recorded for the thinnest and shortest post was significantly lower than that of mean maximum strength (612 +/- 85 N) obtained from those of the thickest and longest post. Proportional bond strengths of the posts comprising their surface areas ranged between 6.8 and 7.9 N mm(-2) which were not significantly different between any group. The retention was effected strongly with the increase in the length (approximately 100%) than with the increase in the diameter (approximately 60%). Concerning the posts tested in this study, it is concluded that some caution should be exercised in the choice of post with appropriate length rather than diameter for the tooth concerned.     

43例成品桩断裂的临床分析

目的：分析成品桩断裂好发部位与牙桩钉受力关系。方法：通过临床及X光片观察断桩与牙面根管口的关系，观察所取出断桩与原成品桩的对应关系。结果：43例断桩均为成品桩，断裂位于成品桩靠近固位盘根方的沟槽处，断桩面与牙根管口平齐或位于根管口下0－3mm之间，槽柱形成品桩钉多在根方沟槽处断裂，结论：桩冠桩钉的沟槽部位应避开安放在根管口及其下3mm范围内，最好选择作桩核冠，桩冠修复后应慎重使用。     

Influence of surface remodelling using burs on the macro and micro surface morphology of anatomically formed fibre posts

AIM: To evaluate the effect of modifying preformed fibre-reinforced composite (FRC) endodontic posts on their surface morphology and to determine how this procedure affects the integrity of the posts. SUMMARY: Surfaces of 10 preformed glass-fibre posts (group 1) and carbon-fibre posts (group 2) were compared with those of individually formed glass-fibre posts (group 3). Ten FRC posts were modelled in order to give them a shape as close as possible to the anatomy of oval root canals. Starting from a preformed cylindrical fibre post 2.5 mm in diameter, it was modelled in such a way as to passively occupy the entire post-space length, using a cast previously created as a guide. Microscopic analyses (optical stereomicroscope and scanning electron microscope) of the post surfaces revealed similar features in all three groups. All posts had regular surfaces after cutting with a diamond bur. Smear layer mainly attributable to the cutting procedures covered the cut surface of some specimens. In conclusion, modulation of a fibre post using a diamond-coated bur did not show a loss of integrity of the post. *Because of the importance of micromechanical retention, the surface integrity of fibre posts may be important for adhesion between post and composite resin. *Modification of a fibre post using a diamond-coated bur did not damage the surface integrity of the posts. *Fibre posts can be ground to a different shape without losing their surface integrity, resulting in posts with a surface that is not visibly different from unmodified commercially available fibre posts.     

In vitro fracture resistance and marginal adaptation of metallic and tooth-coloured post systems

The aim of this in vitro study was to compare the fracture resistance and marginal adaptation of all-ceramic incisor crowns with all-ceramic posts, glass-fibre-reinforced posts and titanium posts as well as a control without any post. Three groups of eight maxillary incisors were restored with an all-ceramic post, a fibre-reinforced composite (FRC) post, a titanium post and a further group was restored without posts. Composite cores were provided and all-ceramic crowns were adhesively luted. After artificial ageing, the fracture resistance of the restored teeth was determined. The marginal adaptation of the restorations at the interfaces between cement-tooth and cement-crown was evaluated with scanning electron microscopy using replica specimen before and after ageing. The restored teeth without posts [270N (235/335)] showed no significantly different fracture strength compared with teeth with the titanium system [340N (310/445)]. The all-ceramic posts [580N (425/820)] and the FRC posts [505N (500/610)] both provided a significant higher fracture resistance than the teeth without posts. Prior to ageing, all materials showed <5% separation at the margins cement-tooth or cement-crown ('marginal gap'). After ageing, the interfaces of all systems deteriorated to values between 6 and 14% marginal gap. The greatest marginal gap was found with the titanium system (14%) at the interface cement-crown and with the all-ceramic posts (12%) at the transition between cement-tooth. Regarding fracture resistance and the marginal adaptation, the all-ceramic and FRC posts may be considered as an alternative to the commonly used titanium post restorations.     

Incidence of root fractures and methods used for post removal

AIM: This study was undertaken to determine the incidence of root fractures during post removal, as well as the methods used and the success rates achieved with various post removal devices and techniques. METHODOLOGY: Patient records from a specialist endodontic practice were examined. A total of 1600 teeth from which posts were removed were identified. These teeth had no preoperative signs or symptoms to suggest root fractures. The incidence of root fractures was determined and a subset of 234 patient records were examined in detail to determine the methods used to remove different types of posts. RESULTS: Only one tooth fractured during post removal (0.06%) and all posts were successfully removed, typically in about 3 min. Most cast posts were removed with an Eggler post remover but some dislodged when the crown was removed; ultrasonics was used occasionally. Most parallel-sided posts were removed with ultrasonics and threaded posts were unscrewed. The Masserann kit and ultrasonics were combined to remove fractured cast posts and some parallel-sided posts. CONCLUSIONS: This study indicates that, with good case selection, post removal is a predictable procedure. If appropriate techniques and devices are used for the particular type of post being removed, then root fracture is a rare occurrence.     

A survey of methods used for post removal in specialist endodontic practice

AIM: The aims of this study were to determine the attitudes of endodontists toward the risk of root fracture when removing posts and to determine which methods they commonly used to remove posts from root-filled teeth. METHODOLOGY: A survey was sent to all 74 members of the Australian and New Zealand Academy of Endodontists. The survey was divided into three parts to gather information concerning root canal retreatment performed in specialist endodontic practice, attitudes about the risk of root fracture when removing posts and the methods used to remove different post systems. RESULTS: Responses were received from 62 (84%) of the Academy members. When a post was present in a tooth that required root canal retreatment, 66% of the endodontists preferred to remove the post, whilst 27% considered either post removal or periapical surgery. Forty-five per cent reported that a root fracture had occurred during post removal, but this represented less than 0.002% of the estimated number of posts removed by all respondents. Ultrasonic vibration was the most common method used to remove posts, although post removal devices were used more often in anterior teeth; the Eggler post remover was the most commonly used device. CONCLUSIONS: Most endodontists preferred to remove posts rather than perform periapical surgery. Few root fractures were reported. Ultrasonic vibration was the most common method used to remove posts from all tooth types, with the Eggler post remover used most commonly for posts in anterior teeth.