树脂粘接剂在全瓷修复中的应用

全瓷修复是当今口腔固定修复的发展趋势之一。全瓷修复体依赖良好的树脂粘接剂以保证其临床成功。目前,全瓷修复树脂粘接剂与牙本质的粘接技术及瓷表面处理技术仍在不断探索改进之中,以期进一步提高临床粘接效果。本文对全瓷修复树脂粘接剂的组成及其与牙本质的粘接、与全瓷修复体的粘接原理、技术和效果作一综述。     

树脂粘接剂在全瓷修复中的应用

全瓷修复是当今口腔固定修复的发展趋势之一。全瓷修复体依赖良好的树脂粘接剂以保征其临床成功。目前，全瓷修复树脂粘接剂与才本质的粘接技术及瓷表面处理技术仍在不断探索改进之中，以期进一步提高临床粘接效果。本文对全瓷修复树脂粘接剂的组成及其与牙本质的粘接、与全瓷修复体的粘接原理、技术和效果作一综述。     

树脂类粘接剂对全瓷与牙本质之间粘接强度的影响

目的比较3种不同粘接剂对3种全瓷材料与牙本质之间抗剪切粘接强度的影响。方法样本为热压铸造陶瓷组、氧化铝渗透陶瓷组和氧化锆切削陶瓷组,每组各18片,各组再随机分为A、B、C3个小组,每小组6片。将收集的离体恒磨牙打磨至牙本质浅层,分别采用树脂类粘接剂RelyXTM ARC、PanaviaTMF以及Rely XTM Unicem与3种全瓷片粘接。所有试件均置于37℃人工唾液,24h后测试54个试件的抗剪切强度。结果热压铸造陶瓷组与氧化锆切削陶瓷组均为RelyXTM Unicem抗剪切粘接强度最高,而氧化铝渗透陶瓷组PanaviaTM F抗剪切粘接强度最高。结论对于3种不同全瓷材料,临床上可根据全瓷修复体的种类选择适当的粘接剂系统。     

氧化锆陶瓷与三种树脂粘接剂粘接剪切强度比较

目的探讨适合牙科氧化锆陶瓷的粘接材料。方法将烧结后的氧化锆陶瓷片分为3组,每组32片,分别采用三种自酸蚀粘接剂RelyX Unicem、PanaviaTM F、Superbond C﹠B与喷砂后的氧化锆陶瓷片粘接,水浴24h和水浴30d后,测试其粘接剪切强度。数据用SAS9.12软件进行统计学分析,粘接断面用扫描电镜观察。结果 PanaviaTMF树脂粘接材料粘接强度最好,分别为（31.36±3.49）MPa（水浴24h）、（29.52±3.44）MPa（水浴30d）。Superbond C﹠B能够取得较好的初期粘接强度（31.85±3.61）MPa（水浴24h）,但水浴30d后明显下降至（21.32±2.58）MPa,P〈0.05。RelyX Unicem的初期（水浴24h）粘接强度最小为（13.29±3.05）MPa,P〈0.0001,但水浴30d后粘接强度为（12.06±2.28）MPa,未见明显降低,P（0.05。结论含有MDP磷酸单体的树脂粘接材料可以使牙科氧化锆陶瓷获得最好的粘接效果。使用不含无机填料的化学固化型纯树脂粘接剂可以取得较好的初期粘接强度但长期效果欠佳。一步法自酸蚀树脂粘接剂虽然没有很高的初期粘接强度,但粘接效果尚能持久。     

表面处理提高瓷与树脂粘接强度的研究进展

树脂粘接剂是目前使用最多的全瓷粘接剂,研究表明瓷的表面必须有一层硅烷偶联剂来增大瓷与树脂的粘接强度。本文介绍了喷砂、酸蚀、硅烷化等方法处理全瓷修复体表面以提高树脂粘接剂粘接强度的研究进展,旨在增进临床医师对表面处理在全瓷修复粘接系统中作用的了解,进一步指导其在临床中的应用。     

表面处理提高瓷与树脂粘接强度的研究进展

树脂粘接剂是目前使用最多的全瓷粘接剂，研究表明瓷的表面必须有一层硅烷偶联剂来增大瓷与树脂的粘接强度。本文介绍了喷砂、酸蚀、硅烷化等方法处理全瓷修复体表面以提高树脂粘接剂粘接强度的研究进展，旨在增进临床医师对表面处理在全瓷修复粘接系统中作用的了解，进一步指导其在临床中的应用。     

通用型粘接剂和水门汀对氧化锆与全瓷托槽粘接力的影响

目的:采用通用型粘接剂和水门汀对氧化锆和全瓷托槽进行粘接并测定其断裂载荷。方法:选用2种水门汀Transbond^TM XT和Clearfil SAC,以及通用型粘接剂Clearfil SE One将上颌中切牙全瓷托槽Inspire Ice分别与氧化锆粘接(n=10)。试件冷热循环10 000次后测量断裂载荷(N),立体显微镜观察破坏形态。结果:Transbond^TM XT组的断裂载荷均值最低(65.13±37.32) N,SAC-BracketSand-ZrSand组的断裂载荷均值最高(517.07±94.18) N。结论:使用Clearfil SAC粘接全瓷托槽的剪切粘接力高于正畸全瓷托槽粘接水门汀Transbond^TM XT。喷砂提高了氧化锆和全瓷托槽的粘接力。     

瓷层厚度及粘接剂种类对全瓷粘接性能的影响

全瓷修复体修复失败的两个主要原因是修复体断裂和修复体脱落，都与粘接方法有关系。聚合光能通过半透明的瓷层发生衰减，可能导致粘接剂聚合不足并难以获得充分的粘固力。本文旨在研究瓷层厚度、光聚合树脂粘接剂及双聚合树脂粘接剂对二硅酸锂全瓷（Empress2）系统早期粘棒力及持久性的影响。     

通用型粘接剂和树脂水门汀对氧化锆 剪切粘接强度的影响

目的 研究通用型粘接剂和树脂水门汀对氧化锆陶瓷剪切粘接强度和耐久性的影响。方法 氧化锆陶瓷烧结制作20 mm×10 mm×10 mm和10 mm×10 mm×10mm两种尺寸的试件,实验分为12组,将这2种试件分别采用不同的树脂水门汀（RelyX Ultimate树脂水门汀、Clearfil SAC自粘接树脂水门汀）和通用粘接剂（无粘接剂、Scotchbond通用粘接剂、Clearfil SE One粘接剂）在不同的储存条件（水浴、水浴+冷热循环）下进行粘接。测试剪切粘接强度,分析断裂形态。结果 水门汀（F=8.41,P<0.01）和粘接剂（F=30.34,P<0.01）对氧化锆剪切粘接强度的影响有统计学意义;储存条件对剪切粘接强度的影响无统计学意义（F=1.83,P=0.18）。RelyX Ultimate树脂水门汀、无粘接剂、水浴+冷热循环储存时的剪切粘接强度最低（14.02 MPa±6.86 MPa）,RelyX Ultimate树脂水门汀、Scotchbond通用粘接剂、水浴+冷热循环储存时的剪切粘接强度最高（54.12 MPa±8.37 MPa）。结论 通用型粘接剂可提高树脂水门汀对氧化锆的粘接耐久性。非自粘接的树脂水门汀如不使用通用型粘接剂则其粘接耐久性下降。     

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提要：纤维桩-树脂核-冠修复体越来越多用于口腔修复中。树脂核-冠间的黏结力是全冠获得固位力的主要因素之一,而树脂核-水门汀间黏结强度对冠黏结力的获得具有重要影响。本文就树脂成核材料及其临床应用,影响树脂核-水门汀间黏结强度的因素做一综述。     

Luting glass ceramic restorations using a selfadhesive resin cement under different dentin conditions

Objectives

The aim of this study was to investigate the bond strength of ceramic restorations luted using a self-adhesive resin cement (RelyX Unicem, 3M ESPE) under different dentin conditions.

Material and Methods

In the experimental groups, ceramic restorations were luted to bovine incisors with RelyX Unicem under the following conditions: [Dry dentin]: surface was dried using air stream for 15 s; [Moist dentin]: excess dentin moisture was removed with absorbent paper; [Bonding agent]: Clearfil SE Bond (Kuraray) self-etching adhesive system was previously applied to dentin. In the Control group, cementation was done using an etch-and-rinse adhesive (Excite DSC) and Variolink II resin cement (Ivoclar Vivadent). Photoactivation of the resin cements was performed with UltraLume LED 5 unit (Ultradent). The restorations (n=5 per group) were sectioned into beams and microtensile testing was carried out. Data were subjected to ANOVA and Tukey''s test (p<0.05). Failure modes were classified under Scanning Electron Microscopic (SEM) (×120 magnification).

Results

The bond strength was dependent on the moisture status of the dentin. Bond strength in the "dry dentin group" was significantly lower than that of all other groups, which showed similar results. A predominance of mixed failures was detected for the control group, while a predominance of adhesive failures was observed for the "bonding agent" and "dry dentin" groups. The "moist dentin" group presented predominantly cohesive failures within the luting material. The previous application of a self-etching adhesive showed no significant effect.

Conclusions

Only excess dentin moisture should be removed for the cementation of ceramic restorations with self-adhesive resin cements.     

Er:YAG激光在拆除全瓷修复体中应用的研究进展

全瓷修复体因兼具美观性及高强度在口腔修复中被广泛应用。玻璃陶瓷及氧化锆全瓷材料是临床中应用最为广泛的两种全瓷材料。然而,当全瓷修复体因边缘微渗漏、继发龋等问题需要拆除时,其高强度和高粘接强度极大地增加了拆除难度。近年来,临床医师开始尝试使用Er:YAG激光拆除全瓷修复体。研究表明,Er:YAG激光可以安全高效地应用于玻璃陶瓷修复体的拆除,对于较薄的氧化锆修复体也能发挥作用。全瓷修复体材质及厚度、水门汀类型、激光功率等多种因素均可以影响Er:YAG激光的作用时间。然而,目前研究局限于病例报道及体外研究,缺乏系统的临床研究。Er:YAG激光拆除全瓷修复体的具体作用机制以及激光频率、粘接剂类型、基牙对拆除速度的影响有待进一步研究。     

Influence of resin cements on cuspal deflection and fracture load of endodontically-treated teeth restored with composite inlays

Abstract

Objectives. To evaluate the influence of resin cements on cuspal deflection, fracture load and failure mode of endodontically-treated teeth restored with composite resin inlays. Materials and methods. Forty maxillary premolars were randomly divided into four groups: G1 (sound teeth, control), G2 (RelyX ARC), G3 (RelyX Unicem) and G4 (Maxcem Elite). The teeth from groups 2, 3 and 4 received mesial-occlusal-distal preparations and endodontic treatments. Impressions were taken with vinyl polysiloxane and poured using type IV die stone. Inlays with Z250 composite resin were built over each cast and luted with the resin cements. A 200-N load was applied on the occlusal surface and the cuspal deflection was measured using a micrometer. The specimens were then subjected to an axial load until failure occurred. The resulting failure mode was analyzed. Results. The means for cuspal deflection (μm) and fracture load (N) followed by the same letter represent no statistically significant difference based on ANOVA and Tukey's test (p < 0.05). Cuspal deflection: G1 = 4.7 (±1.7)^a, G2 = 12.0 (±8.9)^a, G3 = 39.0 (±27.0)^b and G4 = 56.8 (±18.2)^b. Fracture load: G1 = 1982 (±893)^a, G2 = 690.9 (±225.5)^b, G3 = 679 (±193.6)^b and G4 = 465.5 (±121.6)^b. G1 presented cusp fractures only at the cement–enamel junction (CEJ). There was a high frequency of cusp fractures below the CEJ in G2, G3 and G4. Conclusions. Composite resin inlays luted with resin cements do not recover the strength of sound teeth. However, teeth restored with composite resin inlays and luted with RelyX ARC can withstand mechanical fatigue longer before failure occurs than those luted with RelyX Unicem and Maxcem Elite.     

树脂粘接剂色调对牙体瓷贴面美学效果的影响

目的 比较树脂粘接剂与同色调试色糊剂颜色效果的一致性,评价树脂粘接剂色调对牙体瓷贴面美学效果的影响,以期为临床提供参考.方法 选用48颗树脂右上颌中切牙,用随机化数字表随机分为8组(每组6颗),模拟临床贴面牙体预备.制作二硅酸锂压铸陶瓷贴面,分别使用8种色调(LV-3、LV-2、MV、HV+2、HV+3、WO、TR、A3色)试色糊剂试色,并用同色调树脂粘接剂粘接于树脂牙上.使用比色仪测量瓷贴面粘接前、试色时及粘接后的色度参数,并计算粘接前后贴面色差值(△E1)和试色时与粘接后贴面色差值(△E2).结果 8种色调树脂粘接剂△E1范围为0.93～ 6.79,其中LV-3、HV+3和WO色调树脂粘接剂△E1分别为3.31、4.90和6.79.除HV+3色调树脂粘接剂△E2为3.65外,其余色调树脂粘接剂粘接后与试色时的瓷贴面色差值在0.72～ 1.79之间.结论 LV-3、HV+3和WO色调树脂粘接剂能改变贴面的最终颜色.除HV+3色调外,其余色调树脂粘接剂与同色调试色糊剂对瓷贴面颜色的影响有较好的一致性.     

铸瓷全冠修复体树脂粘接效果的3年临床评估

目的 评估2种类型复合树脂水门汀与E.MAX铸瓷全冠的3年临床粘接效果.方法 对154名接受E.MAX铸瓷全冠修复的患者进行为期3年的随访,共计218件冠修复体,使用的树脂粘接系统包括自酸蚀类复合树脂水门汀PANAVIA F,需使用ED-Primer预处理基牙表面和自粘接类复合树脂水门汀Rely X Unicem,粘接前均使用硅烷偶联剂预处理冠内粘接面.3年观察期间出现的修复体脱落和折裂均记为失败.记录失败情况并计算成功率.结果 E.MAX铸瓷全冠与PANAVIA F和Rely X Unicem粘接的3年保存率分别为97.5％和96.0％,脱落失败均出现在后牙区有大面积树脂充填物的基牙上.结论 在3年观察期内,自酸蚀类和自粘接类复合树脂水门汀粘接的E.MAX铸瓷全冠临床表现良好.     

树脂粘结剂与瓷表面处理对全瓷粘结微拉伸强度的影响

目的 研究3种树脂粘结剂配合2种瓷表面处理方法对全瓷粘结微拉伸强度的影响.方法 制作60个体积为5mm×6mm×8mm瓷试件(Empress Ⅱ),抛光后分成两组:对照组和HF SIL组(5%氢氟酸酸蚀20秒,硅烷处理1分钟).分别采用3种树脂粘结剂(RelyX Unicem, Variolink或Panavia F)与复合树脂粘结,37℃保存7天,切割成接触面积为1.0mm2的75个柱形体.试件经热循环(5℃～55℃循环3000次)后,测量粘结微拉伸强度(uTBS).结果 表面处理因素有重要意义(HF SIL组>对照组).对照组中Rely X Unicem的uTBS明显高于Variolink和Panavia F.HF SIL组中经RelyX Unicem和Variolink的uTBS明显高于Panavia F.结论 无论使用何种树脂粘结剂,在粘结前进行酸蚀和硅烷处理都是必要的.     

Comparison of the tensile bond strengths of cast metal crowns luted with resin cements

The limitation of photoactivation of dual-polymerized resin cements along the margins of metal restorations may adversely affect the mechanical properties of these cements, thus impairing the retention of restorations. The aim of this study was to assess the bond strength of cast metal crowns cemented with three dual-polymerized resin cements, using a chemically-activated resin cement and zinc phosphate as controls. Fifty nickel-chromium alloy crowns were cast and randomly assigned to five groups of equal size. Castings were cemented on their corresponding metal dies with one of the tested luting agents: Scotchbond Resin Cement, Enforce and Panavia F (dual-polymerized resin cements), Cement-It (chemically-activated resin cement) and Zinc Phosphate Cement (zinc phosphate cement). Specimens were stored in distilled water at 37 degrees C for 24 h and then loaded in tension until failure. Panavia F and Zinc Phosphate Cement provided the highest and lowest bond strength means, respectively. Scotchbond Resin Cement, Enforce and Cement-It cements exhibited similar intermediate values, but with statistically significant difference compared to the other materials (P < 0.05). Even with the restriction or absence of light activation, all tested dual-polymerized resin cements produced significantly higher bond strength than did the zinc phosphate cement and yielded similar or better results than the chemically activated cement. It should be pointed out that the findings of this study relate to a test scenario which does not mimic clinical circumstances and that further work is required to identify the clinical significance of the reported tensile bond strength differences between the different luting materials.     

光照模式对双固化树脂粘接剂聚合程度的影响

目的研究不同光照模式对两种双固化树脂粘接剂聚合程度的影响。方法采用间歇光照、即刻光照、延迟光照和无光照4种不同固化方式,分别制备3MRelyXUnicem和DMGPermaCem2．0双固化树脂试件．24h避光保存后使用显微硬度仪测定样本表面硬度．三点弯曲试验测量挠曲强度．差示扫描量热仪进行玻璃化转变温度测量。数据采用协方差分析进行统计。结果两种树脂粘接剂各组表面硬度和挠曲强度由高到低依次为：间歇光照模式、即刻光照模式〉延迟光照模式〉无光照模式（P〈0．05）。差示扫描量热分析未检测到明显吸热峰,不能确定玻璃化转变温度。除无光照组外．3MRelvX Unicem表面硬度均显著高于DMG PermaCem2．0（P〈0．05）;DMG PermaCem2．0挠曲强度显著高于3MRelyX Unicem（P〈0．05）。结论间歇光照模式比延迟光照模式更有利于提高双固化树脂粘接剂聚合程度：双固化树脂粘接剂在无光照情况下聚合不全;与3MRelyX Unicem相比．DMGPernlaCem2．0抗压性能较差．但韧性较好．且无光照条件下聚合程度更高。     

树脂水门汀颜色稳定性及其对全瓷修复效果影响的研究进展

树脂水门汀广泛用于粘接全瓷修复体,其颜色稳定性与修复体的长期效果有直接关系。树脂水门汀变色的内源性因素通常与材料构成及聚合反应的引发机制相关,树脂水门汀变色的外源性因素主要与口腔局部环境相关。树脂水门汀的颜色稳定性与全瓷修复体长期美学效果关系密切。本综述系统介绍目前临床常用树脂水门汀的颜色稳定性及影响因素,以及其对全瓷...