计算机辅助设计与计算机辅助制作后牙修复体的三年临床观察及失败病例分析

目的评估计算机辅助设计（computer aided design，CAD）与计算机辅助制作（conaputer aided manufacture，CAM）后牙全瓷修复体的3年临床使用效果，分析病例失败的原因。方法使用CAD—CAM系统和可切削瓷块治疗32例后牙大面积牙体缺损患者，共修复14颗前磨牙和18颗磨牙。根据缺损的形态和体积分别制作11个嵌体、10个冠和11个髓腔固位冠，追踪观察3年。结果28个修复体完好，2个修复体折断（磨牙嵌体和冠各1个）并重新制作，2个修复体边缘破损（磨牙和前磨牙嵌体各1个）。结论在正确选择适应证并严格按要求进行牙体预备的前提下，使用CAD．CAM全瓷修复能满足患者对咀嚼功能和美学的要求。     

口腔修复技术进展(一)

口腔修复医学是近年来发展迅速的学科,涉及学科众多,与口腔组织学、解剖生理学、口腔生物力学、材料学等密切关联,随着现代科技的发展而迅速发展,山此产生了许多新的修复方法和技术.二十世纪的修复的许多新技术、新方法,如计算机辅助设计与辅助制作(CAD/CAM);人工种植技术;激光在口腔修复的应用;铸钛技术;精密铸造技术;烤瓷、铸瓷技术、全瓷技术等.这些深刻影响到口腔修复学的发展.本文就其中部分新技术作一介绍.一 计算机义齿辅助设计与辅助制作计算机义齿辅助设计与辅助制作(CAD/CAM)足本世纪口腔修复领域最大的进展之一,从根本上改变了传统的义齿制作方法,是义齿制作史上的一场革命.口腔修复的CAD/CAM的主要特点包括:完成的修复体准确,与基牙密合;节省大量时间,如以往完成一个嵌体或牙冠最少也要就诊两次,而用CAD/CAM仅一次就可完成,而且从预备到完成制作只需40～50     

计算机辅助设计与制作陶瓷修复体

计算机辅助设计与制作陶瓷修复体何玉林，陈必胜传统的陶瓷和复合树脂嵌体等修复治疗，需要至少两次就诊才能完成。光学扫描方法和计算机辅助设计与制作技术的应用，改变了常规的修复体制作工艺。目前，运用ＣＥＲＥＣ系统可将一预成陶瓷块铣磨成修复体。牙科医生能在牙体...     

CAD/CAM系统中单冠设计的研究

目的 探索口腔固定修复计算机辅助设计／计算机辅助制作-CAD／CAM（ComputerAidedDesin／ComputerAided Manufacture）系境的单冠设计路线，为研制我国具有自主知识产权的固定修复CAD／CAM系境奠定基础。方法 通过机械式扫描仪获取已进行完牙体预备需进行单冠修复的模型、对颌模型及正中（牙合）的咬合模型的数据，在I—DEAS软件中通过一系列的调整得到适于该个体的单冠的数据，从而得到单冠的设计路线，并以IGES格式存储所得数据。以备后续的数控加工程序进行加工。结果 得到了单冠的计算机辅助设计的设计路线。结论 单冠的计算机辅助设计路线是可行的，具有一定的理论与实战意义，为口腔固定修复CAD/CAM系统的进一步开发打下基础。     

后牙嵌体的教育处机辅助设计

目的 通过计算机辅助设计（CAD）获得待修复的后牙嵌体,以备计算机辅助加工（CAM）之用。方法 拟作修复的牙预备体、邻牙、对He牙经过光学测量。获得其表面三维形状后,选用患牙所对应的理想牙冠的形状,根据缺牙区邻牙和对He牙的情况进行修改,使之适合该牙列的情况,然后用修改好的理想牙冠的形状数据减去牙预备体的形状数据,即获得待修复的嵌体的数据。以备CAM加工之用。结果 获得待修复的嵌体的数据和图像,结论 本研究建立了一套通用性良好的嵌体的CAD系统,为CAM的实现奠定了基础。     

浅谈当代牙体缺损的嵌体修复技术

因龋坏、外伤、磨耗等原因造成的牙体缺损极为常见,对于一些用直接充填修复效果不佳的牙体缺损的患牙,我们通常使用间接修复体修复。临床上,我们常使用的间接修复体有嵌体修复和全冠修复。随着粘接技术的提升,嵌体,通过粘接及固位形修复,已作为现在临床常用的牙体缺损后的间接修复体之一。较全冠相比,它具有尽可能保存剩余牙体组织的优点而被优先选择,但仍需要有剩余的牙体组织来提供足够的抗力。嵌体可以使用不同的材料制作,如金属嵌体、瓷嵌体等。随着计算机辅助设计与制造（computer aided design/manufacturing,CAD/CAM) 技术的兴起,全瓷材料也因为具有良好的生物相容性和易切削性被广泛应用。该文对牙体缺损的嵌体修复的分类、适应证和禁忌证、临床常见术后问题、嵌体修复材料种类等各方面的研究现状作一综述,期盼为牙体缺损的嵌体修复技术的临床应用和研究提供参考。     

CAD／CAM制作陶瓷嵌体的三年临床评价

采用计算机辅助设计／计算机辅助制作系统制作陶疱嵌体修复磨牙牙体缺损，通过三年来对２１例修复体的临床观察均未发现继发龋，病人对修复体的颜色匹配，耐磨性等方面较为满意。临床成功率为７６．２０％。但也发现有５例嵌体拆裂及２例嵌体边缘与牙齿窝洞壁之间出现明显缝隙，其主要原因是嵌体厚度不足，粘固剂选择不当。     

嵌体的临床应用

５０年代在口腔修复临床上，嵌体是与金属全冠、部分冠共同被选作牙体修复的修复体或牙列固定桥修复的固位体，那时作嵌体的材料基本是用金合金。６０年代由于黄金控制供应，就采用不多了。８０年代前后开始应用软质钴铬合金为材料作嵌体，质量不够理想，但也勉强能用。９０年代由于对银汞合金含汞的责难，以及人民生活水平的提高，科学的进步，并采用计算机辅助设计和计算机辅助制作（ＣＡＤ／ＣＡＭ）金属和瓷嵌体，又有条件作一些金合金嵌体了。在笔者所经历的目前仍能随访到的２５件嵌体中，有２件嵌体脱落，１件牙冠折断，均为钴铬合金…     

CAD/CAM全瓷嵌体与复合树脂嵌体修复后牙Ⅱ类洞临床疗效对比分析

目的：对比分析CAD/CAM全瓷嵌体与复合树脂嵌体修复后牙Ⅱ类洞的临床疗效。方法：选择在解放军总医院口腔内科就诊的后牙Ⅱ类洞患者193例（共226颗牙）,根据患者意愿,其中101颗采用CAD/CAM全瓷嵌体修复,其余125颗采用复合树脂嵌体修复,分别在术后6个月、12个月、18个月进行随访,观察其修复体磨耗、折裂、脱落、边缘密合性、边缘着色及继发龋等情况。结果：2种嵌体在修复体磨耗及边缘着色的差异有统计学意义（P〈0.05）,在修复体折裂、修复体脱落、继发龋和边缘密合性的差异无统计学意义（P〉0.05）。CAD/CAM全瓷嵌体的成功率为：96.84%,树脂嵌体的成功率为：81.05%,两组之间成功率的差异有统计学意义（P〈0.05）。结论：在后牙Ⅱ类洞缺损的修复治疗中,CAD/CAM全瓷嵌体的效果优于复合树脂嵌体。     

国产口腔修复CAD-CAM系统的研究与开发

目的 开发具有我国自主知识产权的口腔修复体的计算机辅助设计与辅助制作系统。方法 利用自行研制的3轴三维激光扫描仪获取全牙列28颗标准牙冠的形态数据。利用Matlab 5.3作为数据处理和程序开发平台，对数据进行处理，同时在牙冠表面定义特征区和特征点并进行各种变换和调整。用Surfacer10.5作为开发平台，进行修复体设计程序的研究与开发。用国产3.5轴的数控加工设备进行修复体加工。结果 建立了国人28颗标准牙冠的三维图形数据库。开发了咬合形态调整和修改程序。初步实现了冠修复体的计算机辅助设计全过程并完成了其计算机辅助制作的全过程。结论 本项实验系统的研制成功表明，我国学者已掌握了口腔修复CAD－CAM的基本理论、数学描述、技术和制造工艺。为进一步的产业化开发奠定了基础。     

Ceramic Inlays: A Case Presentation and Lessons Learned from the Literature

Ceramic dental restorative materials offer an esthetic alternative to dental amalgam or gold. There is uncertainty relative to the longevity of ceramic inlay restorations. Recently published long-term research studies reveal general clinical performance trends. These trends are discussed while presenting a ceramic inlay case. Successful clinical use of ceramic inlay materials is absolutely dependent on the creation of an uncompromised adhesive tooth/ceramic interface. Ceramic inlay restorations perform well in terms of long-term retention, color match, and anatomic contour stability. These restorations all experience limited margin deterioration that does not predispose to marginal discoloration or secondary caries. Patients rarely suffer from postoperative sensitivity secondary to ceramic inlay placement.
Ceramic inlays fail predominantly as a result of crack propagation from material flaws leading to bulk fracture. Some superficial ceramic defects may be repaired with composite resin. Internal material flaws are minimized by industrial production of indirect pressable glass-ceramic materials or ceramic blocks designed for computer-aided design/computer-assisted manufacturing (CAD/CAM). External surface flaws are limited by careful polishing techniques. Strategic placement of ceramic inlays in teeth that are not subject to heavy occlusal loading will result in more predictable long-term performance. Preparation design to prevent flexure of ceramic inlay materials is essential.

CLINICAL SIGNIFICANCE

Use of ceramic inlays to restore defects in posterior teeth requires careful attention to detail. Placement of ceramic inlay materials in high-stress areas may result in less predictable long-term performance. Ceramic inlays are advantageous for restoring moderately sized defects when optimal control of restoration contours and esthetics is desired.     

CAD/CAM瓷嵌体在活髓后牙牙体缺损修复中的应用

牙体缺损的治疗原则是保护牙髓及恢复牙齿功能,并兼顾微创美学修复。近年来,计算机辅助设计和计算机辅助制作（CAD/CAM）椅旁修复系统以其精确便捷的加工技术、简单微创的牙体预备、可靠稳定的粘接修复等优势在牙体缺损修复领域迅速得以应用。现对CAD/CAM瓷嵌体在活髓后牙牙体缺损修复应用中的相关问题做一阐述。     

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??Posterior tooth defect with vital pulp is very common in endodontics. Materials and methods have been constantly updated based on the concept of pulp protection?? restoration of function as well as minimally invasion. In recent years?? CAD/CAM chairside repair technology and various ceramic inlay appear and are quickly used in restoration of dental defects?? with their precise and convenient processing technology?? minimally invasive tooth preparation as well as reliable and stable bonding restoration. This article will elaborate the problems related to the application of CAD / CAM ceramic inlay in vital pulp tooth restoration.     

Fully automatic CAD design of the occlusal morphology of partial crowns compared to dental technicians' design

Objectives

The aim of this study was to compare the occlusal morphology of partial crown reconstructions made by dental technicians with reconstructions made by a fully automatic software process (biogeneric tooth model) in relation to the original natural tooth shape.

Material and methods

Stone replicas of natural teeth were measured three-dimensionally before preparing inlay and onlay cavities for ceramic restorations (n?=?5). For each preparation, five reconstructions (in total n?=?25) were made by five dental technicians. Additionally, reconstructions were calculated automatically by a software based on the biogeneric tooth model (Cerec 3D). In order to compare the two different kinds of reconstruction, an objective metrical similarity measure (shape similarity value, SSV) based on calculated volumes between compared datasets was used.

Results

In 22 of 25 cases, the reconstructions made by the CAD software were closer to the original situation than the reconstructions made by the technicians. Mean average SSV of reconstructions made by the technicians (310.2?±?78.8 μm) was significantly higher (p?<?0.05) than mean SSV of CAD reconstructions (biogeneric model) (222.0?±?47.7 μm).

Conclusions

In the design of naturally shaped occlusal inlay/onlay surfaces, a fully automatic CAD system can be at least as good as conventional wax-ups by dental technicians.

Clinical relevance

The adjustment of a dental restoration to fit the morphology of surrounding tooth structures, still presents challenges for the dentist.     

数字化口腔医学课程体系建设

数字化口腔医学是口腔医学学科重要的发展方向之一,高水平的数字化口腔人才需求日益增长,相关专业人才的培养成为国内口腔医学院校面临的新任务,其核心问题是建立全新的数字化口腔医学课程体系。笔者团队多年坚持开展数字化口腔医学教学方法、教学模式的改革创新,并初步建立了一套相对系统、全面的数字化口腔医学课程体系,在国内口腔医学教学领域开创先河,文章就数字化口腔医学课程体系建设做一介绍。     

数字化口腔医学课程体系建设

 数字化口腔医学是口腔医学学科重要的发展方向之一，高水平的数字化口腔人才需求日益增长，相关专业人才的培养成为国内口腔医学院校面临的新任务，其核心问题是建立全新的数字化口腔医学课程体系。笔者团队多年坚持开展数字化口腔医学教学方法、教学模式的改革创新，并初步建立了一套相对系统、全面的数字化口腔医学课程体系，在国内口腔医学教学领域开创先河，文章就数字化口腔医学课程体系建设做一介绍。     

CEREC 3D全瓷嵌体修复后牙Ⅱ类洞的临床研究

目的：观察Cerec 3系统制作的全瓷嵌体修复后牙Ⅱ类洞的临床效果。方法：选取48例56颗后牙缺损Ⅱ类洞患牙,使用Cerec 3系统制作全瓷嵌体。修复后追踪观察1年,按照改良的USPHS标准进行临床评价。结果：85%瓷嵌体各项指标达到了B标准,其中颜色匹配最令人满意,达到A标准者为96%。结论：Cerec 3系统制作全瓷嵌体修复牙体缺损Ⅱ类洞具有较好的临床效果。     

数字化口腔修复（12）--CAD／CAM全瓷嵌体修复楔状缺损（附病例报告）

目的：观察计算机辅助设计和制作（CAD／CAM）二矽酸锂全瓷嵌体修复牙颈部缺损的临床疗效。方法：临床病例为1颗牙颈部继发龋坏深达龈下的患牙,采用CAD／CAM全瓷嵌体修复,按照改良的USPHS标准分别进行6个月和1年的临床疗效评价。结果：各个复查阶段：嵌体无脱落,折断、劈裂等不良现象,临床指标均达到A级指标。结论：CAD／CAM嵌体修复牙颈部楔状缺损是一种效果良好的修复方法。     

基于逆向工程技术的嵌体计算机辅助设计

目的 运用逆向工程软件进行嵌体计算机辅助设计(CAD)，探讨符合生理要求的嵌体He面与邻面的CAD方法，为嵌体专用CAD平台的开发提供方法学基础。方法 取一个别正常He自愿者牙颌超硬石膏模型，在模型上牙体预备G．V．Black Ⅰ类洞、Ⅱ类洞、Ⅵ类(MOD)洞嵌体洞型，以牙科自凝树脂取牙尖交错位(ICP)He记录与模拟功能性He记录(FGP)。在同一坐标系下采集预备体、邻牙及He记录数字印模。运用逆向工程软件进行数据处理，同时结合标准牙数据库完成CAD。结果 在逆向工程软件基础上确立了嵌体CAD的技术路线，CAD完成后的各类型后牙嵌体形态协调美观，表面光滑，咬合及邻接关系符合生理要求。结论 基于通用逆向工程软件二次开发构建的嵌体CAD专用平台，是一种可行的方法。     

Developing meaningful systematic review of CAD/CAM reconstructions and fiber-reinforced composites

Objective: Clinical literature was examined for evidence supporting use of CAD/CAM reconstructions and fiber‐reinforced materials. Materials and methods: Potential evidence was identified via databases [PubMed; EMBASE (R) Drugs & Pharmacology; Center for Reviews and Dissemination, University of York; Cochrane Library], hand search of non‐indexed literature, secondary reference searches, and personal contacts with clinical trial PI's. Search terms included: dental restorations; CAD/CAM; CEREC; LAVA; CERCON; Procera; inlay/onlay; dental prosthesis; fiber‐reinforced composite (FRC). Results: Two randomized‐controlled clinical trials were identified as examined in one Cochrane Collaboration review relevant to CAD/CAM inlays. One systematic review of 15 CAD/CAM inlay studies was examined. Six studies were identified of three commercial FRC endodontic posts and eight reported on FRC use for fixed denture prostheses. Fifteen ongoing prospective trials were identified studying CAD/CAM fabricated zirconia‐based prostheses. A total of 76 papers were referenced including those related to use of in vitro measures as evidence. Conclusions: Review of the Cochrane analysis raised concerns that typical RCT protocols may prove insufficient for stratification of confounding variables (patient, practitioner, material) when treatment outcomes are primarily prosthesis‐ or material‐based (not patient‐based, e.g., as in fracture). RCT designs are most straightforward when treatment outcomes are patient‐based (e.g., soft tissue changes). When treatment responses are material‐based, controls also become difficult to define and studies become tests of equivalency/superiority; where well‐stratified cohort designs are likely preferred. Large numbers of independent cohort studies support the use of CAD/CAM ceramic inlay/onlay restorations and crowns but many complications inhibit the application of high‐level systematic review. Except perhaps for fiber‐based endodontic posts, the clinical FRC literature appears insufficient for expert review. Single in vitro measures cannot currently serve as evidence for clinical practice, except in limited cases of simple function (e.g., impression material accuracy). Batteries of in vitro measures are often applied during materials development but cannot substitute for clinical study.