前牙断冠再接的研究进展

由于外伤造成的前牙冠折是临床上较常遇见的问题,随着粘接系统性能的提高,断冠再粘接成为一种更好的选择,就是将折断部分的牙冠重新粘接回原处,可以保留釉质的原始形态、颜色,美观,成本低,患者易于接受。本文将对近年断冠粘接技术的进展进行综述。     

自体前牙断冠再接的临床疗效

目的 比较恒前牙牙本质固位钉结合双层固化树脂断冠再接与常规断冠再接的临床疗效.方法 将外伤冠折片保留完整的38例患者的49颗龈上冠折上颌恒前牙随机分为实验组(21颗)和对照组(28颗),分别采用牙本质固位钉结合双层固化树脂行断冠再接和常规断冠再接(双层固化树脂行断冠再接).治疗后第1、6、12个月复查,进行疗效评价.结...     

150例年轻恒前牙断冠再接的疗效观察

1病案报告典型病例:病人王某,男,11岁,因活动时致上颌前牙冠折。4 h(2007-09)就诊(图1~3)。检查:11牙冠中1/3自唇面向舌面斜向折断,露髓,探(+)、叩(-)、松动(-)、X线片未发现牙根折断线及牙槽突折断线,根尖发育接近完成(图7)。诊断:11冠折露髓。治疗:11碧兰麻局麻下行活髓切断术(图8),对折断牙及游离冠断面采用     

自体牙断冠再接临床应用

近年来，笔者采用自体牙断冠再接技术对前牙牙冠折断进行修复，共治疗３４名患者３７个牙。１材料和方法１．１材料选择杭州新亚仪表器材厂牙用根管螺纹桩Ｍ１．２、Ｍ１．５、Ｍ１．８；Ｌ１１００型牙用自攻自断螺纹固位钉，Ｍ０．６；古莎光固化复合树脂、光固化机。１...     

玻璃纤维桩用于前牙自体牙断冠再接治疗体会

前牙外伤冠折在临床上很常见,多数患牙的断端都碎裂或丢失,但也有部分病人的断端牙冠仍较完整。我科选择前牙断端牙冠仍较完整的病例采用玻璃纤维桩和含氟复合树脂粘合剂行自体牙断冠再接治疗,观察6～36个月,取得了较为满意的效果。     

上颌前牙断冠再接术50例疗效观察

笔者利用桩钉，一次性根充并辅以切龈术给前牙冠折患者施行断冠再接术，尤其对冠折至龈下的患者，疗效较好，自1990年4月至今用此法治疗50例，计56个牙。效果都较满意，现将有关治疗结果报道如下：     

年轻恒牙冠折后自体断冠再接疗效观察

由于儿童、青少年处于身体生长旺盛时期，喜欢剧烈的活动，但又缺乏运动风险防护意识，因此牙外伤的发生呈上升趋势。牙外伤的高危人群是6～15岁的儿童青少年，为了保持年轻恒牙的天然解剖形态，促进牙根的正常发育，自2002—03--2005-01我们对35例37个冠折的年轻恒前牙采取自体断冠再接修复，随访观察3年，临床疗效满意。     

Er：YAG激光在年轻恒牙复杂冠根折病例断冠再接中的应用

目的探讨Er：YAG激光在年轻恒牙复杂冠根折病例断冠再接中的应用情况。方法选择临床上冠折至龈下达秞牙骨质界的年轻恒牙病例,用Er：YAG激光进行相应组织处理后进行活髓切断和断冠再接,观察其临床效果。结果追踪观察12月-18月,效果良好。仅一例患者在术后7月时由于咬到硬物,断冠再次折断,行再次粘接。余患者无自觉症状,牙周健康,断冠无折断,根尖周未见异常。结论 Er：YAG激光在年轻恒牙复杂冠根折再接中效果可靠,是临床上一种可推荐尝试的方法。     

超级粘接剂和平行桩在断牙再接中的应用

目的：探讨超级粘接剂和平行桩在断牙再接修复中的临床疗效。方法：26例中老年患者折断的上前牙应用超级粘接剂和平行桩进行再接修复,观察再接牙的形态和功能。结果：经过0.5～3年的观察,再接牙保持了天然牙的色泽、形态和功能。结论：超级粘接剂和平行桩应用于断牙再接,临床疗效满意。     

不同粘接剂对前牙外伤断冠粘接的抗剪切强度实验研究

目的：比较两种牙本质粘结剂在前牙断端粘结中的作用。方法：采用因牙周病拔除的中切牙24颗,按粘接模式分为4组。A组（直接粘结）,B组（内部倒凹＋唇侧洞斜面）,C组（内部倒凹＋舌侧排溢道）,D组（内部倒凹＋舌侧排溢道＋唇侧洞斜面）。每组6颗牙齿;每组按粘接剂不同又分为2小组（3M自酸蚀粘接剂Adper EasyTM one和传统全酸蚀粘接剂Single bond 2）,用万能材料力学实验机测试其剪切力并计算断冠抗剪切强度。结果：B、D组抗剪切强度明显大于A、C组（P〈0．05）,每组内2小组之间抗剪切强度无统计学差异（P〉0．05）。结论：内部倒凹为前牙外伤断冠粘接的最佳方式,而粘接剂的种类对断冠粘接无明显影响。     

复合树脂联合两种酸蚀粘结剂与乳牙釉质及牙本质的剪切粘结强度比较

目的:比较复合树脂联合全酸蚀和自酸蚀粘结剂与乳牙釉质及牙本质的剪切粘结强度。方法:收集新鲜拔除的滞留乳磨牙48个,随机分为4组,分别制备全酸蚀和自酸蚀粘结剂的釉质和牙本质试件,电子万能试验机测定各组剪切强度;体视显微镜下观察试件断面的破坏模式;扫描电镜观察粘结界面情况。结果:全酸蚀粘结剂组的釉质剪切强度明显高于牙本质剪切强度(P<0.05);自酸蚀粘结剂组釉质与牙本质剪切粘结强度无统计学差异(P>0.05);全酸蚀粘结剂组的釉质、牙本质剪切粘结强度均明显高于自酸蚀粘结剂组(P<0.05);体视显微镜及扫描电镜观察均显示,全酸蚀粘结剂与釉质和牙本质的粘结界面结合程度好于自酸蚀粘结剂。结论:全酸蚀粘结剂处理对乳牙釉质及牙本质的剪切粘结强度高于自酸蚀粘结剂。     

不同粘接剂对烤瓷瓷面与金属托槽间剪切强度影响的体外研究

目的 研究不同粘接剂对烤瓷瓷面与金属托槽间剪切强度的影响.方法 40个烤瓷瓷面经打磨、氢氟酸酸蚀、冲洗干燥、硅烷偶联剂处理瓷面后,再根据使用粘接剂的不同分为A组:光固化复合树脂粘接剂、B组:单组份化学固化复合树脂粘接剂、C组:树脂改良型光固化玻璃离子粘接剂、D组:双组份化学固化复合树脂粘接剂.将40个金属托槽粘接于烤瓷瓷面,经水浴孵化24 h后测得样本剪切强度,并进行统计分析.结果 A组剪切强度大于其他组(P＜0.05),C组剪切强度小于B组(P＜0.05),D组与B、C组剪切强度差异无统计学意义(P＞0.05).结论 光固化复合树脂粘接剂可获得最大的剪切强度,树脂改良型光固化玻璃离子粘接剂对金属托槽与烤瓷瓷面的粘接效果欠佳.     

Three different adhesive systems; three different bond strength test methods

Abstract

Objective. The aim of this study was to evaluate the efficacy of the microtensile, microshear and shear bond strength test methods to assess the bond strength of two self-etch adhesives and one etch&rinse adhesive on dentin. Materials and methods: Seventy-five extracted human molars were ground to expose their flat dentin surfaces and randomly assigned to one of three groups according to the type of test method (15 for microtensile, 15 for microshear, 45 for shear). Each of these groups was then assigned to three sub-groups according to the bonding systems (Clearfil SE Bond, Kuraray; G Bond, GC; Prime&Bond NT, Dentsply) used. Then, 15 specimens were prepared for each sub-group according to the test method employed (n = 15). After being stored in distilled water at 37°C for 24 h, the specimens were placed in a universal testing machine for three test methods and stressed at a crosshead speed of 0.5 mm/min. Mean bond strengths were analyzed using Kruskall-Wallis and Mann-Whitney U-tests at a significance level of p < 0.05. Results. The microtensile test had the highest bond strength (p = 0.046). Clearfil SE Bond and Prime&Bond NT produced significantly higher values than the G Bond in the microtensile bond test (p < 0.05), whereas no significant differences were found among the adhesives in the microshear bond test (p > 0.05). For the shear test, Clearfil SE Bond showed higher bond strength than Prime&Bond NT and G Bond (p < 0.05). Conclusion: Bond strength to dentin depends on the material and the test method used.     

Shear bond strengths of tooth fragments reattached or restored

This study investigated the shear bond strengths of sectioned human mandibular incisor edge fragments reattached using luting cements, bonding agents or restored with composite resins. Seventy teeth were randomly distributed among six experimental groups and a control group. Leaving half of the anatomic crowns exposed, the teeth were embedded in self-cure acrylic resins with the exposed part then sectioned. The fragments in groups 1-4 were bonded to their respective teeth using Clearfil Liner Bond 2V, Scotch Bond Multi Purpose Plus, Panavia-F and 3M Opal Luting cement. The 5th and 6th groups were restored with composite resins (Silux 3M and Clearfil AP-X) using their bonding agents (Single Bond and Clearfil SE Bond). The results indicated that reattachment of fractured incisal fragments by using new generation bonding agents was effective against shear stresses, comparable with the intact teeth. Instead of restoration with composite resins therefore reattachment of a fractured fragment might be more preferable in cases of dental trauma.     

两种树脂粘结剂对不同材料粘结性能的比较

目的：通过比较2种树脂粘结剂对不同修复材料的剪切强度来评价其粘结性能,为修复临床提供一定的依据。方法：选用两种树脂类粘结剂,将5种不同的修复材料分别粘于牙本质,测定剪切强度,并在Olympus立体显微镜下观察断裂面破坏方式。结果：用SAS的ANOVA过程对各组数据进行统计分析,结果：（1）Super-bond C＆B对各种材料均有良好的粘结强度,Panavia-F对钴铬合金最强。（2）Super-bond对各种修复材料与牙本质的粘结强度,都明显高于Panavia-F。（3）从界面破坏的光镜分析可看出,Super-bond 22.5%为粘结剂的内聚破坏,65%为混合破坏,而Panavia-F 75%为沿牙本质面断裂的粘结破坏。结论：Super-bond的粘结性能高于Panavia-F,Panavia-F对钴铬合金的粘结强度最高。     

不同粘接剂去除方式对釉质微观结构及托槽抗剪切粘接强度的影响

目的 对比研究5种不同牙面残留粘接剂去除方式对釉质及托槽抗剪切粘接强度(shear bond strength, SBS)的影响。方法 选取66颗离体前磨牙,随机分为6组。A组：空白组,牙面不做任何处理;B组：金刚砂车针处理组;C组：绿砂石处理组;D组：慢速钨钢钻处理组;E组：慢速钨钢钻+抛光杯处理组;F组：慢速钨钢钻+硅粒子处理组,用上述处理方法对各组等量粘接剂样本进行磨除,记录操作时间,分别用扫描电镜和表面粗糙度仪对釉质表面进行定性和定量评价。各组处理样本粘接金属托槽后,应用万能力学测试仪检测各组托槽SBS,分析牙面粘接剂残留指数(adhesive residual index, ARI)。结果 B、C组去除效率较高,E组效率最低;扫描电镜显示F组处理后的釉质形态最接近正常牙釉质;F组表面粗糙度最低((0.48±0.13)μm),与A组无统计学差异(P>0.05);D组托槽再粘接强度最高((16.61±1.99)MPa),明显高于A组(P<0.05);各组托槽去除后的ARI指数无显著性差异(P>0.05)。结论 金刚砂车针及绿砂石去除效率较高,但对釉质损伤较大;慢...     

Shear bond strength of composite resin cements to lithium disilicate ceramics

The aim of this study was to evaluate the shear bond strength of different commercial composite resin cement systems to lithium disilicate all-ceramic substrate. Five adhesive resin cement systems Panavia 21 and Panavia F (Kuraray), Variolink 2 (Ivoclar-Vivadent), RelyX Unicem Applicap and RelyX ARC (3M ESPE) were used on all-ceramic (IPS Empress 2; Ivoclar-Vivadent) substrate. Shear bond strength of adhesive resin cement to substrate was tested after thermocycling, or without thermocycling (n = 10). Substrate surfaces of the specimen after loading were SEM microscopically examined. The highest bond strengths in water stored conditions were obtained with RelyX ARC (28.7 +/-3.9 MPa), while in thermocycled conditions the highest bonding values were obtained with Variolink 2 (23.2 +/- 7.5 MPa). The lowest values in both water stored (5.8 +/- 4.0 MPa) and thermocycled (2.4 +/- 2.9 MPa) conditions were obtained with Panavia 21. Shear bond strengths appeared to be affected significantly by thermocycling (anova, P < 0.05). It was concluded that there were significant differences between the bond strengths of adhesive resin cements to lithium disilicate substrate.