个性化氧化锆基台在前牙区种植一次诱导牙龈成型的美学观察

目的:探讨CAD/CAM个性化氧化锆基台一次诱导牙龈成型在前牙区种植修复获得的美学效果.方法:42例患者在上前牙区植入42枚种植体后,制作CAD/CAM个性化基台进行一次牙龈成形,6个月后永久修复,对修复后即刻和修复后1年分别进行美学效果评价.结果:42例患者均获得较好的美学效果.修复后即刻和1年后PES的均值分别为11.87±1.95、11.65±2.11,WES均值分别为8.09±1.39、7.98±1.37,PES/WES总均值分别为19.96±3.34、19.63±3.48,VAS均值分别为92.30±5.43、89.12±6.24.结论:利用CAM/CAM个性化氧化锆基台一次诱导牙龈成型,能较好地符合患者个体的生理机能需求,短期观察美学效果稳定.     

CAD/CAM to fabricate ceramic implant abutments and crowns: a preliminary in vitro study

Background:  This study evaluated the feasibility of fabricating implant abutments and crowns from pre-sintered feldspathic porcelain blocks using the chair-side CAD/CAM, CEREC3D^® system.
Methods:  Thirty-two implant analogues were divided into two groups. In the control group, prefabricated machined anatomical titanium (Ti) abutments were screw-retained to the analogues. In the test group, machined feldspathic porcelain abutments were cemented on prefabricated machined Ti links and screw-retained to the implant analogues. These feldspathic porcelain abutments were fabricated out of pre-sintered feldspathic porcelain blocks as duplicates of the abutments in the control group using the CAD/CAM, CEREC3D^® system. Thirty-two feldspathic porcelain crowns, also fabricated out of pre-sintered ceramic blocks, were then cemented with resin cement on all the abutments in both groups. All samples were subsequently subjected to fracture strength testing under static load. An unpaired t-test was used to compare fracture load values between the two groups.
Results:  The test group using feldspathic porcelain abutments and crowns showed statistically significant higher mean fracture strength than the control group with the Ti abutments and feldspathic porcelain crowns.
Conclusions:  This preliminary study showed that the chair-side CAD/CAM technology can be utilized to fabricate customized ceramic abutments with their associated ceramic crowns using pre-sintered feldspathic porcelain blocks.     

计算机辅助设计和制造(CAD/CAM)的种植手术导板的应用

目的将计算机辅助设计和制造(CAD/CAM)种植手术的导板应用于种植手术,保证种植体植入在正确的位点和方向。方法按照导板制做的数据要求,用CT扫描患者的上下颌骨,在获取颌骨数据后输入种植导板设计的软件中,模拟种植体的位置和上部修复体,然后引导制造以修复为导向的准确的种植手术导板并在手术中应用。结果 16例患者采用计算机辅助设计引导制造的手术导板较好地完成了以修复为导向和最终获得良好位置的种植体的植入。结论计算机辅助设计和制造种植手术的导板能在术前了解患者颌骨的解剖结构和种植区骨量,确定术中种植的位点、控制植入的方向、缩短了手术时间,具有很好的应用前景。     

CAD/CAM��ֲ�޸�����������򢻼����Ӧ��

计算机辅助设计和制作系统（CAD／CAM）应用于牙科学领域已有20余年历史，其快速发展和不断完善为口腔种植修复治疗提供越来越广泛的服务。无牙颌患者因颌骨条件较差，传统的黏膜支持式义齿通常存在固位不佳、咀嚼功能恢复不良的问题。种植体支持的固定义齿彻底改善了无牙颌患者的固位和稳定，但种植固定长桥的制作及就位困难。利用CAD／CAM制作的无牙颌修复体具有精确的边缘密合性、良好的机械学性能及生物相容性，本文介绍CAD／CAM技术发生、发展、制作过程及临床应用注意事项，并通过运用CAD／CAM技术完成1例颌骨重度萎缩无牙颌患者的种植修复。     

CAD/CAM纯钛烤瓷冠的抗疲劳性与抗折性分析

目的 比较CAD/CAM纯钛烤瓷冠及镍铬烤瓷冠的抗疲劳性与抗折性。方法 制作前磨牙形态镍铬合金烤瓷冠（Ni组）、CAD/CAM纯钛烤瓷冠（Ti组）各12个。为缩小2组试件之间的尺寸差异,制作过程中对试件进行扫描、图像测量及反馈调整。将所有烤瓷冠粘结于统一切削制作的纯钛代型上,经过5000次冷热循环（5~55℃）和75000次50 N的往复加载后,再接受静态加载至崩瓷,获得崩瓷时的载荷力值（F）。折裂面置于体式显微镜下,观察折裂范围及破坏形式。采用SPSS13.0软件包对数据进行统计学分析。结果 2组试件崩瓷时的载荷力值分别为Ni组(1645±356)N、Ti组(1555±331)N,差异无统计学意义(P=0.525)。折裂主要发生在冠的舌1/3。Ti组有3个试件为界面破坏,其余为混合破坏;而Ni组均为混合破坏。结论 CAD/CAM纯钛烤瓷冠具有与镍铬合金烤瓷冠相近的抗疲劳性及抗折性。     

An In Vitro Comparison of Vertical Marginal Gaps of CAD/CAM Titanium and Conventional Cast Restorations

Purpose: To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations.
Materials and Methods: Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences.
Results: The vertical margin openings were CAD/CAM: 79.43 ± 25.46 μm; WAX/CAM: 73.12 ± 24.15 μm; WAX/CAST: 23.91 ± 9.80 μm. There was a statistically significant difference between the WAX/CAST group and the remaining groups.
Conclusions: There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.     

Microscopical and chemical surface characterization of CAD/CAM zircona abutments after different cleaning procedures. A qualitative analysis

PURPOSE

To describe and characterize the surface topography and cleanliness of CAD/CAM manufactured zirconia abutments after steaming and ultrasonic cleaning.

MATERIALS AND METHODS

A total of 12 ceramic CAD/CAM implant abutments of various manufacturers were produced and randomly divided into two groups of six samples each (control and test group). Four two-piece hybrid abutments and two one-piece abutments made of zirconium-dioxide were assessed per each group. In the control group, cleaning by steam was performed. The test group underwent an ultrasonic cleaning procedure with acetone, ethyl alcohol and antibacterial solution. Groups were subjected to scanning electron microscope (SEM) analysis and Energy-dispersive X-ray spectroscopy (EDX) to verify and characterize contaminant chemical characterization non-quantitatively.

RESULTS

All zirconia CAD/CAM abutments in the present study displayed production-induced wear particles, debris as well as organic and inorganic contaminants. The abutments of the test group showed reduction of surface contamination after undergoing an ultrasonic cleaning procedure. However, an absolute removal of pollutants could not be achieved.

CONCLUSION

The presence of debris on the transmucosal surface of CAD/CAM zirconia abutments of various manufacturers was confirmed. Within the limits of the study design, the results suggest that a defined ultrasonic cleaning process can be advantageously employed to reduce such debris, thus, supposedly enhancing soft tissue healing. Although the adverse long-term influence of abutment contamination on the biological stability of peri-implant tissues has been evidenced, a standardized and validated polishing and cleaning protocol still has to be implemented.     

基于CAD/CAM技术的改良式金属牙种植导板的应用研究

目的 对Simplant牙种植导板进行改良设计,评价其临床应用效果。方法 利用Simplant软件设计种植导板,3Shape软件进行三维镂空改良设计,并铸造转化为改良金属导板。应用改良导板实施20例种植手术,植入31颗种植体,并评价种植体术后与术前三维设计的位置偏差：颈部偏移量、尖部偏移量与偏移角度,评估导板的固位、视野及散热性。结果 31颗种植体平均颈部、尖部偏移量分别为（1.5±1.1）mm和（2.1±0.8）mm,平均偏移角度（4±1.5）°,经t检验,差异无统计学意义（P>0.05）。改良导板临床应用固位稳定、视野清晰、散热良好。结论 改良式种植导板精度较高、利于散热、应用方便,具有辅助临床手术的价值。     

两种粘结剂粘结CAD/CAM氧化锆全瓷冠边缘微渗漏的研究

目的评价两种不同粘结剂在CAD/CAM氧化锆全瓷冠修复中的边缘微渗漏情况。方法制作10个CAD/CAM氧化锆全瓷冠,随机分成2组,分别采用磷酸锌水门汀粘结剂和Panavia F树脂粘结剂粘固于前磨牙,经温度循环试验后,将样本浸入2%品红溶液中24h,用体视显微镜观察牙-粘结剂界面边缘微渗漏状况,并进行分级评估。结果采用SPSS 17.0软件对2组的微渗漏程度进行统计分析,得出Panavia F树脂粘结剂微渗漏小于磷酸锌水门汀粘结剂(χ2=81.142,P<0.05)。结论 Panavia F树脂粘结剂具有较优越的抗边缘微渗漏性能。     

Evaluation of gold-machined UCLA-type abutments and CAD/CAM titanium abutments with hexagonal external connection and with internal connection

PURPOSE: The purpose of this study was to assess the precision at the implant interface of gold-machined UCLA-type abutments and computer-assisted design and manufacture (CAD/CAM) titanium abutments with both external-hexagonal connection and internal-hexagonal connection. MATERIALS AND METHODS: Fifteen gold-machined UCLA-type abutments with external-hexagonal connection, 15 gold-machined UCLA-type abutments with internal-hexagonal connection, 15 CAD/CAM titanium abutments with external-hexagonal connection, and 15 CAD/CAM titanium abutments with internal-hexagonal connection were produced. The rotational freedom of all the abutments was assessed to detect the precision of fit of each abutment on the top of the implant platform. Measurements of rotational freedom were compared among groups. The quantitative differences among groups were assessed using 1-way analysis of variance (alpha = .05). RESULTS: Significant differences relative to rotational freedom were not found among the 4 groups (P > .19). CONCLUSION: Both types of abutments (gold-machined UCLA-type and CAD/CAM titanium) consistently showed 1 degree of rotational freedom between the implant and abutment in both cases of external-hexagonal connection and internal-hexagonal connection.     

CerecⅡ型CAD/CAM全瓷冠的初步临床研究

目的　探讨由SiemensCerecⅡ型CAD/CAM系统加工陶瓷内冠 ,经玻璃渗透和烤瓷工艺制成前磨牙全瓷冠与镍铬合金烤瓷冠的临床效果。方法　分别制作 6个全瓷冠和 6个镍铬合金烤瓷冠 ,比较修复体颜色、形态、基牙龋患率、边缘密合度、边缘着色、修复体折断情况、菌斑指数 (PI)和牙龈指数 (GI) ,随访 6个月至 1年。结果　CerecⅡ型CAD/CAM全瓷冠与金属烤瓷冠在外形基牙龋患率 ,修复体边缘密合度及折断情况 ,无统计学差异。全瓷冠在颜色 ,菌斑指数 (PI)和牙龈指数 (GI)方面优于镍铬合金烤瓷冠 (P <0 .0 1)。结论　与镍铬合金烤瓷冠相比 ,CerecⅡCAD/CAM全瓷冠颜色美观 ,近期修复效果良好 ,值得临床推广应用。     

CAD/CAM全瓷冠边缘适合性的评价

目的：研究采用计算机辅助设计及制作系统（Kavo Everest）制作的氧化锆全瓷冠的边缘适合性。方法：选取1颗无龋的离体前磨牙行牙体预备,双重印模法取模,翻制20个相同尺寸的超硬石膏代型,将代型随机分为2组,分别制作10个金属烤瓷冠和10个Kavo Everest氧化锆全瓷冠。然后采用双色硅橡胶印模法复制间隙模型,应用光学显微镜采集间隙图像及使用AutoCAD2006软件对其厚度进行测量。结果：利用失蜡铸造法制作的金属烤瓷冠的垂直边缘间隙（69.6±29.7）μm,水平边缘间隙（56.1±20.8）μm,绝对边缘间隙（91.1±28.8）μm;利用CAD/CAM制作的氧化锆全瓷冠的垂直边缘间隙（51.4±19.9）μm,水平边缘间隙（41.1±16.8）μm,绝对边缘间隙（66.2±21.9）μm。两种系统制作的冠的水平边缘间隙、垂直边缘间隙、绝对边缘间隙均具有显著性差异（P〈0.05）。结论：利用Kavo Everest系统制作的全瓷冠具有良好的边缘适合性。     

��ǻCAD/CAM�豸��Ӧ�ø���

计算机辅助设计与制造（CAD／CAM）是将光电子技术、计算机技术与数控机械加工技术集成于一体的一门技术。随着计算机技术的飞速发展，CAD／CAM技术在口腔临床上的应用越来越广泛。目前主要使用的有CEREC系统、EVEREST系统、PROCERA系统、CERCON系统和国产爱尔创系统。本文就各系统的设备结构及应用原理和切削材料做一概述。     

Two new clinical/laboratory protocols for CAD/CAM implant restorations

BACKGROUND: Conventional casting technology has some disadvantages for dental laboratory technicians and restorative dentists, including porosity of restorations, miscasting and inaccuracy. It also is labor-intensive. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was developed in the late 1980s for dentistry, and it significantly reduced and/or eliminated problems associated with dental castings. The purpose of this article is to give readers an overview of the use of CAD/CAM technology for dental implants and illustrate two clinical protocols for that use. CLINICAL IMPLICATIONS: The CAD/CAM technology described in this article can reduce restorative dentists' chairside time associated with implant treatment in both edentulous and partially edentulous patients, can decrease costs without sacrificing accuracy or biocompatibility for both clinicians and dental laboratory technicians, and is available to dental laboratories without the capital expenses associated with purchasing new technology.     

CAD/CAM纯钛烤瓷冠对2型糖尿病患者牙周组织的影响

目的 探讨CAD/CAM纯钛烤瓷冠对2型糖尿病患者牙周组织的影响.方法 选取2型糖尿病且需全冠修复的患者20名(患牙22颗),牙周洁治后2周采用CAD/CAM纯钛烤瓷冠修复全部患牙,以对侧同名健康天然牙作为对照,分别于修复前、修复后6个月、12个月及18个月检测并对比菌斑指数、牙龈指数、出血指数及探诊深度.结果 修复组与对照组相比,在CAD/CAM纯钛烤瓷冠修复后6个月、12个月及18个月时各项牙周指标差异无统计学意义(P＞0.05).修复组自身相比,在修复后6个月、12个月及18个月时与自身修复前各项牙周指标相比差异均无统计学意义(P＞0.05).结论 在临床修复18个月内,CAD/CAM纯钛烤瓷冠对2型糖尿病患者的牙周组织影响甚微.