3种方法修复深度楔状缺损的临床观察

目的探讨疗效较理想的修复深度楔状缺损的材料和方法。方法189名患者的486颗患牙随机分为3组,分别用玻璃离子黏固剂修复法、光固化复合树脂修复法和夹层技术修复深度楔状缺损。修复后1-2年复查,观察其临床疗效。结果修复1年和2年后玻璃离子黏固剂修复法、光固化复合树脂修复法和夹层技术修复的成功率分别为89．66％、84．72％、93．46％和69．17％、82．22％、90．28％。夹层技术组成功率明显高于其他2组。结论夹层技术用于修复深度楔状缺损的临床疗效较好。     

Resin composites in minimally invasive dentistry

The concept of minimally invasive dentistry will provide favorable conditions for the use of composite resin. However, a number of factors must be considered when placing composite resins in conservatively prepared cavities, including: aspects on the adaptation of the composite resin to the cavity walls; the use of adhesives; and techniques for obtaining adequate proximal contacts. The clinician must also adopt an equally conservative approach when treating failed restorations. The quality of the composite resin restoration will not only be affected by the outline form of the preparation but also by the clinician's technique and understanding of the materials.     

�������֬Ƕ���½�չ

复合树脂材料用于牙科已有20余年历史。这类材料既可用于前牙也可用于后牙。复合树脂发展到今天已经出现了许多专门应用于后牙的修复材料,并已取得满意的临床效果。银汞合金的许多缺点都可以为复合树脂所克服。因此,后牙复合树脂修复已为越来越多的患者和牙科医生所接受。然而,直接充填复合树脂材料仍旧被认为有许多局限性。比如边缘缺陷、面磨损、牙尖变形以及术后的牙髓敏感等。因此,近年来发展了复合树脂的一种新技术——间接性复合树脂嵌体与高嵌体修复技术。它的临床应用在某种程度上克服了上述直接充填树脂的局限性。复合树脂嵌体或高嵌体是作为固体黏固在预备洞型中的一种修复体。这种呈固态的修复体由复合树脂材料采用间接的方法制成,最后再黏固于口内。本文将最近的有关间接性复合树脂嵌体和高嵌体方面的资料进行综述,包括它的临床应用,优缺点以及面临的问题等。     

Marginal seal comparisons between resin-bonded Class II porcelain inlays, posterior composite restorations, and direct composite resin inlays

The microleakage of indirect porcelain and direct composite resin-bonded inlays was compared with that of posterior composite resin restorations using Class II preparations of extracted molar teeth. The resin-bonded inlay restorations provided a better marginal seal at the cervical restoration/dentin interface than did the composite resin restoration. The efficacy of this marginal seal varied with the particular treatments and materials used. Resin-bonded porcelain inlays had a higher incidence of cervical excess from the composite resin luting agent than did the posterior composite resin restorations.     

Class I Composite Resin Restoration

Composite resin materials and methods for their use have improved to the extent that long lasting Class I carious lesions on stress-bearing surfaces can be restored with predictable results. This article demonstrates a step-by-step clinical technique for placement of a Class I composite resin restoration lined with a light-hardened glass-ionomer dentin replacement foundation. Emphasis is placed on tooth isolation, thoughtful handling of the respective materials, and the importance of final sealing of the resin/enamel margins.     

Class I composite resin restoration.

Composite resin materials and methods for their use have improved to the extent that long lasting Class I carious lesions on stress-bearing surfaces can be restored with predictable results. This article demonstrates a step-by-step clinical technique for placement of a Class I composite resin restoration lined with a light-hardened glass-ionomer dentin replacement foundation. Emphasis is placed on tooth isolation, thoughtful handling of the respective materials, and the importance of final sealing of the resin/enamel margins.     

Finishing and polishing of direct posterior resin restorations.

Direct composite resin materials have revolutionized the delivery of minimally invasive treatment in the posterior region. Contemporary resin formulations provide improved strength, wear resistance, and aesthetics. Microhybrid formulations have also been associated with enhanced polishability. Development of an optimal surface polish in turn reduces stain and plaque accumulation, minimizes wear, and enhances the appearance of the definitive restoration. This article presents a simplified technique and protocol for finishing and polishing composite resin materials following restoration of the posterior region. LEARNING OBJECTIVES: This article discusses techniques and a protocol for finishing and polishing posterior direct resin restorations. Upon reading this article, the reader should: Understand the clinical protocol necessary to create direct posterior resin restorations that require minimal finishing. Be able to select appropriate instrumentation for direct posterior resin finishing and polishing procedures. Understand the importance of correct finishing and polishing on plaque accumulation, stain resistance, and wear resistance.     

The use of intermediary resins when bonding glass polyalkenoate (ionomer) cement to composite resin

This study was designed to examine the effects of three different types of glass polyalkenoate lining cement combined with three different types of bonding resin and varying surface treatments on the seal between the lining cement and the composite resin as used in the so called 'laminate' technique. The seal was assessed using a radioisotope and autoradiographic technique.
Results showed that all the cements behaved in a manner specific to them. The seal of all systems examined could be improved, or at least, not compromised, by modification of the surface of the cement prior to attachment of the resin. Only one type of intermediate resin gave a reliable seal when applied to an unmodified surface of any of the cements under investigation.
It is concluded that all the glass polyalkenoate cements tested behave differently when used beneath composite resin. Recommendations about the laminate restoration technique must be related to the specific combinations of materials used.     

Comparison of the retention of 5 core materials supported by a dental post

PURPOSE: This study evaluated the retention of dental post heads (No. 2 Flexi-Post) embedded in 5 core materials (1 automix resin composite, 2 hand-mixed resin composites, and 2 glass ionomers). MATERIALS AND METHODS: Samples were prepared by embedding post heads in 4.5-mm-thick disks of core material. RESULTS: The resin composite materials provided significantly more retention than the glass-ionomer-based materials. The post head retention of the automix resin composite was comparable to that of the hand-mixed resin composites. CONCLUSION: Unlike the resin composite samples, all the glass-ionomer samples fractured during testing. This is an unacceptable condition for a clinically successful restoration.     

A 5-year evaluation of semipermanent composite resin crowns.

The use of composite resin crowns in the restoration of traumatized and hypoplastic permanent incisors has proved to be of great clinical and aesthetic value for the pedodontic practice. Due to the composite resin materials and the acid etch technique, an easy method of making and retaining the restorations is at hand. The present study deals with long-term observations of composite resin crowns in restoring Ellis Class II and Class III coronal fractures of traumatized permanent incisors. In all, 253 composite resin crowns were controlled every year for a minimum of 5 years. In no case was an intermediate resin layer applied on etched enamel before the restoration material was placed. Surface, marginal and "body" discoloration, marginal leakage, marginal caries, abrasion, and fractures were controlled. The study demonstrated that discoloration of the surface of the restorations, and a discoloration of the restorative material not restricted to its surface ("body" discoloration) were the most frequent causes for considering the crowns as semipermanent restorations. The other factors seemed to be of minor clinical significance.     

A 5-year evaluation of semipermanent composite resin crowns

ABSTRACT – The use of composite resin crowns in the restoration of traumatized and hypoplastic permanent incisors has proved to be of great clinical and aesthetic value for the pedodontic practice. Due to the composite resin materials and the acid etch technique, an easy method of making and retaining the restorations is at hand. The present study deals with long-term observations of composite resin crowns in restoring Ellis Class II and Class III coronal fractures of traumatized permanent incisors. In all, 253 composite resin crowns were controlled every year for a minimum of 5 years. In no case was an intermediate resin layer applied on etched enamel before the restoration material was placed. Surface, marginal and "body" discoloration, marginal leakage, marginal caries, abrasion, and fractures were controlled. The study demonstrated that discoloration of the surface of the restorations, and a discoloration of the restorative material not restricted to its surface ("body" discoloration) were the most frequent causes for considering the crowns as semipermanent restorations. The other factors seemed to be of minor clinical significance.     

Emergency repair followed by complete-coronal restoration of a fractured mandibular incisor.

Severely fractured anterior teeth often require immediate repair, while long-term restoration is delayed until a healing period is completed. This paper details a technique of immediate emergency repair of a fractured mandibular incisor followed by placement of a bonded composite resin complete-coronal restoration months later. Careful diagnosis, gentle handling of the freshly traumatized tooth and surrounding tissues, and ideal selection and use of the respective bonding materials are necessary to ensure eventual replication of form, function, and tooth shade when the long-term restoration is placed.     

Voids and interlayer gaps in Class 1 posterior composite restorations: a comparison between a microlayer and a 2-layer technique.

OBJECTIVE: The main objective was to compare the presence of interlayer gaps between 2 hybrid composites placed using a microlayer and a 2-layer technique. METHOD AND MATERIALS: Standardized Class 1 cavities were prepared in 40 extracted posterior teeth. Two resin composite materials were used. The control group, group A, consisted of samples of the materials extruded out of the manufacturers' syringes. Group B consisted of 10 teeth restored using 2 layers per restoration. Group C consisted of 30 teeth restored using 6 microlayers per restoration. A scanning electron microscope was used to detect voids in the samples. RESULTS: Round, well-defined voids were found in 85% to 100% of the samples within the bulks of the resin composite materials only. A statistically significant relationship between the type of composite and presence of bubbles (Fisher exact test, P = .04) was found among the 2-layer technique group. No statistically significant difference (Fisher exact test, P = .48) was found among the microlayer technique group. Irregular interlayer gaps were found in 5% to 15% of specimens within areas between bulks of composite, as detected by an electron microscope based on the different densities of the bulks of composite and the interlayer areas. No such statistically significant relationship was found (Fisher exact, P = .62) among the study groups. CONCLUSIONS: Voids are routinely found in bulks of composite materials. Higher incidences of interlayer gaps in the 2-layer samples suggest that the use of a microlayering technique may result in fewer gaps.     

复合树脂嵌体的研究进展及应用现状

复合树脂嵌体也称间接性树脂修复,是由含有双甲基丙烯酸酯基类的复合树脂在体外固化制作而成。体外固化过程释放了复合树脂嵌体的聚合收缩应力,使修复体的聚合收缩局限在粘接层内;同时提高了复合树脂的聚合程度,提升了其机械性能。同样,由于复合树脂嵌体有体外操作过程,因此在解剖形态方面更佳,有着相比直接树脂充填更良好的邻面接触和面形态。相比瓷嵌体,复合树脂嵌体有着修补方便,不磨耗对牙等特点。随着复合树脂材料及树脂粘接材料的更新,复合树脂嵌体的性能如抗折裂强度、边缘微渗漏、硬度及耐磨性等方面得以提高,复合树脂嵌体在临床方面的应用逐渐广泛,不仅限于牙体严重缺损活髓牙的修复,在完成牙髓治疗后的牙齿、隐裂牙、重度磨损牙等疾患中均有应用。本文就近年来复合树脂嵌体的性能研究及临床应用现状作一综述。     

Depth of cure of dental resin composites: ISO 4049 depth and microhardness of types of materials and shades

The optimal degree of curing throughout the bulk of a visible light-activated dental resin composite is acknowledged to be important to the clinical success of a resin composite restoration. Unfortunately, the dentist has no means of monitoring the cure of the resin surfaces not directly exposed to the curing light. Techniques, such as the layered buildup of restorations in 2 mm increments with longer activation times than 20 seconds, have been suggested. This study investigated the depth of cure (DOC) of a commercial resin composite in three types: flowable, hybrid and packable and in three shades: B1, A3 and D3 after 20 second activation with a quartz halogen light (620 mW/cm2). Depth of cure was measured by scraping the uncured material and by using a Knoop Hardness profile, starting from the surface exposed to the light. Using a minimum Knoop Hardness ratio of 0.8 bottom/top only, the flowable in shade B1 achieved a 2 mm DOC. Using the less restrictive scraping test, only the B1 shade of flowable and hybrid significantly exceeded a 2 mm DOC. Knoop Hardness at the DOC obtained by scraping ranged from 55%-70% of the top surface hardness. These data suggest that a 2 mm buildup layering technique may not result in adequate curing of the bottom layer for such a wide range of materials and that manufacturers need to provide quantitative information about DOC at specific activation times and light intensities for their entire range of resin materials and shades so that the dentist can devise a placement technique that will ensure adequate cure of the bulk of a restoration.     

Influence of adhesive system and placement technique on microleakage of resin-based composite restorations

PURPOSE: To analyze the influence of two placement techniques and two adhesive systems on the marginal microleakage of Class II resin-based composite restorations using different resin composite materials. MATERIALS AND METHODS: Two hundred standardized Class II cavities (5 mm x 3 mm x 1.5 mm) were cut in human premolars and restored using five resin composite materials (A.L.E.R.T.-AL, Solitaire-SO, SureFil-SU, Filtek A110-A, and Z100-Z), two adhesive systems (Bond 1-B1 and Etch & Prime 3.0-EP), and two placement techniques (incremental or bulk). Specimens were thermocycled (700 cycles, 5 degrees - 55 degrees C, 1 min dwell time), immersed in 0.5% methylene blue solution for 4 h, and sectioned longitudinally to evaluate the extent of microleakage. Data were submitted to statistical analysis using the Kruskal-Wallis test. RESULTS: It was observed that both adhesive systems presented similar results (p > 0.05), and neither achieved complete marginal sealing. The bulk placement technique led to greater microleakage than the incremental technique (p < 0.001). Restorations prepared using SO resin composite showed greater microleakage than those performed using Z or AL materials. However, SO obtained similar values of microleakage when compared to SU and A materials. CONCLUSION: The use of incremental placement technique resulted in less microleakage for Class II resin-based composite restorations. No difference was observed among adhesive systems regarding prevention of marginal dye penetration. Furthermore, the type of resin composite material employed for restoration may have an influence on the extent of microleakage.     

儿童乳磨牙牙体大面积缺损不同修复方式的对比研究

目的：探讨儿童乳磨牙牙体大面积缺损不同修复方式的临床效果差异。方法：选择280例患儿乳磨牙大面积缺损400颗患牙,随机分成4组,作铸瓷嵌体、树脂嵌体、光固化复合树脂充填、银汞合金充填修复,并经1-2年临床疗效的追踪观察。结果：在牙体完整性方面,4种修复方式无显著性差异,而在修复体情况、边缘密合性、继发龋、磨耗情况、邻接关系等方面,嵌体修复均优于充填修复。结论：综合性能从高到低可排序为铸瓷嵌体和树脂嵌体〉复合树脂充填〉银汞合金充填。嵌体修复技术值得临床推广使用。     

Margin quality and microleakage of Class II composite resin restorations

Margin quality and isotope microleakage analyses of Class II restorations placed in extracted human molars were compared using various composite resins and placement techniques. At occlusal margins, the traditional (experimental) composite resin restoration placed by the incremental technique showed less microleakage than did the traditional (commercial) [corrected] composite resin restoration placed by the bulk technique. In each group, the occlusal and proximal adaptations had significantly higher "excellent margin" than did the cervical adaptation. Thus, the marginal adaptation at the cervical aspect of conventional Class II composite resin restorations may present a problem with respect to microleakage.     

Using modified polyetheretherketone (PEEK) as an alternative material for endocrown restorations: A short-term clinical report

A modified polyetheretherketone (PEEK) framework material veneered with indirect light-polymerized composite resin was used as an alternative material for the fabrication of an endocrown restoration for an extensively damaged molar. The elastic modulus of the polyetheretherketone framework (4 GPa) veneered with indirect composite resin could dampen the occlusal forces protecting tooth structures better than ceramic materials. This is important in the restoration of extensively damaged molars with weak roots. Long-term clinical evidence is required before recommending the application as a substitute material.     

Treatment of an amelogenesis imperfecta with restorations prepared using a modified clear matrix technique

The rehabilitation of a patient with amelogenesis imperfecta (AI) from both functional and esthetic standpoints represents a challenge. A number of treatment options have been proposed. Recently, the use of adhesive restorations has gained popularity because of the improved physical properties of these materials. This article describes a treatment with direct resin composite for the restoration of teeth affected by the hypomature type of AI. A modified clear matrix technique was used during the preparation and restoration process. The use of the technique provides clinicians with reduced chair time, and the matrix can be repeated when needed; restorations can be performed relatively quickly with a minimal post‐operative finishing process. This article highlights the use of direct‐bonded resin composites providing satisfactory esthetics and function in restoring AI‐affected teeth.