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。     

复合树脂直接充填与树脂嵌体修复治疗垂直型食物嵌塞的临床分析

目的:比较硬质树脂嵌体与复合树脂直接充填治疗后牙垂直型食物嵌塞的临床效果.方法:将符合纳人标准的141个患牙随机分为两组,分别以Solidex硬质树脂嵌体和复合树脂直接充填恢复邻面接触区,1年后随访观察并比较两种治疗后修复体边缘密合情况、牙龈情况、邻接关系和牙髓敏感状况.结果:嵌体修复组的边缘密合性略优于树脂直接充填组,但二者间无显著性差异(P>0.05);嵌体修复后牙龈健康情况和邻接关系显著优于树脂充填组(P<0.05);牙髓敏感情况二者间无显著性差异(P>0.05).结论:硬质树脂嵌体修复较传统复合树脂充填修复能更好地恢复后牙正常的邻接关系,有助于恢复和保持患牙的牙周组织健康.     

两种不同材料的瓷嵌体用于后牙修复的临床效果比较

目的 比较在计算机辅助设计/计算机辅助制作(CAD/CAM)下IPS e.max全瓷高嵌体及LavaUltimate优韧瓷高嵌体用于修复后牙缺损的临床治疗效果。方法 临床完成IPS e.max全瓷高嵌体75个，LavaUltimate优韧瓷高嵌体62个，随访观察6个月、1年、2年、3年，参考美国公共健康会（USPHS）标准,对其临床效果进行观察。结果 IPSe.max全瓷高嵌体的颜色优于LavaUltimate优韧瓷高嵌体；而Lava Ultimate优韧瓷高嵌体的修复体完整性优于IPS e.max全瓷高瓷嵌体。结论 两种材料瓷嵌体用于后牙修复的临床效果没有显著差异，优选哪种材料取决于患者的喜好。关注修复体完整性的患者建议优选Lava Ultimate优韧瓷，关注高嵌体的颜色的患者建议优选IPSe.max全瓷。     

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目的评价二氧化锆嵌体修复后牙牙体缺损的临床效果。方法对2010年1月至2011年12月于中国医科大学附属口腔医院修复科就诊的后牙牙体缺损患者63例（患牙108颗）,采用二氧化锆嵌体修复,其中高嵌体修复61颗、多面嵌体修复47颗。修复后随访12个月,检查其形态、边缘适合性、颜色、周围龋发生情况以及修复体磨耗、折裂情况。结果 108颗患牙修复后,仅有1颗嵌体出现脱落,但牙体和嵌体均未有破损,消毒后重新黏固,后续使用情况良好;其余107颗修复体随访期间未发现脱落,修复体评价项目均无C级出现。结论二氧化锆嵌体修复后牙缺失临床效果良好。     

二氧化锆嵌体修复后牙牙体缺损63例疗效分析

目的 评价二氧化锆嵌体修复后牙牙体缺损的临床效果。方法 对2010年1月至2011年12月于中国医科大学附属口腔医院修复科就诊的后牙牙体缺损患者63例 （患牙108颗）,采用二氧化锆嵌体修复,其中高嵌体修复61颗、多面嵌体修复47颗。修复后随访12个月,检查其形态、边缘适合性、颜色、周围龋发生情况以及修复体磨耗、折裂情况。结果 108颗患牙修复后,仅有1颗嵌体出现脱落,但牙体和嵌体均未有破损,消毒后重新黏固,后续使用情况良好;其余107颗修复体随访期间未发现脱落,修复体评价项目均无C级出现。结论 二氧化锆嵌体修复后牙缺失临床效果良好。     

新塑钢嵌体修复后牙缺损的临床应用

新塑钢嵌体修复后牙缺损的临床应用何玉林，陈必胜上海第二军医大学长征医院（２００００３）由于美学因素、汞对牙科人员的毒性和对环境的污染，学者们一直在寻找银汞合金充填物的替代材料。复合树脂由于其美观效果而被用于后牙修复。但复合树脂材料也有一些缺陷，如边缘...     

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目的评价Ceramage聚合瓷高嵌体和多面嵌体修复后牙牙体缺损的临床效果。方法选择2005年1月至2008年1月于中国医科大学口腔医学院修复科就诊的后牙牙体缺损患者129例(患牙200颗),行Ceramage聚合瓷高嵌体和多面嵌体修复各100颗牙,于患者戴用修复体后6个月、1年、2年、3年,检查其形态、边缘适合性、颜色、周围龋、修复体磨耗程度、接点及折裂情况。结果200颗患牙修复后中共出现5颗失败,其中高嵌体修复体破损1颗、松动1颗、食物嵌塞2颗;多面嵌体修复体未发现有破损,1颗出现基牙折裂。结论Ceramage聚合瓷是一种很好的后牙牙体缺损修复材料;与高嵌体相比,多面嵌体保留了更多牙体组织,更有利于修复体力学或生物学的使用周期。     

树脂嵌体冠修复无髓牙的临床研究

目的:比较树脂嵌体冠与口内直接树脂修复、瓷嵌体修复方法临床疗效的差别.方法:将符合纳入标准的94个患牙随机分为3组,分别以硬质树脂嵌体冠、复合树脂充填和瓷嵌体修复牙体外形.随访2年,观察比较3种修复体边缘密合情况、邻接恢复、牙周健康、术后牙体组织折裂率.结果:树脂嵌体冠组术后2年牙齿和修复体折断率为零.其边缘密合性、邻接恢复、牙周健康程度均明显优于树脂直接充填组(P<0.05),与全瓷嵌体相比无统计学筹异.结论:嵌体冠能精准地修复无髓牙的邻、(牙合)面外形,较复合树脂直接充填有助于患牙的牙周组织健康,降低无髓牙受力折裂的几率.     

复合树脂嵌体充填牙体窝洞5年疗效观察

目的 观察复合树脂嵌体的远期疗效。方法 用光固化复合树脂制成嵌体应用于后牙,并以单纯光固化复合树脂充填的后牙作对照,观察治疗5a后的效果。结果 复合树脂嵌体有很好的远期疗效。结论 复合树脂嵌体是一种很好的新型牙体修复体。     

铸瓷嵌体的纵向研究

用于后牙的某些修复材料存在一些常见的问题,如边缘微漏、继发龋、磨损,以及颜色稳定性差等。本研究的目的在于确定使用IPS Empress铸瓷材料制做后牙嵌体及高嵌体的可靠性。 材料和方法 研究对象是一家私人诊所中为29名患者制做的125个嵌体,修复材料为IPS Empress铸瓷。对修复体的观察持续7至56个月,平均为40.3个月。所有的嵌体由同一口腔技工室按照厂家的说明制     

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.     

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence‐based decision‐making, minimally invasive approaches, and approaches to education. The implications for these in an ‘amalgamless’ profession are identified.     

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.     

Functional and aesthetic guidelines for stress-reduced direct posterior composite restorations

Amalgam has been used in the restoration of structurally compromised posterior teeth for many years. When placing large amalgam restorations, replacement of weak cusps with restorative material is recommended to prevent tooth fracture. This recommendation can be modified with new guidelines using modern adhesive techniques. Semidirect and indirect inlay/onlay composite restorations have progressively replaced amalgam restorations over the past 20 years. Lately, single visit direct resin-bonded composite (RBC) restorations have also been used as a viable alternative to conventional indirect restorations. This paper is intended to introduce a step-by-step protocol for the direct restoration of structurally compromised posterior teeth using RBCs with stress-reducing protocols.     

Aesthetic resin onlay restorations: 'rationale and methods'

Resin composite restorations have gained increasing popularity over the past two decades. This has been largely driven by a patient-orientated demand for the use of aesthetic restorative materials. It has occurred concomitantly with an improvement in the mechanical properties of available materials, and advances in our knowledge of resin bonding. Onlay restorations are advocated for a plethora of clinical applications. This paper considers the role of adhesive onlay restorations fabricated in resin composite in contemporary restorative practice, including the presentation of two case reports. Clinical Relevance: This case report describes a minimally invasive, aesthetic solution to provide cuspal coverage by means of either a direct or indirect resin composite onlay restoration, respectively.     

Posterior composite resin inlays and onlays: a comparison of available systems

With the increasing proliferation of materials and techniques for placement of posterior composite resin restorations, the dentist must have the information to make informed judgements on which to use in various clinical situations. This paper examines the advantages and disadvantages of each of three systems: 1) Direct, 2) Direct/Indirect and 3) Indirect. The increased demand for posterior esthetic restorations has been one of the hallmarks of the eighties. According to a recent American Dental Association survey, the use of resin restorations in posterior teeth is markedly increasing and is the restoration of choice over amalgam for 70 percent of those dentists who responded to the survey. For the restorative dentist who chooses to do posterior esthetic restorations, the biggest challenge lies in acquiring the knowledge and judgement to know which of the three current classes of materials and techniques to apply to each clinical situation. Although the influx of new materials into the marketplace makes it difficult to evaluate and categorize these materials as accurately as would be desired, generally, posterior composite resins can be classified in three general categories based on method of placement. These categories are: a) Direct placement b) Direct/Indirect placement or Direct Composite Inlay (DCI) c) Indirect placement     

1-Year clinical study of indirect resin composite restorations luted with a self-adhesive resin cement: effect of enamel etching

In vitro studies have recommended enamel-etching before luting indirect restorations with self-adhesive resin cement. However, there is no scientific proof that this procedure has any clinical relevance. Thus, the aim of this study was to evaluate the effect of enamel-etching on the marginal quality of indirect composite resin restorations (inlay/onlay) using the self-adhesive cement RelyX Unicem clicker. Forty-two posterior teeth were selected from 25 patients that presented one or two teeth with large restorations in need of replacement. All teeth were prepared by the same operator and impressed with polyvinylsiloxane material. The composite resin restorations were built over plaster casts using the incremental technique with a LED device for light-curing the increments. The inlays/onlays were cemented according to one of the following protocols: 1. Etched group (ETR) - selective enamel phosphoric-acid etching + RelyX Unicem clicker; 2. Non-etched group (NER) - RelyX Unicem clicker alone. Each surface was light-cured for 60 s. Recalls occurred after 1 week (baseline), 6 and 12 months when the teeth were evaluated according to previously established scores (modified USPHS criteria). The clinical analysis showed little or no visible changes in the marginal quality after 1 year, even though a probe could detect all the restorations margins. Statistical analysis (Fisher's exact test, p<0.05) detected no differences between the groups after 12 months. No restorations failed and no secondary caries were found. Enamel acid etching had no clinical relevance on the marginal quality of indirect composite resin restorations luted with RelyX Unicem clicker after 1 year of follow up.     

复合树脂嵌体修复后牙体抗力的三维有限元研究

目的:对直接树脂和间接树脂嵌体修复后牙体的抗力进行三维有限元研究。方法:通过2种加载方式(中央窝垂直加载和2功能面上与牙长轴呈45°加载),研究4种材料(Tescera间接树脂、Renew通用树脂、陶瓷和Co-Cr合金)嵌体修复后牙体应力分布的变化。对照组:备洞未充填的缺损牙体和完整牙体。结果:4种材料嵌体均可以提高缺损牙的抗力,改善缺损牙体内部的应力分布。2种树脂嵌体修复后的牙体应力分布与完整牙体相似;陶瓷、Co-Cr合金则改变了牙本质原有的应力分布。结论:复合树脂嵌体修复能提高缺损牙体的抗力;复合树脂不同固化处理对牙体抗力无明显影响。