临时冠在粘结前辅助排龈的应用

目的：观察前牙固定修复中,利用临时冠在粘结前辅助排龈,防止修复后牙龈及牙周损伤的效果。方法：追踪观察2004～2006年间于粘结前利用临时冠辅助排龈组和不排龈组金属烤瓷全冠修复患牙的牙龈、牙周组织状况,并进行统计学分析。结果：金属烤瓷全冠修复后牙周组织的主要变化为颈缘变色,单纯性牙龈炎和牙周炎。于粘结前进行排龈处理和不进行排龈处理的牙周改变有显著差异,排龈组优于未排龈组。结论：前牙金属烤瓷全冠粘结前利用临时冠辅助排龈的应用可以修复牙周组织,有效预防牙周疾病的发生。     

排龈膏在老年人口腔固定修复中的应用

目的：评价糊剂型排龈材料在老年人固定修复中的临床使用效果。方法：在对60例门诊患者140颗牙进行固定修复时，采用Expasyl排龈膏于取模过程压排牙龈。对排龈止血效果、印模清晰程度、修复体就位后与牙体的适合性进行评价。结果：采用排龈糊剂压排牙龈的患牙，在排龈止血效果、印模清晰程度及修复体与牙体的吻合程度方面，取得良好效果。结论：应用糊剂型排龈材料进行老年人固定修复临床排龈操作，高效省时、减少椅旁操作时间、提高修复体质量，是一种较好的方法。     

颈缘瓷在前牙烤瓷全冠修复中的美学效果

目的评价颈缘瓷在前牙镍铬合金烤瓷全冠修复中的临床美学效果。方法265例患者的527颗牙用金刚砂车针进行常规牙体及颈部肩台制备，用Ivoclar低温瓷粉制作具有颈缘瓷的镍铬合金烤瓷全冠。临床试戴、抛光、粘结。结果修复后随访1～4年，与具有颈缘瓷的镍铬合金烤瓷全冠相接触的牙龈未见龈缘灰线，约3％的患者有轻到中度龈炎。结论鉴于对牙龈组织的保护和牙龈及牙体美学的考虑，笔者认为在制作镍铬合金烤瓷全冠时，添加颈缘瓷是一个非常有效的修复方法。     

金属瓷聚体冠修复后发生颈缘灰线的临床观察

目的:评价金属瓷聚体全冠修复后对颈缘灰线的影响.方法:将前牙需进行烤瓷修复的病例随机分为2组,一组采用金属瓷聚体全冠修复.另一组采用普通金属烤瓷全冠(PFM)修复.观察修复后颈缘灰线的发生情况.结果:修复后即刻2组发生颈缘灰线的比例无显著性差异.戴牙3个月后两组龈灰线的发生无显著性差异(p＞0.05);戴牙1年后治疗组龈灰线发生明显少于对照组,有显著性差异(p＜0.05).结论:金属瓷聚体全冠修复发生颈缘灰线的比例较少,与普通金属烤瓷全冠(PFM)相比具有较好的修复效果.     

如何规避前牙美学修复的龈边缘暴露

前牙修复后常因修复体龈边缘暴露而影响最终美学效果,如何规避此问题是口腔医生面临的挑战.本文通过牙龈生物型、牙周组织状况、修复体龈边缘位置、排龈技术与排龈线及暂时修复体制作等几个方面,探讨前牙美学修复中如何有效地规避修复体龈边缘暴露,以提高前牙修复的美学效果.     

排龈术的发展及应用状况

排龈技术在口腔临床中,尤其是在固定义齿修复临床中的应用非常广泛,同时也可应用于楔状缺损修复时,以获得良好的充填体边缘[1]。固定义齿修复成功取决于良好的设计及精密的制作。牙体预备及印模制取是修复成功的关键,而排龈又是牙体预备及印模制取过程中必不可少的环节。作者就近年来排龈术的发展及应用状况,作一简要的概述。     

排龈技术联合流动复合树脂和自酸蚀粘结剂在龈下楔状缺损修复中的临床应用

目的评估排龈技术联合流动复合树脂和自酸蚀粘结剂修复楔状缺损的效果。方法选择龈壁齐龈缘或位于龈下≤1 mm楔状缺损患者20例(90颗患牙),排龈组使用#00Ulrapak排龈线排龈,联合流动复合树脂和自酸蚀粘结剂修复楔状缺损,而对照组直接充填,不排龈。修复后1年复查,以美国公共卫生署直接临床评价系统评估临床疗效结果。结果 1年后复查,排龈组成功率为100%,高于未排龈的对照组(成功率为86.7%),有显著性统计学差异(P<0.01)。排龈组A级达40颗(88.9%),而对照组A级仅21颗(46.7%),统计学有显著差异(P<0.01)。结论排龈技术联合流动复合树脂、自酸蚀粘结剂修复龈下楔状缺损获得良好的效果,值得临床推广应用。     

烤瓷牙修复过程中对牙周组织保护的临床研究

目的:探讨烤瓷牙修复过程中对牙周组织的保护措施。方法:选择合适的修复体颈缘位置,使用Gin-gi-PakR○Z-TwistR○缩龈线,设计合理的修复体颈环。结果:操作过程视野清晰,无出血,牙龈得到很好地保护。制取的印模及灌制的石膏模型肩台部位清晰明确。223个烤瓷修复体在戴冠时211例牙龈状况良好,7个活髓牙牙龈水肿,颈缘长短均适宜,9个修复体有悬突。修复3个月后,51例78个修复体复诊。3个修复体龈缘水肿,暗红,探诊后出血,未发现有牙周袋的形成,其中2个修复体在修复前存在牙龈炎。结论:通过选择合适的修复体颈缘位置,使用Gingi-PakR○Z-TwistR○缩龈线,设计合理的修复体颈环,可以使牙周组织得到较好的保护。     

间接法制作个别取模器龈下取模技术的临床应用评价

目的：介绍一种简便高质量的龈下取模技术，解决龈下肩台边缘至龈沟底之间的牙体，牙龈外形精确复制问题。方法：在备牙的同时制作个别取模器，采用一次调和两步取模法。结果：可清晰、准确、完全地取得基牙肩台及肩台下精细结构的外形，经20例患者76颗基牙固定修复一年半的随访，修复质量明显提高。结论：个别取模器龈下取模技术操作简便易学，可大幅度改善固定修复颈缘质量，值得推广。     

自制胶体型牙龈收缩剂的排龈效果和安全性评价

目的:探讨自制胶体型牙龈收缩剂(以下简称排龈膏)的排龈效果和安全性。方法:选择2只成年杂种犬的40颗牙作为实验牙。牙体预备后,分为4组,分别用自制排龈膏,Expasyl排龈膏,排龈线和加药(15.5%Fe2SO4溶液)排龈线4种方法排龈处理。处理前后分别用硅橡胶取模并灌制模型,然后通过影像式精密测绘仪测量和分析排龈前后的龈沟宽度和龈缘高度变化,采用SAS6.12软件包进行统计分析。结果:自制排龈膏与Expasyl排龈膏、排龈线、加药排龈线排龈后龈沟宽度的变化无统计学意义(P>0.05)。加药排龈线的排龈前龈缘高度为0.423±0.348,排龈后一周的龈缘高度为0.623±0.278,与其他3组比较均有统计学意义(P<0.05)。结论:低黏度可注射胶体型自制排龈膏与Expasyl排龈膏、排龈线、加药排龈线排龈效果相似。4组排龈材料排龈后,加药排龈线会引起牙龈退缩,自制排龈膏﹑Expasyl排龈膏和排龈线不会引起牙龈退缩。自制排龈膏有一定的临床安全性。     

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目的 分析国产排龈线对冠桥修复后牙体、牙龈、牙周组织、修复体边缘的适合性。方法 选择2006年1月至2008年12月南阳市口腔医院收治的因前牙缺损或缺失做冠桥修复的患者52例（109颗基牙）,随机分为3组,进行常规牙体预备。阴性对照组32颗牙,不排龈;阳性对照组37颗牙,备牙后采用美国进口的UltraPak排龈线排龈;试验组40颗牙,采用南阳齿康研究所研制的国产排龈线排龈。完成灌注印模后,通过肉眼及探针对牙预备体、牙龈和修复体模型进行评价。结果 采用国产排龈线、进口排龈线和未采用排龈技术的满意率：牙预备体分别为93%、95%、17%;牙龈分别为83%、76%、14%;模型分别为80%、81%、14%;修复体边缘分别为88%、86%、12%。国产排龈线和进口排龈线满意率相当。结论 国产排龈线与进口排龈线临床应用对比差异无统计学意义,可以替代进口排龈线,且成本低,副反应小,安全性能好。     

应用排龈技术减少临床牙龈损伤

目的：当需要将固定修复体的边缘放置于龈下,如何才能在牙体预备时尽可能避免损伤周围组织,采集准确印模以获得精美持久的修复效果是临床须解决的主要问题。方法：作者在对47例门诊患者128颗牙行冠桥修复时,于预备牙及取模过程中应用排龈线排龈,结果：取得良好结果：结论：该技术可减少牙体预备对牙龈组织的损伤及出血,能帮助取得清晰的软硬组织界限。健康的牙龈及细微的操作是减少损伤,修复成功的关键。     

不同排龈取模方式对固定修复临床效果研究

目的：比较不同排龈取模技术对固定修复模型质量效果的影响。方法：在对门诊金属烤瓷全冠修复患者107例144颗牙中,随机分为3组,分刖采用不同排龈取模技术,制取印模,完成修复体。对排龈止血效果、牙预备体肩台、模型清晰程度进行评价。结果：备牙前排龈组与备牙后排龈组的牙体预备有显著性差异,备牙前排龈组印模质量明显高于备牙后排龈组。结论：正确应用排龈技术可减少牙体预备对牙龈组织的损伤及出血,能帮助取得清晰的印模。     

A comparison of the marginal and internal adaptation of amalgam and resin composite restorations in small to moderate-sized Class II preparations of conventional design.

OBJECTIVE: The purpose of this study was to compare the marginal and internal adaptation of a non-gamma-2 amalgam and an ultrafine compact-filled light-cured composite in small to moderate-sized Class II restorations of conventional design. METHOD AND MATERIALS: Fifty recently extracted human premolar and permanent molar teeth were selected for the study. The teeth were restored with either a non-gamma-2 amalgam alloy or a light-cured resin composite. The marginal adaptation of the restorative materials to the proximal surface outline form of each preparation was assessed. The mean percentages of perfect margins, marginal fissuring, and underfilled margins for the 2 restorative materials were recorded and statistically analyzed. RESULTS: Both materials performed equally well in the buccal and lingual segments of the proximal box. At the cervical margin, the resin composite restorations showed a significantly greater number of imperfect margins and marginal fissuring. The incidence of underfilled margins was low for both restorative materials even at the cervical margin. CONCLUSION: Although there was some cause for concern about the marginal adaptation of the resin composite restorations along the cervical margin, the findings support contemporary teaching that small to moderately sized conventional Class II preparations may justifiably be restored with an appropriate resin composite.     

排龈技术在固定修复中的联合应用

目的：研究固定修复中龈下牙体预备时,如何保护龈沟底上皮附着,采集准确印模,确保牙周的生物学宽度不受侵犯。方法：对86例患者242颗牙行冠桥修复时,干备牙术中排龈线排龈及龈挡保护周围组织,术后排龈膏排龈。结果：排龈及止血效果良好,肩台与龈沟处印模清晰程度均取得良好的结果。结论：排龈技术的合理应用,避免了牙体预备时对牙龈组织的损伤及出血,能迅速打开龈沟,并且牙龈收缩是完全可逆的过程。     

Effect of different retraction and impression techniques on the marginal fit of crowns

OBJECTIVES: Periodontal conditions in restored teeth are strongly influenced by the marginal fit of the restoration which is closely related to the quality of the impression. However, the influence of the retraction and impression technique on the outcome of the impression has only sparsely been investigated. Thus, it was the objective of this study to compare the marginal fit in fixed restorations using two modes of gingival retraction and two different impression techniques in an animal model. METHODS: To simulate clinical conditions, 6 teeth in each of 10 lower jaws of freshly slaughtered cows were prepared with subgingival finish lines. Two different retraction techniques were used to expose the finish line: retraction cords containing epinephrine (Surgident) and electro-surgery were applied contra-laterally at 3 teeth per quadrant. Two impressions per jaw were taken in a two-step putty-wash technique (TPW) and a one-step putty-wash technique (OPW), respectively. On the casts, measurement copings were fabricated and seated on the extracted original tooth. In each coping the marginal discrepancy was assessed at 8 reference marks. Since the data was normally distributed, results were subjected to parametric statistics (T-test; p=0.05). RESULTS: Overall marginal discrepancies ranged between 0 and 200 microm. There was a small but not significant difference between electro-surgery and the retraction cords whereas TPW produced significantly better results than OPW (p<0.05). CONCLUSIONS: Within the limits of the study it can be concluded that the use of gingival retraction cords as well as electro-surgery lead to acceptable results. The difference between TPW and OPW concerning the marginal discrepancies can be regarded as clinically insignificant.     

不同排龈方法修复龈下楔状缺损临床疗效观察

目的:评估不同排龈方法修复龈下楔状缺损(楔缺)的临床疗效。方法:选择颈部边缘位于龈下0～2 mm内较难充填的楔缺,分3组:I组:龈边缘位于龈下0～1 mm的楔缺40个,使用排龈线排龈;II组:龈边缘位于龈下0～1 mm的楔缺40个,使用推龈器排龈;III组:龈边缘位于龈下1～2 mm的楔缺20个,使用推龈器排龈;IV组:龈边缘位于龈上的楔缺40个,直接充填,作为对照。各组均使用可乐丽菲露自酸蚀粘接剂粘接,3M Z250树脂进行充填。治疗后1年随访,以改良的USPHS直接临床评价系统评估疗效。数据行卡方检验。结果:I-III组病例修复体均无脱落,对照组有2个脱落。楔缺修复1年后4组成功率差异无显著性;在充填体脱落、边缘适合性、继发龋、边缘着色、新发缺损、牙龈反应及牙髓反应7个方面,4组间差异均无显著性(P>0.05);对于任何一组,基线与1年后复查的差异均无显著性(P>0.05)。结论:在采用有效排龈方法的前提下,龈下楔状缺损的修复可取得满意疗效,颈部边缘于龈下的深度并不影响治疗效果;推龈器的使用对于龈下楔状缺损的治疗有较大帮助。     

Viability of fibroblasts in cell culture after treatment with different chemical retraction agents

Prior to fixed prosthodontic impression procedures, temporary horizontal retraction of the free gingival tissue should be accomplished apically to the preparation finishing line. The mechanical-chemical method using cotton retraction cords of various sizes impregnated with various retraction chemicals is the most commonly employed retraction technique. Most retraction agents have pH values from 0.8 to 0.3, and are therefore hazardous to the cut dentine and periodontal tissues. Sympathomimetic vasoconstrictors introduced recently have a pH of 5.6, and are free of systemic side-effects. The present study using the dye exclusion test, colony forming ability test and colorimetric assay was undertaken to evaluate cytotoxic effects of four chemical retraction agents on cultured V-79 fibroblasts, and the dependence of cytotoxicity on the agent concentration and time of exposure. Original concentrations of retraction agents produced stronger cytotoxic effects than dilutions of 1:1 and 1:10. The most aggressive agent, 25% aluminium chloride, took only 1 min to damage all cell cultures. The proportion of cells damaged after 10 min of exposure to tetrahydrozoline was 60%, which was significantly less compared with other chemicals tested. With the colony forming ability test using retraction agents diluted to 1:10 the greatest number of colonies emerged in samples treated with tetrahydrozoline (statistical significance: P < 0.01). The colorimetric assay showed equal cytotoxic effects for 25% aluminium sulphate and tetrahydrozoline. The colorimetric test used in the study has proved an ergonomic, accurate and reliable test for cytotoxicity determination.     

Clinical trial of gingival retraction cords

STATEMENT OF PROBLEM: A wide spectrum of different gingival retraction cords is used, while the relative clinical efficacy of these cords remains undocumented. PURPOSE: This study aimed to determine whether clinicians were able to identify differences in clinical performance among 3 types of gingival retraction cords. METHODS AND MATERIAL: Dental students and faculty members ranked pairs or series of cords according to 6 criteria for clinical performance, with a blind experimental study design. Cords differed in consistency (knitted or twined) and impregnation (8% dl-epinephrine HCl, 0.5 mg/in or 25% aluminum sulfate, 0.5 mg/in). RESULTS: Knitted cords were ranked better than twined cords (P =.03). Cords containing epinephrine performed no better clinically than aluminum sulfate cords (P >.05). CONCLUSION: Clinicians were unable to detect any clinical advantages of using epinephrine impregnated gingival retraction cords compared with aluminum sulfate cords.     

全冠预备体肩台周径的初步测量研究

目的:初步调查成人恒牙全冠预备体肩台周径,便于在全冠预备采取印模前准确裁取排龈线长度进行排龈操作,并对预成冠的制作及为CAD/CAM数字化修复的数据库提供数据支持.方法:收集全冠预备后的合格工作模型,对除第三磨牙之外的所有牙位的全冠预备体终止线(肩台)的外缘用0号缝合丝线和游标卡尺进行周径测量.对左右侧对称牙位、男女之间相同牙位、及不同牙位之间的周径之差进行统计学分析,P＜0.05为差异有统计学意义.结果:获得了全牙列每牙位30颗共计840颗牙的全冠预备体肩台周径值.其中,左右侧对称牙位之间的周径差异无统计学意义P＞0.05,男、女性之间上颌中切牙、侧切牙、第二前磨牙、和下颌第一磨牙之间差异有统计学意义P＜0.05,各个牙位之间差异有统计学意义P＜0.05.结论:本研究初步获得了除第三磨牙外全牙列所有牙位(每个牙位平均30颗牙)的全冠预备体肩台周径值,为临床上精确裁取排龈线长度和需要肩台周径的数字化数据库提供了参考数值.