IPS e.max Press全瓷贴面在前牙修复中的应用

目的 评价IPS e.max Press全瓷贴面在前牙美容修复应用中的临床疗效.方法 对52例患者的103颗前牙进行IPS e.max Press全瓷贴面修复,于修复体粘接后每半年进行复查评价其临床效果.结果 经过2年的复查,有1个瓷贴面发生折裂,2个出现裂纹,2颗贴面修复的基牙有轻度的牙龈炎症,无瓷贴面脱落.结论 IPS e.max Press全瓷贴面修复能有效保存牙体组织,获得满意的美学修复效果,在前牙美容修复中具有良好的应用前景.     

CAD/CAM氧化锆全瓷与IPS e.max Press铸瓷固定局部义齿修复的临床对比研究

目的：比较不同全瓷系统用于前牙及前磨牙区固定桥修复的临床效果。方法选取20～60岁因前牙或第一前磨牙缺失而行3单位固定桥修复的患者,随机分成CAD/CAM氧化锆和IPS e.max Press两组,分别在修复体戴入后3、6、12个月,临床观察其是否发生脱落、折裂、崩瓷、修复体边缘密合性及牙龈表现,参照改良美国公共卫生署评价标准进行疗效评价,并进行统计学分析。结果随着时间的延长,两种全瓷材料的固定修复成功率均有所下降,但均在90%以上,两者之间差异无统计学意义（P＞0.05）。结论在严格控制临床适应证的前提下,CAD/CAM二氧化锆与IPS e.max Press两种全瓷材料均能达到良好的修复效果。     

IPSe.max铸瓷贴面美学修复的临床评价

目的：评价IPSe.max铸瓷贴面在前牙美容修复的临床效果。方法：对13例患者（总计63颗）行IPS e.max铸瓷贴面修复。1个月、3个月、12个月、24个月后复诊检查,根据改良Ryge评价标准评价临床效果。结果：63例瓷贴面均完整未脱落;1例出现边缘渗漏着色;3颗患牙出现牙本质敏感现象。结论：IPS e.max铸瓷贴面是前牙较理想的美学修复方法,能满足患者对美观的要求,取得良好的临床效果。     

数字化口腔修复（6）--应用口内扫描仪精确设计冠边缘位置（附病例报告）

目的：探讨CEREC?椅旁计算机辅助设计（computer aided design,CAD）精确地确定冠边缘位置的方法。方法：报告1例采用CAD／CAM IPS e．max瓷块修复前牙（11、21）牙体缺损的病例,按照改良的美国公共卫生署（United States Public Health Service,USPHS）标准评价临床疗效。牙体预备后,通过CEREC?口内扫描仪测量排龈前后游离龈缘（FGM）的变化。结果：取出排龈线30min后,FGM的变化趋于稳定,11和21的FGM分别根向退缩了0．2 mm。各阶段复查结果表明：患牙无折断、劈裂及继发龋等不良现象。临床指标均达到A级标准。结论：二矽酸锂玻璃陶瓷用于前牙牙体缺损的修复可以取得理想的美学效果,远期疗效有待进一步观察。CEREC?椅旁CAD精确设计冠边缘的位置方法可用于临床。     

CAD/CAM全瓷高嵌体修复磨牙大面积牙体缺损的临床疗效评价

目的探讨CEREC 3D椅旁计算机辅助设计和制作(computer-aided design/computer-aided manufacture,CAD/CAM)系统制作全瓷高嵌体修复后牙牙体缺损的临床效果。方法对50例后牙牙体缺损患者,使用CEREC 3D椅旁CAD/CAM系统制作全瓷高嵌体,术后即刻和修复后6个月采用改良美国牙科协会评价标准对修复体进行评价,对患者进行满意度调查。结果修复后即刻检查边缘密合度、解剖外形、表面光滑度、色彩匹配度、牙龈健康和固位等6个方面达到满意比率分别为96%、98%、98%、94%、94%和100%,6个月后满意比率分别达到96%、98%、98%、94%、98%和100%。修复后6个月患者对全瓷高嵌体修复在形态、色彩和舒适性方面的满意度分别为88%、90%和92%。结论CEREC 3D椅旁CAD/CAM系统制作全瓷高嵌体修复后牙牙体缺损取得了较满意的初期临床效果,但是长期临床应用尚需进一步研究。     

80件CEREC3全瓷修复体的临床效果回顾分析

目的探讨应用数字椅旁全瓷修复系统（CEREC3）进行椅旁即刻全瓷修复的临床效果。方法采用数字椅旁全瓷修复系统（CEREC3）共完成75例患者的全瓷修复体80件。追踪观察1.0～1.5年,询问患者对全瓷修复的主观感受,记录全瓷修复体的变化等。回顾分析80件全瓷修复的临床疗效。结果患者对CEREC3全瓷修复体的主观评价满意率为95.00%（76/80）,崩瓷率为3.75%（3/80）。结论采用CEREC3,能制作出高质量并且具有天然牙色的全瓷修复体,方便快捷,临床效果满意。     

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。     

椅旁CAD/CAM(CEREC AC~(TM))全瓷修复的临床回顾性研究

目的评价椅旁CAD/CAM系统(CEREC AC~(TM))进行全瓷修复的临床效果。方法针对619例患者的667颗各类牙体缺损患牙采用西诺德的瓷睿刻系统(CEREC AC~(TM))进行临床即刻椅旁CAD/CAM全瓷修复,1年后对597例患者的603颗瓷睿刻修复体进行临床效果评价。采用USPHS修订版指标检查,包括美观——解剖形态、颜色匹配、边缘变色、表面质地;功能——边缘吻合性、磨耗(邻接、动静态咬合关系);生物学性能——牙髓活力、继发龋。结果 1年的随访结果发现,临床存留率达到95.11%,失败病例中修复体折裂占比为83%。93%的全瓷修复体表现出较高的美学评分,82%的修复体保持了较好的功能评分,而100%的修复体未见生物学并发症。结论不同牙体缺损患牙的瓷睿刻椅旁CAD/CAM全瓷修复,可获得理想的临床效果,但仍需长期随访。     

CAD/CAM全瓷高嵌体修复根管治疗后牙体缺损的临床评价

目的:采用瓷睿刻计算机辅助设计与制作(CAD/CAM)系统制作全瓷高嵌体修复根管治疗后的后牙牙体缺损,观察其1年期床疗效。方法::选取46例根管治疗后的后牙,使用瓷睿刻(CEREC)系统,IPS e.max CAD材料,制作全瓷高嵌体,双固化树脂水门汀粘结。修复后1年,采用改良USPHS标准对修复体、牙体、牙周等各方面指标进行评价,同时评价患者满意度。结果:87 ％的修复体各项检查标准都达到了USPHS 标准A类,患者满意率92％。CEREC 全瓷高嵌体1年期疗效确切。结论:使用瓷睿刻(CEREC)系统制作的 IPS e.max CAD全瓷高嵌体可作为根管治疗后后牙牙体缺损的有效修复方案。     

IPS e.max CAD全瓷冠修复的短期临床评价

目的 对IPS e.max CAD全瓷冠近期修复效果进行观察和评价。 方法 共选取469例542颗前、后牙IPS e.max CAD全瓷冠修复体,修复3~12个月后,按照美国加州牙科协会(CDA)制定的全瓷修复临床评定标准进行修复体评估。 结果 97.2%的修复体保持完整,未出现破裂、崩瓷、脱落、基牙冠折等并发症,患者满意度较高。 结论 IPS e.max CAD全瓷修复体的近期修复效果良好。     

Effect of Crystallization Firing on Marginal Gap of CAD/CAM Fabricated Lithium Disilicate Crowns

Purpose

To evaluate the marginal gaps of CAD/CAM (CEREC 3) produced crowns made from leucite‐reinforced glass‐ceramic (IPS Empress CAD) blocks (LG), and lithium‐disilicate (IPS e.max CAD) blocks before (LD‐B), and after (LD‐A) crystallization firing.

Materials and Methods

A human molar tooth (#19) was mounted with adjacent teeth on a typodont and prepared for a full‐coverage ceramic crown. The typodont was assembled in the mannequin head to simulate clinical conditions. After tooth preparation 15 individual optical impressions were taken by the same operator using titanium dioxide powder and a CEREC 3 camera per manufacturer's instructions. One operator designed and machined the crowns in leucite‐reinforced glass‐ceramic blocks (n = 5) and lithium‐disilicate blocks (n = 10) using the CEREC 3 system. The crowns were rigidly seated on the prepared tooth, and marginal gaps (μm) were measured with an optical microscope (500×) at 12 points, 3 on each of the M, B, D, and L surfaces of the leucite‐reinforced glass‐ceramic crowns and the lithium‐disilicate crowns before and after crystallization firing. Results were analyzed by two‐way ANOVA followed by a Tukey's post hoc multiple comparison test (α = 0.05).

Results

The overall mean marginal gaps (μm) for the crowns evaluated were: LG = 49.2 ± 5.5, LD‐B = 42.9 ± 12.2, and LD‐A = 57.2 ± 16.0. The marginal gaps for LG and LD‐B were not significantly different, but both were significantly less than for LD‐A.

Conclusions

The type of ceramic material did not affect the marginal gap of CAD/CAM crowns. The crystallization firing process required for lithium‐disilicate crowns resulted in a significant increase in marginal gap size, likely due to shrinkage of the ceramic during the crystallization process. Clinical Relevance: The marginal gap of CAD/CAM‐fabricated lithium disilicate crowns increases following crystallization firing. The marginal gap still remains within clinically acceptable parameters.     

美观区铸瓷贴面修复的临床效果观察

目的 评价美观区铸瓷贴面修复的短期临床效果.方法 美观区修复病例22例,共105颗IPS e·max铸瓷贴面,采用改良的瓷贴面评价标准评估修复后2年的修复体完整度、修复体磨耗、颜色满意度、边缘染色、边缘适合性、继发龋、牙本质敏感症状及牙龈指数共8项指标.结果 修复后2年,105颗IPS e·max铸瓷贴面,在修复体完整度一项有3颗贴面评估失败：1颗瓷贴面崩折,2颗出现明显影响美观的裂纹;其余7项指标的成功率均为100％.结论 IPS e·max铸瓷贴面应用于美观区修复的短期临床效果良好.     

How adjustment could affect internal and marginal adaptation of CAD/CAM crowns made with different materials

PURPOSERecently introduced hybrid and reinforced glass ceramic computer-aided design/computer-aided manufacturing (CAD/CAM) materials have been used for full-coverage restorations. However; the effect of adjustment and type of materials on internal and marginal adaptation are unknown. This study aimed to evaluate and compare the marginal and internal adaptations of crowns made of three different CAD/CAM materials before and after adjustment.MATERIALS AND METHODSOne acrylic resin maxillary first molar was prepared and served as the master die. Thirty-six restorations were fabricated using CAD/CAM system (CEREC Omnicam, MCXL) with three materials including lithium disilicate (IPS e.max CAD), zirconia-reinforced lithium silicate (Suprinity), and hybrid ceramic (Enamic). Internal and marginal adaptations were evaluated with the reference point matching technique before and after adjustment. The data were analyzed using mixed ANOVA considering α=.05 as the significance level.RESULTSThe effect of adjustment and its interaction with the restoration material were significant for marginal, absolute marginal, and occlusal discrepancies (P<.05). Before adjustment, Suprinity had lower marginal discrepancies than IPS e.max CAD (P=.18) and Enamic (P=.021); though no significant differences existed after adjustment.CONCLUSIONWithin the limitations of this study, crowns fabricated from IPS e.max CAD and Suprinity resulted in slightly better adaptation compared with Enamic crowns before adjustment. However, marginal, axial, and occlusal discrepancies were similar among all materials after the adjustment.     

CEREC AC全瓷修复系统的临床效果研究

目的 探讨椅旁CAD/CAM CEREC AC全瓷修复系统在牙体缺损修复中的应用和效果。方法 观察自2012年8月至2014年7月期间,采用CEREC AC全瓷修复系统所修复的70个病例,其中瓷嵌体10颗,全瓷冠60颗,由同一医生利用改良的美国公共健康协会修订标准（USPHS）对修复后6个月及12个月修复体的外形、边缘适合性、颜色匹配性、边缘染色、固位、修复后敏感性、牙龈健康及继发龋等方面进行评价。结果 70件修复体在观察期内保存完整,边缘密合,无明显松动、脱落、折断、继发龋、明显的牙齿敏感以及牙龈炎症等不良现象发生,修复后6个月及12个月的临床评价结果对比无统计学差异（P>0.05）。结论 CEREC AC全瓷修复系统可以高效地应用于牙体缺损的修复治疗,基于此方法制作出的修复体能达到令人满意的临床效果。     

Vita MK II CAD/CAM后牙全瓷冠5年临床观察

目的:比较VitaMKII陶瓷制作的前磨牙和磨牙CAD/CAM全瓷冠的5年临床效果,确定VitaMKII全瓷冠的应用范围和常见的折裂模式。方法:随机选择门诊病例11例,使用CAD/CAM技术制作VitaMKII前磨牙全瓷冠9个、磨牙3个,分别在戴用后1、3、6月、1、3、5年定期观察。结果:VitaMKII制作的全瓷冠适合性好,咀嚼功能良好,无食物嵌塞,无继发龋及龈炎,无一例脱落。前磨牙组全瓷冠1个折裂,磨牙组2个折裂.经5年临床观察前磨牙组全瓷冠折裂明显少于磨牙组(P<0.05)。VitaMKII全瓷冠的折裂模式为沿牙冠咬合面近远中沟方向发生折裂。结论:VitaMKII陶瓷可以制作前磨牙CAD/CAM全瓷冠。     

数字化口腔修复（18）--CAD／CAM全瓷冠与个性化基台的适合性

目的：比较不同计算机辅助设计和制造（ computer aided design／manufacture,CAD／CAM）全瓷冠与氧化锆个性化基台的边缘和内部适合性。方法：用CAD／CAM分别设计和加工氧化锆个性化基台和全瓷冠3组（ IPS e． max、Enamic和Suprinity）,每组各5个全瓷冠。通过微机断层扫描（ micro computed tomography,micro?CT）测量全瓷冠与氧化锆个性化基台的绝对边缘差异（ absolute marginal discrepancy,AMD）、轴面间隙（ axial gap,AG）、咬合间隙（ oc?clusal gap,OG）,比较不同材料全瓷冠与氧化锆个性化基台的边缘和内部适合性。结果：Enamic组分别与IPS e． max组和Suprinity组AMD之间的比较差异均具有统计学意义（P＜0．05）;而IPS e． max组与Suprinity组AMD之间的差异则无统计学意义（P＞0．05）。 Suprinity组分别与IPS e． max组和Enamic组AG之间的比较差异均具有统计学意义（P＜0．05）;IPS e． max组与Enamic组AG之间的差异不具有统计学意义（P＞0．05）。 Suprinity组、IPS e． max组和Enamic组3组OG之间的比较差异具有统计学意义（P＜0．05）。结论：不同的CAD／CAM全瓷冠材料影响其边缘和内部适合性。 Suprinity和IPS e． max陶瓷材料的边缘适合性优于Enamic材料,Suprinity材料全瓷冠的轴面间隙和咬合间隙最小。     

Fatigue resistance of ultrathin CAD/CAM ceramic and nanoceramic composite occlusal veneers

ObjectiveThe fracture resistance of different ultrathin occlusal computer-aided design/computer-aided manufacturing (CAD/CAM) veneers was investigated under cyclic mechanical loading to restore combined enamel-dentin defects.MethodsEighty-four molars were reduced occlusally until extensive dentin exposure occurred with a remaining enamel ring. Twenty-four molars were ground flat for examination of highly standardized specimens, of which 8 were treated with uniformly flat 0.3 mm IPS Empress CAD and 0.3 and 0.5 mm IPS e.max CAD restorations. Sixty-four molars were anatomically prepared until dentin exposure and were restored using occlusal veneers with fissure/cusp thicknesses of 0.3/0.5 mm from 3 different dental CAD/CAM materials: IPS Empress CAD, IPS e.max CAD and Lava Ultimate CAD/CAM. Teeth were etched with 37% phosphoric acid, and occlusal veneers were bonded using an adhesive luting system (Syntac Primer, Adhesive, Heliobond and Variolink II). Specimens were placed under cyclic mechanical loading in a chewing simulator (1 million cycles at 50 N) and were examined for cracks after each cyclic loading sequence. The anatomical 0.3/0.5 mm IPS e.max CAD specimens experienced an additional 1 million cycles at 100 N. Kaplan–Meier survival curves and log-rank tests were used for data analysis.ResultsAll highly standardized and 0.3/0.5 mm IPS e.max CAD specimens tolerated cyclic loading. One anatomical Lava Ultimate CAD/CAM and 10 IPS Empress CAD specimens showed cracks.SignificanceUltrathin occlusal veneers of lithium disilicate ceramic and nanoceramic composite showed remarkably high fracture strength under cyclic mechanical loading. These veneers might be a tooth substance preserving option for restoring combined dentin–enamel defects.     

前牙超薄瓷贴面美学修复临床效果评价

目的    评价超薄瓷贴面用于前牙美学修复的临床效果。方法    对2012年2月至2013年2月于南京市口腔医院口腔修复科就诊的54例要求改善前牙美观患者的126颗前牙,采用IPS e.max Press热压铸二硅酸锂玻璃陶瓷系统高半透性HT色系瓷块制作超薄瓷贴面,口内试戴满意后用光固化树脂黏结剂黏固。修复完成后第1、6个月及第1、2、3、4、5年复诊,参照改良美国公共卫生署（USPHS）评价标准,从继发龋、边缘适合性、外形、颜色匹配和破裂等方面对临床效果进行评价。结果    本研究共制作了126颗超薄瓷贴面进行前牙修复。修复完成后1个月复诊,2颗贴面（1.6%）颜色匹配为B级,其余指标均达A级。修复完成后6个月、1年和2年复诊,所有修复体各项指标均达A级。修复完成后3年复诊,2颗贴面（1.6%）边缘可探及间隙,边缘适合性评为B级。修复完成后4年复诊,2颗贴面（1.6%）切端折裂1 mm,破裂指标为C级。修复完成5年复诊,1颗贴面（0.8%）失访;1颗贴面（0.8%）远中切角部分折裂,破裂指标为C级;5颗贴面（4.0%）边缘有较明显的轻度着色,颜色匹配为B级。所有患牙修复后均无牙髓敏感症状、未见继发龋和牙龈炎。结论    超薄瓷贴面的透光性极佳,颜色自然协调,边缘适合性非常好,临床效果令医患满意,是一种理想的前牙美学修复方法。