数字化微笑设计在前牙瓷贴面美学修复中的应用及其修复效果分析
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摘要
目的:分析结合数字化微笑设计(DSD)进行前牙瓷贴面修复患者的术后满意度及修复体的修复效果,探讨其在前牙美学修复中的应用。方法:选择因四环素牙、氟斑牙、牙体着色、轻度釉质缺损和前牙散在间隙等原因要求进行美学修复,且临床诊断符合贴面修复适应证的患者32例共91颗前牙。术前采用DSD软件对患者进行牙齿形态的美学分析及虚拟修复效果的预览,并在设计结果指导下进行牙体预备,常规印模制取后制作IPS e-max瓷贴面,最后完成永久修复体的戴入。在治疗完成后采用调查问卷的形式让患者对修复体的外形、与邻牙协调程度、颜色、发音、微笑效果和医患交流等6项内容作出满意度评价,并在治疗后1、3、6和12个月参照改良版美国公共卫生署(USPHS)标准对瓷贴面的临床修复效果进行评估。结果:患者对于各项调查内容的满意率均可达90%以上,其中对于微笑效果和医患交流2项满意率高达100%。将DSD应用于瓷贴面修复后,患者对于最终修复体的功能、美学效果和医患交流体验等各方面满意度较高。各时期修复体临床表现,修复后1个月,4颗牙齿出现轻度牙龈炎,3颗牙齿出现术后敏感;修复后3个月,1颗修复体出现不影响美观及功能的微小缺损,3颗牙齿出现牙龈轻度红肿,1颗修复体轻微变色;修复后6个月,1颗修复体出现切缘缺损,4颗牙齿出现轻度牙龈炎;修复后12个月,2颗牙齿出现修复体缺损,3颗牙齿修复体边缘欠密合,1颗牙齿出现牙龈炎。修复后出现牙龈炎症反应的患者在经过正确的口腔卫生指导后牙周状况均有明显好转,且上述缺损均不影响修复体的美观和功能,调磨后可正常使用,医患双方对修复体的修复效果均满意。结论:将DSD与瓷贴面修复联合应用是一种可获得较高患者满意度和理想修复效果的前牙美学修复方案。
Objective:To analyze the postoperative satisfaction and repair effect of prosthesis of the patients who received digital smile design(DSD)combined with porcelain veneers in the anterior teeth,and to illustrate the their application in anterior teeth aesthetic restoration.Methods:A total of 91 anterior teeth of 32 patients whose clinical diagnosis conformed to the indications of porcelain veneers and aesthetic restoration because of tetracycline pigmentation teeth,dental fluorosis,color stained teeth,enamel defects and anterior teeth space were selected.DSD software was used to design the preoperative aesthetic analysis of the teeth morphology and to show the virtual effect of restoration.The preparation of tooth under the guidance of the design results was finished.The IPS e-max porcelain veneers were prepared after the conventional impression preparation.At last,the permanent restorations were manufactured and bonded to teeth.After the adhesive program was completed,the satisfaction of the patients in the shape of restorations,the degree of coordination with the adjacent teeth,color,pronunciation,smile effect and doctor-patient communication effect were evaluated by the questionnaires.The patients were required to regularly return after one month,three months,six months and twelve months,and observe the clinical effects of restoration was observed referring to the modified American Public Health Service(USPHS)standard.Results:The patients' satisfaction rates of each evaluation content were all over 90%.Among them,the satisfaction rates of the smile effect and the doctor patient communication were as high as 100%.The clinical performances of the rehabilitations in each period were as follows:one month after treatment,there were four teeth occurred mild gingivitis and three teeth appeared the postoperative sensitivity symptoms;three months after treatment,there were one tooth showed a minor fracture in the restoration without affecting the appearance and function and three teeth had mildly congestive gums reaction,at the same time one tooth showed slight discoloration of the restoration;six months after treatment,one tooth showed ceramics fracture of restoration and four teeth developed mild gingivitis;twelve months after treatment,two teeth showed ceramics fracture,the edge of three restorations had slightly crack and one tooth appeared gingivitis.The periodontal conditions of the patients with gingival inflammation after treatment were improved significantly after receiving the correct oral hygiene guidance.The above defects didn't affect the aesthetics effect and the functions of restorations,and the restorations could be used normally after intraoral adjustments.Both the doctors and the patients were satisfied with the repair effects of the restorations.Conclusion:The combination of DSD and porcelain veneer in repairing anterior aesthetic teeth is good treatment plan that can achieve high patient satisfaction and ideal clinical effect.
Objective:To analyze the postoperative satisfaction and repair effect of prosthesis of the patients who received digital smile design(DSD)combined with porcelain veneers in the anterior teeth,and to illustrate the their application in anterior teeth aesthetic restoration.Methods:A total of 91 anterior teeth of 32 patients whose clinical diagnosis conformed to the indications of porcelain veneers and aesthetic restoration because of tetracycline pigmentation teeth,dental fluorosis,color stained teeth,enamel defects and anterior teeth space were selected.DSD software was used to design the preoperative aesthetic analysis of the teeth morphology and to show the virtual effect of restoration.The preparation of tooth under the guidance of the design results was finished.The IPS e-max porcelain veneers were prepared after the conventional impression preparation.At last,the permanent restorations were manufactured and bonded to teeth.After the adhesive program was completed,the satisfaction of the patients in the shape of restorations,the degree of coordination with the adjacent teeth,color,pronunciation,smile effect and doctor-patient communication effect were evaluated by the questionnaires.The patients were required to regularly return after one month,three months,six months and twelve months,and observe the clinical effects of restoration was observed referring to the modified American Public Health Service(USPHS)standard.Results:The patients' satisfaction rates of each evaluation content were all over 90%.Among them,the satisfaction rates of the smile effect and the doctor patient communication were as high as 100%.The clinical performances of the rehabilitations in each period were as follows:one month after treatment,there were four teeth occurred mild gingivitis and three teeth appeared the postoperative sensitivity symptoms;three months after treatment,there were one tooth showed a minor fracture in the restoration without affecting the appearance and function and three teeth had mildly congestive gums reaction,at the same time one tooth showed slight discoloration of the restoration;six months after treatment,one tooth showed ceramics fracture of restoration and four teeth developed mild gingivitis;twelve months after treatment,two teeth showed ceramics fracture,the edge of three restorations had slightly crack and one tooth appeared gingivitis.The periodontal conditions of the patients with gingival inflammation after treatment were improved significantly after receiving the correct oral hygiene guidance.The above defects didn't affect the aesthetics effect and the functions of restorations,and the restorations could be used normally after intraoral adjustments.Both the doctors and the patients were satisfied with the repair effects of the restorations.Conclusion:The combination of DSD and porcelain veneer in repairing anterior aesthetic teeth is good treatment plan that can achieve high patient satisfaction and ideal clinical effect.
引文
[1]MEEREIS C T,DE SOUZA G B,ALBINO L G,et al.Digital smile design for computer-assisted esthetic rehabilitation:Two-year follow-up[J].Oper Dent,2016,41(1):E13-E22.
[2]COACHMAN C,CALAMITA M.Digital smile design:Atool for treatment planning and communication in esthetic dentistry[J].Quintessence Dent Technol,2012,35:103-109.
[3]PIMENTEL W,TEIXEIRA M L,COSTA P P,et al.Predictable outcomes with porcelain laminate veneers:Aclinical report[J].J Prosthodont,2016,25(4):335-340.
[4]张玲,李俊颖,于海洋,等.预告美学修复技术[J].中国实用口腔科杂志,2015,8(2):73-77.
[5]陈端婧,李俊颖,于海洋,等.美学修复临床路径再造[J].中国实用口腔科杂志,2015,8(2):65-68.
[6]包炯,光寒冰.DSD在前牙美学修复中的应用要点与临床效果探究[J].口腔医学,2017,37(12):1099-1103.
[7]NALBANDIAN S,MILLAR B J.The effect of veneers on cosmetic improvement[J].BDJ,2009,207(2):E3.
[8]VENEZIANI M.Ceramic laminate veneers:clinical procedures with a multidisciplinary approach[J].Int J Esthet Dent,2017,12(4):426-448.
[9]MAGNE P,BELSER U C.Novel porcelain laminate preparation approach driven by a diagnostic mock-up[J].J Esthet Restor Dent,2004,16(1):7-16;discussion 17-8.
[10]GUREL G,MORIMOTO S,CALAMITA M A,et al.Clinical performance of porcelain laminate veneers:outcomes of the aesthetic pre-evaluative temporary(APT)technique[J].Int J Periodont Restora Dent,2012,32(6):625-635.
[11]MAGNE P,MAGNE M.Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers[J].Eur J Esthet Dent,2006,1(1):10-19.
[12]MAGNE P,HANNA J,MAGNE M.The case for moderate“guided prep”indirect porcelain veneers in the anterior dentition.The pendulum of porcelain veneer preparations:from almost no-prep to over-prep to no-prep[J].Eur J Esthet Dent,2013,8(3):376-388.
[13]ZTRK E,BOLAY,HICKEL R,et al.Shear bond strength of porcelain laminate veneers to enamel,dentine and enamel-dentine complex bonded with different adhesive luting systems[J].J Dent,2013,41(2):97-105.
[14]JAVASOORIVA P R,PEREIRA P N R,NIKAIDO T,et al.Efficacy of a resin coating on bond strengths of resin cement to dentin[J].J Esthet Restor Dent,2003,15(2):105-113;discussion 113.
[15]SHI J Y,LI X,NI J,et al.Clinical Evaluation and patient satisfaction of single zirconia-based and high-noble alloy porcelain-fused-to-metal crowns in the esthetic area:Aretrospective cohort study[J].J Prosthodont,2016,25(7):526-530.
[16]BAYNE S C,SCHMALZ G.Reprinting the classic article on USPHS evaluation methods for measuring the clinical research performance of restorative materials[J].Clin Oral Invest,2005,9(4):209-214.
[17]WEI S H,TANG E.Laminate veneers for the aesthetic restoration of anterior teeth[J].Ann R Australas Coll Dent Surg,1989,10:148-159.
[18]ROUSE J,MCGOWAN S.Restoration of the anterior maxilla with ultraconservative veneers:clinical and laboratory considerations[J].Pract Periodont Aesthet Dent,1999,11(3):333-339;quiz 340.
[19]FAUS-MATOSES V,FAUS-MATOSES I,RUIZ-BELL E,et al.Severe tetracycline dental discoloration:Restoration with conventional feldspathic ceramic veneers.A clinical report[J].J Clin Exp Dent,2017,9(11):1379-1382.
[20]许少平,骆小平,石玉娟.热压铸造陶瓷制作前牙瓷贴面的临床效果观察[J].上海口腔医学,2012,21(5):572-575.
[21]李健慧,邸萍,胡秀莲,等.应用无创瓷贴面技术改善种植区域美学效果的临床研究[J].北京大学学报:医学版,2010,42(1):103-107.
[22]BABAR S,CALAMIA J R,SORREL J M.Management of an adult with classⅢmalocclusion,gummy smile,and spaced dentition[J].Dent Clin North Am,2015,59(3):665-674.
[23]D’ARCANGELO C,DEANGELIS F D,VADINI M,et al.Fracture resistance and deflection of pulpless anterior teeth restored with composite or porcelain veneers[J].J Endod,2010,36(1):153-156.
[24]TRUSHKOWSKY R,ARIAS D M,DAVID S.Digital smile design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile[J].Int J Esthet Dent,2016,11(3):338-354.
[25]STANLEY M,PAZ A G,MIGUEL I,et al.Fully digital workflow,integrating dental scan,smile design and CAD-CAM:case report[J].BMC Oral Health,2018,18(1):134.
[2]COACHMAN C,CALAMITA M.Digital smile design:Atool for treatment planning and communication in esthetic dentistry[J].Quintessence Dent Technol,2012,35:103-109.
[3]PIMENTEL W,TEIXEIRA M L,COSTA P P,et al.Predictable outcomes with porcelain laminate veneers:Aclinical report[J].J Prosthodont,2016,25(4):335-340.
[4]张玲,李俊颖,于海洋,等.预告美学修复技术[J].中国实用口腔科杂志,2015,8(2):73-77.
[5]陈端婧,李俊颖,于海洋,等.美学修复临床路径再造[J].中国实用口腔科杂志,2015,8(2):65-68.
[6]包炯,光寒冰.DSD在前牙美学修复中的应用要点与临床效果探究[J].口腔医学,2017,37(12):1099-1103.
[7]NALBANDIAN S,MILLAR B J.The effect of veneers on cosmetic improvement[J].BDJ,2009,207(2):E3.
[8]VENEZIANI M.Ceramic laminate veneers:clinical procedures with a multidisciplinary approach[J].Int J Esthet Dent,2017,12(4):426-448.
[9]MAGNE P,BELSER U C.Novel porcelain laminate preparation approach driven by a diagnostic mock-up[J].J Esthet Restor Dent,2004,16(1):7-16;discussion 17-8.
[10]GUREL G,MORIMOTO S,CALAMITA M A,et al.Clinical performance of porcelain laminate veneers:outcomes of the aesthetic pre-evaluative temporary(APT)technique[J].Int J Periodont Restora Dent,2012,32(6):625-635.
[11]MAGNE P,MAGNE M.Use of additive waxup and direct intraoral mock-up for enamel preservation with porcelain laminate veneers[J].Eur J Esthet Dent,2006,1(1):10-19.
[12]MAGNE P,HANNA J,MAGNE M.The case for moderate“guided prep”indirect porcelain veneers in the anterior dentition.The pendulum of porcelain veneer preparations:from almost no-prep to over-prep to no-prep[J].Eur J Esthet Dent,2013,8(3):376-388.
[13]ZTRK E,BOLAY,HICKEL R,et al.Shear bond strength of porcelain laminate veneers to enamel,dentine and enamel-dentine complex bonded with different adhesive luting systems[J].J Dent,2013,41(2):97-105.
[14]JAVASOORIVA P R,PEREIRA P N R,NIKAIDO T,et al.Efficacy of a resin coating on bond strengths of resin cement to dentin[J].J Esthet Restor Dent,2003,15(2):105-113;discussion 113.
[15]SHI J Y,LI X,NI J,et al.Clinical Evaluation and patient satisfaction of single zirconia-based and high-noble alloy porcelain-fused-to-metal crowns in the esthetic area:Aretrospective cohort study[J].J Prosthodont,2016,25(7):526-530.
[16]BAYNE S C,SCHMALZ G.Reprinting the classic article on USPHS evaluation methods for measuring the clinical research performance of restorative materials[J].Clin Oral Invest,2005,9(4):209-214.
[17]WEI S H,TANG E.Laminate veneers for the aesthetic restoration of anterior teeth[J].Ann R Australas Coll Dent Surg,1989,10:148-159.
[18]ROUSE J,MCGOWAN S.Restoration of the anterior maxilla with ultraconservative veneers:clinical and laboratory considerations[J].Pract Periodont Aesthet Dent,1999,11(3):333-339;quiz 340.
[19]FAUS-MATOSES V,FAUS-MATOSES I,RUIZ-BELL E,et al.Severe tetracycline dental discoloration:Restoration with conventional feldspathic ceramic veneers.A clinical report[J].J Clin Exp Dent,2017,9(11):1379-1382.
[20]许少平,骆小平,石玉娟.热压铸造陶瓷制作前牙瓷贴面的临床效果观察[J].上海口腔医学,2012,21(5):572-575.
[21]李健慧,邸萍,胡秀莲,等.应用无创瓷贴面技术改善种植区域美学效果的临床研究[J].北京大学学报:医学版,2010,42(1):103-107.
[22]BABAR S,CALAMIA J R,SORREL J M.Management of an adult with classⅢmalocclusion,gummy smile,and spaced dentition[J].Dent Clin North Am,2015,59(3):665-674.
[23]D’ARCANGELO C,DEANGELIS F D,VADINI M,et al.Fracture resistance and deflection of pulpless anterior teeth restored with composite or porcelain veneers[J].J Endod,2010,36(1):153-156.
[24]TRUSHKOWSKY R,ARIAS D M,DAVID S.Digital smile design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile[J].Int J Esthet Dent,2016,11(3):338-354.
[25]STANLEY M,PAZ A G,MIGUEL I,et al.Fully digital workflow,integrating dental scan,smile design and CAD-CAM:case report[J].BMC Oral Health,2018,18(1):134.