不同粒度车针预备牙体对冠固位及适合性影响的研究
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摘要
随着口腔修复技术的不断发展,患者和牙医对修复体的要求也逐渐提高。有文献报道,以瓷熔附金属修复体为代表的口腔固定修复体在临床上的应用已占修复体总数的65%以上。然而,固定修复失败的现象却时有发生,边缘不密合和固位不良导致的失败占失败修复体总数的33.3%~41.8%。可以说,适合性不佳和固位不良已成为导致固定修复失败的两个主要原因。
     提高固定修复体的固位力和边缘适合性的方法很多,通过改变牙预备体表面粗糙度,从而调整全冠修复体的固位效果并改善其适合性也是一种行之有效的手段。目前关于牙预备体表面粗糙程度对冠修复体固位及内部适合性影响的研究还较少,有限的研究结果中亦存在较大分歧。
     本研究旨在比较不同粒度车针预备后的牙体与三种牙科水门汀的粘固效果;分析不同粒度车针预备牙体对基底冠适合性的影响;探讨不同粒度车针预备牙体对基底冠粘固性能的影响,以期为临床操作提供一定参考依据。
     本课题分为四个实验,分别是不同粒度车针预备后的牙体表面粗糙度测试、不同粒度车针预备牙体对其与三种牙科水门汀粘固性能的影响、不同粒度车针预备牙体对基底冠适合性的影响和不同粒度车针预备牙体对基底冠粘固性能的影响。
     实验一,采用临床常用的4种不同粒度的MANI金刚砂车针,在冷水喷雾下分别打磨牙本质表面。粗糙度测量仪测定牙本质表面粗糙度并在扫描电镜下观察车针及牙本质试件的表面形貌。实验发现:预备完成后的基牙表面粗糙度是由金刚砂车针的粒度决定的,车针的粒度越小,牙本质表面粗糙度越低。
     实验二,将经不同粒度车针打磨后的4组牙本质片分别与聚羧酸锌水门汀、玻璃离子水门汀和树脂改性玻璃离子水门汀粘固,测试其剪切粘固强度并观察试件的断裂模式。实验发现:牙本质表面粗糙度对水门汀材料与牙本质之间的粘固强度具有显著影响;预备用车针的粒度越小,水门汀材料与牙本质之间的剪切强度越低;牙本质表面粗糙度相同时,玻璃离子水门汀和树脂改性玻璃离子水门汀与牙本质的粘固效果间未见显著差异,且均优于聚羧酸锌水门汀。
     实验三,在自制平行研磨仪上,用4种不同粒度的MANI金刚砂车针依次打磨牙预备体的表面,然后用玻璃离子水门汀将个别制作的镍铬合金基底冠粘固在牙预备体上。将试件浸泡在0.5%品红溶液中24h后纵向剖开,体视显微镜下测量指定点位的粘固剂层厚度并记录微渗漏等级。实验发现:随预备用车针粒度的减小,牙预备体与镍铬合金基底冠之间的微渗漏等级逐渐降低;使用车针依次精修牙面至粒度为53~63μm的金刚砂车针(即细型MANI车针)时,牙预备体与镍铬合金基底冠之间的适合性可满足临床要求。
     实验四,为每个牙预备体试件制作相对应的带环金属冠,牙预备体试件的制备方法同实验三,采用玻璃离子水门汀粘固牙预备体与相应金属冠,测试冠的固位力并借助体视显微镜观察断裂模式。实验发现:采用不同粒度车针预备牙体对冠修复体的固位力无显著影响;当其它条件一定时,基底冠试件与牙预备体脱位后的断裂模式和牙体表面粗糙度之间的相关性较小。
     综上所述,当牙体预备初步完成后,采用粒度较小的金刚砂车针对牙预备体表面进行精修时,随车针粒度的减小:
     (1)牙本质表面粗糙度逐渐降低;
     (2)水门汀材料与牙本质之间的剪切粘固强度降低,玻璃离子水门汀和树脂改性玻璃离子水门汀与牙本质的粘固效果间未见显著差异,且均优于聚羧酸锌水门汀;
     (3)牙预备体与镍铬合金基底冠之间的适合性逐渐提高;
     (4)牙预备体与镍铬合金基底冠间的固位力间未见显著差异。
     根据上述研究结果,临床上基牙预备时,为了兼顾全冠修复体的固位力和内部适合性,建议使用粒度为53~63μm的细型金刚砂车针对牙预备体进行精修。
With the development of dental prosthodontics,the requirements from dentists and patients increased gadually.Fixed restorations,especially porcelain fused to metal crown/ bridge(PFM),have been widely applied in clinic restoration,accounting for 65%in all kinds of restorations.However,in cases of restoration failure,33.3%~41.8%of restorations are caused by bad marginal seal and poor retention.Therefore,marginal seal and retention have come to be of the two main factors inducing the failure of fixed restorations.
     There are numbers of methods have been applied to improve the retention and internal adaptation of fixed restorations.Among these,changing dentin surface roughness by diamond burs with different grit sizes may be an effective and simple way.Most of the relative have been focusing on the effect of etching on restorations,the effect of different luting agents on marginal adaptation between dentin and crown,and surface treatments that may improve crown retention.The effect of trimming with diamond burs of different grit sizes on the bond strength and internal adaptation between full crown and dentin has seldom been reported. The purpose of the present study is to evaluate the effect of trimming with diamond burs of different grit sizes on the shear and tensile bond strength, internal adaptation between dentin and luting agents;retention between dentin and based crowns after cementation.It may be helpful to improve the retention and adaptation of fixed restorations in clinic.
     The total study was divided into four experiments:
     Experiment 1:All the dentin plates were divided into four groups which were prepared with diamond burs of different grit sizes.The dentin surface roughness was measured and observed with SEM,respectively.Results showed that:dentin surface roughness was affected by the grit size of diamond burs applied.The smaller the grit size of diamond bur was,the lower the dentin surface roughness would be.
     Experiment 2:After being prepared with diamond burs of different grit sizes, all the dentine plates were divided into three subgroups and bonded with polycarboxylate cement,glass-ionomer cement,and resin-modified glass ionomer cement respectively.Specimens were then subjected to shear bond strength test. The fracture mode of each specimen was also recorded.Results showed that:the smaller the grit size of diamond bur was,the lower the shear bond strength was; with the same dentin surface roughness,the use of glass-ionomer cement and resin-modified glass ionomer cement could obtain higher shear bond strength than polycarboxylate cement.
     Experiment 3:According to the type of the final diamond bur used for the finishing of tooth preparation,all the prepared teeth were divided into 4 groups. All the teeth were prepared using a set of diamond burs with decreasing grit size equipped on a self-made parallel muller.A Ni-Cr alloy crown was individually fabricated.Glass ionomer cement was used to cement the crowns.Specimens were soaked into 0.5%fuchsine solution for 24h.The bonded specimens were evaluated for microleakage and internal adaptation.Results showed that:as the grit size of diamond bur for preparation decreases,the adaptation between dentin and Ni-Cr based crown increased;when using the brand of MANI diamond bur to prepare teeth ruth decreasing-sized bur until a red code,the internal adaptation between abutment and Ni-Cr based crown could meet clinical needs.
     Experiment 4:The specimens were prepared according to the methods mentioned in experiment 3.The impressions were made and Ni-Cr alloy crowns with rings were fabricated.Glass ionomer cement was used to cement the crowns. The tensile bond strength and the fracture mode were observed for each bonded specimen.Results showed that:no significant effect was found on the tensile bond strength between teeth prepared with diamond bur of different grit sizes and Ni-Cr based crown when bonded with glass ionomer cement;regardless of other related factors,the correlation between fracture mode and dentin surface roughness after the separation of the cemented specimens is little.
     Based on the results above,it could be briefly concluded that:when a final trimming with diamond burs of smaller grit size was applied to dentin surface after the regular tooth preparation,as the grit size of diamond bur for preparation decreases,
     (1) dentin surface roughness would decrease;
     (2) the shear bond strength between cements and dentin decreases;with the same dentin surface roughness,glass-ionomer cement and resin-modified glass ionomer cement obtain higher shear bond strength than polycarboxylate cement;
     (3) the adaptation between dentin and Ni-Cr based crown increased;
     (4) no significant difference was found on tensile bond strength between prepared teeth by diamond bur with different grit sizes and Ni-Cr based crown when bonded with glass ionomer cement.
     Based on these conclusions mentioned above,considering the retention and internal adaptation of full crown,it is suggested that when using the MANI diamond bur to prepare teeth following the grit size order to red code (53~63μm),the retention and internal adaptation between abutment and Ni-Cr based crown could meet clinical needs.
引文
1.马轩祥主编.口腔修复学.第5版,北京:人民卫生出版社,2004:109
    2.张玉梅,施生根,郭天文.冠桥制作过程失败原因分析.临床口腔医学杂志,1996,12(2):107-108
    3.李勇伟.铸造冠桥修复失败的原因分析.海南医学,2006,17(3):93
    4.Irie M,Suzuki K,Watts DC.Marginal and flexural integrity of three classes of luting cement,with early finishing and water storage[J].Dental Materials.2004,20(1):3-11
    5.姜元新.影响全冠固位的因素.齐齐哈尔学院学报.2005,26(11):1317-1318
    6.吉宁.瓷全冠边缘适合性的影响因素.国外医学口腔医学分册.2005.32(2):148-150
    7.Marker VA,Miller AW,Miller BH,et al.Factors affecting the retention and fit of gold castings.J Prosthet Dent.1987,57(4):425-430
    8.Ayad MF,Rosenstiel SF,Hassan MM.Surface roughness of dentin after tooth preparation with different rotary instrumentation.J Prosthet Dent.1996.75(2):122-128
    9.史久慧,马肃,关呈超.金属烤瓷冠肩台制备方法对牙龈健康影响的临床研究.口腔医学研究.2004,20(2):211-212
    10.丁伟山,王铎,曹洪喜等.不同牙本质切割方法的比较.口腔材料器材杂志.1998,7(4):199-200
    11.Amintan A,Brunton PA.A comparison of the depths produced using three different tooth preparation techniques.J Prosthet Dent.2003,89(1):19-22
    12.李玉玲,王庆涛,兰利冲等.金属烤瓷修复体两种牙体预备形式的临床性能比较.华西口腔医学杂志.2004,22(4):323-324
    13.何虹.牙体缺损中全冠修复的牙体预备体会.贵州医药.2005,29(3): 241-242
    14.Herbert T.Shillingberg.固定义齿修复学精要(第三版).北京:人是军医出版社,2005.
    15.Anthony H.L.Tjan,Ruben Sarkissian.Effect of preparation finish on retention and fit of complete crowns.J Prosthet Dent.1986,56(3),283-288
    16.Jeffrey N,Dennis W.Warren S,et al.The taper of clinical preparations for fixed prosthodontics.J Prosthet Dent.1988,60(2):148-151
    17.马轩祥主编.口腔修复学.第5版.北京:人民卫生出版社,2004:101
    18.Weed RW.Suddick RK,Kleffner HL.Taper of clinical and typodont crowns prepared by dental students.J Dent Research.1984,63:286
    19.Dodge WW,Weed RW,Baez RZ,et al.The effect of convergence angle on retention and resistance form.Quintessence Int.1985,16:191-194
    20.Ushiwata O,De Morase JV,Bottino MA,et al.Marginal first of nickel-chromium copings before and after internal adjustments with duplicated stone die and disclosing agent.J P D.2000,83:634-643
    21.Mou SH,Chai T,Wang JS,et al.Influence of different convergence angles and tooth preparation heights on the internal adaptation of Cerec crowns.J Prosthet Dent.2002,87(3):248-255
    22.陈丽萍,华楠,葛艳等.不同牙冠高度与全冠固位力关系的实验分析.上海口腔医学.2004,13(4):308-311
    23.Parker MH,Calverley MJ,Gardner FM,et al.New guidelines for preparation taper.J Prosthet Dent.1993,2(1):61-66
    24.Parker MH,Malone KH 3rd,Trier AC,et al.Evaluation of resistance form for prepared teeth.J Prosthet Dent.1991,66(6):730-733
    25.陈吉华.与牙冠修复相关的牙周组织结构.实用口腔医学杂志,2002,18(4):373-376
    26.Tarnow D,Stahl SS,Magner A,et al.Human gingival attachment responses to subgingival crown placement.Marginal remodelling.J Clin Periodontol.1986,13(6):563-569
    27.Kancyper SG,Koka S.The influence of intracrevicular crown margins on gingival health:Preliminary findings.J Prosthet Dent.2001,85(5):461-465
    28.Gavelis JR.Morency JD,Riley ED,et al.The effect of various finish line preparations on the marginal seal and occlusal seat of full crown preparations.J Prosthet Dent.1981,45(2):138-145
    29.Broderson SP.Complete-crown and partial-coverage tooth preparation designs for bonded cast ceramic restorations.Quintessence Int.1994,25(8):535-539
    30.proos KA,Swain MV,Ironside J,et al.Influence of margin design and taper abutment angle on a restored crown of a first premolar using finite element analysis.Int J Prosthondont.2003,16(4):442-449
    31.Piemjai M.Effect of seating force,margin design,and cement on marginal seal and retention of complete metal crowns.Int J Prosthodont.2001,14(5):412-416
    32.Ayad MF,Rosenstiel SF,Salama M.Influence of tooth surface roughness and type of cement on retention of complete cast crowns.J Prosthet Dent.1997,77(2):116-121
    33.Laufer BZ,Pilo R,Cardash HS.Surface roughness of tooth shoulder preparations created by rotary instrumentation,hand planing,and ultrasonic oscillation.J Prosthet Dent.1996,75(1):4-8
    34.Richter WA,Mitchem JC,Brown JD.Predictability of retentive values of dental cements.J Prosthet Dent.1970,24(3):298-303
    35.吴玮.陈吉华.赵三军.3种水门汀早期溶解性比较研究.口腔医学研究.2007,23(2):194-196
    36.Wilson AD,Crisp S,Lewis BG,et al.Experimental luting agents based on the glass ionoments.Br Dent J.1977,142:117-122
    37.韩宁宁.莫三心.玻璃离子粘结剂凝固初期溶解性的研究.口腔颌面修复学杂志.2002,3(3):190-191
    38.Stephe F,Martin F,Bruce J.Dental luting agents:A review of the current literature.J Prosthet Dent.1998,80:280-301
    39.Gao W,Smalcs RJ,Yip HK.Demincralisation and rcmineralisation of dentine caries,and the role of glass-ionomer cements.Int Dent J.2000,50(1):51-56
    40.Smith DC.Development of glass-ionomer cement system.Biomaterials.1998,19(6):467-478
    41.Cttani-Lorente MA,Dupnis V,Payan J,et at.Effect of water on the physical properties of resin-modified glass ionomer cements.Dental Material.1999,15(1):71-78
    42.Qualtrough AJ,Piddock V.Fitting accuracy of indirect restorations:a review of methods of assessment.Eur J Prosthodont Restor Dent.1992,1(2):57-61.
    43.Wilson PR.Low force cementation.J Dent.1996,24(4):269-73.
    44.万红,杜传诗,吴德全.粘固剂对烤瓷熔附金属底层冠就位的影响.华西口腔医学杂志.1991,9(4):256-258
    45.Eames WB,O'Neal SJ,Monteiro J,et al.Techniques to improve the seating of casting.J Am Dent Assoc.1978,96(3):432-437
    46.Wilson PR.The effect of die spacing on crown deformation and seating time.Int J Prosthodont.1993,6:397-401.
    47.Wilson PR.Goodkind RJ,Delong R and Sakaguchi R.Deformation of crowns during cementation.J Prosthet Dent.1990,64:601-609.
    48.Wylie SG,Wilson PR.An investigation into the pressure transmitted to the pulp chamber on crown cementation:a laboratory study.J Dent Res.1994,73:1684-1689.
    49.Wermilyea SG,Kuffler MJ,Huget EF.The effect of die relief agent on the retention of full coverage castings.J Prosthet Dent.1983,50:207-210
    50.Fusayama T.Relief of resistance of cement of full cast crowns.J Prosthe Dent.1964.18:95-108.
    51.Hoard RJ,Caputo AA,Contino RM,et al.Intracororal pressure during crown cementation.J Prosthet Dent.1978,40(5):520-525
    52.Jorgensen KD,Esbenden AL.The relationship between the film thickness of zinc phosphate cement and the retention of veneer crowns.Acta Odontol Scand.1968,26:169
    53.Phillips.Science of Dental Material.Eight Edition
    54.Vallittu PK,Forss H.Adhesion of glass ionomer cement to a ceramometal alloy.J Prosthet Dent.1997,77(1):12-16
    55.邓危梧.理论力学.上册,重庆:重庆大学出版社,1986:136-150
    56.袁长良,丁志华,武文堂.表面粗糙度及其测量.北京:机械工业出社,1989:21
    57.孙亚波.表面粗糙度的评定参数的解读.中国教育研究与创新.2006,3:119-120
    58.Mitchell CA,Pintado MR,Douglas WH.Nondestructive.in vitro quantification of crown margins.J Prosthet Dent.2001,85(6):575-584
    59.Kazunichi W akabayashi,Taiji Sohmura,Takashi Nakamura,et al.New exalution methodby microfocus radiogaph CT for 3D assessment of internal adaptation of all-ceramic crons.Dent Mater J.2005,24(3):362-367
    60.韩东,伊哲.临床评价全冠修复体适合性的一种方法.实用医技杂志.2005,12(8):2160
    61.Michaelides PL.Use of the operating microscopy in dentistry.J Calif Dent Assoc.1996,24(6):45-50
    62.Kihn PW,Barnes DM.The clinical longevity of porcelain veneers:a 48-month clinical evaluation.J Am Dent Assoc.1998,129:747-752
    63.ISO7711-3:2004(E).Dentistry-Diamond rotary instruments-Part3:Grit sizes,designation and colour code.
    64.Chen J-H,Matsumura H,Atsuta M.Effect of different etching periods on the bond strength of porcelain.J Dent.1998,26:53-58
    65.于淑湘,陈吉华.周泽渊,等.不同粗化处理后瓷表面微观结构的电经研究.中国美容医学.2007,16(3):391-393
    66.张汉平,卫彦,邓旭亮,等.模拟口内喷砂对牙釉质与复合树脂间的粘接 强度的影响.北京大学学报(医学版).2004,36(2):207-209
    67.Attar N,Tam LE,Mc Comb D.Mechanical and physical properties of comtemporary dental luting agents.J Prosthet Dent.2003,89:127-134
    68.Mitchell CA,Douglas WH,Cheng YS.Fracture toughness of convertional,resin-modified glass-ionomer and composite luting cements.Dent Mater.1999,15:7-13
    69.Williams JA,Billington RW,Pearson GJ.The comparative strengths of commercial glass-ionomer cements with and without metal additions.Br Dent J.1992,172:279-282
    70.Sarkar NK.Metal-matrix interface in reinforced glass ionomers.Dent Mater.1999,15:421-425
    71.John W.Nicholson.Adhesive dental materials and their durability.International Journal of Adhesion &Adhesives.2000,20(1):11-16
    72.Yamazaki T,Schricker SR,Brantley WA,et al.Viscoelastic behavior and fracture toughness of six glass-ionomer cements.J Prosthet Dent.2006,96(4):266-72.
    73.Millett DT,Cummings A,Letters S,et al.Resin-modified glass ionomer,modified composite or conventional glass ionomer for band cementation?-an in vitro evaluation.Eur J Orthod.2003,25(6):609-14
    74.马轩祥主编.口腔修复学[M].第5版:北京:人民卫生出版社,2004:129-130
    75.Lopes MB,Consani S,Sinhoreti MA,et al..Influence of recasting palladium-silver alloy on the fit of crowns with different marginal configurations.J Prosthet Dent.2005;94(5):430-434.
    76.Ferrari M,Dagostin A,Fabianelli A.Marginal integrity of ceramic inlays luted with a self-curing resin system.Dent Mater.2003;19(4):270-276.
    77.邬烈,骆小平.固定修复体适合性的研究方法[J].口腔颌面修复学杂志.2007,8(1):68-70
    78.郑庄,唐亮.粘接材料与口腔固定修复的微渗漏(讲座)[J].暨南大学学报 (医学版).2003,24(4):111-114
    79.American Dental Association.ANSI/ADA Specification No.8 for zinc phosphate cement In:Guide to dental materials and devices.5th ed.Chicago,American Dental Association.1970-1971
    80.Mclean JW,Von Fraunhofer JA.The estimation of cement film thickness by an in vivo technique[J].Br Dent J.1971,131(3):111-127
    81.陈治清.管利民.口腔粘接学.北京:北京医科大学、中国协和医科大学联合出版社,1992:18

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