国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (5): 497-505.doi: 10.7518/gjkq.2021097

• 专家笔谈 •    下一篇

浅谈嵌体和高嵌体修复的临床应用

王剑()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心 四川大学华西口腔医院修复科 成都 610041
  • 收稿日期:2020-04-06 修回日期:2021-06-10 出版日期:2021-09-01 发布日期:2021-09-10
  • 作者简介:王剑,教授,博士,Email: <email>ferowang@hotmail.com</email>;王剑,四川大学华西口腔医院修复科教授,博士研究生导师,中华口腔医学会口腔修复专业委员会常务委员,四川省口腔医学会口腔修复专业委员会常务委员,四川省口腔医学会理事,国际牙医师学院院士,四川省卫生健康委员会学术带头人,《华西口腔医学杂志》常务编委,曾于美国哈佛大学牙学院及华盛顿大学牙学院公派博士后研究,主持多项国家级及省部级科研项目,参编多部教材和著作,发表论文100余篇。
  • 基金资助:
    国家自然科学基金(81970985);国家自然科学基金(81771122)

Research progress and clinical application of inlays and onlays

Wang Jian()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2020-04-06 Revised:2021-06-10 Online:2021-09-01 Published:2021-09-10
  • Supported by:
    National Natural Science Foundation of China(81970985);National Natural Science Foundation of China(81771122)

摘要:

全冠修复是后牙牙体缺损最常见的修复方式之一,然而全冠修复由于备牙量大,对患牙抗折性存在潜在影响。随着粘接技术和微创修复的发展,嵌体和高嵌体可以大大减少牙体预备量,有效保存残留牙体组织,已逐渐成为后牙牙体缺损修复的主流形式,得到越来越广泛的应用。本文就嵌体和高嵌体修复的材料、适应证、修复效果、预备要点及粘接等各方面作一讨论,以期为临床工作提供参考。

关键词: 牙体缺损, 嵌体, 高嵌体, 牙体预备, 粘接

Abstract:

A full crown is one of the most widely used restorations for defects in molars. However, the strength of the prepared tooth is compromised because of the large extent of tooth cutting during crown preparation. With the development of bonding technology and mini-invasive restoration, inlays and onlays have become the most popular restorations for defect in molars because the extent of tooth cutting is less than that of crown. This article reviews the mate-rials, indications, advantages, preparation key points, and bonding techniques to provide recommendations for clinical practice.

Key words: tooth defect, inlay, onlay, tooth preparation, adhesion

中图分类号: 

  • R783.3

图1

不同形式的嵌体"

图2

嵌体(左、中)和高嵌体(右)修复后牙齿所受应力示意图"

表 1

不同缺损情况修复方案总结"

缺损情况 活髓牙 根管治疗后的牙齿
??面洞 充填修复或嵌体修复 存在双侧边缘嵴,且壁厚度大于2 mm:充填修复或嵌体修复
洞壁厚度不足:高嵌体
近中-??面、??面-远中洞型 边缘嵴缺失一侧附近有良好支持的牙尖(2.5~3 mm):嵌体
边缘嵴缺失一侧牙尖残留底部厚度不足(2 mm):高嵌体
牙尖底部厚度大于3 mm,可用简单嵌体修复
牙尖底部厚度不足3 mm:高嵌体
MOD洞型 各面厚度都很充足(4~6 mm):嵌体(很少见)
一侧1个或2个牙尖(近中尖或远中尖)厚度不足:高嵌体
2个或多个残留牙尖厚度不足:超嵌体
超嵌体
冠部大量牙体组织缺损 根管治疗后桩核冠修复 桩核冠
釉质大面积受损 全冠 全冠或桩核冠
??龈高度不足3 mm 根管治疗后髓腔固位冠修复 髓腔固位冠

图3

高嵌体的预备步骤 A:牙体预备前;B:预备??面洞型;C:预备邻面洞型;D:预备肩台;E:降低??面,预备对接边缘;F:用抛光针打磨精修各个牙面;G、H:预备完成图;I:预备肩台边缘。"

图4

高嵌体的粘接步骤 A:技工室制作好的瓷嵌体;B:用小粘接棒黏起嵌体;C:用10%氢氟酸酸蚀嵌体内表面90 s,然后用水雾充分冲洗,去除酸蚀剂;D:在嵌体内表面涂布一层硅烷偶联剂,90~120 s后涂布粘接剂;E:上橡皮障隔湿患牙;F:37%磷酸酸蚀30~60 s;G:涂布粘接剂并吹匀;H:将树脂水门汀挤入洞型,就位嵌体后仔细清除多余的水门汀,并用卤素灯光照,每个面至少20 s;I:调??、抛光,完成嵌体粘接。"

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