活髓后牙(高)嵌体修复2年的临床疗效及失败病例分析

A 2-year clinical study of inlay and onlay on posterior teeth with vital pulp

目的探讨活髓后牙较大缺损(两面或多面洞)嵌体修复2年的临床疗效及失败病例分析。方法本研究为56位患者60颗患牙制作金钯嵌体33例、金钯高嵌体13例及铸瓷嵌体(Empress2)14例,随诊2年,统计生存率,并用改良USPHS系统对2年的随访结果进行评估。结果所有修复体2年生存率为90.0%,前磨牙与磨牙修复体及3种修复体间生存率无显著差异。按USPHS评估系统逐条分析发现铸瓷嵌体与金钯(高)嵌体在解剖形态、边缘密合度、继发龋坏、牙髓活力各项标准均一致。失败的主要原因是修复体脱落、牙髓炎、瓷崩裂和继发龋坏。结论金钯(高)嵌体适合咬合力较大的患者,金钯高嵌体能保存活髓并最大程度恢复患牙的功能;在恰当选择适应证和遵守严格的生物力学原则下,使用牙色修复材料铸瓷嵌体能取得良好临床功能及美学效果。

Objective To evaluate the clinical effect of inlay/onlay （gold-palladium alloy） and inlay （ Empress 2） on seriously defected posfior teeth（ two or multi-surface cavity） with vital pulp and analyze the possible failure reason. Methods In this study, 33 gold-palladium inlay, 13 gold-palladium onlay and 14 Empress inlay were made for 56 patients and followed up for 2 years. The survival rates were recorded and the results evaluated with modified USPHS evaluation system. Results The 2 years survival rate was 90. 0% for all restorations. The survival rates between premolars and molars and among the three kinds of restorations were not significantly different When analysed item by item with USPHS evaluation criterion, Empress inlay was similar to gold-palladium inlay/onlay in anatomical form, marginal adaptation, secondary caries and pulp vitality. The causes of failure were mainly crown dropping, pulpitis, ceramic fracture and secondary caries. Conclusion The gold-palladium inlay/onlay can be used for patients with strong occlusal force. The gold-palladium onlay has advantage of protecting dental pulp and recovering function and form. Under proper indicatons and following strict biomechanical principle, tooth-colored Empress inlay can achieve good restoration outcome and esthetic effect