复合树脂直接粘接修复技术在前牙美学修复中的应用

Application of adhesive composite resins in direct esthetic anterior restoration

复合树脂充填材料用于牙体修复已超过半个世纪的时间,随着科技的进步,粘接系统和复合树脂材料已达到既牢固又美观的临床使用要求,成为牙体直接修复中的首选技术。复合树脂直接粘接修复技术的适应证包括修复各种原因造成的前牙牙体缺损及色泽、形态的异常等,修复的最终目的是恢复患牙的形态和美观。对于牙釉质的粘接需使用磷酸酸蚀粘接系统,对于牙本质的粘接则使用全酸蚀或自酸蚀牙本质粘接系统,修复材料则应选择复合树脂材料。修复中可根据患者的要求及患牙的条件选择单色、双色和多色树脂修复技术,以满足不同的美学修复目标。唇舌侧贯通的牙体组织缺损,应在舌侧充填具有遮色效果的树脂以减小口腔暗背景对修复体色泽的影响。唇面缺损的修复应体现牙体组织的细节和个性化解剖特征。对于外伤冠折牙齿的美学修复,可以用粘接系统将断离牙冠与剩余牙体组织对位粘接,必要时还可以用纤维桩增强固位。复合树脂直接粘接修复技术有保守、隐形、快捷等优势,但不适用于牙体组织缺损过大、色泽等严重异常的患牙。

Composite resin materials have been intro- duced into operative dentistry for over 50 years. Along with the improvement of material sciences, the performance of ad- hesive systems and composite resins may fulfill the clinical re- quirement for the filling materials nowadays. Composite fill- ings have already been the first choice of direct restorations in operative dentistry. The indications of anterior composite resto- ration include various types of coronal defects of tooth. Acid etching techn{que should be used for the adhesion to enamel surfaces and total etching or self-etching adhesive systems should be adopted for the adhesion to dentinal surfaces. The filling materials should mostly be the composite resins. Single layer, double layer and multiple layer filling techniques can be conducted for various esthetic demands of patients. For the restoration of Class IV cavity, the opaque shades of composite resins should be used in the lingual surface. For the restora- tion of defects involving labial surface, the enamel shades of composite resins should be used for mimic the texture and anatomy of labial surface of tooth. Dental adhesive systems can also be employed in restoration of coronal fracture of ante- rior teeth due to trauma. The direct adhesive restoration tech- nique possesses the advantages of conservation, ＂being invisi- ble＂, simpleness and convenience. However it is not suitable for restoring those teeth with severe coronal defects.