数字化椅旁CAD/CAM系统制作高嵌体修复后牙牙体缺损1100例的临床分析

Clinical analysis of digital chair-side CAD/CAM system in manufacturing onlay repair of 1100 cases of posterior teeth defects

目的:分析数字化椅旁计算机辅助设计/计算机辅助制造(computer-aided design/computer-aided manufacturing,CAD/CAM)系统制作高嵌体修复后牙牙体缺损的临床应用价值。方法:研究对象为2016年1月~2018年1月在川北医学院附属医院口腔科接受CAD/CAM系统制作高嵌体修复后牙牙缺损的1100例患者,共计1249颗患牙;分别于修复后即刻、修复后6个月时采用按照改良的美国公共卫生协会(United States Public Health Service,USPHS)评价标准评价疗效。结果:数字化椅旁CAD/CAM系统制作高嵌体1249个,经修复治疗后均成功回访;修复后即刻修完整性、边缘密合性、牙周状态、修复体固位达A级比重分别为90.07%、98.64%、100.00%、95.28%,且未发生边缘着色及继发龋。修复6个月后,修复体在完整性、修复体颜色匹配度上与修复后即刻比较,差异均无统计学意义(P>0.05);但边缘密合性、牙周状态、修复体固位较修复后即刻均有显著改善(P<0.05)。且完整性、边缘密合性、修复体固位达B级患者中修复体厚度<1 mm比重及髓高嵌体余留牙壁厚度<1 mm比重均显著高于A级(P<0.05)。结论:数字化椅旁CAD/CAM系统制作高嵌体修复后牙牙体缺损具良好的临床获益,部分修复体完整性、边缘密合性、固位欠佳或与修复体厚度、髓高嵌体余留牙壁厚度有关,值得临床重视。

Objective:To analyze the clinical application value of digital chair-side computer-aided design/computer-aided manufacturing(CAD/CAM)system in manufacturing onlay repair of posterior teeth defects.Methods:The study subjects were 1100 patients who underwent CAD/CAM system to make onlay to repair posterior teeth defects,1249 affected teeth in total.The improved United States Public Health Service(USPHS)evaluation criteria was used to evaluate efficacy immediately after repair and at 6 months after repair.Results:Totally 1249 onlays were made by chair-side CAD/CAM system,which were successfully returned after repair and treatment.Immediately after repair,the proportions of integrity,marginal adhesion,periodontal status and restoration retention reaching grade A were 90.07%,98.64%,100.00% and 95.28%,and there were no edge coloring and secondary caries.After 6 months of repair,there were no statistically significant differences in the the restoration integrity and color matching compared with those immediately after repair(P>0.05).However,the edge adhesion,periodontal status and restoration retention were significantly improved compared with those immediately after repair(P<0.05).The proportion of thickness of restoration <1 mm and the proportion of thickness of residual dental wall in pulp onlay<1 mm in patients with integrity,marginal adhesion and restoration retention reaching grade B were significant higher than those of patients reaching grade A(P<0.05).Conclusion:Digital chair-side CAD/CAM system has a good clinical benefit in manufacturing onlay repair of posterior teeth defects,and partial restoration integrity,manufacturing onlay repair adhesion and poor retention or may be related to thickness of restoration and thickness of residual dental wall in pulp onlay,which deserves clinical attention.