椅旁CAD/CAM修复失败相关因素的回顾分析

A retrospective analysis of factors related to the failure of ceramic restorations with chairside CAD/CAM

目的探讨椅旁CAD/CAM牙体修复方式、修复材料以及修复牙位与修复体失败的关系;分析修复体失败的原因,以期提高椅旁CAD/CAM修复治疗成功率。方法选取2016年11月至2019年10月就诊于山东大学口腔医院牙体牙髓科经椅旁CAD/CAM修复治疗的患者4468名。其中男性2060名、女性2408名,年龄18~80岁。收集患者信息包括姓名、性别、年龄、修复方式(嵌体、高嵌体、贴面、全冠)、修复材料(VitablocksⅡ、IPS e.max CAD、Celtra Duo、Vita Suprinity、Vita Enamic、Lava Ultimate)、牙位(上颌牙、下颌牙、前牙、前磨牙、磨牙)、是否需要更换修复体及更换原因等。计数资料描述为频数和率。采用Logistic回归分析计算比值比(OR),探讨失败的相关危险因素。采用SAS 14统计软件进行数据处理,所有检验均为双尾检验,P<0.05为差异有统计学意义。结果4468名患者共4933颗患牙中失败病例160颗,总失败率为3.2%。修复方式中贴面的失败率最高,失败风险高(P=0.014),其次为冠和嵌体,高嵌体失败率最低;修复材料中VitablocksⅡ失败率最高,失败风险高(P=0.016),其次是Celtra Duo(P=0.033);牙位中上颌牙比下颌牙失败率高,失败风险高(P=0.015);前牙失败率最高,失败风险高(P=0.005),其次为磨牙,前磨牙失败率最低。结论采用任何一种椅旁CAD/CAM修复方式及修复材料都有一定的失败率,修复体失败与多种因素相关。采用椅旁CAD/CAM修复技术应严格把握适应证、选择合适的修复方式及材料、规范临床操作,减少修复体并发症,降低椅旁CAD/CAM系统的临床失败率。

Objective The aim of this study was to investigate and analyze the relationship between the methods of restorations,restorative materials,tooth position and the failure of ceramic restorations fabricated with chairside CAD/CAM system.Methods A total of 4505 patients with ceramic restorations fabricated with chairside CAD/CAM were collected in Department of Endodontics of Stomatology Hospital of Shandong University from November 2016 to October 2019.Among them,2078 were males and 2427 were females,aged from 18 to 80 years old.The information of the patients was collected including name,gender,age,methods of restoration(inlay,onlay,veneer,full crown),restorative materials(VitablocksⅡ,IPS e.max CAD,Celtra Duo,Vita Suprinity,Vita Enamic,Lava Ultimate),tooth position(maxillary teeth,mandibular teeth,anterior teeth,premolar and molar),whether to replace restoration or not and reasons for replacement of restoration,et al.The counting data was described as frequency and rate.Logistic regression analysis was used to investigate risk factors associated with failure of ceramic restorations.SAS 14 statistical software was used for data analysis.All tests were double-tailed,and P<0.05 was considered statistically significant.Results A total of 4933 restorations were included,among which 160(3.2%)restorations were failure.The failure rate of veneer was the highest among all methods of restorations,followed by crown,inlay,and onlay.Meanwhile the failure risk of veneer was statistically significant(P=0.014).Among the restorative materials,the failure rate of VitablocksⅡwas the highest,and the risk was statistically significant(P=0.016)compared with other materials,the failure rate of Vita Enamic and Celtra Duo was lower,and the risk of Celtra Duo was statistically significant(P=0.033).The failure rate of maxillary teeth restorations was higher than that of mandibular teeth restorations(P=0.015).The failure rate of anterior teeth restorations was the highest,followed by molar restorations,and the failure rate of premolar restorations was lowest,and the risk of anterior teeth was statistically significant(P=0.005).Conclusions The failure of ceramic restorations fabricated with chairside CAD/CAM system may occur among any methods of restorations,restorative materials and tooth position,and the failure was related to many factors.Therefore,when applying of chairside CAD/CAM technology for ceramic single-tooth restorations,the dentists should strictly grasp the indications,select the appropriate restoration methods and materials,standardize the clinical operation to reduce the restoration complications and the clinical failure rate of restorations with chairside CAD/CAM.