前牙全瓷悬臂式粘接桥的应用及研究策略

Application and research strategy of all-ceramic cantilever bonded bridge for anterior teeth

背景:全瓷悬臂式粘接桥,其从治疗时间、侵入性、美观性及价格等多方面体现出来的优势,使其成为目前临床口腔前牙美学修复中热门的话题。目的:总结归纳全瓷悬臂式粘接桥临床技术难点上的解决策略以及在前牙应用的优势,并介绍目前现有的全瓷悬臂式粘接桥的临床随访方法,以期在前牙牙列部分缺损的美学修复领域提供临床及科研指导。方法:由第一作者检索Web of Science、PubMed、中国知网和万方数据库检索1955-2021年发表的文献,英文检索词为“Denture,Partial,Fixed,Resin-Bonded,Resin Bonded Bridge,Maryland Bridge,Adhesive bridge,single-retainer,all-ceramic”;中文检索词为“粘接桥、马里兰桥、粘接固定桥、全瓷、悬臂式、单端”,经筛选后纳入60篇文献进行综述分析。结果与结论:①通过选择氧化锆瓷材料进行有效的表面预处理能较好地预防折裂发生;设计近缺隙侧盒状洞形及舌隆突处钉洞固位形为现在专家共识之一,能有效减少粘接桥脱落的发生,提高远期存留效果;在满足适应证的条件下,全瓷悬臂式粘接桥的龋坏牙周病等并发症发生率较低,美学效果好,存留时间长,可作为永久性修复体使用。②对于临床研究,除统计基本的存留率成功率外,推荐同步使用口腔健康相关生活质量表、满意度问卷调查以及美国公共卫生协会修复体评价标准等进行评估,以此全面评估修复效果。③但值得注意的是,不同研究对存留率和成功率的定义不同,对数据统计造成一定的偏差,因此全瓷悬臂式粘接桥的实际临床效果还值得进一步探究。

BACKGROUND:All-ceramic cantilever bonded bridge has become a hot topic in the clinical aesthetic restoration of anterior teeth due to its advantages in treatment time,invasiveness,aesthetics and price.OBJECTIVE:To summarize the solutions to the clinical technical difficulties of all-porcelain cantilever bonded bridge and its advantages in the application of anterior teeth,and to introduce the clinical follow-up methods of the existing all-porcelain cantilever bonded bridge,in order to provide clinical and scientific guidance in the field of aesthetic repair of partial dentition defects of anterior teeth.METHODS:The articles published from 1955 to 2021 were retrieved by the first author on Web of Science,PubMed,CNKI,and Wanfang databases.The English search terms were“denture,partial,fixed,resin-bonded,resin bonded bridge,Maryland bridge,adhesive bridge,single-retainer,all-ceramic”.The Chinese search terms were“bonded bridge,Maryland bridge,adhesive bridge,all-ceramic,cantilever,single-retainer”.Totally 60 articles were summarized for review after screening.RESULTS AND CONCLUSION:(1)Effective surface pretreatment with zirconia ceramic material could prevent the occurrence of fracture.Designing the retention form of the box-shaped hole near the gap side and the nail hole at the bulge of the tongue is one of the current consensus of experts,which can effectively reduce the occurrence of bonded bridge shedding and improve the long-term retention effect.Under the condition of meeting the indications,the all-ceramic cantilever adhesive bridge has the advantages of low incidence of complications such as caries and periodontal disease,good aesthetic effect,and long retention time,and can be used as a permanent restoration.(2)For clinical studies,in addition to counting the basic success rate of retention rate,it is recommended to simultaneously use the oral health-related quality of life questionnaire,satisfaction questionnaire,and the American Public Health Association prosthesis evaluation criteria to comprehensively evaluate the repair effect.(3)It should be noted that different studies have defined the retention rate and success rate differently,which makes certain deviation for data statistics.Therefore,the actual clinical effect of all-ceramic cantilever bonded bridge is worthy of further investigation.