Peumans M, Van Meerbeek B, Yoshida Y, Lambrechts P, Vanherle G
Department of Operative Dentistry and Dental Materials, School of Dentistry, Oral Pathology and Maxillo-Facial Surgery, Catholic University of Leuven, Belgium.
Dent Mater. 1999 Mar;15(2):105-19. doi: 10.1016/s0109-5641(99)00020-2.
The porcelain veneer technique bonds a thin porcelain shell to a minimally prepared tooth surface (enamel and/or dentin) with a luting composite in combination with an adhesive system. When complete, two adhesive interfaces are formed--resin to etched porcelain and resin to tooth structure. The purpose of this laboratory investigation is to analyze the ultra-structure of these two adhesive interfaces in order to find an explanation for some clinical phenomena and/or shortcomings of bonded porcelain veneers.
The surfaces of four porcelain disks were treated successively by sandblasting, etching with hydrofluoric acid, ultrasonic cleaning, and silanizing. The effect of each step on the surface structure of the porcelain was evaluated by field-emission scanning electron microscopy (FE-SEM). In addition, the effect of acid etching the tooth surface of veneer preparations on seven extracted upper anterior teeth was similarly determined. Finally, pre-treated porcelain veneers were luted to veneer preparations on 12 extracted upper anterior teeth by means of a contemporary total-etch adhesive system and a photo-polymerizable luting composite. The tooth/luting composite and the luting composite/porcelain interface of the veneer complex were then evaluated ultra-morphologically by FE-SEM after the specimens had been etched with an argon-ion beam to enhance the surface relief.
FE-SEM imaging of the tooth/luting composite/porcelain interface showed strong micro-mechanical interlocking of the luting composite in the micro-retentive pits both of the acid-etched tooth surface and in the etch pits of the acid-etched porcelain surface. From this ultra-morphological perspective, the etched porcelain surface is more retentive than the etched tooth surface. At the tooth surface, cervical aprismatic enamel and exposed dentin showed the least resin-receptive surface texture. However, in these areas, no separation of the interface was observed when a multi-step total-etch adhesive system was used.
The strong interlocking of the luting composite into the retentive etch pits of both the porcelain and tooth substrates contributes to strong adhesion of porcelain veneers with good retention. This study suggests that a modern multi-step total-etch adhesive system can produce adhesion even to the less retentive cervical enamel and exposed dentin. Further clinical research is necessary to evaluate the long-term retention of porcelain veneers and to correlate these in vitro observations with clinical performance.
瓷贴面技术通过粘结性复合树脂结合粘结系统，将一层薄瓷壳粘结到经过最小限度预备的牙齿表面（牙釉质和/或牙本质）。完成后，会形成两个粘结界面——树脂与酸蚀处理后的瓷以及树脂与牙齿结构。本实验室研究的目的是分析这两个粘结界面的超微结构，以便为粘结瓷贴面的一些临床现象和/或缺点找到解释。
对四个瓷盘表面依次进行喷砂、氢氟酸蚀刻、超声清洗和硅烷化处理。通过场发射扫描电子显微镜（FE - SEM）评估每一步骤对瓷表面结构的影响。此外，同样测定酸蚀七颗拔除的上前牙的贴面预备体的牙齿表面所产生的效果。最后，通过一种当代的全酸蚀粘结系统和一种可光固化的粘结性复合树脂，将预处理后的瓷贴面粘结到十二颗拔除的上前牙的贴面预备体上。在用氩离子束蚀刻标本以增强表面起伏后，通过FE - SEM对贴面复合体的牙齿/粘结性复合树脂和粘结性复合树脂/瓷界面进行超微形态学评估。
牙齿/粘结性复合树脂/瓷界面的FE - SEM成像显示，粘结性复合树脂在酸蚀处理后的牙齿表面的微固位坑以及酸蚀处理后的瓷表面蚀刻坑中均呈现出强烈的微机械锁合。从这种超微形态学角度来看，酸蚀处理后的瓷表面比酸蚀处理后的牙齿表面更具固位性。在牙齿表面，颈部棱柱形牙釉质和暴露牙本质的树脂接受性表面纹理最少。然而，当使用多步骤全酸蚀粘结系统时，在这些区域未观察到界面分离。
粘结性复合树脂与瓷和牙齿基底的固位蚀刻坑之间的强锁合有助于瓷贴面的强粘结性和良好固位。本研究表明，一种现代的多步骤全酸蚀粘结系统甚至可以与固位性较差的颈部牙釉质和暴露牙本质产生粘结。有必要进行进一步的临床研究，以评估瓷贴面的长期固位情况，并将这些体外观察结果与临床性能相关联。
