Deliperi Simone, Bardwell David N
Tufts University School of Dental Medicine, Boston, MA, USA.
J Esthet Restor Dent. 2006;18(5):256-65; discussion 266-7. doi: 10.1111/j.1708-8240.2006.00033.x.
Composite resins have esthetic properties; they join the ability to preserve and reinforce sound tooth structure. Conservation is becoming popular for both small to medium defects and more compromised teeth.
This study aimed to evaluate the clinical performance of Class II cuspal coverage direct composite restorations.
Twenty patients, 18 years or older, were included in this clinical trial restoring 25 vital molar teeth with one or two missing cusps. Criteria for inclusion are two or three surface restorations, replacement of composite and amalgam fillings (secondary decay, fracture of either filling material or tooth structure, aesthetic considerations), or virgin teeth with decay undermining a cusp. Teeth with residual cavity walls less than 1 mm or with complete loss of the clinical crown were excluded. Teeth were restored using a combination of Ultra-Etch 35% phosphoric acid, PQ1 adhesive system, and Vit-l-escence microhybrid composite resin (Ultradent Products, Inc., South Jordan, UT, USA). The enamel peripheral skeleton of the restoration was built up first, followed by dentin and enamel occlusal surface stratification. Wedge-shaped increments of composite resin were placed and cured using the variable intensity polimerizer (VIP) light (Bisco Inc., Schaumburg, IL, USA) through a combination of a pulse and progressive curing technique.
All 25 restorations were evaluated at 6-month intervals during the 30-month period using a modified US Public Health Service (USPHS) criteria by two independent evaluators precalibrated at 85% reliability. No failures were reported and alpha scores were recorded for all parameters. Statistical analysis was performed using a Chi-square test (chi(2)) and the Fisher's exact test. Sixteen of the 25 samples (64%) exhibited preoperative sensitivity to air (chi(2)=10.6; p=0.001). A significant difference in tooth sensitivity was reported after completion of the restorations. No teeth exhibited sensitivity both at the 2-week recall and the 30-month follow-up (chi(2)=23.5; p < 0.0001).
Microhybrid composite resin demonstrated excellent clinical performance in direct cuspal coverage at completion of a 30-month evaluation. CLINICAL SIGNIFICANCE In selected clinical situations, cuspal coverage direct posterior composite restorations may represent a valid alternative to conventional indirect restorations.
复合树脂具有美学特性；它们兼具保存和加固健康牙体组织的能力。对于中小龋损以及情况更复杂的牙齿，保存修复正变得越来越流行。
本研究旨在评估Ⅱ类牙尖覆盖直接复合树脂修复体的临床性能。
本临床试验纳入了20名18岁及以上的患者，他们的25颗活髓磨牙存在一个或两个牙尖缺失。纳入标准为两到三个面的修复、复合树脂和银汞合金充填体的替换（继发龋、充填材料或牙体组织折断、美学考虑因素），或龋损累及牙尖的未治疗牙齿。剩余洞壁小于1mm或临床牙冠完全缺失的牙齿被排除。使用Ultra-Etch 35%磷酸、PQ1粘结系统和Vit-l-escence微混合复合树脂（美国犹他州南乔丹市Ultradent Products公司）联合对牙齿进行修复。修复体的釉质周边支架先构建，随后是牙本质和釉质咬合面分层。通过脉冲和渐进固化技术相结合的方式，使用可变强度聚合器（VIP）光（美国伊利诺伊州绍姆堡市Bisco公司）放置并固化复合树脂的楔形增量。
在30个月期间，每隔6个月由两名预先校准可靠性为85%的独立评估者使用改良的美国公共卫生服务（USPHS）标准对所有25个修复体进行评估。未报告失败情况，所有参数均记录了α评分。使用卡方检验（χ²）和费舍尔精确检验进行统计分析。25个样本中有16个（64%）术前对空气敏感（χ² = 10.6；p = 0.001）。修复完成后，牙齿敏感性有显著差异。在2周复诊和30个月随访时均无牙齿表现出敏感（χ² = 23.5；p < 0.0001）。
在30个月的评估结束时，微混合复合树脂在直接牙尖覆盖方面表现出优异的临床性能。临床意义：在特定临床情况下，牙尖覆盖直接后牙复合树脂修复可能是传统间接修复的有效替代方法。
