Frankenberger Roland, Krämer Norbert, Lohbauer Ulrich, Nikolaenko Sergej A, Reich Sven M
Dental Clinic 1, Operative Dentistry and Periodontology, University of Erlangen-Nuremberg, Erlangen, Germany.
J Adhes Dent. 2007;9 Suppl 1:107-16.
In vitro testing of dental materials is daily routine for the preclinical investigation of restoratives. Although clinical trials remain the ultimate instrument, preclinical screenings are still important. However, it is still not fully understood whether clinical performance is predictable in the lab. The aim of this paper is to combine known facts and recent results to answer the question concerning in vitro predictability of clinical marginal integrity and related outcome.
(a) The literature in the field from 1990-2005 was analyzed regarding marginal integrity in vitro and in vivo, especially in frequently cited papers. (b) Five different adhesives, a 4-step etch-and-rinse adhesive (Syntac), a 3-step etch-and-rinse adhesive (OptiBond FL), a 2-step etch-and-rinse adhesive (Single Bond), a 2-step self-etching adhesive (Clearfil SE Bond), and a 1-step self-etching adhesive (Xeno III) were used for bonding of a resin composite (Tetric Ceram) in Class I cavities (n = 8 in vitro and n = 8 in vivo). In vitro, the restorations were thermomechanically loaded (TML; 100,000 with 50 N and 2500 cycles of 5 degrees C/55 degrees C) according to a previously published protocol. Replicas of restorations were analyzed initially and after TML (in vitro) and two years of clinical service (respectively).
(a) Marginal integrity is reliably predictable in laboratory in vitro studies by simulating clinical circumstances. However, marginal analyses of direct restorations in vitro still suffer from not being able to determine a lower boderline, ie, actually worse in vitro results may still result in acceptable restorations in vivo. (b) The in vitro-in vivo comparison revealed significantly better marginal adaptation in (enamel) margins when etch-and-rinse adhesives were used for bonding. After 2 years of clinical service, restorations bonded with self-etching adhesives did not clinically fail but exhibited significantly more marginal gaps.
Clinical behavior of restoration margins is predictable. However, marginal adaptation is only one among several important aspects in restorative dentistry, ie, clinical outcome is not predictable from marginal integrity alone.
牙科材料的体外测试是修复体临床前研究的日常工作。尽管临床试验仍是最终手段，但临床前筛查仍很重要。然而，实验室中临床性能是否可预测仍未完全明确。本文旨在结合已知事实和最新研究结果，回答关于临床边缘完整性及相关结果的体外可预测性问题。
(a) 分析了1990年至2005年该领域关于体外和体内边缘完整性的文献，特别是经常被引用的论文。(b) 使用五种不同的粘结剂，一种四步酸蚀冲洗粘结剂（Syntac）、一种三步酸蚀冲洗粘结剂（OptiBond FL）、一种两步酸蚀冲洗粘结剂（Single Bond）、一种两步自酸蚀粘结剂（Clearfil SE Bond）和一种一步自酸蚀粘结剂（Xeno III），在I类洞型中粘结树脂复合材料（Tetric Ceram）（体外n = 8，体内n = 8）。在体外，根据先前公布的方案对修复体进行热机械加载（TML；100,000次，50 N，2500个5℃/55℃循环）。最初以及在TML后（体外）和两年临床使用后（分别）对修复体的复制品进行分析。
(a) 通过模拟临床情况，在实验室体外研究中边缘完整性可可靠预测。然而，直接修复体的体外边缘分析仍存在无法确定下限的问题，即实际上较差的体外结果在体内仍可能产生可接受的修复体。(b) 体外 - 体内比较显示，使用酸蚀冲洗粘结剂进行粘结时，（牙釉质）边缘的边缘适应性明显更好。临床使用两年后，用自酸蚀粘结剂粘结的修复体在临床上未失败，但边缘间隙明显更多。
修复体边缘的临床行为是可预测的。然而，边缘适应性只是修复牙科几个重要方面之一，即临床结果不能仅从边缘完整性来预测。
