Dietschi Didier, Duc Olivier, Krejci Ivo, Sadan Avishai
Department of Cariology and Endodontics, School of Dentistry, University of Geneva, Geneva, Switzerland.
Quintessence Int. 2008 Feb;39(2):117-29.
The restoration of endodontically treated teeth has long been guided by empirical rather than biomechanical concepts. Part I of this literature review presented up-to-date knowledge about changes in tissue structure and properties following endodontic therapy, as well as the behavior of restored teeth in monotonic mechanical tests or finite element analysis. The aim of the second part is to review current knowledge about the various interfaces of restored, nonvital teeth and their behavior in fatigue and clinical studies.
The basic search process included a systematic review of articles contained in the PubMed/Medline database, dating between 1990 and 2005, using single or combined key words to obtain the most comprehensive list of references; a perusal of the references of the references completed the review.
Nonvital teeth restored with composite resin or composite resin combined with fiber posts resisted fatigue tests and currently represent the best treatment option. In comparison to rigid metal and/or ceramic posts, when composite resin or composite resin/fiber posts fail, the occurrence of interfacial defects or severe tooth breakdown is less likely. Adhesion into the root, however, remains a challenge because of the unfavorable ovoid canal configuration, as well as critical dentin microstructure in the deepest parts of the canal. Thus, specific combinations of adhesives and cements are recommended. The clinical performance of post-and-core restorations proved satisfactory overall, in particular with a contemporary restorative approach using composite resin and fiber posts. However, the clinical literature does not clearly isolate or identify exact parameters critical to success. This, in turn, emphasizes the importance and relevance of in vitro studies to further improve the quality and long-term stability of prosthetic foundations.
长期以来，牙髓治疗后牙齿的修复一直受经验而非生物力学概念的指导。本综述的第一部分介绍了牙髓治疗后组织结构和性能变化的最新知识，以及修复后牙齿在单调力学测试或有限元分析中的行为。第二部分的目的是综述关于修复后的无活力牙齿的各种界面及其在疲劳和临床研究中的行为的当前知识。
基本检索过程包括系统检索1990年至2005年间PubMed/Medline数据库中包含的文章，使用单个或组合关键词以获取最全面的参考文献列表；查阅参考文献的参考文献以完成综述。
用复合树脂或复合树脂与纤维桩联合修复的无活力牙齿能够抵抗疲劳测试，目前是最佳治疗选择。与刚性金属和/或陶瓷桩相比，当复合树脂或复合树脂/纤维桩失效时，界面缺陷或严重牙齿崩解的发生可能性较小。然而，由于根管呈不利的卵形结构以及根管最深处关键的牙本质微观结构，根管内的粘结仍然是一个挑战。因此，推荐使用特定的粘结剂和水门汀组合。桩核修复体的临床性能总体上令人满意，特别是采用复合树脂和纤维桩的现代修复方法。然而，临床文献并未明确分离或确定对成功至关重要的确切参数。这反过来强调了体外研究对于进一步提高修复体基础质量和长期稳定性的重要性和相关性。
