Schwendicke F, Kern M, Dörfer C, Kleemann-Lüpkes J, Paris S, Blunck U
Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Prosthodontics, Propaedeutics and Dental Materials, Christian-Albrechts Universität, Kiel, Germany.
J Dent. 2015 Mar;43(3):327-34. doi: 10.1016/j.jdent.2014.12.014. Epub 2014 Dec 31.
Selective (incomplete) caries excavation reduces the risk of pulpal complications, but might compromise the properties of teeth or restorations. Different restorative approaches might be required after selective instead of complete excavation. We compared margin integrity, micro-leakage and fracture resistance of selectively excavated and differently restored premolars in vitro.
In 72 extracted human premolars, artificial residual lesions were induced on pulpo-axial walls of standardized cavities. Teeth were restored using one of three bonding systems (OptiBond FL, Clearfil SE Bond, G-aenial Bond) and a fibre-enforced (EverX) or standard hybrid composite resin (Filtek Z250). After thermo-mechanical cycling, groups (n = 12) were compared regarding their gingivo-cervical margin integrity (proportion of acceptable margins), microleakage depth, and fracture resistance, with statistical evaluation using generalized linear modelling.
Margin integrity was significantly influenced by the bonding system (p < 0.001), but not by the composite (p = 0.105). Proportions of acceptable margins were increased in teeth restored with OptiBond FL (median [25th/75th percentiles]: 93 [78/100%]) or Clearfil SE (82 [60/94]%) compared with G-aenial Bond (43 [15/74%]; p < 0.05). Neither bonding systems nor composites significantly influenced leakage depth in enamel (p = 0.749/0.569) or dentine (p = 0.112/0.909). Fracture resistance was significantly influenced by bonding system (p = 0.008) and composite (p = 0.001), and was higher in teeth restored using OptiBond FL (mean [SD]: 1210 [336]N) compared with Clearfil SE (1007 [208]N) or G-aenial Bond (1023 [281]N, p < 0.05), and using EverX (1182 [314]N) instead of Filtek Z250 (979 [228]N; p < 0.01).
Bonding systems which perform well in completely excavated teeth also yielded good results for selectively excavated teeth in vitro. Using fibre-enforced composites to restore selectively teeth increased fracture resistance.
Bonding systems which perform well in completely excavated teeth are also suitable for restoring selectively excavated teeth. Using fibre-enforced composites seems suitable for increasing the fracture resistance of selectively excavated teeth and their restorations.
选择性（不完全）龋洞预备可降低牙髓并发症的风险，但可能会影响牙齿或修复体的性能。与完全龋洞预备相比，选择性龋洞预备后可能需要不同的修复方法。我们在体外比较了选择性龋洞预备并采用不同修复方式的前磨牙的边缘完整性、微渗漏和抗折强度。
在72颗拔除的人前磨牙上，在标准化洞型的髓轴壁上诱导人工残留龋损。使用三种粘结系统（OptiBond FL、Clearfil SE Bond、G-aenial Bond）之一和纤维增强型（EverX）或标准混合型复合树脂（Filtek Z250）对牙齿进行修复。经过热循环后，比较各实验组（n = 12）的龈颈边缘完整性（可接受边缘的比例）、微渗漏深度和抗折强度，并使用广义线性模型进行统计评估。
边缘完整性受粘结系统的显著影响（p < 0.001），但不受复合树脂的影响（p = 0.105）。与G-aenial Bond（43 [15/74%]）相比，使用OptiBond FL（中位数[第25/75百分位数]：93 [78/100%]）或Clearfil SE（82 [60/94]%）修复的牙齿中可接受边缘的比例增加（p < 0.05）。粘结系统和复合树脂均未对釉质（p = 0.749/0.569）或牙本质（p = 0.112/0.909）中的渗漏深度产生显著影响。抗折强度受粘结系统（p = 0.008）和复合树脂（p = 0.001）的显著影响，与使用Clearfil SE（1007 [208]N）或G-aenial Bond（1023 [281]N，p < 0.05）相比，使用OptiBond FL修复的牙齿抗折强度更高（平均值[标准差]：1210 [336]N），与使用Filtek Z250（979 [228]N；p < 0.01）相比，使用EverX修复的牙齿抗折强度更高（1182 [314]N）。
在完全龋洞预备的牙齿中表现良好的粘结系统在体外对选择性龋洞预备的牙齿也产生了良好的效果。使用纤维增强型复合树脂修复选择性龋洞预备的牙齿可提高抗折强度。
在完全龋洞预备的牙齿中表现良好的确粘结系统也适用于修复选择性龋洞预备的牙齿。使用纤维增强型复合树脂似乎适用于提高选择性龋洞预备的牙齿及其修复体的抗折强度。
