Mainjot A K, Dupont N M, Oudkerk J C, Dewael T Y, Sadoun M J
Dental Biomaterials Research Unit (d-BRU) and Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège (ULg) and University of Liège Hospital (CHU), Liège, Belgium
Dental Biomaterials Research Unit (d-BRU) and Department of Fixed Prosthodontics, Institute of Dentistry, University of Liège (ULg) and University of Liège Hospital (CHU), Liège, Belgium.
J Dent Res. 2016 May;95(5):487-95. doi: 10.1177/0022034516634286. Epub 2016 Mar 1.
Indirect composites have been undergoing an impressive evolution over the last few years. Specifically, recent developments in computer-aided design-computer-aided manufacturing (CAD-CAM) blocks have been associated with new polymerization modes, innovative microstructures, and different compositions. All these recent breakthroughs have introduced important gaps among the properties of the different materials. This critical state-of-the-art review analyzes the strengths and weaknesses of the different varieties of CAD-CAM composite materials, especially as compared with direct and artisanal indirect composites. Indeed, new polymerization modes used for CAD-CAM blocks-especially high temperature (HT) and, most of all, high temperature-high pressure (HT-HP)-are shown to significantly increase the degree of conversion in comparison with light-cured composites. Industrial processes also allow for the augmentation of the filler content and for the realization of more homogeneous structures with fewer flaws. In addition, due to their increased degree of conversion and their different monomer composition, some CAD-CAM blocks are more advantageous in terms of toxicity and monomer release. Finally, materials with a polymer-infiltrated ceramic network (PICN) microstructure exhibit higher flexural strength and a more favorable elasticity modulus than materials with a dispersed filler microstructure. Consequently, some high-performance composite CAD-CAM blocks-particularly experimental PICNs-can now rival glass-ceramics, such as lithium-disilicate glass-ceramics, for use as bonded partial restorations and crowns on natural teeth and implants. Being able to be manufactured in very low thicknesses, they offer the possibility of developing innovative minimally invasive treatment strategies, such as "no prep" treatment of worn dentition. Current issues are related to the study of bonding and wear properties of the different varieties of CAD-CAM composites. There is also a crucial need to conduct clinical studies. Last, manufacturers should provide more complete information regarding their product polymerization process, microstructure, and composition, which significantly influence CAD-CAM material properties.
在过去几年中，间接复合材料经历了令人瞩目的发展。具体而言，计算机辅助设计-计算机辅助制造（CAD-CAM）块体的最新进展与新的聚合模式、创新的微观结构和不同的成分相关联。所有这些最新突破都在不同材料的性能之间造成了重要差距。这篇关键的综述分析了不同种类CAD-CAM复合材料的优缺点，特别是与直接和手工间接复合材料相比。事实上，用于CAD-CAM块体的新聚合模式——尤其是高温（HT），最重要的是高温高压（HT-HP）——与光固化复合材料相比，显示出显著提高了转化率。工业生产过程还允许增加填料含量，并实现具有更少缺陷的更均匀结构。此外，由于其转化率的提高和单体组成的不同，一些CAD-CAM块体在毒性和单体释放方面更具优势。最后，具有聚合物渗透陶瓷网络（PICN）微观结构的材料比具有分散填料微观结构的材料表现出更高的弯曲强度和更有利的弹性模量。因此，一些高性能复合CAD-CAM块体——特别是实验性PICN——现在可以与玻璃陶瓷竞争，如二硅酸锂玻璃陶瓷，用于天然牙齿和种植体上的粘结局部修复体和牙冠。由于能够以非常低的厚度制造，它们提供了开发创新的微创治疗策略的可能性，例如对磨损牙列的“无预备”治疗。当前的问题与不同种类CAD-CAM复合材料的粘结和磨损性能研究有关。进行临床研究也至关重要。最后，制造商应提供有关其产品聚合过程、微观结构和成分的更完整信息，这些信息会显著影响CAD-CAM材料的性能。
