1 Department of Preventive and Restorative Sciences, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.
J Dent Res. 2018 Feb;97(2):132-139. doi: 10.1177/0022034517729134. Epub 2017 Sep 6.
Digital manufacturing, all-ceramics, and adhesive dentistry are currently the trendiest topics in clinical restorative dentistry. Tooth- and implant-supported fixed restorations from computer-aided design (CAD)/computer-aided manufacturing (CAM)-fabricated high-strength ceramics-namely, alumina and zirconia-are widely accepted as reliable alternatives to traditional metal-ceramic restorations. Most recent developments have focused on high-translucent monolithic full-contour zirconia restorations, which have become extremely popular in a short period of time, due to physical strength, CAD/CAM fabrication, and low cost. However, questions about proper resin bonding protocols have emerged, as they are critical for clinical success of brittle ceramics and treatment options that rely on adhesive bonds, specifically resin-bonded fixed dental prostheses or partial-coverage restorations such as inlays/onlays and veneers. Resin bonding has long been the gold standard for retention and reinforcement of low- to medium-strength silica-based ceramics but requires multiple pretreatment steps of the bonding surfaces, increasing complexity, and technique sensitivity compared to conventional cementation. Here, we critically review and discuss the evidence on resin bonding related to long-term clinical outcomes of tooth- and implant-supported high-strength ceramic restorations. Based on a targeted literature search, clinical long-term studies indicate that porcelain-veneered alumina or zirconia full-coverage crowns and fixed dental prostheses have high long-term survival rates when inserted with conventional cements. However, most of the selected studies recommend resin bonding and suggest even greater success with composite resins or self-adhesive resin cements, especially for implant-supported restorations. High-strength ceramic resin-bonded fixed dental prostheses have high long-term clinical success rates, especially when designed as a cantilever with only 1 retainer. Proper pretreatment of the bonding surfaces and application of primers or composite resins that contain special adhesive monomers are necessary. To date, there are no clinical long-term data on resin bonding of partial-coverage high-strength ceramic or monolithic zirconia restorations.
数字化制造、全陶瓷和黏接牙科目前是临床修复牙科中最热门的话题。计算机辅助设计（CAD）/计算机辅助制造（CAM）制造的高强度陶瓷制成的牙和种植体支持的固定修复体，即氧化铝和氧化锆，已被广泛接受为传统金属陶瓷修复体的可靠替代品。最近的发展集中在高强度整体式全轮廓氧化锆修复体上，由于其物理强度、CAD/CAM 制造和低成本，在短时间内变得非常流行。然而，关于适当的树脂黏接协议的问题已经出现，因为它们对于脆性陶瓷的临床成功和依赖黏接的治疗选择（特别是树脂黏接固定牙科修复体或部分覆盖修复体，如嵌体/高嵌体和贴面）至关重要。树脂黏接长期以来一直是保留和增强低到中等强度二氧化硅基陶瓷的金标准，但与传统黏固相比，需要对黏接面进行多次预处理步骤，增加了复杂性和技术敏感性。在这里，我们批判性地回顾和讨论与牙和种植体支持的高强度陶瓷修复体的长期临床结果相关的树脂黏接证据。基于有针对性的文献搜索，临床长期研究表明，使用传统水泥插入时，瓷贴面氧化铝或氧化锆全冠和固定牙科修复体具有很高的长期存活率。然而，大多数选定的研究建议进行树脂黏接，并建议使用复合树脂或自黏接树脂黏固剂获得更大的成功，特别是对于种植体支持的修复体。高强度陶瓷树脂黏接固定牙科修复体具有很高的长期临床成功率，尤其是当设计为仅 1 个固位体的悬臂时。有必要对黏接面进行适当的预处理，并使用包含特殊黏接单体的底漆或复合树脂。迄今为止，没有关于高强度陶瓷或整体氧化锆修复体部分覆盖的树脂黏接的临床长期数据。
