J Adhes Dent. 2018;20(6):495-510. doi: 10.3290/j.jad.a41630.
Adhesively luted partial ceramic crowns have been documented to be clinically more durable than direct composite restorations when minimally invasively restoring large defects (replacing two cusps or more) in posterior teeth. The clinical longevity of such restorations is largely determined by the tooth-preparation design, material selection and adhesive luting procedure. The most frequently recorded failure in medium- to long-term clinical trials is fracture of the restoration. The clinical protocol of adhesively luted partial ceramic crowns can be optimized by taking the etiology of these restoration fractures into account. In this article, a simplified nonretentive bonded ceramic partial crown concept is presented that aims to achieve an adhesively luted ceramic restoration - composite cement - residual tooth structure biomechanical unit that maximally resists functional aging. Therefore, the three primary components of the bonded restoration-cement-tooth complex must function in synergy. Methods, Results and Discussion: The clinical protocol starts with a tooth preparation designed to optimally absorb chewing stress. A stable, internally rounded and gently sloping tooth-preparation design with all outer margins inclined towards the tooth center assures a favorable and homogenous stress distribution with low cyclic fatigue subjected to the adhesive interface. This preparation form additionally enables the dental technician to fabricate a well-seating and -fitting ceramic restoration of uniform thickness. As restoration material, monolithic lithium-disilicate glass ceramic is sufficiently strong for the partial crown indication and preferred in order to decrease the fracture risk. Clinically essential for a long-lasting restoration is the optimal bond that can be obtained by combined micromechanical interlocking and chemical bonding of composite cement to hydrofluoric acid-etched and silanized glass ceramic.
The clinical effectiveness of this nonretentive bonded ceramic partial crown concept is confirmed by the overall high success rate as well as the very low fracture and debonding rate, as was recorded in long-term clinical trials.
在微创修复后牙大缺损（替换两个或更多牙尖）时，黏结性全瓷冠的临床耐用性明显优于直接复合树脂修复体。此类修复体的临床寿命主要取决于牙体预备设计、材料选择和黏结剂黏固过程。在中长期临床试验中，最常记录到的失效模式是修复体折裂。如果考虑到这些修复体折裂的病因，黏结性全瓷冠的临床方案可以得到优化。本文提出了一种简化的无固位黏结陶瓷部分冠概念，旨在实现黏结陶瓷修复体-复合树脂黏结剂-剩余牙体结构的生物力学单元，最大限度地抵抗功能老化。因此，黏结修复体-黏结剂-牙体复合体的三个主要组成部分必须协同作用。方法、结果和讨论：临床方案从旨在最佳吸收咀嚼应力的牙体预备开始。稳定、内聚且平缓倾斜的牙体预备设计，所有外边缘向牙体中心倾斜，确保了在黏结界面上具有有利且均匀的应力分布和较低的循环疲劳，从而降低了黏结界面的循环疲劳。这种预备形式还使牙科技师能够制作出具有均匀厚度、贴合良好的陶瓷修复体。作为修复材料，整体式锂硅玻璃陶瓷具有足够的强度，适用于部分冠修复，可降低折裂风险。对于长期修复体而言，临床必不可少的是最佳的粘结，这可以通过复合树脂与经氢氟酸蚀刻和硅烷化处理的玻璃陶瓷的微观机械锁合和化学结合来获得。结论：该无固位黏结陶瓷部分冠概念的临床有效性已被长期临床试验中记录的高总体成功率以及极低的折裂和脱黏发生率所证实。
