后牙区深边缘抬高的 197 个部分间接修复体长达 12 年的临床评估。

Up to 12 years clinical evaluation of 197 partial indirect restorations with deep margin elevation in the posterior region.

机构信息

University Medical Center Groningen, University of Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry and Biomaterials, Groningen, The Netherlands.

Private Practice, Montreux, Switzerland.

出版信息

J Dent. 2019 Dec;91:103227. doi: 10.1016/j.jdent.2019.103227. Epub 2019 Nov 4.

DOI:10.1016/j.jdent.2019.103227

PMID:31697971

Abstract

OBJECTIVES

Deep margin elevation (DME) relocates the cervical outline of large-sized cavity dimensions in the posterior area supragingivally, using a resin composite in a direct technique. The aim of this study is to evaluate the clinical performance of partial indirect restorations with DME and compare the effects of selected baseline variables on the (quality of) survival of the restorations.

METHODS

All teeth that were restored in combination with indirect restorations and DME between 2007 and 2016 were eligible for inclusion. Overall cumulative survival rates were calculated (Kaplan-Meier estimates) and compared among subsets of variables. Qualitative evaluation of all surviving restorations was performed using the modified United States Public Health Service (USPHS) criteria using Chi-square tests.

RESULTS

A total of 197 indirect restorations in 120 patients could be included. Restorations or teeth presenting with secondary caries, fracture of the restoration/tooth, debonding of the indirect restoration, root caries, severe periodontal breakdown or pulpal necrosis were considered as absolute failures (n = 8) leading to an overall cumulative survival rate of 95.9% (SE 2.9%) up to 12 years, with an average evaluation time of 57.7 months. Some indication of degradation of the restorations was seen over time. Indirect composite restorations showed more degradation compared to ceramic restorations (p = 0.000). More wear of the antagonist was observed when teeth were opposed to ceramic restorations (p = 0.04). Endodontic treatment negatively impacted the occurrence of fracture of restorations and teeth (p = 0.000).

CONCLUSIONS

Indirect restorations with DME have a good survival rate in this study, however longer follow-up is needed as degradation of the restorations is seen over time.

CLINICAL SIGNIFICANCE

This long-term study shows the possible clinical applicability of deep margin elevation.

摘要

目的

通过直接技术中的树脂复合材料，深边缘抬高（DME）可将后牙区大尺寸腔的牙颈轮廓向上移位。本研究旨在评估采用 DME 的部分间接修复体的临床性能，并比较选定基线变量对修复体（质量）存活率的影响。

方法

2007 年至 2016 年间，对联合间接修复体和 DME 修复的所有牙齿进行了入选标准评估。使用 Kaplan-Meier 估计计算并比较了各个变量组的总体累积存活率。使用改良的美国公共卫生服务（USPHS）标准，采用卡方检验对所有存活修复体进行定性评估。

结果

共纳入 120 名患者的 197 个间接修复体。当出现继发龋、修复体/牙折、间接修复体脱粘、根面龋、严重牙周破坏或牙髓坏死时，修复体或牙齿被视为绝对失败（n=8），这导致 12 年内的总体累积存活率为 95.9%（SE 2.9%），平均评估时间为 57.7 个月。随着时间的推移，修复体出现了一定程度的降解迹象。与陶瓷修复体相比，间接复合修复体的降解情况更为严重（p=0.000）。当牙齿与陶瓷修复体相对时，观察到对颌牙更多的磨损（p=0.04）。牙髓治疗会对修复体和牙齿折裂的发生产生负面影响（p=0.000）。