State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2021 Feb 1;39(1):9-19. doi: 10.7518/hxkq.2021.01.002.
Tooth preparation is a common operation in dental clinical practice. This procedure is irreversible and invasive from the point of view of tooth preservation. Conditions of the abutment tooth, treatment methods, and restoration materials for target restoration affect tooth preparation. To achieve the goals of tooth tissue preservation, dental pulp protection, and periodontal health, dentistry professionals agreed on the importance of minimizing the amount of tooth reduction. The foundations for realizing this consensus are as follows. First, the available restoration materials with improved comprehensive performance need less target restoration space. Next, teeth can be prepared under a digital guide, and the real-time measurement of restoration space can be verified due to the invention of digital technologies for the analysis of the quantity and shape of the prepared tooth and tooth measurement. Moreover, guiding methods for preparation have been developed from freehand operation under the naked eye based on accumulated personal experience to digital-guidance jointing microscope. These innovations indicate the creation of a prototype of guided prosthodontics that is precise and applies real-time measurement throughout the process of tooth preparation. From the perspective of the evolution of digital, guided, and micro prosthodontics, this article raised seven questions about the numerical value and quantitative data transfer of tooth preparation and evaluated the authenticity of existing numerical requirements from the perspective of the four elements of measurement. Identifying unified measuring methods and developing measuring tools with a precision of hundred or ten microns will be the key to solving the problem about the authenticity of numerical measurement. Furthermore, this paper summarizes the methods of how to control tooth reduction and explains in depth why the currently dominant tooth preparation technology, which is based on empiricism, cannot effectively achieve the goals in digital prosthodontics. Therefore, we strongly call for rebuilding the digital foundation of prosthodontic treatment immediately.
牙体预备是口腔临床的常见操作，从保存患牙的角度来看，该操作具有不可逆性和侵入性。基牙条件、治疗方法和目标修复体的修复材料等均会影响牙体预备。为了实现牙体组织保存、牙髓保护和牙周健康的目标，口腔医学专业人员达成了尽量减少牙体预备量的共识，其共识基础如下。首先，综合性能不断提升的修复材料需要的目标修复空间更小；其次，由于数字化技术的发明，可以对牙体预备量和牙体测量的数量和形态进行分析，通过数字化导板进行预备，实现实时测量和验证；再次，从基于个人经验积累的自由手操作到数字化导板联合显微镜下操作，预备的引导方法也在不断发展。这些创新为精确、实时测量的引导式修复学的制作原型提供了可能。从数字化、引导式、微创式修复学的发展角度来看，本文围绕牙体预备的数值和定量数据传递提出了 7 个问题，并从测量的 4 个要素角度对现有数值要求的真实性进行了评估。确定统一的测量方法和开发精度达到百微米或十微米的测量工具将是解决数值测量真实性问题的关键。此外，本文还总结了控制牙体磨除的方法，并深入探讨了为什么目前基于经验的主导牙体预备技术不能有效地实现数字化修复学的目标。因此，我们强烈呼吁立即重建修复治疗的数字化基础。
