Ferrando Cascales Álvaro, Sauro Salvatore, Hirata Ronaldo, Astudillo-Rubio Daniela, Ferrando Cascales Raúl, Agustín-Panadero Rubén, Delgado-Gaete Andrés
Department of Biomaterials Engineering, Faculty of Medicine, UCAM, Universidad Católica de Murcia, Campus Los Jerónimos, 135 Guadalupe, 30107 Murcia, Spain.
Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, University CEU Cardenal Herrera, C/Santiago Ramón y Cajal, s/n, Alfara del Patriarca, 46115 Valencia, Spain.
J Clin Med. 2023 Aug 10;12(16):5222. doi: 10.3390/jcm12165222.
Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials.
The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria.
Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences ( < 0.005) on the survival of the restorations.
According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.
目前，几乎没有临床证据支持在全口修复中使用粘结修复体的超保守方法的中长期生存率和临床性能。本病例系列研究的目的是评估使用树脂复合材料和玻璃陶瓷基材料通过直接和间接技术应用的前牙和后牙粘结修复体的中期临床性能。
纳入标准是以美观问题为主要咨询原因，且根据牙齿磨损评估系统（TWES 2.0）为2至4级的严重广泛性磨损。此外，在每次随访预约时，要求患者根据修改后的美国公共卫生服务（USPHS）标准提交临床参数监测记录。
西班牙一家私人牙科诊所的一名操作员（AFC）对8名严重牙齿磨损患者进行了全面修复治疗。共进行了212次修复，分布如下：66次咬合面贴面、26次腭面贴面和120次前庭面贴面。随访期后，在任何咬合面、前庭面和/或腭面修复体中均未观察到边缘微渗漏或术后敏感的迹象。在60个月的观察期内，212次修复的估计生存率为90.1%，生存时间为57.6个月。只有21次修复出现并发症，大多通过直接复合树脂解决。修复类型（后牙贴面、前牙贴面）和修复牙齿类型（前牙、后牙）的二分变量是对修复体生存有统计学显著影响（<0.005）的风险预测因素。
根据本研究结果，后牙修复并发症的风险明显高于前牙。此外，可以得出结论，对于患有严重多因素牙齿磨损的患者，在前牙和后牙进行粘结修复的适应症是合理的，因为它们的失败风险较低。
