严重磨耗患者 CAD/CAM 树脂基复合材料修复体的 5.5 年生存率。

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients.

机构信息

Department of Conservative Dentistry and Periodontology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Germany; Department of Dentistry, Radboud University Medical Centre, Nijmegen, the Netherlands.

Department of Dentistry, Radboud University Medical Centre, Nijmegen, the Netherlands.

出版信息

Dent Mater. 2024 May;40(5):767-776. doi: 10.1016/j.dental.2024.03.001. Epub 2024 Mar 7.

DOI:10.1016/j.dental.2024.03.001

PMID:38458918

Abstract

OBJECTIVES

Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years.

METHODS

Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05).

RESULTS

568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7).

SIGNIFICANCE

Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

摘要

目的

本前瞻性研究旨在评估使用微创 CAD/CAM 树脂基复合材料（RBC）修复体和直接贴面修复严重牙齿磨损患者的全口修复效果，通过评估最长 5.5 年的修复体存活率来实现。

方法

纳入 22 名患有广泛严重牙齿磨损且存在功能和/或美观问题的患者。在进行微创预备后，采用 CAD/CAM RBC 修复体（LAVA Ultimate，3M）进行黏接固位，在美学区域应用直接 RBC 贴面（Filtek Supreme XTE，3M）。在 1 个月、1 年、3 年、5 年时进行随访，若患者出现任何不适，由其全科牙医或临床研究中心进行随访。失败类型分为 F1（需要更换/拔除的严重缺陷）、F2（需要重新黏接/修复的局部缺陷）和 F3（需要重新打磨/监测的小碎片）。使用寿命表和 Kaplan-Meier 图评估间接修复体的存活率，区分失败类型和牙齿类型（前牙=FT，前磨牙=PM，磨牙=M）。使用 Cox 回归分析了牙齿类型/位置、年龄、性别和 VDO 增加等变量对 F1+F2 和 F1+F2+F3 失败的影响（p<0.05）。

结果

21 名患者共评估了 568 个间接修复体和 200 个直接贴面，最长随访时间为 5.5 年。间接修复体共记录 96 例失败（F1：6；F2：41；F3：49），F1+F2 年失败率为 0.29%（FT）、1.56%（PM）、2.93%（M），F1+F2+F3 年失败率为 0.53%（FT）、2.42%（PM）、6.11%（M）。失败原因包括碎裂（48 例）、黏接断裂（32 例）、完全脱黏（7 例）、龋齿（4 例）、根管治疗（1 例）和原因不明（由全科牙医记录，4 例）。M 磨牙类型的 F1+F2+F3 失败概率明显高于前牙和前磨牙（p<0.006）。直接贴面修复体出现 18 例失败（F1：2；F2：9；F3：7）。