Duarte Sillas, Phark Jin-Ho
Advanced Operative and Adhesive Dentistry, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA.
J Esthet Restor Dent. 2025 Jan;37(1):257-276. doi: 10.1111/jerd.13371. Epub 2024 Nov 18.
This review aims to evaluate the current understanding and clinical applications of machinable ceramic-reinforced composites (CRCs) and the emerging first generation of 3D-printed CRCs in dental restorations.
Machinable CRCs, introduced over a decade ago, have shown moderate success in short- to medium-term clinical applications, particularly in low-stress areas. However, their long-term durability limitations, such as increased wear and marginal deterioration, restrict their use in high-stress situations and full crowns. The first generation of 3D-printed CRCs offers customization advantages but is still in early development and exhibits lower mechanical strength and higher wear rates than CAD-CAM CRCs and traditional ceramics. Additionally, the classification and definitions surrounding CRCs remain ambiguous, as ADA categorizations do not clearly differentiate CRCs from ceramics, complicating clinical indication, usage, and billing practices.
Machinable CAD-CAM CRCs are moderately successful in low-stress applications, while 3D-printed CRCs show limitations in wear resistance and durability, raising concerns for their use in definitive restorations. Both require further research and clinical validation.
Machinable CAD-CAM CRCs are best suited for low-stress applications, while 3D-printed CRCs may be more appropriate for provisional use. Until long-term clinical data are available, ceramics should be preferred for high-stress or full-coverage restorations. Clearer definitions for porcelain/ceramic and comprehensive application guidelines are urgently needed to support clinician decision-making and improve patient outcomes.
本综述旨在评估可加工陶瓷增强复合材料（CRCs）以及新兴的第一代3D打印CRCs在牙齿修复中的当前认知和临床应用情况。
十多年前引入的可加工CRCs在短期至中期临床应用中已取得一定成功，尤其是在低应力区域。然而，它们存在长期耐久性限制，如磨损增加和边缘劣化，这限制了它们在高应力情况和全冠修复中的使用。第一代3D打印CRCs具有定制优势，但仍处于早期开发阶段，与计算机辅助设计与制造（CAD-CAM）CRCs和传统陶瓷相比，其机械强度较低且磨损率较高。此外，围绕CRCs的分类和定义仍不明确，因为美国牙科协会（ADA）的分类并未清晰区分CRCs与陶瓷，这使得临床适应症、使用方法和计费操作变得复杂。
可加工CAD-CAM CRCs在低应力应用中取得了一定成功，而3D打印CRCs在耐磨性和耐久性方面存在局限性，这引发了对其用于确定性修复的担忧。两者都需要进一步研究和临床验证。
可加工CAD-CAM CRCs最适合低应力应用，而3D打印CRCs可能更适合临时使用。在获得长期临床数据之前，对于高应力或全冠修复，应优先选择陶瓷材料。迫切需要更清晰的瓷器/陶瓷定义和全面的应用指南，以支持临床医生的决策并改善患者治疗效果。
