磨牙根管治疗后锂基玻璃陶瓷髓腔固位冠修复的回顾性分析  

Retrospective analysis of endocrown made of lithium disilicate based glass ceramic for molars after root canal treatment

作　　者：曾百进[1] 张介冰 罗斌 孟丹[1] 江青松[1] ZENG Bai-jin;ZHANG Jie-bing;LUO Bin;MENG Dan;JIANG Qing-song(Department of Prosthodontics,Beijing Stomatological Hospital and School of Stomatology,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京口腔医院修复科,北京100050 [2]首都医科大学附属北京口腔医院种植科,北京100050

出　　处：《口腔颌面修复学杂志》2024年第4期283-291,共9页Chinese Journal of Prosthodontics

基　　金：首都医科大学基础-临床科研合作基金(项目编号:17JL42);首都卫生发展科研专项项目(项目编号:首发2022-1-2141)。

摘　　要：目的:了解根管治疗后磨牙采用锂基玻璃陶瓷髓腔固位冠(endocrown)修复的临床效果。方法:选择根管治疗后的磨牙,经同一医师评估为大面积牙体缺损或者临床冠较短常规修复无法获得足够的固位力。所有预备体肩台均采用端对端的预备方式,保证至少1.0 mm的瓷厚度;髓腔深度大于4.0 mm时采用玻璃离子垫底。采用CAD/CAM制作锂基玻璃陶瓷髓腔固位冠后粘接。临床随访并观察和记录相关临床指标。结果:纳入观察的234个患者249个髓腔固位冠在4-9年的观察中,继发龋32颗;修复体折断5颗;脱粘接25颗,脱粘接的25颗中除5颗拔除外其余重新再粘接或重新修复;患根尖周炎8颗,其中7颗拔除;14颗患牙拔除,其中5颗因为预备体折断,1颗因为牙周牙髓联合病变,7颗因根尖周炎,7颗中有3颗合并预备体折断;4颗因继发龋后缺损太大。髓腔固位冠修复4-9年患牙总保存率可达94.38%。性别、年龄、牙位、预备体边缘位置对预备体是否会发生折裂以及是否会产生根尖周炎无明显关系;髓腔垫底会降低患牙根尖周炎及以及最终拔除的风险。第二磨牙脱粘接和患龋率明显高于第一磨牙。预备体边缘位于龈下与患龋、脱粘接以及修复体损坏的风险相关。随着年龄的增加,修复体脱粘接风险增高。结论:锂基玻璃陶瓷瓷髓腔固位冠可满足临床修复效果,是临床冠短患牙修复的理想选择,是大面积牙体缺损需要桩核冠修复患牙的有益补充。对于根管治疗后的患牙采用髓腔固位冠修复时应考虑垫底及避免预备体边缘位于龈下。Objective:To investigate the clinical effect of endocrown using lithium disilicate based glass ceramics for molars after root canal treatment.Methods:Molars after root canal treatment which were considered to be with large tooth defects or short crowns that could not obtain sufficient retention for conventional restoration by the same physician were selected.All preparation forms were butt-joint type,and the minimal thickness of restoration was 1.0 mm.When the depth of the pulp cavity was greater than 4.0 mm,the glass ion cement was used as liner.The endocrown of lithium disilicate based glass ceramics was made by CAD/CAM and then cemented to the preparation.Clinical follow-up was conducted,and relevant clinical indicators were observed and recorded.Results:Among the 249 endocrowns in 234 patients,32 teeth with secondary caries were observed during 4-9 years,while prosthesis fracture occurred in 5 teeth.Moreover,there were 25 debonding teeth,of which 5 teeth were extracted and the others were re-bonded or re-repaired.8 teeth suffered from periapical inflammation and 7 teeth were extraced.A total of 14 affected teeth were removed,of which 5 teeth due to tooth fracture,1 tooth due to endodontic and periodontic lesion,and 7 teeth due to periapical inflammation.There were 3 teeth affected both by tooth fracture and periapical inflammation.4 teeth were extracted because of large defects after secondary caries.The total preservation rate of affected teeth restored with endocrown from 4 to 9 years was 94.38%.Gender,age,tooth position,and marginal position of the preparation had no significant relationship with whether the preparation would fracture or whether it would suffer from periapical inflammation.The cavity liner reduced the risk of periapical periodontitis and eventual tooth extraction.The probability of debonding and caries in the second molar was significantly higher than that in the first molar.The subgingival edge of the preparation was closely related with the risk of caries,debonding,and prosthesis damage.

关 键 词：髓腔固位冠 磨牙 玻璃陶瓷 CAD/CAM 

分 类 号：R783.3[医药卫生—口腔医学]