瓷美学修复中预备体边缘与修复体边缘的专家共识

doi:10.7518/hxkq.2022.02.001

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (2): 123-133.doi: 10.7518/hxkq.2022.02.001

• 专家共识 • 下一篇

瓷美学修复中预备体边缘与修复体边缘的专家共识

于海洋¹(), 岳莉¹, 刘伟才², 刘峰³, 牛丽娜⁴, 邵龙泉⁵, 廖红兵⁶, 骆小平⁷, 李鸿波⁸, 江青松⁹, 于皓¹⁰, 赵彬¹¹, 吴哲¹², 李长义¹³, 吴国锋⁷, 王焱¹⁴, 牟雁东¹⁵, 刘云松³, 张海洋¹⁶, 陈吉华⁴, 刘洪臣⁸

^1.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041
^2.同济大学附属口腔医院，上海 200072
^3.北京大学口腔医（学）院，北京 100081
^4.第四军医大学口腔医院，西安 710032
^5.南方医科大学南方医院，广州 510280
^6.广西医科大学附属口腔医院，南宁 530013
^7.南京大学医学院附属口腔医院，南京 210008
^8.解放军总医院第一医学中心口腔科，北京 100853
^9.首都医科大学附属北京口腔医院，北京 100006
^10.福建医科大学附属口腔医院，福州 350002
^11.山西医科大学口腔医（学）院，太原 030012
^12.广州医科大学附属口腔医院，广州 510013
^13.天津医科大学口腔医院，天津 300070
^14.中山大学光华口腔医学院·附属口腔医院，广州 510055
^15.电子科技大学附属医院·四川省人民医院口腔科，成都 610072
^16.吉林大学口腔医院，长春 130021

收稿日期:2021-12-01 修回日期:2022-01-05 出版日期:2022-04-01 发布日期:2022-04-01
通讯作者: 于海洋 E-mail:yhyang6812@scu.edu.cn
作者简介:于海洋，教授，博士，E-mail：yhyang6812@scu.edu.cn
基金资助:
国家自然科学基金(82071145);四川大学交叉学科创新项目(RD-03-202009)

Consensus on the preparation margin and restoration margin in ceramic esthetic rehabilitation

Yu Haiyang¹(), Yue Li¹, Liu Weicai², Liu Feng³, Niu Lina⁴, Shao Longquan⁵, Liao Hongbing⁶, Luo Xiaoping⁷, Li Hongbo⁸, Jiang Qingsong⁹, Yu Hao¹⁰, Zhao Bin¹¹, Wu Zhe¹², Li Changyi¹³, Wu Guofeng⁷, Wang Yan¹⁴, Mou Yandong¹⁵, Liu Yunsong³, Zhang Haiyang¹⁶, Chen Jihua⁴, Liu Hongchen⁸

^1.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.Hospital of Stomatology, Tongji University, Shanghai 200072, China
^3.School and Hospital of Stomatology, Peking University, Beijing 100081, China
^4.School of Stomatology, The Fourth Military Medical University, Xi, an 710032, China
^5.Nanfang Hospital, Southern Medical University, Guangzhou 510280, China
^6.College of Stomatology, Guangxi Medical University, Nanning 530013, China
^7.Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing 210008, China
^8.Research Institute of Stomatology, Chinese PLA General Hospital, Beijing 100853, China
^9.Beijing Stomatological Hospital, School of Stomatology, Capital Medical University, Beijing 100006, China
^10.School and Hospital of Stomatology, Fujian Medical University, Fuzhou 350002, China
^11.Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030012, China
^12.Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou 510013, China
^13.Stomatological Hospital, Tianjin Medical University, Tianjin 300070, China
^14.Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou 510055, China
^15.Dept. of Stomatology, Sichuan Provincial People, s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, China
^16.Hospital of Stomatology, Jilin University, Changchun 130021, China

Received:2021-12-01 Revised:2022-01-05 Online:2022-04-01 Published:2022-04-01
Contact: Yu Haiyang E-mail:yhyang6812@scu.edu.cn
Supported by:
The National Natural Science Foundation of China(82071145);The Research Fund of Inter-disciplinary Innovation Project from Sichuan University(RD-03-202009);Correspondence: Yu Haiyang, E-mail: yhyang6812@scu.edu.cn

摘要/Abstract

摘要：

瓷美学修复是固定修复的热点，如何提升其边缘修复效果一直是瓷美学修复诊疗水平提升、相关并发症防治的重点以及医技合作的难点。但长期以来固定修复中对边缘的定义与分类、预备术以及制作工艺、质检等还存在诸多不完整的认知，医技统筹合作不足，而实操中医生或技师常常也缺乏核查牙体预备磨切量、预备体与修复体外形形态的可靠方法，大多依赖目测观察和个人经验。这些认知和医技实操的模糊欠缺，使得当前固定修复的边缘质量难以获得进一步的提升。随着数字化诊疗及制作技术在瓷美学修复中的大量运用，数字化牙科扫描及数控切削对边缘质量提出了更高更明确的要求，无法被扫描识别的边缘，无法信息化，再便捷的数字化流程也无法进行下去；不符合数控加工规范的过薄过锐的边缘即使扫描成功，也无法准确切削。为了更好地解决上述难题，有效提升边缘质量，集合了参与专家的共同意见，本文将从边缘涉及的不规则微小目标修复体空间的分析设计梳理入手，采用口腔立体几何“线—面—体”视角，定义了预备体边缘和修复体边缘“两个边缘”的内涵，并对8个亚分类概念进行解读，进一步提出可及性好的两个边缘宽度的实测方法，以及临床和制作的质检实测核查方案。以实测核查几何量—目标修复体空间为特征的两个边缘的新认识与新方案，将对全程数字化瓷美学修复提供更好的支撑。

关键词: 预备体边缘, 修复体边缘, 瓷美学修复, 数字化, 实测, 医-患-技交流合作

Abstract:

In esthetic rehabilitation, methods used to enhance the margin quality have always been the focus and difficulty of improving the level of diagnosis and treatment, prevention and treatment of complications, and collaboration between clinicians and technicians. However, it is impeded by the ambiguous definition and classification of margin, unstandardized tooth preparation, manufacturing process of restoration, and lack of reliable means of checking the quantitative requirements of preparation or restoration. The digital technologies that are increasingly applied, such as intra-oral scanner, impression scanner, and computerized numerical control cutting machine, have strict requirements about margin quality. Failure of recognizing margins by these scanners will hinder the digital process of diagnosis and treatment. Even if these sharp and narrow margins are successfully scanned, they cannot be milled accurately. To overcome these problems, this article demonstrated the clear and complete definition of preparation margin and restoration margin, as well as their subclassifications, by analyzing the target restoration space from a geometric perspective. Practical approaches to measuring the margin width and inspecting the margin quality were proposed. The new and full understanding and proposal about preparation margin and restoration margin characterized by measurements will effectively support the thoroughly digitalized process of esthetic rehabilitation using porcelain in fixed prosthodontics, which is based on the guidance of values.

Key words: preparation margin, restoration margin, esthetic porcelain rehabilitation, digitalization, physical measurement, clinician-patient-technician collaboration

中图分类号:

R 783.3

于海洋, 岳莉, 刘伟才, 刘峰, 牛丽娜, 邵龙泉, 廖红兵, 骆小平, 李鸿波, 江青松, 于皓, 赵彬, 吴哲, 李长义, 吴国锋, 王焱, 牟雁东, 刘云松, 张海洋, 陈吉华, 刘洪臣. 瓷美学修复中预备体边缘与修复体边缘的专家共识[J]. 华西口腔医学杂志, 2022, 40(2): 123-133.

Yu Haiyang, Yue Li, Liu Weicai, Liu Feng, Niu Lina, Shao Longquan, Liao Hongbing, Luo Xiaoping, Li Hongbo, Jiang Qingsong, Yu Hao, Zhao Bin, Wu Zhe, Li Changyi, Wu Guofeng, Wang Yan, Mou Yandong, Liu Yunsong, Zhang Haiyang, Chen Jihua, Liu Hongchen. Consensus on the preparation margin and restoration margin in ceramic esthetic rehabilitation[J]. West China Journal of Stomatology, 2022, 40(2): 123-133.

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瓷美学修复中预备体边缘与修复体边缘的专家共识

Consensus on the preparation margin and restoration margin in ceramic esthetic rehabilitation

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