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| 牙齿美学间接修复体指南之一（老苏翻译） |
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[ 2008-3-23 0:17:00 | By: laosu ] |
Aesthetic Indirect Restorative Options
间接美学修复体选择指南
Like many areas of dentistry, aesthetic indirect restorative
materials have improved significantly in the last decade. This
ever-changing group of products continues to improve, providing
clinicians additional tools in the quest to mimic natural dentition.
Currently,dentists have a bevy of indirect restorative materials at
their disposal. These options can be classified into two general
groups: non-metal restorative materials (the primary focus of this
course), and metal supported restorative materials.
象牙科其他许多领域一样，再过去十多年间，美学间接修复材料有了很大的进步。这类材料不断进步，提供给临床医生额外的选择。通常牙医会有几种间接修复材料可以选择。这些材料可以分为两类：非金属修复材料（本课程的焦点之一），金属支持类修复材料。
Despite the increasing popularity of non-metal restorative
materials, the vast majority of full-coverage crowns and bridges
continue to be all cast or porcelain to metal restorations. Despite its
color, many clinicians and patients believe an artfully fabricated full
gold restoration can be an extremely aesthetic restoration. Although
some might argue the aesthetics of a full cast restoration, no one can
discredit gold as one of dentistry’s finest restorative options.
尽管非金属修复材料越来越流行，仍然有大量的全冠与桥是金属铸造或者金属烤瓷修复体。除去颜色原因，很多牙医与患者确信全金合金修复体是最美观的修复体。虽然一些人争论全金属铸造修复体的美观性，但是没有一个人相信金合金是最合适的修复体之一。
Despite being limited by a cast metal substructure,
porcelain-fused-tometal restorations—the mainstay of indirect
restorative options—can provide an excellent esthetic result when
combined with proper preparation and outstanding laboratory support.
如果不限于铸造金属结构外，结合适合的牙体预备与出色的技工室支持，金属烤瓷冠可以提供良好的美学效果。
This staple of indirect materials continues to improve as teams of
ceramic engineers from every dental manufacturer continuously work to
develop stronger, kinder, more aesthetic porcelains. New
porcelain-fused-to-metal ceramics such as Ivoclar’s d.SIGN, Degussa’s
Duceragold and Ceramco’s Finesse, to name a few, utilize new or
modified ceramic particles and/or new processing methods to create
ceramics with improved physical and aesthetic properties.
来自各牙科材料制造商的瓷材料研发团队持续工作，使得间接修复材料更结实，更友好，更美观。新的金属烤瓷瓷粉系统，举几个例子，比如义获嘉公司的
D.SIGN帝赞瓷粉系统，德古萨公司的DUCERGOLD与CERMCO公司的FINESSE系统，这些系统都使用了新的或者改良过的瓷颗粒或者采用了
新的加工工艺提高瓷材料的物理与美学性能。
For example, IPS d.SIGN (Ivoclar Vivident) achieves its improved
characteristics by utilizing synthetic base materials, rather than the
more traditional materials—such as feldspar, nepheline, or kaolin—found
in conventional feldspathic metalceramics. IPS d.SIGN is a
glass-ceramic with two distinct crystalline components: fluorapatite
and leucite. The integration of these two crystals into a single
glass-ceramic promotes a combination of diverse optical and physical
properties. The fluorapatite crystals found in d.SIGN have similar size
and shape to the hydroxyapatite crystals found in natural tooth
structure and subsequently affect light in a similar manner.
例如，与常规金属烤瓷常用的传统材料相比，比如长石，nepheline, kaolin，
IPS
帝赞系统（义获嘉）通过使用合成基材，使得材料性能得到极大的提高。帝赞瓷粉系统是一种玻璃瓷系统，使用了两种石英类材料，氟磷灰石和白榴石。这两种材料
整合到一种单一的玻璃瓷中达到了光学与物理性能提升的结合。帝赞瓷粉中的氟磷灰石的颗粒与天然牙结构中的羟基磷灰石有类似的大小与形状，相应的光学性能也
基本类似。
Ducergold (Degussa Dental), another state-of-the-art porcelain, is
a low-fusing hydrothermal ceramic. Laboratory tests reveal it reacts
with saliva to form a silica-hydroxyl layer on the ceramic that is
softer, less abrasive, and gentler to opposing dentition than
conventional porcelains. Most ceramics develop surface microflaws after
exposure to the oral environment. The silica-hydroxyl layer on
Duceragold continuously heals surface flaws, thereby strengthening the
restoration. Hydrothermal ceramics also promote a true-to-nature
opalescent effect that improves aesthetic results.
Ducergold（德古萨公司）瓷粉系统是另一种仿真瓷粉，是一种低熔点瓷粉系统。实验室检测显示，这种瓷粉会与唾液反应在瓷层表面形成一个硅
羟基层，这个硅羟基层更软，磨损度更小，与传统瓷粉相比对对颌牙更温和。大多数瓷粉系统暴露在口腔环境后在表面会出现微缺陷。在DUCERAGOLD瓷粉
表面硅羟基层会不断的修复表面的瑕疵、微隙，因此修复体得以加强。hydrothermal瓷粉效果可以增强仿真的荧光效果提高了美学效果。
In addition to improved PFM ceramics, very thin high gold content
substructures fabricated using a variety of techniques, conventional
casting (Bio2000, Argen Mfg.), capillary action (Captek, Precious
Chemicals Inc.), and electroforming (GES,Gramm Technology Inc.) can
also improve PFM aesthetics by reducing the thickness of the
substructure and emitting a warm yellow color under the veneering
porcelain. Finally, a recent PFM innovation combines conventional PFM
castings with all-ceramic pressing technology in a system called
Authentic Pressable Ceramics (Microstar Corp.). This hybrid system uses
special equipment to press a molten ceramic ingot onto a cast metal
substructure creating a restoration with 360 degree all-porcelain
margins.
除了加强烤瓷瓷粉的物理与美观性能之外，各种内冠较薄的高金含量结构的制作工艺由于减少了金属基底冠的厚度，内冠表面反射温暖的黄色，可以极大的
提高了金属烤瓷冠的美学性能。这方面的代表有bio2000公司，CAPTEK技术，金沉积冠技术等。最终，最近的金属烤瓷冠方面的进展来自将常规金属铸
造技术与全瓷铸压技术结合在一起的AUTHENTIC铸压瓷系统。这种混合型系统采用特殊的设备将熔融的瓷铸压在铸造金属结构表面制作出360度全瓷肩台
的修复体。
Although significant innovations have improved the characteristics
of metal supported restorations, it is generally believed that the best
cosmetic results are achieved with non-metal restorative materials.
Non-metal restorative materials have gone from relative obscurity to a
standardized procedure in many dental offices. These materials can be
divided into two groups: all-ceramic restorations and composite
restorations.
虽然这些金瓷修复领域的进展极大的提高了金瓷修复体的性能，大家还是相信，最美的修复效果来自非金属修复材料。在很多牙科诊所非金属类修复材料已经从非主流走向标准步骤。这些材料可以分为两类：全瓷类修复体与树脂类修复体。
Most composite resin systems on the market today are highly filled
microhybrid composites. The differences in these systems are based on
ceramic filler content and particle size, as well as the processing
method to achieve polymerization. In the past,
composite resins were cured with light exclusively. This technique
prevented the restoration from achieving high levels of polymerization
and caused the material to wear excessively in the oral environment.
Newer composite resin systems such as Belleglass HP (Kerr Mfg. Inc.)
and Sculpture cure the final layers of the composite under heat and
pressure in an oxygen free environment to achieve maximum
polymerization and improved wear resistance. For large restorations and
bridgework, many of these systems incorporate synthetic fiber sub3
structures. Belleglass HP (Kerr Mfg.Inc.), Targis (Ivoclar-Vivident)
and Sculpture use fibrous substructures (Connect, Fibercor, and Vectris
respectively) to strengthen and support the veneering composite resin.
现在市场上大多数复合树脂系统是高填料微混和树脂。这些树脂系统的差异主要基于瓷填料的含量与颗粒的尺寸以及聚合的操作方法。过去，复合树脂仅仅
是光照聚合。这种技术阻碍了修复体达到高水平的聚合，导致材料在口腔环境中过度磨损。更新的复合树脂系统比如美国KERR公司的BELLEGLASS树脂
以及SCULPTURE等，最终树脂的固化是在无氧环境中，热与压力之下，这样可以获得最大程度的聚合，从而提高树脂的耐磨损性能。对于大的修复以及桥来
说，许多类似的系统采用合成纤维完成3单位的桥。KERR的BELLEGLASS系统，义获嘉－伟瓦登特公司的TARGIS系统，以及SCULPTUER
系统采用纤维结构来加强与支持其表面的复合树脂。
All-ceramic indirect restorative systems differ significantly from
one another in both their material composition and the fabrication
process. Dental manufacturers utilize various ceramic materials and
particles in their systems to achieve particular strength
and aesthetic objectives including feldspathic, lucite, magnesium
oxide, zirconium, lithium disilicate, and aluminious oxide. The
processing methods for today’s all-ceramic restorations are equally
diverse.
不同的全瓷间接修复系统其材料组分与制作过程都有很大不同。牙科材料制造商在其各自系统内使用各种瓷材料与瓷填料颗粒来达到特定的强度与美学效果。这些材料包括长石，白榴石，氧化镁，锆，锂基类材料，氧化铝等。现在全瓷修复体加工方法各自不同。
Some systems, like Fortress (Mirage Dental Co.) and Cerinate
(Den-Mat Corp.), utilize a direct build up of a ceramic on a refractory
die or on a master die swedged with palladium or platinum foil. This
classic procedure yields restorations that lack the strength of newer
systems but can provide outstanding aesthetic results and clinically
acceptable strength when properly bonded onto tooth structure.
包括MIRAGE公司的FORTRESS系统、DENMAT公司的CERINATE系统的一类全瓷系统采用在耐火代型表面或者铺钯箔或铂箔的主代
型表面直接恢复瓷牙外形。这类经典步骤一般用于强度较低的新系统修复体的制作，但是这些系统能获得理想的美学效果，而且在粘接正确的条件下其强度也是临床
可以接受的。
A very popular all-ceramic technique is “pressing.” This procedure
utilizes the lost wax technique whereby the technician creates a waxup
of a full contoured restoration or a coping substructure, and then
invests and casts a monochromatic ceramic ingot using
specially designed pressing porcelain furnaces. This technique can
provide excellent aesthetics on full coverage restorations where 1.5 -
2.0 mm of tooth reduction allows the technician an opportunity to
accent the pressed substrate with additional ceramic.
With veneers and inlays, a technician is often limited, by
preparation and strength considerations, to pressing the veneer full
contour and characterizing the external surface with stain.
现在非常流行的全瓷技术是“铸压瓷”。这种技术采用失蜡法，即技师制作一个完全恢复形态的蜡冠或者内冠，然后包埋、在特殊设计的铸压瓷炉种铸造出
一个均一颜色的瓷铸件。这项技术能在全冠牙体预备1.5~2.0毫米后能获得极佳的美学效果，因为它给技师采用额外瓷粉的机会。制作瓷贴面与嵌体时，技师
常常受到牙体预备与强度考虑的限制。只能铸出全形态后在外表面染色。
All-ceramic restorations are also fabfabricated with slip casting
and CAD/ CAM technology. Inceram (Vident Inc.) restorations are
fabricated with slip casting, a process which forms a ceramic
substructure onto a duplicate die. The substrate is removed and
transferred to the master die on which porcelain is built and
contoured.
CAD CAM which fabricate all-ceramic restorations using optical or
contact scanning to precisely measure the die enabling a coping or a
full coverage restoration to be fabricated through a direct or indirect
milling or powder technology process. Primarily, dental laboratories
use CAD/CAM systemsto produce restorations for their clientele.
However, Cerac can be used directly in the dental office. Of the many
promising systems being introduced, Procera (Noble Biocare Inc.)is the
most popular and proven CAD/ CAM system currently available.
全瓷修复体也可以采用slip铸造或CAD-CAM技术制作。INCERAM类修复体就是在一个复制的代型上堆积形成瓷内冠。然后瓷内冠取下来转
移到主代型上堆瓷、成形。CADCAM类修复体采用光学或者接触式扫描精确测量代型来确保瓷内冠或者全冠能直接或间接磨铣出来。最初，技工室使用CAD
CAM技术为牙医制作修复体。现在CEREC系统已经在牙科诊所可以直接应用。在市场提供的众多系统中，NOBLE
BIOCARE公司的PROCERA系统是全球最流行并被临床证明的CADCAM系统。
In summary, with the current quantity and diversity of indirect
restorative materials, dentists, after careful review of the
capabilities and indications of these systems, are in the favorable
position of having a choice of restorative materials which can satisfy
challenging clinical situations as well as the most discerning
clientele. The following product summaries of some of the most popular
all-ceramic and composite systems provides detailed information on each
product, its indications, preparation, cementation, and shade selection
guidelines.
总之，面对如此种类繁多、性能各异的间接修复材料，牙医在仔细的审视这些系统的性能与适应症后，就能作出正确的选择，满足临床的需求与患者的期望。下面的产品总结提供了每种产品的详细信息，适应症，牙体预备，粘接与颜色选择指导。
COMPOSITE SYSTEMS
复合树脂系统
Targis Vectris (Ivoclar-Williams)
TARGIS系统，义获嘉公司
DEscriptION: The Targis Vectris system combines
state-of-the-art ceromer technology with a processed fiber
substructure. Targis, the ceromer, consists of submicron (.04 -1.0 um)
ceramic fillers (75-85% by weight) in a polymer matrix. Targis offers
durable aesthetics, abrasion resistance, and a low degree of
brittleness and susceptibility of fracturing. Targis can be used alone,
with a metal substrate, or with Vectris fiber reinforcement. Vectris is
a multiple layered fiber matrix consisting of thousands of presilinated
resin-saturated synthetic fibers. The use of this framework in
conjunction with Targis resin improves the flexural strength to
approximately 1000MPa.
概述：TARGIS系统结合了艺术瓷复合体技术与纤维技术。TARGIS瓷复合体包括0。04微米到1微米的瓷填料与聚合基质，瓷填料其重量比达
到75％～85％。TARGIS可以提供长久的美学效果，耐磨损，脆性低，不易折。TARGIS可以单独使用，还可金属烤塑，还可以与VECTRIS纤维
加强技术结合。VECTRIS是一种多层纤维，包括上万根预硅烷化树脂浸润合成纤维。这种纤维框架与TARGIS结合使用可以将其抗折强度提高到
1000MPA。
INDICATION: Inlays/onlays, veneers, anterior crowns, posterior
crowns, anterior three unit bridges, posterior three unit bridges,
anterior and posterior “Maryland Type”
bridges.
适应症：嵌体，高嵌体，贴面，前牙冠，后牙单冠，前牙三单位桥，后牙三单位桥，前后牙马里兰桥。
PREPARATION: Clear margins are a prerequisite for an accurate
restoration. Gingival margins can be prepared with a deep chamfer or a
shoulder. Avoid featheredges, long bevels and sharp internal line
angles.
牙体预备：
为修复体的精确，必须有明确的边缘。可以制备深凹肩台或者直角肩台。避免羽状边缘、长斜面边缘与内部的尖锐线角。
CEMENTATION: Contemporary bonding and resin luting techniques are
recommended. In addition, Vectris-supported crowns and bridges can be
conventionally cemented utilizing a modified laboratory technique. A
new cement, ProCem, has recently been developed for use in
conventionally cementing this material.
粘接：
推荐现代树脂粘接技术。另外，VECTRIS支持的冠桥修复体可以使用改良的技工室技术常规粘固。一种新粘接剂PROCEM最近已经开发应用于该种材料的常规粘接。
SHADE SELECTION: Shades are matched to the Chromascop shade guide.
颜色选择：比色与CHROMOSCOP比色板匹配。
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| Re:牙齿美学间接修复体指南之一（老苏翻译） |
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[ 2008-10-16 19:45:29 | By: 开心小牙(游客) ] |
 学习了 |
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| Re:牙齿美学间接修复体指南之一（老苏翻译） |
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[ 2008-7-25 23:24:28 | By: 樊成涛(游客) ] |
| discredit但是没有一个人discredit金合金是最合适的修复体之一。 |
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| Re:牙齿美学间接修复体指南之一（老苏翻译） |
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[ 2008-3-28 21:18:02 | By: 杨裕红(游客) ] |
| 学习了 |
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