董涛 殷新民

[摘要]目的：探究CAD/CAM系统制作玻璃瓷高嵌体修复严重磨牙缺损的临床效果与安全性。方法：选取2014年1月-2016年1月笔者医院口腔科收治的龋病致严重磨牙缺损的188例患者（患牙264颗），根据随机数字表法将其分为观察组（94例，患牙131颗）和对照组（94例，患牙133颗）。观察组在一次性根管治疗1周后采用CAD/CAM玻璃瓷高嵌体修复，对照组采用银汞合金嵌体修复。嘱患者每半年复诊1次，采用改良美国公众健康服务标准对修复体进行评价。随访期间检测两组患者患侧龈沟液内肿瘤坏死因子-α（tumor necrosis factor alpha， TNF-α）与基质金属蛋白酶-8（matrix metalloproteinase-8， MMP-8）含量。术后24个月，采用笔者医院自拟的牙科患者生活质量评分量表对其进行评价。结果：术后12、18及24个月观察组临床疗效均优于对照组（均P<0.05）。术后6、12、18及24個月观察组患侧龈沟液内TNF-α和MMP-8含量均低于对照组（均P<0.05）。术后24个月观察组生理功能、情感功能和社会功能评分均高于对照组（均P<0.05）。结论：在修复磨牙缺损方面，CAD/CAM系统制作玻璃瓷高嵌体较银汞合金嵌体效果显著，具有更高的稳定性和生物相容性，值得临床推广。

[关键词]龋病;牙齿缺损;CAD/CAM;玻璃瓷高嵌体;口腔修复

[中图分类号]R783.4    [文献标志码]A    [文章编号]1008-6455（2019）02-0113-04

Abstract： Objective To explore the clinical effect of glass ceramic inlay in repairing severe molar defect by CAD/CAM system. Methods  From Jan. 2014 to Jan. 2016， 188 patients （264 teeth） with dental caries caused by dental caries admitted to Department of stomatology in our hospital were divided into observation group （94 cases， 131 teeth） and control group （94 cases， 133 teeth） according to the random digital table method. The observation group was treated with CAD/CAM glass ceramic inlay after 1 weeks of disposable root canal treatment， while the control group was treated with Amalgam inlay. The revised American public health service standard was used to evaluate the prostheses. During the follow-up period， the levels of tumor necrosis factor alpha （TNF-α） and matrix metalloproteinase-8 （MMP-8） in the gingival crevicular fluid were detected between two groups. The quality of life was evaluated between two groups 24 months after the operation. Results The clinical efficacy of the observation group was better than that of the control group at 12 months， 18 months and 24 months after operation（P<0.05）. The levels of TNF-α and MMP-8 in the gingival crevicular fluid of the observation group were lower than those of the control group at 6 months， 12 months， 18 months and 24 months after operation（P<0.05）. The scores of physiological function， emotional function and social function in the observation group were higher than those in the control group 24 months after operation（P<0.05）.  Conclusion  In the aspect of repairing molar defect， the glass-ceramic inlay made by CAD/CAM system is more stable and biocompatible than amalgam inlay.

Key words： dental defects; CAD/CAM; vitreous porcelain inlay; oral prosthesis

下颌磨牙在根管治疗后生物力学和理化特性均发生改变，牙折裂的几率大大提高[1]。CAD/CAM系统制作玻璃瓷高嵌体修复缺损的磨牙，对牙体磨除较少，同时可达到固位作用，与牙周组织的相容性较高[2]。笔者科室自2013年将这项技术用于临床，效果显著，本次研究就CAD/CAM系统制作玻璃瓷高嵌体与银汞合金嵌体的效果进行比较，现将结果报道如下。

1  资料和方法

1.1 研究对象：经笔者医院医学伦理委员会同意，选取2014年1月-2016年1月笔者科室收治的龋病致磨牙缺损患者188例（患牙264颗），其中男100例，女88例，年龄18～54岁，平均（30.6±5.1）岁，第一前磨牙56颗，第二前磨牙72颗，第一磨牙90颗，第二磨牙46颗。……