| Objectives:Using the chairside CAD/CAM CEREC Blocs inlays, polymeric ceramic inlays and nano resin fillings to repair Class Ⅱ cavity or large proximalocclusal defect of posterior tooth, and to compare the clinical process and efficacy. Through the clinical experience of the operation and the evaluation of short-term clinical effect, we summarized the advantages and disadvantages of three methods,and also attention to matters improving the success rate of treatment. To guide the clinical reasonable selections of treatment and to improve the success rate of posterior Ⅱ cavity repair treatment as well as the patients’ satisfaction.Methods:1 Case Selection: Selected 75 patients from Stomatology Hospital oral medicine department of Hebei Medical University who had interproximal defects of posterior tooth from June 2014 to December 2014,ranging from 20 to 60 years old. Inclusion criteria:(1) the remaining tooth tissue had sufficient resistance that can be repaired with methods of filling or inlays.(2) patients who had fine periodontal condition.(3) all subjects enrolled in this study were informed consent and signed an agreement.2 Experimental groups: according to the wishes of the patients,they were divided into three experimental groups: chairside CAD/CAM CEREC Blocs inlays group(hereinafter referred to as chairside group), polymeric ceramic inlays group(hereinafter referred to as polymeric ceramic group), and nano resin fillings group(hereinafter referred to as resin group), 25 cases for each group. Using the healthy contralateral or contralocclusal teeth of the same name as the control group.3 Experimental methods:3.1 Records of patients in general:Name, gender, age, health status, contact details, date of the first visit, plaque index and gingival index of the teeth;3.2 Checked the patient’s oral hygiene, treated the defected tooth with supragingival scaling and rinsed with medicine, made an oral health education.3.3 Communicated with patients according to the clinical examination, repaired the teeth according to their wishes.Patients who had deep caries and are sensitive in preparing teeth were firstly treated by sedative treatment, and observed 2-4 weeks; patients who had pulpitis or apical periodontitis must complete the root canal treatment firstly. Before restoration the gingival state of the defected tooth had been returned to normal level.3.3.1 Chairside group: removed the detritus, prepared the tooth as required, used the CEREC AC equipment to achieve optical model, designed and cut to produce the final prosthesis, try-in, glazed, bonded and polished.3.3.2 Polymeric ceramic group: removed the detritus, prepared the tooth as required, obtained a working model with silicone rubber, and a nonworking model through alginate impression material, used teethers to temporarily close the cavity, perfusion model, sended the models to the hospital laboratory for production, called the patient to further consultation after the restoration was completed, tried, bonded and polished.3.3.3 Resin group: removed the detritus, prepared the cavity, filled the cavity with nano resin directly and polished.3.4 Recorded the plaque index and gingival index of the teeth immediately after the surgery.3.5 Reviewed after 3 months: Observed the anatomic form and color matching of the restorations, as well as the gingival index and plaque index of the experimental and control teeth, and maked an patient satisfaction questionnaire. Statistical analysis was performed using SPSS13.0 software.Result1 In terms of anatomic form: 100% chairside group and polymeric ceramic group were up to the standard for class A, 100% resin group was class B.2 In terms of color matching: 43.5% chairside group was class A, 56.5% for B; 38.1% polymeric ceramic group was class A, 61.9% for B; 30% resin group was class A, 70% for B. Three groups compared with each other, the difference was not statistically significant(P>0.05).3 In terms of plaque index: 4.4% chairside group were diagnosed 0 score at the first visit, 91.3% immediately after the visit, 95.7% after three months and 87% in the control group; 0% polymeric ceramic group were diagnosed 0 score at the first visit, 90.5% immediately after the visit, 90.5% after three months and 95.2% in the control group; 10% resin group were diagnosed 0 score at the first visit, 40% immediately after the visit, 80% after three months and 90.0% in the control group. Scores at the first visit were lower than scores immediately after restoration and after three months in the experimental groups, the difference was statistically significant(P<0.05);difference between immediately after restoration and after three months in the chairside group and polymeric ceramic group was instatistically significant(P>0.05), while difference between immediately after restoration and after three months in the resin group was statistically significant(P<0.05); after three months when three experiments groups were compared with each control group, the difference was not statistically significant(P>0.05).4 In terms of gingival index : 8.7% chairside group were diagnosed 0 score at the first visit, 91.3% immediately after the visit, 95.7% after three months and 100% in the control group; 47.6% polymeric ceramic group were diagnosed 0 score at the first visit, 95.2% immediately after the visit, 100% after three months and 100% in the control group; 25% resin group were diagnosed 0 score at the first visit, 50% immediately after the visit, 90% after three months and 100% in the control group. Scores at the first visit were lower than scores immediately after restoration and after three months in the experimental groups, the difference was statistically significant(P Results: <0.05);difference between immediately after restoration and after three months in the chairside group and polymeric ceramic group was instatistically significant(P> 0.05), while difference between immediately after restoration and after three months in the resin group was statistically significant(P<0.05); after three months when three experiments groups were compared with each control group, the difference was not statistically significant(P>0.05).5 In terms of patients’ satisfaction: All the patients were very satisfied with the color and shape of the restorations in three groups; for the aspect of comfort, 87% chairside group felt very satisfied, while polymeric ceramic group 90.5%, and resin group 85%; in the costs, 8.7% chairside group felt very satisfied, while polymeric ceramic group 85.7%, and resin group 100%;in the number of visits, all the patients were very satisfied in both the chairside and resin group, 71.4% of the patients are satisfied in polymeric ceramic group.Conclusions:1 Chairside CAD/CAM CEREC Blocs inlays for posterior teeth can achieve good clinical effect.2 Comparing chairside CAD/CAM CEREC Blocs inlays and traditional polymeric ceramic inlays, the former can satisfy the patients more at the number of clinical visits and chairside time.3 Inlays are better in the anatomical shape and occlusal function in restoring large defect of posterior teeth,onlays can achieve good clinical effect with endodontically treated posterior teeth.4 In ensuring the effectiveness of making chairside CAD/CAM posterior inlays,we should be strictly in accordance with the inlay preparation requirements to ensure a certain thickness,choose the appropriate basing material, obtain the optical impression rapidly、stably and accurately, bond firmly with resin adhesives. |
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