Email Alert | RSS

北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (1): 208-213. doi: 10.19723/j.issn.1671-167X.2025.01.031

• 经验交流 • 上一篇    

青少年恒牙牙体缺损的修复难点及过渡修复的方式选择

程雅雯1, 李德利1, 赵彦1, 夏斌2,*(), 刘云松3,*()   

  1. 1. 北京大学口腔医学院 · 口腔医院第二门诊部，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字化医疗技术和材料国家工程实验室，口腔数字医学北京市重点实验室，北京 100081
    2. 北京大学口腔医学院 · 口腔医院儿童口腔科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字化医疗技术和材料国家工程实验室，口腔数字医学北京市重点实验室，北京 100081
    3. 北京大学口腔医学院 · 口腔医院修复科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字化医疗技术和材料国家工程实验室，口腔数字医学北京市重点实验室，北京 100081
  • 收稿日期:2024-09-26 出版日期:2025-02-18 发布日期:2025-01-25
  • 通讯作者: 夏斌,刘云松 E-mail:xiabin@pkuss.bjmu.edu.cn;liuyunsong@hsc.pku.edu.cn
  • 基金资助:
    北京市自然科学基金(L232110);`北京大学医学部教育教学研究课题(2022-ZD-05);国家口腔医学中心适宜技术推广项目(2023-NCSHTP-04)

Clinical dilemma and indication selection of restoration for permanent tooth defects in adolescents

Yawen CHENG1, Deli LI1, Yan ZHAO1, Bin XIA2,*(), Yunsong LIU3,*()   

  1. 1. Second Clinical Division, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    3. Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2024-09-26 Online:2025-02-18 Published:2025-01-25
  • Contact: Bin XIA, Yunsong LIU E-mail:xiabin@pkuss.bjmu.edu.cn;liuyunsong@hsc.pku.edu.cn
  • Supported by:
    the Beijing Municipal Natural Science Foundation(L232110);Peking University Health Science Center Medical Education Research Funding Project(2022-ZD-05);National Center of Stomatology Suitable Technology Promotion Project(2023-NCSHTP-04)

RICH HTML

   

PDF (PC)

关键词: 青少年, 青少年恒牙, 过渡修复, CAD/CAM树脂基陶瓷, 聚合瓷

Abstract:

Adolescence is defined as a population ranging from ten to nineteen years old. Permanent teeth in adolescents are of critical significance as they are actively involved in mastication, contribute to aesthetic appearance, play a role in pronunciation, and are integral to the growth and development of the stomatognathic system. Specifically, permanent teeth in adolescents comprise those with incomplete root development and those with complete root development but unstable gingival margin positions. However, the prevalence of permanent tooth defects among adolescents remains high, primarily due to their insufficient awareness of oral health care and poor compliance with preventive measures. Therefore, it is very important to emphasize the necessity for timely and appropriate restoration of permanent tooth defects in adolescents. Given the distinct physiological characteristics of adolescent permanent teeth compared with mature permanent teeth, interim restoration approaches are required. The field of adolescent permanent tooth restoration is an interdisciplinary area, involving both prosthodontics and pediatric dentistry. Currently, a comprehensive and standardized principle for the selection of restoration indications is lacking, which poses challenges for clinicians in making optimal treatment decisions. Therefore, this article aims to comprehensively summarize the clinical dilemmas associated with the restoration of adolescent permanent teeth, and propose a set of principles for the selection of restoration methods and materials, aiming to offer practical clinical guidelines for dentists when dealing with permanent tooth defects in adolescent patients. In particular, because of the different restoration dilemmas of anterior and posterior permanent teeth, a variety of interim restoration methods, their applicable conditions, advantages, and disadvantages are introduced respectively. Additionally, it provides an in-depth discussion of different interim restoration materials, including direct restoration materials like light-cured composite resin and dual-cured temporary crown resin, as well as indirect restoration materials such as polymeric porcelain and CAD/CAM resin-matrix ceramics. The goal of this research is to provide a foundation for the development of evidence-based restoration plans in clinical practice and to contribute to the establishment of future standards in the field of adolescent permanent tooth restoration. This will enhance the quality of dental care for adolescents and promote better oral health outcomes in this population.

Key words: Adolescents, Permanent teeth in adolescents, Interim restoration, CAD/CAM resin-matrix ceramics, Polymeric porcelain

中图分类号: 

  • R783.3

表1

青少年恒前牙的修复方式"

修复方式 适应证 推荐材料 示意图
复合树脂直接粘接修复 1. 牙根未发育完成的年轻恒牙
2. 小范围缺损，无明显牙髓症状的活髓牙		 复合树脂
临时冠 1. 大范围缺损，或根管治疗后抗力不足的患牙
2. 影响美观的严重变色牙		 直接法：双固化临时冠专用树脂
间接法：聚合瓷和CAD/CAM树脂基陶瓷
纤维桩树脂核+临时冠 根管治疗后超过一壁范围的大面积牙体缺损，冠修复体固位不足 纤维桩、树脂核
CAD/CAM一体化纤维树脂桩核冠修复材料选择同上

表2

青少年恒后牙的修复方式"

修复方式 适应证 推荐材料 示意图
复合树脂直接粘接修复 1. 牙根未发育完成的年轻恒牙
2. 2个牙面以内且粘接面积充足的活髓牙		 复合树脂
嵌体 能够行直接粘接修复的活髓牙，更适用于：
1. 大范围牙体缺损，树脂充填体固位及抗力不足的患牙
2. 临床冠高度不足，隔湿困难的患牙
3. 咬合紧的患牙		 聚合瓷和CAD/CAM树脂基陶瓷
高嵌体 牙体缺损洞形的峡部超过颊舌尖间距的1/3的活髓牙 聚合瓷和CAD/CAM树脂基陶瓷
临时冠 根管治疗后，剩余牙体组织抗力不足的患牙 聚合瓷和CAD/CAM树脂基陶瓷
桩核+临时冠 根管治疗后牙体组织广泛破坏，通常为一壁缺损以上，冠修复体固位不足的患牙 根据剩余牙体组织量、咬合力大小、牙位等情况综合考虑纤维桩(包括预成纤维桩和CAD/CAM一体化纤维树脂桩核)或金属桩冠修复材料选择同上
嵌体冠 根管治疗后的青少年恒后牙，更适用于：
1. 临床冠短，无法固位
2. 颌间距离不足		 聚合瓷和CAD/CAM树脂基陶瓷
1 WHO. Adolescent health[EB/OL]. (2024-09-23)[2024-11-10]. https://www.who.int/health-topics/adolescent-health/#tab=tab_1.
2 秦满, 夏斌. 儿童口腔医学[M]. 3版 北京: 北京大学医学出版社, 2020: 43- 44.
3 Morrow LA , Robbins JW , Jones DL , et al. Clinical crown length changes from age 12－19 years: A longitudinal study[J]. J Dent, 2000, 28 (7): 469- 473.
doi: 10.1016/S0300-5712(00)00023-3
4 Dye BA , Mitnik GL , Iafolla TJ , et al. Trends in dental caries in children and adolescents according to poverty status in the United States from 1999 through 2004 and from 2011 through 2014[J]. J Am Dent Assoc, 2017, 148 (8): 550- 565.e7.
doi: 10.1016/j.adaj.2017.04.013
5 Leite JR , Bomfim RA . Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study[J]. Dent Traumatol, 2023, 39 (5): 478- 482.
doi: 10.1111/edt.12846
6 Ulgen M , Baran S , Kaya H , et al. The influence of the masticatory hypofunction on the craniofacial growth and development in rats[J]. Am J Orthod Dentofacial Orthop, 1997, 111 (2): 189- 198.
doi: 10.1016/S0889-5406(97)70215-4
7 陈宸, 田雨婷, 程立, 等. 儿童第一恒磨牙大面积缺损永久修复时机的考量和展望[J]. 国际口腔医学杂志, 2021, 48 (2): 129- 134.
8 Massaro C , Miranda F , Janson G , et al. Maturational changes of the normal occlusion: A 40-year follow-up[J]. Am J Orthod Dentofacial Orthop, 2018, 154 (2): 188- 200.
doi: 10.1016/j.ajodo.2017.10.028
9 Theytaz GA , Christou P , Kiliaridis S . Gingival changes and secondary tooth eruption in adolescents and adults: A longitudinal retrospective study[J]. Am J Orthod Dentofacial Orthop, 2011, 139 (Suppl 4): S129- S132.
10 de Kuijper MCFM , Cune MS , Özcan M , et al. Clinical performance of direct composite resin versus indirect restorations on endodontically treated posterior teeth: A systematic review and metaanalysis[J]. J Prosthet Dent, 2023, 130 (3): 295- 306.
doi: 10.1016/j.prosdent.2021.11.009
11 Oliveira GM , Ritter AV . Composite resin restorations of permanent incisors with crown fractures[J]. Pediatr Dent, 2009, 31 (2): 102- 109.
12 刘云松, 周倜, 叶红强. 前牙美学修复的整体策略及细节剖析[J]. 北京大学学报(医学版), 2022, 54 (1): 1- 6.
doi: 10.19723/j.issn.1671-167X.2022.01.001
13 谭建国, 李德利. 一步一步做好前牙美学设计[J]. 中华口腔医学杂志, 2020, 55 (10): 799- 802.
14 杨帆, 白向松, 王晓燕, 等. 以剩余牙本质壁状况指导大面积牙体缺损修复方式的选择[J]. 中国实用口腔科杂志, 2021, 14 (1): 118- 123.
15 Marchionatti AME , Wandscher VF , Rippe MP , et al. Clinical performance and failure modes of pulpless teeth restored with posts: A systematic review[J]. Braz Oral Res, 2017, 31, e64.
16 Zicari F , De Munck J , Scotti R , et al. Factors affecting the cement-post interface[J]. Dent Mater, 2012, 28 (3): 287- 297.
doi: 10.1016/j.dental.2011.11.003
17 Lempel E , Lovász BV , Bihari E , et al. Long-term clinical evaluation of direct resin composite restorations in vital vs. endodontically treated posterior teeth: Retrospective study up to 13 years[J]. Dent Mater, 2019, 35 (9): 1308- 1318.
doi: 10.1016/j.dental.2019.06.002
18 Opdam NJ , van de Sande FH , Bronkhorst E , et al. Longevity of posterior composite restorations: A systematic review and meta-analysis[J]. J Dent Res, 2014, 93 (10): 943- 949.
doi: 10.1177/0022034514544217
19 陈宇, 李勉香, 张颖. 铸瓷高嵌体修复牙体严重缺损的年轻恒磨牙的效果分析[J]. 华西口腔医学杂志, 2019, 37 (3): 299- 303.
20 齐春光, 高雪彬, 杨华, 等. 儿童年轻恒磨牙大面积缺损常见修复方式的选择[J]. 口腔医学, 2022, 42 (7): 645- 649.
21 Ye JR , Park SH , Lee H , et al. Influence of limited mouth opening in children on intraoral scanning accuracy: An in vitro study[J]. Int J Paediatr Dent, 2024, 34 (6): 755- 763.
doi: 10.1111/ipd.13175
22 Davidovich E , Shay B , Nuni E , et al. An Innovative treatment approach using digital workflow and CAD-CAM part 1: The restoration of endodontically treated molars in children[J]. Int J Environ Res Public Health, 2020, 17 (4): 1364.
doi: 10.3390/ijerph17041364
23 Gómez-Polo M , Revilla-León M , Limones á , et al. Intraoral digital scans for fabricating tooth-supported prostheses using a custom intraoral scan body[J]. J Prosthodont, 2022, 31 (4): 356- 361.
doi: 10.1111/jopr.13468
24 Goujat A , Abouelleil H , Colon P , et al. Marginal and internal fit of CAD-CAM inlay/onlay restorations: A systematic review of in vitro studies[J]. J Prosthet Dent, 2019, 121 (4): 590- 597.e3.
doi: 10.1016/j.prosdent.2018.06.006
25 王潇, 王旭, 夏斌. 年轻第一恒磨牙牙体缺损的高嵌体修复一例[C/OL]//2019年中华口腔医学会儿童口腔医学专业委员会儿童口腔医学技术进步与发展高端论坛论文汇编. 中国重庆, 2019[2024-09-01]. https://kns.cnki.net/KCMS/detail/detail.aspx?dbcode=CPFD&filename=HZKQ201911001128.
26 Pratt I , Aminoshariae A , Montagnese TA , et al. Eight-year retrospective study of the critical time lapse between root canal completion and crown placement: Its influence on the survival of endodontically treated teeth[J]. J Endod, 2016, 42 (11): 1598- 1603.
doi: 10.1016/j.joen.2016.08.006
27 Nahhas RW , Valiathan M , Sherwood RJ . Variation in timing, duration, intensity, and direction of adolescent growth in the mandible, maxilla, and cranial base: The Fels longitudinal study[J]. Anat Rec (Hoboken), 2014, 297 (7): 1195- 1207.
doi: 10.1002/ar.22918
28 Arboleda C , Buschang PH , Camacho JA , et al. A mixed longitudinal anthropometric study of craniofacial growth of Colombian mestizos 6－17 years of age[J]. Eur J Orthod, 2011, 33 (4): 441- 449.
doi: 10.1093/ejo/cjq099
29 Koleventi A , Sakellari D , Arapostathis KN , et al. Periodontal impact of preformed metal crowns on permanent molars of children and adolescents: A pilot study[J]. Pediatr Dent, 2018, 40 (2): 117- 121.
30 Tickotsky N , Petel R , Haim Y , et al. Post-and-core restoration of severely damaged permanent posterior teeth in young adolescents[J]. Int J Prosthodont, 2017, 30 (5): 458- 460.
doi: 10.11607/ijp.5243
31 Falcão Spina DR , da Costa RG , Correr GM , et al. Scanning of root canal impression for the fabrication of a resin CAD-CAM-customized post-and-core[J]. J Prosthet Dent, 2018, 120 (2): 242- 245.
doi: 10.1016/j.prosdent.2017.08.009
32 Eid RY , Koken S , Baba NZ , et al. Effect of fabrication technique and thermal cycling on the bond strength of CAD/CAM milled custom fit anatomical post and cores: An in vitro study[J]. J Prosthodont, 2019, 28 (8): 898- 905.
doi: 10.1111/jopr.13101
33 Maia LM , Júnior WB , Toubes KM , et al. Endodontic guide for the conservative removal of a fiber-reinforced composite resin post[J]. J Prosthet Dent, 2022, 128 (1): 4- 7.
doi: 10.1016/j.prosdent.2020.11.044
34 Lenz U , Bacchi A , Della Bona A . Biomechanical performance of endocrown and core-crown restorations: A systematic review[J]. J Esthet Restor Dent, 2024, 36 (2): 303- 323.
doi: 10.1111/jerd.13119
35 Sedrez-Porto JA , Rosa WL , da Silva AF , et al. Endocrown restorations: A systematic review and meta-analysis[J]. J Dent, 2016, 52, 8- 14.
doi: 10.1016/j.jdent.2016.07.005
36 Einhorn M , DuVall N , Wajdowicz M , et al. Preparation ferrule design effect on endocrown failure resistance[J]. J Prosthodont, 2019, 28 (1): e237- e242.
37 Wierichs RJ , Kramer EJ , Meyer-Lueckel H . Risk factors for failure of direct restorations in general dental practices[J]. J Dent Res, 2020, 99 (9): 1039- 1046.
doi: 10.1177/0022034520924390
38 Yantcheva SM . Marginal adaptation and micropermeability of class Ⅱ cavities restored with three different types of resin composites: A comparative ten-month in vitro study[J]. Polymers (Basel), 2021, 13 (10): 1660.
doi: 10.3390/polym13101660
39 Wassell RW , St George G , Ingledew RP , et al. Crowns and other extra-coronal restorations: Provisional restorations[J]. Br Dent J, 2002, 192 (11): 619-622, 625-630.
doi: 10.1038/sj.bdj.4801443
40 中华口腔医学会口腔美学专业委员会, 中华口腔医学会口腔材料专业委员会. 全瓷美学修复材料临床应用专家共识[J]. 中华口腔医学杂志, 2019, 54 (12): 825- 828.
41 Goujat A , Abouelleil H , Colon P , et al. Mechanical properties and internal fit of 4 CAD-CAM block materials[J]. J Prosthet Dent, 2018, 119 (3): 384- 389.
doi: 10.1016/j.prosdent.2017.03.001
42 Rayyan MM , Aboushelib M , Sayed NM , et al. Comparison of interim restorations fabricated by CAD/CAM with those fabricated manually[J]. J Prosthet Dent, 2015, 114 (3): 414- 419.
[1] 邓敏婷, 王楠, 夏斌, 赵玉鸣, 朱俊霞. 儿童及青少年挫入恒前牙自行再萌出的相关影响因素[J]. 北京大学学报（医学版）, 2025, 57(1): 148-153.
[2] 王敏, 李倩. 青少年抑郁症患者心理弹性影响因素的路径分析[J]. 北京大学学报（医学版）, 2024, 56(5): 809-814.
[3] 沈鹤军,侍崇艳,郑清,黄玉,景涛. 我国高中生静坐时长与健康素养现状及其影响因素调查[J]. 北京大学学报（医学版）, 2024, 56(2): 239-246.
[4] 崔孟杰,马奇,陈曼曼,马涛,王鑫鑫,刘婕妤,张奕,陈力,蒋家诺,袁雯,郭桐君,董彦会,马军,星一. 不同生长模式与7~17岁儿童青少年代谢综合征的关系[J]. 北京大学学报（医学版）, 2023, 55(3): 415-420.
[5] 党佳佳,蔡珊,钟盼亮,王雅琪,刘云飞,师嫡,陈子玥,张依航,胡佩瑾,李晶,马军,宋逸. 室外夜间人工光暴露与中国9~18岁儿童青少年超重肥胖的关联[J]. 北京大学学报（医学版）, 2023, 55(3): 421-428.
[6] 郑丹枫,李君禹,李佳曦,张英爽,钟延丰,于淼. 青少年特发性脊柱侧凸椎旁肌的病理特征[J]. 北京大学学报（医学版）, 2023, 55(2): 283-291.
[7] 刘云飞,党佳佳,钟盼亮,马宁,师嫡,宋逸. 1990—2019年中国5~24岁人群伤害死亡率分析[J]. 北京大学学报（医学版）, 2022, 54(3): 498-504.
[8] 陈曼曼,杨招庚,苏彬彬,李艳辉,高迪,马莹,马涛,董彦会,马军. 中山市儿童青少年青春期身高生长突增规律[J]. 北京大学学报（医学版）, 2021, 53(3): 506-510.
[9] 杨雪,孙伟,王哲,姬爱平,白洁. 儿童和青少年牙外伤急诊患者临床分析[J]. 北京大学学报（医学版）, 2021, 53(2): 384-389.
[10] 周境,刘怡. 不同垂直骨面型骨性Ⅱ类青少年女性颞下颌关节锥形束CT测量分析[J]. 北京大学学报（医学版）, 2021, 53(1): 109-119.
[11] 罗冬梅,闫晓晋,胡佩瑾,张京舒,宋逸,马军. 1990—2010年中国女性早婚和生育的地区不平等性[J]. 北京大学学报（医学版）, 2020, 52(3): 479-485.
[12] 陶春燕,李红霞,李雪迎,唐朝枢,金红芳,杜军保. 体位性心动过速综合征儿童及青少年在直立试验中血流动力学变化[J]. 北京大学学报（医学版）, 2019, 51(3): 414-421.
[13] 董彦会，宋逸，董彬，邹志勇，王政和，杨招庚，王西婕，李艳辉，马军. 2014年中国7~18岁学生血压状况与营养状况的关联分析——基于中国儿童青少年血压评价标准[J]. 北京大学学报(医学版), 2018, 50(3): 422-428.
[14] 陈天麒，董彬，张文静，高迪思，董彦会，马军，马迎华. 儿童青少年睡眠时间与速度和耐力成绩的相关性研究[J]. 北京大学学报(医学版), 2018, 50(3): 429-435.
[15] 李昕，王欣，吴迪，陈智滨，王梦醒，高艳霞，巩纯秀，秦满. 青少年糖尿病患者血浆及龈沟液中白细胞介素-1β和C反应蛋白水平[J]. 北京大学学报(医学版), 2018, 50(3): 538-542.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部