目的: 对比后牙高嵌体和贴面修复体在不同性别、不同牙位、活髓牙和根管治疗牙上的4年临床成功率, 探讨与全冠对比这种修复方式的优劣及更细化的适应证。方法: 对2016—2019年由同一位术者诊治的共102位患者的124颗患牙进行前磨牙及磨牙计算机辅助设计/计算机辅助制造(computer aided design/computer aided manufacturing, CAD/CAM)二硅酸锂增强玻璃陶瓷高嵌体或者贴面修复, 其中活髓牙43颗, 根管治疗牙81颗, 咬合面修复体厚度为1.5 mm。在修复4年后进行回顾性调查, 记录修复体生存率、修复体失败原因、患者满意率, 比较活髓牙和根管治疗牙之间、修复牙位之间的修复体生存率。结果: 活髓牙和剩余牙体组织较多的根管治疗牙修复4年后的生存率分别为95.5%和90.0%, 平均生存率为91.9%。活髓牙的生存率高于根管治疗牙, 但是差异无统计学意义, 牙位之间生存率差异无统计学意义。失败原因有修复体崩瓷或折裂、修复体脱落、基牙劈裂、邻接触点下方继发龋, 以及邻接触点松弛导致食物嵌塞等。患者总体满意率为91.5%。结论: 玻璃陶瓷高嵌体和贴面的4年生存率低于全冠修复体, 并发症多于单冠修复体, 应根据基牙牙髓活力和牙体组织剩余量来慎重选择其适应证, 牙体组织剩余过少时最好选择桩核冠来进行修复, 应保证修复体充分强度和厚度, 预防食物嵌塞的发生, 由于基牙预备量少, 有对牙髓和牙周组织刺激小等优点, 可推荐为试用修复方式。

Objective: To investigate the survival rate and clinical failure reasons of onlay and occlusal veneer restorations retrospectively, and to put forward valuable suggestions for the selection of clinical indications. Methods: A total of 102 patients and 124 teeth treated by one of the authors from 2016 to 2019 were subjected to CAD/CAM lithium silicate reinforced glass-ceramic onlay or veneer restorations of premolars and molars, including 43 teeth with pulp vitality, 81 endodontic treated teeth, and occlusal thickness of restoration was 1.5 mm. After four years of restoration, retrospective surveys were conducted to record the survival rate of restorations, the causes of restoration failure, and patient satisfaction rates, and the survival rate of restorations between vital teeth and endodontic treated teeth and among restored teeth was statistically analyzed by Chi-square test. Results: The survival rates of restorations on vital teeth and endodontic treated teeth were 95.5% and 90.0%, respectively, the average survival rate was 90.2%. The survival rates of vital teeth were higher than those of endodontic treated teeth without statistical difference. There was also no statistically significant difference among the tooth locations. The causes of failure included the cracking of the restoration, the loss of the restoration, the fracture of the abutment teeth, secondary caries below the adjacent contact point, and food impaction caused by the loosening of the adjacent contact point. The overall patient satisfaction rate was 91.5%. Conclusion: The 4-year survival rate of glass-ceramic onlays and occlusal veneers is lower than that of the full crown restoration, and there are more complications than that of the single-crown restorations. The design of the restoration should be carefully selected based on the vitality of the abutment tooth and the remaining amount of tooth tissue. When there is too little tooth structure left, a post and crown should be selected for restoration. Adequate strength and thickness of the restoration should be ensured to prevent food impaction. Due to the small amount of abutment tooth preparation, it has the advantages of less stimulation of the pulp and periodontal tissue, and can be recommended as a trial restoration.