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Source: Chinese Journal of Practical Medicine
Author: Dong Wen, Department of dental pulp, Beijing Stomatological Hospital, Capital Medical University
Abstract: This paper mainly introduces the clinical design scheme, the design of hole and inclined plane, the design concept and method of the color of aesthetic layered restoration of different types of clinical teeth by using composite resin. Combined with clinical cases, it also introduces the important links in the restoration process, such as smile analysis of mouth cavity, tooth color comparison, tooth preparation, acid etching, bonding, tooth restoration, polishing and dressing The operation steps and clinical points were summarized. The purpose of this study is to provide reference and help for clinicians to reasonably use composite resin for tooth restoration and obtain good aesthetic effect, so as to work together to improve the aesthetic restoration level of composite resin.
Key words: composite resin; aesthetic dentistry; tooth restoration; bonding technology; clinical treatment; smile Aesthetics
In the 1940s, the chemical curing self setting resin appeared and became the predecessor of composite resin. Since 1955, buonocore, an American scholar, first used phosphoric acid to treat tooth surface to promote the bonding between resin and tooth, the bonding repair technology has developed rapidly. In 1963, composite resin materials appeared. In the next 10 years, UV curable composite resin and visible light curable composite resin appeared in succession. With the development of tooth bonding technology and composite resin repair technology, the defects in the bonding performance of composite resin materials in the past have been overcome, and the clinical application is more extensive. Later In the past 20 years, composite resin repair materials and technologies have developed rapidly, and a common composite resin for front and rear teeth has emerged, which can meet the requirements of clinical compressive strength and bonding strength, so that more healthy tooth tissues can be retained in clinical operation. At the same time, the progress of new bonding system and resin materials, especially the improvement and specification of technical details in clinical operation, to a certain extent It reduces the microleakage between the filling body and the tooth body, so as to prevent the secondary caries, obtain more reliable clinical bonding, and meet the daily clinical needs of the oral cavity. near In the past 10 years, with the continuous enhancement of people's aesthetic consciousness, more and more patients have asked for dental restoration. From the past practical beauty to meet the needs of chewing function, they have started to move forward to a higher level of aesthetic needs. Aesthetic dentistry has emerged. Composite resin aesthetic restoration has also become an important part of aesthetic dentistry. Instead of focusing only on functional restoration and ignoring the performance of tooth color in the past Traditional concept of restoration. In 2001, dietschi (1) first proposed the idea of multi-color layered restoration based on the layered techniques of tooth anatomy, using composite resin to imitate the color characteristics of enamel dentin natural layer From then on, composite resin repair has entered a new era of aesthetic layered repair. In recent years, composite resin aesthetic layered restoration has become a popular fashion in the conservative treatment of various types of clinical cosmetic defects, especially in the anterior teeth. The clinical application of restorative materials and technologies is more and more oriented to the direction of aesthetics, conservatism and personality. It can be said that the progress of bonding technology and restoration technology can promote the tooth preservation and restoration to the greatest extent, reduce the invasive treatment in the design of tooth restoration, and maximize the effectiveness of natural teeth. A large number of basic and clinical researches continue to focus on this bonding repair system, which makes us start to recognize the bonding and bonding repair system from a new aesthetic perspective, and start to pay attention to the operation details in clinical application, pay attention to the repair quality, so as to obtain more ideal clinical repair effect.
Today, the high development of modern dental restoration brings us new opportunities and challenges for every clinician. This is how to use composite resin to carry out aesthetic restoration and creation of teeth; how to analyze, research and think about various difficult problems in clinical practice; how to deal with various hot and difficult problems in clinical work; how to use composite resin to carry out tooth color matching and external application Shape reconstruction; how to create a more perfect smile to better meet the needs of patients.
This paper will focus on the clinical design methods and steps of aesthetic restoration of teeth with composite resin, including doctor-patient communication, determination of clinical restoration scheme, design of tooth hole slope and color matching, clinical operation steps and key points of bonding restoration details. For the common problems of aesthetic defects of clinical teeth (such as deep caries, crown fracture of tooth trauma and large tooth space) aesthetic restoration, clinical analysis and summary of clinical key points are carried out one by one. I hope to share some clinical thinking, experience and experience with you, and also hope to bring you some practical help.
1. Clinical design of aesthetic restoration of composite resin 1. Design process of aesthetic clinical restoration scheme of composite resin (1) through communication between doctors and patients to understand aesthetic needs of patients. The general examination of oral cavity and the preliminary observation and analysis of smile aesthetics were carried out to understand the oral conditions of patients and evaluate the clinical effect of aesthetic restoration.
(2) Balance the characteristics of various beauty techniques, fully understand the patient's bearing capacity, and develop appropriate aesthetic restoration programs for patients.
(3) In the repair treatment, the treatment plan was further revised to obtain the patients' recognition and satisfactory repair design.
(4) It emphasizes the overall clinical design of oral cavity, and the final design scheme can be combined with diversified clinical beauty technology.
1.2 smile analysis through the analysis of oral smile performance, to understand the details of tooth beauty defects and the attention of smile aesthetic effect, to observe the teeth arrangement and occlusion status, to understand the details of tooth surface. The common forms of oral smile and the key points of clinical design are as follows.
(1) Low smile: tooth exposure at the time of smile & lt; 75% of the area of upper anterior teeth (Figure 2a). It is the weakest smile state, which can be seen in daily light speech; tooth defects are easy to be hidden by lip tissue, and the aesthetic effect is less concerned.
(2) Middle smile: when smiling, the exposure of teeth is 75% - 100% of the area of upper anterior teeth, and some gingival papillae are exposed (Fig. 2b). It is a middle smile state, which can be seen in the daily intense language; some patients smile at the maximum position, which is the most aesthetic smile form. The same amount of exposure in the defect of anterior teeth has a certain degree of aesthetic effect.
(3) High smile: when smiling, the exposure of teeth is 100% of the area of upper anterior teeth, with continuous gingival exposure (Figure 2C). Also known as "open gum smile". Some patients murmur as "open lips and open teeth", while others smile at the biggest position as this form. At this time, the problem of anterior teeth will be revealed, and the aesthetic effect will be paid more attention.
1.3 aesthetic restoration design 1.3.1 aesthetic layered restoration
(1) Dietschi [1] first proposed the concept of layered restoration based on the anatomical layer of teeth in 2001. The composite resin was used to imitate the color characteristics of enamel dentin natural layer for multi-color layered restoration, so as to obtain more ideal aesthetic restoration effect.
(2) The key to aesthetic restoration of composite resin is color recognition and reproduction. Due to the different material properties and color characteristics of different companies and manufacturers, there is a lack of unified specifications. Therefore, it is more difficult to express the color of natural teeth.
A. Imitating dentin color: usually the color of the main body of teeth is mainly determined by the dentin color, and its color is opaque. Through the application of composite resin materials containing certain shade components, the low color characteristics of natural dentin transparency were imitated [1,3-6]. In clinic, the composite resin containing opaque or dentin can be used.
B. Imitation enamel color: natural enamel has translucency. Through the application of composite resin materials with certain transparency, the color characteristics of enamel with high transparency are imitated. In clinical application, the restorative material can be e (enamel) or T (transparent).
1. Incised end of tooth: highly transparent. In general, special transparent material t is used to simulate the high transparent color characteristics of natural cutting ends.
Special modified staining: the modified material is placed between the dentin and enamel to imitate the yellow or white plaque of the natural teeth, which is used to simulate the modification. See Figure 3.
1.3.2 the slope of the aesthetic hole is usually 45 ° and the slope of the hole edge can be designed; the shallow concave slope can be designed; the aesthetic expansion preparation area can be designed according to the size of the hole and the characteristics of the tooth surface; the design of the slope range of the hole is more important; the edge stop is not clear to facilitate the concealment of the prosthesis [6]. See Figure 4.
1.4 basic clinical steps and operation points of composite resin aesthetic repair although the composite resin bonding repair has been widely carried out in the world, however, due to the lack of unified and standardized clinical technical guidance and evaluation standards for the clinical effect of composite resin bonding repair, the clinical effect of some cases of bonding repair is not ideal. Therefore, it is very necessary to establish the appropriate and standardized technical operation standards as early as possible, especially the clinical standards applicable to the clinical evaluation and operation details of aesthetic restoration of anterior teeth, in order to obtain a more ideal effect of aesthetic improvement. I hope this paper can provide some reference.
1.4.1 preoperative preparation
(1) Doctor patient communication
Communicate and pay attention to listen to the patients (or beauty doctors) dental beauty demands, fully understand whether their dental beauty needs can be achieved through the aesthetic clinical design.
(2) Analysis of smile in mouth
By observing the relative position of lips and teeth when smiling, we can understand the cosmetic defects of anterior teeth [5-6]. Communicate before the mirror, help the patients to carry out all-round oral examination, analyze beauty related problems, let the patients know the factors related to smile aesthetics, and prepare for further development of clinical beauty plan.
(3) Analysis of occlusal state
Occlusal state inspection is an essential link of repair analysis. By observing the situation of oral occlusion, we can fully understand and evaluate the repair space and occlusal force, and predict the repair effect.
(4) Making aesthetic goals and plans
Through adequate communication between doctors and patients, we can understand the beauty needs of patients, weigh the factors of oral conditions, advantages and disadvantages of various beauty techniques, predict and evaluate the curative effect, consider the patient's bearing capacity, and develop appropriate tooth aesthetic restoration programs that meet the needs of patients.
(5) Preoperative colorimetry
Clean the operation area, remove the plaque, pigment and necessary caries tissue on the tooth surface, and then compare the color rapidly under natural light [3,6-7]. The color comparison should be carried out before the rubber barrier is placed, and completed quickly before the tooth dehydration. The color comparison plate should be as close to the target tooth as possible.
It is suggested to use the composite resin color comparison plate which is consistent with the bonding repair system material for color comparison. When the tooth color is more complex, the Vita color comparison plate can be used for preliminary color comparison, to understand the color distribution trend, and then the resin color comparison plate can be transformed; the color comparison can be divided into sections, pay attention to observe the color characteristics of the neck, body and cutting end of the tooth, and preliminarily determine the enamel surface color and dentin color.
The color that is not easy to locate accurately can be combined with the color test of repair materials and pre repair methods to determine the color of clinical application. Note that the selected color should match the color of the adjacent teeth. When designing more restorations, we should pay attention to the color coordination of the whole dentition and set up the goal of improving the overall tooth color in the operation area.
1.4.2 clinical steps of adhesive repair
(1) Surgical isolation
Good control operation area pollution environment is sticky