Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses.
Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses.
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DOI：
10.1016/j.dental.2011.09.012
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发表时间：
2012-01
期刊：
影响因子：
5
通讯作者：
Anusavice, Kenneth J.
中科院分区：
文献类型：
--
作者：
Anusavice, Kenneth J.
关键词：
“没有什么有价值的事情是没有并发症的。”最近陶瓷碎裂临床研究报告的增加提出了一个问题：哪些标准应该构成全陶瓷修复体的成功或失败。诸如轻微碎裂、部分碎裂、技术并发症和生物并发症等术语已经渗透到牙科术语中，它们使我们对这些牙冠和牙桥修复体的成功和失败的分类变得复杂。一些期刊允许将骨折报告为“并发症”，并且它们不一定被归类为研究中的失败。一项研究试图根据碎裂骨折的严重程度和后续治疗对碎裂骨折进行分类。这是解决碎屑断裂分类挑战的一种有前景的方法。 “碎裂断裂”一词比“碎裂”更具描述性，因为后者往往意味着后果轻微的事件。这些研究中通常报告两种类型的统计数据，即成功百分比，这是衡量在没有任何不利影响的情况下存活的修复体的指标；以及存活百分比，这是衡量所有存活的修复体的指标，即使它们可能出现碎裂骨折或可能已被修复。为什么会出现这种情况呢？一种可能的解释是，许多此类骨折非常小，不会影响功能或美观。另一个原因是企业赞助商更喜欢使用“碎裂”一词，因为它并不像“断裂”一词那样意味着失败。无论如何，我们需要更加精确地对骨折进行科学观察，并对各种类型的骨折进行分类，包括骨折位置和假体设计配置的详细信息。由于缺乏描述碎裂断裂的标准化方法，材料科学家无法正确分析材料特性和设计因素对陶瓷固定假牙 (FDP) 随时间变化的生存概率的影响。基于对临床试验的回顾和对这些试验的系统回顾，本研究旨在制定陶瓷和金属陶瓷修复体的功能表现、成功率、生存率和碎裂易感性分类以及后续治疗的指南。制定全面的描述性指南和临床报告表，以协助牙科科学家分析金属陶瓷和全瓷修复体的碎裂断裂行为，特别强调贴面氧化锆修复体。需要这些指南来优化骨折特征的记录，这些特征可用于区分陶瓷碎裂骨折和整体骨折，并帮助牙医确定后续治疗方法，从而最大限度地减少更换受影响修复体的需要。临床骨折观察的记录表必须足够清晰和完整，以便牙科保健专业人员能够在让患者充分了解陶瓷修复体治疗的潜在风险和益处的背景下翻译最相关的信息。它应该清楚地允许临床医生确定陶瓷骨折是否构成失败，这需要更换假体，或者骨折表面是否相对较小或位于非功能区域，即无助于咬合、美观、近端接触或食物嵌塞的区域。为了完成这项任务，有必要回顾临床试验的相关出版物，以确定骨折事件报告的变异性。审查的重点是氧化锆基 FDP 和 PFM FDP 的临床研究，这些研究已通过召回检查进行了三年或更长时间的监测。这些报告和所有相关出版物的系统综述均于 2004 年至 2010 年间发表在英语牙科期刊上。这篇综述的主要重点是氧化锆贴面固定假牙 (FDP) 和金属陶瓷 FDP（本文也称为烤瓷熔附金属 (PFM) FDP）对碎裂或整体断裂的敏感性。
“Nothing worthwhile is ever without complications.” The recent increase in reports from clinical studies of ceramic chipping has raised the question of which criteria should constitute success or failure of total-ceramic prostheses. Terminology such as minor chipping, partial chipping, technical complications, and biological complications have crept into the dental terminology and they have complicated our classification of success and failure of these crown and bridge restorations. Some journals have permitted the reporting of fractures as “complications” and they are not necessarily classified as failures in the study. One study has attempted to classify chipping fractures according to their severity and subsequent treatment. This is a promising approach to resolve the challenges to the classification of chipping fracture. The term ‘chipping fracture’ is more descriptive than ‘chipping’ since the latter term tends to imply an event of minor consequence. Two types of statistics are reported routinely in these studies, i.e., percent success, which is a measure of restorations that survive without any adverse effects, and percent survival, which is a measure of all restorations that survive even though they may have exhibited chipping fracture or they may have been repaired. Why has this scenario occurred? One possible explanation is that many of these types of fractures are very small and do not affect function or esthetics. Another reason is that corporate sponsors prefer to use the term chipping since it does not connote failure in the sense that the term fracture does. In any event, we need to be more precise in our scientific observations of fracture and classifications of the various types of fracture including details on the location of fracture and the prosthesis design configuration. Because of the lack of standardized methods for describing chipping fractures, materials scientists are unable to properly analyze the effect of material properties and design factors on the time-dependent survival probability of ceramic fixed dental prostheses (FDPs). Based on the review of clinical trials and systematic reviews of these trials, the present study was designed to develop guidelines for classifying the functional performance, success, survival, and susceptibility to chipping fracture, and subsequent treatment of ceramic and metal-ceramic restorations. To develop comprehensive descriptive guidelines and a clinical reporting form to assist dental scientists in their analyses of chipping fracture behavior of metal-ceramic and all-ceramic prostheses with particular emphasis on veneered-zirconia restorations. These guidelines are required to optimize the recording of fracture features that can be used to differentiate ceramic chipping fracture from bulk fracture and to assist dentists in identifying subsequent treatment that may minimize the need to replace affected restorations. A recording form for clinical fracture observations must be sufficiently clear and complete so that dental health professionals can translate the most relevant information in a context that allows their patients to fully understand the potential risks and benefits of treatment with ceramic restorations. It should clearly allow a clinician to determine whether or not a ceramic fracture constitutes a failure, which requires replacement of the prosthesis, or whether the fracture surface is relatively small or located in a nonfunctional area, i.e., one that is not contribute to occlusion, aesthetics, proximal contacts, or .food impaction. To accomplish this task, a review of the relevant publications of clinical trials was necessary to identify the variability in reporting of fracture events. The reviews were focused on clinical research studies of zirconia-based FDPs and PFM FDPs, which had been monitored through recall exams for three years or more. These reports and systematic reviews of all relevant publications were published in English dental journals between 2004 and 2010. The primary focus in this review was on the susceptibility to chipping fracture or bulk fracture of veneered zirconia-based fixed dental prostheses (FDPs) and metal-ceramic FDPs, which are also referred to in this paper as porcelain-fused-to-metal (PFM) FDPs.
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