Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramic-based dental prostheses?
Which mechanical and physical testing methods are relevant for predicting the clinical performance of ceramic-based dental prostheses?
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DOI：
10.1111/j.1600-0501.2007.01460.x
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发表时间：
2007-06-01
影响因子：
4.3
通讯作者：
Ferree, N.
中科院分区：
文献类型：
--
作者：
Anusavice, K. F.;Kakar, Kunian;Ferree, N.
目的：临床使用陶瓷假体的存活率和性能本质上是概率性的。只有在非常罕见的情况下，一组中的所有假体在5年或更长时间内都表现出100%的成功或100%的失败。假体失效可定义为导致置换的任何情况。这些情况包括继发性龋齿、不可逆的牙髓炎、相对牙齿表面的过度磨损、陶瓷表面的过度侵蚀和粗糙化、粘固剂的沟、边缘、不可接受的美学、开裂、碎裂和断裂。对牙科文献进行了系统的回顾，以确定牙科合金和陶瓷的机械和物理性能在多大程度上可以预测金属陶瓷和全陶瓷固定义齿（FDP）的5年临床性能，并确定与这些临床研究相关的报告结果的相关质量。材料和方法：该综述基于1980年至2006年期间在英文牙科期刊上发表的5年或更长时间的临床研究，使用以下关键词和MeSH术语。我们的检索策略如下：检索1：部分固定义齿OR义齿，部分，固定OR义齿，部分固定OR牙科陶瓷OR金属陶瓷合金OR牙科陶瓷检索2：修复失败OR牙科修复失败OR时间因素OR生存分析检索3：荟萃分析或评价研究或综述或临床试验或比较研究或随访研究或前瞻性研究或临床随访-向上研究或临床试验或纵向研究纳入检索1、2和3，并限制发表日期从1980年1月1日开始，英语和涉及人类的临床研究，共得到684篇文章。通过将临床研究的持续时间限制在5年或更长时间，数量减少到193。通过排除树脂粘结的FDP、悬臂梁设计、种植体支持的假体、牙冠、嵌体或高嵌体支持的假体，总共有37篇文章可供详细综述。在排除综述文章和涉及树脂粘结桥的文章、单作者临床研究文章、悬臂梁设计和种植体支持的FDP后，保留了11篇临床研究文章。对于这些文章，这是不可能的，以最终确定失败的概率为三个单位的FDP相比，四个单位和更大的假体或位置的冠和pontics.Results：这一系统的审查研究陶瓷为基础的FDP证实了以前的研究结果，在大多数情况下，< 15%的这些假体被删除或需要更换在10年。然而，报告的参数数量以及发生故障的详细信息范围存在相当大的差异。在一些研究中，使用了一个标准化的评价系统，其中应用了USPHS或Ryge标准。然而，也有很大的不确定性，失败的定义与可修复的骨折和确定的致病因素是否直接或间接与更换的prosthes.Conclusions：本次审查表明，没有一个体外测试变量，可以预测这些假体的临床性能。基于这些综述，迫切需要开发一个全面的分类系统，用于识别临床假体失效、技术并发症和生物并发症。还应制定关于取出断裂假体和/或获取断裂表面细节的印模的指南。体外数据的预测能力可通过有限元应力分析和计算机程序如CARES/Life软件（NASA刘易斯研究中心，克利夫兰，OH）来提高，该软件估计陶瓷结构存活的时间依赖性。
Purpose: The survival and performance of clinical prostheses with a ceramic component are probabilistic in nature. Only under very rare circumstances will all of the prostheses in a group exhibit either 100% successes or 100% failures over a period of 5 years or more. Prosthesis failure may be defined as any condition that leads to replacement. These conditions include secondary caries, irreversible pulpitis, excessive wear of opposing tooth surfaces excessive erosion and roughening of the ceramic surface ditching of the cement,, margin, unacceptable esthetics, cracking, chipping and fracture. A systematic review of the dental literature was performed to determine the extent to which the mechanical and physical properties of dental alloys and ceramics can predict the 5-year clinical performance of metal-ceramic and all-ceramic fixed dental prostheses (FDP) and to determine the associated quality of reported outcomes associated with these clinical studies.Materials and methods: The review was based on clinical research studies of 5 years or greater duration that were published in English dental journals between 1980 and 2006 using the following key words and MeSH terms. Our search strategy was as follows:Search 1: Partial fixed denture OR denture, partial, fixed OR denture, partial fixed OR dental porcelain OR metal ceramic alloys OR dental ceramicSearch 2: Prosthesis failure OR dental restoration failure OR time factors OR survival analysisSearch 3: Meta-analysis OR evaluation studies OR review OR clinical trial OR comparative study OR follow-up studies OR prospective studies OR clinical follow-up study OR clinical trial OR longitudinal studiesInclusion of searches 1, 2 and 3 and limits placed on the publication date starting on January 1, 1980, English language, and clinical studies involving humans resulted in a total of 684 articles. By restricting the clinical studies to 5 years or more in duration, the number was reduced to 193. By eliminating resin-bonded FDPs, cantilever designs, implant-supported prostheses, crowns, inlay- or onlay-supported prostheses, a total of 37 articles remained for detailed review. After excluding review articles and articles involving resin-bonded bridges, single-author clinical research articles, cantilever designs and implant-supported FDPs, 11 clinical research articles remained. For these articles, it was not possible to determine conclusively the probability of failure for three-unit FDPs compared with four-unit and larger prostheses or the location of the crowns and pontics.Results: This systematic review of studies on ceramic-based FDPs confirms the results of previous studies that, in most cases, < 15% of these prostheses were removed or were in need of replacement at 10 years. However, there was considerable variability in the number of parameters that were reported as well as the range of details on failures that occurred. In some studies, a standardized evaluation system was used in which USPHS or Ryge criteria were applied. However, there was also great uncertainty in the definition of failure with respect to repairable fractures and whether the identified causative factors were directly or indirectly associated with the replacement of the prostheses.Conclusions: This review indicates that there is no single in vitro test variable that can predict clinical performance in these prostheses. Based on these reviews, there is an urgent need to develop a comprehensive classification system for identifying clinical prosthesis failures, technical complications and biologic complications. Guidelines on the retrieval of fractured prostheses and/or impressions that capture the fracture surface details should also be developed. The predictive power of in vitro data can be increased by finite element stress analysis and computer programs such as the CARES/Life software (NASA Lewis Research Center, Cleveland, OH) that estimates the time-dependent nature of ceramic structure survival.