牙体缺损修复备牙过程图解

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**章 牙体缺损概述
　　牙体缺损（tooth defect）是口腔科最常见的疾病之一，是指由于各种原因引起的牙体硬组织不同程度的外形、结构及颜色的破坏和异常， 表现为牙体失去了正常的解剖学外形和颜色，对牙髓、牙周组织、咀嚼、发音、面容，甚至对全身健康都会产生不同程度的影响。
　　牙体缺损较小时可以采用直接充填法治疗， 但如果剩余牙体组织薄弱， 无法为充填体提供良好的固位， 剩余牙体组织抗力不足、充填体强度不足或者为了实现更高的美学诉求时，则需要采用修复治疗的方法。牙体缺损的修复是用间接法制作的人工修复体恢复缺损牙的形态、美观和功能，包括嵌体、贴面、部分冠、全冠和桩核冠等。
　　修复体是一个应用于人体口腔内的机械装置， 应满足生物学原则、生物力学原则和美学原则。三原则贯穿于牙体缺损修复治疗的每个阶段，不能过分强调其中的单一方面，否则会影响其他原则的实现，在进行牙体缺损修复的设计时， 要综合分析、具体评价。
　　本书内容就是在综合考虑修复治疗三原则的基础上，设计和实施牙体缺损修复的牙体预备部分。
　　Chapter 1 Summary of Tooth Defect
　　The tooth defect is one of the most common manifestation of dental disease. Tooth defect is defined as the destruction and abnormity of the shape，color and tooth structure caused by various reasons. It shows that the tooth has lost its normal anatomical shape and color，which has a different degree of impact on chewing，pronunciation，dental pulp，periodontal tissue，facial appearance and even on the general health.
　　When the tooth defect is small， it can be treated by direct composite filling. However， if the residual tooth tissue is thin and can not provide enough retention for filling， or the esistance of the residual tissue is lack， or the strength of the filling is not enough， or to achieve a better esthetics appearance， the restoration treatment is needed. The restoration of the tooth defect is to fabricate artificial restoration in indirect process to recover the contour， esthetics and function of the defected tooth， which includes inlay， veneer， partial crown， full-crown and post-core crown.
　　The dental restoration is a mechanical device applied on human oral， the design of which must be in line with the multifaceted biological，biomechanical and esthetic principles. These three fundamental principles should be applied well through each step from treatment plan design to operation procedure. If we overemphasize one of the three principles，it may interfere in the others. In this way，a comprehensive and concrete analysis is needed when you design the process of restoring the tooth defect.
　　Based on comprehensive consider of three principles，this book designs and implements the tooth preparation of the defective tooth restoration.
　　第二章 前牙全瓷冠牙体预备
　　全冠是牙体缺损修复治疗中适应范围最广的一种修复体，覆盖整个缺损患牙的所有轴面和面，可以用来修复缺损患牙的形态、功能和美观；在前牙区，还可用于轻度排列不齐或者扭转牙的美学修复。
　　前牙除具有咀嚼和发音功能外，更重要的功能是美观，因此具备良好美学性能的全瓷冠受到越来越多患者的青睐，临床应用日益广泛。本章就以21牙经典的双层结构全瓷冠——氧化锆加饰的全瓷冠牙体预备（预备流程及预备量见图2-1）为例进行图文视听讲解。
　　图2-1 前牙全瓷冠牙体预备
　　Chapter 2 Preparation of All-Ceramic Crown of Anterior Tooth All-ceramic crown is the most popular type of crown used in the dental defects prosthodontic treatment. It covers all the axial and occlusal surfaces of the defected tooth. It can e.ectively repair the contour，function and aesthetic of the defected tooth. For the anterior，it especially corrects the slight malalinement and torsiversion of the anterior tooth.
　　The anterior tooth has the function of mastication，pronunciation and more importantly esthetics. Therefore，the all-ceramic crown possessing good esthetic performance is popular increasingly. And it is widely used in clinic growingly. The chapter describes the two layer structure zirconia with decorative porcelain all-ceramic crown which takes the 21 tooth as an example (the procedure and reduction are shown in Fig 2-1) in the form of .gure，text and audiovisual instruction.
　　Fig 2-1 The preparation of all-ceramic crown of the anterior tooth
　　一、制作硅橡胶index
　　开始牙体预备前使用加成反应硅橡胶油泥混合型制作index（图2-2），唇侧盖过牙龈缘且不影响就位，腭侧制作背板，便于检查腭侧预备量并起固位作用，两侧包绕至预备牙近远中至少两个牙位，index需制作2个，用于显露预备牙不同的位置。
　　图2-2 牙体预备前制作index
　　严格按照硅橡胶说明书上的硬固时间（一般4～5min），待硅橡胶硬固后取下，其中一个index（index-Ⅰ）用手术刀片沿21预备牙正中唇向垂直切开（图2-3），可以用于检查唇面预备量及预备体形态。
　　图2-3 index-Ⅰ的制作
　　1. Fabrication of Silicone Index
　　Before the tooth preparation， use additional type silicone putty to fabricate two silicone indexes(Fig 2-2). This index extends over the labial gingival edge without interfering with the placement， the palatal side of which is fabricated as the backplane for checking the reduction and providing retention， the proximal side should include at least two other adjacent teeth. Two indexes are made for exposing di.erent parts of the preparation.
　　Fig 2-2 Fabricate a silicone index before the tooth preparation
　　According to the setting time of the instruction(4-5minutes)， put out the putty when it gets hard. To check the facial and palatal reduction，one index(index-Ⅰ) is cut vertically along the midline labiopalatine direction of the 21 tooth(Fig 2-3).
　　Fig 2-3 The fabrication of index-Ⅰ