【作者】 潘祁；

【导师】 陈吉华；

【作者基本信息】 第四军医大学 ， 口腔临床医学， 2010， 硕士

【摘要】 对于前牙的美容修复来说，美观是关键，而色彩是美观的前提。瓷贴面由于具有与天然牙相似的色泽、逼真的美学效果及不易着色等优点而被广泛用于前牙美容修复。尽管全瓷贴面对于非四环素牙具有良好的遮色效果及颜色匹配性；但其对四环素牙只有一定的遮色能力且其颜色与比色板不能完全匹配，修复后明度值显著降低，从而限制了其对四环素牙的临床修复效果。有关瓷贴面对四环素变色牙的颜色改善效果的研究也成为全瓷美容修复领域的热点之一，目前该方面的研究主要集中于瓷贴面修复后整体效果的临床观察，而对于瓷贴面修复系统各组成部分对四环素变色牙整体颜色改善的系统研究相对较少。因此，本研究在建立四环素基牙模型（后称模拟四环素牙）的基础上，综合考虑树脂粘结剂（A1、A3色RelyX veneer光固化树脂水门汀，浅色、白色Panavia F双重固化复合树脂水门汀）、基牙颜色（偏黄、偏浅灰、偏亮红、偏深灰、偏暗红色）、瓷贴面自身结构（核瓷厚度）三方面因素，利用CM700d/600d分光测色仪研究IPS e.max铸瓷贴面对模拟四环素牙修复体颜色的影响，从中找出变化规律，从而为临床工作提供帮助。实验结果显示：1.使用不同颜色树脂水门汀粘接瓷贴面修复模拟四环素基牙，粘接后模拟四环素基牙颜色改善显著，L*值升高；Dunnett-t检验结果显示使用Panavia F白色树脂水门汀时，粘接前后瓷贴面试件表面的L*、a*、b*值之间的差异无统计学意义；其余各实验组粘接前后瓷贴面试件表面的L*、a*、b*值之间有统计学差异（P﹤0.05）；各实验组修复后的L*值均减小，可能是由于瓷贴面良好的半透性导致了模拟基牙颜色的透出造成的。使用Panavia F白色树脂水门汀粘接前后瓷贴面试件表面颜色的色差△E﹤1.5，不易为肉眼识别；使用其余各树脂水门汀时，瓷贴面试件表面颜色的色差均大于1.5，肉眼可以分辨，造成比色与最终修复效果的差异。采用RelyXveneer光固化树脂水门汀粘接前后瓷贴面试件表面的色差值较大，其中A3色RelyX veneer树脂水门汀粘接前后瓷贴面试件表面的平均色差可达6.26±0.37NBS、A1色RelyX veneer树脂水门汀粘接前后瓷贴面试件表面的平均色差可达6.24±0.19NBS，RelyX veneer树脂水门汀两种颜色之间的色差较小为0.15±0.02NBS。2.在不同的模拟四环素基牙背景颜色（偏黄、偏浅灰、偏亮红、偏深灰、偏暗红色）基础上进行瓷贴面修复，粘接前后瓷贴面试件表面的L*、a*、b*值之间有统计学差异（P﹤0.05），与标准A2色瓷贴面相比，粘接后的瓷贴面试件表面的L*值减小。随着背景明度值减小，粘接后的瓷贴面试件表面的明度值L*降低程度增加。模拟四环素基牙背景颜色偏黄色时，粘接后瓷贴面试件表面的的a*值减小，b*值增大；模拟四环素基牙背景颜色偏浅灰色及深灰色时，粘接后瓷贴面试件表面的的a*、b*值均减小；模拟四环素基牙背景颜色偏亮红色时，粘接后瓷贴面试件表面的a*、b*值均增大；模拟四环素基牙背景颜色偏暗红色时，粘接后瓷贴面试件表面的a*值增大，b*值减小。模拟四环素基牙背景颜色偏黄色组瓷贴面试件粘接前后的色差值最小为1.25±0.09NBS，背景颜色偏深灰色时瓷贴面试件粘接前后的色差值最大，可达5.28±0.16NBS。3.瓷贴面核瓷厚度改变时，透明色Choice光固化树脂水门汀粘接后的瓷贴面试件表面的L*a*b*值与模拟基牙试件表面的L*a*b*值之间的差异有统计学意义（P﹤0.05），粘接后的试件表面的L*值增大而且随核瓷厚度的减小，各实验组明度值增加程度变大。粘接前后的色差值最大可达10.46±1.37NBS，此时瓷贴面核瓷厚度为0.3mm；瓷贴面核瓷厚度为0.4mm时粘接前后的色差值最小为9.33±0.75NBS。使用透明色Choice及白色Panavia F树脂水门汀粘接后，瓷贴面试件表面的L*值与原瓷贴面试件表面的L*值比较均有所下降，白色PanaviaF树脂水门汀粘接后试件表面的L*值下降程度低于使用透明色Choice树脂水门汀粘接后瓷贴面试件表面的L*值的下降程度。透明色Choice树脂水门汀粘接组中瓷贴面核瓷厚度为0.5mm时，对瓷贴面试件表面的L*值进行的配对样本t检验表明差异无统计学意义，瓷贴面核瓷厚度为0.5mm粘接前后的色差值最小为3.98±0.52NBS，瓷贴面核瓷厚度为0.3mm粘接前后的色差值最大为6.13±1.16NBS。白色Panavia F树脂水门汀粘接组，配对样本t检验结果显示：核瓷厚度为0.5mm及0.4mm时，粘接前后瓷贴面试件表面的L*值之间的差异无统计学意义；瓷贴面核瓷厚度为0.4mm粘接前后的色差值最小为1.76±0.83NBS，瓷贴面核瓷厚度为0.5mm粘接前后的色差值最大为3.43±0.29NBS。由此可见，树脂水门汀、基牙颜色、瓷贴面核瓷厚度均对四环素牙瓷贴面修复体的色彩有着一定的影响。其中使用不同树脂水门汀时，白色Panavia F双重固化复合树脂水门汀对四环素基牙有较好的遮色能力；背景（基牙）颜色为黄色对于修复体的整体颜色影响较小，修复体的整体色彩效果较理想；背景（基牙）颜色偏深灰色时对修复体整体颜色有显著影响，此种情况下应选择遮色效果较好的树脂水门汀粘接瓷贴面或是使用核瓷进行遮色；瓷贴面核瓷厚度越厚其遮色效果越好，然而过厚的核瓷会影响整个瓷贴面的光泽度和半透性。临床医生可根据患者的具体情况和要求选择合适的粘结剂，制作适合的瓷贴面。更多还原

【Abstract】 Aesthetics is essential to the anterior teeth restoration and the color is oneof the most important aspect of the aesthetics. Porcelain laminate veneer isfavored because of its color-rendering properties and optical properties thatsimulate natural teeth. Porcelain laminate veneer possesses a favorable opaqueeffect and color matching on non-tetracycline teeth, but for tetracycline teeth,the masking capability of the veneer is limited and the lightness of therestoration decreases significantly, which may lead to poor aesthetic effects.As yet, the researches in this field mainly focused on the clinicalobservation of one certain method or comparison of several repair methods.There are no systemic research about the effects of the resin cement, abutmentteeth color and the thickness of core porcelain on the final color of tetracyclinediscolored teeth after porcelain laminate veneer restoration. Therefore, in thisstudy we established a tetracycline-based dental model and systemicallyassessed the effects of resin cement (including A1- and A3-shade of the RelyXveneer light-curing system, and light- and opaque-shade of Panavia F doublecuringsystem), abutment teeth color (including yellow, light gray, bright red, dark gray, dull red), and the core porcelain thickness of the veneer on the colorof IPS e.max porcelain veneer restorations for mimic-tetracyclinepigmentation teeth. In our investigation, the L*a*b* values were measured byspectrophotometers CM-700d/600d and the color differences(△E) werecalculatedThe results are listed as follows:1. The difference of the L*a*b* values among different resin cementgroups were significant(P<0.005). There was no significant difference betweenthe L*a*b* values of the control group and the opaqueshade of Panavia Fgroup. The color difference (△E) was lower than 1.5 only between the controlgroup and the opaqueshade of Panavia F group, but not among others.2. The L*a*b* values were significantly different(P<0.005) amongdifferent simulated background (abutment teeth). With the backgroundbrightness value decreased, compared with the control group, the L* valuedecreased greatly and the color difference(△E) value increased obviously. Itshowed that the color of the abutment teeth influenced the color of therestoration seriously, and the influence was the least when the abutment teethcolor was yellow.3. L*a*b* values were significantly different(P<0.005) among differentcore porcelain thickness. With the nuclear porcelain thickness thinning,△L*value and color difference(△E) value increased of experimental group. Thatindicate porcelain veneers masking ability trail off.In summary, resin cements, abutment teeth color and core porcelainthickness of veneers all have significant effects on the color aesthetics of theporcelain veneer restoration. Compared with other resin cements used in thisstudy, the Opaqueshade of Panavia F resin cement has better masking ability. The restorations possesses favorable as abutment teeth color is yellowmeanwhile it should choose preferable masking cements when abutment teethcolor is dark grey. As the thickness of the core porcelain increased, the maskingability increased greatly, but the thickness also affected the glossiness andtranslucency of the veneers. Therefore, the dentists should choose appropriateresin cements and porcelain veneers according to the patient’s requirementsand the specific circumstances.更多还原