Doctor 3/2018

3-2018 Visit Infodent International at DenTech China Hall 1 stand E 68-69, E 91-92

ImplantBook 2018 Dealers e Dentists: Download your copy from www.implant-book.com to discover new brands and products

Manufacturers: Learn more about ImplantBook on www.implant-book.com to reach your next partner

The ultimate global guide 2017

The ultimate global guide 2018 DENTAL IMPLANTS

Iris View

OSSEOINTEGRATION &BIOMATERIALS

Polaris

AROUND IMPLANTOLOGY

Nuvolina

3D PRINTERS

The best lights, for the best implants.

EQUIPMENT PIEZOSURGERY

www.gcomm-online.com

SOFTWARE RADIOLOGY CONGRESSES

Gcomm Cover DEF.indd 1

Topic: Dental Implants pag. 9 - 65

Topic: Equipment & Supplies for Dental Implants pag. 81 - 98

Topic: Software pag. 117 - 125

21/12/16 11:45

COMPANY LIST

implant-book.com

implant-book.com

代理商，牙医:下载ImplantBook 2018完整 版免费从 www.implant-book.com, 以便找到新品牌和产品

制造商: 点击www.implant-book.com 了解更多 ImplantBook杂志, 以通达您的业务合作伙伴

The Chapters: Dental Implants, Osseointegration & Biomaterials, Around Implantology, Congresses, Company List For more, please write to prc@infodent.com | 如需了解更多信息，请发送电子邮件到 prc@infodent.com

CONTENTS 目录

Editorial

5

学术文章

Increase our ability and passion to team up with our customers in getting to their goal 不断提高我们的能力和热情， 并与我们的客户同在实现他们的目标

Highlights

6

Scientific Update

11

22 CAD/CAM patient specific-abutments and a new implant design 26 患者量身定制的CAD/CAM基台和新的

6 安福士 L9 侧递式 ANTHOS Classe L9 Side Delivery

种植设计 30 Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report 36 龈沟内Captek修复边缘的牙周相容性：

7 公理福V286 – 一生好伙伴 Victor V286 a lifetime partner

病例报告

与卡斯特里尼(CASTELLINI) 一同触摸未来 Touch the future with Castellini 8 赛特伟邦 STERN S320TR STERN WEBER Stern S320TR 9 迈锐(MYRAY) - 性能卓越、用户友好的解决方案 MyRay, solutions which bring you performance and user-friendliness.

infodent.com infodent@infodent.com

• CEO: Baldo Pipitone baldo.pipitone@infodent.com • General Manager: Paola Uvini paola@infodent.com • Editorial Director: Silvia Borriello infodent@infodent.com • Marketing Consulting Manager: Riccardo Bonati riccardo.bonati@infodent.com • Exhibition Manager: Alessia Murano alessia.murano@infodent.com • Newsroom: Nadia Coletta nadia@infodent.com Claudia Ragonesi pressoffice@infodent.com • Social: Ilaria Ceccariglia ilaria.ceccariglia@infodent.com • Graphic Dept.: Silvia Cruciani silvia.cruciani@infodent.com Lorenzo Burla lorenzo.burla@infodent.com • Account Dept.: Alessandra Mercuri alessandra.mercuri@infodent.com

12 A Preliminary study on the clinical threshold of translucency in prosthodontics 17 口腔修复中半透性临床阈值的初步探索

• Translator: Zhuoling Xiong 熊卓玲 renmei1@126.com - Tel: +39 331 2507669 Publishing House: Infodent S.r.l.

Str. Cassia Nord Km 86,300 01100 Viterbo - Italy Tel: +39 0761 352 198 Fax: +39 0761 352 133 VAT 01612570562 Printer: 宁波市镇海印颂电子商务有限公司 No.1 Qiujing Road, Shiqi town, Yinzhou District, Ningbo, Zhejiang, China. +86 0574 8658 2081 n°3/2018 - aut. trib. VT n°496 del 16-02-2002 Doctor by Infodent International is the title of this magazine as well as an applied for trademark. Any use there of without the publisher’s authorization is to be deemed illegal and shall be prosecuted.

日历

Calendar

41

Trade Shows and Conferences for Dental Practitioners 牙科技术会议及展览会

Cover page: MyRay (Cefla Group) Via Bicocca, 14/C I-40026 Imola (BO) - Italy imaging@my-ray.com +39 0542 653441 AEEDC 2019.............................................................................................................................p.47 Anthos..............................................................................................................................................p.21 Castellini.............................................................................................................................................p.2 Dental World Hungary 2019............................................................................................p.4 DenTech China 2019....................................................................................................III cover GNYDM....................................................................................................................................II cover ImplantBook...................................................................................................................................p.1 Infomedix Odontoiatria Italiana....................................................................................p.48 Shenpaz Back..........................................................................................................................Cover Stern Weber.................................................................................................................................p.35 Suzhou Victor Medical Equipment..............................................................................p.10 Vanmax..........................................................................................................................................p.45

The ultimate global guide 2017

DOCTOR牙医 Infodent International • 3 2018

3

XIX. Dental World

International Dental Conference & Exhibition

Conference

Exhibition

Implant Show

17-18-19 October 2019 Budapest, Hungary

AESTHETICS ENDODONTICS MICROWORLD ORTHODONTICS IMPLANTOLOGY

D EN TALWO R LD.HU 9000 visitors

400 brands

4000

congress participants

70

from countries

EDITORIAL We increase our ability and passion to team up with our customers in getting to their goal Communication is at the moment facing a period of marked uncertainties making it difficult to focus on the current situation and to correctly foresee future perspectives. We are daily confronted with a stressing environment which gives us no time to reflect and to think about our tomorrow in a positive mood.

On the other hand, times of crisis often open up new opportunities and motivate us further to look for newer and more concrete approaches. The structure and size of the market is being reshaped: in the future, there are likely to be less actors on the scene but better qualified and organized to face the new-business on an international scale.

The main task of a marketing professional is to be sincere and to go beyond the schemes that communication itself has created: dreams, unfulfilled promises etc. As such a sincere dialogue with the reference target becomes essential. The crisis brings with it new opportunities of growth and improvement to those companies ready for it. Infodent International operates as counselling and business partner for Italian and international companies. Our “global” attitude that brings us in the international medical and dental markets, attending all the main events in these sectors, gives us a deep understanding of what is going on in the different markets and helps us discern direct and diverse feedbacks: trade/consumers. We strive to create new opportunities for companies also in terms of services and type of communication offered: strategic insight, creativity mixed with technology, social networking and search engine marketing and, most of all, the interaction among all these ingredients. Infodent International has a marked attitude towards identifying new ways to communicate even with less resources and in a consumer environment that is changing rapidly and radically. We focus on the creation of models and strategies, mono- or multi-medial, with greater ability than in the past to captivate and have an impact on the consumer. This implies a new structure of communication, more complete, sophisticated, enveloping and engaging towards the reference target. Of course, these strategies are made possible by our high level of interaction and market penetration, mainly, but not only, in the medical and dental trade sectors, that we have achieved through many years of participation at countless international exhibitions and events. Against this background, we are capable of measuring results before and after we implement custom-made communication strategies, constantly improving the understanding of what means work better for which products. The necessary requirements for our company to achieve this result is a good organization coupled with flexibility, aimed at finding always more effective approaches. We need to keep up to date with an international scenery of rapid and continuous market transformation, where factors such as innovation, quality and availability play a key role. Nevertheless, even in the hardest times, there aren’t necessarily “saturated markets”; we prefer to think of them as “tired” or “opportunist” markets, but it is always possible to stimulate them and companies can benefit from knowing that they can create great value through information and right interpretative counselling. Not all companies can support and coordinate such issues all by themselves. Therefore, here is our core mission, to always increase our ability and passion to team up with our customers in getting to their goal.

不断提高我们的能力和热情， 并与我们的客户同在实现他们的目标 沟通是一段面临明显的不确定性而使得不能专注于现状和 正确预见未来的时刻。我们每天都在面临一个压力环境，让 我们没有积极的情绪去思考明天 。 另一方面 ， 危机时刻往 往开辟了新的机会并激励我们进一步寻找更多新的机会 。 市场的结构和规模正在重塑：在未来 ，出现的行动者会减 少，但变得更有能力更有组织来面对国际化的新挑战 。专 业市场营销者的主要任务是要真诚 ，且要超越沟通本身创 造的价值 ，如梦想 ，无法兑现的承诺等 。因此与目标的真诚 对话就显得至关重要了 。危机会给已经做有准备的公司带 来新的成长和进步的机会。Infodent是意大利及其他国际企 业的咨询顾问和合作伙伴。我们 “全球性“的态度使我们在 国际医疗和牙科市场参与该行业的主要事件 ，让我们深刻 了解在不同市场的发生的一切 ，并帮助我们辨别来自各种 贸易者和消费者的反馈 。我们也在努力为提供服务和沟通 类型的公司创造新的机遇：战略研究，基于技术的创造力， 社交网络和搜索引擎混合营销，最重要的是，是所有这些资 源之间的相互作用。 Infodent对不断变化且资源甚少的消费环境都有寻找新途径 实现沟通的强烈态度。我们专注于创造模式和策略，单一或 是多样途径，用比过去更大的能力来征服消费者，对消费者 产生影响 。这就意味着一种新的沟通结构，更加完整 ，更加 精良，覆盖面更广，目的性更明确。当然，我们之所以能思考 出这些策略，主要原因可能是因为我们的高交互性和市场渗 透力，而且在医疗和牙科贸易领域，我们已经参加过无数的 国际展览和活动。在此背景下，我们会对比测试实施定制沟 通策略（针对不同产品为提高工作效率而不断改善工作方 式）前后的效果。我们的自我要求是为达到目标建立起一支 灵活变通的组织，旨在寻找更有效的方法。我们需要站在世 界舞台跟随不断快速持续更新的市场改革，创新、质感和可 实施性 ，这些因素都是我们做出反应的重要依据 。然而 ，即 使在最困难的时候，也未必是“饱和市场”；我们更愿意把它 当作“疲软”的市场或是“等待机会”的市场，但也可能刺激某 些公司，使他们了解到准确的行业信息和咨询辅导从而创造 巨大的价值。不是所有的公司都能自我扶持并协调解决所有 的问题。因此，这就是我们的核心任务：不断提高我们的能 力和热情，并与我们的客户同在实现他们的目标。

DOCTOR牙医 Infodent International • 3 2018

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highlights

ANTHOS

Classe L9 Side Delivery Top-of-the-range Classe L9 floor-fixed treatment centre features the latest evolution of the Full Touch control panel, a new patient chair, and can fit the complete range of hygiene devices and the full multimedia system with the new HD camera. Highly compact, the Classe L9 will fit any surgery and adapt to most every operating style. Classe L9 puts patients who prefer to settle into the patient chair without seeing the instruments at their ease. Full freedom of movement and unlimited space allow for unobstructed workflows where dentist and team can operate unhindered, confidently and professionally.

赛特伟邦 （STERN WEBER） 安福士 L9 侧递式 STERN S320TR 顶级的安福士L9落地式治疗台具有一系列的最新革命性科 技装备，触摸式控制面板、新型病人椅，全能消毒装置以 及整合新HD内窥镜的多媒体系统。高度紧凑的空间使L9 适用于任何外科治疗和日常诊疗。由于看不到器械，当患 者坐入L9病人椅后会感到非常舒适轻松。自由的移动及无 拘束的工作空间带来畅快的操作流程，医生及其团队均可 无阻碍、自信且专业地进行治疗。 www.anthos.com

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。 A级系列 完整的A级系列口腔综合治疗台的设计宗旨是尽可 能提供最大的灵活性，使牙医可以选择最适合其 操作风格和专业需求的人体工学和功能设置。 A5级可提供6种不同的配置。 适合各种操作风格的 人体工学，整合的安福士品牌器械，脚控和手术 灯的扩展性选择，不同的卫生学系统、可选配置 和颜色主题，从每个方面讲都具有多样的变化。 选择 A7 +级的牙医知道他们可以根据当前和未 来的特殊需求对其口腔综合治疗台进行个性化定 制，无论他们的专业领域属于常规牙科还是种植 科。鉴于搭载了向所有的可整合安福士设备开放 的基础技术配置接口，这款高端的治疗台可以在 现场或在未来与超高性能器械仪器、X-射线装 置、多媒体系统以及先进的卫生学设备相匹配， 达到扩展功能的目的。

基于分体落地式的主体特征，S320TR在保证患者椅 运行的独立性同时，依然具备极高的稳定性和充分的 治疗操作空间。作为来自意大利的最新型号款式，牙 医在诊断上能够获得崭新的操作体验。 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 符合人体工程学结构以及自身出色的性能），TR系列 最大限度的为您提供前所未有的丰富的新的机遇。 医生位的良好机动性保证了此种操作风格的完美定 位性和移动操作的优化流畅性。医生位采用铸铝支架 臂，具备出色的稳定性，再加上通过按键操作进行高 度调节，可以让牙科医生从容而安心的工作。由于采 用了最新的数码电子科技，使得S320TR给牙科医生 们带来了最好的操作体验。

www.anthos.com

sternweber.com

ANTHOS. THE BRAND WITH LIMITLESS SOLUTIONS FOR DENTISTS ALL AROUND THE WORLD. The Classe A range Developed to provide as much flexibility as possible, the full Classe A range of units enables dentists to select the ergonomic and functional set-up best suited to their operating style and professional needs.

Classe A5 can be supplied in 6 different configurations. Ergonomics to suit every operating style, integrated Anthos brand instruments, an extensive choice of foot controls and operating

8 2

lights, various hygiene systems, options and colour schemes: versatility in every sense of the word.

Dentists who choose Classe A7 Plus know they can personalise their dental unit according to the specific needs of today and tomorrow, whatever their field of specialization, from conservative dentistry to implantology. Thanks to the underlying technological configuration, open to all integrated Anthos systems, this premium treatment centre can be expanded, immediately or at a later date, with ultra-high performance instruments, X-ray and multimedia systems, and advanced hygiene devices.

DOCTOR牙医 Infodent International •1 2018 6 Doctor DOCTOR 牙医 Infodent International • 3 2018 Os 牙医 Infodent International •3/2017

STERN WEBER Stern S320TR Characterised by a floor-mounted unit body, which remains independent from the patient chair and its movements, the S320TR models provide stability and extensive operating space. This latest model from the Italian brand lets dentists explore new capabilities within the diagnostic field.

By taking the guiding principles behind Stern Weber’s advanced dental unit development program – sturdiness, compactness, user-friendliness, ergonomics and performance – the TR Series maximises them as never before

so as to provide you with a wealth of new opportunities.

Excellent manoeuvrability of the dentist’s module ensures perfect positioning and optimises fluidity of the movements associated with this operating style. The outstanding stability of the dentist’s module and its cast aluminium support arm, coupled with a telescopic height adjustment function operated via the keypad, allows the dentist to work calmly and confidently. Thanks to the latest digital electronics, the S320TR brings out the dentist’s very best. sternweber.com

highlights

VICTOR V286 – a lifetime partner

迈锐(MYRAY) - 性能卓越、 用户友好的解决方案。

作者投稿指南

赛特伟邦 （STERN WEBER） STERN S320TR

Built with premium quality materials for lasting service and superb reliability, the V286 boasts cast aluminium structural elements for increased stability and injection moulded plastics to provide an excellent surface finish.

Developed and engineered in Europe, the latest treatment centre in the 迈锐Hyperion X9 体现了一种模块化概念，覆 Victor range not only seduces from a design point of view, but can also 盖了从 2D 全景成像、头影测量到具有真正 count on the latest solutions in terms of ergonomics and space-efficiency. 的全颌弓容积扫描范围的3D 锥形束立体断层 Advanced electronics allow extensive personalisation for up to 5 diffe的所有拍摄功能。 rent operators. Synchronised patient chair movements (lift capacity can 迈锐Hyperion 通过全局的360°扫描进行 reach up to 190 kg)X9 enable maximum comfort and soft upholstery is an 容积采集，可以有效消除所得图像中的伪 attractive option.The unit can be fitted with up to 4 dynamic instruments, 影。它可以在极低的X-射线剂量下实现高分 including the high-performance brushless micromotor manufactured in 辨率成像，从而提供超凡的图像质量、精致 Italy.

Dentists can select operating parameters and visualise key settings on the的细节呈现以及即时的诊断结果。 new, large 3-digit LCD control panel.The LCD display provides details MyRay, solutions which 11 cm FOV, but it can also be 的扫描视野宽度为Ø 11厘 of 迈锐Hyperion operating status X9 and includes a self-diagnostic system. bring you performance equipped with a large image and user-friendliness. detector, 8 cm high and extend米，它可以配备大号图像传感器器提供检测 able to 13 cm, or a small version 区高度8厘米（可扩展到13厘米）的视野；也 Hyperion X9 is a modular conthat limits the height of the ex公理福V286 – 一生好伙伴 cept which covers all aspects amined region to 5 cm, extend可提供较小版本的传感器器，提供检测区高 from 2D panoramic imaging, able to 8 cm. 度5厘米（可扩展到8厘米）的视野。 精心挑选优质材料保证持久运行及超凡的可靠性，V286采用铸 through cephalometric配，体现奢华。治疗台可以配备4组可动器械，包括意大利原装 exams up The software processes all types to cone beam 3D with true full of acquired data, including 3D 其软件可在不到1分钟内处理所有采集数据 进口的高性能无碳刷电动马达。口腔医生可以通过带有新款三 铝结构部件来增加稳定性，和注塑塑料工艺来提供出色的表面 arch volumetric scan capability. data, in less than a minute. The 并完成重建，包括3D数据。X9所提供图像信 Hyperion X9 performs a voluquantity and quality of the in位液晶数字屏幕的控制面板调整及观察参数和设置。液晶面板 处理。作为最新款的公理福口腔综合治疗台，结合了美观设计 metric acquisition with a full 360° formation X9 provides and the 息的数量、质量以及管理这些数据的便捷方 与最新人体工学及空间利用理念的V286在欧洲开发并完成工程 scan capable of eliminating the simple way you can manage that 可以显示操作状态的细节，并进行自我诊断。 式有助于进行更高效的诊断，并为达到有效 artefacts of the resulting image. data makes for a clearer diagnosis 学测试。高级的电子电路允许最多5位不同操作者的个性化设 High resolution at extremely low and helps effective planning, ready 治疗进行有效的规划。 X-ray doses: excellentMore quality, finfor efficient treatment. details on www.victordentalequipment.com 置。最新的具有同步功能的病人椅（最大可以提升190公斤的 est details, immediate diagnosis. www.my-ray.com A级系列 www.victordentalequipment.com 重量）可确保患者的最佳舒适度，也有柔软的沙发皮垫可供选 Hyperion X9 scans 更多信息请详见 with a Ø www.my-ray.com

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。

完整的A级系列口腔综合治疗台的设计宗旨是尽可 能提供最大的灵活性，使牙医可以选择最适合其 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 运行的独立性同时，依然具备极高的稳定性和充分的 与卡斯特里尼(CASTELLINI) A5级可提供6种不同的配置。 适合各种操作风格的 Skema 6 brings dentistry a step closer to the future, with a host of innova治疗操作空间。作为来自意大利的最新型号款式，牙 tive solutions enabling excellent hygiene, total control and enviable comfort, 人体工学，整合的安福士品牌器械，脚控和手术一同触摸未来 医在诊断上能够获得崭新的操作体验。 both for patients and medical staff. 灯的扩展性选择，不同的卫生学系统、可选配置 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 和颜色主题，从每个方面讲都具有多样的变化。 将公司80年的历史、创新精神及丰富的临 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 与卡斯特里尼(CASTELLINI)一同触摸未来 选择 A7 +级的牙医知道他们可以根据当前和未床专业经验熔于一体创造出一流的口腔综 符合人体工程学结构以及自身出色的性能），TR系列 6。 来的特殊需求对其口腔综合治疗台进行个性化定合治疗台Skema 最大限度的为您提供前所未有的丰富的新的机遇。 制，无论他们的专业领域属于常规牙科还是种植 将公司80年的历史、创新精神及丰富的临床专业经验熔于 医生位的良好机动性保证了此种操作风格的完美定 卡斯特里尼Skema 6，集高科技器械、触摸屏控制 科。鉴于搭载了向所有的可整合安福士设备开放界面和整合式的内建系统，可满足从牙体牙髓到 一体创造出一流的口腔综合治疗台Skema 6。 位性和移动操作的优化流畅性。医生位采用铸铝支架 的基础技术配置接口，这款高端的治疗台可以在种植等各专业口腔医生高品质临床需求的理想工 臂，具备出色的稳定性，再加上通过按键操作进行高 现场或在未来与超高性能器械仪器、X-射线装具。它还可以提供高端卫生消毒设备，经意大利 卡斯特里尼Skema 6，集高科技器械、触摸屏控制界面和整合 度调节，可以让牙科医生从容而安心的工作。由于采 大学测试认证有效，为医生提供舒适的符合人体 式的内建系统，可满足从牙体牙髓到种植等各专业口腔医生 置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 Touch the future with Castellini ably, enjoying total peace of mind. 工学的感控解决方案，使他们可以平静专注地对 Skema 6 is equipped with Implantor LED, 高品质临床需求的理想工具。它还可以提供高端卫生消毒设 们带来了最好的操作体验。 达到扩展功能的目的。 Eighty years of experience, innovation an extremely lightweight induction micro-

待患者。 Skema 6 装备的LED光纤种植电马达，其 备，经意大利大学测试认证有效，为医生提供舒适的符合人 sternweber.com 具有超轻的重量，高达5.3Ncm的扭矩，可耐全面 into a high-class unit: Skema 6.

5.3 Ncm, fully autoclavable and suitable for 体工学的感控解决方案，使他们可以平静专注地对待患者。 integrated endodontics and implantology. 高温高压灭菌，可用于包括根管及种植等临床应 Eighty ofwith experience, and clinical expertise Skema 6 装备的LED光纤种植电马达，其具有超轻的重量， Skema 6 years

by Castellini, its high-tech in- innovation Full Touch consolle, available as an optional, 用。本机还可以选配具有坚固的5.7英寸触摸屏用 STERN WEBER struments, touchscreen controls and inteso as to provide you with a wealth of features aSkema tempered glass display and 5.7” concentrated a high-class unit: 6.

ANTHOS. THEinto BRAND lights, various hygiene systems, options grated systems, offers dental professionals touchscreen interface. 高达5.3Ncm的扭矩，可耐全面高温高压灭菌，可用于包括 Stern S320TR new opportunities. 户界面的全触摸屏控制器。 WITH LIMITLESS and colour schemes: versatility in every the ideal tool for high-performance treat- Skema 6 brings dentistry a step closer to Excellent manoeuvrability of the den凭借高效的卫生学解决方案、全面操控体验以及 根管及种植等临床应用。本机还可以选配具有坚固的5.7英 SOLUTIONS FOR DENTISTS ofwith the aword. ment including conservative dentistry, end- thesense future, host of innovative soSkema 6 by Castellini, with its high-tech instruments, touchscreen controls and Characterised by a floor-mounted unit tist’s module ensures perfect positionodontics and implantology. advanced lutions enabling ALL AROUND THEThe WORLD. Dentists whoexcellent choose hygiene, Classe total A7 Plus令人羡慕的舒适度，无论医生及护士团队均可轻 寸触摸屏用户界面的全触摸屏控制器。 body, which remains independent from ing and optimises fluidity of the moveintegrated systems, professionals theenviable ideal tool for high-performanhygiene devices, fully offers certifieddental by leading control comfort, both know and they can personalise theirfordental松体会Skema6带领牙科界更进一步迈入未来。 the patient chair and its movements, ments associated with this operating Italian universities, together with a design patients and medical staff. 凭借高效的卫生学解决方案、全面操控体验以及令人羡慕 ce treatment including conservative dentistry, endodontics and implantology.

Touch theconcentrated future with and clinical expertise motor withCASTELLINI electronic torque control up to www.anthos.com

The Classe A range

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Developed to provide as much flexibiltoday and tomorrow, whatever their to- 的舒适度，无论医生及护士团队均可轻松体会Skema6带领 The advanced devices, fully certified by leading Italian universities, tions, enables the hygiene dentist to work comfortcastellini.com castellini.com and extensive operating space. This latdentist’s module and its cast aluminium ity as possible, the full Classe A range field of specialization, from conservagether with a design which ensures functionally ergonomic solutions, enables the 牙科界更进一步迈入未来。 est model from the Italian brand lets support arm, coupled with a telescopic of units enables dentists to select the tive dentistry to implantology. Thanks dentists explore new capabilities height function operated 7 DOCTOR 牙医 Infodentwithin International •1 adjustment 2018 dentist to work comfortably, enjoying peace of mind.technological conergonomic and functional set-up best total to the underlying 1 the dentist to Doctorfield.

Os 牙医 Infodent International •3/2017 the diagnostic via the keypad, allows Skema is equipped with LED, anopen extremely lightweight suited to6their operating style andImplantor pro- figuration, to all integrated An- in- castellini.com By taking the guiding principles behind work calmly and confidently. Thanks fessional needs. systems, this premium duction micromotor with electronic thos torque control up to 5.3treatment Ncm, fully Stern Weber’s advanced dental unit to the latest digital electronics, the Classe A5 canand be supplied differ- centre can be expanded, immediately autoclavable suitable infor6 integrated endodontics and implantology. development program – sturdiness, S320TR brings out the dentist’s very ent configurations. Ergonomics to suit or at a later date, with ultra-high percompactness, user-friendliness, ergobest.

Full Touch consolle, as an features a tempered display every operating style,available integrated An-optional, formance instruments, X-ray glass and mulnomics and performance – the TR Seand touchscreen thos 5.7” brand instruments,interface. an extensive timedia systems, and advanced hygiene

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DOCTOR牙医 Infodent International •1 2018 Doctor Os 牙医 Infodent International •3/2017

DOCTOR牙医 Infodent International • 3 2018

7

highlights

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。 STERN WEBER

赛特伟邦 （STERN WEBER） STERN S320TR 赛特伟邦 （STERN WEBER） STERN S320TR

赛特伟邦（STERN WEBER） STERN S320TR A级系列 完整的A级系列口腔综合治疗台的设计宗旨是尽可 STERN S320TR 能提供最大的灵活性，使牙医可以选择最适合其 Characterised by a floor-mounted unit body, which remains indepen- 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 dent from the patient chair and its movements, the S320TR models 运行的独立性同时，依然具备极高的稳定性和充分的 A5级可提供6种不同的配置。 适合各种操作风格的 provide stability and extensive operating space.This latest model from 治疗操作空间。作为来自意大利的最新型号款式，牙 the Italian brand lets dentists explore new capabilities within the dia人体工学，整合的安福士品牌器械，脚控和手术 医在诊断上能够获得崭新的操作体验。 gnostic field. 灯的扩展性选择，不同的卫生学系统、可选配置 By taking the guiding principles behind Stern Weber’s advanced dental 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 和颜色主题，从每个方面讲都具有多样的变化。 unit development program – sturdiness, compactness, user-friendli- 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 选择 +级的牙医知道他们可以根据当前和未 安福士 (ANTHOS) ness,A7 ergonomics and performance-向全世界牙 – the TR Series maximises them as 符合人体工程学结构以及自身出色的性能），TR系列 来的特殊需求对其口腔综合治疗台进行个性化定 never before so as to provide you with a wealth of new opportunities. 最大限度的为您提供前所未有的丰富的新的机遇。 医提供无限解决方案的品牌。 制，无论他们的专业领域属于常规牙科还是种植 医生位的良好机动性保证了此种操作风格的完美定 Excellent manoeuvrability of the dentist’s module ensures perfect 科。鉴于搭载了向所有的可整合安福士设备开放 位性和移动操作的优化流畅性。医生位采用铸铝支架 A级系列 positioning and optimises fluidity of the movements associated with 的基础技术配置接口，这款高端的治疗台可以在 完整的A级系列口腔综合治疗台的设计宗旨是尽可 this operating style. The outstanding stability of the dentist’s module 臂，具备出色的稳定性，再加上通过按键操作进行高 现场或在未来与超高性能器械仪器、X-射线装 安福士 (ANTHOS) -向全世界牙 能提供最大的灵活性，使牙医可以选择最适合其 and its cast aluminium support arm, coupled with a telescopic height 度调节，可以让牙科医生从容而安心的工作。由于采 置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 adjustment function operated via the keypad, allows the dentist to 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 医提供无限解决方案的品牌。 运行的独立性同时，依然具备极高的稳定性和充分的 work calmly and confidently.Thanks to the latest digital electronics, the 们带来了最好的操作体验。 达到扩展功能的目的。 A5级可提供6种不同的配置。 适合各种操作风格的 治疗操作空间。作为来自意大利的最新型号款式，牙 S320TR brings out the dentist’s very best. 人体工学，整合的安福士品牌器械，脚控和手术 www.anthos.com sternweber.com A级系列 医在诊断上能够获得崭新的操作体验。 www.sternweber.com 灯的扩展性选择，不同的卫生学系统、可选配置 完整的A级系列口腔综合治疗台的设计宗旨是尽可 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 STERN WEBER so as to provide you with a wealth of 和颜色主题，从每个方面讲都具有多样的变化。 能提供最大的灵活性，使牙医可以选择最适合其 ANTHOS. THE BRAND lights, various hygiene systems, options 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 Stern S320TR new opportunities. 基于分体落地式的主体特征，S320TR在保证患者椅 WITH LIMITLESS and colour schemes: versatility in every 选择 A7 +级的牙医知道他们可以根据当前和未 操作风格和专业需求的人体工学和功能设置。 符合人体工程学结构以及自身出色的性能），TR系列 Excellent manoeuvrability of the denSOLUTIONS FOR DENTISTS sense of the word. 运行的独立性同时，依然具备极高的稳定性和充分的 Characterised by a floor-mounted unit tist’s module ensures perfect position来的特殊需求对其口腔综合治疗台进行个性化定 A5级可提供6种不同的配置。 适合各种操作风格的 最大限度的为您提供前所未有的丰富的新的机遇。 ALL AROUND THE WORLD. Dentists who choose Classe A7 Plus 治疗操作空间。作为来自意大利的最新型号款式，牙 body, which remains independent from ing and optimises fluidity of the moveknow they can personalise their dental 制，无论他们的专业领域属于常规牙科还是种植 人体工学，整合的安福士品牌器械，脚控和手术 医生位的良好机动性保证了此种操作风格的完美定 the 医在诊断上能够获得崭新的操作体验。 patient chair and its movements, ments associated with this operating The Classe A range unit according to the specific needs of the S320TR models provide stability style. The outstanding stability of the 科。鉴于搭载了向所有的可整合安福士设备开放 灯的扩展性选择，不同的卫生学系统、可选配置 位性和移动操作的优化流畅性。医生位采用铸铝支架 Developed to provide as much flexibil- today and tomorrow, whatever their and 赛特伟邦（Stern extensive operating space.Weber）以持续开发先进的牙科设备 This latdentist’s module and its cast aluminium ity as possible, the full Classe A range field of specialization, from conserva的基础技术配置接口，这款高端的治疗台可以在 臂，具备出色的稳定性，再加上通过按键操作进行高 和颜色主题，从每个方面讲都具有多样的变化。 est 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 model from the Italian brand lets support arm, coupled with a telescopic of units enables dentists to select the tive dentistry to implantology. Thanks dentists explore new capabilities within height adjustment function operated 现场或在未来与超高性能器械仪器、X-射线装 度调节，可以让牙科医生从容而安心的工作。由于采 选择 andA7 +级的牙医知道他们可以根据当前和未 ergonomic functional set-up best to the underlying technological conthe 符合人体工程学结构以及自身出色的性能），TR系列 diagnostic field. via the keypad, allows the dentist to suited to their operating style and pro- figuration, open to all integrated An置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 来的特殊需求对其口腔综合治疗台进行个性化定 By taking the guiding principles behind work calmly and confidently. Thanks 最大限度的为您提供前所未有的丰富的新的机遇。 fessional needs. thos systems, this premium treatment Stern Weber’s advanced dental unit to the latest digital electronics, the 们带来了最好的操作体验。 达到扩展功能的目的。 制，无论他们的专业领域属于常规牙科还是种植 Classe A5 can be supplied in 6 differ- centre can be expanded, immediately 医生位的良好机动性保证了此种操作风格的完美定 development program – sturdiness, S320TR brings out the dentist’s very ent 科。鉴于搭载了向所有的可整合安福士设备开放 configurations. Ergonomics to suit or at a later date, with ultra-high per位性和移动操作的优化流畅性。医生位采用铸铝支架 www.anthos.com sternweber.com compactness, user-friendliness, ergobest. every operating style, integrated An- formance instruments, X-ray and mulnomics and performance – the TR Se的基础技术配置接口，这款高端的治疗台可以在 臂，具备出色的稳定性，再加上通过按键操作进行高 thos brand instruments, an extensive timedia systems, and advanced hygiene ries maximises them as never before sternweber.com choice of foot controls and operating devices. 现场或在未来与超高性能器械仪器、X-射线装 度调节，可以让牙科医生从容而安心的工作。由于采 STERN WEBER so as to provide you with a wealth of ANTHOS. THE BRAND lights, various hygiene systems, options Stern用了最新的数码电子科技，使得S320TR给牙科医生 S320TR new opportunities. 置、多媒体系统以及先进的卫生学设备相匹配， DOCTOR 牙医 Infodent International 2018 WITH LIMITLESS and•1 colour schemes: versatility in every Excellent manoeuvrability of the denSOLUTIONS FORInfodent DENTISTS sense•3/2017 of the word.

Doctor Os 牙医 International 们带来了最好的操作体验。 达到扩展功能的目的。 Characterised by a floor-mounted unit tist’s module ensures perfect positionALL AROUND THE WORLD. Dentists who choose Classe A7 Plus

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know they can personalise their dental www.anthos.com The Classe A range unit according to the specific needs of Developed to provide as much flexibil- today and tomorrow, whatever their ity as possible, the full Classe A range field of specialization, from conservaANTHOS. THEto BRAND lights, various hygiene systems, options of units enables dentists select the tive dentistry to implantology.

Thanks WITH colour schemes: versatility in every ergonomic andLIMITLESS functional set-up best to theand underlying technological consenseopen of thetoword. suitedSOLUTIONS to their operatingFOR style DENTISTS and pro- figuration, all integrated AnALL AROUND THE WORLD.thos systems, Dentists this whopremium choose Classe A7 Plus fessional needs. treatment theyexpanded, can personalise their dental Classe A5 can be supplied in 6 differ- centreknow can be immediately The Classe AErgonomics range according to the specificperneeds of ent configurations. to suit or at unit a later date, with ultra-high to provide as much todayinstruments, and tomorrow, every Developed operating style, integrated An-flexibilformance X-ray whatever and mul- their ity as possible, the full A range field of specialization, from conservathos brand instruments, an Classe extensive timedia systems, and advanced hygiene of units enables dentists to select the tive dentistry to implantology.

Thanks choice of foot controls and operating devices. ergonomic and functional set-up best to the underlying technological consuited牙医 to their operating style and pro-•1 2018 figuration, open to all integrated AnDOCTOR Infodent International fessional needs. thos systems, this premium treatment Doctor Os 牙医 Infodent International •3/2017 Classe A5 can be supplied in 6 differ- centre can be expanded, immediately ent configurations. Ergonomics to suit or at a later date, with ultra-high perevery operating style, integrated An- formance instruments, X-ray and multhos brand instruments, an extensive timedia systems, and advanced hygiene choice of foot controls and operating devices.

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DOCTOR牙医 Infodent International •1 2018 DOCTOR 3 2018 Doctor Os 牙医 牙医 Infodent Infodent International International ••3/2017

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DOCTOR牙医 Infodent International •1 2018 Doctor Os 牙医 Infodent International •3/2017

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DOCTOR牙医 Infodent International • 3 2018

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SCIENTIFIC UPDATE 学术文章

SCIENTIFIC UPDATE A Preliminary study on the clinical threshold of translucency in prosthodontics

First author JiangYun, Attending physician YanTai stomatological hospital of ShanDong province Cell phone 13325147370 Email address 147813645@qq.com Corresponding author XiongFang, Deputy chief physician West China school of stomatology, Sichuan University Cell phone 13699084186 Email address xofa@163.com KEY WORDS Translucency; clinical threshold; prosthodontics; dental ceramic

A Preliminary study on the clinical threshold of translucency in prosthodontics ABSTRACT Aim:The aim of this study is to investigate the translucency clinical threshold in prosthodontics Materials and Methods: Vita 95 ceramic porcelain powder was used with a translucency of 6.0% as a control; then according to the increase of the translucency (∆T as 0.25%, 0.5%,1.0%, 1.5%, 2%, 2.5%, 3, 3.5%, 4, 4.5%,) and decrease (∆T as -0.25%, -0.5% , -1.0%, -1.5%, -2%, -2.5%, -3%, -3.5%) to make disc-shaped tiles of different translucency. Under the observation condition of 45°/0° illumination and neutral gray background, 40 observers made their evaluations according to six sensory levels of identical, similar, slight difference, perceivable, identifiable and large difference; the results then were statistically analyzed.

Results: When the translucency of the control ceramic disc is 6,032% and the translucency of the comparison ceramic disc is decreased by 1% or increased by 3%, observers think that there is a slight difference between the control ceramic disc and the comparison disc; when the translucency of the comparison ceramic disc is decreased 2,5% or increased 4,5%, observers believe that the two discs are not in the same order of magnitude.

Conclusions: Under this experimental condition, the upper limit of the translucency clinical threshold is 3% and 1% of lower limit.

As well as the color, the translucency is also important in the simulation of the appearance of dental prostheses to natural teeth [1-3] . Some studies believe that the translucency is the most important second optical performance[4]. At present, many scholars have conducted many studies on the translucency of natural teeth, tooth structure and dental ceramic materials [2,5-9]. When measuring and comparing the color of an object, the chromatic aberration(∆E) is generally used to measure the difference between the two different colors. Since the resolution of human eye is limited, establishing a chromatic aberration threshold to distinguish the difference between two colors is very helpful to the observer. When the chromatic aberration of two different colors is lower than chromatic aberration threshold, it is considered that the two colors cannot be distinguished by human eyes, for the observer the two colors are the same; while the chromatic aberration is higher than threshold, the two colors are considered different.The chromatic aberration thresholds of different national color systems are different. The Chinese chromatic aberration threshold of color system is: color group with ∆E<3, achromatic color group ∆E<1.5[10,11]. All relevant color studies in this experiment are based on this system. However, there is no corresponding clinical threshold for the difference in translucency ∆T and no relevant studies have been found.

This experiment uses dental ceramic discs with different translucency to investigate the clinical threshold of the translucency difference ∆T through visual analysis, hoping to be helpful for the studies of the translucency on natural teeth and prosthesis.

12

DOCTOR牙医 Infodent International • 3 2018

1. Method 1.1 Determining the test samples translucency range The translucency of ceramic specimens is quite sensitive to the thickness changes [12]. Taking to account the simplicity of the test sample preparation and the control of the color difference, we decided to use Vita 95 glazed porcelain to make test sample, then change the translucency by changing the thickness of samples, to make the translucency varies between 2% to 11%. At the same time, taking the advantage of the nearly colorless character of the glaze porcelain, the color difference is controlled to a minimum.

1.2 Test group classification Taking a sample with a translucency of 6.0% as a control disc, then a series of samples with different translucency were prepared according to the two directions of increasing and decreasing translucency, the ∆T between each sample and the control sample was controlled, as shown in table 1.

Table 1 Test group classification Table 1 Group classification condition Group A ∆T (%) increasing*

Group B ∆T (%) decreasing*

A1 0.25

A2 0.5

A3 1

A4 1.5

A5 2

A6 2.5

A7 3

A8 3.5

B1 0.25

B2 0.5

B3 1

B4 1.5

B5 2

B6 2.5

B7 3

B8 3.5

*: The translucency of the control sample is 6.0%

A9 4

A10 4.5

A Preliminary study on the clinical threshold of translucency in prosthodontics SCIENTIFIC UPDATE

1.3 Preparation and measurement of test samples Mix the porcelain powder according to the power ratio of the product, inject it into the round hole of the homemade plastic mold, slightly overflowing. The porcelain powder compression oscillator is oscillated repeatedly, use the filter paper to absorb excess water.

Scrap the excess material horizontally along the surface of the mold with a sharp blade, then demold the sample after leaving it for 10 minutes, sinter in a vacuum oven according to standard procedures.The sintered samples were sequentially wet-polished with 400#, 600#, 800#, 1000#, 1200# waterproof abrasive paper, keep two sides of the samples flat, the diameter was about 15mm, the thicknesses varied according to the different translucency. The experimental samples were placed under a stereo microscope to observe whether the surface had obvious defects, if there were obvious defects present, samples would be excluded. After Ultrasonic cleaning, the samples were dried for later use.

The translucency of the central part of each sample was measured using PR-650spectral scanning colorimeter. After the measurement, the sample was rotated 45’ for the second time, then the sample was inverted, and the measurement was repeated twice as described above.

The results of 4 times measurement for each sample were averaged.

The main wavelength and color purity of the samples on a black and white background is simultaneously measured and recorded.

1.4 Visual evaluation 1.4.1Visual observation condition Light source: Using the D65 analog light source from “The Judge® II” visual evaluation standard light box by (Gretag Macbeth Company America), the color temperature is 6500K, representing the average north window light.

Illumination and observation direction: using the 45°/0°method which is recommended by CIE, with 45° illumination on ceramic sample, and observed in the vertical direction. The ceramic pieces were placed on the observation stand, a black-and-white striped background was put in the back of the comparison and control samples.

Observation background and environment: The sample observation was carried out in the standard light source light box of the “The Judge® II” visual evaluation.The inner wall of the light box was a Munsell N7 neutral gray low/gloss surface to avoid the influence of the background color on visual evaluation. Observations are made in a darkroom to avoid interference from other sources than standard light source.

Observers: A group of young doctors with a certain clinical color comparison experience, including 18 males and 22 females, aged between 24 to 35 years old.

1.4.2 Observation level The observation results are divided in six sensory levels: Identical: the observer considers the two specimens presented in the same vision field to be identical Similar: looks like the same, but not completely sure.

Slight difference: the observer hardly noticed a difference between two specimens Perceivable: there is a difference between two pieces without a careful identification.

Identifiable: the observer can clearly distinguish the difference between the two pieces, and feel the difference is relatively large.

Big difference: Observers can not only see the difference between the two specimens, the difference is too abvious.

The ∆T value corresponding to the light-difference is taken as the clinical threshold of translucency.

1.4.3 Experimental operation During the experiment, the light is irradiated on the observation stand at 45°, and the ceramic sample is placed on the surface of the stand, the human eye is perpendicular to the sample, and the angle of deviation between the two does not exceed 10°. The ceramic sample was disc-shaped with the diameter of 15mm, the distance between the eyes and sample was about 40cm, maintaining the observation condition with 10° of vision field.

The control sample was placed on the observation stand, the comparative samples were randomly numbered, and the operator randomly took the comparative samples and placed them next to the control sample until a satisfactory level of feeling is obtained. Given the evaluation time is not long, it generally does not cause visual fatigue of the observer. During the experiment if the observer feels tired of using the eyes, he can rest at any time, then continue to evaluate after recovery.

2. Results and Discussion 2.1 The measurement results of ceramic samples translucency and the difference between the translucency are show in Table2

Table 2 ceramic translucency T (%) the difference of translucency ∆T (%) Group B T (%)

∆ (%)

Group A T (%)

∆ (%)

对照

B8 2.426 (+0.074)* 3.606

B7 2.981 (-0.019)* 3.051

B6 3.572 (+0.072)* 2.46

B5 4.041 (+0.041)* 1.991

B4 4.528 (+0.028)* 1.504

B3 5.010 (+0.010)* 1.022

B2 5.452 (-0.048)* 0.58

B1 5.755 (+0.005)* 0.277

6.032 (+0.032)* 0

A1 6.280 (+0.030)* 0.248

A2 6.508 (+0.008)* 0.476

A3 7.009 (+0.009)* 0.977

A4 7.535 (+0.035)* 1.503

A5 8.037 (+0.037)* 2.005

A6 8.539 (+0.039)* 2.507

A7 9.091 (+0.091)* 3.059

A8 9.473 (-0.027)* 3.441

A9 9.913 (-0.087)* 3.881

A10 10.59 (+0.090)* 4.558

*: the number in parentheses is the difference between the measured value and the set value

DOCTOR牙医 Infodent International • 3 2018

13

SCIENTIFIC UPDATE A Preliminary study on the clinical threshold of translucency in prosthodontics

To determine the clinical threshold of translucency, the ideal experiment should include the entire range of translucency involved in the restoration field, divide the translucency range from high to low into several grades, take each translucency grade as control, and establish a series of comparative samples with ∆T value changing from small to large. Meanwhile, it should be considered whether the difference between the upper and lower limits of the translucency at the same level has an effect to the experimental results, the comparative sample of each level difference should have two comparable series above and below the translucency of the control sample. It is difficult to meet the above requirements under the existing conditions, so this experiment is only tried within a limited range. Table 2 shows the difference in translucency and translucency of the experimental samples. The translucency of the control sample was 6.032%, and the translucency of the remaining comparative samples was sequentially increased or decreased with maximum of 10.59% and minimum of 2.46%. the translucency range of the experimental samples is not large, because the sensitivity of the human eye is taken into consideration, and it has been found through preliminary experiments that it is not necessary to set samples with an excessively large difference. At the same time, when the difference in translucency is large, the color difference of the sample will increase, which will affect the experimental results. Table 2 shows the difference between the measured value of the translucency and the set value of each experimental piece in

parentheses, and the absolute value is at minimum 0.005%, and maximum is 0.091%, the average value is 0.041%.The measured values of the translucency of each experimental sample are close to the set value, and the average value of the difference between the measured value and the set value of the translucency is much smaller than the difference between the control sample and comparative sample, so the production of the experimental sample basically meets the setting requirements. The size difference between the control sample and the comparison sample will directly affect the accuracy of the visual evaluation. The finer the classification of the difference, the higher the visual evaluation accuracy. In this experiment ∆T is been set in different grades of 0.25%, 0.5%, 1.0%, 1.5%, 2%, 2.5%, 3% and3.5%, and divided into two series of increasing and decreasing translucency.

In the group of samples with increased rates were also added two grades more with the ∆T value of 4% and 4.5%. The grade difference ∆T we set in this experiment is a relatively fine and accurate value that can be achieved under the existing production conditions. If the grade difference is further refined, the translucency of the test piece cannot be guaranteed to be consistent with the set value under the production conditions available at present.

2.2 The measurement results of ceramic sample color parameters are shown in Table 3.

Table 2 Main wavelength of the ceramic sample ∆D (nm)and color purityPe (%) Group B White background

Black background

B8

B7

B6

B5

B4

B3

B2

B1

Comparison

‫ג‬D (nm)

581

581

580.9

580.7

580.7

580.7

580.7

580.7

580.6

Pe (%)

80.88

80.88

80.47

80.31

80.14

80.15

80.01

80.1

79.9

‫ג‬D (nm)

580.3

580.2

580.2

580.1

580

580

579.9

580

579.9

Pe (%)

78.45

78.67

78.22

78.01

77.71

77.66

77.55

77.43

77.08

A1

A2

A3

A4

A5

A6

A7

A8

A9

A10

‫ג‬D (nm)

580.6

580.7

580.6

580.6

580.6

580.6

580.6

580.6

580.5

580.5

Pe (%)

79.94

79.97

79.8

79.89

79.6

79.73

79.69

79.65

79.63

79.54

‫ג‬D (nm)

579.9

579.9

579.9

579.8

579.8

579.8

579.8

579.8

579.8

579.8

Pe (%)

77.22

77.62

77.12

77.16

77.11

77.07

77.09

76.85

76.69

76.76

Group A

White background

Black background

*: The number in parentheses is the difference between the measured value and the set value

14

DOCTOR牙医 Infodent International • 3 2018

A Preliminary study on the clinical threshold of translucency in prosthodontics SCIENTIFIC UPDATE

The perception properties of color include value, hue and chroma, which together are also called chromaticity. Color chromaticity can be expressed in chromaticity coordinates, or in main wavelength and color purity, the second one is more intuitive. Therefore, the main wavelength and color purity are used in this experiment to indicate the color characteristics of the sample, as it is showing in Table 2 that the experimental samples have substantially the same main wavelength and color purity in the same background. The mean value of the wavelength on a white background 580.6789nm, the maximum difference is 0.5nm; the mean value of wavelength on a black background is 579.9421nm, with the maximum difference of 0.5nm. The mean value of color purity on a white background is 80.015%, maximum difference is 1.34%; on a black background the mean value is77.446%, with a maximum difference of 1.98%. The chromatic resolution of human eye includes wavelength resolution and color purity resolution.

The wavelength resolution of the middle section of the spectrum is relatively high, especially in the blu-green 490nm and yellow 590 resolutions, and the resolution threshold near 590nm is about 1nm.

The color purity resolution of human eye is related to the color purity. When the color purity is low, the threshold is 5%, and when the color purity is high, the threshold is about 2%13. Since the maximum difference of the wavelength and the color purity in this experiment is lower than the threshold of human eye resolution, the chromaticity of the experimental sample can be considered consistent. In this experiment the formula ∆E=(∆L*2 + ∆a*2 ∆b*2)1/2 was not used to calculate the color difference, because the value changed when the translucency of the sample changed. Since ∆E increases due to ∆L* changes, the chromaticity of each sample does not change significantly.

It can also be seen from Fig. 1 that the chromaticity coordinates of each experimental sample are very concentrated on the CIE 1964 chromaticity diagram, and almost coincide with one point.

Fig. 1 Chromaticity coordinates location of test samples on CIE 1964 chromaticity diagram (white background)

2.2 Visual evaluation results

The results of 40 observers are shown in Table 3. The statistical processing of the results is based on the conventional statistical method in psychophysics, selection of the number of times by observers on each sample exceeds 75% from the total number of discriminations as the grade difference determination limit.

Table 3 Sensory level of the comparison sample Comparison

∆T (%)

Identical (times)

Similar (times)

Slight difference (times)

Perceivable (times)

Identifiable (times)

Big difference (times)

B8

3.606

0

0

0

0

4

36

B7

3.051

0

0

0

0

10

30

B6

2.460

0

0

0

3

12

25

B5

1.991

0

0

1

5

24

10

B4

1.504

0

0

4

24

11

1

B3

1.022

0

2

9

22

7

0

B2

0.580

1

16

14

8

7

0

B1

0.277

2

22

10

6

0

0

A1

0.248

18

14

8

0

0

0

A2

0.476

8

18

14

0

0

0

A3

0.977

6

19

14

1

0

0

A4

1.503

5

15

17

2

1

0

A5

2.005

2

8

22

8

0

0

A6

2.507

2

7

18

13

0

0

A7

3.059

0

3

22

10

5

0

A8

3.441

0

1

15

19

5

0

A9

3.881

0

1

12

24

3

0

A10

4.558

0

0

4

26

8

2

DOCTOR牙医 Infodent International • 3 2018

15

SCIENTIFIC UPDATE A Preliminary study on the clinical threshold of translucency in prosthodontics The experimental statistics are shown in Table 4.

Table 4 Sensory level of translucency difference Identical (∆T)

Similar (∆T)

Slight difference (∆T)

Perceivable (∆T)

Identifiable (∆T)

Big difference (∆T)

Down limit (%)

-

0.580

1.022

1.504

2.460

3.606

Up limit (%)

0.977

1.503

3.059

3.881

4.558

-

As we can see from Table 4, when the translucency of the control sample is 6.032% and the translucency of comparative sample is decreased by1% or increased by 3%, observers think that there is a slight difference between comparative sample and the control sample; when the translucency of the comparative sample is decreased by 2.5% or increased by 4.5%, observers believe that the two samples are not in the same order of magnitude.Table 4 lacks the decreased limit value of the “same” level and the increased limit value of the “large difference”, because after observation on the sample with translucency decreased, only very few observers think that there are same samples as the control sample; likewise, in the observation with translucency at elevated rates, just a few observers considered comparative samples that differed greatly from the control sample. Since the number of observations of the two sets of sensory value is too small, the magnitude of the ∆T of the two sets of level difference is not indicated in Table4.

Further analysis of the experimental results shows that the upper limit ∆T value corresponding to each sensory level in the experiment is higher than the lower limit ∆T value. Analysis of the reasons may be related to the production of samples. As can see from Table 2, the difference of color purity between the sample group B with reduced translucency and the control sample was 0.98% (white background) and 1.59% (with black background), the color purity difference between the sample group A with increased translucency and the control sample was 0.36% (on white background) and 0.39% (on black background). Although the difference of color purity between sample A/B and control sample is lower than the color purity sensory threshold of human eyes, since the color purity of group B is higher than group A, whether it will affect the observer is required further research. During a study on Chinese eyes discrimination of color differences in achromatic colors, Sun Xiuru et al∆11∆found that for each achromatic value scale, the lower limit ∆E is always lower than upper limit ∆E. Since this experiment has similar findings, this reminds us that the reason for this phenomenon, in addition to the influence of production factor, is that there is still the possibility that when the human eye observes, the psychophysical quantities such as color and translucency of the object, it is subjective observations are directional, ie sensitive to changes in one direction. Of course, the above is only speculation, and the specific reasons remain to be further studied.

In this experiment, the observation results of translucency are divided into six sensory levels. We integrated both national and international studies on color difference threshold, here we used the slight difference level as the translucency clinical threshold. Under the conditions of this experiment, when the sample with a translucency of 6% was used as a control, the upper limit of the translucency clinical threshold considered to be 3%, and the lower limit was 1%. However, it should be noted that due to the limitation of the experimental conditions, the translucency range of the sample is not sufficiently large, and there is only one type 16

DOCTOR牙医 Infodent International • 3 2018

of control sample. If the translucency of control sample changes, it is not certain whether the translucency clinical threshold is still consistent with the results of this experiment. Although the discrimination of color chromatic aberration on achromatic color there is no great difference for human eyes, regardless of whether it is high, middle or low value scale11. however whether this conclusion can be popularized in translucency discrimination still need to be studied in the future.

3. Conclusion In this experiment, 40 observers used a sample with a translucency of 6% as a control, and observed comparative samples with translucency ∆T value reduced and increased of 0.25%,0.5%,1.0%,1.5%,2%,2.5%,3 %,3.5%,4%,4.5%, we classified the sensory level into identical, similar, slight difference, perceivable, identifiable and large difference, took the slight difference as the translucency clinical threshold, and the result showed that under the conditions of this experiment, the upper limit of the translucency clinical threshold is 3%, and the lower limit is 1%.

Reference

1. Winter R. Visualizing the natural dentition. J Esthet Dent, 1993; 5(3): 102-117 2. Xiong F, Chao YL, Zhu ZM.Translucency of newly extracted maxillary central incisors at nine locations. J Prosthet Dent. 2008; 100(1): 11-17 3. Xiao B, et al. Looking against the light: how perception of translucency depends on lighting direction. J Vision. 2014; 14(3): 17 4.Terry DA, Geller W,Tric O, Anderson MJ,Tourville M, Kobashigawa A. Anatomical form defines color: function, form and aesthetics. Practical Procedures and Aesthetic Dentistry 2002; 14: 59-67.

5. Pop-Ciutrila IS, Ghinea R, Colosi HA, et al. Dentin translucency and color evaluation in human incisors, canines, and molars. J Prosthet Dent. 2016; 115(4):475-81.

6. Hasegawa A, Ikeda I, Kawaguchi S. Color and translucency of in vivo natural central incisors. J Prosthet Dent 2000, 83(4): 418-423 7. Harada K, Raigrodski AJ, Chung KH, et al. A comparative evaluation of the translucency of zirconias and lithium disilicate for monolithic restorations. J Prosthet Dent. 2016; 116(2): 257-63.

8. Shiraishi T, Watanabe I.Thickness dependence of light transmittance, translucency and opalescence of a ceria-stabilized zirconia/alumina nanocomposite for dental applications. Dent Mater. 2016; 32(5): 660-7.

9. Jeong ID, Bae SY, Kim DY, et al.Translucency of zirconia-based pressable ceramics with different core and veneer thicknesses. J Prosthet Dent. 2016; 115(6): 768-72.

10. 孙秀如, 林志定, 张家英, et al. 中国人眼对表色色差鉴别的实 验研究. 心理学报, 1996; 28(1): 9-15 11. 孙秀如, 林志定, 张家英, et al. 中国人眼对非彩色表色色差 鉴别的实验研究. 心理学报, 1995; 27(3): 231-240 12. 熊芳, 巢永烈, 朱智敏. 瓷层厚度比和瓷粉混合比对饰面瓷 半透性的影响. 实用口腔医学杂志. 2008; 24(4): 482-487 13. 汤顺青. 色度学. 北京: 北京理工大学出版社, 1990: 82-85

口腔修复中半透性临床阈值的初步探索 SCIENTIFIC UPDATE

口腔修复中半透性临床阈值的初步探索

摘要： 目的：研究口腔修复领域中半透性的临床阈值。方法：采用Vita 95 釉瓷瓷粉，以透射率为 6.0%为对照，按照透射率升高（ΔT为0.25%、0.5%、1.0%、1.5%、2%、2.5%、3%、3.5% 、4%、4.5%）和降低（ΔT为-0.25%、-0.5%、-1.0%、-1.5%、-2%、-2.5%、-3%、-3.5%） 制作不同透射率的圆盘状瓷片。40名观察者在中性灰背景和45°/0°方式的照明及观察条件 下，按相同、相似、微量差、可觉差、可识别、大差别六个等级进行判断，对结果进行统计 分析。结果：当对照瓷片的透射率为6.032%时，比较瓷片的透射率下降1%或升高3%时观察 者认为比较瓷片和对照瓷片有微量的差别；当比较瓷片的透射率下降2.5%或升高4.5%时观察 者认为两个瓷片不属于同一个数量级。结论：在本实验条件下，半透性的临床阈值的上限为 3%，下限为1%。

口腔修复体对天然牙外观的模拟，除了颜色之 外，半透性也同样重要[1-3]。有学者认为半透 性是最重要的第二光学性能[4]。目前，已有 许多学者对天然牙、牙体组织和牙科陶瓷材 料的半透性进行了多方面的研究[2,5-9]。在对 物体的颜色进行测量和比较时，一般采用色差 （ΔE）来度量两种不同颜色之间的差异。由于 人眼的分辨力是有限的，因而确立了色差阈值 来判别两种颜色的差别是否对观察者有意义。 当两种颜色的色差小于色差阈值时，认为这两 种颜色不能被人眼所区分，对于观察者来说两 种颜色相同；当色差大于色差阈值时，则认为 这两种颜色不同。不同国家颜色体系的色差阈 值各不相同，中国颜色体系的色差阈值是：彩 色系△E<3，非彩色系△E<1.5［10,11］。各 项有关颜色的研究均是基于这个基础之上。但 半透性的差异（△T）却还没有相应的临床阈 值，且尚未见相关研究。 本实验利用不同透射率的牙科陶瓷片，通过视 觉分析探索半透性差值ΔT的临床阈值，希望能 对天然牙和修复体半透性的研究有所帮助。 1. 实验方法 1.1 实验样片透射率范围的确定 陶瓷试件的透射率对厚度的变化相当敏感［12 ］。考虑到实验样片制作的简便和颜色差异的 控制，本实验拟采用Vita 95 釉瓷制作实验样 片，通过实验样片的厚度来改变透射率，使透 射率变化范围在2～11%之间。同时利用釉瓷几 乎无色的特点，将颜色差异控制到最小。

第一作者： 姜云，主治医师 山东省烟台市口腔医院 联系电话：13325147370 邮箱：147813645@qq.com 通讯作者： 熊芳，副主任医师 四川大学华西口腔医学院 联系电话：13699084186 邮箱：xofa@163.com 关键词 半透性；临床阈值； 口腔修复；牙科陶瓷

1.2 实验分组 以透射率为6.0%的样片为对照，按照透射率升 高和降低两个方向制作一系列不同透射率的样 片，控制各样片与对照样片之间的ΔT，如表1 所示。 1.3 实验样片的制作和测量 按照产品要求的粉液比调拌瓷粉，注入到自 制的塑料模具的圆孔中，稍满溢。用瓷粉压 缩振荡器反复振荡，滤纸吸去多余水分。用锋 利刀片沿模具表面水平刮除多余材料，静置 10分钟后脱模，在真空烤瓷炉中按标准程序烧 结。将烧结好的样片依次用400#、600#、800# 、1000#、1200#水砂纸湿法打磨抛光，保持两 面平整，直径约15mm，厚度根据透射率的不 同而各异。实验样片置于体视显微镜下，观察 表面有无明显缺陷，若有明显缺陷者，应予以 排除。试件超声清洗后，干燥备用。 采用PR－650光谱扫描色度仪，测量每个样片 中央部分的透射率。测量一次后将样片旋转 45°测量第二次，再将样片翻转，按上述方法 重复测量2次。将每个样片的测量4次的结果取 平均值。同时测量并记录实验样片在黑色、白 色背景下的主波长和色纯度。

表1 实验分组 A组 ΔT (%)增加* B组 ΔT (%)降低*

A1 0.25

A2 0.5

A3 1

A4 1.5

A5 2

A6 2.5

A7 3

A8 3.5

B1 0.25

B2 0.5

B3 1

B4 1.5

B5 2

B6 2.5

B7 3

B8 3.5

A9 4

A10 4.5

*：对照样片透射率为6.0%

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17

SCIENTIFIC UPDATE 口腔修复中半透性临床阈值的初步探索

1.4 目视评比 1.4.1目视观察条件 光源：采用美国GretagMacbeth 公司The Judge® II目视评比 用标准光源灯箱中的D65模拟光源，色温为6500K，代表平 均北窗光。 照明及观察方向：采用CIE推荐的45°/0°方式，即45° 照射陶瓷样片，垂直方向观察。陶瓷样片放置在观察支架 上，比较样片和对照样片的后方采用黑白条纹的背景。 观察背景环境：样片观察时在The Judge® II目视评比用标准 光源灯箱中进行，灯箱内壁采用的是Munsell N7中性灰色低 光泽度表面，可以避免背景色对目视评比的影响。观察在 暗室中进行，避免标准光源以外的其他光线的干扰。 观察者：观察者是具有一定临床比色经验的年轻医生40 人，其中男性18人，女性22人，年龄在24～35岁。 1.4.2 观察结果等级 观察结果分为六个感觉等级： 相同：观察者对呈现在同一个视场内的两个试件认为完全 相同。 相识：感觉相同，但又不能完全肯定相同。 微量差：观察者刚刚能察觉到两试件之间有差别。 可觉差：两试件之间不用仔细辨认就可以判断出来有差别。 可识别：观察者能明显清晰的区别两试件之间的差异，并 感觉差异比较大。 大差别：观察者不仅能感觉到两试件之间的差异较大，甚 至感觉到了不可接受的程度。 对结果进行统计分析，确立△T与感觉等级之间的关系。将 微量差所对应的△T值作为半透性的临床阈值。 1.4.3 实验操作 实验时光线以45°照射在观察支架上，陶瓷样片放置于支 架表面，人眼与样片垂直，两者之间偏离角度不超过10° 。陶瓷样片为直径1.5cm的圆片，双眼距样片的距离约为 40cm，保持10°视场的观察条件。 对照样片放置在观察支架上。将比较样片随机编号，观察 时由操作者随机拿取比较样片放在对照样片旁边。观察者 可以对比较样片和对照样片反复对比，直到得出满意的感 觉等级为止。因所需评价时间不长，一般不会引起观察者 视觉上的疲劳。实验中，若观察者感到眼睛疲倦，随时可 以休息，待恢复后再继续评价。 2. 结果和讨论 2.1 陶瓷样片透射率和透射率差值的测量结果见表2。 要确定透射率的临床阈值，理想的实验应当包括修复领域 所涉及到的整个透射率范围，将这个范围从高到低划分为 几个档次，以每个档次的透射率为对照，建立一系列△T值

从小到大变化的比较样片。同时，应当考虑在同一级比较 时透射率的上限和下限的不同是否对实验结果有影响，因 此每一级差的比较样片都应当有高于和低于对照样片透射 率的两个可比较系列。以现有的条件要达到上述要求很困 难，因此本实验仅在有限的范围内进行尝试。表2显示了实 验样片的透射率和透射率差。对照样片的透射率为6.032% ，其余比较样片的透射率依次升高或降低，最高为10.59% ，最低为2.426%。实验样片的透射率跨度范围并不大，这 是因为考虑到人眼的敏感性，经过预实验后发现没有必要 设置差异过大的样片。同时，透射率差异较大时样片的颜 色差异也会加大，对实验结果会有影响。表2括弧内所示为 各实验样片的透射率实测值与设定值之差，其绝对值最小 为0.005%，最大为0.091%，平均值为0.041%。各实验样片 的透射率实测值与设定值比较接近，透射率实测值与设定 值之差的平均值远小于对照样片和比较样片的级差，因而 实验样片的制作基本符合设定要求。对照样片和比较样片 级差的大小会直接影响目视评比精度，级差划分越细，目 视评比精度就越高。本实验中ΔT设定了0.25%、0.5%、1.0% 、1.5%、2%、2.5%、3%、3.5%这几个等级，并分为透射率 升高和降低两个系列，其中透射率升高的实验样片还增加 了ΔT为4%、4.5%两个等级。本实验所设定的级差ΔT值是在 现有制作条件下能达到的比较精细和准确的值。如果进一 步细化级差，以现有的制作条件无法保证实验样片的透射 率与设定值一致。 2.2陶瓷样片颜色参数的测量结果见表3。 颜色的知觉特性包括亮度、色调和饱和度，后两方面合起 来又称为色品。颜色的色品可以用色品坐标表示，也可以 用主波长和色纯度表示，后者更加直观。因此本实验中采 用主波长和色纯度来表示样片的颜色特性。从表2中可见实 验样片在相同背景下的主波长和色纯度基本相同。主波长 在白色背景下的平均值为580.6789nm，最大差异为0.5nm； 黑色背景下的平均值为579.9421nm，最大差异为0.5nm。色 纯度在白色背景下的平均值为80.015%，最大差异为1.34% ；黑色背景下的平均值为77.446%，最大差异为1.98%。人 眼的色品分辨力包括波长分辨力和色纯度分辨力。光谱中 段的波长分辨力较高，尤其在蓝绿色490nm和黄色590nm左 右分辨力最强，590nm附近分辨阈值约为1nm。人眼的色 纯度分辨力与色纯度的高低有关，色纯度低时分辨阈值为 5%，色纯度高时阈值约为2%［13］。由于本实验中主波长 和色纯度的最大差值均低于人眼分辨力的阈值，因此可认 为实验样片的色品是一致的。本实验中没有用公式 计算色 差，原因是当样片的透射率发生变化时亮度也随之变化， 由于ΔL*变化会导致ΔE增大，但各样片的色品并没有明显

表2 陶瓷样片的透射率T (%)和透射率差值ΔT (%) 组别 T (%)

∆ (%)

组别 T (%)

∆ (%)

B7 2.981 (-0.019)* 3.051

B6 3.572 (+0.072)* 2.46

B5 4.041 (+0.041)* 1.991

B4 4.528 (+0.028)* 1.504

B3 5.010 (+0.010)* 1.022

B2 5.452 (-0.048)* 0.58

B1 5.755 (+0.005)* 0.277

6.032 (+0.032)* 0

A1 6.280 (+0.030)* 0.248

A2 6.508 (+0.008)* 0.476

A3 7.009 (+0.009)* 0.977

A4 7.535 (+0.035)* 1.503

A5 8.037 (+0.037)* 2.005

A6 8.539 (+0.039)* 2.507

A7 9.091 (+0.091)* 3.059

A8 9.473 (-0.027)* 3.441

A9 9.913 (-0.087)* 3.881

*：括号里的数值为测量值与设定值之差

18

对照

B8 2.426 (+0.074)* 3.606

DOCTOR牙医 Infodent International • 3 2018

A10 10.59 (+0.090)* 4.558

口腔修复中半透性临床阈值的初步探索 SCIENTIFIC UPDATE

表2 陶瓷样片的主波长λD (nm)和色纯度Pe (%) 组别 白背景

黑背景

B8

B7

B6

B5

B4

B3

B2

B1

对照

‫ג‬D (nm)

581

581

580.9

580.7

580.7

580.7

580.7

580.7

580.6

Pe (%)

80.88

80.88

80.47

80.31

80.14

80.15

80.01

80.1

79.9

‫ג‬D (nm)

580.3

580.2

580.2

580.1

580

580

579.9

580

579.9

Pe (%)

78.45

78.67

78.22

78.01

77.71

77.66

77.55

77.43

77.08

A1

A2

A3

A4

A5

A6

A7

A8

A9

A10

‫ג‬D (nm)

580.6

580.7

580.6

580.6

580.6

580.6

580.6

580.6

580.5

580.5

Pe (%)

79.94

79.97

79.8

79.89

79.6

79.73

79.69

79.65

79.63

79.54

‫ג‬D (nm)

579.9

579.9

579.9

579.8

579.8

579.8

579.8

579.8

579.8

579.8

Pe (%)

77.22

77.62

77.12

77.16

77.11

77.07

77.09

76.85

76.69

76.76

组别

白背景

黑背景

*：括号里的数值为测量值与设定值之差 变化。从图1也可见各实验样片的色品坐标在CIE 1964色品 图上的分布非常集中，几乎重合为一点。 40名观察者的试验结果见表3。对结果进行统计处理时， 是以心理物理统计学中常规的统计方法，即将观察者对每 个样片选择次数之和超过辨别总数的75%作为级差确定界 限。实验统计结果见表4。 从表4中可知，当对照样片的透射率为6.032%时，比较样 片的透射率下降1%或升高3%时观察者认为比较样片和对 照样片有微量的差别；当比较样片的透射率下降2.5%或升 高4.5%时观察者认为两个样片不属于同一个数量级。表4 中缺乏相同级差的下限值和大差别级差的上限值，原因是 观察者在观察透射率下降的样片时，只有个别观察者认为 有与对照样片相同的样片；同样，在观察透射率升高的样 片时，只有个别观察者认为有与对照样片存在大差别的样 片。由于这两组感觉值的观察例数太少，因而表4中没有注 明这两组级差的ΔT的大小。 对实验结果作进一步分析可知，实验中每一个感觉等级对 应的上限ΔT值均大于下限的ΔT值。分析其原因，可能与样 片的制作有关。从表2可知，透射率降低的B组样片与对照 样片的色纯度差异为0.98%（白背景）和1.59%（黑背景） ，而透射率升高的A组样片与对照样片的色纯度差异为 0.36%（白背景）和0.39%（黑背景）。 虽然B组和A组样片与对照样片的色纯度差值均低于人眼的 色纯度分辨力阈值，但由于B组的色纯度差大于A组， 是否会对观察者产生影响还有待于进一步的研究。 孙秀如 等［11］在研究中国人眼对非彩色系表色色差的辨别时发 现，每一个明度级的上限和下限的ΔE值相比较，下限的 ΔE均小于上限的ΔE。由于本实验也有类似的发现，这提醒

图1 实验样片的色品 坐标在CIE 1964色品 图上的分布 （白色背 景）

我们，产生这种现象的原因，除了样片制作因素的影响 外，是否还存在以下可能：人眼在观察物体的颜色、半 透性等心理物理量时，其主观观察结果带有方向性，即 对某一方向上的变化较为敏感。当然，以上仅为推测， 具体原因还有待于进一步的研究。 本实验将透射率的观察结果分为六个感觉等级，结合国内 外对色差阈值的研究，本实验以微量差这一等级作为半透 性的临床阈值。在本实验条件下，以透射率6%的样片为 对照时，可认为半透性的临床阈值的上限为3%，下限为 1%。不过需要注意的是，由于实验条件的限制，实验样 片的透射率覆盖范围不够大，并且对照样片仅有一种。如 果对照样片的透射率发生变化，则不能肯定其半透性的临 床阈值是否与本实验结果一致。虽然对非彩色系颜色色差 的辨别研究表明，不论是高明度、中明度还是低明度，人 眼辨别的色差值无显著差异［11］，但这个结论是否能推 广到半透性的辨别还有待于今后的研究。 3. 结论 在本实验中，40个观察者以透射率为6%的样片为对照， 观察了ΔT为0.25%、0.5%、1.0%、1.5%、2%、2.5%、3% 、3.5%、4%、4.5%的透射率降低和升高的比较样片，并

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SCIENTIFIC UPDATE 口腔修复中半透性临床阈值的初步探索

2.2 目视评比结果 表3 比较样片的感觉等级 比较样片

∆T (%)

相同(次)

相似(次)

微量差(次)

可觉差(次)

可识别(次)

大差别(次)

B8

3.606

0

0

0

0

4

36

B7

3.051

0

0

0

0

10

30

B6

2.460

0

0

0

3

12

25

B5

1.991

0

0

1

5

24

10

B4

1.504

0

0

4

24

11

1

B3

1.022

0

2

9

22

7

0

B2

0.580

1

16

14

8

7

0

B1

0.277

2

22

10

6

0

0

A1

0.248

18

14

8

0

0

0

A2

0.476

8

18

14

0

0

0

A3

0.977

6

19

14

1

0

0

A4

1.503

5

15

17

2

1

0

A5

2.005

2

8

22

8

0

0

A6

2.507

2

7

18

13

0

0

A7

3.059

0

3

22

10

5

0

A8

3.441

0

1

15

19

5

0

A9

3.881

0

1

12

24

3

0

A10

4.558

0

0

4

26

8

2

表4 透射率差的感觉值 相同 (∆T)

相似 (∆T)

微量差 (∆T)

可觉差 (∆T)

可识别 (∆T)

大差别 (∆T)

下限 (%)

-

0.580

1.022

1.504

2.460

3.606

上限 (%)

0.977

1.503

3.059

3.881

4.558

-

按照感觉等级相同、相似、微量差、可觉差、可识别、大 差别进行分类，以微量差作为半透性的临床阈值，结果表 明：在本实验条件下，半透性的临床阈值的上限为3%，下 限为1%。 参考文献 1. Winter R. Visualizing the natural dentition. J Esthet Dent, 1993; 5(3): 102-117 2. Xiong F, Chao YL, Zhu ZM. Translucency of newly extracted maxillary central incisors at nine locations. J Prosthet Dent. 2008; 100(1): 11-17 3. Xiao B, et al. Looking against the light: how perception of translucency depends on lighting direction. J Vision. 2014; 14(3): 17 4. Terry DA, Geller W, Tric O, Anderson MJ, Tourville M, Kobashigawa A. Anatomical form defines color: function, form and aesthetics. Practical Procedures and Aesthetic Dentistry 2002; 14: 59-67.

5. Pop-Ciutrila IS, Ghinea R, Colosi HA, et al. Dentin translucency and color evaluation in human incisors, canines, and molars. J Prosthet Dent.

2016; 115(4):475-81.

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DOCTOR牙医 Infodent International • 3 2018

6. Hasegawa A, Ikeda I, Kawaguchi S. Color and translucency of in vivo natural central incisors. J Prosthet Dent 2000, 83(4): 418-423 7. Harada K, Raigrodski AJ, Chung KH, et al. A comparative evaluation of the translucency of zirconias and lithium disilicate for monolithic restorations. J Prosthet Dent. 2016; 116(2): 257-63.

8. Shiraishi T, Watanabe I. Thickness dependence of light transmittance, translucency and opalescence of a ceria-stabilized zirconia/alumina nanocomposite for dental applications. Dent Mater. 2016; 32(5): 660-7.

9. Jeong ID, Bae SY, Kim DY, et al. Translucency of zirconia-based pressable ceramics with different core and veneer thicknesses. J Prosthet Dent. 2016; 115(6): 768-72.

10. 孙秀如, 林志定, 张家英, et al. 中国人眼对表色色差鉴别的实验研 究. 心理学报, 1996; 28(1): 9-15 11. 孙秀如, 林志定, 张家英, et al. 中国人眼对非彩色表色色差鉴别的 实验研究. 心理学报, 1995; 27(3): 231-240 12. 熊芳, 巢永烈, 朱智敏. 瓷层厚度比和瓷粉混合比对饰面瓷半透性的 影响. 实用口腔医学杂志. 2008; 24(4): 482-487 13. 汤顺青. 色度学. 北京: 北京理工大学出版社, 1990: 82-85

SCIENTIFIC UPDATE CAD/CAM patient specific-abutments and a new implant design

CAD/CAM patient specificabutments and a new implant design Prof. Dr. Ning Wu, Shanghai University of Medicine & Health Sciences wnmoon918@hotmail.com

Introduction The objective of any dental reconstruction is the natural, functional reconstruction of the stomatognathic system and the functionally unimpaired or functionally treated masticatory organ. This objective can only be achieved if individual patient parameters and distinctive anatomical features are incorporated into surgical planning and the subsequent prosthetic restoration.

Implant-prosthetic care methods must be established as independent therapy alternatives for specialists and patients, and the possibility of achieving this objective is high. With attention focused on the prosthetic functional aspects of implantology, the prosthetic therapy objective is currently becoming the focal point of all efforts. From the point of view of the practising dentist, the main emphasis in treatment planning for implant-supported dentures is placed on the prosthetic specialist.

If said specialist is also trained in implants and surgery, he will place the implant himself as a

Fig. 1 Maxillary anterior gap in regions 12, 11, 21 and 22 (Kennedy Class IV), four months after implant insertion.

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DOCTOR牙医 Infodent International • 3 2018

First author Dr. Frank Liebaug & Prof. Dr. Ning Wu support measure for his prosthetic therapy, which results in great simplification with regard to planning and the treatment process.

As a rule, however, a dentist who deals with prosthetics will complete his implant prosthesis in close collaboration with an oral surgeon or oral-maxillofacial surgeon.

While surgeons are concerned with the best possible implant procedure or implant design, prosthetic specialists bring us back to the starting point of implantology: the patient’s wishes. Patients do not want implants; rather they want beautiful new teeth with which they feel confident in day-to-day life.1 Team-work is gaining increasing importance in this regard, since, depending on the functional prosthetic objective, prosthetic specialists, dental technicians and implant surgeons might have to work together on the optimal implementation of the planned results using navigation and CAD/CAM systems.

In the future, this method of integrating implantology will be found in just about every

Fig. 2 Occlusal view of the maxilla with an interdental gap between teeth #13 and 23.

practice. As the hardware for 3-D planning is currently very expensive, dentists should seek suitable partners to support them in the integration of current therapy options.

Furthermore, from a biological and an economic perspective, production should rely on the most biologically compatible material with sufficient mechanical stability, for example titanium and cobalt - chromium alloys. Zirconium oxide is also an option. However, in terms of casting engineering, the processing of these alternative materials does not offer sufficient precision of fit. Cast implant structures manufactured from non-precious metals have been found to exhibit gaps with an average width of 200 to 230 μm between the superstructure and the implant abutment.2 In contrast, cast structures manufactured from precious metal alloys have been found to have gaps with an average width of 40 to 50 μm.3 The use of alternative materials thus requires the use of alternative production technologies, if only to obtain the required precision. Ideally, a superstructure is milled from an industrially

Fig. 3 Implant exposure four months post-op.

I

I

Fig. 5_Three weeks of good healing

case report case report

tissue.

and moulding of the peri-implant soft Fig. 6_Schematic d CAD/CAM patient specific-abutments and a new implant design SCIENTIFIC UPDATEConical Seal Design tissue. custom-fitted conic Fig. 6_Schematic depiction of the between the implan Conical Seal Design for a Fig. 4 Fig. 5 Fig. 7_Abutments o conical connection Fig.custom-fitted 4_Condition immediately after Fig. 4_Condition immediately after with the gingival m the implant and placed abutment. thebetween healingthe abutments were healing abutments were placed tures using the CNC (computer nuFig. 5 Fig. of 7_Abutments on the master cast (height 2(height mm). of 2 mm). merical control) procedure began Fig. 4Fig.with theFig. gingival mask.

5_Three weeks of healing 5_Threegood weeks of good healing

Fig. 4

more than ten years ago. Attempts tures using the CNC (computer nu- and moulding Fig. 7 of the peri-implant soft andCAD/CAM moulding oftechnology the peri-implant soft with this kind of merical control) procedure began tissue. tissue. tures using t demonstrated that the achievable precimore than ten years ago. Attempts Fig. 6_Schematic depiction of the Fig. 6_Schematic depiction of the merical cont sion of current constructions—between 20 and 30 Fig. 7 with this kind of CAD/CAM technology Conical Seal Design forDesign a Conical for awith more than ten µm—is better than the precision ofSeal fit achieved 7 demonstrated that the achievable preci- custom-fitted 3conical connection custom-fitted conicalFig. connection with this kind of cast precious metal structures. sion of current constructions—between 20 and 30 between the Fig. 6 implant and abutment. between the implant and abutment. demonstrated that Fig. 4 Fig. 4 Fig. with 5 Fig. µm—is better thanFig. the precision achieved Fig.57_Abutments on the master cast Fig. 4 Condition immediately expensive, Fig. 5 dentists Three weeks ofseek good 6 Schematic depiction of scanning Fig. 7software Abutments the Fig. 7_Abutments onon master cast should suitable partners to 3 of fit With modern and technology, sion ofthecurrent constructions cast of precious structures. with the gingival mask. after the healing abutments weresupport healing andinmoulding the ofmetal the Conical Sealthis Design for a principle master cast with mask. the gingival withbeen the gingival them the integration current therapy production has extended to the µm—is better than the precisi Fig. 6 tures using CNC (computer nuplaced (height of 2 mm). peri-implant soft tissue. custom-fitted conical connection teeththe #13CNC andmilling 23. turesthe using the CNC (computer nu-mask.Thus, options. area of virtual construction. cast precious metal structure between the software implant and control) procedure began expensive, dentists should seek suitable partners to With modernmerical scanning and technology, merical control) procedure began Fig.for 6 years, is suppleprocedure, which has been used abutment. more years ago.

Attempts support them in the integration of current therapyfromthis production principle has been extended to the moreten than ten years ago.

Attempts Furthermore, a biological an than economic mented with the possibility of a purely virtual Fig. 7 Fig.and e xpensive, dentists should seek suitable partners to Withconmodern scanning and 7 with this kind of CAD/CAM technology options. area of virtual construction.

Thus, the CNC milling with this kind of CAD/CAM technology perspective, production should relysupport on the most bistruction.

This technology is now offered by various them in the integration ofatrophy currentboth therapy this production prefabricated solid material in order to eli- sing aesthetic demands—with regard to the angular vestibularly and oral- principle has that the achievable which has been used for years, isprecisuppledemonstrated that the achievable preciologically compatibleprocedure, materialdemonstrated with sufficient memanufacturers. options. area of virtual6 construction. minate inhomogeneities safely.

Following this anterior tooth area in particular— through ly, that is, 360 degrees around the implant. ofsion current constructions—between and 20 30 and 30 Furthermore, from a biologicalchanical and an economic mented with possibility virtual conof the current stability, forsion example titanium andconstructions—between cobaltof - a purely20 line of thought, milling-based of bisuitable bone and soft-tissue management.

Restoration with patient-specific ATLANTIS procedure, which has been us µm—is better than thethan of _Objective fit achieved with with perspective, production shouldmanufacture rely on the most struction.

This is precision now offered by various µm—is better the of fit achieved chromium alloys. Zirconium oxide istechnology also anprecision option.

3 superstructures using the CNC (computer Thus,cast even when the implant is being inserabutments (DENTSPLY Implants) was planfrom3 a biological and an economic mented with the possibility o precious metalFurthermore, structures. ologically compatible material with sufficient me- ofmanufacturers. cast precious metal structures.

However, inFig. terms casting engineering, thetopro6ted,Fig. numerical control) procedure began more preference mustperspective, be given keeping the should ned inrely order to complete prosthetic resto6 production the mostmust bi- not struction.

This technology is n chanical stability, for example titanium and cobalt -alternative materials does not ofOur objective ason specialists onlyimplantabe the cessing of thesecrestal than ten years ago.

Attempts with this kind bone structure as unchanged as possiration optimally after successful expensive, dentists should seek suitable partners to With modern scanning and software technology, ologically compatible material with sufficient memanufacturers. _Objective chromium alloys.dentists Zirconium oxide is also an option. expensive, should seek suitable partners to of fit. modern scanning software replacement ofand a lost tooth as soon asAs possible after in fer sufficient precision Castway implant struc- and of CAD/CAM technology demonstrated ble because in With this the interdental papilla tiontechnology, osseointegration. described support them in the integration of current therapy this production principle has been extended to the chanical stability, for example titanium and cobalt However, in terms of casting engineering, the pro7 them inprecision the integration current therapy this production has been extended to thethe the extraction, but also be satisfaction ourcan pa-be turesofmanufactured non-precious metals that support the achievable of current con- and thefrom peri-implant gingivaprinciple can be maintaiNoelken (2011), marginal of bone options. areaOur ofarea virtual construction.

Thus, the CNC milling _Objective chromium alloys.

Zirconium oxide is also an option.

4 asan objective specialists must not only be the cessing of these alternative materials does not ofoptions. of with virtual construction.

Thus, the CNC milling tients’ constantly increasing demands— been found gaps average structions—between 20 and 30 have μm—is betnedtoinexhibit the long term. preserved cheaply byaesthetic the use of these improcedure, which forused years, isyears, suppleinused terms of engineering, replacement ofHowever, ahas lostbeen tooth as soon ascasting possible after ferter sufficient precisionofoffitfit.

Cast implant with regard to the anterior tooth area particular— width of cast 200structo 230 µm between the superstructure procedure, which has been for iswhich supplethan the precision achieved with plants, are the newproto theindental market.

Furthermore, from a biological and an economic mented with the possibility of a purely virtual con2 3 objective as specialist these alternative materials does not of- management. extraction, butcessing alsocast beof the satisfaction of our patures manufactured from metals In contrast, structhrough suitable bone and soft-tissue and the implant abutment.

Furthermore, from anon-precious biological and an economic mented with the possibility of a purely virtual conprecious metal structures.

With modern Case presentation Optimal soft-tissue support can Our be achieved perspective, production should relytures onthis the most This technology iswish now offered by various of a lost tooth as ferThis sufficient precision ofdemands— fit. Cast implant manufactured struc- replacement tients’ constantly increasing aesthetic have been found to exhibit gaps with an average scanning and software technology, proThe struction. realisation of the patient’s was faci- offered with individualised abutments. manufactured fromstruction. precious metal alloys perspective, production should rely on thebimost bitechnology is now by various ologically compatible material with sufficient memanufacturers. duction principle has been extended to the litated in the following case in close collabowith regard to the anterior tooth area in particular— width of 200 to 230 µm between the superstructure have been found to have gaps with an average Thus, even when the implant is being inserted, tures manufactured from non-precious metals extraction, but also be the s ologically compatible material with sufficient me- manufacturers. chanical stability, for example cobalt - µm.through area ofimplant virtualstability, construction.

Thus, theand CNC ration Zahntechnik Zentrum Eisenach Challenge in an terms of maxillary anterior of alternative matewidth of 40 to preference must given toaverage keeping thetients’ crestal bone Intitanium contrast, cast strucsuitable bone and soft-tissue management. and thechanical abutment. for2example titanium and50 cobalt3with -The use constantly increasing have been found to exhibit gapsbe with _Objective chromium alloys.

Zirconium oxide is also an option. milling procedure, which has been used for after the tooth replacement was firmly in tooth loss rials thus requires the use of_Objective alternative production as unchanged as possible because in thisto the anterior too tures manufactured from precious metal alloys chromium alloys.

Zirconium oxide is also an option. with regard width of 200 to 230structure µm between the superstructure However, terms of engineering, While replacing aand missing tooth with ginim- Fig. 8_Virtual 3-D m years, is in supplemented with the technologies, possibility ofproplace, despite alveolar bonethe loss and difficult 2inserted, ifthe only to obtain theand required preciway the interdental papilla the peri-implant have been found tocasting have gaps with anthe average Thus, even when implant is being However, in terms of casting engineering, proIn contrast, cast structhrough an suitable bone and sof the implant abutment.

Our objective as specialists must not only be the cessing of these alternative materials does not of4routine, rehaplant can now be considered a purely virtual construction.

This technology gingival conditions (Figs.

1 & 2).

The surgi3 sion. givathe can be maintained in thealloys long term. abutment planning use of alternative mate-not ofwidth of 40 to of 50these µm. The preference must be given keeping crestal bonebe the cessing alternative materials does Our objective as to specialists must not only tures manufactured from precious metal replacement a lostcase tooth soon as possible after in the maxillary anterior region still subsequent crowns feris sufficient precision of fit. Cast implant strucnow offered by various cal procedure forofthis is as in bilitation rials thus theprecision use ofmanufacturers. alternative production structure as unchanged asdescribed possible because in this fer requires sufficient of fit. Cast implant strucreplacement of5been a lost tooth as asgaps possible after have found tosoon have an average even the imp represents a particular challengeThus, for the tre-when Liebaug and Wu (2011).

The anatomically extraction, but also be the satisfaction of our pa-with tures manufactured from non-precious metals _Case presentation Ideally, aprecisuperstructure isinterdental milledwidth from an indusFig. 9_Virtual 3-D m 3 technologies, if only to obtain the non-precious required way the and the peri-implant ginFig. 8_Virtual 3-D model for tures manufactured from metals extraction, butpapilla also be the satisfaction of our pause of alternative mate-to successful of 40-toSpeed 50 µm.TXThe preferenceossemust be given to ke atment team. In addition Objective formed andconstantly bevelled increasing Osseo tients’ aesthetic demands— have been found to exhibit gaps trially with an average 4 prefabricated solid material in order toin elimipatient-specific abu sion. giva can be(DENTSPLY maintained the longthe term. abutment planning below the have been as found to exhibit gaps with an Profile average tients’ constantly increasing aesthetic demands— rials thus requires use of alternative production structure as unchanged as po ointegration of the implant, particular attenOur objective specialists must not only implants Implants) were with regard to the anterior tooth area in particular— width of 200 to 230 µm between thenate superstructure The realisation of the patient’s wish was faciliinhomogeneities safely.

Following this line of Fig. 10_Occlusal vi width of 200 to 230 µm between the superstructure with regard to the anterior tooth area in particular— subsequent crowns.

2 lost tooth as soon tion must be given to functional and aesthetic be the replacement of a used in regions #12, 11, 21 and 22.

These technologies, if only to obtain the required preciway the interdental papilla an cast struc- through suitable bone and soft-tissue management. and the implant abutment. In contrast, 2thought, milling-based manufacture of superstructated in the followingFig. case in close collaboration and athe implant abutment. through suitable bone and soft-tissue management.

In contrast, cast struc_Case presentation Ideally, superstructure is milled from anthe indus9_Virtual 3-D model for that per- abutment and adjus parameters to achieve a restoration as possible after extraction, but also be implants are specially designed to preserve sion. giva can be maintained in the tures manufactured from precious metal alloys 8 tures manufactured from precious trially prefabricated material in order tometal elimipatient-specific abutment planning. satisfaction of ourtosolid patients’ constantly increafectly harmonises with natural teeth. thealloys marginal bone when in an the alveolar ridge have been found have gaps with an average Thus, even implant is with being inserted, Thus, evenofwhen the implant iswas being inserted, have been found to have gaps with an of average The realisation the wish facilinate safely.

Following thismateline Fig. 10_Occlusal view of the use of alternative widthinhomogeneities of 40 to 50 µm.3 The preference must beIdeally, given toapatient’s keeping the crestal superstructure is bone milled from an indus- _Case presentation 3 preference must be given to keeping the crestal bone width of 40 to 50 µm.

The use alternative matetated in the following case in close collaboration thought, milling-based manufacture of superstrucabutment and adjustment thereof. rials thus requires the use of alternative production structure as unchanged as possible because in this trially prefabricated solid material in order to elimias unchanged asperi-implant possible because this rials thus the usethe of alternative production technologies, if requires only to obtain required preciway thestructure interdental and the gin- inFig. 8_Virtual natepapilla inhomogeneities safely. Following this line3-Dofmodel for The realisation of the pat the interdental papilla the Fig. 8_Virtual 3-D model for 4 peri-implant ginsion. technologies, if only to obtain the required precigiva canway be maintained the longand term. abutment planning below the in the following case tated thought,inmilling-based manufacture of superstrucgiva can be maintained in the long term.4 sion. abutment planning below the subsequent crowns. subsequent crowns.

Ideally, a superstructure is milled from an indus- _Case presentation Fig. 9_Virtual 3-D model for Ideally, a superstructure is milled from an indus_Case presentation Fig. 9_Virtual 3-D model for trially prefabricated solid material in order to elimipatient-specific abutment planning. trially prefabricated solid material in order to elimipatient-specific abutment planning.

The realisation ofFig. the8 patient’s wish was facili- Fig. 10_Occlusal nate inhomogeneities safely. Following this line of view9 of the Fig. nate inhomogeneities safely. Following this linetated of in the Thefollowing realisation of the patient’s wish was faciliview of the case in close collaboration thought, milling-based manufacture of superstrucabutment Fig. and 10_Occlusal adjustment thereof. thought, milling-based manufacture of superstruc- tated in the following case in close collaboration abutment and adjustment thereof.

Fig. 8

Fig. 8 Virtual 3-D model for abutment planning below the subsequent crowns.

Fig. 9

implants

Fig. 9 Virtual 3-D model for patient-specific abutment planning.

Fig. 8

Fig. 10

8 of the Fig. 10 OcclusalFig. view 4_ 2012 abutment and adjustment thereof.

Fig. 9

Fig. 8

implant 4

_ 20

I 29 Fig. 10

Fig. 9

Fig. 10

DOCTOR牙医 Infodent International • 3 2018

implants I 29I 29 4 implants _ 2012

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SCIENTIFIC UPDATE CAD/CAM patient specific-abutments and a new implant design

Fig. 11

Fig. 12

Fig. 11

Fig. 11 Patient-specific abutment Fig. 11_Patient-specific abutment prior to insertion.

Fig. 13

Fig. 12

Fig. 13

Fig. 12 Complete individualised

Fig. 13 Abutment insertion and mounting

with Zahntechnik Zentrum Eisenach after the tooth _Prior to surgery: crown restoration on master cast. with a torque wrench at 25 Ncm. prior to insertion. replacement was firmly in place, despite alveolar Addressing Fig. 11_Patient-specific abutment with Zahntechnik Zentrum Eisenach after the tooth _Prior to surgery:the patient’s wishes Fig. 12_Complete individualised bone loss and difficult gingival conditions (Figs. 1 & and providing information prior to insertion. replacement was firmly in place, despite alveolar Addressing the patient’s wishes crown restoration on master cast. 2). The surgical procedure for this case is described in Fig. 12_Complete individualised bone loss and difficult gingival conditions (Figs.

1 & and providing The patient’sinformation wishes must always be considered Fig. 13_Abutment insertion and Liebaug and Wu (2011).5 crown restoration on master cast.with a2).

Thewrench surgical before treatment begins.

The patient should be ofmounting torque at procedure for this case is described in achieved through special Prior to surgery: Addressing the pa- alveolar 5process is achieved, and thus the the soft tissue was wishes must be considered Fig. 13_Abutment insertion and Liebaug The anatomically formed and bevelled OsseoThe - patient’s fered clarification prior toalways treatment, particularly in 25and Ncm. Wu (2011). plastic cover and the primary wound closure gingiva formers or healing abutments (Figs. 4 tient’s wishes and providing information Speed TX Profile implants (DENTSPLY Implants) difficult initial situations with evident hard-tissue before treatment begins.

The patient should be ofmounting with a torque wrench at The patient’s wishes must always be consi- are simplified for the surgeon. This is also the & 5). The results obtained in terms of preserwere used in regions #12, 11, 21 and 22. -These im- clarification loss and unfavourable gingival particularly conditions. For anatomically formed Osseo fered prior to treatment, in 25 Ncm. vation of the marginal bone using the ASTRA basis for a quickand and bevelled smooth healing process. dered before treatment begins. TheThe patient plants are specially designed to preserve the mar- forensic reasons, photographic documentation of Speed TX Profile implants (DENTSPLY Implants) difficult initialImplant situations with(DENTSPLY evident hard-tissue TECH System Implants) Three-dimensional bone be the should be offered clarification prior to treatginal bone in an alveolar ridge structures with angularcan atrophy initial situation is an indispensable aid in addiloss and unfavourable gingival conditions.

For were used in regions #12, 11, 21 and 22.

These imare documented in Palmer et al.

(2000) preserved using the above-mentioned Ossement, particularly in difficult initial situations both vestibularly and orally, that is, 360 degrees tion to diagnostic casts. It should also be used asand the 9 6 preserve forensic reasons, photographic documentation of plants are specially designed to the marWennström et al.

(2005). , 10 Preservation oSpeed TX Profile implant.

Healthy bone is with evident hard-tissue loss and unfavouaround the implant. Restoration with patient-spe- basis for discussion with the patient. of the marginal bone level and healthy soft a prerequisite for optimal prosthetic restorarable gingival conditions. For forensic reasons, ginal bone in ancific alveolar ridgeabutments with angular atrophyImplants) the initial situation is an indispensable aid in addiATLANTIS (DENTSPLY tissue areoncasts. indispensable the long-term tionand withorally, regard to aesthetics.

The otherwise photographic documentation ofboth the vestibularly initial was planned in that order complete prosthetic If bone the labial side hasfor already been lost and tion to diagnostic It should also be used as the is,to360 degrees success of implant treatment both clinically often6 Restoration necessary hardand soft-tissue transituation is an indispensable aid inaround additionthe toimplant. restoration optimally after successful implantation the optimal bone contours have not been restored with patient-spe- basis for discussion with the patient.

5 osseointegration.

As be described in Noelken with bone transplant, the desired aesand aaesthetically.

The achieving bone provides the soft splants can now mostly avoided. diagnostic casts. It should also be cific used ATLANTIS as the and abutments (DENTSPLY Implants) 7 (2011), the marginal bone can be preserved cheaply thetic nevertheless not difficult. tissueresult with isstability, whileoften the soft tissue probasis for discussion with the patient.

If bone was planned intheorder to complete prosthetic to the If bone on the labial side has already been lost and use of these implants, which are new The extent to which a temporary restora- tects the bone from micro-organisms. on the labial side has already been lost and by restoration optimally after successful implantation the boneofcontours have not beentherestored market.

Optimal soft-tissue support can beoptimal In terms this 67-year-old patient, implants tion can be screwed together after prosthethe optimal bone contours have not been dental and osseointegration.

As described in Noelken with a bone transplant, achieving the desired aesachieved with individualised manufactured abut- were exposed by incision toimplant the middle of theused alvetic pretreatment and after the implant region A special feature of the system restored with a bone transplant, achieving 7 the marginal bone can be preserved cheaply (2011), thetic result is nevertheless often not difficult. ments. olar ridge from regions #12, 11, 21 and 22 after the desired aesthetic result is nevertheless has been moulded, or whether a removable is the patented Conical Seal Design, whicha healing phase (Fig. 3). by the use of these implants, whichtemporarily, are new todepends the device can be used si- four-month prevents micro-movements and micro-gaps

often not difficult. In terms of this 67-year-old _Challenge in termssupport of financial maxillary dental Optimal soft-tissue can be In terms of this 67-year-old patient, implants at the interface between the the implant and on the patient’s resources. patient, the implants were exposed by market. inci- gnificantly anterior tooth loss It should be noted that, owing to the bevelled dewith In individualised manufactured were exposed by incision to the middle the alveabutment, reliably protecting the of implant and addition to the use of gingiva abutformers natision to the middle of the alveolarachieved ridge from sign of the implants used, an almost seamless inserto thereplacing system,atemporary restorationsolar aid ridge boneinto from bacteria.

The clinical relevance regions #12, 11, 21 and 22 after aments. four-mon- ve While regions #12, 11, 21 and 22 after ais missing tooth with an implant tionfrom the natural osseous alveolar process the moulding, preparation and stabilisation of of the pump effect caused by micro-moveth healing phase (Fig. 3). four-month healing phase (Fig. 3).cover and the primary can now be considered routine, rehabilitation in the achieved, and thus the plastic the periimplant soft tissue during and after wound ment and possible crestalforbone resorption _Challenge maxillary in terms of maxillary anterior region still represents a particuclosure are simplified the surgeon.

This is the healing phase.

As the interim prosthesis were experimentally tested by Zipprich et It should be noted that, owing to anterior the bevel- tooth lar challenge also the basis that, for aowing quick to andthe smooth healing loss for the treatment team. In addition to It should be noted bevelled de11 guaranteed functionality and aesthetics that al.

(2007).

Furthermore, arising stress is led design of the implants used, an almost successful osseointegration of the implant, particprocess. sign of the implants used, an almost seamless insersatisfied the patient, additional moulding of distributed farther into the bone and peak seamless insertion into the natural osseous ular attention must be given to functional and aes-

While replacing a missing tooth with an implant tion into the natural osseous alveolar process is thetic parameters to achieve a restoration that perThree-dimensional bone structures can be precan now be considered routine, rehabilitation in the achieved, and thus the plastic cover and the primary fectly harmonises with natural teeth.8 served using the above-mentioned OsseoSpeed TX maxillary anterior region still represents a particu- wound closure are simplified for the surgeon. This is larofchallenge also the basis for a quick and smooth healing Fig. 14_Occlusal view the inserted for the treatment team. In addition to abutment. successful osseointegration of the implant, partic- process.

Fig. 15_Closing of the screw opening must be given to functional and aesular attention with Cavit (3M ESPE)thetic prior to parameters cementto achieve a restoration that perThree-dimensional bone structures can be preing the superstructure. fectly harmonises with natural teeth.8 served using the above-mentioned OsseoSpeed TX

Fig. 14_Occlusal view of the inserted abutment.

Fig. 15_Closing of the screw opening

Fig. 14

with Cavit (3M ESPE) prior to cementing the superstructure.

30 I implants

Fig. 15

Fig. 14 Occlusal view of the inserted abutment.

Fig. 15 Closing of the screw opening with Cavit (3M ESPE) prior to cementing the superstructure.

4_ 2012

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DOCTOR牙医 Infodent InternationalFig. • 3142018

Fig. 15

eport

CAD/CAM patient specific-abutments and a new implant design SCIENTIFIC UPDATE

loads are simultaneously reduced.12, 13 In this regard, the preference for preserving the marginal bone level must be clarified as well.

The implant–abutment connection is thus reliably sealed against bacteria and the bone is thereby protected from external influences.

Maintenance of the superstructure is also made easier for the patient.

The integration of the abutment is simplified by the conical implant–abutment connection (Fig. 6). However, with regard to the bevelled OsseoSpeed TX Profile implants, particular attention must be given to the precise transfer of the clinical situation to the model being manufactured using moulding aids and transfer posts during precision moulding, which requires specific experience and a good instinct.

The individualised ATLANTIS abutments are a good solution for cemented crowns or bridges, as they guarantee optimal functionality, are the basis for sophisticated prostheses and are easy to use. ATLANTIS abutments fabricated from titanium, titanium nitride-coated titanium (ATLANTIS GoldHue) or zirconium oxide are available for all established implant systems. All abutments are supplied by the manufacturer with the corresponding abutment screws. The ATLANTIS VAD (virtual abutment design) software allows the production of abutments that are based on the final tooth form and thus guarantees not only a natural, aesthetic result but also optimal functionality.

A model was produced from the impression following healing, implant exposure (Fig. 3) and insertion of temporary gingiva formers (Fig. 4). The master cast should have a stable removable gingival mask made of silicone (Fig. 7). Casts should be placed onto articu-

lators before the dentist or dental laboratory sends them in to Astra Tech so they can subsequently be sent with the ATLANTIS CaseSafe shipping box. The models can be converted into a virtual image using a 3-D scanner after the model has been produced in a high-tech dental laboratory or after the model has been sent, should no scanner be available immediately (Figs. 8–10). After the specialist has confirmed the virtual abutment design, which is sent via e-mail, the ATLANTIS abutment is manufactured, verified and sent to the attending dentist (Figs. 7 & 11). Individualised prostheses can be manufactured in the dental laboratory after the precision of fit and the position of the patient-specific abutment have been verified (Fig. 12).

It must always be ensured that the abutment screw delivered with the abutment is used for the final insertion of the abutment in the mouth. The ATLANTIS abutments are designed to correspond to the form of the dentine core of natural teeth. Of course, the ATLANTIS VAD software allows for consideration of the specialist’s preferences, which should take the patient situation into account, with regard to the production of the individualised abutment. The size of the abutment is determined by the average profile created by the form and size of the healing or temporary abutment. The mucosa may be temporarily anaemic when the abutment is inserted into the patient’s mouth (Figs. 13–15).

the patient and the dental/prosthetic specialist was achieved after the individualised crown restoration had been placed (Figs. 16 & 17).

The patient’s wish for stable and natural-looking teeth was fully satisfied, which was ultimately the main criterion and motivation for our efforts as the treating team. Additional improvement of the soft-tissue situation is expected if the patient adheres to the appropriate cleaning technique.

Conclusion Implantology is a central component of modern therapy procedures in dentistry. Continuous development of materials, implant design and the relevant technologies seeks to obtain high reliability with a good long-term prognosis for a wide range of indications. Careful diagnosis and detailed planning are indispensable if patients’ increasing demands are to be satisfied. In particular, care in aesthetically demanding clinical situations requires interdisciplinary treatment in many cases.The possibilities presented by this case report for the production of patient-specific abutments on anatomically formed and bevelled OsseoSpeed TX Profile implants constitute a gain and are the basis for long-term success, even in the event of reduced bone and difficult soft-tissue conditions.

ATLANTIS abutments are manufactured with standard gingival moulding if the specialist does not select or provide any particular options when the order is placed. Considering the extremely unpromising initial situation (Figs. 1 & 2), a result that was satisfying in terms of functionality and aesthetics for both

ediately after ndividualised n restoration. ult soft-tissue gival stippling n the cervical sufficient oseous support.

Prof. Dr. Ning Wu Shanghai University of Medicine & Health Sciences wnmoon918@hotmail.com

Fig. 16

Fig. 16 Condition immediately after placement of the crown oratory or after theindividualised model has been sent, should restoration. no scanner be available immediately (Figs. 8–10).

After the specialist has confirmed the virtual abutment design, which is sent via e-mail, the ATLANTIS abutment is manufactured, verified and sent to the attending dentist (Figs. 7 & 11). Individualised prostheses can be manufactured in the dental laboratory after the precision of fit and the

Fig. 17

Fig. 17 Despite difficult soft-tissue conditions, a good gingival stippling effect _Conclusion was achieved in the cervical area, which attests to sufficient osseous support.

Implantology is a central component of modern therapy procedures in dentistry. Continuous development of materials, implant design and the relevant technologies seeks to obtain high reliability with a good long-term prognosis for a wide range of indications. Careful diagnosis and detailed planning are indispensable if patients’ in-

Dr. Frank Liebaug Tel.: +49 36847 31788 frankliebaug@hotmail.com

DOCTOR牙医 Infodent International • 3 2018

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SCIENTIFIC UPDATE 患者量身定制的CAD/CAM基台和新的种植设计

患者量身定制的CAD/CAM基台 和新的种植设计 吴宁 教授 上海健康医学院 wnmoon918@hotmail.com

第一作者： Frank Liebaug 博士 和 吴宁 教授

引言

程由自己来完成种植手术，

维规划硬件目前来说非常昂贵 ，

所有牙科重建的目标都是口颌系统和 未受功能性损伤或已接受功能性治疗 的咀嚼器官的自然和功能性重建。只 有将个体患者参数和独特的解剖学特 征结合到手术计划和随后的假体修复 中，才能实现这个目标。

这将大大简化规划和治疗的过程。但 是，按规则，一个牙医要进行修复体 种植的话需要在一个口腔外科医生或 口腔颌面外科医生密切的合作下才能 完成他的修复体修复手术。

此外，从生物学和经济学的角度来 看，修复体的生产应基于具有足够机 械稳定性且具有最好生物相容性的材 料，如钛和钴铬合金. 然而，就铸造工 序而言，这些替代材料的加工提供不 了足够配备的精度。

应该把种植体支撑的修复治疗方法作 为专家和患者的独立治疗方案，而且 实现这个目标的可能性也是很高的。 随着对种植学修复体功能的关注度提 高，修复体治疗的目标正在成为所有 努力的方向。

当外科医生们把注意力集中在最好的 种植手术或种植体设计的时候，修复 体专家却提醒我们不要忘了种植学的 初衷：那就是患者的意愿。患者们不 需要植入物，相反，他们想要美观的 新牙齿，那样他们才能对日常生活充 满信心。1

从职业牙医的角度来讲，植入式修复 体治疗的主要重点在于修复体专家 上。如果所涉及的专科医生也接受过 种植手术和外科手术的培训，他将种 植手术作为修复体治疗的一个辅助过

由此看来，团队工作显得越来越重 要，由于考虑到功能性修复目标、修 复体专家、牙科技师和种植外科医生 可能必须使用导航和CAD/CAM系统才 能实现计划结果的最佳实施。由于三

图. 5 在十多年前，CNC(计算机数字控制)程 序开始应用在基于铣销的上部结构制 造。尝试使用这种CAD/CAM技术后的 结果表明，目前上部结构的精确度在 20至30微米之间，其精确度要高于使 用铸造贵金属结构所获得精度。3 借助现代扫描和软件技术，该生产原 理已扩展到虚拟构造领域。因此，用 已经使用多年的CNC铣削程序来弥补

图. 1_种植体插入后4个月，12、11、21 图. 2_上颌咬合视图，13和23号牙齿的 图. 3_种植手术后4个月时的种植体暴 和22号牙区域的上颌前牙间隙（Kennedy 齿间距离 露.

IV级）

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DOCTOR牙医 Infodent International • 3 2018

I

I

Fig. 5_Three weeks of good healing

case report case report

and moulding of the peri-implant soft tissue.

Fig. 6_Schematic depiction of the

tissue.

Fig. 6_Schematic d

患者量身定制的CAD/CAM基台和新的种植设计 SCIENTIFIC UPDATEConical Seal Design

custom-fitted conic between the implan Conical Seal Design for a Fig. 5 Fig. 7_Abutments o conical connection Fig.custom-fitted 4_Condition immediately after Fig. 4_Condition immediately after with the gingival m the implantwere and placed abutment. thebetween healingthe abutments healing were placed using the CNCabutments (computer nuFig. 5turesFig. 7_Abutments on the master cast (height of 2(height mm). of 2 mm).

Fig. 4

Fig. 4

merical control) procedure began Fig. 4 with theFig. gingival mask.

5_Three good healing 5_Three weeks of good healing moreFig.than tenweeks yearsofago.

Attempts tures using the CNC (computer nu- and moulding Fig. 7 of the peri-implant soft and moulding of the peri-implant soft with this kind of CAD/CAM technology merical control) procedure began tissue. tissue. tures using t demonstrated that the achievable precimore than ten years ago. Attempts Fig. 6_Schematic depiction of the Fig. 6_Schematic depiction of the merical cont sion of current constructions—between 20 and 30 Fig. 7 with this kind of CAD/CAM technology Conical Seal Design forDesign a Conical Seal for a more than ten µm—is better than the precision of fit achieved with Fig. 7 demonstrated that the achievable preci- custom-fitted 3conical connection custom-fitted conical connection with this kind of cast precious metal structures. sion of current constructions—between 20 and 30 between the Fig. 6 implantthe and abutment. between implant and abutment. demonstrated that Fig. 4 Fig. 4 Fig. with 5 Fig. µm—isseek better than图. the precision achieved 图. 5_种植体周围良好愈合和 6_锥形密封设计的示意图描 图.and 7_铸件主体上带有牙 图. 4_放置愈合基台后的状况 Fig.57_Abutments on the master cast Fig. 7_Abutments onof the master cast expensive, dentists should suitable partners to 3 of fitWith modern scanning software technology, sion current constructions （高度为2mm). 成型三周后。 龈护罩的基台 cast precious metal述了种植体和基台之间特别定制 structures. with the gingival withbeen themask. gingival mask.to the support them therapy this production principle has extended µm—is better than the precisi Fig.in6 the integration of current 的锥形链接.

tures using CNC (computer nuturesthe using the CNC (computer nuoptions. area of virtual construction.

Thus, thecast CNCprecious milling metal structure control) procedure began expensive, dentists should seek suitable partners to With modernmerical scanning and software technology, merical control) procedure began Fig. 6 procedure, which has been used for years, is supplemore than ten years ago.

Attempts support them in the integration of current therapyfromthis production principle has been extended to the more than ten years ago.

Attempts Furthermore, a biological and an economic with the possibility of a purely virtual Fig. 7 Fig. e7xpensive, dentistsmented should seek suitable partners to Withconmodern scanning and with this kind of CAD/CAM technology options. area of virtual construction.

Thus, the CNC milling with thisbikind struction. of CAD/CAM technology perspective, production should relysupport on the most This technology is now offered by various them in the integration of current therapy this production 理想的情况是，对工业预制的固体材 现，Leibaug 纯粹虚拟结构变成了可能。现在很多 that thethat achievable procedure, which has been used for years, isprecisupple-preci-和Wu在(2011) 5描述了本 principle has demonstrated the achievable ologically compatible materialdemonstrated with sufficient memanufacturers. options. area of virtual construction. 病例中所使用的外科手术。 料进行研磨后作为上部结构，以便安 制造商都有提供这项技术。. ofsion current constructions—between and 20 30 and 30 Furthermore, from a biologicalchanical and an economic mented with possibility virtual conof the current stability, forsion example titanium andconstructions—between cobaltof - a purely20 procedure, which has been us 全地消除其不均匀性。 按照这个思路， µm—is better than the precision of fit achieved with perspective, production should rely on the most bi-Zirconium struction.

Thisbetter is precision now_Objective offered byachieved various with µm—is the of fit chromium alloys. oxide istechnology alsothan an option.

3 from a biological Furthermore, and an economic mented with 根 据 解 剖 学 原 理 成 形 和 倾斜的 O sthe - possibility o 目的 cast precious metal structures. ologically compatible material with sufficient me- ofmanufacturers. cast precious metal structures.3 However, inFig. terms casting engineering, the pro6我们作为专家的目标，不仅仅是拔牙 Fig. 6 seo-Speed TX profile种植体（DENTperspective, production rely the mostmust bi- notstruction.

This technology is n chanical stability, for example titanium and Ourshould objective ason specialists only be the cessing ofcobalt these -alternative materials does not ofSPLY 的种植体）用于12、11、21和 后尽快补上已经失去的牙齿， 还要 图. expensive, 4_放置愈合基台后的状况（高度为 expensive, dentists shouldshould seek suitable partners to With modern scanning and software technology, ologically compatible material with sufficient memanufacturers. _Objective chromium alloys.dentists Zirconium oxide is also an option. seek suitable partners to of fit.With software technology, replacement of a lost tooth as soon as possible after fer sufficient precision Castmodern implantscanning struc- and 22号牙区，这种种植体专门为保护伴 满足患者对前牙区不断增加的美学要 2mm). support them inthem theofintegration oftures current therapy thisfrom production principle has been extended tobut thealso chanical stability, for example titanium and However, in terms engineering, the prosupport incasting the integration ofmanufactured current therapy this production principle has been extended to be the extraction, thecobalt satisfaction of our panon-precious metals 有口腔前庭角萎缩的牙槽嵴边缘骨而 求。 options. area of virtual construction.

Thus, the CNC milling chromium alloys.

Zirconium is also an option.

Ourarea objective asan specialists must not constantly only be the cessingoptions. of these alternative materials of- to exhibit of with virtual construction.

Thus, theoxide CNC milling tients’ increasing aesthetic_Objective demands— havedoes beennot found gaps average 设计，覆盖了种植体周围的360°，6 5_种植体周围良好愈合和成型三周 procedure, which forused years, isyears, suppleinused terms of engineering, proreplacement ofHowever, ahas lostbeen tooth as soon ascasting possible after fer图. sufficient precision of fit. Cast implant with regard to the anteriorthe tooth area in particular— width of 200structo 230 µm between the superstructure procedure, which has been for is supple手术决定用患者量身定制的ATLAN因此，即使是在放置种植体的时候， 后。 Furthermore, from a biological and an economic mented with the possibility of a purely virtual con2 Our objective as specialist cessing of these alternative materials does not ofextraction, but also be the satisfaction of our patures manufactured from non-precious metals In contrast, struc- through suitable bone and soft-tissue management. and theand implant abutment.mented Furthermore, from a biological an economic with cast the possibility of a purely virtual conTIS基台（DENTLPLY种植体）进行 也必须优先保持牙槽骨结构尽可能不 图.

6_锥形密封设计的示意图描述了种 perspective, production should rely on the most bistruction.

This technology is now offered by various ferThis sufficient ofdemands— fit. Cast implant struc- replacement of a lost tooth as tients’ constantly increasing aesthetic have been found to exhibit gaps withrely an average tures manufactured fromstruction. precious metal alloysprecision perspective, production should on the most bitechnology is now offered by various 修复，以保证成功植入和骨整合后得 变，这样才可以长期保持牙间乳头和 植体和基台之间特别定制的锥形链接. ologically compatible with sufficient memanufacturers. with the anterior tooth areaThus, in particular— width of 200 to 230 µmmaterial between the superstructure have been found to haveregard gaps to with anmanufactured average even when the implant inserted,but also be the s extraction, tures from non-precious metalsis being ologically compatible material with sufficient memanufacturers. 到一个最佳的修复效果。如 Noelken 图. 7_铸件主体上带有牙龈护罩的基台. 种植体周围的牙龈。4 chanical stability,abutment. for example and cobalt - µm.through of alternative matewidth of 40 to preference must given keeping thetients’ crestalconstantly bone bone and soft-tissue management.

Intitanium contrast, cast strucand thechanical implant stability, for2example titanium and50 cobalt3 -The usesuitable increasing have been found to exhibit gapsbe with antoaverage (2011)所述7，通过使用这些牙科市场 在由非贵金属制造的种植体上发现， _Objective chromium alloys. Zirconium oxide is also an option. rials thus requires the use of_Objective alternative production structure as unchanged as possible because in this tures manufactured from precious metal alloys chromium alloys.

Zirconium oxide is also an option. width of 200 to 230 µm between the superstructure with regard to the anterior too 上的新型种植体，可以非常实惠地就 病例介绍 其结构和种植体基台之间呈现出平均 However, infound terms of engineering, pro2inserted, papilla and the peri-implant gintechnologies, ifthe only to Thus, obtaineven theand required preciway the interdental Fig. 8_Virtual when the implant is being have been tocasting have gaps with anthe average However, in terms of casting engineering, proIn contrast, cast struc- through suitable bone and3-D sofm the implant abutment. 保留住边缘骨，用患者量身定制的基 宽度为200至230 相比 Our objective as specialists must not only be the cessing of these alternative materials does not of4 3微米的间隙。2 sion. givathe can be maintained in thealloys long term. abutment planning use of alternative mate-not ofwidth of 40 to of 50these µm. The preference must be given keeping crestal bonebe the cessing alternative materials does Our objective as to specialists must not only manufactured from precious metal 台获得最佳的软组织支撑效果。 尽管有牙槽骨缺损且牙龈情况不够好 replacement of tures a lost tooth as soon as possible after fer之下，发现由贵金属制造的铸造结构 sufficient precision of fit. Cast implant strucsubsequent rials thus requires theprecision use of alternative production structure as unchanged as possible because in this fer sufficient of fit.

Cast implant strucreplacement of a lost tooth as soon as possible after been found to have gaps Thus, even when thecrowns imp （图1和图2） 只有平均宽度为40至50微米的间隙。3 extraction, but have also be the satisfaction ofpresentation our pa-with an average tures manufactured from non-precious _Case Ideally,metals aprecisuperstructure isinterdental milled from an indusFig. 9_Virtual 3-D m 3 technologies, if only to obtain the required way the papilla and the peri-implant ginFig. 8_Virtual 3-D model for tures manufactured from non-precious metals extraction, but also be the satisfaction of our paThe use of alternative matewidth of 40 to 50 µm. preference must be given to ke 上颌前牙缺失的挑战 因此如果只是为了获得所需的精度， constantly increasing aesthetic demands— have been found to exhibit gaps trially with an average tients’ 4 prefabricated solid material in order toin elimipatient-specific abu sion. giva can be maintained the long term. abutment planning below the have been found to exhibit gaps with an average tients’ constantly increasing aesthetic demands— rials thus requires the use of alternative production structure as unchanged as po 虽然用植入物替换缺失的牙齿在现在 替代材料的使用还需要用替代的生产 但 等with 到牙 齿置 固到位 之后 ，in 在particular— regard to换 the牢anterior tooth width of 200 to 230 µm between thenate superstructure The realisation of the patient’s wish was facili- Fig. 10_Occlusal vi inhomogeneities safely.

Following of area width of 200 to 230 µm between the superstructure with regard tothis theline anterior tooth area in particular— subsequent crowns. technologies, if only to obtain the required preciway the interdental papilla an 已被认为是个常规手段，但是上颌前 技术.

Zahntechnik Zentrum Eisenach 的 cast structhrough suitable bone and soft-tissue management. and the implant abutment.2 In contrast, 2thought, milling-based manufacture of superstructated in the following case in close collaboration abutment and adjus and athe implant abutment. suitable and management. contrast, cast Ideally, superstructure is milledInfrom an indusFig. 9_Virtual 3-D model 密struc切_Case 合 作through 下presentation 患 者sion. 的 意 愿bone 变的 易soft-tissue 于 实 牙区域的修复仍然是治疗团队面临的 givaforcan be maintained in the tures manufactured from precious metal alloys tures manufactured from in precious trially prefabricated solid material order tometal elimi- alloys patient-specific abutment planning. have been found to have gaps with an average Thus, even when the implant is being inserted, Thus, even when the implant is being inserted, have been found to have gaps with an average The realisation of the patient’s wish was facilinate inhomogeneities safely.

Following this line of Fig. 10_Occlusal view of the of alternative mate- preference must beIdeally, width of 40 to 50 µm.3 The use given toakeeping the crestal superstructure is bone milled from an indus- _Case presentation 3 must be given keeping the width of 40the to 50 µm.

The use ofproduction alternative matetated preference in as theunchanged following case intoclose collaboration thought, milling-based manufacture superstrucabutment and adjustment thereof. rials thus requires use of alternative structure as possible because increstal this in bone trially prefabricated solid material order to elimias unchanged asperi-implant possible because this rials thus the usethe of alternative production technologies, if requires only to obtain required preciway thestructure interdental and the gin- inFig. 8_Virtual natepapilla inhomogeneities safely. Following this line3-Dofmodel for The realisation of the pat way the interdental papilla and the technologies, if only to obtain the required preciFig. 8_Virtual 3-D model for 4 peri-implant ginsion. giva can be maintained in the long term. abutment planning below the in the following case tated thought, milling-based manufacture of superstrucgiva can be maintained in the long term.4 sion. abutment planning below the subsequent crowns. subsequent crowns.

Ideally, a superstructure is milled from an indus- _Case presentation Fig. 9_Virtual 3-D model for Ideally, a superstructure from an indus- _Case presentation Fig. 9_Virtual 3-D model for trially prefabricated solid material is in milled order to elimipatient-specific abutment planning. trially prefabricated solid material in order to elimipatient-specific abutment planning.

The realisation ofFig. the8 patient’s wish was facili- Fig. 10_Occlusal nate inhomogeneities safely. Following this line of view9 of the Fig. nate inhomogeneities safely.

Following this line of The realisation of the patient’s wish was faciliFig. 10_Occlusal view of the thought, milling-based manufacture of superstruc- tated in the following case in close collaboration abutment and adjustment thereof. thought, milling-based manufacture of superstruc- tated in the following case in close collaboration abutment and adjustment thereof.

Fig. 8

Fig. 9

Fig. 10

implants

implant 4

_ 20

I 29

Fig. 8 图. 8_虚拟3D模型用于后续牙冠下方的基 图. 9_用于特定患者基台规划的虚拟 图. 10_基台的咬合视图及其调整.

4_ 2012 台规划.

3D模型.

Fig. 8

Fig. 9

Fig. 8

Fig. 10

Fig. 9

Fig. 10

implants I 29I 29 4 implants 4

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I case report

SCIENTIFIC UPDATE 患者量身定制的CAD/CAM基台和新的种植设计

I case report

Fig. 11

Fig. 12

Fig. 11

图. 11_特定患者专用基台在插入之前.

Fig. 13

Fig. 12

Fig. 13

图. 12特制修复冠在主铸件上.

图. 13_用25牛的扭矩扳手插入并安装

with Zahntechnik Zentrum Eisenach after the tooth 基台. _Prior to surgery: replacement was firmly in place, despite alveolar Addressing Fig. 11_Patient-specific abutment with Zahntechnik Zentrum Eisenach after the tooth _Prior to surgery:the patient’s wishes Fig. 12_Complete individualised bone loss and difficult gingival conditions (Figs. 1 & and providing information prior to insertion. replacement was firmly in place, despite alveolar Addressing the patient’s wishes crown restoration on master cast. 2). The surgical procedure for this case is described in Fig. 12_Complete individualised bone loss and and difficult gingival conditions (Figs. 1 & and providing 5 The patient’sinformation wishes must always be considered Fig. 13_Abutment insertion Liebaug and Wu (2011). crown restoration on master cast.with a2).

Thewrench surgical before treatment begins. The patient should be ofmounting torque at procedure for this case is described in 5 Fig. 13_Abutment insertion and Liebaug patient’s wishesprior musttoalways be particularly consideredin The anatomically formed bevelled Osseo - 周围组织的成型、生长和稳定。由于 fered clarification treatment, 25and Ncm. Wu 、(2011).

21和 22号牙齿 区 域and 的牙 槽嵴中 部The 一个特殊挑战。除了植入物的成功骨 Speed TX Profile implants (DENTSPLY Implants) difficult initial situations with evident hard-tissue mounting with a torque wrench at before treatment begins.

The patient should be of临时修复体确保了能够满足患者对功 整合以外，还必须特别注意功能和美 (图. 3)。 were used in regions #12, 11, 21 and 22.

These imloss and unfavourable gingival conditions.

The anatomically formed and bevelled Osseo- fered clarification 25 Ncm. prior to treatment, particularly For in 能和美学的需求，还能通过特殊的牙 学指数，才能得到一个和天然牙完美 plants are specially designed to preserve the mar- forensic reasons, photographic documentation of Speed TX Profile implants (DENTSPLY Implants) difficult龈成型器或愈合基台取得了软组织更 initial situations with evident hard-tissue 应该注意的是，由于所使用的种植体 协调的修复体。8 ginal bone in an alveolar ridge with angular atrophy the initial situation is an indispensable aid in addi优质的成型(图.

4gingival 和It 5). 的倾斜设计，实现了几乎无缝式地插 were used in regions #12, 11, 21 22. that These loss and both vestibularly andand orally, is, im360 degrees tionunfavourable to diagnostic casts. shouldconditions. also be used asFor the 入牙槽突的天然骨质中，这也为外科 手术前: 6 preserve the marplants are specially designed to forensic reasons, photographic documentation of around the implant. Restoration with patient-spe- basis for discussion with the patient. 使用ASTRA TECH种植系统（DENT医生简化了塑料愈合帽的覆盖和伤口 了解患者意愿并为其提供信息 ginal bone in ancific alveolar ridgeabutments with angular atrophyImplants) the initial situation is an indispensable aid in addiATLANTIS (DENTSPLY 的初步处理，也为愈合过程的快速平 在治疗开始前，必须始终考虑患者的 was planned orderis,to360 complete If bone oncasts. the labial side hasalso already been lost and both vestibularly and orally,in that degreesprosthetic tion to SPLY种植体）来保留边缘骨的结果记 diagnostic It should be used as the 6 restoration optimallywith after successful implantation the optimal bone contours haveWennström not been restored 录在Palmer等人(2000)和 等 稳打好了基础。 意 愿 。 治 疗 前 应 给 患 者 提around 供情况 说implant.

Restoration patient-spethe basis for discussion with the patient. osseointegration.

As described in Noelken 人 with a bone transplant, achieving the desired aes的(2005)文献中。9, 10 保留边缘骨的 明 ， 特 别 是 在 比 较 复 杂 的cific 初 始ATLANTIS 情 况 and abutments (DENTSPLY Implants) 7 the marginal bone can be preserved cheaply (2011), thetic result is nevertheless often not difficult. 水平和健康的软组织对于临床和美学 使用上述的Osseo Speedprosthetic TX Profile 种植If bone 下，如有明显的硬组织损失和不利的 was planned by intheorder to complete on the labial side has already been lost and use of these implants, which are new to the 种植治疗的长期成功是必不可少的， 体可以保留三维的骨结构， 健康的骨 牙龈状况。按理来说，除了诊断模型 restoration optimally after successful implantation thebeoptimal boneofcontours have not beentherestored dental market.

Optimal soft-tissue support can In terms this 67-year-old patient, implants 骨骼为软组织提供稳定性，而软组织 之外，初始情况的摄影记录是不可或 骼是修复体取得最佳美学修复的先决 and osseointegration.

As described in Noelken with a bone transplant, achieving the desired achieved with individualised manufactured abut- were exposed by incision to the middle of theaesalve可以保护骨骼免受微生物的侵害。 条件，现在大多数情况下都可以避免 缺的辅助手段。它还应该用作与患者 bone can be preserved cheaply thetic result (2011),7 the marginal is nevertheless not21difficult. ments. olar ridge from regionsoften #12, 11, and 22 after a 软硬组织的移植。5 沟通讨论的基础。 four-month healing phase (Fig. 3). by the use of these implants, which are new to the Fig. 11_Patient-specific abutment prior to insertion.

这个种植方案的一个特点是，我们使 in termssupport of maxillary dental market._Challenge Optimal soft-tissue can be In terms of this 67-year-old patient, the implants 用了一个已经获得专利的锥形密封设 如果唇侧的骨已经遗失，但最佳的骨 在假体预处理之后或植入区域制模之 anterior tooth loss It should be noted that, owing to the bevelled deachieved with individualised manufactured abut- were exposed by incision to the middle of the alvesign of the implants used, an almost seamless inser轮廓并未接受骨移植修复，那么要实 后，拧上一个临时螺丝修复体，还是 计，它可防止种植体和基台之间界面 ments. olar ridge from #12, 11, 21alveolar and 22process after ais While replacing a missing tooth with an implant 处的微小运用和微小间隙，可靠地保 tion into regions the natural osseous 安装可摘除的临时修复体，在很大程 现所需的美学效果并不困难。 four-month healing phase (Fig. 3).cover and the primary can now be considered routine, rehabilitation in the 护种植体和骨骼免受细菌侵害。Zippachieved, and thus the plastic 度上取决于患者的财务状况。 除了使 _Challenge in terms of maxillary maxillary anterior region still represents a particu- wound closure are simplified for the surgeon. This is 这名67岁的患者，经过4个月的愈合时 用系统原生的牙龈成型器外，临时修 rich 等人 (2007)11 通过试验测试了由微 lar challenge also the basis that, for aowing quick to andthe smooth healing anterior tooth loss for the treatment team. In addition to It should be noted bevelled de复体也有助于愈合期间和之后种植体 观运动和可能性的牙槽骨吸收引起的 间后，通过切口种植体暴露在12、11 successful osseointegration of the implant, particprocess. sign of the implants used, an almost seamless inserular attention must be given aes- into the natural osseous alveolar process is While replacing a missing tooth withtoanfunctional implant andtion thetic parameters to achieve a restoration that perThree-dimensional bone structures can be precan now be considered routine, rehabilitation in the achieved, and thus the plastic cover and the primary fectly harmonises with natural teeth.8 served using the above-mentioned OsseoSpeed TX maxillary anterior region still represents a particu- wound closure are simplified for the surgeon. This is larofchallenge also the basis for a quick and smooth healing Fig. 14_Occlusal view the inserted for the treatment team. In addition to abutment. successful osseointegration of the implant, partic- process.

Fig. 15_Closing of the screw opening must be given to functional and aesular attention with Cavit (3M ESPE)thetic prior to parameters cementto achieve a restoration that perThree-dimensional bone structures can be preing the superstructure.

8 fectly harmonises with natural teeth. served using the above-mentioned OsseoSpeed TX Fig. 14_Occlusal view of the inserted abutment.

Fig. 15_Closing of the screw opening with Cavit (3M ESPE) prior to cementing the superstructure.

Fig. 14

Fig. 15

图. 14_基台安装后的咬合视图

图.15_粘固上部结构之前，用Cavit (3M ESPE)闭合螺帽

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DOCTOR牙医 Infodent International • 3 2018 Fig. 14

Fig. 15

患者量身定制的CAD/CAM基台和新的种植设计 SCIENTIFIC UPDATE

泵效应的临床相关性。此外，产生的 应力进一步分部到骨骼中，同时降低 峰值载荷。12, 13 在这方面，还必须阐 明保留边缘骨水平的好处。种植体基 台连接处如此可靠的密封性足以抵抗 细菌，从而保护骨骼免受外部影响。 对于患者来说，上部结构的维护也变 得更加容易。 锥形的种植体和基台链接简化了基台 的整合(图. 6). 然而，对于倾斜的Osseo Speed TX Profile 种植体来, 需要特别注 意的是，要把临床情况精确转移到用 模塑助剂和转移桩制造模体的精密模 塑过程中，这需要特定的经验和良好 的直觉。 个性化的ATLANTIS基台是胶合牙冠 或牙桥良好的选择方案，因为他们能 够保证种植体的最佳性能, 也是复杂型 假牙的基础且易于使用。 ATLANTIS 基台由钛、氮化钛涂层钛 或氧化锆制成 (ATLANTIS GoldHue) ，这种基台可用于所有已建立的种植 体系统中。所有基台均由制造商提供 相应的基台螺丝。 用ATLANTIS VAD (虚拟基台设计) 软件可生产基于最终 牙齿形状的基台，它不仅保证了美学 效果，也保证最佳的功能。从愈合后 的印模、植入物暴露(图. 3) 和临时牙 龈成型器的插入直到生产出最终的模 型 (图. 4). 主铸件应该有一个硅胶树脂制成的稳 定可移除的牙龈罩(图. 7) 。牙科医生或 牙科实验室将铸件送Astra Tech 之前， 应将铸件放置在咬合架上以便于随后

将其与ATLANTIS Case Safe包装箱一 起送去。 在高科技牙科实验室产生模 型后或模型被发送后，如果没有立即 可用的扫描仪， 可以使用3D扫描仪将 模型转换为虚拟图像(图. 8–10)。

全的满足，这最终也是我们作为治疗 团队所有努力的标准和动力。如果患 者坚持用适当的清洁方法，那么预期 的软组织情况还有额外改善的空间。.

在专家确认通过电子邮件发送的虚拟 基台设计后，开始制造ATLANTIS基 台、验证并发送给主治牙医（图7和11） 。经过验证合身精度和患者特定基台 的位置之后，可以在牙科试验室中制 造量身定制的义齿了(图. 12)。

结论

必须始终确保与基台一起配送的 基台螺丝用于最后插入口中的那 个基台。ATLANTIS基台的设计符 合天然牙齿的牙本质核心形状。当 然，ATLANTIS VAD软件允许由专家 根据自己的需要和偏好来定义，这包 括患者的情况和量身定制基台的生产 等因素。基台大小一般由愈合情况或 临时基台的形状和大小所产生的轮廓 决定。

种植学是现代牙科治疗程序的核心组 成部分。材料的不断发展、植入物的 设计和相关技术的目的都是为了获得 高可靠性，并且具有良好的长期预 后，还使用于各种适应症。如果要满 足患者日益增长的需求，必须进行仔 细的诊断和详细的计划。特别是在美 学要求苛刻的临床情况下的护理，许 多情况下需要进行跨学科的治疗。该 病例报告显示，用解剖学原理成形和 倾斜的Osseo Speed TX Profile种植体上 生成患者个性化定制基台，可能对取 得长期成功有益，也是取得长期成功 的基础，即使是在出现骨骼减少和软 组织条件糟糕的情况下。

当基台插入患者口腔时，黏膜可能会 暂时贫血（图 13至15）。如果专家 在下单时未提供或选择任何特定选 项，ATLANTIS基台都是用标准的牙 龈成型标准生产的。 初始情况是非常不乐观的（图 1和图2 ），但是在放置了个性化冠修复体之 后，患者、牙科专家和修复专家都认 为在无论是在功能方面还是在美学方 面都取得了一个满意的效果(图. 16 和 17)。 患者对牙齿稳定自然的预期得到了完

eport

ediately after ndividualised n restoration. ult soft-tissue gival stippling n the cervical sufficient oseous support.

吴宁 教授 上海健康医学院 wnmoon918@hotmail.com

Fig. 16 Fig. 17 图.

17_尽管软组织条件并不乐观，但 图. 16_刚安装完患者量身定制的修复冠 是在牙颈线区域出现了良好的牙龈点 时 oratory or after the model has been sent, should 刻效果，表明有足够的骨质支撑. _Conclusion

Frank Liebaug 医生 电话: +49 36847 31788 frankliebaug@hotmail.com

no scanner be available immediately (Figs. 8–10).

After the specialist has confirmed the virtual abutment design, which is sent via e-mail, the ATLANTIS abutment is manufactured, verified and sent to the attending dentist (Figs. 7 & 11). Individualised prostheses can be manufactured in the

Implantology is a central component of modern therapy procedures in dentistry. Continuous development of materials, implant design and the relevant technologies seeks to obtain high reliability with a good long-term prognosis for a wide range of indications. Careful diagnosis and de-

DOCTOR牙医 Infodent International • 3 2018

29

SCIENTIFIC UPDATE Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report

First author Guest Author: Robert A. Lowe, DDS Ross W. Nash, DDS

Robert A. Lowe, DDS Private Practice, Charlotte, North Carolina Email: boblowedds@aol.com Dr. Robert A. Lowe maintains a private practice with Dr. Ross Nash in Charlotte, North Carolina. Dr. Lowe lectures internationally on restorative and esthetic dentistry, has published many articles in dental journals, and consults with dental manufacturers on clinical products.

He currently teaches with Dr. Nash at The Nash Institute of Dental Learning in Charlotte, North Carolina.

Ross W. Nash, DDS Private Practice, Charlotte, North Carolina Clinical Instructor Medical College of Georgia School of Dentistry Email: rosswnashdds@aol.com Dr. Nash is founder of Ross Nash Seminars and director of The Nash Institute of Dental Learning in Charlotte, North Carolina. A consultant to numerous dental product manufacturers, he lectures internationally on subjects in esthetic dentistry.

Dr. Nash is an accredited member of the American Society for Dental Aesthetics and a Fellow in the American Academy of Cosmetic Dentistry.

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DOCTOR牙医 Infodent International •3 2018

Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report Captek (Captek: A Division of Precious Chemicals Company) as a porcelain-fused-to-metal (PFM) restorative material [QA: Is this correct] has many clinical benefits when compared with traditional dental alloy and all-ceramic systems. One significant finding is that it has been noted through clinical study that Captek “composite” precious metal supports 71% less bacteria than natural teeth.1 In the intracrevicular environment and surrounding periodontal tissues, this can have a direct benefit as to the long-term retention of a dental restoration. It makes sense that if there is less plaque accumulation, there will also be a lesser likelihood of recurrent marginal caries and chronic gingival inflammation, both of which can lead to early restorative failure. In March 2003, Knorr and colleagues2 at the University of Minnesota concluded that the lower surface-free energy of Captek “composite” precious metal might be an important factor in predicting plaque resistance. A significant difference was found in the surface-free energy of Captek as compared to type III casting gold. This finding was attributed to the unique composite metal of Captek and may be the reason why plaque was repelled. Based on this information, it can be concluded that Captek would be an excellent choice of restorative material in difficult clinical situations where biocompatibility may be a problem.

CASE REPORT: A “CALCULATED” CLINICAL COMPROMISE Surgical Plan and Execution The patient in Figures 1 and 2 presented for esthetic evaluation and restoration of the “smile zone.” [QA. How did the patient’s smile get this way?] On examination it was noted that an asymmetry of the gingival display was present at full smile.

The incisal plane was uneven; with tooth No. 9 positioned severely apical to the incisal plane (open bite) and facially to the rest of the

maxillary anterior teeth. An orthodontic consult was made to find out the feasibility of extruding tooth No. 9 into a more favorable position and aligning the facial surface with the rest of the maxillary anterior teeth. It was discovered that tooth No. 9 was ankylosed and could not be orthodontically repositioned. The only alternative to evening the gingival plane was to apically reposition the tissue (gingiva and/or alveolar bone) over the other maxillary anterior teeth. The incisal edges of the maxillary anterior teeth could be slightly shortened to maintain an ideal width-to-length ratio; however, with very little incisor overjet, care must be maintained not to compromise disclusion of the posterior teeth in eccentric mandibular movements.3 After planning the surgical procedure with a fine felt marker (Figure 3), a gingivectomy was performed using a diode laser (Figure 4). The teeth were prepared for full coverage esthetic restorations on teeth Nos. 6 to 11 (Figure 5).

Teeth Nos. 4, 5, 12, and 13 were prepared for onlay veneer restorations.4 After tooth preparation, a provisional stent from a preoperative esthetic mockup was filled with Bis-acrylic temporary restorative material and placed over the preparations for 2 minutes (Figure 6). The provisional restoration was then carved, polished, and prepared for placement. Before provisional cementation, an intrasulcular incision was made with a 15C scalpel and a full thickness mucoperiosteal flap was reflected (Figure 7). Ostectomy was performed using a hard-tissue laser to create a bony architecture that was a refection of the restorative margins 3 mm apically (Figure 8). After refinement of the alveolar crest and root surfaces with hand instrumentation, the gingival tissues were repositioned and using interrupted 3/0 silk sutures (Figure 9). The preparations were cleansed and rehydrated with a dentin desensitizer (AcquaSeal, Acquamed Technologies) provi-

Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report SCIENTIFIC UPDATE

Fig. 1 Preoperative smile.

Fig. 2 A full-smile, retracted view shows the disparate gingival heights and tooth asymmetry problems when comparing the patient’s right and left sides.

Fig. 3 Because extrusion was ruled out as a treatment option, the only way to gain gingival symmetry was to apically position the tissue above the remaining maxillary anterior teeth.

Fig. 4 The gingival levels were corrected, using a diode laser and the incisal edges were reduced accordingly. Notice the symmetry created at the gingival level.

sional restorations were then cemented with polycarboxylate cement (Figure 10).

It was noted at closure that a lack of adequate thickness of attached gingiva over tooth No. 9 would subsequently require augmentation with a connective tissue graft. The provisional restoration was then cemented with polycarboxylate cement. An asymmetry of the gingival zeniths of the maxillary central incisors was noted because of the flatter facial profile of the ankylosed tooth. This problem was addressed after the maturation of the connective tissue graft. After cementation of the provisional restoration, all mandibular excursive movements were rechecked. Canine guidance and protrusive disclusion was verified. After 6 to 8 weeks of maturation after placement of a connective tissue graft over tooth No. 9, the gingival zeniths over the maxillary central incisors were evaluated (Figure 11). The flatter profile of the gingival tissue over tooth No. 9 (because of the flat root morphology and corresponding alveolar bone contour) was definitely asymmetric when compared with the curvature of the gingival zenith over tooth No. 8. The plan was to make a correction of the soft-tissue archi-

tecture with an erbium laser and correct the contour of the provisional restoration to support the change in gingival tissue position. A tissue marker was used to draw the surgical plan on the gingival tissue above tooth No. 8 (Figure 12). The Erbium laser (Delight, Hoya Conbio) was used to make the gingival correction. Next, a periodontal probe was used to assess the depth of the remaining gingival sulcus to decide whether bony contouring would be needed to correct biologic width.

Bony correction was not needed in this case because 1 mm of gingival sulcus remained.

The restorative margin was then refined to match the contour of the surgerized gingival tissue and the provisional restoration was repaired. This was done without removal of the provisional restoration. The cervical one third of the provisional restoration was beveled using a rotary diamond instrument (Figure 13). Next, a microhybrid composite matching the color of the provisional restoration was sculpted into place using a composite placing instrument (Figure 14). The newly contoured cervical one third of the provisional restoration supported the corrected gingival contour as the marginal tissue matured.

One significant finding is that it has been noted through clinical study that Captek “composite” precious metal supports 71% less bacteria than natural teeth.

After light-curing, the composite correction was contoured, using a No. 8 fluted carbide finishing bur and polished with composite polishing abrasives and brushes. After 3 weeks of healing, the patient was ready for the registration of master impressions (Figure 15). Minor marginal correction was made where needed after removal of the provisional restorations. The gingival profiles over the maxillary central incisors, while not perfectly symmetrical, were acceptable to the patient. This is an important consideration because of gingival display when the patient smiles. Figure 16 shows an incisal view during final impressions, after removal of the No. 1 retraction cord. Because of an anatomic defect on the facial surface below the gingival crest, the restorative margin had to be located deeper in the gingival sulcus than normal— in fact, very close to the base of the gingival sulcus. Additional bony crown lengthening was ruled out. Because of the extreme labial angulation of the root, placing a facial restorative margin would necessitate excessive facial tooth structure reduction to eliminate undercut and allow a crown to seat to the restorative margin. Because of these

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SCIENTIFIC UPDATE Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report

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Fig. 5 The maxillary anterior teeth were prepared circumferentially to restore the esthetic (facial) and functional (palatal) surfaces.

Fig. 6 A plastic provisional stent made from a composite mock-up was filled with Bis-acrylic provisional material and placed over the preparations for about 2 minutes.

Fig. 7 After reflection of a full thickness mucoperiosteal flap, the positions of the restorative margins can be seen relative to the alveolar crest.

Fig. 8 The alveolar crest over teeth Nos. 6 through 8 after surgical correction.

Fig. 9 After bony correction, the gingival tissue was sutured to place using interrupted 3/0 silk sutures.

Fig. 10 The surgical provisional restorations are shown after cementation with polycarboxylate cement.

Fig. 11 A retracted 4-week postoperative view.

Fig. 12 The distolabial area (gingival zenith) over the maxillary right central incisor was marked with a fine felt marker.

Fig. 13 After gingival correction with the diode laser, the gingival sulcus was measured to determine if bony correction was needed.

Fig. 14 Microhybrid composite in the same shade as the provisional material was added using a plastic filling instrument.

Fig. 15 The maturation of the gingival tissues over the maxillary central incisors is shown at about 16 weeks after surgery.

Fig. 16 An incisal view of the maxillary central incisors at final impressions. Note the facial restorative margin on tooth No. 9.

DOCTOR牙医 Infodent International •3 2018

Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report SCIENTIFIC UPDATE

Fig. 17 The Captek copings on the master laboratory models.

Fig. 18 The Captek copings after the addition and firing of powered Captek P (build-up material) before the addition of Captek G.

Fig. 20 The finished Captek restoration from the facial aspect.

Fig. 21 The finished Captek crowns from the lingual aspect.

reasons, Captek was chosen as the restorative material of choice. The plan was for the laboratory to fabricate tooth No. 9 with a circumferential Captek metal collar. The extreme thinness of the Captek “composite” gold collar combined with the bacteriostatic effect and the potential for accuracy of marginal seal of Captek metal would give this restoration the best chance for biologic acceptance. If this tooth could not be restored to a healthy condition, a dental implant would have been required; therefore, it was the choice of the patient (risk vs benefit) to give the Captek restoration a try. When final impressions were successfully made, the provisional margins were corrected with flowable composite trimmed, polished, and cemented.

The laboratory then fabricated the definitive restorations.

Laboratory Fabrication Porcelain to Captek restorations were cho-

sen for teeth Nos. 7 through 10.Teeth Nos. 7, 8, and 10 had 360-degree porcelain margins.

Tooth No. 9 had a 360- degree Captek margin. Teeth Nos. 4, 5, 6, 11, 12, and 13 (maxillary cuspids, first and second bicuspids) were fabricated with pressed ceramic materials. It is well documented that Captek, as a PFM restoration, blends well with all ceramic restorations and natural teeth. The Captek substructure is comprised of two gold alloys that at the beginning of the fabrication process are impregnated in wax—Captek P and Captek G. Captek P is a metal alloy consisting of approximately equal parts of gold, platinum, and palladium.This layer is pneumatically adapted for consistency with a “P-Press” unit at 90 psi. After burnout in the oven, a high content platinum-palladium coping is formed with a microscopic capillary network. Captek G is an alloy (metal) of 97.5% gold and 2.5% silver. It is press fit over the Captek P layer and refired.The molten gold is drawn into the ca-

Fig. 19 Captek G was added to the elongated copings.

pillary network and totally encapsulates the Captek P layer. The final Captek coping is a high strength metal composite with a deep yellow gold appearance. The final Captek coping is comprised of a gold/platinum/palladium mix (88% gold, 4% platinum, 4% palladium, 3% silver, and 1% iridium) with gold covering the entire surface and intaglio of the coping. The natural reflectivity of this surface illuminates the surrounding hard and soft tissues, increasing the value in the cervical one third of the tooth. The cervico-incisal heights of the completed ceramic restorations were longer than the actual tooth preparations as a result of the apical repositioning of the soft-tissue envelope. Therefore, the Captek copings were elongated before adding porcelain to the incisal edges (Figure 17).

The Captek build-up material is actually Captek P material in a powder form. This material is designed to facilitate additional support structure to a basic Captek coping. It is

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SCIENTIFIC UPDATE Periodontal Compatibility of Intracrevicular Captek Restorative Margins: A Case Report

Fig. 22 A full-smile view of the completed maxillary restorations 6 weeks after delivery.

made up of the high-fusing, hard particles of platinum and palladium, the same as the original Captek P material used to fabricate the coping. The premise of the composite metal is that, anywhere the coping needs to be formed, a “metal sponge” or “skeleton” is developed into which gold (Captek G) will flow.

Thus, if a metal collar of some design, occlusal support, or even a metal stop is needed, this material can be used. This technology together with other principles of reinforcing porcelain enables the technician to develop porcelain support with Captek for most any clinical situation (Figures 18 through 21).

Restoration Delivery The Captek restorations were tried in, interproximal and occlusal contacts were adjusted, and then the restorations were polished and cemented, using a resin modified ionomer cement. The all-ceramic restorations were bonded, using a dual cure resin cement. The esthetic result was remarkable considering the preoperative apical positioning of the left maxillary central incisor. The open bite was corrected giving the patient anterior guidance and canine disclusion. Width-tolength ratios of the maxillary central incisors were estheti-

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Fig. 23 A full-retracted view 10 weeks after delivery.

cally acceptable (75% to 80% considered ideal). Golden proportions of the maxillary anterior segment were also esthetically pleasing.

The patient was pleased with the outcome and the tissue acceptance was to be monitored and evaluated at regular intervals.

Case Follow Up The patient has follow-up appointments at 2 weeks, 4 weeks, 3 months, and 6 months.

The quality of the soft tissue around the left maxillary central incisor was comparable to the right maxillary central incisor. There was a probable gingival sulcus that did not bleed whenprobed. Marginal and papillary gingiva surrounding all maxillary anterior teeth were healthy and within normal limits. The esthetics in the cervical one third of the four anterior Captek restorations was comparable to the all-ceramic units on the maxillary canines and premolars.

The high value and lack of darkness at the gingival margin was indicative of the natural esthetics that Captek PFM restorations consistently provides.5 (Figures 22 through 24). j ACKNOWLEDGMENT The author would like to acknowledge the ceramic artistry of Michael Felgenhauer and

Fig. 24 View at 12 weeks after delivery.

the help of Jeff Stubblefield at DAL Signature Laboratories in Peoria, Illinois.

REFERENCES 1. Goodson JM, Shoher I, Imber S, et al.

Reduced dental plaque accumulation on composite gold alloy margins. J Perdiodontal Res. 2001;36(4):252-259.

2. Knorr S, Combe EC, Wolff LS, et al.

The surface free energy of gold alloy systems.

University of Minnesota. Presented as an abstract at the AADR meeting in San Antonio, Texas, March 2003.

3. Lowe RA. Direct preparation of preexisting implant abutments.

Dent Today. 2004;23(3):95-101.

4. Lowe RA. The contact lens inlay/onlay veneer: A combination of structural strength and esthetic beauty. Contemporary Esthetics and Restorative Practice. 2001;5(7):50-55.

5. Nathanson D, Nagai S, Po S, et al. Preliminary evaluation of the effect of crown on gingival color. Boston University School of Dental Medicine, Massachusetts. Harvard University School of Dental Medicine, Boston, Massachusetts. Abstract presented at the IADR/AADR/CADR/ 82nd General Session, March 10–13, 2004.

SCIENTIFIC UPDATE 龈沟内Captek修复边缘的牙周相容性：病例报告

龈沟内Captek修复边缘的牙周 相容性：病例报告 第一作者： Ross W. Nash博士

客座作者： Robert A. Lowe， 牙医外科博士 北卡罗来纳州夏洛特市私人 诊所 Robert A. Lowe博士与Ross Nash博士在北 卡罗来纳州夏洛特市开设了一家私人诊 所。Lowe博士通过国际学术演讲讲解修复 和美学牙医学知识，已在牙科期刊上发表 了很多文章，并与牙科生产商协商临床产 品的相关事宜。当前，Lowe博士与Nash博 士一同在北卡罗来纳州夏洛特市纳什牙科 学院 The Nash Institute of Dental Learning） 任教。 Email: boblowedds@aol.com

Captek（Captek：是Precious Chemicals, Inc公司的一个部门）是一种烤瓷 熔附金属（PFM）修复材料 [问答： 这种说法是否正确]，与传统牙科合金 和全瓷系统相比，它具有许多临床优 势。其中一个重大研究结果是：通过 临床研究，发现Captek“复合材料”的贵 重金属支架可以比天然牙减少71%的细 菌。1在沟内环境和牙周组织中，这种 属性可以带来直接的好处，即牙科修 复体可以长时间使用。如果菌斑聚集 量越小，边缘部位发生复发性骨溃疡 和慢性牙龈炎的可能性就越小；这两 种疾病都会导致修复提早失败。 2003年3月，Knorr和他的同事们2在 University of Minnesota（明尼苏达大 学）得出结论：Captek“复合材料”贵重 金属的低表面能可能是预测菌斑抵抗 能力的重要因素。将Captek与第III类 铸造金进行对比，发现它们的表面能 存在显著差异。这一发现归功于这种 独特的Captek复合金属，并可能是它 为什么能够防止菌斑形成的原因。基 于这些信息，可以得出这样的结论： 在可能存在生物相容性问题的困难临 床条件下，Captek是修复材料方面的 明智选择。 病例报告：“计算得出的”临床折衷方 案

Ross W. Nash博士 北卡罗来纳州夏洛特 市私人诊所 佐治亚医科大学牙科学院临 床讲师 Nash博士是Ross Nash研讨会的创办 人、北卡罗来纳州夏洛特市纳什牙 科学院（The Nash Institute of Dental Learning）主任。他作为多家牙科产 品生产商的顾问举办过多次国际美学 牙医专题演讲。Nash博士是美国牙齿 美容学会（American Society for Dental Aesthetics）正式会员，美国牙科美容 学会（American Academy of Cosmetic Dentistry）Fellow级会员。 rosswnashdds@aol.com

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DOCTOR牙医 Infodent International •3 2018

手术计划和实施 图1和图2所示的患者代表了美学评价 和修复领域的“微笑区”。[问答：牙长 成这样怎么笑得出？] 在检查中，发 现牙龈的不对称图像正是深度微笑时 的形状。切平面不均匀；9号牙的位置 严重超出切平面顶部（开式咬合）并 与其他上颌前牙相对。进行了正畸咨 询，看能否存在将前突的9号牙恢复到 一个更好的位置，并将其与其他上

已骨长合，不能用正畸的方法使 其复位。平复龈平面的唯一替代 方案是从顶部重新定位该组织（ 牙龈和/或牙槽骨）相对于其他上 颌前牙的位置。上颌前牙的切缘 可稍稍截短，以便保持理想的宽长比；但由于略带切牙覆盖，操 作时要小心，不要影响到后牙的 咬合分离，造成下颌运动异常。3 在用细毡毛马克笔做好手术治疗 计划后（图3），使用二极管激 光器进行龈切除术（图4）。对6 至11号牙进行进行全冠美学修复 制备。对4、5、12和13号牙进行 贴面修复制备。4牙齿制备完成 后，将术学美学实体模型上的临 时性支架充满双丙烯酸暂时修复 材料，并安装在制备区上2分钟（ 图6）。然后对暂时修复体进行雕 刻、抛光和安装前准备。暂时粘 结前，用15C手术刀进行沟内切 开术，并将全层骨膜瓣翻开（图7 ）。使用组织激光器完成骨切除 术，以便建立一个距修复边缘顶 部3mm恢复区间的骨架构（图8） 。 在用手工器械对牙槽嵴和根面进 行精心修整后，将牙龈组织复 位，并用间断3/0丝线缝合（图9 ）。使用牙本质脱敏剂（AcquaSeal, Acquamed Technol-ogies）清 洗制备部位并补充水分；然后将 暂时修复体用聚羧酸盐粘固剂粘 结（图10）。

结束时发现9号牙的附着龈厚度不 足，需要后期采用结缔组织移植 颌前牙的切平面对齐。发现9号牙 术增厚。随后将暂时修复体用

龈沟内Captek修复边缘的牙周相容性：病例报告 SCIENTIFIC UPDATE

由于龈嵴下的颊面部存

图1－手术前的微笑。

图2－大笑，嘴唇收缩视图：将患者左 右两侧对比时发现牙龈高度不平衡和牙 齿不对称问题。

图3－因为排除了拔牙的治疗方案，所以 使牙龈对称的唯一途径就是升高其余上 颌前牙外侧组织的高度。

图4－使用二极管激光器调整了牙龈位 置，切缘位置也相应下降。注意观察 创造出的牙龈位置对称效果。

病例报告：“计算得出的”临床折衷方案

4、5、12和13号牙进行贴面修复制 备。4牙齿制备完成后，将术学美 学实体模型上的临时性支架充满双 丙烯酸暂时修复材料，并安装在制 备区上2分钟（图6）。然后对暂时 修复体进行雕刻、抛光和安装前准 备。暂时粘结前，用15C手术刀进 行沟内切开术，并将全层骨膜瓣翻 开（图7）。使用组织激光器完成 骨切除术，以便建立一个距修复边 缘顶部3mm恢复区间的骨架构（图 8）。 在用手工器械对牙槽嵴和根面进行 精心修整后，将牙龈组织复位，并 用间断3/0丝线缝合（图9）。使用 牙本质脱敏剂（AcquaSeal, Acquamed Technol-ogies）清洗制备部位 并补充水分；然后将暂时修复体用 聚羧酸盐粘固剂粘结（图10）。

在结构缺陷，修复边缘 必须要比正常情况下更 加深入到龈沟内。

Captek（Captek：是Precious Chemicals, Inc公司的一个部门）是一种烤瓷熔附金 属（PFM）修复材料 [问答：这种说法 是否正确]，与传统牙科合金和全瓷系 统相比，它具有许多临床优势。其中一 个重大研究结果是：通过临床研究，发 现Captek“复合材料”的贵重金属支架可 以比天然牙减少71%的细菌。1在沟内环 境和牙周组织中，这种属性可以带来直 接的好处，即牙科修复体可以长时间使 用。如果菌斑聚集量越小，边缘部位发 生复发性骨溃疡和慢性牙龈炎的可能性 就越小；这两种疾病都会导致修复提早 失败。 2003年3月，Knorr和他的同事们2在University of Minnesota（明尼苏达大学）得 出结论：Captek“复合材料”贵重金属的 低表面能可能是预测菌斑抵抗能力的重 要因素。将Captek与第III类铸造金进行 对比，发现它们的表面能存在显著差 异。这一发现归功于这种独特的Captek 复合金属，并可能是它为什么能够防止 菌斑形成的原因。基于这些信息，可以 得出这样的结论：在可能存在生物相容 性问题的困难临床条件下，Captek是修 复材料方面的明智选择。

手术计划和实施 图1和图2所示的患者代表了美学评价和 修复领域的“微笑区”。[问答：牙长成这 样怎么笑得出？] 在检查中，发现牙龈 的不对称图像正是深度微笑时的形状。 切平面不均匀；9号牙的位置严重超出 切平面顶部（开式咬合）并与其他上颌 前牙相对。进行了正畸咨询，看能否存 在将前突的9号牙恢复到一个更好的位 置，并将其与其他上

颌前牙的切平面对齐。发现9号牙 已骨长合，不能用正畸的方法使其 复位。平复龈平面的唯一替代方案 是从顶部重新定位该组织（牙龈 和/或牙槽骨）相对于其他上颌前 牙的位置。上颌前牙的切缘可稍稍 截短，以便保持理想的宽-长比； 但由于略带切牙覆盖，操作时要小 心，不要影响到后牙的咬合分离， 造成下颌运动异常。3 在用细毡毛马克笔做好手术治疗计 划后（图3），使用二极管激光器 进行龈切除术（图4）。对6至11号 牙进行进行全冠美学修复制备。对

结束时发现9号牙的附着龈厚度不 足，需要后期采用结缔组织移植术 增厚。随后将暂时修复体用聚羧 酸盐粘固剂粘接。发现两颗上颌 中切牙的龈缘高点不对称，原因是

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SCIENTIFIC UPDATE 龈沟内Captek修复边缘的牙周相容性：病例报告

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图5－对上颌前牙进行圆周制备，以恢 复其美学效果（面部）和功能性表面（ 上颚）。

图6－将一个美学实体模型制成的注满 双丙烯酸脂的塑料临时性支架安装在制 备区上约2分钟。

图7－在将全层骨膜瓣翻开后，可以看 到修复体边缘与牙槽嵴之间的相对位 置。

图8－手术矫正后6至8号牙的牙槽嵴。

图9－骨骼矫正后，将牙龈组织复位， 并用间断3/0丝线缝合。

图10－将暂时修复体用聚羧酸盐粘固剂 粘结后的视图。

图11－手术4周收缩期后的视图。

图12－上颌右中切牙的远中唇区（牙龈 高点）用细毡毛马克笔做好了标志。

图13－在用二极管激光器调整了牙龈位 置后，测量龈沟以便决定是否需要骨矫 正。

图14－用塑料填充工具将一种与暂时修 复体颜色相同的微混合复合材料添加到 位。

图15－手术后约16周，上颌中切牙外侧 的牙龈组织已成熟，情况如图所示。

图16－取终印模过程中的上颌中切牙视 图。注意9号牙的面部修复边缘。

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龈沟内Captek修复边缘的牙周相容性：病例报告 SCIENTIFIC UPDATE

图17－在主技工所模型上的Captek基底 冠。

图18－在添加了增强型Captek P（积层材 料）并烧制后，再添加Captek G。

图20－完成后的Captek修复体面部视 图。

图21－完成后的Captek牙冠舌侧视图。

平坦的面部轮廓下存在骨牙粘连。 这个问题要待结缔组织移植术成 熟以后再进行处理。粘结完暂时修 复体后，再次检查所有的下颌侧方 运动。对犬齿导引和突出部位咬合 分离问题进行确认。 在对9号牙处 实施结缔组织移植术并成熟6至8周 后，对上颌中切牙龈缘高点进行评 估（图11）。通过与8号牙的弧形 龈缘高点对比，9号牙外牙龈组织 的平坦外形轮廓（由于牙根和相应 的牙槽骨形貌扁平）明显不对称。 制定手术计划：用铒激光器矫正软 组织架构，并修整暂时修复体的外 形轮廓对牙龈组织位置的变化提 供支撑。使用组织马克笔在8号牙 的牙龈组织上画出手术方案（图12 ）。使用铒激光器（Delight, Hoya Conbio）完成牙龈矫正。接下来， 用牙周探针插入其余龈沟部位检测 骨轮廓线确定是否需要矫正生物学 宽度。这种情况下不需要进行骨矫 正，因为要保留1 mm的龈沟宽度。 然后，再对修复体边缘进行精心修 整，使之适应手术后的牙龈组织轮 廓，并修复暂时修复体。进行这些

操作时，不需要拆下暂时修复体。 暂时修复体的颈部三分之一处用旋 转式金刚石工具修成斜面（图13） 。接下来，用复合材料定位工具将 一种与暂时修复体颜色相配的微混 合复合材料雕刻就位（图14）。待 边缘组织成熟后，暂时修复体最新 成形的颈部三分之一处支撑了修复 后的牙龈外观。光固化后，用8号 硬质合金槽精修钻修整外形，并复 合材料抛光磨料和刷子抛光。 3周愈合期后，患者已准备好取主 印模（图15）。拆下暂时修复体 后，对边缘进行小幅修整。虽然上 颌中切牙的龈缘外形还不是完美 对称，但患者认为可以接受。这是 一项重要的因素，因为患者笑时就 会露出牙龈。图16所示为取终印模 过程中拆下1号排龈线后的切齿视 图。由于龈嵴下的颊面部存在结构 缺陷，修复边缘必须要比正常情况 下更加深入到龈沟内——事实上， 已经十分接近龈沟底部基础部位 了。额外骨冠延长术方案被排除 了。由于牙根部存在很大的唇形 角，使面部显露出修复边缘，所

图19－Captek G添加到细长的基底冠上。

以必须除去多余的面部牙体组织， 以便消除底切影响并使牙冠在修复 边缘就位。由于这些原因，选择了 Captek作为修复材料。 修复计划是由技工所制作带圆周状 Captek 金属领圈的9号牙齿。该超 薄Captek“复合”金领圈具有抑菌效 果和精确边缘封闭能力，两大功效 使Captek金属为此次修复提供了最 佳的生物可接受性保障。如果牙齿 不能修复到正常状态，就需要考虑 种植牙了；因此，是患者（通过风 险收益比）选择了Captek修复的尝 试机会。成功取完终印模后，暂时 修复体边缘用流动树脂修边、抛光 和粘结。随后，由技工所制作最终 的修复体。 技工所制作 选择用瓷－Captek 修复体制作7至 10号牙齿。7、8和10号牙齿带360度 全瓷边缘。而9号牙则带360度Captek边缘。4、5、6、11、12和13号 牙齿（上颌犬齿、第一和第二双尖 齿）则采用压铸陶瓷材料制作。 有大量的文件证明：Captek作为一 种烤瓷熔附金属（PFM）修复材 料，与全瓷修复体和天然牙齿都能

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SCIENTIFIC UPDATE 龈沟内Captek修复边缘的牙周相容性：病例报告

图22－交付6周后的完整上颌修复体开口 微笑视图。

很好地结合在一起。Captek的底层 结构由两种金合金组成。在制作程 序开始时，把它们浸入蜡（Captek P 和 Captek G）中。Captek P是一 种金属合金，由大致等量的金、 铂和钯组成。这一层结构是由气 动压合稳定性的，“P-Press”压强单 位为90 psi（磅每平方英寸）。在 经烤箱烧制后，就形成了一个带 微毛细管网结构的高含量铂－钯 基底冠。Captek G是一种合金（ 金属），含97.5% 金和2.5% 银。它 是通过Captek P层压合后再烧制而 成。熔化的金被吸入毛细管网结构 之中，形成胶囊状结构将Captek P 层包裹起来。最终的Captek基底冠 是一种高强度金属复合材料，外观 颜色为暗黄金色。最终的Captek基 底冠由金/铂/钯混合物组成（88% 金、4% 铂、4% 钯、3% 银、和1% 铱），由金覆盖整个外表面，而基 底冠呈凹雕状。这种表面的天然反 射率照亮了它周围的硬组织和软组 织，提高了牙齿颈部三分之一部位 的亮度值。 完成后陶瓷修复体的颈部至切端 高度比实际的牙体制备高度要长一 些，这是由于切端对软组织包封的 重新定位的结果。因此，在切端添 加瓷质之前，Captek基底冠是细长 形的（图17）。Captek的积层材料 实际上是粉末状的Captek P材料。 这种材料的设计目的是为基础Captek基底冠提供额外的支撑结构。 它是由高熔点的铂和钯硬粒子组成 的，与最初用于制作基底冠的Captek P材料相同。该复合材料存在的 前提是：在任何需要形成基底冠 的位置，形成“海绵金属”或“骨架” 40

DOCTOR牙医 Infodent International •3 2018

图23－交付10周后的嘴唇完全收缩视图。

，使金（Captek G）流入其中。这 样，如果某种设计的金属领圈，需 要咬合支持甚至是金属挡块，都可 以使用这种材料。该技术与其他增 强陶瓷原理一起为技术人员在大多 数据临床情况下使用 Captek时实现 陶瓷支持（图18至21）。 修复体的交付 Captek修复体进行试戴，调整与相 邻牙的接触及咬合接触，然后对修 复体进行抛光并用树脂改良型离子 粘固剂粘结。全瓷修复体用双重固 化树脂水门汀粘结。与术前根尖定 位时的上颌左侧中门齿相比较，美 学效果非常好。开式咬合已纠正， 使患者实现前导和犬齿的牙合分 离。上凳中门齿的宽-长比处于美 学可接受范围内（75% 至 80%被认 为是理想的）。上颌前段的金色属 性在美学效果方面表现另人满意。 患者对手术效果满意，而且，组织 接受性监测和评估结果处于正常范 围内。 病例跟踪 与患者约定在2周、4周、3个月和 6个月时进行跟踪调查。上颌左侧 中门齿周围的软组织与上颌右侧中 门齿相差无几。有可能一侧龈沟在 探诊时未出血。所有上颌前牙周 围的边缘龈和乳突龈健康良好，并 且在正常限度内。四颗上颌前牙 Captek修复体的颈部三分之一处的 美学效果与上颌犬齿和前臼齿的全 瓷结构相匹配。龈缘部位的高亮度 且没有暗色是Captek 烤瓷熔附金属 （PFM）修复材料一贯提供的天然 美学效果。5（图22-24）

图24－交付12周后的视图。

鸣谢 作者感谢Michael Felgenhauer的陶 瓷艺术支持，以及Jeff Stubblefield 在伊利诺斯州皮奥瑞亚市DAL Signature技工所的帮助。 参考文献 1. Goodson JM, Shoher I, Imber S, et al. Reduced den-tal plaque accumulation on composite gold alloy margins.

J Perdiodontal Res. 2001;36(4):252-259.

2. Knorr S, Combe EC, Wolff LS, et al. The surface free energy of gold alloy systems. University of Minnesota.

Presented as an abstract at the AADR meeting in San Antonio, Texas, March 2003.

3. Lowe RA. Direct preparation of preexisting implant abutments. Dent Today. 2004;23(3):95-101.

4. Lowe RA. The contact lens inlay/ onlay veneer: A combination of structural strength and esthetic beau-ty. Contemporary Esthetics and Restorative Practice. 2001;5(7):50-55.

5. Nathanson D, Nagai S, Po S, et al. Preliminary eval-uation of the effect of crown on gingival color.

Boston University School of Dental Medicine, Massachusetts. Harvard University School of Dental Medicine, Boston, Massachusetts. Abstract present-ed at the IADR/AADR/CADR/ 82nd General Session, March 10–13, 2004.

CALENDAR 日历 TRADE-SHOWS AND CONFERENCES FOR DENTAL PRACTITIONERS

牙科技术会议及展览会

Calendar

NOVEMBER

2018广告-230x330_0930.pdf 1 2017/9/30 15:25:45

DenTech China 2018 The 22nd International Exhibition and Symposium on Dental Equipment Technology and Products Infodent Booth: Hall 1 stand E 68-69, E 91-92 31/10-03/11/2018 Shanghai - China C

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CM

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UBM China (Shanghai) 9F, CIROS Plaza, No 388 Nanjing West Road, Huangpu Shanghai, 200003 China

CY

CMY

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International Developing Manager: Sandra Shen Phone: +86 21 61573953 // +86 21 61573953 Email: sandra.shen@ubm.com Venue: Shanghai World Expo Exhibition and Convention Center Shanghai - China

www.dentech.com.cn/en-us/index

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DOCTOR牙医 Infodent International • 3 2018

ACOMS Taipei 2018 13th Asian Congress on Oral & Maxillofacial Surgery 08-11/11/2018 Taipei - Taiwan Venue: Taipei Marriott Hotel Taipei, Taiwan

www.2018acoms.com/cms-user

eHealth 2018 China eHealth Show

Greater New York Dental Meeting 2018 (GNYDM) 94th Annual Session Infodent Booth: 1005

16-21/11/2018 Shenzhen - China

25-28/11/2018 New York City - USA

Organised by: Creativity Convention & Exhibition Ltd. (CCEC) Room 518, No. 72, Electronic Appliance Building, Zhenhua Road, Shenzhen - China Phone: +86 755 8326 0488 / 8322 4480

Greater New York Dental Meeting 200 W. 41st Street, Suite 800 New York, NY 10036 Tel: +1 212 398 6922 Fax +1 212 398 6934 E-mail: info@gnydm.com Website: www.gnydm.com

Contact person: Shanna Wang Phone: +86 755 8831 2773 / 2522 Email: shanna.wang@elexcon.com Venue: Shenzhen Convention & Exhibition Center Shenzhen - China

Referent: Dr. Robert R. Edwab (Executive Director) E-mail: execdirector@gnydm.com Exhibits Manager: Ms. Carla M. Borg E-mail: exhibits@gnydm.com Exhibition venue: Jacob K. Javits Convention Center 655 West 34th Street, New York, NY 10001, USA

www.gnydm.com

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Calendar

DECEMBER

Vietnam Medi-Pharm 2018 Dental Vietnam 2018 Hanoi - The 25th International Medical, Hospital & Pharmaceutical Exhibition - The International Dental 06-08 12 2018 Hanoi - Vietnam

Myanmar Phar-Med Expo 2018 - Myanmar Lab Expo 2018 - Myanmar Dental Expo 2018 - The 6th International Exhibition and Conference on Pharmaceutical and Medical Industry for Myannar 14-16/12/2018 Yangon - Myanmar

Organised by: rade Fair & Advertising JSC (VINEXAD) Address: 9 Dinh Le St., Hanoi, Vietnam Phone: +84 90 4811648 Fax: +84 24 37911864 Email: contact@vinexad.org.vn Website: medipharm.vinexad.org.vn

Organised by: Minh Vi Exhibition and Advertisement Services Co., Ltd (VEAS CO., LTD) 12th Floor, Room 12A03, Cong Hoa Plaza, 19 Cong Hoa Street, Ward 12, Tan Binh District, Ho Chi Minh City - Vietnam Phone: +84 8 3842 7755 - Fax: +84 8 3948 1188 Website: www.veas.com.vn

Venue: Hanoi International Center for Exhibition (ICE) Hanoi Vietnam

Contacts: Ms Rosie, Email: rosie.tran@veas.com.vn Ms Ann, Email: ann.ltb@veas.com.vn

www.medipharm.vinexad.org.vn/en#

Venue: Rose Garden Hotel 171 Upper Pansodan Rd Yangon, Myanmar

www.pharmed-myanmar.com

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Calendar

DECEMBER

Thai Dental Show 2018 19-21/12/2018 Bangkok - Thailand Organised by: The Dental Association of Thailand Email: thaidentalnet@gmail.com Venue: Central World Bangkok Bangkok - Thailand

www.thaidental.net

Expodent International India 2018 India’s Biggest Dental Exhibition 21-23/12/2018 New Delhi - India Organized by: ADITI (Association of Dental Industry & Trade of India) #3, LSC, MOR Land, Near J Block, New Rajinder Nagar, New Delhi - 110060 India Email: secretary@aditidental.co.in Phone: +91 11 45551200, 9599189519 Fax: +91 11 45551222 Venue: Pragati Maidan Hall No. 8,9,10,11,12 & 12A New Delhi India

www.expodent-india.com

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Now you can get directly to Italy 现在你可以直接去意大利

redazione@infomedix.it

Whatsapp: +39 366 7456196

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Shenpaz Dental Ltd., with over 30 years of dedication and passion in designing and manufacturing of dental furnaces, proudly unveils the ALL NEW BLAZIR.

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It’s all about simplicity, accessibility and intuitiveness. The full 7” touch screen is user friendly with a superbly comfortable interface.

BLAZIR is the perfect solution for sintering zirconia requiring up to 1530°C maximum temperature with the ability to sinter full loads in 4 hours.

BLAZIR is equipped with VIA™ system, a bridge to simple sintering option. The programming methodology is designed to assist the operator of the furnace by recommending the most adequate sintering program.

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