阅读说明：本技术 一种减少粘接固位种植修复过程中残留粘结剂形成的方法 (Method for reducing formation of residual binder in bonding retention implant repair process ) 是由 王伟 周益锋 华锶滢 王诗莹 孙健 陈超群 茅彩云 顾新华 于 2021-06-22 设计创作，主要内容包括：本发明公开了一种减少粘接固位种植修复过程中残留粘结剂形成的方法。本发明通过采用CAD系统设计个性化基台和全冠修复体的同时数字化回切获得预粘接基台,无需重复扫描个性化基台,可简化步骤,提高精度。数字化精确制作的预粘接基台可根据粘接剂的性能,精准梯度预留30～100μm预粘接间隙(每10μm),可调节最终全冠粘接所需要的精确粘接剂体积,从而获得粘接固位和粘接剂溢出的平衡,在体外预粘接去除溢出的粘接剂后,迅速将全冠就位于口内个性化基台至初步硬固,去除冠四周多余水门汀,从而避免过量水门汀残留的发生。(The invention discloses a method for reducing the formation of residual binder in the process of bonding retention implant repair. According to the invention, the pre-bonded abutment is obtained by designing the personalized abutment and the full crown prosthesis by adopting the CAD system and simultaneously performing digital back cutting, so that repeated scanning of the personalized abutment is not required, the steps can be simplified, and the precision is improved. The digitalized and accurately manufactured pre-bonded abutment can reserve a pre-bonded gap (every 10 micrometers) of 30-100 micrometers in an accurate gradient mode according to the performance of an adhesive, the volume of the accurate adhesive required by final full-crown bonding can be adjusted, balance of bonding retention and adhesive overflow is obtained, after the overflowing adhesive is removed through in-vitro pre-bonding, the full crown is rapidly positioned in the mouth of the individualized abutment until the base is initially hardened, and redundant gatekeeper around the crown is removed, so that the residual occurrence of the excess gatekeeper is avoided.)

1. A method of reducing residual cement formation during an adhesive retained implant repair procedure, the method comprising the steps of:

1) a healing abutment is arranged on a patient, the temporary denture repair is not carried out, a mixed polyether silicon rubber closed impression is carried out on a double-diagnosis machine after healing for 2 weeks, and an ultra-hard plaster model is poured after the artificial gum is prepared;

2) scanning the gypsum model, introducing the gypsum model into a CAD system, selecting the position channel direction of the planting area, marking the edge line, designing and storing the personalized abutment (1) and the full crown restoration (2) in the planting area;

3) the screw channel of the personalized abutment part is sealed by adopting a scanning and cutting function, the condition of clinical sealed screw channel is simulated, and the sealed personalized abutment (3) and the implant substitute (4) are independently stored;

4) establishing a wax pattern reduction mode design scheme in a CAD system, selecting a PMMA material, introducing a stored implant substitute body (4) as a registered model and a sealed personalized base station (3) as a scanning wax pattern, setting a channel positioning direction (6) and drawing a margin line (5);

after the base design is finished, matching the base station with a scanning wax model, marking a gum penetrating part and a shoulder part of the base station as an unreduced area (7), and uniformly and gradiently reducing the axial wall and the top (8) of the base station;

the fused, saved and reduced restoration body is a pre-bonded abutment, and finally a personalized abutment (9), a pre-bonded abutment (10) and a full crown restoration body (11) which are designed in a digital mode are obtained;

5) after the individual base station (9) and the full crown prosthesis (11) are tried on, the torsion of the base station is adjusted to 35N cm, and a temporary sealing object is used for sealing a screw channel of the base station until the top of the base station is flush;

6) mixing glass ion cement, putting the cement into 1/2 inner crown volume cement, uniformly coating the inner wall of the crown, positioning the whole crown prosthesis (11) on the pre-bonding base station (10), pressing the cement to the cement (12), cleaning the overflow part, rapidly positioning the whole crown on the intraoral individualized base station (9) until the cement is initially hardened, and removing the redundant cement around the crown by using a probe, dental floss and super dental floss respectively.

2. The method of claim 1, wherein the step of reducing residual cement formation during the bonded retained implant repair comprises: the axial wall and the top (8) of the base station are uniformly reduced by 30-100 mu m in gradient, wherein the gradient is every 10 mu m.

3. The method of claim 1, wherein the step of reducing residual cement formation during the bonded retained implant repair comprises: the personalized abutment (9), the pre-bonded abutment (10) and the full crown prosthesis (11) are obtained by digital cutting of a CAD system at the same time.

Technical Field

The invention relates to a method for reducing the formation of residual binder in the process of bonding retention implant repair.

Background

The fixation and restoration supported by the implant mainly adopts two retention modes of bonding retention or bolt retention, although bolt retention is more advocated for the health of the implant, the bonding retention implant restoration cannot be completely replaced due to the limitations of the long axis and the implantation direction of the residual alveolar bone, particularly in the American area of anterior teeth. In addition, the adhesive retention implant has the advantages of keeping the integrity of the tooth appearance, avoiding the penetration of the joint surface, having stronger aesthetic property, reducing the operation time beside the chair and the like, so the adhesive retention implant has wide application in clinic.

The main defect of the cement retained implant repair is adhesive residue, and the local inflammatory progression which is thought to be caused is considered to be one of the important causes of peri-implantitis. At present, the pathogenesis of peri-implantitis caused by Residual cement (REC) is not fully understood, generally believed to be due to plaque accumulation during the years after the repair is complete. Because the clinical application of the bonded retained implant prosthesis is wide and cannot be completely avoided, the method for effectively treating the residual adhesive is very limited. Clinical REC is common, with 59.5% of these cement retained implants repairing adhesive residues, and 80% of these cases showing peri-implantitis symptoms.

Chaar et al, after studies on bonded-retention implant prostheses, showed that about 20% of the prostheses needed to be re-bonded, and residual cement often resulted in bone resorption greater than 2mm around the implant. In fact, the probability of REC generated by the clinical adhesive retention implant repair is far higher than that, due to the blocking of soft tissues, part of the cement is squeezed into a deep subgingival position due to the in-situ pressure, and an effective residual adhesive detection means is not available at present, but the REC is always found until the REC causes peri-implant inflammation. Therefore, as long as peri-implant soft tissue is present, REC is likely to occur. Once the cement residue occurs, inflammatory symptoms can appear in 4 months after the cement is bonded at the fastest time in the implant week, and some cases with cement residue can not show the radiological or clinical symptoms of peri-implant inflammation in an observation period of 29 months, which increases the difficulty in REC discovery and diagnosis, while the treatment after the cement residue is discovered is usually a remedial treatment and has great difficulty in recovering the defects of soft and hard tissues in the implant week.

How to control the overflow of the cement and reduce the residual adhesive around the implant is always an important problem for the implant repair doctors. Wadhwani et al found that different adhesive application patterns had an effect on adhesive spillage, while he also found that excessive adhesive spillage could be reduced by modifying the implant abutment, Patel et al reduced subgingival intrusion by creating a spill trough in the restoration or abutment to direct excessive adhesive spillage. In addition, researchers have also studied using rubber dams, teflon films, etc. to limit the intrusion of water gates into the subgingival region. The use of pre-adhesive treatment to control the amount of flutriatin has received much attention from scholars as compared to these highly technically sensitive and unstable preventative treatments. Compared with RECs of 4 different adhesive coating modes, Winston and the like prove that the application of the different adhesive coating modes can effectively reduce the quantity of the RECs, and particularly, the overflowing adhesive quantity can be reduced to the minimum by a pre-bonding method of firstly positioning the dental crown fully coated with the adhesive on an anode die prepared by silicon rubber and then bonding the dental crown. Yuzbasioglu et al demonstrated that the use of resin adhesive formulations can reduce adhesive bleed. In addition to abutment molding and resin pre-bonded abutments, silicone rubber, thermosetting plastics and self-setting temporary tooth plastics can be used to make pre-bonded abutments. The simple method for manufacturing the pre-bonding base station can effectively improve the efficiency by chair-side manufacturing and reduce the time and cost consumption, but the defects and bubbles of the pre-bonding base station are easily caused by the manufacturing, meanwhile, certain difficulty exists in controlling the pre-bonding clearance, the insufficient amount or excessive overflow of the water gate is easily caused, and the effect of pre-bonding treatment is reduced. Therefore, the accurate control of the pre-bonding gap to adjust the dosage of the cement accelerator before bonding to balance the excessive overflow and shortage of the cement is the key for successfully controlling the formation of the REC, and the data of the pre-bonding gap and a stable and reliable manufacturing method for data verification are not available at present. The pre-bonded gap obtained by applying the gap agent 3-4 times through the teflon film or the coping is very inaccurate and unstable.

Computer aided design and Computer aided fabrication (CAD/CAM) provide the possibility of obtaining pre-bonded abutments with high precision. CAD/CAM technology plays an increasingly important role in today's dental field, and a large number of research and clinical reports indicate that CAD/CAM can provide better precision and standardized high quality restorations for implant restoration. The study of Moldovan et al shows that compared with the conventional technician manufacturing, the zirconia all-ceramic crown prepared by CAD/CAM can reduce the bonding gap by 20-40 mu m, and has better bonding adhesion. The CAD/CAM can provide possibility for digitally manufacturing the personalized base station and the pre-bonding base station, and particularly in the aesthetic region of the anterior teeth, the personalized base station can obtain better aesthetic effect and is widely promoted. Lee et al have studied methods for fabricating pre-bonded abutments using digital technology, which have been introduced into CAD design systems by digital scanning of the final abutment and have used CAM cutting to obtain pre-bonded abutments. However, the two-step digital preparation of the pre-bonded stage will affect the pre-bonding gap due to the error finally generated by the digital scanning. Therefore, a perfect digital technology is explored to manufacture a more accurate pre-bonding base station, overflow of the water gate heater is more accurately controlled, and the avoidance of REC has important significance for guaranteeing the effect of the pre-bonding technology.

Therefore, the formation of REC in the bonding retention implant repair process is reduced, the incidence rate of peri-inflammation of the implant is reduced, and the method is very important for improving the long-term success rate of the bonding retention implant repair. The formation of RECs can be effectively reduced through the pre-bonding treatment, the defects and bubbles of the pre-bonded base station are easily caused by the existing pre-bonding treatment method, meanwhile, the control of the pre-bonding gap is difficult, the quantity of the water heater is easily insufficient or excessive, and the pre-bonding treatment effect is reduced. The two-step method for digitally preparing the pre-bonded base station needs to scan the personalized base station again and then cut, so that the operation steps are complicated, and the precision of the pre-bonded gap is reduced. Therefore, the method for obtaining the high-efficiency, accurate and reliable pre-bonding treatment by applying the digital technology has important significance for improving the clinical application effect.

Disclosure of Invention

In order to prevent periphyton caused by residual adhesive in the process of bonding, retaining, planting and repairing, the invention provides a method for manufacturing a pre-bonded abutment in a full-digital mode, so that the overflow of the adhesive in the process of bonding, retaining, planting and repairing is accurately controlled, and the residual adhesive is prevented from being formed.

The specific technical scheme of the invention is as follows:

1) the patient is healed with the abutment without temporary denture repair, the re-diagnosis machine is used for making the mixed polyether silicon rubber closed impression after healing for 2 weeks, and the superhard gypsum model is poured after the artificial gum is prepared.

2) Scanning the plaster model, guiding the plaster model into a CAD system, selecting the position channel direction of the planting area, marking the edge line, designing the personalized abutment and the full crown prosthesis in the planting area, and storing.

3) The screw channel of the personalized abutment part is sealed by adopting a scanning and cutting function, the condition of the clinical sealed screw channel is simulated, and the sealed personalized abutment and the implant substitute are independently stored.

4) Establishing a wax pattern reduction mode design scheme in a CAD system, selecting PMMA (polymethyl methacrylate) and other substitute materials, introducing a stored implant substitute as a deposit model and a sealed personalized base station as a scanning wax pattern, setting a channel-in-place direction and drawing a margin line;

matching the base station to a scanning wax model after the base design is finished, marking a gum penetrating part and a shoulder part of the base station as unreduced areas, and uniformly and gradiently reducing the axial wall and the top of the base station by 30-100 micrometers (the gradient is every 10 micrometers);

and storing the reduced restoration after fusion to obtain the pre-bonded abutment. Finally, the individual abutment, the pre-bonded abutment and the full crown restoration body which are digitally designed are obtained and are simultaneously obtained through digital cutting of a CAD system.

5) After the personalized abutment and the full crown restoration are tried on, the torsion of the abutment is increased to 35N cm, and the screw channel of the abutment is closed by a polytetrafluoroethylene film temporary sealing object until the top of the abutment is flush.

6) Mixing the glass ion cement, putting the cement into 1/2 inner crown volume cement, uniformly coating the inner wall of the crown, pressing the whole crown on the pre-bonded base station, until the cement overflows and is cleaned up, rapidly placing the whole crown on the intraoral individualized base station until the cement is initially hard, and removing the redundant cement around the crown by using a probe, dental floss and super dental floss respectively.

The invention has the beneficial effects that: according to the invention, the pre-bonded abutment is obtained by designing the personalized abutment and the full crown prosthesis by adopting the CAD system and simultaneously performing digital back cutting, so that repeated scanning of the personalized abutment is not required, the steps can be simplified, and the precision is improved. The pre-bonding abutment which is digitally and accurately manufactured can reserve a pre-bonding gap (every 10 mu m) of 30-100 mu m according to the performance of the bonding agent in an accurate gradient manner, the volume of the accurate bonding agent required by final full-crown bonding can be adjusted, so that the balance between bonding retention and bonding agent overflow is obtained, after the overflowing bonding agent is removed by in-vitro pre-bonding, the full crown is rapidly positioned in the mouth, the individualized abutment is initially hardened, and the excessive cement around the crown is removed by using a probe, a dental floss and a super dental floss respectively, so that the occurrence of excessive cement residue is avoided. Compared with the conventional clinical bonding method (after the cement is placed in the crown, the cement is directly placed in the mouth), due to the blocking of soft tissues, part of cement can be extruded into the deep part under the gum due to the in-place pressure, and the cement extruded into the deep part is difficult to clean.

Drawings

Fig. 1 shows a designed and manufactured personalized abutment and a full crown prosthesis.

Fig. 2 is a schematic diagram of the application software Cut scan function closing screw channel and respectively storing the personalized abutment and the substitute.

FIG. 3 is a flow chart of a fully digital pre-bonded submount, which includes (A) marking edge lines, (B) designing a substrate, (C) marking an unreduced area after the submount is generated, (D) reducing 50 μm to form a pre-bonded gap, and (E) simultaneously completing the pre-bonded submount.

FIG. 4 shows the full crown prosthesis and the pre-cemented abutment obtained in the step 4).

Fig. 5 is a flow chart of the process operation of the water heater.

FIG. 6 is a graph comparing the present invention with a prior art method.

Detailed Description

The invention is further described below with reference to the accompanying drawings.

The invention comprises the following steps:

1) the patient is healed with the abutment without temporary denture repair, the re-diagnosis machine is used for making the mixed polyether silicon rubber closed impression after healing for 2 weeks, and the superhard gypsum model is poured after the artificial gum is prepared.

2) Conventionally scanning the plaster model, introducing into a CAD system, selecting the position channel direction of the planting area, marking the edge line, designing and storing the personalized abutment 1 and the full crown prosthesis 2 in the planting area, and showing in figure 1.

3) The screw channel of the personalized abutment part is sealed by adopting a scanning and cutting function, the condition of the clinical sealed screw channel is simulated, and the sealed personalized abutment 3 and the implant substitute 4 are independently stored, as shown in figure 2.

4) Establishing a wax pattern reduction mode design scheme in a CAD system, selecting PMMA (polymethyl methacrylate) and other substitute materials, introducing a stored implant substitute 4 as a deposit model and a sealed personalized base station 3 as a scanning wax pattern, setting a channel positioning direction 6 and drawing an edge line 5.

After the base design is finished, the abutment is matched with a scanning wax model, the gum penetrating part and the shoulder part of the abutment on the abutment are marked as an unreduced area 7, the axial wall and the top 8 of the abutment are uniformly reduced by 30-100 mu m in a gradient way (namely reduced by 30 mu m, 40 mu m, 50 mu m, 60 mu m, 70 mu m, 80 mu m, 90 mu m or 100 mu m), and the reduced prosthesis is stored after fusion, namely the pre-bonded abutment. Finally, the individual abutment 9, the pre-bonded abutment 10 and the full crown prosthesis 11 which are designed in a digital mode are obtained and are digitally cut through a CAM system, and the numerical cutting is simultaneously obtained, and the numerical cutting is shown in the figure 3 and the figure 4.

In the embodiment, the pre-bonding clearance of 30-100 mu m (every 10 mu m) is uniformly and gradiently reduced by the axial wall and the top of the abutment, so that the generation of residual bonding agent can be effectively reduced, and meanwhile, the sealing property and the retention force of the edge of the prosthesis are not influenced; the pre-bonded abutment is obtained by designing the personalized abutment and the full crown prosthesis by adopting a CAD system and simultaneously performing digital back cutting, the personalized abutment does not need to be repeatedly scanned, the steps can be simplified, and the precision is improved.

5) After the personalized abutment 9 and the full crown prosthesis 11 are tried on, the torsion of the abutment is increased to 35N cm, and the screw channel of the abutment is sealed by temporary sealing objects such as polytetrafluoroethylene membrane and the like until the top of the abutment is flush.

6) Blending the glass ionomer cement according to a standard method, placing the cement into the cement with about 1/2 inner crown volume, uniformly coating the inner wall of the crown, positioning the whole crown 11 on the pre-bonded abutment 10, then pressing the whole crown until the cement 12 overflows and is cleaned up, quickly positioning the whole crown on the individualized abutment 9 in the mouth until the whole crown is initially hardened, and respectively removing the redundant cement around the crown by using a probe, dental floss and super dental floss, as shown in figure 5.

As shown in fig. 6, after conventional bonding, a great amount of cement overflows from the edge of the crown, and no bonding defect is formed (a); after the bonding of the invention, the bonding agent at the edge of the crown just seals the bonding gap, and no obvious water gate heater overflows (B).

In conclusion, the method described in the embodiment can effectively reduce the formation of residual binder in the bonding retention implant repair process, thereby reducing the incidence rate of peri-inflammation of the implant and improving the long-term success rate of the bonding retention implant repair.

The embodiments described in this specification are merely illustrative of implementations of the inventive concept and the scope of the present invention should not be considered limited to the specific forms set forth in the above description but rather by the claims and their equivalents.