Objective: To explore the digital design and fabrication technology of personalized restorative matrix for dental filling, and to explore the feasibility of direct resin restoration for deep caries lesions in distal neck of mandibular second molar. Methods: For patients with deep caries lesions in the distal neck of the mandibular second molar who visited the Department of Cariology and Endodontology of Peking University School and Hospital of Stomatology from September 2023 to April 2024, after preparing the cavity and gingival retractor, a three-dimensional intraoral scanner was used to obtain three-dimensional data of the patient's dentition. In the dental restoration computer-aided design software, the inlay function was used to generate the restored tooth morphology. The edge range of the personalized restorative matrix was drawn on the restored model by three-dimensional reverse engineering software to achieve edge sealing effect. The selected edge range data was processed with distal shelling to generate a digital model of a personalized restorative matrix with a thickness of 0.5 mm. A metal three-dimensional printer was used to fabricate the titanium alloy restorative matrix, and its application was completed in 10 clinical cases. The marginal adaptation and retention stability of the personalized restorative matrix were evaluated under a dental microscope, and forming effect evaluation was performed through immediate postoperative periapical radiographs. Results: The preliminary clinical application of the personalized restorative matrix fabricated using digital technology revealed that, in the treatment of 10 affected teeth, rubber dam isolation was successfully ensured, resulting in clinically effective direct resin composite restorations with optimal marginal adaptation and reasonable contours. Immediate postoperative periapical radiographs showed good convexity of the filling body, with no overhangs found. Both marginal adaptation and retention stability met the requirements of clinical treatment. Conclusions: The personalized restorative matrix designed in this study can solve the clinical problems of moisture separation and resin forming in the treatment of deep caries lesions in distal neck of the mandibular second molar, and can achieve stable and reliable adhesive restoration effects.
目的： 探索牙齿充填用个性化成形片的数字化设计和制作技术路径，并探讨其用于下颌第二磨牙远中颈部深龋损树脂直接粘接修复的可行性。 方法： 对2023年9月至2024年4月于北京大学口腔医学院·口腔医院牙体牙髓科就诊的下颌第二磨牙远中颈部深龋损患者，备洞排龈后使用口内三维扫描仪获取患者牙列三维数据。使用口腔修复计算机辅助设计软件的嵌体功能生成修复后牙齿形态，使用三维逆向工程软件于修复后模型上绘制个性化成形片的边缘范围，以达到边缘密合效果，对选定的边缘范围内数据进行远中向抽壳处理，生成厚度为0.5 mm的个性化成形片数字模型。使用金属三维打印机制作钛合金成形片，并完成10例临床病例的应用。牙科显微镜下评价个性化成形片的边缘密合性和固位稳定性，并通过术后即刻根尖片评价树脂成形效果。 结果： 数字化技术制作的个性化成形片临床初步应用显示，10颗患牙治疗中能保证橡皮障隔湿，实现边缘密合、外形合理的树脂直接粘接修复临床效果，术后即刻根尖片显示充填体外形凸度良好，均未发现悬突，密合性和固位稳定性均能满足临床要求。 结论： 本项研究设计的个性化成形片于下颌第二磨牙远中颈部深龋损治疗中可解决临床隔湿和树脂成形问题，并可获得稳定可靠的粘接修复效果。.