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ENGLISH ABSTRACT
基于修复体-牙-牙周界面的美学区固定修复诊断分型及边缘策略
林淑贤
刘伟才
作者及单位信息
·
DOI： 10.3760/cma.j.cn112144-20250118-00025
Margin strategies for fixed restorations in esthetic zone based on the restoration-tooth- periodontium interface relationship
Lin Shuxian
Liu Weicai
Authors Info & Affiliations
Lin Shuxian
Department of Prosthodontics, Shanghai Tongji Stomatological Hospital and Dental School, Tongji University & Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology, Shanghai 200072, China
Liu Weicai
Department of Prosthodontics, Shanghai Tongji Stomatological Hospital and Dental School, Tongji University & Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology, Shanghai 200072, China
·
DOI： 10.3760/cma.j.cn112144-20250118-00025
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摘要

固定修复中制订合理的边缘策略，获得修复体-牙-牙周（RTP）界面的协调关系，是实现修复成功及疗效长期稳定的关键。本文围绕这一核心问题，阐明理想的RTP界面关系，并详述基于RTP界面考量的美学区固定修复的生物学-美学双轴诊断分型，以及基于该分型的临床治疗决策及方案。进一步从如何降低RTP界面破坏、提升牙周软组织保护作用的角度，对美学区修复体的边缘策略及相应临床操作进行阐述。

美学，牙科;义齿修复术;美学区;固定修复;嵴上结缔组织厚度;修复体-牙-牙周界面关系;修复体边缘
ABSTRACT

Establishing a harmonious relationship between the fixed restoration-tooth-periodontium (RTP) at the interface is crucial for achieving successful and long-lasting outcomes in esthetic zone restorations. This paper focuses on this core issue by elucidating the ideal RTP interface relationship, detailing a biological-esthetic dual-axis diagnostic classification for esthetic zone restorations based on RTP interface situation, and discussing clinical decision-making and treatment plans guided by this classification. Furthermore, specific strategies for managing the restoration margins in the esthetic zone are explored, emphasizing approaches that minimize adverse impact and enhance periodontal soft tissue protection on RTP interface in different diagnostic categories.

Esthetics, dental;Prosthodontics;Esthetic zone;Fixed restoration;Supracrestal connective tissue thickness;Restoration-tooth-periodontium interface relationship;Restoration margin
Liu Weicai, Email: mocdef.3ab61igov, Tel: 0086-21-66315021
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引用本文

林淑贤,刘伟才. 基于修复体-牙-牙周界面的美学区固定修复诊断分型及边缘策略[J]. 中华口腔医学杂志,2025,60(04)：332-339.

DOI:10.3760/cma.j.cn112144-20250118-00025

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美学区固定修复的核心目标是在恢复或改善牙齿形态与功能的同时，最大限度满足美学需求并维护牙周健康。众所周知，修复体、牙体组织和牙周组织三者密切关联，其界面关系的协调性是实现美学效果、牙周健康和远期预后的关键。因此，制订美学区固定修复策略时，必须将修复体-牙-牙周（restoration-tooth-periodontium，RTP）界面关系的重要性置于核心地位，不应仅考虑修复体边缘形态、密合度等影响牙-修复体界面关系的因素，还应考虑修复体对周围软组织健康与稳定的影响。
当患牙牙周组织健康且现有龈缘位置形态与预期龈缘位置形态基本协调时，修复治疗相对简单。然而，牙周炎症、牙颈部龋、旧修复体不良边缘或牙萌出不全等情况，常导致患牙的现有牙龈性状及位置形态不符合预期，实现协调RTP关系的难度明显增大。因此，对美学区患牙进行准确的诊断分型，可为制订科学合理的治疗策略、重塑协调的RTP界面关系奠定基础。然而，现有的诊断分型多从龈缘位置或牙体缺损程度等单一角度出发，较少纳入牙周状况的考量，导致牙周-修复协同管理不足，不利于RTP界面重塑。此外，临床实际操作难以获得媲美天然牙-牙周关系的RTP界面；换言之，任何介入性的修复治疗均是对组织完整性的破坏，可给牙周以及牙体组织带来不稳定因素或造成不良影响。相反，充足的牙周软组织封闭厚度以及良好的牙龈表型则是保障RTP界面关系协调、实现牙周组织与牙-修复体复合体长期稳定共存的基础。因此，临床操作中还应制订合理的边缘策略，以减少介入性治疗的影响，同时维护甚至提升牙周组织的保护作用。
本文以重塑协调的RTP界面关系为核心，提出基于生物学和美学双轴考量的美学区固定修复诊断分型，阐明不同诊断分型的临床治疗方案；进一步从“攻-守”辩证的角度，阐述具体的边缘策略。通过强调RTP界面关系的重要性，为临床医师提供一种系统化思维框架，以在复杂多变的前牙美学修复中更好地平衡美学、功能与牙周健康的三重目标。
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备注信息
A
刘伟才，Email： mocdef.3ab61igov，电话：021-66315021
B

林淑贤：病例整理、完善文章构思、文章撰写及修改；刘伟才：文章主题与内容构思、临床病例的操作与收集、文章撰写指导、文章审核

C
林淑贤, 刘伟才. 基于修复体-牙-牙周界面的美学区固定修复诊断分型及边缘策略[J]. 中华口腔医学杂志, 2025, 60(4): 332-339. DOI: 10.3760/cma.j.cn112144-20250118-00025.
D
所有作者声明不存在利益冲突
E
国家自然科学基金 (82270998)
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