【作者】 马丹；

【导师】 陈小冬；

【作者基本信息】 大连医科大学 ， 口腔临床医学， 2010， 硕士

【摘要】 目的：通过比较四种不同比色方法制作的烤瓷修复体与患者天然牙的色彩差异,来评价其用于牙科比色的可行性与合理性,从而选出一种更为准确便捷的比色方法。方法：选取在大连市口腔医院就诊的14例单侧上颌中切牙缺损、要求以镍铬合金烤瓷冠修复的患者为本实验研究对象,要求前牙缺损不超过2颗,单侧上颌中切牙缺损,同名牙牙冠活髓,发育正常,无龋坏,无充填物及修复体,颜色均匀,无异常牙色,表面无牙石及菌斑。牙齿排列整齐,无错位扭转,牙龈颜色正常,无正畸治疗史及漂白史。比色前对待测牙进行超声洁治,除去软垢。选择在天气晴朗的上午10：00至下午2：00临窗自然光下比色。医师和患者不穿明度特别高的衣服,不涂抹口红,且为患者胸前覆盖灰色的治疗巾。(1).临床医师比色法：由三位无视觉功能障碍,辨色力强,对色彩学有较丰富知识的修复科医师操作。按照明度、彩度、色相的顺序用Vita 3D-Master比色板进行选色。(2).技师参与比色：将制作义齿的技师邀请到临床,按照上述方法与医师共同选色。(3).仪器比色法：本实验选用Vita公司生产的分光光度计Vita Easyshade测量牙冠中1/3的L*、a*、b*值,每颗牙测量三次,取三次测量结果的平均值。(4).数码相机传递比色信息：将Vita 3D-Master比色板与患者待测牙的数码照片传到技师的电脑中,以此为参考,制作义齿。按照常规制作烤瓷修复体的方法进行牙体预备,邀请同一位有经验的技师用以上四种方法分别为每位患者制作烤瓷修复体。试戴时用双盲法调查患者的满意度。然后用Vita EasyShade测量四种方法制作的修复体中1/3的L*、a*、b*值。按公式计算出它们与天然牙的色差值,以SPSS11.5统计软件对其进行单因素方差分析结果：天然牙与四种比色方法制作的烤瓷冠之间的平均色差为：临床医师比色法5.68,技师参与比色法4.59,数码相机法3.39,仪器比色法5.96。其中由数码相机传递色彩信息的比色法与天然牙色差值最小,仪器比色法与天然牙色差值最大。数码相机组与技师参与组存在显著性差异,技师参与组与医师比色组存在显著性差异,医师比色组与仪器比色组不存在显著性差异。数码相片组的患者满意率高达85.71%,技师参与组为71.43%,医师比色组为64.29%,仪器比色组为57.14%。结论：数码相机传递色彩信息比色方法明显优于其他3组。有技师参与的比色法优于单纯临床医师的目视比色法。单纯临床医师目视比色法与电脑比色仪比色法无明显差别。更多还原

【Abstract】 Objective:Comparing the color difference values△E between natural teeth and PFM (porcelain-fused-to-metal restoration) producted by four different shade matchings, to evaluate the reliability and reasonability of tooth color matching by different methods.Methods:The experimental objects are 14 patients of one maxillary incisor dental defect, needing Ni-Cr ceramic restorations in Dalian Stomatology Hospital and every patient s incisor dental defect is less than two teeth. The same name tooth is existing, live and healthy. And there are no carious lesion and restoration in it. The color is uniform and normal. The surface have no dental calculus and plaque. The color of gingival is healthy and have no periodontopathy. Dentition is regular arrangement and no history of orthodontic or bleach treatment. The experimental teeth are ultrasonic scaled before color selection in order to remove soft dirt. All patients with lipstick removed and a grey bib covering the personal clothing are performed at the same period of time (10:00-14:00 hours) on clear days, under window daylight. (1) Clinician visual shade matching:The shade matching is performed by three clinicians with negative history of visual color deficiency and rich chromatics knowledge. Making shade matching with Vita 3D-Master shade guide in the follow orders:value, chroma, hue. (2) Technician participation color selection:The technician who will make the metal ceramic restorations is invited to participate color selection with the clinician as aforesaid methods.(3) Computer colorimeter color selection: The experiment use Vita Easyshade to determine the value of L*,a*, b* of the middle 1/3 of the tooth. Every tooth determines three times and the average values are the final results.(4) Digital camera color selection:The digital photographes of Vita 3D-Master shade guide and patients teeth are transmitted to the computer of technician by internet and used as the reference of restorations producted. The same technician product restorations with the four methods for every patient after tooth preparation as regular process. The satisfaction degree of patients are investigated by double-blind method when trying them in. Then the value of L*, a*, b* of the middle 1/3 of the restorations are determined by Vita EasyShade.The values of AE are calculated by equation and compared in One-Way ANOVA using SPSS 11.5 software.Results:The average color difference values△E between natural teeth and PFM producted by four different shade matchings:Clinician visual shade matching 5.68, Technician group 4.59, Digital camera group 3.39, Computer colorimeter group 5.96. The difference between Digital camera group and Technician group、Technician group and Clinician visual shade matching both have statistics significance(P<0.05). Clinician visual shade matching and Computer colorimeter group has no statistics significance (P>0.05).The satisfaction rate of patients:Digital camera group 85.71%, Technician group 71.43%.Clinician visual shade matching 64.29%, Com-puter colorimeter group 57.14%.Conclusion:Digital camera group is the best in shade selection. Technician group is better than clinician visual shade matching.The clini-cian visual shade matching and computer colorimeter group have no obvious difference.更多还原