[Selection of restorative strategies for extensive tooth defects in young permanent molars].

内容摘要

Restoration of extensive defects in young permanent molars is more complex than that in mature permanent teeth. Young permanent teeth are characterized by insufficient enamel mineralization, large pulp chambers, short occlusogingival distance, and unstable gingival margins, limiting both mechanical retention and bonding conditions. In addition, individual factors such as patient cooperation, caries risk, and orthodontic needs further complicate treatment planning. Based on current clinical evidence, this review summarizes the indications, advantages, and limitations of direct adhesive restorations, preformed crowns, provisional crowns, inlays/onlays/overlays, endocrowns, and computer-aided design/computer-aided manufacturing (CAD/CAM) indirect restorations, proposing a clinical decision-making framework for extensive defects in young permanent molars. The proposed pathway follows a"three-level assessment and integrated decision-making"approach, in which the physiological characteristics of young permanent teeth, the objective condition of the affected tooth, and patient-and treatment-related factors are comprehensively evaluated to develop an individualized restorative plan. When moisture control is achievable and tooth conditions are favorable, adhesive restorations with cusp coverage can be selected. When moisture control is difficult or rapid restoration of coronal integrity is required, preformed metal crowns may serve as interim restorations. For non-vital teeth with short occlusogingival distance and insufficient retention, endocrowns may be considered. At present, CAD/CAM resin-ceramic indirect adhesive restorations have shown favorable short-to medium-term outcomes over 18-24 months; however, the long-term performance still requires further validation through multicenter studies with larger sample sizes. 年轻恒磨牙大面积牙体缺损修复较成熟恒牙更为复杂。年轻恒牙存在牙釉质矿化不足、髓腔宽大、(牙合)龈距离短及龈缘位置不稳定等特点，使机械固位与粘接条件受限；患儿配合度、龋风险及正畸需求等个体差异也会增加修复方案的选择难度。本文基于现有临床研究，系统梳理直接粘接修复、预成冠、临时冠、嵌体/高嵌体/超嵌体、髓腔固位冠及计算机辅助设计与辅助制作（CAD/CAM）间接修复的适应证、优势与局限性，并据此构建适用于年轻恒磨牙大面积缺损修复的临床决策体系。年轻恒磨牙大面积牙体缺损修复可遵循“三层评估，交叉决策”的临床路径，即综合考量年轻恒牙生理特点、患牙客观状况以及患者与治疗相关因素制订个性化方案。在隔湿可控且牙体条件允许时，可选择粘接性覆盖修复；隔湿困难或需快速恢复牙冠完整性时，金属预成冠可作为过渡性修复；(牙合)龈距离短且固位不足的无髓牙，可考虑采用髓腔固位冠。目前，CAD/CAM树脂陶瓷间接粘接修复已展现出良好的中短期（18~24个月）效果，但长期疗效仍需多中心、大样本研究进一步验证。.