Embora pequeno, As cunhas dentárias desempenham um papel insubstituível na odontologia restauradora. Eles são usados principalmente para separação dentária, Estabilizar bandas de matriz e moldar as bordas das restaurações. Dependendo do material e do design, O desempenho clínico e o uso de cunhas variam. Neste artigo, Analisaremos sistematicamente os tipos de Fuas dentárias, suas propriedades materiais, suas principais funções e sua aplicação no preenchimento e restauração.
1. Tipos de cunhas dentárias e propriedades do material
Cardas dentárias de plástico
Material: Frequentemente feito de polipropileno médico (Pp), flexível.
Vantagens:
- A elasticidade moderada reduz a pressão nas gengivas.
- Pode ser esterilizado em altas temperaturas e é adequado para reutilização.
Desvantagens:
- Suporte limitado, Não é adequado para casos com cárie profunda ou lacunas apertadas.
Exibição de amostra:
- guardas dentárias (GD-5675): com buraco com rblade
três tamanhos: Grande/média/pequena
- cunhas adaptativas (GD-5677): com núcleo plástico interno firme, coberto com silicone
- Resina cunhas dentárias (GD-5678): quatro tamanhos, XS/S/M/L.
- Custas de diamante (GD-5679): sete tamanho, X-small/pequeno/médio/grande/profundo/L-medium/L-largo
- TULWAR CABELAS (GD-5680): três tamanhos, Pequeno/médio/grande
Cascas dentárias de madeira
Material: Principalmente bétula ou pinheiro, esterilizado. Cunhas de bétula com um teor de água de 12% pode expandir até 18.7% em 30 minutos em um ambiente fluido gengival. Esta propriedade adaptativa os torna particularmente adequados para casos de recessão gengival em pacientes antigos. No entanto, Cuidado deve ser tomado: A excesso de expansão pode levar a pressão excessiva na membrana periodontal, desencadeando sensibilidade pós -operatória.
Vantagens:
- Naturalmente absorvente e inchado, Melhor ajuste para a lacuna intraoperativamente.
- Rígido, Adequado para o suporte de alta força das cavidades de classe II.
Desvantagens:
- Inutilizável, exagerta pode causar desconforto.
Exibição de amostras:
Outros tipos
- Cunha de metal: Cru, comumente usado para preparação completa da coroa ou cenários restauradores especiais.
- Cunha de silicone: macio e flexível, Adequado para restaurações estéticas, mas mais caro.
2. As três funções principais da cunha de dente
Separação de dentes
- Separa temporariamente os dentes vizinhos por 0.2-0.5 mm com força mecânica leve para criar um espaço operacional.
- Isso impede que a restauração seja pendente e restaure a forma natural dos pontos vizinhos.
- Estudos clínicos mostraram que o uso adequado das cunhas pode reduzir o risco de impactação alimentar até 60%.
Estabilização da banda da matriz
- Fuas dentárias podem ajudar a consertar a peça de moldagem, impedindo o vazamento do material restaurador e moldando o contorno ideal.
- Restaurações de cavidade II: a combinação com o Bandas Matrix A estabilização é a solução clássica.
- Restaurações de classe V: geralmente em combinação com uma placa de moldagem curva.
Gum protection and hemostasis
- Dental wedges can provide a certain degree of protection above the gums.
- After the dental wedge is inserted into the tooth, it will exert a slight pressure on the gum, reducing bleeding during the operation.
3. Application Skills in Filling and Repair
Como escolher a cunha certa
| Critérios | Tipo de cunha recomendado |
|---|---|
| Espaço Interproximal estreito | Custas de madeira, it’s expand and fit together after getting wet |
| Amplo espaço interproximal | Cunha de plástico, elastic fit |
| Resina leve e curada | Clear plastic wedges, facilitate light penetration |
| Preenchimento de amálgama | Custas de madeira, it can offer stronger support |
Insert the Angle and direction
The dental wedge should be inserted obliquely into the interdental space from the lingual or buccal side of the tooth, and the Angle should be controlled at 30° to 45°. The core purpose of this Angle design is to avoid the gum tissue, prevent direct compression or scratching of the gum during vertical insertion, and reduce the risk of postoperative gum redness, swelling and bleeding.
Insertion depth control
The top of the wedge should be slightly higher than the edge of the restoration by approximately 0.5mm. This reserved space is designed to compensate for the shrinkage during the curing process of subsequent filling materials (como resina), ensuring that the material can closely adhere to the edge of the tooth after curing and avoiding the formation of gaps that could lead to secondary caries.
Clinical precautions
Avoid excessive pressure on the gums: Durante a operação, the insertion force of the dental wedge should be controlled. Excessive pressure can damage the attachment relationship between the gums and the teeth, which may cause postoperative gum recession. Clinical statistics show that the incidence of such complications is approximately 3% para 7%.
Precise positioning of the insertion position: If the dental wedge is inserted at an offset position (such as being too close to the occlusal surface or the root tip direction), it may cause the contact points of adjacent teeth to be too loose, thereby affecting the stability of the normal occlusal relationship. Patients may experience problems such as weak bite and food impaction.
Actual case: Repair of deep wedge-shaped defect
Taking the repair of a deep wedge-shaped defect of the left lower first premolar as an example, the specific operation and therapeutic effect are as follows:
- Preoperative assessment: The patient was a 45-year-old adult. The cervical defect of the left lower first premolar had reached the deep dentin, accompanied by obvious cold and heat sensitivity symptoms. The Visual Analogue Scale (VAS) was used to assess the sensitivity degree, with a score of 6/10.
- Key operation techniques: Primeiro, use the No. 00 gingival line for gingival drainage treatment. Então, insert a pre-moistened pine wedge and let it stand for 15 minutes until it fully expands to widen the tooth gap. Próximo, fluid resin is used as the base, and then 3M Z350XT resin is used for layered filling. The wedges should be retained until the resin has initially cured before being removed to prevent material deformation during the filling process.
- Postoperative efficacy: The patient was followed up for one year after the operation. The examination showed that the integrity rate of the restoration reached 98%, with no loosening, detachment or secondary caries. The patient’s cold and heat sensitivity symptoms completely disappeared, and the occlusal function returned to normal.
4. Purchasing Criteria for Dental Wedges
Prioridade de segurança do material
Core certification standards
The material and sterilization treatment of the wedge must comply with professional medical standards. Different materials correspond to clear certification requirements:
- Custas de plástico: Must have FDA (Food and Drug Administration of the United States) or CE (European Union Product Safety Certification) medical-grade polymer certification. The core needs to avoid harmful substances such as phthalates, which may migrate through contact and pose potential health risks. Compliance certification is the key basis for ensuring the safety of materials.
- Custas de madeira: A complete EO (ethylene oxide) sterilization report must be provided, and the report should clearly state that the biological load is ≤10⁻⁶ (Ou seja,, the probability of microbial survival after sterilization does not exceed one in a million), ensuring that there are no pathogenic bacteria remaining before use to avoid cross-infection or postoperative inflammation.
Key points to avoid pitfalls in procurement
Ao comprar, be cautious of non-medical grade products and especially reject “industrial wooden wedges” without any marking. Most of these products are made from leftover materials from industrial processing and have not undergone medical-grade treatment. They may contain harmful chemicals such as formaldehyde. When used, they not only easily irritate the gum tissue but may also be absorbed through the oral mucosa, posing a threat to the patient’s health. Além disso, there are no unified standards for their size and hardness, which cannot meet the precise operation requirements of dental restoration.
Maximize the size fit rate
When choosing wedges, it is necessary to combine the actual clinical needs and maximize the size fit rate through “preoperative assessment + multi-specification reserve”.
Before the operation, the size of the required wedge should be initially determined based on the width of the interdental gap of the affected tooth (such as the interdental caries gap, wedge-shaped defect gap) and the tooth morphology (such as deciduous teeth and permanent teeth, normal teeth and inclined teeth).
It is recommended to stock up on multiple sizes of wedges (such as thin, médio, espesso, or thin and thick styles for special tooth gaps) to avoid poor fit due to insufficient single size, which may affect the gap opening effect or cause gum compression. This ensures that a matching model can be found for different cases, improving operational efficiency and restoration quality.
5. Conclusão
Although dental wedges are small in size and seem insignificant, they are indispensable “key supporting roles” in dental restoration operations. From material selection to standardized use, precise control over every link is not only the core guarantee for enhancing the stability of the restoration and reducing postoperative complications, but also can effectively improve the patient’s diagnosis and treatment experience and lay a foundation for a long-term good prognosis.
