乳磨牙牙髓切断术后预成冠修复的疗效评价

doi:10.7518/hxkq.2024.2024122

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (5): 652-659.doi: 10.7518/hxkq.2024.2024122

乳磨牙牙髓切断术后预成冠修复的疗效评价

邓舒曼¹(), 牛姗姗², 高奇³, 张莉¹(), 陈志晓¹, 刘梦¹

^1.深圳市儿童医院口腔科，深圳 518026
^2.深圳市龙华区人民医院口腔科，深圳 518109
^3.深圳市第二人民医院口腔病区，深圳 518029

收稿日期:2024-04-02 修回日期:2024-06-25 出版日期:2024-10-01 发布日期:2024-09-21
通讯作者: 张莉 E-mail:dengsm98@163.com;adazhangl@126.com
作者简介:邓舒曼，住院医师，硕士，E-mail：dengsm98@163.com
基金资助:
深圳市科技计划项目(JCYJ20230807093811023)

Efficacy evaluation of zirconia crown on primary molars with caries defects

Deng Shuman¹(), Niu Shanshan², Gao Qi³, Zhang Li¹(), Chen Zhixiao¹, Liu Meng¹

^1.Dept. of Stomatology, Shenzhen Children’s Hospital, Shenzhen 518026, China
^2.Dept. of Stomatology, The People’s Hospital of Longhua, Shenzhen, Shenzhen 518109, China
^3.Dept. of Maxillofacial Surgery, Shenzhen Second People’s Hospital, Shenzhen 518029, China

Received:2024-04-02 Revised:2024-06-25 Online:2024-10-01 Published:2024-09-21
Contact: Zhang Li E-mail:dengsm98@163.com;adazhangl@126.com
Supported by:
Shenzhen Science and Technology Program(JCYJ20230807093811023)

摘要/Abstract

摘要：

目的探讨金属预成冠（PMC）与全瓷预成冠（ZC）在儿童乳磨牙龋损中的修复疗效以及对牙周健康的影响，分析其可能的影响因素。方法本研究采用队列研究方法，收集2021年10月—2021年12月于深圳市儿童医院口腔科就诊的3~8岁患儿，下颌第一乳磨牙因龋损行牙髓切断术后进行PMC、ZC修复，共192例，包括PMC组96例（96颗龋齿），ZC组96例（96颗龋齿），分别于治疗后3个月、1年和2年进行临床检查，观察PMC组和ZC组的临床修复效果以及牙周状况，记录修复体是否完整、牙龈指数（GI）、探诊出血指数（BI）、菌斑指数（PLI）和世界牙科联盟（FDI）修复体各项性能评价指标。结果 PMC组与ZC组在修复后3个月、1年、2年的牙周健康指标差异无统计学意义（P>0.05）；经修复3个月、1年、2年后，PMC组GI、BI、PLI高于ZC组，差异有统计学意义（P<0.05）；而FDI修复体各项性能评分差异无统计学意义（P>0.05）。不同性别患儿在2组修复后，GI、BI、PLI差异均无统计学意义（P>0.05）。不同性别患儿在PMC修复后的FDI修复体各项性能评分差异无统计学意义（P>0.05）；在ZC修复后的FDI修复体各项性能评分中，女童评分高于男童，差异有统计学意义（P<0.05）。Pearson相关分析显示，PMC组年龄与GI、BI、PLI、FDI修复体各项性能评分均呈负相关，存在显著相关性（P<0.01），ZC组年龄与GI、BI、PLI、FDI修复体各项性能评分均无显著相关性（P>0.05）。结论 PMC与ZC可为乳磨牙龋损患儿提供较理想的修复手段。两种预成冠修复后的牙周健康状况趋于稳定，乳牙ZC组牙周健康状况优于PMC。患儿的年龄越大，PMC组牙周状况越好。

关键词: 金属预成冠, 全瓷预成冠, 牙龈指数, 探诊出血指数, 菌斑指数

Abstract:

Objective This study aimed to estimate the therapeutic effects of preformed metal crown (PMC) and prefabricated zirconia crowns (ZC) on decayed primary morals in children, as well as to analyze the possible influencing factors. Methods A retrospective cohort study was performed on the data of 192 patients (aged 3 to 8) in the Stomatological Department of Shenzhen Children’s Hospital from October 2021 to December 2021. The decayed mandibular first molars were selected and restored by vital-pulp therapy followed by PMC and ZC, including 96 cases (96 caries) in the PMC group and 96 cases (96 caries) in the ZC group. Oral clinical examination was performed at 3 months, 1 year, and 2 years after treatment, overwiewing the clinical therapeutic effects and periodontal status of PMC and ZC groups, as well as recording the crown integrity, gingival index (GI), probing bleeding index (BI), plaque index (PLI) and various prosthetic indices. Results No significance differences existed in the periodontal status of PMC and ZC groups at 3 months, 1 year, and 2 years after treatment (P>0.05). However, the GI, BI, and PLI in the PMC group were higher than those in the ZC group at 3 months, 1 year, and 2 years after treatment, and the difference was dramatically significant (P<0.05). No significances difference existed in various prosthetic indices (P>0.05), as well as in the GI, BI, and PLI, between the two groups (P>0.05). No significant differences existed in various prosthetic indices between genders after PMC restoration (P>0.05). The scores of girls in various prosthetic indices after ZC restoration were higher than those of boys (P<0.05). Pearson correlation analysis indicated an inverse correlation between age in the PMC group and the GI, BI, PLI, and FDI indices (P<0.01), rather than in the ZC group (P>0.05). Conclusion PMC and ZC can be applied to restore deciduous molar caries. The periodontal status of deciduous teeth in ZC group was superior to that in the PMC group. The periodontal status of deciduous teeth in PMC group may be stable with increased age.

Key words: preformed metal crown, prefabricated zirconia crown, gingival index, probing bleeding index, plaque index

中图分类号:

R788

邓舒曼, 牛姗姗, 高奇, 张莉, 陈志晓, 刘梦. 乳磨牙牙髓切断术后预成冠修复的疗效评价[J]. 华西口腔医学杂志, 2024, 42(5): 652-659.

Deng Shuman, Niu Shanshan, Gao Qi, Zhang Li, Chen Zhixiao, Liu Meng. Efficacy evaluation of zirconia crown on primary molars with caries defects[J]. West China Journal of Stomatology, 2024, 42(5): 652-659.

图/表 9

表 1

FDI修复体各项性能评价指标的评分标准

评价指标	非常满意（1分）	满意（2分）	临床可接受（3分）	临床不可接受（4分）	较差（5分）
美学评价指标
染色（表面、边缘）	无表面染色；无边缘染色	较少表面染色，抛光可轻易去除；较少边缘染色，抛光可轻易去除	较多表面染色，或同时存在于多颗牙，美观上仍可接受；边缘染色较明显，但美观上仍可接受	不可接受的表面染色，需行干预措施；明显的边缘染色，需行干预措施	严重的表面或深层染色，局部或广泛存在，局部干预无法解决；较深的边缘染色，局部干预无法解决
美学解剖形态	解剖形态完美	存在轻微偏差	存在偏差，美学上仍可接受	存在偏差且美学上不可接受，需要局部干预改正	存在较大偏差或丧失正常解剖结构，需要重新替换
功能评价指标
折裂与固位	无折裂或裂纹	头发丝样裂纹	涉及两处以上头发丝样裂纹或材料小块剥落但不影响边缘完整性及邻面接触	材料小块剥落且影响边缘完整性及邻面接触；修复体大块折裂（<修复体1/2）	修复体多处折裂，部分或全部丧失
邻面解剖形态	正常邻面接触点（牙线或2 μm金属片恰好通过；正常外形）	邻面接触点略紧（牙线或25 μm金属片通过略有阻力）；外形略有缺陷	邻面接触点薄弱，对牙齿、牙龈、牙周无害，50 μm金属片可通过；明显的外形缺陷	邻面接触很薄弱，咀嚼压力可能破坏邻面接触或造成食物嵌塞，100 μm金属片可通过；外形缺陷需要修补	邻面接触很弱，有明显食物嵌塞或牙龈炎症；外形缺陷需要替换
放射检查	无病理性改变，牙齿与修复体之间过渡协调	存在过多的修复材料，但在可接受范围内；修复体与牙体之间存在台阶<150 μm	边缘间隙<250 μm；修复体与牙体之间存在台阶<250 μm且无有害影响；材料阻射性差	边缘间隙>250 μm；多余材料无法移除；修复体与牙体之间存在台阶>250 μm且可调改	继发龋、较大间隙、较大悬突；根尖暗影；牙齿或修复体折裂
生物学评价指标
术后敏感及牙齿活力	无术后敏感，牙髓活力正常	术后短期轻微敏感，牙髓活力正常	中度术后敏感；延迟出现术后敏感，无主观不适，无需治疗	强烈的术后敏感；延迟出现术后敏感，有轻微主观不适；临床检测无症状，可采取干预措施但不需要替换修复体	剧烈的牙髓症状或牙髓坏死，需行根管治疗并替换修复体
继发龋、酸蚀症及磨耗	无继发龋或原发性龋坏	小且局部，包括脱矿、酸蚀症、磨耗	较大范围，包括脱矿、酸蚀症、磨耗（牙本质未暴露只需采取预防措施即可）	龋洞形成，可能存在隐匿性龋；酸蚀症暴露牙本质；磨耗暴露牙本质需行局部修补	深龋，牙本质暴露且无法获得直线通路，需要替换修复体
牙周健康	无牙垢、炎症及牙周袋	少量牙垢，无炎症（牙龈炎）及牙周袋；无悬突、间隙或不合适的解剖形态；存在悬突、间隙或不合适的解剖形态	龈乳头探诊出血指数高于正常水平或对照牙1級；无悬突、间隙或不合适的解剖形态；存在悬突、间隙或不合适的解剖形态	龈乳头探诊出血指数高于正常水平或对照牙1级以上，或牙周袋深度比对照牙深1 mm以上，需行干预措施；无悬突、间隙或不合适的解剖形态；存在悬突、间隙或不合适的解剖形态	严重牙龈炎或牙周炎；无悬突、间隙或不合适的解剖形态；存在悬突、间隙或不合适的解剖形态

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年龄/岁	性别		合计/n（%）
年龄/岁	男	女	合计/n（%）
合计	102	90	192
3~4	5	5	10（5.2）
4~5	21	30	51（26.5）
5~6	29	29	58（30.2）
6~7	22	16	38（19.8）
7~8	25	10	35（18.2）

组别	性别/n（%）
组别	男	女
PMC组	48（50）	48（50）
ZC组	54（56.2）	42（43.7）
χ2值	0.753
P值	0.386

组别	年龄/岁
组别	男	女
PMC组	5.79±1.16	5.43±1.15
ZC组	5.77±1.37	5.37±1.12
t值	0.07
P值	0.943

项目	组别	n	修复后3个月	修复后1年	修复后2年
GI	PMC	96	0.88±0.10	0.78±0.10	0.78±0.09
	ZC	96	0.44±0.10	0.34±0.10	0.31±0.10
	t值		-3.306	-2.893	3.652
	P值		0.002	0.005	0.001
BI	PMC	96	0.94±0.10	0.81±0.13	0.81±0.10
	ZC	96	0.44±0.10	0.41±0.14	0.34±0.11
	t值		-3.544	-2.060	3.008
	P值		0.001	0.044	0.004
PLI	PMC	96	1.63±0.08	1.69±0.11	1.69±0.14
PLI	ZC	96	0.78±0.13	0.94±0.14	0.97±0.11
	t值		-4.569	-4.128	5.361
	P值		0.000	0.000	0.000

组别	n	修复后3个月	修复后1年	修复后2年
PMC	96	2.09±0.06	2.03±0.15	2.09±0.13
ZC	96	1.97±0.10	2.28±0.10	1.91±0.15
t值		-0.994	-1.323	0.965
P值		0.325	0.191	0.338

乳磨牙牙髓切断术后预成冠修复的疗效评价

Efficacy evaluation of zirconia crown on primary molars with caries defects

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组别	性别	n	GI	BI	PLI	FDI修复体各项性能评分
PMC	男	48	0.81±0.08	0.83±0.09	1.69±0.09	2.13±0.08
	女	48	0.81±0.07	0.88±0.10	1.65±0.08	2.19±0.09
	t值		0.000	-0.313	-0.343	-0.520
	P值		1.000	0.755	0.732	0.604
ZC	男	54	0.31±0.07	0.33±0.08	0.78±0.10	1.81±0.10
	女	42	0.43±0.09	0.48±0.11	1.05±0.11	2.17±0.12
	t值		0.970	1.033	-1.850	-2.257
	P值		0.330	0.304	0.067	0.026

组别	年龄	n	GI	BI	PLI	FDI修复体性能评分
PMC	①3~4岁	7	1.50±0.22	1.67±0.81	2.33±0.21	2.83±0.30
	②4~6岁	56	0.98±0.04	1.02±0.06	1.85±0.06	2.23±0.07
	③6~8岁	33	0.46±0.06	0.49±0.11	1.30±0.09	1.95±0.09
	F值		16.119	11.304	15.738	7.717
	P值		0.000	0.001	0.019	0.001
	LSD		①>③、②>③	①>③、②>③	①>③、②>③	①>②>③
ZC	①3~4岁	6	0.25±0.25	0.25±0.25	1.00±0.00	2.00±0.00
	②4~6岁	58	0.39±0.08	0.43±0.10	0.89±0.10	1.93±0.11
	③6~8岁	32	0.33±0.09	0.36±0.11	0.89±0.12	2.03±0.13
	F值		0.205	0.205	0.043	0.180
	P值		0.815	0.815	0.958	0.835
	LSD		-	-	-	-

组别	项目	r值	P值	R²值	P值
PMC	GI	-0.558	0.000	0.327	0.000
	BI	-0.533	0.000	0.244	0.000
	PLI	-0.509	0.000	0.257	0.000
	FDI修复体性能评分	-0.324	0.002	0.094	0.002
ZC	GI	0.039	0.705	0.002	0.648
	BI	0.006	0.954	0.001	0.755
	PLI	0.017	0.870	0.001	0.764
	FDI修复体性能评分	0.106	0.303	0.010	0.321

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