磨牙切牙釉质矿化不全的临床治疗研究

doi:10.7518/hxkq.2025.2025123

摘要/Abstract

摘要：

目的评价不同治疗方法对轻度磨牙切牙釉质矿化不全患者切牙局部斑块病损及第一恒磨牙窝沟封闭的疗效。方法选取临床确诊为轻度磨牙切牙釉质矿化不全患者为研究对象，对切牙局部斑块病损和第一恒磨牙窝沟进行前瞻性临床治疗对比研究。切牙局部斑块病损采用渗透树脂与含氟涂料2种方法进行治疗，术前及术后1、3、6月测量切牙局部斑块病损面积和病损区域的明度（L）、红绿色相（a）、黄蓝色相（b），计算色差值（ΔE）及牙齿白度指数（WI_D）。第一恒磨牙窝沟采用磷酸酸蚀窝沟封闭与免酸蚀窝沟封闭2种方法进行治疗，术后1、3、6月计算2种方法的患龋率、封闭剂保留率、窝沟封闭成功率等指标。结果轻度磨牙切牙釉质矿化不全患者切牙局部斑块病损，与术前相比，术后1、3、6月渗透树脂组斑块病损面积减小（P<0.05），L、ΔE值呈降低趋势（P<0.05），而涂氟组斑块病损面积、L值差异无统计学意义（P>0.05）。轻度磨牙切牙釉质矿化不全患者第一恒磨牙窝沟，磷酸酸蚀窝沟封闭术后6月的窝沟封闭成功率、窝沟封闭剂保留率高于免酸蚀窝沟封闭（P<0.05），窝沟封闭剂脱落率低于免酸蚀窝沟封闭（P<0.05）。结论渗透树脂治疗能减小轻度磨牙切牙釉质矿化不全患者切牙局部斑块病损L、ΔE值，渗透树脂治疗对斑块病损面积的改善更显著，且在6个月内效果较稳定。轻度磨牙切牙釉质矿化不全患者第一恒磨牙窝沟封闭建议采用磷酸酸蚀。

关键词: 磨牙切牙釉质矿化不全, 切牙局部斑块病损, 渗透树脂, 第一恒磨牙, 窝沟封闭

Abstract:

Objective This study aimed to evaluate the efficacy of different treatment methods on local plaque lesions of incisors and the sealing of pits and fissures in first permanent molars in patients with mild molar-incisor hypomineralization (MIH). Methods Patients clinically diagnosed with mild MIH were selected as research subjects for a prospective clinical comparative study on the treatment of local plaque lesions in incisors and the pits and fissures of first permanent molars. Infiltrative resin and fluoride varnish were used to treat local plaque lesions on incisors. The area of local plaque lesions on incisors and lightness (L), red-green hue (a), and yellow-blue hue (b) of the lesion area were measured before treatment and at 1, 3, and 6 months after treatment. The color difference value (ΔE) and tooth whiteness index (WI_D) were then calculated. Two methods, phosphoric acid etching pit and fissure sealing and self-etching pit and fissure sealing, were used for the treatment of pits and fissures of first permanent molars. The incidence rate of caries, sealant retention rate, and success rate of pit and fissure sealing for the two methods were calculated at 1, 3, and 6 months after treatment. Results In patients with mild MIH, local plaque lesions on incisors exhibited a significant reduction in area at 1, 3, and 6 months post-treatment in the infiltrative resin group (P<0.05), whereas no significant change was observed in the fluoride application group (P>0.05). After infiltrative resin treatment, the L value and ΔE value showed a decreasing trend (P<0.05), whereas the L value in the fluoride application group did not change significantly (P>0.05). In patients with first permanent molars, the phosphoric acid etching pit and fissure sealing group exhibited superior success and retention rates at 6 months post-treatment compared with the self-etching pit and fissure sealing group (P<0.05) and a lower loss rate than the self-etching pit and fissure sealing group (P<0.05). Conclusion Infiltrative resin treatment can reduce the L value and ΔE value of local plaque lesions on incisors in patients with mild MIH. It demonstrates a significant improvement in plaque lesion area, with relatively stable effects within 6 months. Phosphoric acid etching is recommended for the pit and fissure sealing of first permanent molars in patients with mild MIH.

Key words: molar-incisor hypomineralisation, local plaque lesions of incisors, infiltrative resin, first permanent molar, pit and fissure sealant

中图分类号:

R781.05

单小霞, 杨巧韵, 杨兴花, 杨雨欣, 马亚楠, 赵子昂, 李睿敏. 磨牙切牙釉质矿化不全的临床治疗研究[J]. 华西口腔医学杂志, 2026, 44(1): 137-143.

Shan Xiaoxia, Yang Qiaoyun, Yang Xinghua, Yang Yuxin, Ma Ya’nan, Zhao Ziang, Li Ruimin. Comparative study on the treatment of molar-incisor hypomineralization[J]. West China Journal of Stomatology, 2026, 44(1): 137-143.

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时间	渗透树脂	涂氟	P值
P值	<0.001	0.644
术前	0.10（0.07，0.13）	0.11（0.08，0.14）	0.169
术后1月	0.05（0.03，0.07）	0.10（0.08，0.14）	<0.001
术后3月	0.03（0.02，0.05）	0.10（0.08，0.13）	<0.001
术后6月	0.03（0.02，0.04）	0.10（0.08，0.13）	<0.001

治疗方法	参数	术前	术后1月	术后3月	术后6月	P值
渗透树脂	L	77.98±0.45	69.98±1.12	69.76±1.15	69.84±1.19	<0.001
	a	1.80±0.30	0.96±0.20	1.07±0.15	0.81±0.20	-
	b	25.32±0.92	22.93±0.87	23.60±0.93	23.16±0.83	-
	ΔE	7.15（6.27，10.65）	3.99（2.37，8.35）	4.50（2.91，8.88）	4.07（2.24，9.17）	0.001
	WI_D	8.93（2.68，14.67）	8.13（2.46，14.50）	6.96（4.16，11.84）	8.85（2.63，14.47）	0.926
涂氟	L	76.37±0.88	72.34±1.25	73.11±1.30	73.68±1.37	0.105
	a	2.38±0.17	2.34±0.16	2.30±0.15	2.30±0.15	-
	b	24.26±0.72	23.95±0.62	23.80±0.47	23.80±0.46	-
	ΔE	6.54（3.94，9.95）	4.19（2.79，6.82）	4.73（2.88，7.64）	4.43（2.40，8.41）	0.001
	WI_D	6.81±1.12	5.18±1.22	5.84±1.07	6.12±1.09	0.782

时间	P值（渗透树脂-涂氟）
时间	L	ΔE	WI_D
术前	0.103	0.141	0.393
术后1月	0.163	0.766	0.119
术后3月	0.057	0.443	0.270
术后6月	0.037	0.795	0.203

治疗方法	项目	术后1月	术后3月	术后6月
磷酸酸蚀窝沟封闭	患龋	0/0	0/0	4/10.81
	封闭剂完好	36/97.30	33/89.19	33/89.19
	封闭剂部分保留	1/2.70	2/5.40	1/2.70
	封闭剂保留	37/100	35/94.59	34/91.89
	封闭剂脱落	0/0	2/5.40	3/8.11
	窝沟封闭成功	36/97.30	33/89.19	29/78.38
免酸蚀窝沟封闭	患龋	0/0	1/3.23	2/6.45
	封闭剂完好	25/80.65	22/70.97	12/38.1*
	封闭剂部分保留	0/0	0/0	0/0
	封闭剂保留	25/80.65*	22/70.97*	12/38.1*
	封闭剂脱落	6/19.35*	9/29.03*	19/61.29*
	窝沟封闭成功	25/80.65	21/67.74*	10/32.26*