Clinical effect of onlay and fibre post-core crown in repairing tooth defect after root canal treatment
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摘要:
目的 对比观察高嵌体和纤维桩修复磨牙重度缺损的临床疗效。 方法 选择2017年1月—2018年12月在蚌埠医学院第一附属医院根管治疗后磨牙余留2~3个轴壁的患者为研究对象。共58例患者60颗患牙。随机分为高嵌体组(30颗)和桩核冠组(30颗)。采用改良USPHS对修复体的折断脱落、基牙的保存情况、边缘适应性、邻接关系和牙龈健康状况在术后6个月和12个月进行临床评估。 结果 6个月观察期内，桩核冠组和高嵌体组在牙体完整性和修复体完整性上均为100%，边缘适应性、邻接关系和牙龈健康状况上，桩核冠和高嵌体达A级分别为90%以上和95%以上，2组评分差异无统计学意义，12个月的观察随访里，2组评价指标比较差异均无统计学意义，2组修复体在修复体完整性和牙龈健康状况上各增加1例，其中桩核冠组较高嵌体组发生不良数量多且程度严重。 结论 在修复磨牙严重缺损修复中，使用全瓷高嵌体修复在邻接关系、牙龈健康状况较桩核冠修复更具优势。临床上在牙体大面积缺损修复上值得推广应用。 Abstract:Objective To compare the clinical efficacy of onlay and fibre post in repairing severe molar defects. Methods Patients with two to three axial walls left in molars after root canal treatment in the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2018 were selected as study subjects. Fifty-eight patients had 60 teeth, and they were randomly divided into onlay group and fibre post-core crown group. Modified USPHS was used to assess the fracture, abutment preservation, edge fitness, adjacency relationship and bleeding index at 6 and 12 months postoperatively. Results Six months during observation period, the tooth body integrity and restoration integrity for the onlay group and fibre post-core crown group were 100%. No difference was noted between the groups regarding the edge adaptability, syntopy and healthy gums. The pile nuclear crown and onlay were above A level for more than 90% and 95%, respectively. In the follow-up observation after 12 months, no difference was noted between the two groups in terms of evaluation indexes, restoration, integrity and gum health. In the post core crown group, the number of defects was large and the degree was serious. Conclusion In the restoration of severe molar defects, using all-porcelain onlay is more advantageous than the fibre post-core crown in the restoration of gingival health of adjacent teeth. It is worth popularizing and applying in repairing the large area defect of tooth body. -
Key words:
- Onlay /
- Fibre post-core crown /
- Tooth defect /
- Root canal treatment
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表 1 全瓷高嵌体和桩核冠修复后牙缺损的临床疗效的评价标准
评价指标 级别 临床指标 修复体完整性 A 修复体完整 B 有不影响美观/功能的缺损 C 有清晰可见影响功能的缺损 牙体完整性 A 牙体硬组织完整无缺损 B 牙体硬组织有不影响功能的裂纹和缺损 C 牙体硬组织有影响功能的缺损和折断 边缘适应性 A 冠边缘与牙体密合，不刮探针 B 冠边缘与牙体接触欠佳，刮探针 C 冠边缘与牙体接触不良，探针能插入冠与牙体之间 邻接关系 A 冠邻面接触良好，无嵌塞现象 B 冠邻面外形欠佳，有轻度嵌塞 C 冠邻面接触不良，有重度嵌塞 牙龈健康状况 A 牙龈组织健康 B 有轻度炎症，探诊时有少量出血，但不影响美观 C 修复后有明显红肿，出血、牙周袋加深或出现明显的龈萎缩 
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表 2 6个月复诊时2组牙缺损患者修复体状况评价[例(%)]
组别 例数 修复体完整性 牙体完整性 边缘适应性 邻接关系 牙龈健康状况 A级 B级 C级 A级 B级 C级 A级 B级 C级 A级 B级 C级 A级 B级 C级 桩核冠组 30 30(100.0) 0(0.0) 0(0.0) 30(100.0) 0(0.0) 0(0.0) 28(93.3) 1(3.3) 1(3.3) 28(93.3) 0(0.0) 2(6.7) 28(93.3) 1(3.3) 1(3.3) 高嵌体组 30 30(100.0) 0(0.0) 0(0.0) 30(100.0) 0(0.0) 0(0.0) 29(96.7) 1(3.3) 0(0.0) 30(100.0) 0(0.0) 0(0.0) 29(96.7) 1(3.3) 0(0.0) P值 0.999a 0.237a 0.999a 注：a为采用Fisher精确检验。
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表 3 12个月复诊时2组牙缺损患者修复体状况评价[例(%)]
组别 例数 修复体完整性 牙体完整性 边缘适应性 邻接关系 牙龈健康状况 A级 B级 C级 A级 B级 C级 A级 B级 C级 A级 B级 C级 A级 B级 C级 桩核冠组 30 29(96.7) 0(0.0) 1(3.3) 30(100.0) 0(0.0) 0(0.0) 28(93.3) 1(3.3) 1(3.3) 27(90.0) 1(3.3) 2(6.7) 27(90.0) 1(3.3) 2(6.7) 高嵌体组 30 29(96.7) 0(0.0) 1(3.3) 29(96.7) 0(0.0) 1(3.3) 29(96.7) 1(3.3) 0(0.0) 29(96.7) 0(0.0) 1(3.3) 28(96.7) 1(3.3) 1(0.0) Z值 0.607 1.009 0.478 P值 0.999a 0.544 0.313 0.633 注：a为采用Fisher精确检验。
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[1] ROETZER P L, GUPTA S, SCHULZE K A. Restoration of unusually shaped canals with post endodontic treatment: a review of progressive approaches[J]. Compend Contin Educ Dent, 2018, 39(6): e9-e12. http://europepmc.org/abstract/MED/29847960 [2] ALKHATRI R, SALEH A R M, KHEDER W. Evaluating fracture resistance and failure modes of root filled teeth restored with CAD/CAM-fabricated post and core[J]. Clin Cosmet Investig Dent, 2019, 11: 349-355. doi: 10.2147/CCIDE.S219712 [3] TEKIN S, ADIGUZEL O, CANGUL S, et al. Evaluation of the use of PEEK material in post-core and crown restorations using finite element analysis[J]. Am J Dent, 2020, 33(5): 251-257. http://www.researchgate.net/publication/344688138_Evaluation_of_the_use_of_PEEK_material_in_post-core_and_crown_restorations_using_finite_element_analysis/download [4] MUNAGA S, DAS A, KAUR T, et al. Comparative clinical evaluation of composite overcast gold post and core buildups in endodontically treated teeth[J]. J Contemp Dent Pract, 2018, 19(10): 1273-1277. doi: 10.5005/jp-journals-10024-2416 [5] 李金华, 马长柏, 张雄. 残根纤维桩核与邻牙联冠修复5年临床观察[J]. 中华全科医学, 2015, 13(7): 1101-1102, 1105. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201507022.htm [6] 戚岳孙, 吴晔, 李楠, 等. 纤维桩和铸造桩修复尖牙牙体缺损后牙本质受力的三维有限元分析[J]. 中国临床医学, 2016, 23(3): 278-281. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX201603005.htm [7] 赵灿灿, 胡伟平. 粘结系统对纤维桩核冠修复效果影响的研究进展[J]. 口腔医学, 2019, 39(1): 93-96. doi: 10.3969/j.issn.2095-7882.2019.01.068 [8] 冯明, 张国梅, 胡杨, 等. 近-中-远中洞型嵌体三维有限元模型及粘接界面的应力分析[J]. 中国组织工程研究, 2019, 23(14): 2183-2189. doi: 10.3969/j.issn.2095-4344.1650 [9] HAYES A, DUVALL N, WAJDOWICZ M, et al. Effect of endocrown pulp chamber extension depth on molar fracture resistance[J]. Oper Dent, 2017, 42(3): 327-334. doi: 10.2341/16-097-L [10] 陈岗, 陈志飞, 顾卫平, 等. 不同边缘设计椅旁CAD/CAM全瓷高嵌体修复的对比研究[J]. 口腔医学, 2015, 35(7): 550-552. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201507010.htm [11] 强卫林, 李雨轩, 刘刚, 等. 3种边缘设计铸瓷高嵌体修复不同程度缺损无髓磨牙的3年对比研究[J]. 华西口腔医学杂志, 2018, 36(5): 493-497. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201805010.htm [12] 张孝霞, 韩丁, 朱庆林, 等. 大面积缺损的下颌第一前磨牙桩核冠与高嵌体修复的三维有限元分析[J]. 牙体牙髓牙周病学杂志, 2018, 28(5): 265-269. https://www.cnki.com.cn/Article/CJFDTOTAL-YTYS201805003.htm [13] NAGASIRI R, CHITMONGKOLSUK S. Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study[J]. J Prosthet Dent, 2005, 93(2): 164-170. doi: 10.1016/j.prosdent.2004.11.001 [14] 张维波, 陈佳龙, 曹颖. 2种全瓷高嵌体修复无髓后牙牙体缺损的对比研究[J]. 中华全科医学, 2020, 18(6): 938-941, 1024. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202006015.htm [15] 陈宇, 李勉香, 张颖. 铸瓷高嵌体修复牙体严重缺损的年轻恒磨牙的效果分析[J]. 华西口腔医学杂志, 2019, 37(3): 299-303. https://www.cnki.com.cn/Article/CJFDTOTAL-HXKQ201903018.htm [16] 吴华英, 杜劲英, 刘进, 等. 全瓷高嵌体修复根管治疗后牙体缺损的临床效果评价[J]. 口腔医学, 2016, 36(12): 1118-1120. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201612014.htm [17] 张蕾, 茹菲亚·祖拉提, 何惠宇, 等. CAD/CAM全瓷髓高嵌体在牙体缺损中的临床应用研究[J]. 口腔医学, 2018, 38(6): 523-527. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201806010.htm [18] 高跃忠, 李丽. 全瓷高嵌体修复根管治疗后牙体缺损的疗效及对预后的影响[J]. 中华全科医学, 2019, 17(8): 1305-1307. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201908017.htm -
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