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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