氧化锆和钴铬合金烤瓷髓腔固位冠修复磨牙牙体大面积缺损的临床疗效比较

王楠; 侯爱兵; 范蓬; 邢田; 张素梅; 郑和云

doi:10.16766/j.cnki.issn.1674-4152.002405

氧化锆和钴铬合金烤瓷髓腔固位冠修复磨牙牙体大面积缺损的临床疗效比较

doi: 10.16766/j.cnki.issn.1674-4152.002405

王楠^{1, 2, 3},
侯爱兵^{1, 2, 3, ,},
范蓬^{1, 2, 3},
邢田^{1, 2, 3},
张素梅^{1, 2, 3},
郑和云^{1, 2, 3}

1.
安徽医科大学口腔医学院, 安徽合肥 230032
2.
安徽医科大学附属口腔医院综合科，安徽合肥 230032
3.
安徽省口腔疾病研究重点实验室, 安徽合肥 230032

基金项目:

安徽省重点研究与开发计划项目 1704f080025

详细信息

通讯作者:
侯爱兵，E-mail：houaibing1964@sina.com

中图分类号: R783.3 R781.05
计量
- 文章访问数: 220
- HTML全文浏览量: 71
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-02
- 网络出版日期: 2022-08-20

Comparison of clinical efficacy between zirconia and Co-Cr alloy porcelain endocrown in restoring molars with large coronal destruction

WANG Nan^{1, 2, 3},
HOU Ai-bing^{1, 2, 3
, ,},
FAN Peng^{1, 2, 3},
XING Tian^{1, 2, 3},
ZHANG Su-mei^{1, 2, 3},
ZHENG He-yun^{1, 2, 3}

1.
Stomatological College of Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的探讨氧化锆和钴铬合金烤瓷髓腔固位冠修复磨牙牙体大面积缺损的临床疗效。方法选取2017年6月—2018年12月在安徽医科大学附属口腔医院口腔综合科诊治的110例患者130颗磨牙的临床资料，根据随机数表法随机分为氧化锆及钴铬合金烤瓷髓腔固位冠组，氧化锆髓腔固位冠组(A组)56例67颗磨牙；钴铬合金烤瓷髓腔固位冠组(B组)54例63颗磨牙，在修复完成后的1年进行随访，评估2种材料的修复效果，并对2组患者治疗后1年的牙周情况进行比较。结果氧化锆髓腔固位冠组患者在1年内共出现1例轻度边缘不密合、1例邻接关系微松、0例修复体或牙体存有轻微缺损及0例继发龋，钴铬合金烤瓷髓腔固位冠组患者在1年内共出现3例轻度边缘不密合、2例邻接关系微松、1例修复体或牙体存有轻微缺损及1例继发龋，差异均无统计学意义(均P>0.05)；氧化锆髓腔固位冠组患者治疗后的牙周探诊深度、龈沟出血指数和牙龈指数低于钴铬合金烤瓷髓腔固位冠组[(2.08±0.10)mm vs.(2.14±0.14)mm; 0.12 (0.04, 0.23) vs. 0.19 (0.05, 0.34);1.22±0.21 vs. 0.38±0.13, 均P < 0.05]。结论氧化锆髓腔固位冠修复磨牙牙体大面积缺损的预后恢复水平和修复效果较好。
- 氧化锆 /
- 钴铬合金烤瓷 /
- 髓腔固位冠 /
- 磨牙缺损
Abstract: Objective To investigate the clinical effect of zirconia and Co-Cr alloy porcelain endocrown in restoring molars with large coronal destruction. Methods Clinical data of 130 molars from 110 patients treated in the Department of General Dentistry of the Affiliated Stomatological Hospital of Anhui Medical University from June 2017 to December 2018 were selected and randomly divided into the zirconia and Co-Cr alloy porcelain endocrown groups. The zirconia endocrown group (Group A) with 67 molars (n=56) and the Co-Cr alloy porcelain endocrown (Group B) with 63 molars (n=54) were set using the random number table method. Follow-up was performed at 1 year after completion of restoration to evaluate the effect of the two types of material endocrown. The periodontal condition was compared between the two groups after 1-year treatment. Results During the 1-year recall period, 1 case of minor shortcomings in marginal adaptation and 1 case of slightly weak contact point without any restoration defect, tooth fracture and secondary caries were reported in the zirconia endocrown group. Meanwhile, 3 cases of minor shortcomings in marginal adaptation, 2 cases of slightly weak contact point, 1 case of restoration or tooth with slight defect and 1 case of secondary caries were reported in the Co-Cr alloy porcelain endocrown group. No statistically significant differences were found (all P>0.05). Periodontal probing depth, gingival sulcus bleeding index and gingival index were lower in group A than in group B [(2.08±0.10) mm vs. (2.14±0.14) mm; 0.12(0.04, 0.23) vs. 0.19(0.05, 0.34); 1.22±0.21 vs. 0.38±0.13, all P < 0.05]. Conclusion Zirconia endocrown is better than porcelain endocrown in restoring molars with large coronal destruction.
- Zirconia /
- Co-Cr alloy porcelain /
- Medullary cavity retentive crown /
- Molar defects

HTML全文

表 1 髓腔固位冠的USPHS标准

Table 1. USPHS criteria for medullary cavity retentive crown

评价指标	级别	临床指征
边缘适合性	A	边缘密合，无缝隙
	B	探针可及边缘，牙本质或基底材料未暴露
	C	探针可及边缘，牙体和修复体存有间隙，牙本质或基底材料暴露
邻接关系	A	正常邻接
	B	邻接微松
	C	邻接过松，导致食物嵌塞
折裂及固位	A	修复体无折裂，牙体完整
	B	修复体表面隐裂或存有轻微缺损，调磨后不影响使用
	C	修复体或牙体部分折裂或者脱落，影响使用，需重新修复
继发龋	A	修复体周围无龋坏
	B	修复体周围有龋坏

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表 2 2组磨牙牙体大面积缺损患者临床效果比较[颗(%)]

Table 2. Comparison of clinical effects of two groups of patients with large molar defect [teeth (%)]

组别	颗数	轻度边缘不密合	邻接关系微松	修复体或牙体存轻微缺损	继发龋
A组	67	1(1.5)	1(1.5)	0	0
B组	63	3(4.8)	2(3.2)	1(1.6)	1(1.6)
P值^a		0.354	0.523	0.999	0.999
注：^a为使用Fisher精确检验。A组为氧化锆髓腔固位冠组，B组为钴铬合金烤瓷髓腔固位冠组。

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表 3 2组磨牙牙体大面积缺损患者治疗前后牙周情况比较(x±s)

Table 3. Comparison of periodontal conditions before and after treatment in the two groups of patients with large area of molar defect(x±s)

组别	颗数	PD(mm)		SBI		GI
组别	颗数	治疗前	治疗后	治疗前	治疗后	治疗前	GI治疗后
A组	67	2.01±0.14	2.08±0.10	0.72(0.49, 0.93)	0.12(0.04, 0.23)	1.17±0.18	1.22±0.21
B组	63	2.03±0.12	2.14±0.14	0.74(0.52, 0.95)	0.19(0.05, 0.34)	0.32±0.08	0.38±0.13
统计量		-0.873^a	-2.796^a	-1.013^b	-2.347^b	35.138^a	27.597^a
P值		0.385	0.006	0.221	0.013	< 0.001	< 0.001
注：^a为t值，^b为Z值。A组为氧化锆髓腔固位冠组，B组为钴铬合金烤瓷髓腔固位冠组。

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参考文献(22)

[1]	李韦萱, 金巨楼, 赵楚翘, 等. 桩核冠、髓腔固位冠和嵌体冠修复低矮磨牙残冠后产生的生物力学效应比较及其临床意义[J]. 吉林大学学报(医学版), 2020, 46(4): 828-833. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB202004026.htm LI W X, JIN J L, ZHAO C Q, et al. Comparison of biomechanical effects of repairing lower molar residual crowns among post-core crown, endocrown and inlaycrown and their clinical significances[J]. Journal of Jilin University (Medical Science Edition), 2020, 46(4): 828-833. https://www.cnki.com.cn/Article/CJFDTOTAL-BQEB202004026.htm
[2]	李建宾, 陈维毅, 姚蔚. 髓腔壁缺损对下颌前磨牙髓腔固位冠修复应力的影响[J]. 太原理工大学学报, 2018, 49(1): 158-163. https://www.cnki.com.cn/Article/CJFDTOTAL-TYGY201801026.htm LI J B, CHEN W Y, YAO W. Influence of cavit y wall defect on stress distribution in the mandibular premolar restored with endocrown[J]. Journal of Taiyuan University of Technology. 2018, 49(1): 158-163. https://www.cnki.com.cn/Article/CJFDTOTAL-TYGY201801026.htm
[3]	袁巧云. 铸瓷髓腔固位冠修复联合一次性根管填充治疗磨牙重度缺损的临床效果[J]. 临床医学研究与实践, 2019, 4(5): 89-90. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201905037.htm YUAN Q Y. Clinical effect of casting porcelain pulp cavity retention crown combined with one-off root canal filling on severe molar defect[J]. Clinical Research and Practice, 2019, 4(5): 89-90. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201905037.htm
[4]	李学盛, 李鸿波. 不同厚度内冠对钴铬合金烤瓷髓腔固位冠金瓷结合强度的影响[J]. 口腔医学, 2018, 38(10): 890-893. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201810008.htm LI X S, LI H B. Influence of inner crown thickness on the bonding strength of porcelain fused to Co-Cr alloy endocrown[J]. Stomatology, 2018, 38(10): 890-893. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYX201810008.htm
[5]	ESQUIVEL-UPSHAWA J F, KIMA M J, HSU S M, et al. Randomized clinical study of wear of enamel antagonists against polished monolithic zirconia crowns[J]. J Dent, 2018, 68(1): 19-27.
[6]	HARSHA M S, PRAFFULLA M, BABU M R, et al. The effect of cavity design on fracture resistance and failture pattern in monolithic zirconia partial coverage restorations-an in vitro study[J]. J Clin Diagn Res, 2017, 11(5): 45-48.
[7]	张君侠, 王迎霞, 陈怡丹, 等. 铸瓷和氧化锆髓腔固位冠治疗磨牙缺损的临床疗效对比[J]. 安徽医学, 2019, 40(7): 809-811. doi: 10.3969/j.issn.1000-0399.2019.07.028 ZHANG J X, WANG Y X, CHEN Y D, et al. Clinical comparison of cast porcelain and zirconia pulp cavity retention crowns in the treatment of molar defects[J]. Anhui Medical Journal, 2019, 40(7): 809-811. doi: 10.3969/j.issn.1000-0399.2019.07.028
[8]	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. doi: 10.16766/j.cnki.issn.1674-4152.001397 ZHANG W B, CHEN J L, CAO Y. The comparative study on restoring pulpless posterior tooth defect with two kinds of ceramic onlays[J]. Chinese General practice, 2020, 18(6): 938-941, 1024. doi: 10.16766/j.cnki.issn.1674-4152.001397
[9]	曾翠敏, 崔凤林, 徐志媛, 等. 不同髓超嵌体在根管治疗后磨牙牙缺损修复效果及预后分析[J]. 临床口腔医学杂志, 2020, 36(7): 409-412. doi: 10.3969/j.issn.1003-1634.2020.07.008 ZENG C M, CUI F L, XU Z Y, et al. Effect and prognosis of different types of endo-overlays in molar restoration after root canal therapy[J]. Journal of Clinical Stomatology, 2020, 36(7): 409-412. doi: 10.3969/j.issn.1003-1634.2020.07.008
[10]	KWON S J, LAWSON N C, MCLAREN E E, et al. Comparison of the mechanical properties of translucent zirconia and lithium disilicate[J]. J Prosthet Dent, 2018, 120(1): 132-137. doi: 10.1016/j.prosdent.2017.08.004
[11]	武庆华, 张晓东, 朱坤. 二氧化锆全瓷冠在前牙修复中的临床应用研究[J]. 中华全科医学, 2014, 12(6): 866-868. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201406011.htm WU Q H, ZHANG X D, ZHU K. Clinical application of zirconium dioxide all-ceramic crowns in restoration of anterior teeth. Chinese General practice[J], 2014, 12(6): 866-869. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201406011.htm
[12]	SKALSKYI V, MAKEEV V, STANKEVYCH O, et al. Features of fracture of prosthetic tooth-endocrown constructions by means of acoustic emission analysis[J]. Dental Materials, 2018, 34(3): 46-55. doi: 10.1016/j.dental.2018.01.023
[13]	EINHORN M, DUVALL N, WAJDOWICZ M, et al. Preparation ferrule design effect on endocrownfailtureresistance[J]. J Prosthodont, 2019, 28(1): 237-242. doi: 10.1111/jopr.12671
[14]	王之铭, 郭靖, 赵彤, 等. 不同边缘设计对钴铬合金烤瓷髓腔固位冠微渗漏影响的研究[J]. 中华老年口腔医学杂志, 2017, 15(1): 33-36. doi: 10.3969/j.issn.1672-2973.2017.01.010 WANG Z M, GUO J, ZHAO T, et al. The effect of different margin designs on the microleakage of Co-Cr PFM endocrowns[J]. Chinese Journal of Geriatric Stomatology. 2017, 15(1): 33-36. doi: 10.3969/j.issn.1672-2973.2017.01.010
[15]	GULIZ A, HATICE Y, KIVANC A. Mechanical failure of endocrowns manufactured with different ceramic materials: An in vitro biomechanical study[J]. J Prosthodont, 2018, 27(4): 340-346. doi: 10.1111/jopr.12499
[16]	赵楚翘, 徐一驰, 刘定坤, 等. 髓腔固位冠及桩核冠修复下颌第一磨牙大面积缺损的生物力学分析[J]. 口腔医学研究, 2018, 34(5): 17-21. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYZ201805018.htm ZHAO C Q, XU Y C, LIU D K, et al. Biomechanical analysis of repairing large area defects of mandibular first molar with endocrown and post-core crown[J]. Journal of Oral Science Research, 2018, 34(5): 17-21. https://www.cnki.com.cn/Article/CJFDTOTAL-KQYZ201805018.htm
[17]	李玉梅, 查年保. 两种材料髓腔固位冠修复老年人短冠磨牙的临床效果评价[J]. 中华老年口腔医学杂志, 2018, 16(4): 225-228. doi: 10.3969/j.issn.1672-2973.2018.04.009 LI Y M, ZHA N B. Clinical effect evaluation of endocrowns with two different materials restoring short crown molars in the aged[J]. Chinese Journal of Geriatric Stomatology. 2018, 16(4): 225-228. doi: 10.3969/j.issn.1672-2973.2018.04.009
[18]	胡振刚, 周宝, 梅林果, 等. 二氧化锆全瓷冠在前牙冠折美容修复中的临床应用[J]. 安徽医药, 2017, 21(8): 1426-1428. doi: 10.3969/j.issn.1009-6469.2017.08.018 HU Z G, ZHOU B, MEI L G, et al. Clinical application of zirconia all-ceramic crown in cosmetic repair of anterior crown[J]. Anhui Medical and Pharmaceutical Journal, 2017, 21(8): 1426-1428. doi: 10.3969/j.issn.1009-6469.2017.08.018
[19]	林志明, 陈宏柏, 彭秀燕. 两种冠修复材料对牙周状况及龈沟液中TWEAK、RANKL水平的影响[J]. 临床口腔医学杂志, 2019, 35(8): 467-470. doi: 10.3969/j.issn.1003-1634.2019.08.006 LIN Z M, CHEN H B, PENG X Y. Effect of two kinds of material crown restorations on periodontal status and the levels of TWEAK and RANKL in gingival crevicular fluid of patients with dental defects[J]. Journal of Clinical Stomatology, 2019, 35(8): 467-470. doi: 10.3969/j.issn.1003-1634.2019.08.006
[20]	CHEN Y W, MOUSSI J, DRURY J L, et al. Zirconia in biomedical applications[J]. Expert Rev Med Devices, 2016, 13(10): 945-963. doi: 10.1080/17434440.2016.1230017
[21]	TOPAL S C, TUNCER B B, ELGUN S, et al. Levels of cytokines in gingival crevicular fluid during rapid maxillary expansion and the subsequent retention period[J]. J Clin Pediatr Dent, 2019, 43(2): 137-143. doi: 10.17796/1053-4625-43.2.12
[22]	HAO Z, MA Y, LIU W, et al. Influence of low-temperature degradation on the wear characteristics of zirconia against polymer-infiltrated ceramic network material[J]. J Prosthet Dent, 2018, 120(4): 596-560. doi: 10.1016/j.prosdent.2017.12.014