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复合流动树脂在纤维桩加固中的应用


  [摘要] 目的 研究复合流动树脂纤维加固中的应用效果。 方法 纳入2018年3月~2019年3月我院收治的100例牙齿损伤患者,将其随机分为实验组对照组,每组50例,实验组采用复合流动树脂对纤维桩进行加固,对照组采用超瓷树脂嵌体对纤维桩进行加固,记录两组纤维桩加固效果(成功和失败)及5 d、10 d、15 d的牙周情况牙龈出血情况。 结果 两组患者的治疗成功率、加固后牙周情况和牙龈出血情况比较,差异有统计学意义(P<0.05)。其中采用复合流动树脂对纤维桩加固成功例数较超瓷树脂嵌体多;且随着治疗时间延长,两组患者的牙齿松动程度和附着丧失均逐渐降低(P<0.05),且牙龈出血情况逐渐好转(P<0.05),但复合流动树脂对纤维桩加固效果更显著,且不存在纤维桩脱落现象。 结论 复合流动树脂在纤维桩加固中效果显著,可进行临床推广。
  [关键词] 复合流动树脂;超瓷树脂嵌体;纤维桩;加固
  [中图分类号] R781.1          [文献标识码] B          [文章编号] 1673-9701(2019)32-0071-04
  Application of composite flow resin in fiber pile reinforcement
  LU Wei
  Department of Stomatology, Jiamusi Hospital of Traditional Chinese Medicine in Heilongjiang Province, Jiamusi 154002, China
  [Abstract] Objective To study the application effect of composite flow resin in fiber pile reinforcement. Methods A total of 100 patients with tooth injury admitted to the hospital from March 2018 to March 2019 were enrolled and divided into the experimental group and the control group, with 50 patients in each group. The experimental group was used composite flow resin to reinforce the fiber piles, and the control group was used super-ceramic resin to reinforce the fiber piles. The fiber pile reinforcement effect (success and failure), periodontal conditions and bleeding of the gums at 5 d, 10 d, and 15 d were recorded. Results The treatment success rate, periodontal status, and gingival bleeding were significantly different between the two groups, with significant difference(P<0.05). Among them, the number of successful cases of fiber pile reinforced by composite flow resin was more than that of super-ceramic resin. And with the prolonged treatment time, the degree of teeth looseness and adhesion loss of both groups of patients gradually decreased (P<0.05) and the bleeding of gums gradually improved(P<0.05). But the effect of the composite flow resin on the fiber pile reinforcement was more significant, and there was no fiber pile falling off phenomenon. Conclusion The composite flow resin has a significant effect on fiber post reinforcement and can be clinically promoted.
  [Key words] Composite flow resin; Super-ceramic resin; Fiber pile; Reinforcement
  随着现代生活水平的提高,人们饮食结构的变化及其他口腔疾病带来的影响,牙体缺損的发病率居高不下,严重影响患者的饮食和面部美观程度[1-3]。随着现代医学技术的不断发展及临床试验研究发现,纤维桩是一种新型的非金属复合牙科修复材料,具有无金属腐蚀、不易被细菌等致病菌侵蚀、良好的生物相容性的特点,在临床上应用越来越广泛[4-6]。已有的临床试验证实,纤维桩与树脂相互作用效果更好,在治疗后不易出现纤维桩断裂、患者牙周疾病及牙龈出血的症状;也存在少许的不良现象,而不良现象的发生主要与所选材料、粘结物质、患者本身牙齿及纤维桩的品牌等有关[7-8]。近年来,复合流动树脂的应用备受青睐,治疗效果较好,为了进一步评价复合流动树脂对纤维桩加固的应用效果,本研究对100例牙齿损伤患者分别采用复合流动树脂和超瓷树脂嵌体对纤维桩进行加固,通过比较治疗效果、牙周情况和牙龈出血情况,研究复合流动树脂对纤维桩加固的应用效果,旨在拓宽复合流动树脂的临床应用范围,现报道如下。
  1 资料与方法
  1.1一般资料
  选择2018年3月~2019年3月我院收治的100例牙齿损伤患者进行研究。其中男58例,女42例,年龄20~70岁。按随机数字表法分为两组,其中,实验组患者50例,男32例,女18例,年龄21~70岁;对照组患者50例,男26例,女24例,年龄20~68岁。100例患者均存在牙齿损伤现象,牙髓活力正常,牙列无缺损,且缺损牙齿周围的其他牙齿均正常,均不存在牙龈红肿等其他牙齿疾病,同时排除缺损牙齿周围因其他牙齿不完整而无法进行实验者。两组患者的性别、年龄等一般资料比较,差异无统计学意义(P>0.05),具有可比性。
  1.2 方法
  1.2.1 基础处理  两组患者均接受根管治疗和纤维桩处理,酒精消毒后,采用粘合剂涂抹患者牙齿缺损处。
  1.2.2 纤维桩加固  基础处理后,实验组患者于根管预备位置加入复合流动树脂对纤维桩加固,确定好匹配的根管玻璃纤维桩之后,提前戒断,让桩核冠向的长度比咬合平面更低,再用75%乙醇消毒根管桩吹干备用。迅速调和3M通用自粘树脂型粘固材料。对照组患者采用超瓷树脂嵌体对纤维桩加固,在去干净腐质后,按照树脂嵌体洞型要求做好牙体预备工作,硅橡胶的印模,超硬石膏灌模和闭塞,然后将义齿送至加工厂完成制作,患者在临床试戴合适后,再开展粘接、调和、抛光,光照20 s。两组修复后均检查牙龈边缘是否紧密平整。
  1.3 评价指标[9]
  1.3.1 纤维桩加固效果  通过X线比较两组患者的纤维桩加固效果。其中纤维桩稳定且完整,无其他任何不适为成功;患者牙龈红肿,纤维桩不完整,牙齿缺损部位填充物出现脱落或牙齿周围出现其他病变为失败。
  1.3.2 纤维桩加固后牙周情况  对上述两组患者牙齿的纤维桩加固后,分别于5 d、10 d和15 d对患者的牙周情况进行检查,主要包括牙齿松动的程度、附着丧失和填充物是否脱落3个指标。
  1.3.3 纤维桩加固后患者牙龈出血情况  采用不同时间段患者牙龈出血情况作为评价指标,用牙龈出血评分进行评价,评分越低表示患者的牙龈出血状况越好。对上述两组患者牙齿的纤维桩加固后,分别于5 d、10 d和15 d观察患者的牙龈是否出血,若出血指数较高,则表明纤维桩加固效果较差。
  1.3.4 电镜扫描图比较  观察两组患者电镜扫描图的结果,对比粘结剂渗漏情况,以此判断患者的粘结效果。
  1.4 统计学方法
  采用SPSS20.0统计学软件进行数据统计分析,计量资料均以平均数±标准差(x±s)表示,采用单因素方差分析或t检验,计数资料用n(%)表示,采用χ2检验,P<0.05为差异有统计学意义。
  2结果
  2.1 两组治疗效果比较
  实验组45例成功,对照组36例成功,两组患者治療成功率比较,差异有统计学意义(P<0.05)。成功者不存在牙龈红肿及纤维桩不完整的现象,结果表明复合流动树脂对纤维桩的加固效果较超瓷树脂嵌体好,见表1。
  表1   两组患者治疗效果比较[n(%)]
  2.2 两组患者纤维桩加固前后牙周情况比较
  加固前,两组患者牙周情况比较,差异无统计学意义(P>0.05);两组患者在加固后5 d、10 d和15 d牙周情况比较,差异有统计学意义(P<0.05)。随着治疗时间延长,两组患者的牙齿松动程度和附着丧失均逐渐降低,但实验组效果更明显,实验组的牙齿松动程度由加固前的(80.02±1.23)%降低至(41.23±2.47)%,对照组由(81.02±2.15)%降低至(48.63±2.11)%,差异均有统计学意义(P<0.05),且实验组不存在填充物脱落现象,对照组患者则出现了纤维桩少许脱落的现象,见表2。
  表2   纤维桩加固后两组患者牙周情况比较
  2.3 两组患者纤维桩加固后牙龈出血情况比较
  纤维桩加固后两组患者牙龈出血情况比较,差异有统计学意义(P<0.05)。随着治疗时间延长,两组患者的牙龈出血情况逐渐好转,时间由5 d延长至15 d时,实验组由(1.50±0.11)分降低至(1.06±0.23)分,对照组由(1.78±0.02)分降低至(1.25±0.01)分,差异均有统计学意义(P<0.05),见表3。
  2.4两组患者纤维桩加固后电镜扫描图
  由牙齿纤维桩电镜扫描图可见,对照组患者出现粘结剂渗漏的现象。见图1。
  图1   牙齿纤维桩电镜扫描图(A为对照组,B为实验组)
  3 讨论
  近年来临床调查结果显示,牙体缺损成为较常见的一种口腔疾病,影响患者的生存和生活质量。同时随着现代医学技术的不断发展,患者对牙齿修复的要求越来越高[10-13]。因此在选择治疗牙体缺损的材料时不仅需要与口腔环境有较好的生物相容性,同时还要求其耐腐蚀性强,不易被细菌等致病菌侵蚀[14]。复合流体树脂由于其具有流动性,更易填充到缺损部位中,加强与缺损部位的接触程度,减少填充时的空隙现象,避免牙齿松动,且色泽稳定,能够提高修复效果[15-16]。因此,复合流体树脂被认为是目前临床牙体缺损的最常用材料。本研究通过对100例牙齿损伤患者分别进行复合流动树脂和超瓷树脂嵌体对纤维桩进行加固,观察纤维桩加固效果、牙周情况和牙龈出血情况。结果表明,采用复合流动树脂对纤维桩加固成功例数较超瓷树脂嵌体多,且治疗时间延长至15 d,两组患者的牙齿松动程度和附着丧失均逐渐降低,牙龈出血情况逐渐好转,但复合流动树脂对纤维桩加固效果更显著,其中牙齿松动程度由加固前的(80.02±1.23)%降低至(41.23±2.47)%,且不存在纤维桩脱落现象。因此,复合流动树脂对纤维桩加固的效果显著,可进行临床推广。
  根據上述结果及相关文献说明,复合流动树脂对纤维桩的加固作用较其他材料的效果更显著,安全性较高,且不易造成牙龈红肿、牙齿松动等不良现象的发生。然而若在治疗时操作水平较低,复合流动树脂的流动性较强,会使树脂不能完全填充到牙齿的缺损部位,导致效果变差,牙齿松动,也更易引发其他口腔疾病的发生[17-18]。因此,复合流动树脂也存在一些缺点,在使用时应尽量避免这些缺点带来的不利影响,这也是临床亟需解决的问题之一。
  从牙齿缺损的角度来讲,造成缺损的原因主要包括龋齿病、牙周组织损坏、牙齿断裂及由于年龄增长导致的牙齿部分脱落等[19-20]。给人们的日常生活带来极大的不便,如面部美观度下降、发音不标准及咀嚼功能下降,因此,应及时进行修复。牙齿修复所采用的材料应能够更好地适应口腔环境,填充效果好,避免并发症的出现。对于健康人群,则应注意早晚刷牙,饭后漱口及少吃较硬的食物、定期检查牙齿等,养成良好的生活习惯,保护好牙齿。另外,临床上在治疗牙齿缺损的同时应研发固定效果更好的材料,为牙科的不断发展奠定科学的理论基础。
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