窝沟封闭剂临床应用材料和方式及防龋效果的研究

发布时间：2018-10-05 14:07

【摘要】：龋齿作为口腔最常见疾病之一,其发生常常伴随疼痛、咀嚼、美观和交流障碍问题,影响正常生活,降低生活质量。已有的研究表明儿童和青少年恒牙窝沟封闭可以有效减少龋病的发生。窝沟封闭后的恒牙和未行窝沟封闭的恒牙相比,需要充填修复的可能更小,需要修复治疗的时间也会推迟,修复体的范围也更小。树脂和玻璃离子均可用于窝沟点隙的封闭。在本研究一时,有两种新型玻璃离子上市,glass-carbomer和Ketac Molar Easymix (KMEM)这两种新型玻璃离子和传统玻璃离子材料相比在物理机械强度上有很大的提高。本研究中将这两种窝沟封闭材料的保留率和防龋效果和临床上最常用的树脂材料作比较。另外还比较了一种新的玻璃离子应用方式,在应用于窝沟时在其完全固化前使用LED光照。即共四组窝沟封闭剂组,由于医学伦理学原因不设空白对照组,树脂组为对照组。我们希望实验的结果能够给于临床窝沟封闭剂防龋工作实际的指导,帮助临床医生针对国情,在没有有效的复查系统的情况下,选择更适用于社区和学校的窝沟封闭剂。另一方面,如果我们能了解具体造成材料之间保留率和防龋效果差异的原因,有助有目的性的改善材料的性质。同时,临床医生倾向于使用在口内效果有保障的材料。而作为牙科材料要求最高的性质就是耐磨性,决定了材料在口内的寿命。为了比较树脂和玻璃离子作为窝沟封闭剂时的耐磨性,我们将窝沟封闭后的离体牙置于体外模拟的咀嚼过程,加入磨耗性的介质以加快其磨耗过程。然后测量窝沟封闭剂材料德尔磨耗。轮廓扫描仪扫描磨耗前和磨耗后的牙合面,然后计算材料磨耗的平均高度。第一部分窝沟封闭防龋实验实验1：窝沟封闭剂4年保留率目的：研究假设是,高粘度玻璃离子和glass-carbomer窝沟封闭剂的牙合面和光滑面的完全和部分累计保留率均高于树脂窝沟封闭剂；LED光照后的高粘度玻璃离子窝沟封闭剂的牙合面和光滑面的完全和部分累计保留率均高于单纯的高粘度玻璃离子窝沟封闭剂。方法：共有405名儿童(平均年龄8岁)纳入随机临床试验。三名牙医对这些高患龋风险儿童实施第一恒磨牙窝沟封闭。于封闭后半年、1年、2年、3年和四年后对封闭剂保留情况进行评分。Kaplan-Meier生存分析、ANOVA和t检验用于最终的结果分析。结果：共有1304颗第一恒磨牙被封闭,四年后儿童和窝沟封闭剂的失访率分别为12.3%和15.4%。不论是根据传统的窝沟封闭剂评分标准还是改良标准,树脂窝沟封闭剂在牙合面和光滑面的完全和部分保留率最高,glass carbomer组窝沟封闭剂最低。光照后的高粘度玻璃离子窝沟封闭剂牙合面和光滑面的完全和部分保留率和无光照的高粘度玻璃离子并没有统计学差异。结论：四年后glass carbomer的保留率最低。LED光照不能提高高粘度玻璃离子窝沟封闭剂的保留率。实验2：窝沟封闭剂四年防龋效果目的：实验假说是,四年后,光照后的高粘度玻璃离子和glass-carbomer窝沟封闭剂,和比无光照的高粘度玻璃离子和树脂窝沟封闭剂相比,能保护更多窝沟点隙不发生和发展成牙本质龋。方法：共有405名儿童(平均年龄8岁)纳入随机临床试验。三名牙医对这些高患龋风险儿童实施第一恒磨牙窝沟封闭。于封闭后半年、1年、2年、3年和四年后对封闭剂保留情况进行评分。Kaplan-Meier生存分析、ANOVA和t检验用于最终的结果分析。结果：共有1304颗第一恒磨牙被封闭,四年后儿童和窝沟封闭剂的失访率分别为12.3%和15.4%。四年后有42名儿童发生包括39处牙合面和7处光滑面在内的共46处新生牙本质龋。光照后的玻璃离子组未发生牙本质龋的牙合面比例(98%)显著高于树脂组(96.4%)和glass-carbomer组(94.5%)。glass-carbomer组未发生牙本质龋的牙合面比例低于无光照的玻璃离子组(97.3%)。四组间未发生牙本质龋的光滑面比例没有统计学差异。意义：光照后的高粘度玻璃离子窝沟封闭剂预防牙本质龋的效果最好。第二部分：有树脂涂层的高粘度玻璃离子窝沟封闭剂体外磨耗实验目的：测试在高粘度玻璃离子窝沟封闭剂表面涂布树脂层后是否能增强其耐磨性,并与普通高粘度玻璃离子和树脂窝沟封闭剂的耐磨性作比较。方法：48颗外科拔除的第三磨牙分为三组,分别用树脂(Clinpro),普通高粘度玻璃离子(KMEM)和表面树脂涂层的高粘度玻璃离子(Equia系统)封闭牙合面。在RubRoll咀嚼模拟器和ACTA磨耗性混合液模拟临床磨耗过程。120,000个咀嚼周期后,用轮廓扫描仪测量窝沟封闭剂和釉质的平均高度损失。数据分析中使用配对t检验和ANOVA检验。结果：表面磨耗测量的重复性实验显示其可重复性良好(p=0.303)。三种材料平均磨耗高度分别为29.88μm (Clinpro),36.85μm (KMEM) and35.26μm (Equia系统),没有统计学差异。结论：表面树脂涂层的高粘度玻璃离子的耐磨性并不优于树脂或普通高粘度玻璃离子
[Abstract]:As one of the most common diseases in the oral cavity, dental caries often accompanies the problems of pain, depression, beauty and communication disorder, which affects the normal life and reduces the quality of life. It has been shown that the closure of permanent teeth fossa in children and adolescents can effectively reduce the incidence of dental caries. Compared with the permanent teeth closed by the pit ditch closed permanent teeth and the unlined pit ditch, the possibility of filling and repairing needs to be smaller, the treatment time needs to be repaired, and the scope of the restoration body is smaller. both the resin and the glass ions can be used in the pit-gap In this study, there are two new types of glass ionomer listed, glass-carbomer and Ketac Molar Easymox (KMEM), which have great physical mechanical strength compared with traditional glass ionomer materials. In this study, the retention rate and anticaries effect and the most commonly used resin materials were used in the study. In addition, a new method for the application of glass ion is compared, and the LED is used before it is fully cured when applied to the socket groove. No blank control group was set up for the reason of medical ethics. According to the group, we hope that the results of the experiment can be given to the actual guidance of the caries prevention work of the clinical pit and fissure sealant, which can help the clinician to select the socket seal more suitable for the community and the school in the absence of an effective review system. On the other hand, if we can learn more about the difference between the retention rate and the caries prevention effect between materials, it is helpful to improve the purpose. The nature of the material. At the same time, clinicians tend to use the effect in the mouth The highest quality of the dental material is wear resistance, and the material is determined. In order to compare the wear resistance of the resin and the glass ion as the groove sealant, we put the off-body tooth enclosed in the fossa in the process of in vitro simulation, and the wear-resistant medium was added to speed up. Its wearing course is measured, and then the groove sealant material is measured. Material Delwear. Profile scanner scans worn surfaces before and after wear, and then calculates material wear Average height of the first part. Experimental Study on the Closed Anti-caries Experiment of Sub-fossa 1: 4-year retention rate of pit-and-groove sealant: The assumption is that high-viscosity glass ionomer and glass-carbomer socket sealant have full and partial fatigue on the occlusal and smooth surfaces of the sealant. The retention rate is higher than the resin nest sealant; the total and partial cumulative retention of the high-viscosity glass ionomer socket sealant after LED illumination is higher than that of the single Pure high viscosity glass ionomer socket sealant. Method: A total of 405 children Children (mean age 8 years) were included in a randomized clinical trial. Three dentists were high on these The children with caries risk are closed with the first permanent molar fossa. Half year, 1 year, 2 years, 3 years after the closure. Retention of the sealant after year and four years. Kaplan-Meier survival analysis, A NOVA and t test were used for the final analysis of the results. Results: A total of 1304 first permanent molars were closed, and four years later the children and socket were sealed. The loss-of-visit rate of the closing agent was 12. 3% and 15. 4%, respectively. The lowest in the glass carbomer group, and the full and partial retention of the surface and smooth surface of the high-viscosity glass ionomer cement. and there was no statistical difference in the high viscosity glass ions without illumination.: After four years, the retention rate of glass carbomer is the least. LE D Illumination can't improve the high viscosity glass ion nest The retention rate of the fissure sealant. Experiment 2: The purpose of the four-year anti-caries effect of the pit and fissure sealant: the experimental hypothesis is that after four years, the high-viscosity glass ionomer and glass-carbomer after light irradiation dimple sealant, and high viscosity glass ions and trees that are less light Compared with the pit-groove blocking agent, it is possible to protect the gap of more fossa grooves from occurring and develop into dentin. Caries. Methods: A total of 405 children (mean age 8 years) were included. Randomized clinical trial. Three dentists performed the first permanent molar pit closure for children with high dental caries risk After half-year, 1-year, 2-year, 3-year, and four-year closure, the retention of the sealant was scored. Kap Allan-Meier survival analysis, ANOVA, and t test were used for final results analysis. Results: There were 1304 first constant After four years, the loss-of-visit rates of the children and the fissure sealant were 12. 3% and 15. 4%, respectively. There were 42 children with a total of 46 new dentinal caries, including 39 teeth and 7 smooth surfaces. The proportion of dental caries (98%) in the glass ionomer group after illumination was significantly higher than that of the resin group (96.4%) and the glass-carbomer group (94.5%). glass-carbo The ratio of occlusal surface of non-dentinal caries in mer group was lower than that of non-irradiated glass. The proportion of smooth surfaces between the four groups of non-dentinal caries was not lower than that in the group. Significance: Prevention of high-viscosity glass ionomer socket sealant after light irradiation The effect of dentin caries is best. Part 2: High viscosity glass ionomer cement with resin coating In vitro abrasion experiment purpose: Test in high-viscosity glass ionomer cement The wear resistance of the surface-coated resin layer can be enhanced, and compared with the wear resistance of the common high-viscosity glass ionomer and the resin dimple sealant. o) Common high viscosity glass ionomer (KMEM) and surface resin coated high viscosity glass ion (Equia system) closed denture face. Mix in Rubroll wear simulator and ACTA attrition Fluid simulation clinical wear process. 120,000 weeks After the period, the mean height loss of the groove sealant and enamel was measured with a contour scanner. Paired t-test and ANOVA test. Results: Repeatability of surface wear measurements showed good repeatability (p = 0.303). The average wear height of the three materials was 29. 88. m (Clinpro),36.85渭m (KMEM) and35.26渭m (Equ
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R781.1

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