不同显微微创去龋技术治疗老年根面龋的效果比较

Study of different micro-minimally invasive techniques in treatment of elderly root caries

目的 比较非创伤性修复技术(ART)、Carisolv Ⅲ化学机械去龋法、超声去龋法与传统车针去龋法配合口腔手术显微镜治疗老年根面龋的临床疗效。方法 选取解放军总医院第一医学中心口腔内科2019-12至2021-08就诊的≥60岁,诊断为根面龋的277例(患牙315颗)患者,按就诊顺序编号,采用随机数字表法分为4组,分别为A组(ART法69例,患牙79颗)、B组(Carisolv Ⅲ法67例,患牙76颗)、C组(超声法72例,患牙83颗)、D组(车针法69例,患牙77颗),分别以对应方法在口腔手术显微镜下去龋后,A组用富士Ⅸ玻璃离子水门汀进行充填,其余3组用3M复合树脂进行充填,记录术中各组去龋操作时间,术后疼痛视觉模拟评分法(VAS)分值,所有患者均进行针对性口腔卫生指导。分别于术后3、6、12个月回访,采用改良USPHS/Ryge临床评价标准对各组疗效进行评价。结果 去龋时间:B组[(5.1±1.7)min]> A组[(4.9±1.6)min]>C组[(4.5±1.2)min]>D组[(3.9±1.3)min],除A组与B组、A组与C组去龋用时的差异无统计学意义,其余各组间去龋时间两两比较差异均有统计学意义(P<0.05)。疼痛率:B组(17.91%)<A组(26.09%)<C组(40.28%)<D组(76.81%),A、B、C三组疼痛率与D组的差异有统计学意义(P<0.05),B组与C组疼痛率差异有统计学意义(P<0.05)。同时段内各组间、同组内不同时段比较修复体完整性、边缘密合性、边缘着色、继发龋、牙龈炎症、牙髓反应间的差异均无统计学意义。结论 在口腔手术显微镜配合下应用ART、Carisolv Ⅲ法、超声法去龋,除临床操作时间较传统车针法长,均能达到较满意的临床效果且无显著差异,同时患者术中疼痛发生率低、程度轻。这类显微微创去龋技术兼顾了老年根面龋患者疗效与舒适度,值得在临床推广。

Objective To evaluate the clinical effect of atraumatic restorative treatment(ART), Carisolv Ⅲ chemo-mechanical excavation, ultrasonic excavation and conventional excavation with handpieces & burs combined with dental operating microscope on elderly root caries by removal efficiency, pain degree and filling effect.Methods A total of 277 patients(315 teeth) aged 60 and above diagnosed with root caries in the department of stomatology of our hospital from December 2019 to August 2021 were numbered according to the order of visits and randomly divided into 4 groups using the random number table method: 69 patients(79 teeth) in Group A(the ART group), 67 patients(76 teeth) in Group B(the Carisolv Ⅲ group), 72 patients(83 teeth) in Group C(the ultrasonic group C), and 69 patients(77 teeth) in Group D(the conventional group). After removal of the caries by each minimally invasive technique and conventional excavation combined with dental operating microscope, the cavities were filled with Fuji Glass ionomer cement in group A and 3M composite resin in other three groups. The caries-removal time and patient self-assessment of pain by Visual Analogue Score in each group were recorded. All patients received specific oral health instruction. The follow-up was conducted 3 months, 6 months and 12 months and the clinical evaluations of restorations were carried out in accordance with modified USPHS/Ryge clinical evaluation criteria.Results The caries-removal time was Group B[(5.1±1.7) min]> Group A [(4.9±1.6) min]>Group C [(4.5±1.2) min]> D group [(3.9±1.3) min], difference between Group A and Group B, Group A and Group C was found to be statistically insignificant, but there were statistical differences among the other groups(P<0.05). Pain rate(mild and moderate pain) ranked as Group B(17.91%) < Group A(26.09%) < Group C(40.28%) < D group(76.81%), differences between all the minimally invasive technique groups(A, B, C) and conventional group(Group D) were statistically significant(P<0.05), the pain rate was also statistically less in Group B than Group C(P< 0.05). There were no statistical differences in the survival of restorations, marginal adaptation, marginal staining, secondary caries, gingival inflammation and pulp reaction among all groups at the same period, also within group at different period.Conclusions The application of ART, Carisolv Ⅲ chemo-mechanical excavation and ultrasonic excavation combined with dental operating microscope on elderly root caries can achieve satisfactory clinical effect without significant difference except that the caries-removal time are longer than that of conventional excavation with handpieces & burs. Meanwhile, the patients suffer less pain perception during operation. These micro-minimally invasive techniques can give consideration to the clinical effect and comfort of elderly patients with root caries, and are worthy of clinical promotion.