采用ART技术封闭恒牙防龋的6年临床效果观察

ART sealants placed in Chinese school children——Follow up results after 6 years

目的:评价非创伤性充填(ART)技术对恒牙窝沟封闭后,封闭剂保留及新生龋损发生情况。方法:1996年在四川省德阳市4所中学选取12～13岁儿童140名作191个牙ART封闭。采用WHO的ART标准器械,德国ESPE公司生产的高强度玻璃离子材料,对选择的牙面窝沟进行封闭;操作者为经中等口腔专业训练的医生。封闭后每年对ART封闭及牙龋损情况进行评价。结果:封闭后1、2、4、6年的完整保留率分别为75.4%、62.5%、50.0%、34.6%;成功率分别为89.6%、78.8%、68.5%、57.9%。试验后1年没有新生龋牙的发生,试验后2、3年,龋患发生率分别为1.6%、2.8%。试验后4年龋病有明显增加,试验4、5、6年后,龋病发生率分别为8.5%、16.1%、15.0%。结论:ART封闭试验3年的保存率较高、新生龋发生率低;试验6年封闭剂保留率虽然有所降低,但其结果还是令人满意的,预防龋病的效果是显著的。但封闭物脱落3年后,若没有重新修复,新龋患率大幅度上升,作为恒牙龋病防治的措施是适合和可接受的;是一种适合于在学校、社区开展的有效、实用的龋病预防方法。

Objective：To assess whether ART sealants could be applied on children in school environment in China, and to evaluate long term effects of this treatments. Methods：The study was conducted in Deyang, Sichuan Province. Four dentists placed a total of 191 fissure sealants in 140 chihlren in four secondary schools. Standard instruments and procedures for ART were used. The material used was a high-strength glass-ionomer （ Ketac-Molara, ESPE）. The treatments were evaluated annually by the same dentist who was not involved in the treatment using explorers and mouth-mirrors. Results：The cumulative 1-year, 2-year, 4-year and 6-year complete survival rates of the sealants were 75.4% ,62.5% ,50.0% ,34.6% and the partial or complete retained survival rates were 89.6% , 78.8% , 68.5% and 57.9%. No incidence of new caries was occurred 1 year after ART sealants. The incidence of recurrent caries was very low after 2 and 3 years, which were 1.6% and 2.8% respectively. But there was a high increase of caries 4 years after sealants application. The prevalence of caries were 8.5% , 16. 1% , 15.0% respectively over 4, 5 and 6 years after ART sealants application. Conclusion：The ART approach fiw preventing teeth caries in school chihtrcn is effective and acceptable. The 3-year survival rates of the sealant are high with low prevalence of new caries. Six years after sealants application, the result is acceptable though there is a drop of survival rate. New caries is occurred with a highly increased prevalence three years after sealants missing without re-sealant. ART sealant is a simple, acceptable technique and is suitable for widespread application in China.