Ⅱ类洞三明治修复方法改进的临床观察

Clinical Observation of Improvement of Class II Cavity sandwich Filling Technique

目的:简化传统Ⅱ类洞三明治修复方法及防止充填后出现术后敏感和龈壁继发龋。方法:按纳入标准选择门诊就诊患者患牙300颗(267位患者),随机分为实验组1、实验组2和对照组。实验组1:把树脂增强型玻璃离子充填至整个窝洞壁,光照固化后,不作酸处理、不涂粘接剂,直接充填复合树脂;实验组2:对实验组1的玻璃离子进一步树脂增强,把复合树脂一部分深入到树脂增强型玻璃离子内,另一部分露在窝洞内;对照组按传统方法充填。12个月后复诊,评价。结果:实验组复合树脂与树脂增强型玻璃离子界面间无1例出现分离现象。实验组1有4颗龈壁继发龋,1颗充填物脱落,1颗边缘密合度缺陷,1颗边缘着色,成功率92.47%;实验组2有1颗充填物脱落,1颗边缘密合度缺陷,2颗边缘着色,成功率95.79%;对照组有4颗术后敏感,4颗龈壁继发龋,1颗充填物脱落,1颗边缘密合度缺陷,2颗边缘着色,成功率86.96%。实验组2与对照组差异有统计意义(P<0.05),实验组1与对照组差异无统计意义(P>0.05)。结论:实验组中复合树脂与树脂增强型玻璃离子能牢固结合。实验组1与对照组比较,能简化操作,防止术后敏感,但不能防止龈壁继发龋。实验组2与对照组比较,能简化操作,防止术后敏感和龈壁继发龋。

Objective： To simplify the traditional Class II cavity sandwich filling technique and to prevent the postoperative sensitivity and secondary caries in the gingival walls. Methods：267 out patients’ 300 involved teeth that met the inclusion criteria were randomly divided into experimental group I, experimental group II and the control group. In the experimental group I, the cavities were treated with light cured RMGIC on the whole inner walls and directly filled with composite resins without etching and bounding. In the experimental group II, the RMGIC used in the experimental group I was further strengthened by adding the composite resin （half of the composite resin was put deeply inside the RMGIC and the other half was exposed in the cavity）. In the control group, traditional filling methods were used. The patients were recalled and evaluated after 12 months. Results：In the experimental groups, no separation occurred in the boundary surface between the composite resin and the RMGIC. In the experimental group I, 4 teeth showed secondary caries in the gingival walls, another tooth exhibited marginal sealant defect, 1 other teeth showed marginal discoloration, and 1 restoration dropped out （success rate：92.47%）;In the experimental group II, one restoration dropped out, 1 tooth exhibited marginal sealant defect, 2 other teeth showed marginal discoloration （success rate： 95.79%）; In the control group, 4 teeth showed postoperative sensitivity, 4 teeth exhibited secondary caries in the gingival walls, 1 restoration dropped out, 1 tooth showed marginal sealant defect, 2 teeth exhibited marginal discoloration （success rate： 86.96%）. The difference between the experimental group II and the controlled group was statistically significant （P＆lt;0.05）. And no statistically significant difference was found between the experimental group I and the controlled group （P＆gt;0.05）. Conclusion：The RMGIC and the composite resin used in the experimental groups can be firmly combined. Compared with the technique used in the control group, the method adopted in the experimental group I can simplify the operation and avoid postoperative sensitivity, but cannot help prevent secondary caries in the gingival walls. When the 2 methods used in the experimental group II and the control group were compared, the former can simplify the operation, avoid postoperative sensitivity, as well as avoid secondary caries in the gingival walls.