正畸分牙恢复邻面接触关系的效果观察

Clinical evaluation of abnormal proximal contact restoration with orthodontic separators

目的观察牙体缺损修复中应用分牙法恢复邻牙异常邻面接触关系的效果。方法选择2015年1月至2017年12月于武汉市第一医院和台州恩泽医疗中心(集团)路桥医院口腔科就诊的邻面接触关系异常的牙体缺损患牙150例,按区组随机的方法分为分牙治疗组及常规治疗组各75例,常规治疗组直接进行树脂充填修复或桩冠修复,分牙治疗组根据邻牙倾斜及接触情况分别采用橡皮圈、分牙簧、铜丝等分牙后再行充填或桩冠修复,以恢复正常的接触点、邻接面及外展隙。经1个月随访,观察修复后的邻面接触松紧度、有无食物嵌塞和龈乳头炎及基牙和邻牙有无松动等情况。结果 72例患者最终完成分牙后修复。分牙治疗组邻面接触松紧度临床满意率为88.89%,高于常规治疗组的64.00%,差异有显著统计学意义(P<0.01);分牙治疗组治疗1个月后食物嵌塞发生率为12.50%,低于常规治疗组的28.33%,龈乳头炎发生率为7.14%,低于常规治疗组的21.67%,差异均有统计学意义(P<0.05);而基牙及邻牙松动不适发生率与常规治疗组比较,差异无统计学意义(P>0.05)。结论对邻面接触关系异常的患牙,可在严格选择适应证情况下选择分牙后再行充填或冠修复,其可较好地恢复正常接触点、邻接面及外展隙,从而避免食物嵌塞及龈乳头炎等并发症的发生。

Objective To evaluate the clinical effect of orthodontic separators on abnormal proximal contact restoration. Methods A total of 150 cases of teeth defect with abnormal proximal contact in Wuhan No.1 Hospital and Luqiao Hospital, Taizhou Enze Medical Center（Group） from Jan. 2015 to Dec. 2017 were randomly divided into the orthodontic separator group and the routine repair group by blocked randomization. The teeth defect in the routine repair group were prepared and filled by traditional resin filling or post crown rehabilitation, and the orthodontic group were prepared and filled by traditional approach after dividing teeth by using orthodontic rubber ring, tooth spring, orthodontic copper wire, according to the inclination and proximal contact, in order to restore normal contact points, adjacent surfaces and abduction gaps. The acceptable of proximal contact tightness, the incidence of food impaction, the incidence of gingival papillae and incidence of tooth mobility were compared in one-month follow-up. Results Finally, orthodontic separators was performed successfully in 72 cases, and the satiafaction rate of proximal contact tightness of orthodontic separator group was 88.89%, which was significantly higher than 64.00% in the routine repair group（P〈0.01）. The incidence of food impaction of orthodontic separator group was 12.50%, which was significantly lower than 28.33% in the routine repair group（P〈0.05）. The incidence of gingival papillae of orthodontic separator group was 7.14%, which was significantly lower than 21.67% in the routine repair group（P〈0.05）. There was no significant difference in the incidence of tooth mobility between the two groups（P〉0.05）. Conclusion For the teeth with abnormal proximal contact,the teeth defect could be filled by traditional approach after using orthodontic separators in the case of strict selection of indications. It can get higher rate of acceptable proximal contact, adjacent surfaces and abduction gaps, which can reduce the occurrence of food impaction and gingival papillae.