T-scan联合生物学标志对牙周炎患牙固定义齿修复的评价

Evaluation of Fixed Partial Dentures for Patients with Compromised Periodontal Condition Using T-scan and Biologic Marker

目的:通过T-scanⅢ对咬合力的控制和龈沟液中RANKL、OPG水平的变化及牙槽骨高度的测量评价牙周炎患者固定义齿的修复效果。方法:选择14例前牙缺失并需要固定义齿修复,但至少有一颗或多颗牙基牙牙槽骨吸收≥1/2而≤2/3的患者为受试对象,且将符合牙槽骨吸收≥1/2而≤2/3的基牙作为目标基牙,共20颗。患者经过彻底的牙周治疗并将牙槽骨吸收严重的牙进行去髓术后,行前牙固定义齿修复,并在戴牙时用T-scanⅢ辅助调牙合。并于修复前、修复后即时和修复后1个月、3个月检查咬合力心的位置、检测目标基牙龈沟液中RANKL、OPG水平的变化及目标基牙牙槽骨高度的变化。结果:患者在正中咬合时,COF距X轴的垂直距离在戴牙后即时和修复后与修复前相比显著性降低(P<0.05);目标基牙OPG的浓度在修复后比修复前升高(P<0.05),且随时间的延长而升高;目标基牙RANKL/OPG比值在修复后比修复前降低(P<0.05),且随时间延长而降低。目标基牙牙槽骨高度在任何两个时间点都没有统计学差异(P>0.05),即随时间变化牙槽骨高度变化不明显。结论:牙槽骨吸收大于1/2而小于2/3的牙经完善牙周治疗并行去髓术后作为基牙进行固定义齿修复,在短期内其临床各指标均保持稳定,长期疗效有待进一步观察。

Objective To evaluate the effect of the fixed partial dentures for patients with compromised periodontal condition with the following three methods: the occlusal ajust with T-scan Ⅲ;the detection of the level of RANKL and OPG;The measurement of the alveolar bone hight of the target teeth. Methods 14 subjects with lower anterior teeth missing who were anticipating for the fixed partial dentures are included in this study, and there was at least one abutment teeth with alveolar bone absorbtion to more than 1/2 and less than 2/3. The abutments which with alveolar bone absorbtion to more than 1/2 and less than 2/3 are set as target abutments. The number of which are total 20. The patients already have had systematic periodontal therapy and the abutment teeth with severe bone absorbtion have been deprived of pulp. After that,they have fixed partial dentures in anterior area,and adjust occlusion with T-scan III when inserting the dentures. Record the position of center of the biting force (COF),the level of the RANK、OPG for target teeth .and the alveolar bone hight for target teeth at the time of before restoring, 1 month and 3 months after restoring. Results When at ICP,the vertical dimension of COF to the X axis at the time of inserting the dentures and after restoring is shorter than that before restoring(P <0.05).The concentration of the OPG for target teeth was higer after restoring than that before restoring(P <0.05), and was increasing throughout the experimental period. And the ratio of RANKL to OPG for target teeth was lower after restoring than that before restoring(P <0.05), and was decreasing throughout the experimental period.As to the alvealor bone hight of target teeth, there were still no significant difference existed throughout the experimental period at all times(P >0.05).Conclusion The teeth with alveolar bone asorbtion more than 1/2 and less than 2/3 ,can be used as the abutments of fixed partial dentures after perfect periodontal therapy and pulp deprived. In short time , all the indicators remain stable,but the long-term therapeutic effect is uncertain.