IPS e.max Press铸瓷嵌体治疗后牙牙体缺损的效果及对龈沟液中CXCL16及RANK水平的影响

The effect of IPS e.max Press porcelain inlays in the treatment of posterior tooth defects and its effect on the levels of CXCL16 and RANK in gingival crevicular fluid

目的探讨IPS e.max Press铸瓷嵌体治疗后牙牙体缺损的效果及对龈沟液中人CXC型趋化因子配体16(CXCL16)和核因子κB受体激活因子(RANK)水平的影响。方法选取安康市中医院口腔科2017年2-8月收治的124例(190颗)后牙牙体缺损患者作为研究对象,采用随机数字表法分为观察组和对照组,每组62例(95颗)。对照组患者采用合金嵌体治疗修复法,观察组患者采用IPS e.max Press铸瓷嵌体治疗修复法。治疗3个月后,以美牙效果、后牙牙体缺损边缘密合度作为观察指标,治疗1个月和3个月后检测龈沟液中炎症因子水平,比较龈沟液和血清中CXCL16和RANK水平。分别在治疗6、12、24个月后对患者进行随访并记录结果。结果治疗3个月后,观察组患者美牙效果满意度(94.74%)明显高于对照组(74.74%),差异有统计学意义(χ^(2)=14.691,P<0.05)。治疗3个月后,观察组患者后牙牙体缺损边缘密合度明显高于对照组,差异有统计学意义(χ^(2)=12.429,P<0.05)。治疗1个月后,由于手术治疗的炎性反应,观察组患者龈沟液中CXCL-16、RANK、白细胞介素(IL)-6及IL-8水平均较治疗前有所升高,但观察组患者明显低于对照组,差异均有统计学意义(P<0.05);治疗3个月后,术后炎性反应基本恢复,两组患者龈沟液中CXCL-16、RANK、IL-6及IL-8水平均较治疗1个月后降低,差异均有统计学意义(P<0.05),但观察组患者与对照组比较,差异无统计学意义(P>0.05);观察组患者治疗前后血清CXCL-16和RANK水平与对照组比较,差异均无统计学意义(P>0.05)。随访24个月后,观察组患者修复完整性、继发龋、牙周反应、对颌牙牙合面磨损情况成功率与对照组比较,差异均无统计学意义(P>0.05);但修复体颜色成功率明显优于对照组,差异有统计学意义(P<0.05)。结论与合金嵌体比较,IPS e.max Press铸瓷嵌体治疗后牙牙体缺损不但改善了美牙效果,还提高了牙体缺损边缘密合度,降低了龈沟液中IL-6、IL-8、CXCL16、RANK水平,减轻了炎性反应,治疗效果较好。

Objective To investigate the effect of IPS e.max Press porcelain inlay in the treatment of posterior tooth defect and its effect on the levels of human CXC chemokine ligand 16(CXCL16)and receptor activator of nuclear factorκB(RANK)in gingival crevicular fluid.Methods A total of 124 patients(190 teeth)with posterior tooth defects who were admitted to the Department of Stomatology,Ankang Hospital of Traditional Chinese Medicine from February to August 2017 were selected as the research objects,and were divided into the observation group and the control group by random number table method,62 cases(95 teeth)in each group.The patients in the control group were treated with alloy inlays treatment restoration,and the patients in the observation group were treated with IPS e.max Press porcelain inlays treatment restoration.After 3 months of treatment,the dental aesthetics effect and the margin closeness of the posterior tooth defects were used as the observation indicators.The levels of inflammatory factors in gingival crevicular fluid were detected after 1 month and 3 months of treatment,and the levels of CXCL16 and RANK in gingival crevicular fluid and serum were compared.The patients were followed up after 6,12,and 24 months of treatment and the results were recorded.Results After 3 months of treatment,the satisfaction degree of dental aesthetics effect in the observation group(94.74%)was significantly higher than that in the control group(74.74%),and the difference was statistically significant(χ2=14.691,P<0.05).After 3 months of treatment,the margin closeness of the posterior tooth defects in the observation group was significantly higher than that in the control group,and the difference was statistically significant(χ2=12.429,P<0.05).After 1 month of treatment,due to the inflammatory reaction of surgical treatment,the levels of CXCL-16,RANK,interleukin(IL-6)and IL-8 in the gingival crevicular fluid of the observation group were increased compared with those before treatment,but the observation group was significantly lower than the control group,and the differences were statistically significant(P<0.05).After 3 months of treatment,the postoperative inflammatory response basically recovered,and the levels of CXCL-16,RANK,IL-6 and IL-8 in the gingival crevicular fluid of the two groups were lower than those after 1 month of treatment,and the differences were statistically significant(P<0.05),but there was no significant difference between the observation group and the control group(P>0.05).There was no significant difference in serum CXCL-16 and RANK levels between the observation group and the control group before and after treatment(P>0.05).After 24 months of follow-up,there was no significant difference between the observation group and the control group in terms of restoration integrity,secondary caries,periodontal reaction and docclusal wear of the opposing teeth(P>0.05).However,the success rate of restoration color was significantly better than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with alloy inlays,IPS e.Max Press porcelain inlays not only improve the dental aesthetics effect,but also improve the margin closeness of the tooth defects,reduces the levels of IL-6,IL-8,CXCL16 and RANK in gingival crevicular fluid,reduces the inflammatory response,and has a better therapeutic effect.