即刻牙本质封闭技术对瓷贴面修复牙体预备后牙本质大量暴露的治疗效果研究

Influences of immediate dentin sealing on prognosis of veneer restorations in teeth with extensive dentin exposure

目的探讨即刻牙本质封闭(immediate dentin sealing,IDS)技术对瓷贴面修复牙体预备后牙本质暴露面积超过50%的治疗效果。方法选取2015年6月至2021年6月就诊于空军军医大学第三附属医院修复科行上颌前牙、前磨牙瓷贴面修复患者102例(贴面修复牙139颗),随机分为IDS-TE组、IDS-SE组和对照组,每组34例;其中,IDS-TE组(贴面修复牙47颗)和IDS-SE组(贴面修复牙44颗)在牙体预备后对暴露的牙本质使用通用型粘接剂Single Bond Universal分别按照全酸蚀、自酸蚀模式行IDS,对照组(贴面修复牙48颗)在牙体预备后未进行IDS处理。瓷贴面修复后即刻及每6个月行随访复查,根据改良美国公共卫生署(United States Public Health Service,USPHS)标准对贴面的修复效果进行评价,并计算修复成功率。采用视觉模拟评分法(visual analog scale,VAS)评价患者对修复效果的满意度。结果7例患者失访,失访率为6.9%。对照组、IDS-TE组及IDS-SE组的随访时间依次为(30.8±15.2)、(32.6±13.5)、(31.4±13.9)个月,其差异无统计学意义(F=0.167,P=0.846)。排除失访患者,修复即刻IDS-TE组(贴面修复牙46颗)、IDS-SE组(贴面修复牙42颗)和对照组(贴面修复牙44颗)仅在修复效果评价的修复后敏感项目中差异具有统计学意义(H=6.251,P=0.044)。在最终随访时,对照组有3颗发生修复体脱落、IDS-TE组有1颗发生修复体脱落,排除后行修复效果评价发现,在边缘适合性、修复体崩瓷和形态匹配项目中,3组修复效果比较,差异均有统计学意义(均P<0.05);且IDS-TE组和IDS-SE组的修复效果评价均优于对照组,差异均有统计学意义(均P<0.05)。3组其他项目修复效果评价及患者满意度评分比较,差异均无统计学意义(均P>0.05)。对照组、IDS-TE组及IDS-SE组修复成功率依次为84.1%、97.8%和97.6%,其差异有统计学意义(χ2=8.587,P=0.014)。结论相对于未行IDS处理,使用通用型粘接剂Single Bond Universal按照全酸蚀或自酸蚀模式行IDS,均可显著提高牙本质暴露面积超过50%的瓷贴面修复成功率,并可获得更佳的边缘适合性和形态匹配度。

Objective To investigate the influences of immediate dentin sealing(IDS)on prognosis of veneer restorations in teeth with more than 50%dentin exposure.Methods Patients who planned to receive restoration of maxillary anterior teeth and premolars with laminated veneers and presented more than 50%dentin exposure after tooth preparation were included from June 2015 to June 2021 at the Department of Prosthodontics,the Third Affiliated Hospital of Air Force Medical University.The 102 included patients(139 restored teeth)were randomly divided into three groups(34 patients for each group).In the IDS-TE group(47 restored teeth)and IDS-SE group(44 restored teeth),the exposed dentin was sealed with the universal dental adhesive Single Bond Universal using either the total-etch or self-etch technique immediately after tooth preparation.In the control group(48 restored teeth),IDS was not performed after tooth preparation.After cementation,the veneers were evaluated using the modified United States Public Health Service(USPHS)criteria at baseline and thereafter every 6 months.At the last follow-up,the success rate of the veneer restorations was calculated and the visual analog scale was used to obtain each patient′s satisfaction with the restoration.Results Altogether,7 patients were lost during the follow-up(6.9%),and the follow-up period was(30.8±15.2),(32.6±13.5)and(31.4±13.9)months for the control group,IDS-TE group and IDS-SE group,respectively(F=0.167,P=0.846).After excluding patients that dropped out,IDS-TE group and IDS-SE group revealed lower incidence of postoperative sensitivity at baseline evaluation as compared to the control group(H=6.251,P=0.044).During the follow-up period,there were 3 debondings in the control group and 1 debonding in the IDS-TE group,and these teeth were excluded for final evaluation.In the final evaluation,the three groups revealed significantly different performances regarding marginal fitness,fracture of restoration and contour of restoration(P<0.05),with both the IDS-TE and IDS-SE groups performing better than the control group(P<0.05).The three groups showed no significant differences regarding other aspects of evaluation or patients′satisfaction level.The success rate was 84.1%、97.8%and 97.6%for the control group,IDS-TE group and IDS-SE group,respectively(χ2=8.587,P=0.014).Conclusion For teeth planned for veneer restoration and showing more than 50%dentin exposure after tooth preparation,immediate dentin sealing using the universal adhesive Single Bond Universal with either the total-etch or self-etch mode can significantly increase the success rate and improve marginal fitness and contour of the restorations.