中国实用口腔科杂志

中国实用口腔科杂志

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上前牙牙冠延长术结合冠修复后牙周健康状况分析

王翠a，胡文杰a，张豪b   

  1. 北京大学口腔医学院·口腔医院a牙周科，b修复科；口腔数字化医疗技术和材料国家工程实验室；口腔数字医学北京市重点实验室；北京  100081
  • 出版日期:2017-01-15 发布日期:2017-03-28
  • 基金资助:

    北京市科学技术委员会首都临床特色应用研究基金（z131107002213174）

  • Online:2017-01-15 Published:2017-03-28

摘要：

目的    观察牙冠延长术结合冠修复后上前牙的牙周健康状况，探索影响牙周健康的相关因素。方法    通过电话随访随机叫回2005-07-01至2012-06-30于北京大学口腔医学院·口腔医院接受上前牙牙冠延长术结合冠修复后2 ~ 9年的患者9例（共38颗患牙）。记录患牙唇侧近中、中央、远中及舌侧中央位点的菌斑指数（PLI）、探诊深度（PD）、牙龈指数（GI）、修复体边缘-龈缘的距离、修复体边缘-嵴顶的距离、满足生物学宽度的要求仍需去骨量，唇舌侧位点的出血指数（BI）及唇侧中央位点的角化龈宽度（KTW）等。采用均数±标准差对计量资料进行统计描述，采用方差分析和Spearman秩相关分析分别比较术前、术后牙周指标的变化和分析拟定影响因素与牙龈健康的相关性。结果    随访复查时，38颗术牙均存留，无牙齿松动及明显移位，患者对上前牙区的美观及功能满意度良好，视觉模拟评分法（VAS）评分均≥8。随访复查时，术牙各项牙周指标平均值为PLI 0.6 ± 0.7、PD （2.3 ± 0.7）mm、GI 1.0 ± 0.8、BI 2.3 ± 1.1、KTW（5.5 ± 1.5）mm，与牙冠延长术后、永久性冠修复前相比，除KTW以外，其余各项牙周相关指标的差异均有统计学意义（均P < 0.05），但都在相对健康范围内；修复体边缘至牙槽嵴顶的平均测量距离为（2.3 ± 0.6）mm，满足修复体边缘-嵴顶的距离≥3 mm的位点占15.8% ~ 42.1%。PLI、修复体边缘-龈缘的距离以及修复体边缘-嵴顶的距离与GI具有相关性（r分别为0.328、-0.396和-0.198，均P < 0.05）。结论    常规牙冠延长术结合冠修复后，术牙牙周状况相对健康稳定，修复体边缘-嵴顶的距离≥3 mm的理想目标并未完全达到。PLI、修复体边缘-龈缘的距离以及修复体边缘-嵴顶的距离可能是影响牙周健康的因素。

关键词: 牙冠延长术, 生物学宽度, 修复体边缘至嵴顶的距离, 牙周指标

Abstract:

Objective    To observe the long-term clinical treatment outcome of teeth receiving crown lengthening surgery combined with crown restorations and to explore its influencing factors. Methods    Nine patients with a total of 38 maxillary anterior teeth receiving crown lengthening surgery combined with post-core crown restorations in Peking University School and Hospital of Stomatology from July 1，2005 to June 30，2012 were randomly recruited by the phone in this retrospective study. Parameters evaluated included plaque index，probing depth，gingival index，distance between crown margin and gingival margin，distance between crown margin and alveolar bone crest，bone removal that is required to obtain a 3 mm “biologic width”，bleeding index of facial and lingual surface，and keratinized tissue width of mid-facial surface of teeth treated. Teeth were used as the unit for statistical description and analysis by 　　±s deviation and Analysis of Variance and Spearman rank correlation. Results        Thirty-eight teeth survived with no mobility and obvious migration，and all the patients were satisfied with the aesthetics and function of maxillary anterior teeth with VAS ≥ 8 at the most recent follow-up visit. The mean values were as follows：PLI 0.6 ± 0.7，PD （2.3 ± 0.7）mm，BI 2.3 ± 1.1，GI 1.0 ± 0.8 and KTW（5.5 ± 1.5）mm，and statistical differences were found when compared with those periodontal variables after crown lengthening surgery and before definite crown restorations except for KTW（P < 0.05）. The mean distance measured between crown margin and alveolar bone crest was （2.3 ± 0.6）mm，with the largest value on the lingual surface and the smallest value on the facial surface. The percentage of sites achieving the proposed obtained distance of 3 mm between crown margin and alveolar bone crest varied from 15.8% to 42.1%. Statistical correlations were obtained between plaque index，distance between crown margin and gingival margin，distance between crown margin and alveolar crest and gingival index （r = 0.328，-0.396 and -0.198，P < 0.05）. Conclusion    The proposed objective of 3 mm distance from planned crown margins to bone crest is not routinely achieved in this study. Clinicians may need to be more aggressive in osteotomy procedures during crown lengthening surgery or adjust treatment procedures，such as to advance the crown preparation before or during the surgery.

Key words: crown lengthening surgery, biologic width, distance between crown margin and alveolar bone crest, periodontal indices