牙周探诊重复性比较及牙周病松动前牙夹板固定的临床疗效分析
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摘要
牙周病的诊断和疗效评估,要求探诊结果具有良好的重复性,而探针类型对结果有一定程度的影响。目前,Williams探针临床应用最广泛,Florida探针在国内刚开始使用,本实验首先对这两种探针的测量重复性进行了比较。
松牙固定术是固定牙周病松动牙行之有效的方法,既往临床研究的评价标准比较粗略,临床资料的搜集不够系统。本实验采用多种客观评价指标:包括四种牙周指数、咬合力和X线片,结合患者的四项主观满意度,对暂时性夹板和恒久性夹板的临床疗效进行全面评价。
本课题旨积累牙周探诊和夹板固定的临床资料;为两种探针的临床应用提供可靠的数据,为常见牙周治疗的近、远期疗效评估提供临床研究经验。
目的:比较了Williams探针和Florida探针,测量探诊深度的重复性和工作特点,确保探诊技术准确可靠地用于夹板的疗效评价。然后采用同一纳入标准,选择牙周病导致前牙松动的患者,分别用树脂夹板和烤瓷冠桥进行固定;观察固定后半年内的临床疗效,为临床医生制定合理的松牙固定方案,提供重要参考。
方法:
①探诊深度的重复性:选择2005年在我院就诊的10例牙周炎患者,随机分入Williams探针组和Florida探针组。245颗牙齿共测量了4次PD值,洁牙前、后各两次,获得5880个位点值。比较1、2次的测量值计算洁牙前的重复性,比较3、4次的测量值计算洁牙后的重复性。
②牙周夹板的疗效
a.选择2005～2006年来我院就诊的,因牙周炎导致前牙松动的患者26例。尼龙丝加强树脂夹板组患者16例,保存松动III°的患牙,行双侧结扎固定;烤瓷冠桥组患者10例,拔除松动III°的患牙,3月后行烤瓷桥修复。
b.纳入临床试验的患者分别于初诊、术后0月、术后3月、术后6月四个时间点:拍摄根尖X线片、口内数码照片;记录牙周指数:探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、菌斑指数( plaque index, PLI )、探诊出血( bleeding on probing, BOP )的值;记录松动度、最大咬合力和主观满意度的变化。
c.所有患者夹板固定前行全口龈上、下洁治,PD值超过4mm的位点行局部袋内壁刮治术,术后3月及6月复诊时行夹板区龈上洁治。
结果:
①探诊深度的重复性:Williams探针和Florida探针测量PD值均有良好的重复性,能可靠地应用于牙周病临床研究。
②牙周夹板的疗效
a.牙周指数变化:树脂夹板组术后3月,PD值下降具有统计学意义,3月至6月阶段无明显改变;烤瓷桥组的PD值术后6月时下降具有统计学意义。PD值的下降表明牙周炎的病情得到控制和缓解。
b.咬合力变化:两组夹板术后6月,咬合力均较术前显著提高,咬合无力症状改善。
c.主观满意度变化:咬合力和舒适度均显著改善,两组夹板都有很高的患者接受度。树脂夹板的美观性和修复体质量在6月有轻度下降,但无统计学差异。烤瓷桥夹板的术后美观性显著提高;6月修复体质量无下降。
d. X线检查是观察牙槽骨变化的直观指标,两组夹板术后6月牙槽骨密度和高度均有一定程度增长;但是该指标存在投射角度、曝光强度引起的误差,仅作为一个参考指标。
结论:本研究比较了Williams手工探针和Florida电子探针测量的重复性和工作特点,同时取得了夹板固定的牙周病松动前牙,半年内系统、完整的临床资料。得出以下结论:
①Williams探针和Florida探针重复性都很好,能准确可靠地用于牙周夹板的疗效评价。
②两类夹板都是保存重度牙周炎松动前牙有效、可靠的治疗方式,获得了较满意的临床疗效和较高的患者接受度。树脂夹板更容易被拒绝拔牙或要求控制治疗费用的患者接受,烤瓷冠桥的远期疗效更加确切。
③牙周指数用于夹板的疗效评估,较既往的良好、一般、较差的粗略评价方式准确性显著提高。结合患者主观满意度的调查,使医疗模式由单纯关注疾病的治疗效果,转入对患者心灵关怀的人性化层面。
To diagnose periodontitis and estimate curative effect exactly, it’s very important to probe periodontal pocket uniformly,and the result should be effacted by the type of probe. Williams probe have been used for many years, and Florida probe just begin to use in our country. The reproducibility of these two kinds of periodontal probe was compared in the experiments.
Fixation of loosened tooth is an effective way to satisfy the patient’s demands, but the evaluation criterion was different in some past research, and the clinic data was scattered. In this experiment, temporary splint and permanent splint were estimated roundly with periodontal index, radiograph, occlusal force and subjective satisfaction of patients.
This experioment aims to establish the systematically clinical data of periodontal probing and splint, which can provide reliable document to use periodontal probe and estimate curative effect of splints.
Objective: The reproducibility and characteristics of Williams probe and Florida probe were compared to ensure the reliability, which was used to estimate splint’s effect. Patients with anterior loosened teeth was chosen according identical standard, and then the loosen teeth was fixed by resinic splint and porcelain-fused-to-metal bridge. The clinic effect of splints within six months will give doctors important references about how to choose a plan.
Method:
①Reproducibility of probing depth: 10 adult with periodontitis were assigned to Williams probe group and Florida probe group randomly, they came to our hospital during 2005. The PD of 245 tooth were measured four times, and the data of 5880 sites were gathered. The reproducibility before scaling was calculated by comparing the first time to the second time, the reproducibility after scaling was calculated by comparing the third time to the fourth time.
②The curative effect of periodontal splints.
a. 26 adult with loosened anterior teeth were chosen to this experiment, 16 patients were treated by using resinic splint, and III°loosened teeth were conserved and fixed. 10 patients were treated by using porcelain-fused-to-metal bridge after three months which the III°loosened teeth were extracted.
b. The recorder of radiograph, photograph, periodontal indices (PD, CAL, PLI, BOP), tooth mobility, occlusal force and the subjective satisfaction of patients at the time of visit, the splint finished, the third month and the sixth Month after treatment.
c. 26 patients were accepted the supragigival scaling and subgigival scaling before fixation, and supragigival scaling was operated in the third month and the sixth Month.
Reuslt:
①Reproducibility of probing depth: Both the Williams probe and Florida probe have fine reproducibility, and they can be used to periodontal clinic rearch reliably.
②The curative effect of periodontal splints.
a. Periodontal index: The PD of resinic splint decreased at the third month, and the result was significant different. The PD of porcelain-fused-to-metal bridge decreased at the sixth month, and the result was significant different.
b. Occlusal force: Occlusal force of both splints got increased remarkably, there wasn’t atonia masticatoria.
c. Subjective satisfaction: All the patients in the emperiment felt comfortable about the two splints, and the occlusal force and easement increased notablely. The outlook and quality of resinic splint decreased slightly, but there wasn’t significant different. The outlook of porcelain-fused-to-metal bridge increased significantly, and the quality of bridge didn’t decrease at the sixth month.
d. Radiograph is a visualized index to observe alveolar bone, and there had slightly increase of the densities and height of alveolar bone, but it’s a rough index because of the different of angle and exposure. Conclusion: Data of the reproducibility and characteristics of two probes, and the systematically clinical data of splint’s fixing loosened tooth were obtained from this experiment.
①The reproducibility of both probes was fine, it can be used to clinical work reliably.
②Both splints are effective and reliable to fix severely loosened tooth, and they deserved paient’s satisfaction. It’s easy to accept resinic splint by the patients, who rejected tooth extraction and asked to control the time and cost.
③Comparing periodontal index to the standard of“good, general and failure”, the accuracy of periodontal index increased sharply. Moreover, this experiment considered the patients’feeling, which lead our medical treatment pattern from medical result to human nature.
松牙固定术是固定牙周病松动牙行之有效的方法,既往临床研究的评价标准比较粗略,临床资料的搜集不够系统。本实验采用多种客观评价指标:包括四种牙周指数、咬合力和X线片,结合患者的四项主观满意度,对暂时性夹板和恒久性夹板的临床疗效进行全面评价。
本课题旨积累牙周探诊和夹板固定的临床资料;为两种探针的临床应用提供可靠的数据,为常见牙周治疗的近、远期疗效评估提供临床研究经验。
目的:比较了Williams探针和Florida探针,测量探诊深度的重复性和工作特点,确保探诊技术准确可靠地用于夹板的疗效评价。然后采用同一纳入标准,选择牙周病导致前牙松动的患者,分别用树脂夹板和烤瓷冠桥进行固定;观察固定后半年内的临床疗效,为临床医生制定合理的松牙固定方案,提供重要参考。
方法:
①探诊深度的重复性:选择2005年在我院就诊的10例牙周炎患者,随机分入Williams探针组和Florida探针组。245颗牙齿共测量了4次PD值,洁牙前、后各两次,获得5880个位点值。比较1、2次的测量值计算洁牙前的重复性,比较3、4次的测量值计算洁牙后的重复性。
②牙周夹板的疗效
a.选择2005～2006年来我院就诊的,因牙周炎导致前牙松动的患者26例。尼龙丝加强树脂夹板组患者16例,保存松动III°的患牙,行双侧结扎固定;烤瓷冠桥组患者10例,拔除松动III°的患牙,3月后行烤瓷桥修复。
b.纳入临床试验的患者分别于初诊、术后0月、术后3月、术后6月四个时间点:拍摄根尖X线片、口内数码照片;记录牙周指数:探诊深度(probing depth, PD)、临床附着丧失(clinical attachment loss, CAL)、菌斑指数( plaque index, PLI )、探诊出血( bleeding on probing, BOP )的值;记录松动度、最大咬合力和主观满意度的变化。
c.所有患者夹板固定前行全口龈上、下洁治,PD值超过4mm的位点行局部袋内壁刮治术,术后3月及6月复诊时行夹板区龈上洁治。
结果:
①探诊深度的重复性:Williams探针和Florida探针测量PD值均有良好的重复性,能可靠地应用于牙周病临床研究。
②牙周夹板的疗效
a.牙周指数变化:树脂夹板组术后3月,PD值下降具有统计学意义,3月至6月阶段无明显改变;烤瓷桥组的PD值术后6月时下降具有统计学意义。PD值的下降表明牙周炎的病情得到控制和缓解。
b.咬合力变化:两组夹板术后6月,咬合力均较术前显著提高,咬合无力症状改善。
c.主观满意度变化:咬合力和舒适度均显著改善,两组夹板都有很高的患者接受度。树脂夹板的美观性和修复体质量在6月有轻度下降,但无统计学差异。烤瓷桥夹板的术后美观性显著提高;6月修复体质量无下降。
d. X线检查是观察牙槽骨变化的直观指标,两组夹板术后6月牙槽骨密度和高度均有一定程度增长;但是该指标存在投射角度、曝光强度引起的误差,仅作为一个参考指标。
结论:本研究比较了Williams手工探针和Florida电子探针测量的重复性和工作特点,同时取得了夹板固定的牙周病松动前牙,半年内系统、完整的临床资料。得出以下结论:
①Williams探针和Florida探针重复性都很好,能准确可靠地用于牙周夹板的疗效评价。
②两类夹板都是保存重度牙周炎松动前牙有效、可靠的治疗方式,获得了较满意的临床疗效和较高的患者接受度。树脂夹板更容易被拒绝拔牙或要求控制治疗费用的患者接受,烤瓷冠桥的远期疗效更加确切。
③牙周指数用于夹板的疗效评估,较既往的良好、一般、较差的粗略评价方式准确性显著提高。结合患者主观满意度的调查,使医疗模式由单纯关注疾病的治疗效果,转入对患者心灵关怀的人性化层面。
To diagnose periodontitis and estimate curative effect exactly, it’s very important to probe periodontal pocket uniformly,and the result should be effacted by the type of probe. Williams probe have been used for many years, and Florida probe just begin to use in our country. The reproducibility of these two kinds of periodontal probe was compared in the experiments.
Fixation of loosened tooth is an effective way to satisfy the patient’s demands, but the evaluation criterion was different in some past research, and the clinic data was scattered. In this experiment, temporary splint and permanent splint were estimated roundly with periodontal index, radiograph, occlusal force and subjective satisfaction of patients.
This experioment aims to establish the systematically clinical data of periodontal probing and splint, which can provide reliable document to use periodontal probe and estimate curative effect of splints.
Objective: The reproducibility and characteristics of Williams probe and Florida probe were compared to ensure the reliability, which was used to estimate splint’s effect. Patients with anterior loosened teeth was chosen according identical standard, and then the loosen teeth was fixed by resinic splint and porcelain-fused-to-metal bridge. The clinic effect of splints within six months will give doctors important references about how to choose a plan.
Method:
①Reproducibility of probing depth: 10 adult with periodontitis were assigned to Williams probe group and Florida probe group randomly, they came to our hospital during 2005. The PD of 245 tooth were measured four times, and the data of 5880 sites were gathered. The reproducibility before scaling was calculated by comparing the first time to the second time, the reproducibility after scaling was calculated by comparing the third time to the fourth time.
②The curative effect of periodontal splints.
a. 26 adult with loosened anterior teeth were chosen to this experiment, 16 patients were treated by using resinic splint, and III°loosened teeth were conserved and fixed. 10 patients were treated by using porcelain-fused-to-metal bridge after three months which the III°loosened teeth were extracted.
b. The recorder of radiograph, photograph, periodontal indices (PD, CAL, PLI, BOP), tooth mobility, occlusal force and the subjective satisfaction of patients at the time of visit, the splint finished, the third month and the sixth Month after treatment.
c. 26 patients were accepted the supragigival scaling and subgigival scaling before fixation, and supragigival scaling was operated in the third month and the sixth Month.
Reuslt:
①Reproducibility of probing depth: Both the Williams probe and Florida probe have fine reproducibility, and they can be used to periodontal clinic rearch reliably.
②The curative effect of periodontal splints.
a. Periodontal index: The PD of resinic splint decreased at the third month, and the result was significant different. The PD of porcelain-fused-to-metal bridge decreased at the sixth month, and the result was significant different.
b. Occlusal force: Occlusal force of both splints got increased remarkably, there wasn’t atonia masticatoria.
c. Subjective satisfaction: All the patients in the emperiment felt comfortable about the two splints, and the occlusal force and easement increased notablely. The outlook and quality of resinic splint decreased slightly, but there wasn’t significant different. The outlook of porcelain-fused-to-metal bridge increased significantly, and the quality of bridge didn’t decrease at the sixth month.
d. Radiograph is a visualized index to observe alveolar bone, and there had slightly increase of the densities and height of alveolar bone, but it’s a rough index because of the different of angle and exposure. Conclusion: Data of the reproducibility and characteristics of two probes, and the systematically clinical data of splint’s fixing loosened tooth were obtained from this experiment.
①The reproducibility of both probes was fine, it can be used to clinical work reliably.
②Both splints are effective and reliable to fix severely loosened tooth, and they deserved paient’s satisfaction. It’s easy to accept resinic splint by the patients, who rejected tooth extraction and asked to control the time and cost.
③Comparing periodontal index to the standard of“good, general and failure”, the accuracy of periodontal index increased sharply. Moreover, this experiment considered the patients’feeling, which lead our medical treatment pattern from medical result to human nature.
引文
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