全冠龈边缘对牙周环境的影响
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摘要
目的 (1)探讨不同材料的全冠龈边缘对Beagle犬牙周环境的影响。(2)探讨全冠龈边缘对人牙周环境的影响。
方法 (1)用手用龈上、龈下刮治器对4只Beagle犬进行全口龈上洁治、龈下刮治。三周后,对49颗犬牙行瓷熔附金属(porcelain fused metal,PFM)冠修复术,PFM冠的唇侧边缘为烤瓷边缘,舌侧边缘为金属边缘,均与龈缘平齐。于牙体预备前和PFM冠经玻璃离子水门汀粘固后4周,分别记录实验牙(唇侧近中、远中,舌侧近中、远中)菌斑指数(plaque index,PLI)、牙周探诊深度(probing depth,PD)、龈沟出血指数(sulcus bleeding index,SBI),测量龈沟液量(gingival crevicular fluid,GCF),并检测龈沟液中天冬氨酸转氨酶(aspartate aminotransferase,AST)的水平。整个实验过程每周给予旋转刷牙法刷牙1次。(2)对需作全冠或双端固定桥(固位体为全冠)修复并符合纳入标准的20名患者的30颗天然牙,在牙体预备前、暂时冠经氧化锌水门汀粘固后1周和全冠或双端固定桥经玻璃离子水门汀粘固后7周,分别记录其颊侧牙龈(近中位点、远中位点)的PLI、PD、SBI,并测量其GCF量、GCF-AST活性。全冠或固定桥粘固前后分别测量冠边缘间隙。暂时冠和全冠粘固后对患者各进行口腔健康教育1次。
结果 (1)动物实验结果表明,PFM冠粘固后4周,舌侧牙龈的PD、PLI≥1的频率、GCF量、SBI≥2频率、AST活性明显增加(P<0.01);颊侧牙龈的PD、PLI≥1的频率、GCF量均无明显变化,SBI≥2的频率、AST活性明显增加(P<0.05);两组GCF量、SBI≥2频率、AST活性有明显的差异(P<0.05)。(2)临床实验结果表明,暂时冠粘固后1周或全冠粘固后7周,暂时冠、全冠(烤瓷组、金属组、龈上组、龈下组)对应牙龈的PD、SBI≥2频率、GCF量及GCF-AST活性没有明显变化,PLI≥1的频率明显下降(P<0.01;全冠粘固后冠边缘间隙明显增加(P<0.01),增加量与粘固前边缘间隙大小呈负相关。
结论 (1)动物实验表明每周给Beagle犬刷牙1次,PFM冠粘固后4周,烤瓷边缘和金属边缘对应的牙周组织炎症均明显加重,金属边缘对应的牙周组织尤为明显。可能是
Objectives (1)To evaluate the influence of different materials of PFM crown margin on periodontal conditions in beagle dogs. (2) To investigate the influence of crowns margin on periodontal conditions of human.Methods (1) Four beagle dogs were utilized in this study. Three weeks after commencing oral hygiene procedures through supragingival scaling and subgingival scaling, forty-nine dog teeth were prepared for receiving porcelain fused metal(PFM) crowns. One week later, the PFM crowns were cemented, whose buccal margins were made of porcelain fused to metal (PFM)and lingual margins were metal. Clinical parameters were recorded on four sites (mesiolongual, mesiobuccal, distobuccal, distoiongual) of all test teeth immediately before tooth preparation and after 4 weeks of cementation of PFM crowns. During the studying period, professional oral hygiene was performed for the Beagles dogs one time a week. (2) Twenty patients requiring 30 artificial crowns were selected for this study, who corresponded with entry provisions. GCF volume , AST in GCF, PD and the frequency of SBI≥2 and PLI≥1 in 20 patients has been examined immediately before the preparation, 1 week after cementation of temporary crowns and 8 weeks after cementation of dural crowns(PFM group, metal group, subgingival group, supragingival group). The marginal opening of crowrrs were measured before and after the cementation. The oral health education was given after the cementation of temporary crowns and durable crowns.Results (1) The results of animal research were that the volumn of GCF, the frequency of PLI≥1 and SBI≥2, PD and the activity of AST in GCF increased significantly for the group of lingual gingiva (P<0.01) in the time of four weeks
after cementation of crowns. For the buccal gingiva margin, the activity of GCF-AST and the frequency of SBI^2 increased significantly (P<0. 05) , but PD, GCF and the frequency of PLI^l didn' t change significantly. The difference of GCF, the activity of GCF-AST and the frequency of SBI^2 between two groups are significant after A weeks of c.enient.at. ion of crowns (P<0. 05) . (2) The results of clinical research were that GCF volume ,GCF-AST and the frequency of SB1 ^2 did not differ significantly among the groups of before the teeth preparation , 1 week after cementation of temporary crowns and 7 weeks after cemention of crowns(PFM group, metal group, subgingival group, supragingival group) (P>0. 01) , although the frequency of PLI^l decreased significantly (P<0. 01). The marginal opening increased significantly after cementation(P<0. 01), which was negatively correlated to the opening of margin before cementation.Conclusion (1) When professional oral hygiene was performed one time a week, both PFM and metal margins could contribute to periodontal inflammation. The metal contributes to inflammation more greatly than PFM. The reason may be that the degree of plaque adherence to metal is greater than PFM. (2) For 1 week after cementation of temporary crowns and 7 weeks after cementation of durable crowns , there were not unfavourable influence of the best crowns on the periodontal conditions when oral health education was executed. (3) The marginal opening increased significantly after cementation, which was negatively correlated to the opening of margin before cementation within limits .
方法 (1)用手用龈上、龈下刮治器对4只Beagle犬进行全口龈上洁治、龈下刮治。三周后,对49颗犬牙行瓷熔附金属(porcelain fused metal,PFM)冠修复术,PFM冠的唇侧边缘为烤瓷边缘,舌侧边缘为金属边缘,均与龈缘平齐。于牙体预备前和PFM冠经玻璃离子水门汀粘固后4周,分别记录实验牙(唇侧近中、远中,舌侧近中、远中)菌斑指数(plaque index,PLI)、牙周探诊深度(probing depth,PD)、龈沟出血指数(sulcus bleeding index,SBI),测量龈沟液量(gingival crevicular fluid,GCF),并检测龈沟液中天冬氨酸转氨酶(aspartate aminotransferase,AST)的水平。整个实验过程每周给予旋转刷牙法刷牙1次。(2)对需作全冠或双端固定桥(固位体为全冠)修复并符合纳入标准的20名患者的30颗天然牙,在牙体预备前、暂时冠经氧化锌水门汀粘固后1周和全冠或双端固定桥经玻璃离子水门汀粘固后7周,分别记录其颊侧牙龈(近中位点、远中位点)的PLI、PD、SBI,并测量其GCF量、GCF-AST活性。全冠或固定桥粘固前后分别测量冠边缘间隙。暂时冠和全冠粘固后对患者各进行口腔健康教育1次。
结果 (1)动物实验结果表明,PFM冠粘固后4周,舌侧牙龈的PD、PLI≥1的频率、GCF量、SBI≥2频率、AST活性明显增加(P<0.01);颊侧牙龈的PD、PLI≥1的频率、GCF量均无明显变化,SBI≥2的频率、AST活性明显增加(P<0.05);两组GCF量、SBI≥2频率、AST活性有明显的差异(P<0.05)。(2)临床实验结果表明,暂时冠粘固后1周或全冠粘固后7周,暂时冠、全冠(烤瓷组、金属组、龈上组、龈下组)对应牙龈的PD、SBI≥2频率、GCF量及GCF-AST活性没有明显变化,PLI≥1的频率明显下降(P<0.01;全冠粘固后冠边缘间隙明显增加(P<0.01),增加量与粘固前边缘间隙大小呈负相关。
结论 (1)动物实验表明每周给Beagle犬刷牙1次,PFM冠粘固后4周,烤瓷边缘和金属边缘对应的牙周组织炎症均明显加重,金属边缘对应的牙周组织尤为明显。可能是
Objectives (1)To evaluate the influence of different materials of PFM crown margin on periodontal conditions in beagle dogs. (2) To investigate the influence of crowns margin on periodontal conditions of human.Methods (1) Four beagle dogs were utilized in this study. Three weeks after commencing oral hygiene procedures through supragingival scaling and subgingival scaling, forty-nine dog teeth were prepared for receiving porcelain fused metal(PFM) crowns. One week later, the PFM crowns were cemented, whose buccal margins were made of porcelain fused to metal (PFM)and lingual margins were metal. Clinical parameters were recorded on four sites (mesiolongual, mesiobuccal, distobuccal, distoiongual) of all test teeth immediately before tooth preparation and after 4 weeks of cementation of PFM crowns. During the studying period, professional oral hygiene was performed for the Beagles dogs one time a week. (2) Twenty patients requiring 30 artificial crowns were selected for this study, who corresponded with entry provisions. GCF volume , AST in GCF, PD and the frequency of SBI≥2 and PLI≥1 in 20 patients has been examined immediately before the preparation, 1 week after cementation of temporary crowns and 8 weeks after cementation of dural crowns(PFM group, metal group, subgingival group, supragingival group). The marginal opening of crowrrs were measured before and after the cementation. The oral health education was given after the cementation of temporary crowns and durable crowns.Results (1) The results of animal research were that the volumn of GCF, the frequency of PLI≥1 and SBI≥2, PD and the activity of AST in GCF increased significantly for the group of lingual gingiva (P<0.01) in the time of four weeks
after cementation of crowns. For the buccal gingiva margin, the activity of GCF-AST and the frequency of SBI^2 increased significantly (P<0. 05) , but PD, GCF and the frequency of PLI^l didn' t change significantly. The difference of GCF, the activity of GCF-AST and the frequency of SBI^2 between two groups are significant after A weeks of c.enient.at. ion of crowns (P<0. 05) . (2) The results of clinical research were that GCF volume ,GCF-AST and the frequency of SB1 ^2 did not differ significantly among the groups of before the teeth preparation , 1 week after cementation of temporary crowns and 7 weeks after cemention of crowns(PFM group, metal group, subgingival group, supragingival group) (P>0. 01) , although the frequency of PLI^l decreased significantly (P<0. 01). The marginal opening increased significantly after cementation(P<0. 01), which was negatively correlated to the opening of margin before cementation.Conclusion (1) When professional oral hygiene was performed one time a week, both PFM and metal margins could contribute to periodontal inflammation. The metal contributes to inflammation more greatly than PFM. The reason may be that the degree of plaque adherence to metal is greater than PFM. (2) For 1 week after cementation of temporary crowns and 7 weeks after cementation of durable crowns , there were not unfavourable influence of the best crowns on the periodontal conditions when oral health education was executed. (3) The marginal opening increased significantly after cementation, which was negatively correlated to the opening of margin before cementation within limits .
引文
1 Silness J, Loe H. Periodontal disease in pregnancy Ⅱ. Correlation with oral hygiene and periodontal condition. Acta Odontologica Scandinavica, 1964;22:121-135
2 Mazza JE, Newman MG, Sims TN. Clinical and antimicrobial effect of stannous fluoride on periodontitis. J Clin Periodontol, 1981;8:203-212
3 Page Re, Schroeder HE. Periodontitis in man and other animals. A comparative review. Basel: karger;1982
4 Reddy MS, Palcanis NC. A comparison of manual and controlled-force attachment-level measurements. J Clin Periodontol, 1997;24:920-926
5 Grossi SG, Dunford RG, HO A et al. Sources of error for periodontal probing measurements. J Periodont Res, 1996:31:330-336
6 闫福华,曹采方.龈沟液研究的方法学.国外医学(口腔分册),1994;21:69-72
7 赵亦兵,孟焕新,陈智滨.实验性龈炎的临床观察和龈沟液量的分析.中华口腔医学杂志,2004:39:42-44
8 Christian P, Metzler D.E. Transaminases. New York: John Wiley and Sons, 1985;586-590
9 Ringer PG, Derouen TA, Page RC. Relationship between levels of amonotransferase in gingival crevicular fluid and gingival inflammation. J Periodont Res, 1990:25:17-24
10 段塬塬,王忠义,沈丽娟等.唾液获得性膜对不同桥体材料表面自由能的影响.牙体牙髓病杂志,2003:19:495-497
11 Quirynen M, Narechal M, Busscher HJ. et al. The influence of surface free energy and surface roughness on early plaque formation. J Olin Periodontol, 1990:17:138-144
12 Quirynen M, Marechal N, Busscher HJ, et al. The Influence of Surface Free-energy on Planimetric Plaque Growth in Man. J Dent Res, 1988;68:796-799
13 王贻宁,温国江,施斌等.牙科陶瓷表面粗糙度与细菌粘附的实验研究.中华口腔医学杂志.2003;38:342-344
14 张宁宁,王庆.抛光和自上釉对陶瓷表面平滑度的影响.实用口腔医学杂志.2002;18:54-55
15 崔东培,张振庭,杨圣辉.钴铬合金表面粗糙度与细菌黏附.口腔颌面修复杂志,2003:4:55-57
16 邓旭亮,胡晓阳,欧阳翔英等.牙轴面突度的变化对牙周组织健康的影响.中华口腔医学杂志,2001;36:440-442
17 Kohal R.J, Gerds T, Strub J.R. Effect of different crowns contours on periodontal health in dogs. Clinical results. Journal of Dentistry, 2003;31:407-413
18 Lindhe J, Hamp SE, Loe H. Experimental periodontitis in the beagle dog. Journal of Periodontal Research 1973;8:1-10
19 Tolboe H, Isidor F, Budtz-Jorgensen E, et al. Influence of pontic material on alveolar mucosal conditions. Scand J Dent Res, 1988,96:442
20 曹采方,主编.牙周病学(第二版).北京:人民卫生出版社,2000:31-37.
21 Paolantonio M, D'Ercole S, Perinetti G, Tripodi D, et al. Clinical and mocrobiological effect of different restorative materials on the periodontal tissues adjacent to subgingival class V. restorations. T Clin Periodontal, 2004;31:200-207
22 Steinberg D, Eyal S. Early formation of Streptococcus sobrinus biofilm on various dental restorative materials. Journal of Dentistry, 2001,30:47～51
23 陈治清,主编.口腔材料学(第二版)北京:人民卫生出版社出版,2000:104.
24 朱国威,杨晓红,陈丽娅等.非贵金属烤瓷冠修复后牙龈组织和血液中镍铬元素含量分析.华西口腔医学杂志,2004;22:284-286
25 孙佳凝,赵云风,高宁.牙科合金材料的生物相容性及影响合金离子析出的因素.国外医学(口腔医学分册),2003;30:212-213
2 Mazza JE, Newman MG, Sims TN. Clinical and antimicrobial effect of stannous fluoride on periodontitis. J Clin Periodontol, 1981;8:203-212
3 Page Re, Schroeder HE. Periodontitis in man and other animals. A comparative review. Basel: karger;1982
4 Reddy MS, Palcanis NC. A comparison of manual and controlled-force attachment-level measurements. J Clin Periodontol, 1997;24:920-926
5 Grossi SG, Dunford RG, HO A et al. Sources of error for periodontal probing measurements. J Periodont Res, 1996:31:330-336
6 闫福华,曹采方.龈沟液研究的方法学.国外医学(口腔分册),1994;21:69-72
7 赵亦兵,孟焕新,陈智滨.实验性龈炎的临床观察和龈沟液量的分析.中华口腔医学杂志,2004:39:42-44
8 Christian P, Metzler D.E. Transaminases. New York: John Wiley and Sons, 1985;586-590
9 Ringer PG, Derouen TA, Page RC. Relationship between levels of amonotransferase in gingival crevicular fluid and gingival inflammation. J Periodont Res, 1990:25:17-24
10 段塬塬,王忠义,沈丽娟等.唾液获得性膜对不同桥体材料表面自由能的影响.牙体牙髓病杂志,2003:19:495-497
11 Quirynen M, Narechal M, Busscher HJ. et al. The influence of surface free energy and surface roughness on early plaque formation. J Olin Periodontol, 1990:17:138-144
12 Quirynen M, Marechal N, Busscher HJ, et al. The Influence of Surface Free-energy on Planimetric Plaque Growth in Man. J Dent Res, 1988;68:796-799
13 王贻宁,温国江,施斌等.牙科陶瓷表面粗糙度与细菌粘附的实验研究.中华口腔医学杂志.2003;38:342-344
14 张宁宁,王庆.抛光和自上釉对陶瓷表面平滑度的影响.实用口腔医学杂志.2002;18:54-55
15 崔东培,张振庭,杨圣辉.钴铬合金表面粗糙度与细菌黏附.口腔颌面修复杂志,2003:4:55-57
16 邓旭亮,胡晓阳,欧阳翔英等.牙轴面突度的变化对牙周组织健康的影响.中华口腔医学杂志,2001;36:440-442
17 Kohal R.J, Gerds T, Strub J.R. Effect of different crowns contours on periodontal health in dogs. Clinical results. Journal of Dentistry, 2003;31:407-413
18 Lindhe J, Hamp SE, Loe H. Experimental periodontitis in the beagle dog. Journal of Periodontal Research 1973;8:1-10
19 Tolboe H, Isidor F, Budtz-Jorgensen E, et al. Influence of pontic material on alveolar mucosal conditions. Scand J Dent Res, 1988,96:442
20 曹采方,主编.牙周病学(第二版).北京:人民卫生出版社,2000:31-37.
21 Paolantonio M, D'Ercole S, Perinetti G, Tripodi D, et al. Clinical and mocrobiological effect of different restorative materials on the periodontal tissues adjacent to subgingival class V. restorations. T Clin Periodontal, 2004;31:200-207
22 Steinberg D, Eyal S. Early formation of Streptococcus sobrinus biofilm on various dental restorative materials. Journal of Dentistry, 2001,30:47～51
23 陈治清,主编.口腔材料学(第二版)北京:人民卫生出版社出版,2000:104.
24 朱国威,杨晓红,陈丽娅等.非贵金属烤瓷冠修复后牙龈组织和血液中镍铬元素含量分析.华西口腔医学杂志,2004;22:284-286
25 孙佳凝,赵云风,高宁.牙科合金材料的生物相容性及影响合金离子析出的因素.国外医学(口腔医学分册),2003;30:212-213