乳牙间接牙髓治疗两年疗效观察及影响因素分析
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摘要
目的:以电子病历数据库为依托,观察乳牙间接牙髓治疗术后的预后情况,并对其影响因素进行分析。方法:在北京大学口腔医院电子病历数据库中,利用科研疾病数据库,检索2014年8月至2016年9月间于儿童口腔科进行乳磨牙间接牙髓治疗的9. 0岁以下患儿、乳前牙间接牙髓治疗的4. 5岁以下患儿,选择无全身系统性疾病且规律随访时间超过1. 5年、病历记录完整的患儿为研究对象,收集患儿的病历信息。根据术后临床表现,将所有乳牙预后归为H、P两类,预后H定义为成功,预后P定义为失败。以患牙为单位,绘制生存曲线,用Cox比例风险回归模型分析影响患牙预后的因素。结果:共纳入106名患儿,初诊年龄为1. 6～8. 8岁,平均(5. 0±1. 7)岁,共168颗乳牙(122颗乳磨牙,46颗乳前牙),平均随访时间为(729±244) d。截止至2018年9月,根据临床或影像学检查,术后有35颗乳牙(23颗乳磨牙,12颗乳前牙)治疗失败。经Kaplan-Meier法分析发现168颗患牙不同时间点累计生存率:0. 5年时为93. 5%,1年时为92. 9%,1. 5年时为87. 5%,2年时为82. 7%,2. 5年时为75. 5%。Cox比例回归分析发现,对于乳磨牙来说,龋坏洞形涉及的牙面越多,间接牙髓治疗的预后越差,差异有统计学意义(OR=1. 709,P <0. 05)。乳前牙间接牙髓治疗的术后失败风险高于乳磨牙,但差异无统计学意义。结论:遵从目前所使用的诊疗常规,乳牙间接牙髓治疗的2. 5年生存率为75. 5%。在乳磨牙中,术后失败风险与龋坏侵犯的牙面数量显著相关,龋坏涉及的牙面数量越多,间接牙髓治疗后失败风险越高。
Objective: To evaluate the outcomes and to find out the influence factors of indirect pulp treatment in primary teeth. Methods: Children who received indirect pulp treatment in primary teeth in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from August,2014 to September,2016 were collected in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology,via the database for scientific research provided by the corporation of Kaientai. The children selected as the subjects of this study were followed up over 1. 5 years,and they were under 9 years old if in the group of primary molars while the children in the group of primary anterior teeth were under 4 and a half years old. Those children who were not reviewed regularly or didn't have complete medical records were removed. Basic information,the relevant medical records and radiographic records of those children were collected. All teeth were examined clinically and classified into 2 outcomes,teeth in groupH were regarded as succeeded,and teeth in group P were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: One hundred and six children were finally included,aged from 1. 6 to 8. 8 years,with the mean age of(5. 0 ±1. 7) years. 168 primary teeth(122 primary molars,46 primary anterior teeth) were included,and the average follow up time was(729 ± 244) days. Thirty-five primary teeth(23 primary molars,12 primary anterior teeth) failed upon clinical or radiographic examinations by September,2018. The cumulative survival probability of half a year,one year,one year and a half,two years,two and a half years for the indirect pulp treatment was 93. 5%,92. 9%,87. 5%,82. 7%,and 75. 5% through the Kaplan-Meier method,respectively. Through the analysis of Cox proportional hazard model,in primary molars,the survival probability tended to be lower when the number of tooth surface affected by caries was greater(OR = 1. 709,P < 0. 05). Compared with primary molars,the survival probability of primary anterior teeth was lower,but the difference was not significant. Conclusion: Complying the current instructions in our department,the cumulative survival probability of two and a half years after the indirect pulp treatment in primary teeth was 75. 5%. In primary molars,the survival probability tended to be lower when the number of tooth surfaces affected by caries increased.
Objective: To evaluate the outcomes and to find out the influence factors of indirect pulp treatment in primary teeth. Methods: Children who received indirect pulp treatment in primary teeth in the Department of Pediatric Dentistry in Peking University School and Hospital of Stomatology from August,2014 to September,2016 were collected in the Electronic Medical Record Database of Peking University School and Hospital of Stomatology,via the database for scientific research provided by the corporation of Kaientai. The children selected as the subjects of this study were followed up over 1. 5 years,and they were under 9 years old if in the group of primary molars while the children in the group of primary anterior teeth were under 4 and a half years old. Those children who were not reviewed regularly or didn't have complete medical records were removed. Basic information,the relevant medical records and radiographic records of those children were collected. All teeth were examined clinically and classified into 2 outcomes,teeth in groupH were regarded as succeeded,and teeth in group P were regarded as failed. Survival analysis was applied. The survival rate and survival time of the deciduous teeth calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: One hundred and six children were finally included,aged from 1. 6 to 8. 8 years,with the mean age of(5. 0 ±1. 7) years. 168 primary teeth(122 primary molars,46 primary anterior teeth) were included,and the average follow up time was(729 ± 244) days. Thirty-five primary teeth(23 primary molars,12 primary anterior teeth) failed upon clinical or radiographic examinations by September,2018. The cumulative survival probability of half a year,one year,one year and a half,two years,two and a half years for the indirect pulp treatment was 93. 5%,92. 9%,87. 5%,82. 7%,and 75. 5% through the Kaplan-Meier method,respectively. Through the analysis of Cox proportional hazard model,in primary molars,the survival probability tended to be lower when the number of tooth surface affected by caries was greater(OR = 1. 709,P < 0. 05). Compared with primary molars,the survival probability of primary anterior teeth was lower,but the difference was not significant. Conclusion: Complying the current instructions in our department,the cumulative survival probability of two and a half years after the indirect pulp treatment in primary teeth was 75. 5%. In primary molars,the survival probability tended to be lower when the number of tooth surfaces affected by caries increased.
引文
[1]王兴.第四次全国口腔健康流行病学调查报告[M].北京:人民卫生出版社,2018:50.
[2]夏斌,秦满,韩烨,等.儿童口腔科门诊治疗需求特征分析及对策[J].北京大学学报(医学版),2013,45(1):92-96.
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[6] Kotsanos N,Arizos S. Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars[J]. Eur Arch Paediatr Dent,2011,12(3):170-175.
[7] Franzon R,Guimar2es LF,Magalh2es CE,et al. Outcomes of one-step incomplete and complete excavation in primary teeth:a24-month randomized controlled trial[J]. Caries Res,2014,48(5):376-383.
[8] Chompuinwai P,Boonsongsawat K,Sastraruji T,et al. Three incomplete caries removal techniques compared over two years in primary molars with asymptomatic deep caries or reversible pulpitis[J]. Pediatr Dent,2015,37(6):e41-e48.
[9] Schwendicke F,Frencken JE,Bjrndal L,et al. Managing carious lesions:consensus recommendations on carious tissue removal[J]. Adv Dent Res,2016,28(2):58-67.
[10] Coll JA. Indirect pulp capping and primary teeth:is the primary tooth pulpotomy out of date?[J]. J Endod,2008,34(7):230-236.
[11] Schwendicke F,D9rfer CE,Paris S. Incomplete caries removal:a systematic review and meta-analysis[J]. J Dent Res,2013,92(4):306-314.
[12]窦桂丽,吴南,赵双云,等.乳磨牙牙髓切断术两年疗效观察及其影响因素回顾性分析[J].北京大学学报(医学版),2018,50(1):170-175.
[13] Waggoner WF. Restoring primary anterior teeth:updated for 2014[J]. Pediatr Dent,2015,37(2):163-170.
[14] Demir T,Cehreli ZC. Clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with125%sodium hypochlorite:2-year results[J]. Am J Dent,2007,20(3):182-188.
[15] Randall RC. Preformed metal crowns for primary and permanent molar teeth:review of the literature[J]. Pediatr Dent,2002,24(5):489-500.
[16] Innes NP,Stirrups DR,Evans DJ,et al. A novel technique using preformed metal crowns for managing carious primary molars in general practice:a retrospective analysis[J]. Br Dent J,2006,200(8):451-454.
[17] Innes NP,Evans DJ,Bonifacio CC,et al. TheHall technique 10years on:questions and answers[J]. Br Dent J,2017,222(6):478-483.
[18] Ludwig KH,Fontana M,Vinson LA,et al. The success of stainless steel crowns placed with the Hall technique:a retrospective study[J]. J Am Dent Assoc,2014,145(12):1248-1253.
[19] Falster CA,Araujo FB,Straffon LH,et al. Indirect pulp treatment:in vivo outcomes of an adhesive resin system vs. calcium hydroxide for protection of the dentin-pulp complex[J]. Pediatr Dent,2002,24(3):241-248.
[20] Hafshejani TM,Zamanian A,Venugopal JR,et al. Antibacterial glass-ionomer cement restorative materials:a critical review on the current status of extended release formulations[J]. J Control Release,2017,262:317-328.
[21] Tarasingh P,Reddy JS,Suhasini K,et al. Comparative evaluation of antimicrobial efficacy of resin-modified glass ionomers,compomers and giomers:an in vitro study[J]. J Clin Diagn Res,2015,9(7):ZC85-ZC87.
[2]夏斌,秦满,韩烨,等.儿童口腔科门诊治疗需求特征分析及对策[J].北京大学学报(医学版),2013,45(1):92-96.
[3] Dean JA,Avery DR,Mc Donald RE. Treatment of deep caries,vital pulp exposure,and pulpless teeth[M]. Mcdonald&Averys Dentistry for the Child&Adolescent. 10th ed. Missouri:Mosby Elesevier,2016:221-242.
[4] American Academy on Pediatric Dentistry Clinical Affairs Committee-Pulp Therapy Subcommittee. Guideline on pulp therapy for primary and young permanent teeth[J]. Pediatr Dent,2016,38(6):280-288.
[5] Casagrande L,Bento LW,Dalpian DM,et al. Indirect pulp treatment in primary teeth:4-year results[J]. Am J Dent,2010,23(1):34-38.
[6] Kotsanos N,Arizos S. Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars[J]. Eur Arch Paediatr Dent,2011,12(3):170-175.
[7] Franzon R,Guimar2es LF,Magalh2es CE,et al. Outcomes of one-step incomplete and complete excavation in primary teeth:a24-month randomized controlled trial[J]. Caries Res,2014,48(5):376-383.
[8] Chompuinwai P,Boonsongsawat K,Sastraruji T,et al. Three incomplete caries removal techniques compared over two years in primary molars with asymptomatic deep caries or reversible pulpitis[J]. Pediatr Dent,2015,37(6):e41-e48.
[9] Schwendicke F,Frencken JE,Bjrndal L,et al. Managing carious lesions:consensus recommendations on carious tissue removal[J]. Adv Dent Res,2016,28(2):58-67.
[10] Coll JA. Indirect pulp capping and primary teeth:is the primary tooth pulpotomy out of date?[J]. J Endod,2008,34(7):230-236.
[11] Schwendicke F,D9rfer CE,Paris S. Incomplete caries removal:a systematic review and meta-analysis[J]. J Dent Res,2013,92(4):306-314.
[12]窦桂丽,吴南,赵双云,等.乳磨牙牙髓切断术两年疗效观察及其影响因素回顾性分析[J].北京大学学报(医学版),2018,50(1):170-175.
[13] Waggoner WF. Restoring primary anterior teeth:updated for 2014[J]. Pediatr Dent,2015,37(2):163-170.
[14] Demir T,Cehreli ZC. Clinical and radiographic evaluation of adhesive pulp capping in primary molars following hemostasis with125%sodium hypochlorite:2-year results[J]. Am J Dent,2007,20(3):182-188.
[15] Randall RC. Preformed metal crowns for primary and permanent molar teeth:review of the literature[J]. Pediatr Dent,2002,24(5):489-500.
[16] Innes NP,Stirrups DR,Evans DJ,et al. A novel technique using preformed metal crowns for managing carious primary molars in general practice:a retrospective analysis[J]. Br Dent J,2006,200(8):451-454.
[17] Innes NP,Evans DJ,Bonifacio CC,et al. TheHall technique 10years on:questions and answers[J]. Br Dent J,2017,222(6):478-483.
[18] Ludwig KH,Fontana M,Vinson LA,et al. The success of stainless steel crowns placed with the Hall technique:a retrospective study[J]. J Am Dent Assoc,2014,145(12):1248-1253.
[19] Falster CA,Araujo FB,Straffon LH,et al. Indirect pulp treatment:in vivo outcomes of an adhesive resin system vs. calcium hydroxide for protection of the dentin-pulp complex[J]. Pediatr Dent,2002,24(3):241-248.
[20] Hafshejani TM,Zamanian A,Venugopal JR,et al. Antibacterial glass-ionomer cement restorative materials:a critical review on the current status of extended release formulations[J]. J Control Release,2017,262:317-328.
[21] Tarasingh P,Reddy JS,Suhasini K,et al. Comparative evaluation of antimicrobial efficacy of resin-modified glass ionomers,compomers and giomers:an in vitro study[J]. J Clin Diagn Res,2015,9(7):ZC85-ZC87.