乳磨牙金属预成冠修复后咬合及颞下颌关节评估的临床研究  

Clinical assessment of occlusion and temporomandibular joint after placement of preformed metal crowns for primary molars

作　　者：施宜君 杨燃 王艳[1] 张琼[1] 黄睿洁 邹静[1] SHI Yijun;YANG Ran;WANG Yan;ZHANG Qiong;HUANG Ruijie;ZOU Jing(Department of Pediatric Dentistry,West China Hospital of Stomatology,Sichuan University&State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases,Chengdu 610041,China)

机构地区：[1]四川大学华西口腔医院儿童口腔科口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心,四川成都610041

出　　处：《口腔疾病防治》2022年第11期785-791,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(82170947);四川省科技厅国际科技创新合作/港澳台科技创新合作项目(2019YFH0025)。

摘　　要：目的评估全身麻醉下一次性完成所有乳磨牙金属预成冠修复对儿童咬合及颞下颌关节是否存在影响,为儿童口腔乳磨牙牙体缺损修复的治疗提供参考。方法纳入39例于全麻下行所有乳磨牙金属预成冠修复的患儿,分别在术前、术后1周、术后1月、术后3月、术后6月使用T-scan咬合分析系统对所有患儿的咬合接触面积、总咬合力百分比、咬合力不对称比及咬合接触时间进行分析,牙科垂直距离测量尺测量咬合垂直距离,同时采用改良临床障碍指数及问卷调查评估是否存在颞下颌关节功能障碍。结果术后3月及6月的咬合接触面积恢复到术前,差异无统计学意义(P>0.05);术后3月及6月的总咬合力百分比与术前相比有明显提升(P<0.05);术后6月的咬合力不对称比及咬合接触时间下降(P<0.05);咬合垂直距离于术后1月恢复,与术前差异无统计学意义(P>0.05);颞下颌关节评估表明,治疗前后临床障碍指数及主观症状差异均无统计学意义(P>0.05)。结论一次性完成所有乳磨牙金属预成冠修复的患儿咬合状态在1个月后基本恢复稳定;术后6月,总咬合力百分比大幅提升,咬合状态更稳定,无明显颞下颌关节功能障碍发生。Objective To explore the effect on children's occlusion and temporomandibular joint(TMJ)after placement of preformed metal crowns and provide a reference for the restoration of defective primary molars.Methods A total of 39 children who underwent all primary molar metal crown restorations under general anesthesia were enrolled.The participants underwent occlusal contact area,percentage of total occlusal force,asymmetric ratio of occlusal force and occlusal contact time examinations with the T-scan computerized occlusal analysis system.Vertical dimension of occlusion(VDO)was measured using a dental vertical dimension gauge.TMJ dysfunction signs were recorded using the modified clinical dysfunction index(Di),and TMJ dysfunction symptoms were recorded using questionnaires.All data were collected at pretreatment,1-week,1-month,3-month,and 6-month follow-up visits.Results The occlusal contact area at the 3-month and 6-month follow-up visits returned to the occlusal contact area of pretreatment,and the difference was statistically significant(P>0.05).Compared with pretreatment,the percentage of total occlusal force at the 3month and 6-month follow-up visits increased significantly,and the difference was statistically significant(P<0.05).The asymmetric ratio of occlusal force and the occlusal contact time were significantly decreased at the 6-month followup visit(P<0.05).The vertical dimension of occlusion recovered after one month of treatment(P>0.05).The final statistical analysis of the TMJ assessment showed that there was no significant difference in the clinical disorder index and TMJ dysfunction symptoms before and after treatment(P>0.05).Conclusions After undergoing all primary molar metal crown restorations,occlusal re-equilibrations were attained after approximately one month.The percentage of total occlusal force and occlusal stability were significantly increased after six months of treatment,without significant temporomandibular joint dysfunction.

关 键 词：乳磨牙 龋齿 重症低龄儿童龋 牙体缺损 牙体修复 金属预成冠 咬合 颞下颌关节 全身麻醉 前瞻性研究 T-scan咬合分析系统 Helkimo临床障碍指数 

分 类 号：R78[医药卫生—口腔医学]