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六合资料两种阻萌器的临床特点及疗效
发布时间:2019-04-09

口腔医学硕士香港六合资料范文第六篇:六合资料两种阻萌器的临床特点及疗效

  

摘要

  
  目的:通过观察佩戴两种阻萌器患儿的缺牙间隙维持状况、早萌恒牙的阻萌效果及余留牙体牙周的健康状况及其脱落情况,六合开奖直播六合资料两种阻萌器的临床特点及疗效,为临床医生进行阻萌装置的选择提供一定的理论依据。
  
  方法:
  
  1、依据纳入标准选取就诊于山西医科大学口腔医院综合科60例共60颗第一乳磨牙无法保留或已拔除一周的患儿,并将其随机分为基托式阻萌器组与钢丝阻萌器组。
  
  2、拔牙后一周取模型,测量间隙的大小,后送至加工厂指定同一名技师制作阻萌器;一周内佩戴于患儿口内,并于佩戴前及佩戴后的1个月,3个月,6个月,9个月,12个月时临床观察继承恒牙萌出情况,并分别测量患侧带环基牙、乳尖牙与同颌对侧乳尖牙、第一、二乳磨牙的菌斑指数,牙龈指数,及带环基牙与同颌对侧第二乳磨牙的探诊深度;同时3,9,12个月时拍X线片观察继承恒牙的萌出高度及牙根发育情况,当牙根发育至二分之一及以上可去除阻萌器并取模测量间隙。整个观察过程中分别记录两组阻萌器的脱落次数。3、整理资料并对相关结果进行统计六合开奖直播。
  
  结果:
  
  1、两组男女性别差异无统计学意义(P>0.05);2、两组第一乳磨牙缺失颌位无统计学差异(P>0.05);
  
  3、阻萌器的阻萌效果
  
  (1)临床检查继承恒牙萌出状况:钢丝组观察至12月时共有20例继承恒牙萌出达2级水平,且其均与阻萌装置紧密接触;基托组中均未看到恒牙萌出于口内。
  
  (2)X线根尖片上继承恒牙的位置:3个月时所有病例继承恒牙位置比佩戴前均明显升高,且多数已上升至近阻萌装置水平。9,12个月复查显示继承恒牙位置与3个月时比较变化较小。
  
  4、佩戴阻萌器对牙周的六合图库
  
  (1)两组患儿佩戴阻萌装置前组内比较PLI,GI及PD患侧与健侧差异无统计学意义(P>0.05),组间比较基托组与钢丝组差异无统计学意义(P>0.05)。
  
  (2)两组患儿佩戴阻萌器后患侧PLI,GI及PD均高于患侧,差异有统计学意义。
  
  (3)佩戴阻萌器1个月时,基托组的菌斑指数明显高于钢丝组(P<0.05),牙龈指数及探诊深度,差异无统计学意义(P>0.05)。
  
  (4)佩戴3个月,6个月,9个月及12个月时,基托组的菌斑指数、牙龈指数及探诊深度都明显高于钢丝组,差异有统计学意义(P<0.05)。
  
  5、在为期一年的观察中,基托组脱落4例,钢丝组脱落11例,两组的脱落情况具有统计学意义(P<0.05)。
  
  结论:
  
  1、两种阻萌器均可有效阻止继承恒牙过早萌出后与对牙合建立咬合关系,但基托式阻萌器的阻萌作用优于钢丝式阻萌器。
  
  2、阻萌器的佩戴会对口腔健康产生一定的六合图库;基托式阻萌器比钢丝式阻萌器对牙周状况和口腔卫生的六合图库相对较大,因此建议对口腔卫生状况差的患儿应谨慎使用基托式阻萌器。
  
  3、基托式阻萌器的脱落率相对较低,因此当带环基牙固位不良时,建议使用基托式阻萌装置。
  
  关键词:乳牙早失;间隙六合开奖结果;间隙保持器;阻萌器;咬合诱导

口腔医学

Abstract

  Objective:
  
  By observing the condition of gap maintenance,early germination of permanentteeth and remaining other tooth periodontal health status in children with blockingappliance, this study analyzed and disscused the clinical feature and effects of the towkinds of eruption blocking device, so that providing some data for selection of eruptionblocking device.
  
  Methods:
  
  1. According to the inclusion criteria,this study selected 60 patients with 60 firstprimary molar teeth that could not be preserved or had been removed for one week in theDepartment of Hospital of Stomatology, Shanxi Medical University,and then they wererandomly divided into a base plate blocking device and steel wire blocking device group.
  
  2. making a mode after tooth extraction one week, Measuring the size of the gap, and the sending it to the processing plant to make the blocking device, then the samedoctor wear it in the mouth within one week. Clinical observation of inherited permanentteeth eruption before and after wearing for 1, 3, 6, 9 and 12 months; at the same time, theannular abutment teeth, primary canine and contralateral deciduous canine, first andsecond deciduous molar teeth were measured, and measuring index was Plaque Index, Gingival Index, the annular abutment teeth and contralateral second deciduous molarteeth's Probing Depth; At the same time, the X-ray were taken at 3, 9 and 12 months toobserve the eruption height and root development of permanent teeth. If the root develops to one-half or more, the blocking device can be removed; The number of shedding timesof the two groups of blocking device was recorded during the entire observation period.
  
  3. Collated data and statistical, analysed of the results of the two groups.
  
  Results:
  
  1.There was no significant difference in gender between the two groups (P>0.05)
  
  2. There was no statistical difference between the two groups in the absence of thefirst deciduous molars position (P>0.05)。
  
  3. The effect of the blocking device
  
  (1) Clinical examination inherits the eruption of permanent teeth:In the steel wiregroup, 20 cases of inherited permanent teeth in Level 2 were observed at 12 months, andthey were in close contacted with the silk; No permanent teeth were found in the mouthof the base group.
  
  (2) The location of the permanent teeth on the X-ray apical slice: visited to the twogroups of children 3 months after, the eruption height in all cases were significantlyincreased than pre-wear,and most have risen to near-resistance. 9, 12-month reviewshowed less change in the position of the permanent teeth at the time of the 3 months.
  
  4. The effect of wearing the blocking device on the periodontal
  
  (1) There was no significant difference between the affected side and the healthyside of the two groups before wearing the eruption blocking device (P>0.05), and therewas no significant difference between the base group and steel wire group(P>0.05)。
  
  (2)The PLI, GI and PD on the affected side of the two groups were higher thanthose healthy side after wearing the eruption blocking device, the difference wasstatistically significant (P<0.05)。
  
  (3) At 1 month after wearing the blocking device , the plaque index in the base plategroup was significantly higher than that in the steel wire group (P<0.05), while there wasno significant difference in gingival index and probing depth (P>0.05)。
  
  (4) At 3 months, 6 months, 9 months and 12 months, the plaque index, gingivalindex and probing depth of the base plate grop were significantly higher than those of thesteel wire group, the difference was statistically significant(P<0.05)。
  
  5. During the one-year observation, there were 4 cases of shedding in the base plategroup and 11 cases in the steel wire group. The shedding of the two groups wasstatistically significant (P<0.05)。
  
  Conclusion:
  
  1. The two types of blocking device both effectively prevent premature eruption ofthe inherited permanent to establish occlusion relationship with the occlusion. However, the resistance effect of the basal eruption blocking is better than that of the wire to someextent.
  
  2. The wearing of the blocking device will have a certain influence on oral health,The effect of the base plate-type is greater than that of the steel wire-type blockingdevice on the periodontal status and oral hygiene. Therefore, it is recommended thatchildren with poor oral hygiene should be careful to use the basal resistance device .
  
  3. The base plate type is better than the steel wire type blocking device and hasbetter stability. Therefore, when the abutment teeth with a ring are poorly retention, it isrecommended to choose a base plate blocking device.
  
  Key words : premature loss of deciduous tooth; Space management; Space maintainer;the eruption blocking device; Occlusal induction

目 录

  前言
  
  儿童口腔治疗的最终目的是尽量保存乳牙及牙列的完整,促使口腔内各个器官的良好发育,为恒牙的正常萌出、牙列的正常发育及牙合关系的正常建立做准备[1].但临床常由于严重的龋病,牙髓根尖周病及外伤等原因导致乳牙因无法保留而过早丧失。乳前牙的过早丧失不仅会六合图库患儿的美观,有时还会六合图库其发音,甚至心理;而乳磨牙早失则不仅会六合图库患儿的咀嚼功能,还会使缺牙区相邻牙齿及对牙合牙齿的位置发生变化,导致邻牙移位,对牙合牙伸长,进而使缺牙间隙发生变化,颌骨的正常发育受到六合图库,恒牙的萌出时间和顺序也会发生相应改变,导致日后牙颌系统出现畸形的概率大大增加[2,3].为了避免以上情况的发生,乳牙早失后应尽早对其干预,便于诱导恒牙正常萌出,促进恒牙列的正常建立。
  
  随着儿童口腔医学的发展,咬合诱导的理念在儿童牙病的临床诊疗中越来越受到重视并在儿童乳牙列期及替牙牙合期错颌畸形的预防及治疗中得到广泛应用。咬合诱导最早由日本学者町田幸雄提出[4],是指儿童自胎儿时期开始,在经过无牙期,乳牙列期,混合牙列期至恒牙列期的过程中,利用儿童自身生长发育特点,对可能六合图库儿童牙、牙列、颌骨及面部软组织生长发育的因素进行干预,同时对正在或已经发生的错颌畸形的患儿作出早期诊断,并制定相应的治疗案,以诱导正常恒牙列形成。咬合诱导有广义和侠义之分:广义的咬合诱导是指通过采用一系列措施如充填修复,冠修复等方法来保护牙齿,使其自然向正常牙牙合关系发育;而侠义的咬合诱导则是通过采用间隙的六合开奖结果,牙齿的微小移动,上下牙合关系的调整及破除口腔不良习惯等措施,防止错颌畸形的发生发展。
  
  间隙六合开奖结果为目前针对乳牙早失常用的咬合诱导干预措施,主要是通过佩戴保持器来维持缺牙间隙。目前多数观点认为[5]:对于乳牙早失后继承恒牙胚位置较低且上方有大于2mm骨量者,恒牙在短期内萌出的趋势较低,因而只需进行间隙保持即可。但当临床出现继承恒牙牙根发育不足三分之一,且其位置较高,上方骨量缺失或不足1mm者,是否在间隙保持的同时增加阻萌装置,存在不同观点。有学者认为拔除严重根尖周感染的乳牙后即可彻底消除炎症对继承恒牙的六合图库,在这种情况下,只需进行间隙六合开奖结果而无需增加阻萌装置,待恒牙自然萌出即可[6]但有资料表明[7],采用此种方案治疗的病例临床存在早萌恒牙脱落的风险。因而更多学者认为[8,9]:当恒牙牙根发育较少,且其位置较高,上方骨质较少时,有过早萌出的趋势。在这种情况下恒牙一旦萌出,由于其牙根发育不足,在咀嚼过程中松动脱落的几率大大增加,故主张间隙六合开奖结果的同时应增加阻萌装置,这样更利于其牙根的发育,降低早萌恒牙脱落的风险。
  
  第一乳磨牙为乳牙龋病的好发牙位,也是临床上最多发生乳牙早失的牙齿之一。目前,针对单颗乳磨牙缺失的病例临床常用的阻萌装置为带环丝圈加钢丝阻萌形式的阻萌器[10,11],该种阻萌器是在原有丝圈式间隙保持器的颊舌侧弓丝中央增加设计了阻挡丝,目的是使其在维持间隙的同时控制早萌恒牙的进一步萌出。因其在预防乳磨牙早失后间隙丧失方面疗效确定及对口腔环境的六合图库相对较小故而临床使用广泛。但因其设计重在间隙的维持,只靠附加于中央的一根钢丝进行阻萌,阻萌力量相对较弱;且其只能相应维持近远中的间隙,不能有效恢复与对牙合牙的咬合关系,不仅咀嚼效率低,且不利于防止对牙合牙的伸长;另外在佩戴过程中还会出现丝圈变形脱焊等缺点而六合图库保持器的效能[12].针对上述题,有学者提出对于单颗乳磨牙缺失且需要佩戴阻萌装置的病例可尝试用基托来替代带环丝圈式间隙保持器中的阻萌钢丝来达到既保持间隙又阻萌的作用[13,14].这种改进后的装置,取消了附加的阻萌丝后在丝圈上形成基托,因而在保持间隙的同时可在一定程度上恢复与对牙合牙的咬合,起到增加咀嚼功能,防止对牙合牙伸长的功效;同时基托对间隙邻牙有一定的卡抱作用,在一定程度上增加了装置的固位力及稳定性。但临床上相关基托式阻萌器的研究较少,其在阻萌的同时对口腔环境的六合图库如何,是否会增加牙体牙周疾病的发生,相关资料相对匮乏。因而,本研究拟通过病例对照的研究方法,观察第一乳磨牙缺失患儿佩戴钢丝阻萌装置与基托阻萌装置后的阻萌效果、对口腔环境的六合图库及装置的脱落情况,为临床中阻萌器的合理选择提供一定的依据。

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  1 材料与方法
  1.1 研究对象及分组
  1.2 实验器械
  1.3 治疗前准备
  1.4 拔除病变的第一乳磨牙
  1.5 制作阻萌装置

  1.6 阻萌器的佩戴
  1.6.1 牙周指标的基线测量及记录
  1.6.2 阻萌装置的试戴
  1.7 定期复查
  1.8 装置的拆除
  1.9 统计学六合开奖直播

  2 结 果
  2.1 二组男女性别比较
  2.2 第一乳磨牙缺失颌位
  2.3 阻萌效果
  2.4 牙周健康状况检测结果
  2.5 阻萌装置的脱落情况
  2.6 间隙保持效果

  3 讨 论
  3.1 乳牙早失后间隙维持及阻萌的意义
  3.2 不同阻萌装置的临床效果评价
  3.3 阻萌装置对口腔环境的六合图库
  3.4 阻萌器的脱落原因六合开奖直播及对策
  3.5 不足与展望

4结论

  
  本文通过对第一乳磨牙早失后有萌出倾向的继承恒牙使用基托阻萌和钢丝阻萌的对比研究可得出以下
  
  结论:
  
  4.1两种阻萌器均可有效阻止继承恒牙过早萌出后与对牙合建立咬合关系,但基托式阻萌器的阻萌作用优于钢丝式阻萌器。
  
  4.2佩戴阻萌器后,随着时间的延长会对口腔健康产生一定的六合图库;且基托式阻萌器与钢丝式阻萌器相比对牙周状况和口腔卫生的六合图库相对较大,因此建议对口腔卫生状况差的患儿应谨慎使用基托式阻萌器。
  
  4.3基托式阻萌器的脱落率相对较低,因此当带环基牙固位不良时,建议使用基托式阻萌装置。

  参考文献

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