无托槽隐形矫治中牙釉质脱矿情况的临床调查

doi:10.13591/j.cnki.kqyx.2024.10.004

摘要/Abstract

摘要：

目的调查无托槽隐形矫治过程中牙釉质脱矿的发病率及脱矿严重程度,为临床医疗护理工作提供参考依据。方法收集2015年—2022年于我院进行无托槽隐形矫治的151例患者(3 507颗牙齿),对比观察其治疗前后的牙釉质脱矿情况,使用釉质脱矿指数(enamel decalcification index,EDI)评估脱矿程度,对患者牙釉质脱矿的发病率和脱矿严重程度进行统计分析,比较不同性别、年龄及牙位之间的差异。结果治疗过程中有84例患者出现釉质脱矿,发病率为55.63%,性别及治疗时间对发病率无影响,青少年患者发病率高于成年患者。在被调查的3 507颗牙齿中有601颗出现釉质脱矿,发病率为17.14%,其中上颌前牙和下颌后牙的发病率较高,右侧牙齿的发病率显著高于左侧牙齿,粘接附件后釉质脱矿的发病率也显著增加。88%的牙釉质脱矿病损程度为1~2度,男女患者釉质脱矿程度相似,青少年的釉质脱矿程度显著高于成年患者,上颌前牙的平均EDI值明显大于下颌,上颌后牙的平均EDI值明显小于下颌,右侧的平均EDI值明显大于左侧。结论无托槽隐形矫治过程中出现牙釉质脱矿的发病率较高,且青少年是易感人群,不同牙位之间的脱矿情况有显著差异,粘结附件会增加牙齿釉质脱矿风险。因此医护人员应在釉质脱矿的防治工作中采取积极有效的措施。

关键词: 正畸, 无托槽隐形矫治, 牙釉质脱矿

Abstract:

Objective To investigate the incidence and severity of enamel demineralization during clear aligner treatment and provide reference for clinical medical nursing work. Methods A total of 151 patients(3 507 teeth)undergoing clear aligner treatment in our hospital from 2015 to 2022 were collected. The enamel demineralization before and after treatment was compared, and the enamel demineralization index(EDI) was calculated to evaluate the severity of demineralization. The incidence and severity of enamel demineralization were analyzed statistically, and the differences among different genders, ages and dental positions were compared. Results Enamel demineralization occurred in 84 patients during treatment, with an incidence rate of 55.63%. Gender and treatment time had no effect on the incidence, and the incidence of adolescent patients was higher than that of adult patients. Among the investigated 3 507 teeth, 601 teeth had enamel demineralization, and the incidence rate was 17.14%. The incidence of maxillary anterior teeth and mandibular posterior teeth was higher; the incidence of right teeth was significantly higher than that of left teeth, and the incidence of teeth with adhesive attachments was also significantly increased. 88% of the enamel demineralization lesions were 1-2 degrees, and the degree of enamel demineralization was similar in male and female patients. But the degree in adolescents was significantly higher than that in adult patients. The average EDI value of maxillary anterior teeth was significantly higher than that of mandible, but that of maxillary posterior teeth was significantly lower than that of mandible. The average EDI value of right teeth was significantly higher than that of left. Conclusion The incidence of enamel demineralization is high in the process of clear aligner treatment, and teenagers are susceptible to it. The demineralization of teeth is significantly different among different tooth positions, and adhesive attachments will increase the risk of enamel demineralization. Therefore, medical staff should take active and effective measures in the prevention and treatment of enamel demineralization.

Key words: orthodontics, clear aligner treatment, enamel decalcification

中图分类号:

R783.5

胡丹艳, 陈慧芬, 吴峻青, 李琥, 严斌, 韶青华. 无托槽隐形矫治中牙釉质脱矿情况的临床调查[J]. 口腔医学, 2024, 44(10): 742-746.

HU Danyan, CHEN Huifen, WU Junqing, LI Hu, YAN Bin, SHAO Qinghua. Clinical investigation of enamel demineralization during clear aligner treatment[J]. Stomatology, 2024, 44(10): 742-746.

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参考文献 15

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项目	类别	被调查人数(n)	新发人数(n)	发病率/%	χ²	P
性别	男	49	30	61.22	0.920	0.337
性别	女	102	54	52.94	0.920	0.337
年龄	<18岁	66	44	66.67	5.787	0.016^*
年龄	≥18岁	85	40	47.06	5.787	0.016^*
治疗时间	<24个月	73	42	57.53	0.208	0.648
治疗时间	≥24个月	78	42	53.85	0.208	0.648

项目	类别	被调查牙数(n)	新发牙数(n)	发病率/%	χ²	P
有无附件	无	1 154	145	12.56	25.32	<0.001^***
有无附件	有	2 353	456	19.38	25.32	<0.001^***
上下前牙	上颌前牙	880	235	26.70	-	<0.001^***
上下前牙	下颌前牙	880	94	10.68	-	<0.001^***
上下后牙	上颌后牙	843	113	13.40	-	0.005^**
上下后牙	下颌后牙	843	144	17.08	-	0.005^**
左右侧	左侧	1 734	272	15.69	-	<0.001^***
左右侧	右侧	1 734	321	18.51	-	<0.001^***

项目	类别	平均EDI指数 (中位数,四分位间距)	P
性别	男	0.291 7,0.733 5	0.133
性别	女	0.208 3,0.419 1	0.133
年龄	<18岁	0.337 5,0.775 6	0.006^**
年龄	≥18岁	0.170 3,0.282 1	0.006^**
治疗时间	<24个月	0.212 9,0.414 1	0.120
治疗时间	≥24个月	0.255 4,0.656 3	0.120

项目	类别	平均EDI指数 (中位数,四分位间距)	P
上下前牙	上颌前牙	0.500 0,1.000 0	<0.001^***
上下前牙	下颌前牙	0.000 0,0.333 3	<0.001^***
上下后牙	上颌后牙	0.166 7,0.458 3	0.005^**
上下后牙	下颌后牙	0.166 7,0.666 7	0.005^**
左右侧	左侧	0.250 0,0.566 7	0.001^**
左右侧	右侧	0.250 0,0.575 8	0.001^**