口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (7): 491-498.DOI: 10.12016/j.issn.2096-1456.2022.07.005
收稿日期:
2021-10-28
修回日期:
2022-01-16
出版日期:
2022-07-20
发布日期:
2022-04-25
通讯作者:
甘雪琦
作者简介:
付馨靓,住院医师,硕士研究生,Email: fuxinl1996@126.com
基金资助:
FU Xinliang(), SUN Jiyu, ZHU Zhuoli, GAN Xueqi(
)
Received:
2021-10-28
Revised:
2022-01-16
Online:
2022-07-20
Published:
2022-04-25
Contact:
GAN Xueqi
Supported by:
摘要:
目的 探讨树脂水门汀用于牙本质粘接的不良反应发生情况及其相关因素。方法 选择使用树脂水门汀类牙本质粘接剂进行复合树脂直接修复,或全冠间接修复治疗的牙体缺损患者作为研究对象,回顾性分析其治疗后7 d、1个月、3个月、6个月及1年牙体牙髓病变、软组织不良反应、修复体松动脱落等不良反应的发生情况及原因。结果 在使用树脂水门汀类牙本质粘接剂的5 971位患者14 776例患牙中,共计发生580例次(3.93%)不良反应。单因素分析示,治疗后7 d、1个月、12个月,修复类型为“全冠(桥)”的患牙不良反应发生率最高;治疗后7 d,预备层次为“预备后近髓”的患牙不良反应发生率最高;治疗后7 d和3个月,粘接面处理方式采用“牙本质处理剂-粘接剂-树脂”的患牙不良反应发生率最高。多因素分析结果显示,治疗后7 d“牙体预备穿髓后盖髓”为不良反应发生的危险因素(OR=2.610),治疗后7 d及3个月以“牙本质处理剂-粘接剂-树脂方式处理粘接面”为不良反应发生的保护因素(OR均小于1)。结论 树脂水门汀类牙本质粘接剂用于直接或间接修复时,牙体预备层次和粘接面处理方式可影响不良反应的发生率,牙体预备穿髓后盖髓及自酸蚀粘接易导致不良反应发生。
中图分类号:
付馨靓, 孙吉宇, 朱卓立, 甘雪琦. 树脂水门汀类牙本质粘接剂的不良反应及其相关因素回顾性分析[J]. 口腔疾病防治, 2022, 30(7): 491-498.
FU Xinliang, SUN Jiyu, ZHU Zhuoli, GAN Xueqi. Retrospective analysis of adverse reactions and related factors of resin cement dentin adhesive[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(7): 491-498.
Number of cases | Component ratio(%) | |
---|---|---|
Gender | ||
Female | 9 944 | 67.30 |
Male | 4 832 | 32.70 |
Age/year | ||
<1 | 0 | 0 |
1~4 | 0 | 0 |
5~14 | 146 | 0.99 |
15~44 | 9 347 | 63.26 |
45~64 | 3 814 | 25.81 |
≥65 | 1 469 | 9.94 |
Smoking | ||
No | 10 941 | 74.05 |
Yes | 3 803 | 25.74 |
Quit | 32 | 0.22 |
Allergic history | ||
No | 14 696 | 99.46 |
Yes | 80 | 0.54 |
History of systemic disease (n = 438) | ||
Hypertension | 175 | 39.95 |
Diabetes mellitus | 43 | 9.82 |
Oral mucosal diseases | 0 | 0 |
Heart disease | 50 | 11.42 |
Nervous system disease | 3 | 0.68 |
Others | 167 | 38.13 |
表1 纳入患者一般情况
Table 1 General information of patients
Number of cases | Component ratio(%) | |
---|---|---|
Gender | ||
Female | 9 944 | 67.30 |
Male | 4 832 | 32.70 |
Age/year | ||
<1 | 0 | 0 |
1~4 | 0 | 0 |
5~14 | 146 | 0.99 |
15~44 | 9 347 | 63.26 |
45~64 | 3 814 | 25.81 |
≥65 | 1 469 | 9.94 |
Smoking | ||
No | 10 941 | 74.05 |
Yes | 3 803 | 25.74 |
Quit | 32 | 0.22 |
Allergic history | ||
No | 14 696 | 99.46 |
Yes | 80 | 0.54 |
History of systemic disease (n = 438) | ||
Hypertension | 175 | 39.95 |
Diabetes mellitus | 43 | 9.82 |
Oral mucosal diseases | 0 | 0 |
Heart disease | 50 | 11.42 |
Nervous system disease | 3 | 0.68 |
Others | 167 | 38.13 |
Manifestations of adverse reaction | After operation | Total | Total incidence of adverse reaction | ||||
---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | |||
Hypersensitivity | 158 (27.24) | 47 (8.10) | 6 (1.03) | 4 (0.69) | 3 (0.52) | 218 (37.59) | 1.48% |
Cold and heat stimulating pain | 112 (19.31) | 70 (12.07) | 13 (2.24) | 8 (1.38) | 2 (0.34) | 205 (35.34) | 1.39% |
Sour stimulating pain | 7 (1.21) | 4 (0.69) | 1 (0.17) | 0 (0.00) | 0 (0.00) | 12 (2.07) | 0.08% |
Pulpitis | 0 (0.00) | 11 (1.90) | 7 (1.21) | 8 (1.38) | 7 (1.21) | 33 (5.69) | 0.22% |
Gingivitis | 9 (1.55) | 13 (2.24) | 4 (0.69) | 4 (0.69) | 0 (0.00) | 30 (5.17) | 0.20% |
Secondary caries | 6 (1.03) | 0 (0.00) | 0 (0.00) | 21 (3.62) | 3 (0.52) | 30 (5.17) | 0.20% |
Restoration loose | 10 (1.72) | 1 (0.17) | 2 (0.34) | 7 (1.21) | 20 (3.45) | 40 (6.90) | 0.27% |
Color change of filling/restoration | 0 (0.00) | 0 (0.00) | 0(0.00) | 1 (0.17) | 11 (1.90) | 12 (2.07) | 0.08% |
Total | 302 (52.07) | 146 (25.17) | 33 (5.69) | 53 (9.14) | 46 (7.93) | 580 | 3.93% |
表2 不同时间点不同不良反应表现情况
Table 2 Performance of different adverse reactions at different timepointsn(%)
Manifestations of adverse reaction | After operation | Total | Total incidence of adverse reaction | ||||
---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | |||
Hypersensitivity | 158 (27.24) | 47 (8.10) | 6 (1.03) | 4 (0.69) | 3 (0.52) | 218 (37.59) | 1.48% |
Cold and heat stimulating pain | 112 (19.31) | 70 (12.07) | 13 (2.24) | 8 (1.38) | 2 (0.34) | 205 (35.34) | 1.39% |
Sour stimulating pain | 7 (1.21) | 4 (0.69) | 1 (0.17) | 0 (0.00) | 0 (0.00) | 12 (2.07) | 0.08% |
Pulpitis | 0 (0.00) | 11 (1.90) | 7 (1.21) | 8 (1.38) | 7 (1.21) | 33 (5.69) | 0.22% |
Gingivitis | 9 (1.55) | 13 (2.24) | 4 (0.69) | 4 (0.69) | 0 (0.00) | 30 (5.17) | 0.20% |
Secondary caries | 6 (1.03) | 0 (0.00) | 0 (0.00) | 21 (3.62) | 3 (0.52) | 30 (5.17) | 0.20% |
Restoration loose | 10 (1.72) | 1 (0.17) | 2 (0.34) | 7 (1.21) | 20 (3.45) | 40 (6.90) | 0.27% |
Color change of filling/restoration | 0 (0.00) | 0 (0.00) | 0(0.00) | 1 (0.17) | 11 (1.90) | 12 (2.07) | 0.08% |
Total | 302 (52.07) | 146 (25.17) | 33 (5.69) | 53 (9.14) | 46 (7.93) | 580 | 3.93% |
Restoration Types | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Dental caries filling | 228 (2.25) | 93 (0.92) | 18 (0.18) | 40 (0.39) | 31 (0.31) | 410 (4.04) | 10 146 | |
Full crowns (fixed partial dentures) | 26 (1.62) | 27 (1.68) | 8 (0.50) | 6 (0.37) | 3 (0.19) | 70 (4.36) | 1 605 | |
Wedge-shaped defect | 48 (1.68) | 26 (0.91) | 7 (0.25) | 5 (0.18) | 9 (0.32) | 95 (3.33) | 2 850 | |
Trauma defect filling | 0 (0.00) | 0 (0.00) | 0 (0.00) | 2 (1.14) | 3 (1.71) | 5 (2.86) | 175 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 776 | |
χ2 | 9.029 | 10.349 | ||||||
P | 0.023 | 0.016 | 0.109* | 0.086* | 0.047* |
表3 不同修复类型在不同时间出现不良反应情况
Table 3 Statistics of adverse reactions in different restoration types at different timepointsn(%)
Restoration Types | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Dental caries filling | 228 (2.25) | 93 (0.92) | 18 (0.18) | 40 (0.39) | 31 (0.31) | 410 (4.04) | 10 146 | |
Full crowns (fixed partial dentures) | 26 (1.62) | 27 (1.68) | 8 (0.50) | 6 (0.37) | 3 (0.19) | 70 (4.36) | 1 605 | |
Wedge-shaped defect | 48 (1.68) | 26 (0.91) | 7 (0.25) | 5 (0.18) | 9 (0.32) | 95 (3.33) | 2 850 | |
Trauma defect filling | 0 (0.00) | 0 (0.00) | 0 (0.00) | 2 (1.14) | 3 (1.71) | 5 (2.86) | 175 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 776 | |
χ2 | 9.029 | 10.349 | ||||||
P | 0.023 | 0.016 | 0.109* | 0.086* | 0.047* |
Tooth preparation depth | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Prepared to dentin | 114 (2.08) | 57 (1.04) | 16 (0.29) | 19 (0.35) | 20 (0.36) | 226 (4.12) | 5 493 | |
Near pulp after preparation | 155 (2.53) | 59 (0.96) | 9 (0.15) | 23 (0.38) | 20 (0.33) | 266 (4.35) | 6 115 | |
Pulp capping after pulp exposure | 29 (0.99) | 30 (1.02) | 8 (0.27) | 9 (0.31) | 6 (0.20) | 82 (2.80) | 2 932 | |
Prepared to enamel | 4 (1.70) | 0 (0.00) | 0 (0.00) | 2 (0.85) | 0 (0.00) | 6 (2.55) | 235 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 775 | |
χ2 | 23.816 | 2.554 | ||||||
P | <0.001 | 0.466 | 0.328* | 0.478* | 0.605* |
表4 不同预备层次在不同时间出现不良反应情况
Table 4 Statistics of adverse reactions in different tooth preparation levels at different timepointsn(%)
Tooth preparation depth | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Prepared to dentin | 114 (2.08) | 57 (1.04) | 16 (0.29) | 19 (0.35) | 20 (0.36) | 226 (4.12) | 5 493 | |
Near pulp after preparation | 155 (2.53) | 59 (0.96) | 9 (0.15) | 23 (0.38) | 20 (0.33) | 266 (4.35) | 6 115 | |
Pulp capping after pulp exposure | 29 (0.99) | 30 (1.02) | 8 (0.27) | 9 (0.31) | 6 (0.20) | 82 (2.80) | 2 932 | |
Prepared to enamel | 4 (1.70) | 0 (0.00) | 0 (0.00) | 2 (0.85) | 0 (0.00) | 6 (2.55) | 235 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 775 | |
χ2 | 23.816 | 2.554 | ||||||
P | <0.001 | 0.466 | 0.328* | 0.478* | 0.605* |
Treatments of bonding surface | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Self-etch-resin | 253 (1.93) | 127 (0.97) | 24 (0.18) | 46 (0.35) | 40 (0.31) | 490 (3.74) | 13 112 | |
Dentin conditioner-adhesive-resin | 49 (2.94) | 19 (1.14) | 9 (0.54) | 7 (0.42) | 6 (0.36) | 90 (5.41) | 1 664 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 776 | |
χ2 | 7.601 | 0.453 | 6.955* | 0.202 | 0.147 | |||
P | 0.006 | 0.501 | 0.008* | 0.654 | 0.702 |
表5 不同粘接面处理方式在不同时间出现不良反应情况
Table 5 Statistics of adverse reactions in different bonding surface treating methods at different timepointsn(%)
Treatments of bonding surface | After operation | Total | ||||||
---|---|---|---|---|---|---|---|---|
7 d | 1 month | 3 months | 6 months | 12 months | Number of adverse reactions | Case number | ||
Self-etch-resin | 253 (1.93) | 127 (0.97) | 24 (0.18) | 46 (0.35) | 40 (0.31) | 490 (3.74) | 13 112 | |
Dentin conditioner-adhesive-resin | 49 (2.94) | 19 (1.14) | 9 (0.54) | 7 (0.42) | 6 (0.36) | 90 (5.41) | 1 664 | |
Total | 302 (2.04) | 146 (0.99) | 33 (0.22) | 53 (0.36) | 46 (0.31) | 580 (3.93) | 14 776 | |
χ2 | 7.601 | 0.453 | 6.955* | 0.202 | 0.147 | |||
P | 0.006 | 0.501 | 0.008* | 0.654 | 0.702 |
Factors | Factors included in the analysis | Dummy variable assignment | Reference group |
---|---|---|---|
A | Restoration types | Dental caries filling = (1, 0, 0), full crowns (fixed partial dentures) = (0, 1, 0), trauma defect filling = (0, 0, 1) | Wedge-shaped defect= (0, 0, 0) |
B | Tooth preparation depth | Pulp capping after pulp exposure = (1, 0, 0),near pulp after preparation = (0, 1, 0),prepared to enamel = (0, 0, 1) | Prepared to dentin = (0, 0, 0) |
C | Treatments of bonding surface | Dentin conditioner-adhesive-resin = 1 | Self-etch-resin = 0 |
表6 变量赋值
Table 6 Variable assignment
Factors | Factors included in the analysis | Dummy variable assignment | Reference group |
---|---|---|---|
A | Restoration types | Dental caries filling = (1, 0, 0), full crowns (fixed partial dentures) = (0, 1, 0), trauma defect filling = (0, 0, 1) | Wedge-shaped defect= (0, 0, 0) |
B | Tooth preparation depth | Pulp capping after pulp exposure = (1, 0, 0),near pulp after preparation = (0, 1, 0),prepared to enamel = (0, 0, 1) | Prepared to dentin = (0, 0, 0) |
C | Treatments of bonding surface | Dentin conditioner-adhesive-resin = 1 | Self-etch-resin = 0 |
Variables | β | S.E. | P | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower limit | Upper limit | |||||
Restoration types(Reference=Wedge-shaped defect) | ||||||
Dental caries filling | -0.467 | 0.166 | 0.005 | 0.627 | 0.453 | 0.868 |
Full crowns (fixed partial dentures) | -0.011 | 0.256 | 0.966 | 0.989 | 0.599 | 1.633 |
Trauma defect filling | 12.594 | 343.400 | 0.971 | >999.999 | <0.001 | >999.999 |
Tooth preparation depth (Reference=prepared to dentin) | ||||||
Pulp capping after pulp exposure | 0.959 | 0.221 | <0.001 | 2.610 | 1.694 | 4.022 |
Near pulp after preparation | -0.026 | 0.139 | 0.851 | 0.974 | 0.742 | 1.278 |
Prepared to enamel | 0.445 | 0.518 | 0.391 | 1.560 | 0.565 | 4.309 |
Treatments of bonding surface (reference=self-etch-resin) | ||||||
Dentin conditioner-adhesive-resin | -0.388 | 0.161 | 0.016 | 0.679 | 0.495 | 0.930 |
Constant | 4.117 | 0.162 | <0.001 |
表7 二分类Logistic回归多因素模型的参数估计(术后7 d)
Table 7 Parameter estimation of binary Logistic regression multifactor model (7 d after operation)
Variables | β | S.E. | P | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower limit | Upper limit | |||||
Restoration types(Reference=Wedge-shaped defect) | ||||||
Dental caries filling | -0.467 | 0.166 | 0.005 | 0.627 | 0.453 | 0.868 |
Full crowns (fixed partial dentures) | -0.011 | 0.256 | 0.966 | 0.989 | 0.599 | 1.633 |
Trauma defect filling | 12.594 | 343.400 | 0.971 | >999.999 | <0.001 | >999.999 |
Tooth preparation depth (Reference=prepared to dentin) | ||||||
Pulp capping after pulp exposure | 0.959 | 0.221 | <0.001 | 2.610 | 1.694 | 4.022 |
Near pulp after preparation | -0.026 | 0.139 | 0.851 | 0.974 | 0.742 | 1.278 |
Prepared to enamel | 0.445 | 0.518 | 0.391 | 1.560 | 0.565 | 4.309 |
Treatments of bonding surface (reference=self-etch-resin) | ||||||
Dentin conditioner-adhesive-resin | -0.388 | 0.161 | 0.016 | 0.679 | 0.495 | 0.930 |
Constant | 4.117 | 0.162 | <0.001 |
Variables | β | S.E. | P | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower limit | Upper limit | |||||
Restoration types (reference = wedge-shaped defect) | ||||||
Dental caries filling | 0.219 | 0.448 | 0.626 | 1.244 | 0.517 | 2.996 |
Full crowns (fixed partial dentures) | -1.097 | 0.550 | 0.046 | 0.334 | 0.114 | 0.980 |
Trauma defect filling | 12.719 | 952.900 | 0.989 | >999.999 | <0.001 | >999.999 |
Treatments of bonding surface (reference = self-etch-resin) | ||||||
Dentin conditioner-adhesive-resin | -1.340 | 0.420 | 0.001 | 0.262 | 0.115 | 0.596 |
Constant | 6.394 | 0.420 | <0.001 |
表8 二分类Logistic回归多因素模型的参数估计(术后3个月)
Table 8 Parameter estimation of binary Logistic regression multifactor model (3 months after operation)
Variables | β | S.E. | P | OR | 95% CI | |
---|---|---|---|---|---|---|
Lower limit | Upper limit | |||||
Restoration types (reference = wedge-shaped defect) | ||||||
Dental caries filling | 0.219 | 0.448 | 0.626 | 1.244 | 0.517 | 2.996 |
Full crowns (fixed partial dentures) | -1.097 | 0.550 | 0.046 | 0.334 | 0.114 | 0.980 |
Trauma defect filling | 12.719 | 952.900 | 0.989 | >999.999 | <0.001 | >999.999 |
Treatments of bonding surface (reference = self-etch-resin) | ||||||
Dentin conditioner-adhesive-resin | -1.340 | 0.420 | 0.001 | 0.262 | 0.115 | 0.596 |
Constant | 6.394 | 0.420 | <0.001 |
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