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

doi:10.12016/j.issn.2096-1456.2022.07.005

摘要/Abstract

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。

关键词: 树脂水门汀, 牙本质粘接, 牙体缺损, 复合树脂修复, 冠修复, 不良反应, 牙体牙髓病变, 软组织不良反应, 修复体松动, 单因素分析, 多因素分析, 回顾性研究

Abstract:

Objective To investigate the adverse reactions of resin cement used for dentin bonding and its influencing factors. Methods Patients with dental defects treated with resin cement dentin adhesive for direct composite resin repair or full crown indirect repair were selected as the research objects. The occurrence and causes of adverse reactions, such as dental pulp lesions, soft tissue adverse reactions, and restoration loosening and falling off 7 days, 1 month, 3 months, 6 months, and 1 year after treatment, were analyzed retrospectively. Results Among the 14 776 teeth of 5 971 patients who used resin cement dentin adhesive, 580 cases (3.93%) had adverse reactions. Univariate analysis showed that the incidence of adverse events was highest in teeth with the "full crowns (fixed partial dentures)" restoration type at 7 days, 1 month, and 12 months after treatment. At 7 days after treatment, the incidence of adverse events was the highest in teeth with a preparation depth of "near pulp after preparation". At 7 days and 3 months after treatment, the incidence of adverse events was the highest in teeth with " dentin conditioner-adhesive-resin" treatment of the bonding surface. Multivariate analysis indicated that pulp perforation and pulp capping after tooth preparation were risk factors for adverse events 7 days after treatment (OR=2.610), and the “dentin primer-adhesive-resin” bonding surface treatment method was a protective factor for adverse events 7 days and 3 months after treatment (OR<1). Conclusion When resin cement dentin adhesives are used for direct or indirect restoration, the tooth preparation level and bonding surface treatment method may affect the occurrence of adverse events. pulp perforation, and pulp capping after tooth preparation, and self-etching bonding may contribute to adverse reactions.

Key words: resin cement, dentin bonding, tooth defect, compound resin restoration, crown restoration, adverse reactions, dental pulp lesions, soft tissue adverse reactions, restoration loosening, univariate analysis, multivariate analysis, retrospective study

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.

图/表 8

参考文献 21

[1]	中华口腔医学会牙体牙髓病学专业委员会. 复合树脂直接粘接修复操作规范的专家共识[J]. 中华口腔医学杂志, 2019, 54(9): 618-622. doi: 10.3760/cma.j.issn.1002-0098.2019.09.007. DOI
	Society of Cariology and Endodontology. Chinese Stomatological Association. Consensus recommendations from Chinese experts on the standard operational procedure for direct restorations using adhesive composite resins[J]. Chin J Stomatol, 2019, 54(9): 618-622. doi: 10.3760/cma.j.issn.1002-0098.2019.09.007. DOI
[2]	Marto CM, Baptista PA, Nunes T, et al. Evaluation of the efficacy of dentin hypersensitivity treatments-a systematic review and follow-up analysis[J]. J Oral Rehabil, 2019, 46(10): 952-990. doi: 10.1111/joor.12842. DOI URL
[3]	Ebel M, Bekes K, Klode C, et al. The severity and degree of hypomineralisation in teeth and its influence on oral hygiene and caries prevalence in children[J]. Int J Paediatr Dent, 2018, 28(6): 648-657. doi: 10.1111/ipd.12425. DOI URL
[4]	Pioch T, Stotz S, Buff E, et al. Influence of different etching times on hybrid layer formation and tensile bond strength[J]. Am J Dent, 1998, 11(5): 202-206. doi: 10.1080/000163598428509. DOI PMID
[5]	Tay FR, Gwinnett JA, Wei SH. Relation between water content in acetone/alcohol-based primer and interfacial ultrastructure[J]. J Dent, 1998, 26(2): 147-156. doi: 10.1016/s0300-5712(96)00090-5. DOI PMID
[6]	Zotti F, Falavigna E, Capocasale G, et al. Microleakage of direct restorations-comparison between bulk-fill and traditional composite resins:systematic review and meta-analysis[J]. Eur J Dent, 2021, 15(4): 755-767. doi: 10.1055/s-0041-1724155. DOI URL
[7]	吴政西, 李风兰. 两种老化方式对玻璃陶瓷与牙本质粘接界面的影响[J]. 口腔疾病防治, 2019, 27(11): 703-710. doi: 10.12016/j.issn.2096-1456.2019.11.004. DOI
	Wu ZX, Li FL. Effect of two aging methods on the bonding interface between glass ceramics and dentin[J]. J Prev Treat Stomatol Dis, 2019, 27(11): 703-710. doi: 10.12016/j.issn.2096-1456.2019. 11.004. DOI
[8]	Huang B, Sadeghinejad L, Adebayo O, et al. Gene expression and protein synthesis of esterase from Streptococcus mutans are affected by biodegradation by-product from methacrylate resin composites and adhesives[J]. Acta Biomater, 2018, 81(81): 158-168. doi: 10.1016/j.actbio.2018.09.050. DOI URL
[9]	Alrefeai MH, Alhamdan EM, Al-Saleh S, et al. Assessment of bond integrity, durability, and degree of conversion of a Calcium fluoride reinforced dentin adhesive[J]. Polymers (Basel), 2021, 13(15): 2418. doi: 10.3390/polym13152418. DOI URL
[10]	Dal Piva AMO, Tribst JPM, Borges ALS, Souza ROAE, et al. CAD-FEA modeling and analysis of different full crown monolithic restorations[J]. Dent Mater, 2018, 34(9): 1342-1350. doi: 10.1016/j.dental.2018.06.024. DOI URL
[11]	Bolme J, Gjerdet NR, Laegreid T. Effect of saliva contamination on the bond strength of single-step and three-step adhesive systems[J]. Eur J Oral Sci, 2022, 130(1): e12838. doi: 10.1111/eos.12838. DOI
[12]	Kucukyilmaz E, Celik EU, Akcay M, et al. Influence of blood contamination during multimode adhesive application on the microtensile bond strength to dentin[J]. Niger J Clin Pract, 2017, 20(12): 1644-1650. doi: 10.4103/1119-3077.224127. DOI PMID
[13]	Zhao SJ, Zhang L, Tang LH, et al. Nanoleakage and microtensile bond strength at the adhesive-dentin interface after different etching times[J]. Am J Dent, 2010, 23(6): 335-340. doi: 10.1007/s00266-010-9542-6. DOI
[14]	Assaf J, Hardan L, Kassis C, et al. Influence of resin cement thickness and elastic modulus on the stress distribution of Zirconium dioxide Inlay-Bridge: 3D finite element analysis[J]. Polymers (Basel), 2021, 13(22): 3863. doi: 10.3390/polym13223863. DOI URL
[15]	Machado CM, Zamuner AC, Modena KC, et al. How erosive drinks and enzyme inhibitors impact bond strength to dentin[J]. Braz Oral Res, 2015, 29(1): S1806-83242015000100300. doi: 10.1590/1807-3107BOR-2015.vol29.0105. DOI
[16]	Karadas M, Çağlar İ. The effect of Er:YAG laser irradiation on the bond stability of self-etch adhesives at different dentin depths[J]. Lasers Med Sci, 2017, 32(5): 967-974. doi: 10.1007/s10103-017-2194-x. DOI URL
[17]	魏雅楠, 陈筠, 李志艳. Er:YAG激光对恒牙牙本质粘接性能的影响[J]. 口腔疾病防治, 2020, 28(10): 673-676. doi: 10.12016/j.issn.2096-1456.2020.10.011. DOI
	Wei YN, Chen Y, Li ZY. Effect of Er: YAG laser irradiation on the bonding strength of permanent teeth[J]. J Prev Treat Stomatol Dis, 2020, 28(10): 673-676. doi: 10.12016/j.issn.2096-1456.2020.10. 011. DOI
[18]	廖宇, 刘晓强, 陈立, 等. 不同表面处理方法对氧化锆与树脂水门汀粘接强度的影响[J]. 北京大学学报(医学版), 2018, 50(1): 53-57. doi: 10.3969/j.issn.1671-167X.2018.01.009. DOI
	Liao Y, Liu XQ, Chen L, et al. Effects of different surface treatments on the zirconia-resin cement bond strength[J]. Beijing Da Xue Xue Bao Yi Xue Ban, 2018, 50(1): 53-57. doi: 10.3969/j.issn.1671-167X.2018.01.009. DOI
[19]	Aral K, Milward MR, Cooper PR. Dysregulation of inflammasomes in human dental pulp cells exposed to Porphyromonas gingivalis and fusobacterium nucleatum[J]. J Endod, 2020, 46(9): 1265-1272. doi: 10.1016/j.joen.2020.06.008. DOI URL
[20]	Khorasani Mohammad M Y, Hassanshahi Gholamhossein, Brodzikowska Aniela, et al. Role(s) of cytokines in pulpitis: latest evidence and therapeutic approaches[J]. Cytokine, 2020, 126: 154896. doi: 10.1016/j.cyto.2019.154896. DOI URL
[21]	Politano G, Van Meerbeek B, Peumans M. Nonretentive bonded ceramic partial crowns: concept and simplified protocol for long-lasting dental restorations[J]. J Adhes Dent, 2018, 20(6): 495-510. doi: 10.3290/j.jad.a41630. DOI

	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

	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
Manifestations of adverse reaction	7 d	1 month	3 months	6 months	12 months	Total	Total incidence of adverse reaction
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%

Manifestations of adverse reaction	After operation					Total	Total incidence of adverse reaction
Manifestations of adverse reaction	7 d	1 month	3 months	6 months	12 months	Total	Total incidence of adverse reaction
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
Restoration Types	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^*