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随着种植修复技术的进展,不同材料的冠修复体被应用于临床,然而,有研究[1]指出,不同的冠修复材料由于理化特性不同,长期处于口腔环境中可对牙周组织产生不同的影响。合金烤瓷冠在与人体接触过程中,会有金属离子释放而对周围牙周组织产生刺激作用[2]。钴铬合金烤瓷冠作为常用的非贵金属冠修复材料,金属稳定性较强,耐腐蚀性较高。钴铬合金可克服镍铬合金释放致敏、有毒镍离子的不足,且长期修复牙龈缘黑线发生率较低[3]。纯钛烤瓷冠亦是常用的非贵金属冠修复材料,具有生物相容性较好、耐腐蚀性强等特点[4]。本文就钴铬合金及纯钛烤瓷冠对种植体周围牙周组织的影响作一探讨。
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与T0时相比,2组病人T2~T4时GI和PD均明显升高(P < 0.01),钴铬合金组病人T2~T4时龈沟液含量增加(P < 0.05),而纯钛组病人T1~T4时龈沟液含量秘T0时差异均无统计学意义(P>0.05);纯钛组病人T2~T4时GI、PD和龈沟液含量均低于钴铬合金组(P < 0.05~P < 0.01)(见表 1)。
分组 n T0 T1 T2 T3 T4 F P MS组内 GI 纯钛组 51 0.15±0.11 0.19±0.15 0.34±0.17**## 0.41±0.16**##++ 0.43±0.17**##++ 35.18 < 0.01 0.024 钴铬合金组 46 0.17±0.13 0.19±0.20 0.43±0.19**## 0.54±0.16**##++ 0.61±0.20**##++ 58.33 < 0.01 0.032 t — 0.82 0.00 2.46 4.00 1.08 P — >0.05 >0.05 < 0.05 < 0.01 < 0.01 PD/mm 纯钛组 51 1.31±0.25 1.35±0.40 1.63±0.39**## 1.72±0.37**## 1.94±0.41**##++ 25.98 < 0.01 0.136 钴铬合金组 46 1.32±0.26 1.37±0.28 2.06±0.27**## 2.43±0.31**##++ 2.56±0.25**##++ 205.31 < 0.01 0.076 t — 0.19 0.28 6.36 10.18 9.09 P — >0.05 >0.05 < 0.01 < 0.01 < 0.01 龈沟液/mg 纯钛组 51 0.29±0.03 0.33±0.05 0.32±0.08 0.32±0.03 0.34±0.05 6.76 < 0.01 0.003 钴铬合金组 46 0.30±0.01 0.33±0.02 0.49±0.11* 0.63±0.09* 0.75±0.12* 243.11 < 0.01 0.007 t — 2.25 0.00 8.62 22.27 21.55 P — < 0.05 >0.05 < 0.01 < 0.01 < 0.01 与T0比较*P < 0.05,**P < 0.01;与T1比较##P < 0.01;与T2比较++P < 0.01 表 1 2组病人牙周指标及龈沟液含量比较(x±s)
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与T0时相比,2组病人T3~T4时龈沟液中MDA和IL-6水平均升高,而SOD和GST水平均降低(P < 0.05~P < 0.01);纯钛组病人T3~T4时龈沟液中IL-6水平均低于钴铬合金组,而GST水平则高于钴铬合金组(P < 0.05~P < 0.01)(见表 2)。
分组 n T0 T1 T2 T3 T4 F P MS组内 MDA/(ng/mL) 纯钛组 51 6.37±1.25 6.39±1.27 6.43±1.37 6.73±1.34* 7.11±1.31*#+ 3.00 < 0.05 1.713 钴铬合金组 46 6.35±1.23 6.41±1.29 6.47±1.38 6.97±1.40* 7.32±1.41**##++ 4.56 < 0.01 1.806 t — 0.08 0.08 0.14 0.86 0.76 P — >0.05 >0.05 >0.05 >0.05 >0.05 SOD/(ng/mL) 纯钛组 51 237.53±17.65 232.92±16.58 231.62±15.95 221.67±16.34**##++ 211.57±18.39**##++-- 19.14 < 0.01 288.870 钴铬合金组 46 239.48±17.24 234.82±16.08 231.47±15.93 216.35±15.53** 206.54±14.93** 34.39 < 0.01 254.406 t — 0.55 0.57 0.05 1.64 1.47 P — >0.05 >0.05 >0.05 >0.05 >0.05 GST/(ng/mL) 纯钛组 51 199.61±21.35 196.75±19.42 192.54±20.57 186.35±16.35**## 179.63±15.72**##++ 9.38 < 0.01 354.105 钴铬合金组 46 198.57±20.54 195.73±18.76 191.35±19.34 178.38±13.65**## 170.61±14.36**##++ 31.35 < 0.01 308.079 t — 0.24 0.26 0.29 2.59 2.94 P — >0.05 >0.05 >0.05 < 0.05 < 0.01 IL-6/(ng/mL) 纯钛组 51 2.93±0.47 3.05±0.49 2.97±0.43 3.43±0.64**##++ 3.98±0.53**##++-- 37.38 < 0.01 0.267 钴铬合金组 46 2.91±0.45 2.97±0.51 3.04±0.44 3.95±0.59**##++ 4.43±0.57**##++-- 82.19 < 0.01 0.266 t — 0.21 0.79 0.79 4.15 4.03 P — >0.05 >0.05 >0.05 < 0.01 < 0.01 与T0比较*P < 0.05,**P < 0.01;与T1比较#P < 0.05,##P < 0.01;与T2比较+P < 0.05,++P < 0.01;与T3比较,-P < 0.05,--P < 0.01 表 2 2组病人不同时点龈沟液成分变化情况比较(x±s)
纯钛烤瓷冠和钴铬合金烤瓷冠对种植体周围牙周组织的影响
Effect of titanium porcelain crown and cobalt-chromium alloy porcelain crown on periodontal tissue around the implant
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摘要:
目的探讨纯钛烤瓷冠和钴铬合金烤瓷冠对种植体周围牙周组织的影响。 方法97例行上颌前牙区单颗牙种植修复的病人,根据种植体修复材料的不同分为纯钛组(n=51)和钴铬合金组(n=46)。分别在种植体制备前(T0)和烤瓷冠黏固后1个月(T1)、3个月(T2)、6个月(T3)、12个月(T4)对牙周指标进行检测,提取种植体周围组织龈沟液,利用ELISA法对龈沟液中丙二醛(MDA)、超氧物歧化酶(SOD)、谷胱甘肽S-转移酶(GST)和白细胞介素6(IL-6)水平进行检测。 结果与T0时相比,2组病人T2~T4时牙龈指数(GI)和牙龈龈沟探诊深度(PD)均明显升高(P < 0.01),钴铬合金组T2~T4时龈沟液含量增加(P < 0.05),而纯钛组T1~T4时龈沟液含量与T0时差异均无统计学意义(P>0.05),T2~T4时纯钛组GI、PD和龈沟液含量均低于钴铬合金组(P < 0.05~P < 0.01);与T0时相比,2组T3~T4时龈沟液中MDA和IL-6水平均升高,而SOD和GST水平均降低(P < 0.05~P < 0.01);纯钛组T3~T4时龈沟液中IL-6水平均低于钴铬合金组,而GST水平则高于钴铬合金组(P < 0.05~P < 0.01)。 结论随着时间推移,纯钛烤瓷冠和钴铬合金烤瓷冠修复后均会对种植体周围牙周组织产生影响,但纯钛烤瓷冠的刺激作用相对弱于钴铬合金烤瓷冠。 Abstract:ObjectiveTo investigate the effects of titanium porcelain crown and cobalt-chromium alloy porcelain crown on periodontal tissue around the implant. MethodsNinety-seven patients treated with single tooth implant restoration in maxillary anterior teeth region were divided into the titanium group(n=51) and cobalt-chromium alloy group(n=48) according to the differences of restorative material.Before preparation of the implant(T0), after 1 month(T1), 3 months(T2), 6 months(T3) and 12 months(T4) of porcelain crowns bonding, the periodontal indicators were tested, respectively.The gingival crevicular fluid surrounding implant tissues were extracted from T0 to T4, respectively, and the levels of malondialdehyde(MDA), superoxide dismutase(SOD), glutathione S-transferase(GST), and interleukin 6(IL-6) in gingival crevicular fluids were detected. ResultsCompared with T0, the gingival index(GI) and gingival sulcus exploration depth(PD) in two groups increased(P < 0.01), and the content of gingival crevicular fluid in cobalt-chromium alloy group at T2 to T4 increased(P < 0.05).The differences of the content of gingival crevicular fluid in titanium group among T1-T3 and T4 were not statistically significant(P>0.05).The GI, PD and gingival crevicular fluid in titanium group at T2 to T4 were lower than those in cobalt-chromium alloy group(P < 0.05 to P < 0.01).Compared with T0, the levels of MDA and IL-6 in gingival crevicular fluid in two groups at T3 to T4 increased, while the levels of SOD and GST decreased(P < 0.05 to P < 0.01).The levels of IL-6 in gingival crevicular fluid at T3 to T4 in titanium group were lower than those in cobalt-chromium alloy group, but the levels of GST were higher than those in cobalt-chromium alloy group(P < 0.05 to P < 0.01). ConclusionsAs time going, both titanium porcelain crown and cobalt-chromium alloy porcelain crown can affect the periodontal tissue, but the effect of titanium porcelain crown is weaker than that of cobalt-chromium alloy porcelain crown. -
表 1 2组病人牙周指标及龈沟液含量比较(x±s)
分组 n T0 T1 T2 T3 T4 F P MS组内 GI 纯钛组 51 0.15±0.11 0.19±0.15 0.34±0.17**## 0.41±0.16**##++ 0.43±0.17**##++ 35.18 < 0.01 0.024 钴铬合金组 46 0.17±0.13 0.19±0.20 0.43±0.19**## 0.54±0.16**##++ 0.61±0.20**##++ 58.33 < 0.01 0.032 t — 0.82 0.00 2.46 4.00 1.08 P — >0.05 >0.05 < 0.05 < 0.01 < 0.01 PD/mm 纯钛组 51 1.31±0.25 1.35±0.40 1.63±0.39**## 1.72±0.37**## 1.94±0.41**##++ 25.98 < 0.01 0.136 钴铬合金组 46 1.32±0.26 1.37±0.28 2.06±0.27**## 2.43±0.31**##++ 2.56±0.25**##++ 205.31 < 0.01 0.076 t — 0.19 0.28 6.36 10.18 9.09 P — >0.05 >0.05 < 0.01 < 0.01 < 0.01 龈沟液/mg 纯钛组 51 0.29±0.03 0.33±0.05 0.32±0.08 0.32±0.03 0.34±0.05 6.76 < 0.01 0.003 钴铬合金组 46 0.30±0.01 0.33±0.02 0.49±0.11* 0.63±0.09* 0.75±0.12* 243.11 < 0.01 0.007 t — 2.25 0.00 8.62 22.27 21.55 P — < 0.05 >0.05 < 0.01 < 0.01 < 0.01 与T0比较*P < 0.05,**P < 0.01;与T1比较##P < 0.01;与T2比较++P < 0.01 表 2 2组病人不同时点龈沟液成分变化情况比较(x±s)
分组 n T0 T1 T2 T3 T4 F P MS组内 MDA/(ng/mL) 纯钛组 51 6.37±1.25 6.39±1.27 6.43±1.37 6.73±1.34* 7.11±1.31*#+ 3.00 < 0.05 1.713 钴铬合金组 46 6.35±1.23 6.41±1.29 6.47±1.38 6.97±1.40* 7.32±1.41**##++ 4.56 < 0.01 1.806 t — 0.08 0.08 0.14 0.86 0.76 P — >0.05 >0.05 >0.05 >0.05 >0.05 SOD/(ng/mL) 纯钛组 51 237.53±17.65 232.92±16.58 231.62±15.95 221.67±16.34**##++ 211.57±18.39**##++-- 19.14 < 0.01 288.870 钴铬合金组 46 239.48±17.24 234.82±16.08 231.47±15.93 216.35±15.53** 206.54±14.93** 34.39 < 0.01 254.406 t — 0.55 0.57 0.05 1.64 1.47 P — >0.05 >0.05 >0.05 >0.05 >0.05 GST/(ng/mL) 纯钛组 51 199.61±21.35 196.75±19.42 192.54±20.57 186.35±16.35**## 179.63±15.72**##++ 9.38 < 0.01 354.105 钴铬合金组 46 198.57±20.54 195.73±18.76 191.35±19.34 178.38±13.65**## 170.61±14.36**##++ 31.35 < 0.01 308.079 t — 0.24 0.26 0.29 2.59 2.94 P — >0.05 >0.05 >0.05 < 0.05 < 0.01 IL-6/(ng/mL) 纯钛组 51 2.93±0.47 3.05±0.49 2.97±0.43 3.43±0.64**##++ 3.98±0.53**##++-- 37.38 < 0.01 0.267 钴铬合金组 46 2.91±0.45 2.97±0.51 3.04±0.44 3.95±0.59**##++ 4.43±0.57**##++-- 82.19 < 0.01 0.266 t — 0.21 0.79 0.79 4.15 4.03 P — >0.05 >0.05 >0.05 < 0.01 < 0.01 与T0比较*P < 0.05,**P < 0.01;与T1比较#P < 0.05,##P < 0.01;与T2比较+P < 0.05,++P < 0.01;与T3比较,-P < 0.05,--P < 0.01 -
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