Abstract:

Objective　To analyze the effects of zirconia all-ceramic crown and cobalt(Co)-chromium(Cr) alloy porcelain crown in repairing anterior teeth defect, the patients' gingival health, and the detection of pathogenic bacteria in subgingival plaque. Methods　A prospective study was conducted on 153 patients (226 teeth) with anterior teeth defect treated at Department of Stomatology, Sun Simmiao Hospital, Beijing University of Chinese Medicine from August 2021 to August 2022. The patients were divided into a control group (76 cases, 112 teeth) and a research group (77 cases, 114 teeth) by the random number table method. There were 42 males and 34 females in the control group; they were (33.65±4.72) years old; their disease course was (5.14±1.23) months. There were 44 males and 33 females in the research group; they were (33.74±4.53) years old; their disease course was (5.15±1.22) months. The control group received Co-Cr alloy porcelain crown restoration, and the research group received zirconia all-ceramic crown restoration. Both groups were followed up for 1 year. The restoration effects, detection of subgingival plaque pathogens 1 year after restoration, chewing function, gingival crevicular fluid inflammatory factors before and 1 month after restoration, periodontal statusbefore and 6 months after restoration, and adverse reactions within 1 year after restoration were compared between the two groups. t test and χ² test were used. Results　The total excellent rate 1 year after restoration in the research group was higher than that in the control group [93.51% (72/77) vs. 82.89% (63/76)], with a statistical difference (χ²=4.149, P=0.042). One month after restoration, the bite forces and masticatory efficiencies of the two groups were higher than those before restoration, while the SDHue counts of the two groups were lower than those before restoration, and those in the research group changed more obviously, with statistical differences (all P<0.05). Six months after restoration, the scores of teeth mobility, plaque index (PLI), and gingival index (GI) [(3.54±0.63) and (1.67±0.35); (1.11±0.14) and (0.78±0.12); (0.98±0.14) and (0.79±0.13)] of the control group and the research group were lower than those before restoration [(20.75±3.31) and (20.77±3.24); (1.82±0.23) and (1.85±0.24); (1.47±0.22) and (1.44±0.25)], and those in the research group changed more obviously, with statistical differences (t=22.734, 15.661, and 8.700; all P<0.05). One year after restoration, the detection rates of Porphyromonas gingivalis (Pg), Fusobacterium nucleatum (Fn), Tannerella forsythia (Tf), and Actinobacteria actinomycetemcomitans (Aa) in the research group were lower than those in the control group [2.60% (2/77) vs. 11.84% (9/76), 3.90% (3/77) vs. 14.47% (11/76), 3.90% (3/77) vs. 14.47% (11/76), and 2.60% (2/77) vs. 13.16% (10/76)], with statistical differences (χ²=4.899, 5.148, 5.148, and 5.902; all P<0.05). One month after restoration, the levels of matrix metalloproteinase-8 (MMP-8), tumor necrosis factor-α (TNF-α), aspartate aminotransferase (AST), and C-reactive protein (CRP) in the gingival crevicular fluid of the two groups were higher than those before restoration, and those in the research group changed more obviously, with statistical differences (all P<0.05). There was no difference in the total incidence of adverse reactions within 1 year after restoration between the two groups (P>0.05). Conclusion　Compared with Co-Cr alloy porcelain crown, zirconia all-ceramic crown can improve the restoration effect, chewing function, and periodontal condition, reduce the pathogenic bacteria of subgingival plaque, and inhibit the expression of inflammatory factors in gingival crevicular fluid, and has fewer adverse reactions.

Key words:

Anterior teeth defect, Zirconia all-ceramic crown, Co-Cr alloy porcelain crown, Pathogenic bacteria

摘要：

目的　比较二氧化锆全瓷冠与钴铬合金烤瓷冠修复前牙缺损的效果及患者牙龈健康、龈下菌斑病原菌检出情况。方法　选取2021年8月至2022年8月北京中医药大学孙思邈医院口腔科收治的153例前牙缺损患者（226颗牙）作为研究对象，进行前瞻性研究，随机数字表法分为对照组（76例，112颗牙）和研究组（77例，114颗牙）。对照组年龄（33.65±4.72）岁，男42例、女34例，病程（5.14±1.23）个月；研究组年龄（33.74±4.53）岁，男44例、女33例，病程（5.15±1.22）个月。对照组接受钴铬合金烤瓷冠修复，研究组接受二氧化锆全瓷冠修复，两组均随访1年。比较两组患者修复效果、龈下菌斑病原菌检出情况（修复后1年）与咀嚼功能、龈沟液炎症因子指标（修复前及修复后1个月）与牙周状况（修复前及修复后6个月）、不良反应（修复后1年内），采用t检验、χ²检验进行统计比较。结果　研究组修复后1年优良率（93.51%，72/77）高于对照组（82.89%，63/76），差异有统计学意义（χ²=4.149，P=0.042）。修复后1个月，两组咬合力、咀嚼效能高于修复前，口香糖的混合程度数据（SDHue）值低于修复前，研究组变化更明显，差异均有统计学意义（均P<0.05）。修复后6个月，对照组、研究组牙齿松动度、菌斑指数（PLI）、牙龈指数（GI）［（3.54±0.63）分、（1.67±0.35）分，（1.11±0.14）分、（0.78±0.12）分，（0.98±0.14）分、（0.79±0.13）分］均低于修复前［（20.75±3.31）分、（20.77±3.24）分，（1.82±0.23）分、（1.85±0.24）分，（1.47±0.22）分、（1.44±0.25）分］，而研究组变化更明显，两组比较差异均有统计学意义（t=22.734、15.661、8.700，均P<0.05）。修复后1年，研究组龈下卟啉单胞菌（Pg）、具核梭形杆菌（Fn）、福赛坦菌（Tf）、伴放线放线杆菌（Aa）检出率［2.60%（2/77）、3.90%（3/77）、3.90%（3/77）、2.60%（2/77）］低于对照组［11.84%（9/76）、14.47%（11/76）、14.47%（11/76）、13.16%（10/76）］，差异均有统计学意义（χ²=4.899、5.148、5.148、5.902，均P<0.05）。修复后1个月，两组龈沟液基质金属蛋白酶-8（MMP-8）、肿瘤坏死因子-α（TNF-α）、天冬氨酸转氨酶（AST）、C反应蛋白（CRP）水平均高于修复前，而对照组变化更明显，差异均有统计学意义（均P<0.05）。修复后1年内，两组不良反应总发生率比较，差异无统计学意义（P>0.05）。结论　相较于钴铬合金烤瓷冠，前牙缺损患者应用二氧化锆全瓷冠修复效果更好，改善咀嚼功能、牙周状况，减少龈下菌斑病原菌，抑制龈沟液炎性因子表达，且不良反应少。

关键词:

前牙缺损, 二氧化锆全瓷冠, 钴铬合金烤瓷冠, 病原菌