Application of Different Sealing Materials and Adhedive Systems in Pit and Fissure Sealing of Deciduous Molars
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摘要:
目的 比较树脂型窝沟封闭剂与树脂加强型玻璃离子结合不同粘接系统应用于乳磨牙窝沟封闭的操作时长、接受度及封闭效果，为口腔医疗资源匮乏地区的儿童提供更适宜的口腔医疗保健措施。 方法 将符合条件的第2乳磨牙随机分为3组：树脂型窝沟封闭剂 + 全酸蚀组（SO组，对照组），树脂型窝沟封闭剂 + 自酸蚀粘结剂组（SE组），树脂加强型玻璃离子 + 自酸蚀粘结剂组（SS组）。进行窝沟封闭并记录操作时间与治疗感受度，3、6、12个月复查封闭剂保存情况及患龋情况。 结果 （1） SO组62人共纳入228颗牙，SS组63人共纳入234颗，VS组56人共纳入221颗牙；（2）SE组操作时间（181.88±12.37）s及SS组（103.07±11.37）s与对照组SO组操作时间（108.56±8.65）s，差异具有统计学意义（Z = 460.163，P < 0.001）；（3）与另外2组相比，SO组的治疗感受度较差（ Z = 20.232，P < 0.001）；（4）3 m复查时，SO组封闭剂保存率和龋发病率分别为100%、0%，SS组保存率和龋发病率为62.1%、2.2%，VS组保存率和龋发病率为93.1%、1.8%；6 m复查时，SO组封闭剂保存率和龋发病率分别为98.2%、1.8%，SS组保存率和龋发病率为52.3%、4.2%，VS组保存率和龋发病率为89.2%、3.3%；12 m复查时，SO组封闭剂保存率和龋发病率分别为95.0%、5.0%，SS组保存率和龋发病率为42.8%、7.2%，VS组保存率和龋发病率为78.9%、6.2%。3次复查中，SO组的保存率最高，3组封闭剂保存差异均具有统计学意义（3 m复查 χ2 = 144.286，P < 0.001；6 m复查 χ2 = 159.703，P < 0.001；12 m复查 χ2 = 152.945，P < 0.001）但3组的防龋效果相似（3 m复查 χ2 = 4.842，P = 0.089；6 m复查χ2 = 2.153，P = 0.341；12 m复查χ2 = 0.915，P = 0.613）。 结论 自酸蚀粘接剂结合树脂加强型玻璃离子可简化操作步骤、提高患儿的舒适度且封闭效果较好，对口腔医疗资源匮乏地区封闭技术的推广来说是一种切实有效的选择。 Abstract:Objective To compare the operation time, acceptability and sealing effect of resin-based sealant and resin-reinforced glass ionomer combined with certain adhesive systems applied to seal deciduous molar teeth, so as to provide a more appropriate oral health promotion activity for children in areas with insufficient oral medical resources. Methods The qualified second deciduous molars were randomly divided into three groups: ClinproTM Sealant + phosphoric acid etching （the control group）, ClinproTM Sealant + Single bond Universal, ClinproTM XT Vanish + Single bond Universal.The pit and fissure sealant were applied, operation time and treatment sensitivity were recorded. After 3, 6, and 12 months, preservation conditions and caries incidence were reviewed. Results （1）A total of 62 people in SO group included 228 teeth, 63 people in SS group included 234 teeth, and 56 people in VS group included 221 teeth. （2）The operating time of SE group （181.88±12.37） s and SS group （103.07±11.37） s was significantly different from that of SO group （108.56±8.65） in control group （Z = 460.163, P < 0.001）. （3） Compared with the other two groups, the treatment sensitivity of SO group was worse （Z = 20.232, P < 0.001）. （4） At reexamination 3 months after operation, the preservation rate of sealant and the incidence rate of caries were 100% and 0% in SO group, 62.1% and 2.2% in SS group, and 93.1% and 1.8% in VS group, respectively; At reexamination 6 months after operation, the preservation rate of sealant and incidence rate of caries in SO group were 98.2% and 1.8% respectively, the preservation rate and incidence rate of caries in SS group were 52.3% and 4.2%, and the preservation rate and incidence rate of caries in VS group were 89.2% and 3.3% respectively; At reexamination 12 months after operation, the preservation rate of sealant and the incidence rate of caries in SO group were 95.0% and 5.0% respectively; the preservation rate and the incidence rate of caries in SS group were 42.8% and 7.2%, and the preservation rate and the incidence rate of caries in VS group were 78.9% and 6.2%. Among the three reexaminations, the preservation rate of SO group was the highest, and the difference in the preservation of sealants among the three groups was statistically significant （ χ2 = 144.286, P < 0.001; χ2 = 159.703, P = < 0.001; χ2 = 152.945, P < 0.001）, but the caries prevention effect of the three groups was similar （ χ2 = 24.842, P = 0.089;χ2 = 2.153, P = 0.341; χ2 = 0.915, P = 0.613） Conclusion The self-etching adhesive combined with resin-reinforced glass ionomer can simplify the operation procedure, improve the comfort of children, and achieve good sealing effect, which is a practical and effective choice for the promotion of sealing technology in economically underdeveloped areas. -
图 1 实验进展流程图（n为人数，N为牙数）
Figure 1. Flow chart of the study process（n- number of included participants，N- number of the study tooth）
图 2 不同封闭材料的封闭效果
A：ClinproTM Sealant封闭后（上颌）；B：ClinproTM Sealant复查（上颌）；C：ClinproTM Sealant封闭后（下颌）；D：ClinproTM Sealant复查（下颌）；E：ClinproTM XT Vanish封闭后（上颌）；F：ClinproTM XT Vanish复查（上颌）；G：ClinproTM XT Vanish封闭后（下颌）；H：ClinproTM XT Vanish复查（下颌）。
Figure 2. Effect of different pit and fissure sealing materials
表 1 儿童治疗感受度评分
Table 1. The score of children’s treatment feeling
评分 表情 表现 1 不紧张 能迅速、准确回答医生的问题，表情淡定自然。 2 有点紧张 愿意并能准确回答医生问题，但面部表情不自然，手脚不自然放置，不自觉举手、抬脚。 3 比较紧张 能够回答问题，但声调和语速受紧张影响而改变，身体不自然扭动，举手、
抬脚等动作增加，但比较受控，有时叫停，不影响医生的操作。4 恐惧 想要拒绝治疗，哭叫，手常抬起，想要阻止医生操作，需要强硬的语气命令才能配合，操作受到影响。 5 特别恐惧 持续哭闹，身体不停扭动，需要助手辅助控制身体才能继续治疗，治疗非常困难。 
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表 2 3组操作时间的比较
Table 2. Comparison of operation time among three groups
组别 牙数 操作时间（s） SO组 228 181.88 ± 12.37 SS组 234 103.07 ± 11.37△ VS组 221 108.56 ± 8.65△& Z 460.163 P < 0.001 * *P < 0.05；与SO组比较， △P < 0.05；与SS组比较， &P < 0.05。
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表 3 3组儿童治疗感受情况[n（%）]
Table 3. The children’s treatment feeling among three groups [n（%）]
组别 评分 合计 1 2 3 4 5 SO组 20（32.3） 10（16.1） 8（12.9） 15（24.2） 9（14.5） 62（100.0） SS组 34（54.0） 15（23.8） 5（7.9） 4（6.4） 5（7.9） 63（100.0） VS组 40（71.4） 3（5.4） 7（12.5） 4（7.1） 2（3.6） 56（100.0） Z 20.232 P < 0.001 * *P < 0.05 *。
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表 4 3种方法封闭剂保存率及龋齿发病率（%）
Table 4. The rate of sealant reservation and incidence of tooth decay among three groups （%）
复查时间 组别 复查牙数 保存牙数 保存率 患龋牙数 龋发病率 3个月 SO组 228 228 100.0 0 0.0 SS组 224 139 62.1△ 5 2.2 VS组 217 202 93.1△# 4 1.8 χ2 144.286 4.842 P < 0.001 * 0.089 6个月 SO组 224 220 98.2 4 1.8 SS组 216 113 52.3△ 9 4.2 VS组 213 189 89.2△# 7 3.3 χ2 159.703 2.153 P < 0.001 * 0.341 12个月 SO组 220 209 95.0 11 5.0 SS组 208 89 42.8△ 15 7.2 VS组 209 165 78.9△# 13 6.2 χ2 152.945 0.915 P < 0.001 * 0.613 *P < 0.05；与SO组比较， △P < 0.05；与SS组比较， #P < 0.05。
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