放大镜与显微镜辅助下瓷贴面牙体预备效果的比较

doi:10.19723/j.issn.1671-167X.2019.01.018

摘要/Abstract

摘要：

目的:研究和比较初学者应用放大镜与应用显微镜进行瓷贴面牙体预备的效果,从操作效率、预备体质量、预备准确度以及喜好度等方面比较放大镜和显微镜的应用价值。方法:从北京大学口腔医院修复科选择20名口腔修复医生进行前瞻性、单盲、自身对照试验,试验对象无使用放大镜或显微镜的经验。每人依次在常规视野下(空白对照组)、2.5倍头戴式放大镜下(放大镜组)和8倍医用显微镜下(显微镜组)在仿头模内完成右上中切牙开窗型瓷贴面牙体预备,试验过程中记录牙体预备所需的时间。操作完成后,由医生本人利用视觉模拟评分法(vi-sual analogue score,VAS)对操作效率、预备体质量和喜好度进行主观评分,由第三方专家在体视显微镜下对瓷贴面预备体的质量进行评分,并利用数字化方法对预备准确性进行评价。结果:操作效率方面,对照组、放大镜组和显微镜组的主观VAS评分分别为7.15±1.73、8.10±0.91、5.40±2.04,放大镜组与显微镜组间的差异有统计学意义(P<0.05);客观操作时间三组分别为(430.10±163.04) s、(393.90±157.27) s、(441.95±164.18) s,放大镜组与显微镜组间的差异有统计学意义(P<0.05);放大镜组比显微镜组操作效率高。预备体质量方面,对照组、放大镜组和显微镜组的主观VAS评分分别为6.55±2.09、7.85±0.99、6.25±1.77,放大镜组与显微镜组间的差异有统计学意义(P<0.05);专家评分分别为12.20±1.67、12.50±1.70、11.35±2.60,放大镜组与显微镜组间的差异有统计学意义(P<0.05);放大镜组的预备体质量优于显微镜组。预备准确度方面,对照组、放大镜组和显微镜组的唇面切1/3分别为(0.107±0.097) mm、(0.142±0.118) mm、(0.123±0.087) mm,唇面中1/3分别为(0.128±0.073) mm、(0.113±0.105) mm、(0.125±0.077) mm,唇面颈1/3分别为(0.075±0.054) mm、(0.068±0.044) mm、(0.058±0.047) mm,三组间每个区域的差异均无统计学意义(P>0.05)。喜好度方面,对照组、放大镜组和显微镜组的主观VAS评分分别为6.55±2.31、8.60±1.10、5.80±2.07,放大镜组与显微镜组间的差异有统计学意义(P<0.05),放大镜组最受欢迎。结论:针对初学者而言,放大镜比显微镜用于瓷贴面牙体预备的效果更好。

关键词: 牙科设备, 牙科器械, 牙体预备, 放大镜, 显微镜

Abstract:

Objective: To assess and compare the effects of loupes and microscope on laminate veneer preparation of the first practitioner from the aspects of efficiency, quality and accuracy of preparation, and preference. Methods: Twenty young prosthodontists from the Department of Prosthodontics, Peking University School and Hospital of Stomatology were recruited into this study, which was prospective, single blind, self-control trials. The participants had no experience of using dental magnification devices. They prepared laminate veneers in the artificial dental model, under routine visual field (control group), 2.5× headwear loupes (loupes group), and 8× operating microscope (microscopic group) by turning. The time for tooth preparation was recorded. Thereafter, subjective assessments of efficiency, quality of preparation and preference were performed by themselves using visual analogue score (VAS). Expert assessments of quality and accuracy of preparation were performed by two professors using stereomicroscope and digital technique respectively. Results: In terms of efficiency, the subjective scores for the control group, loupes group and microscopic group were 7.15±1.73, 8.10±0.91 and 5.40±2.04, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The time of tooth preparation for the control group, loupes group and microscopic group was (430.10±163.04) s, (393.90±157.27) s and (441.95±164.18) s, respectively. There was significant diffe-rence between the loupes group and microscopic group (P<0.05). The loupes group was more efficient than the microscopic group. In terms of the quality of preparations, the subjective scores for the control group, loupes group and microscopic group were 6.55±2.09, 7.85±0.99 and 6.25±1.77, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The expert evaluations for the control group, loupes group and microscopic group were 12.20±1.67, 12.50±1.70 and 11.35±2.60, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The loupes group had higher quality than the microscopic group. In terms of the accuracy of preparations, the control group, loupes group and microscopic group of incisal 1/3 were (0.107±0.097) mm, (0.142±0.118) mm and (0.123±0.087) mm, respectively, of middle 1/3 were (0.128±0.073) mm, (0.113±0.105) mm and (0.125±0.077) mm, respectively, and of cervical 1/3 were (0.075±0.054) mm, (0.068±0.044) mm and (0.058±0.047) mm, respectively. There was no significant difference among the three groups (P>0.05). In terms of the preference, the subjective scores for the control group, loupes group and microscopic group were 6.55±2.31, 8.60±1.10 and 5.80±2.07, respectively. There was significant difference between the loupes group and microscopic group (P<0.05). The participants had the highest preference for loupes. Conclusion: For the first practitioners, loupes is better than microscope for laminate veneer preparation.

Key words: Dental equipment, Dental instruments, Tooth preparation, Loupes, Microscopy

中图分类号:

R783.2

葛严军,刘晓强. 放大镜与显微镜辅助下瓷贴面牙体预备效果的比较[J]. 北京大学学报（医学版）, 2019, 51(1): 100-104.

Yan-jun GE,Xiao-qiang LIU. Effects of loupes and microscope on laminate veneer preparation[J]. Journal of Peking University(Health Sciences), 2019, 51(1): 100-104.

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参考文献 16

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Parameter	Excellent (3 points)	Compromised (2 points)	Standard not met (1 point)
Facial reduction	Optimal reduction (incisal third: 0.7 mm, middle third: 0.5 mm, cervical third: 0.3 mm)	Moderately over-reduced or under-reduced	Severely over-reduced or under-reduced
Surface smoothness	Fine diamond texture	Catches with explorer tip	Horizontal or vertical steps
Cervical finish line configuration	Chamfer is continuous and well-defined	Chamfer is moderately nonconti-nuous or moderately lack of definition	Chamfer is noncontinuous or lack of definition or aggressively prepared
Cervical finish line position	Placed to specified target: 0.5-1.0 mm supragingivally	Even with gingival margin or <0.5 mm supragingivally	>1.0 mm supragingivally or subgingivally
Interproximal finish line	Mesial and distal finish lines are continuous and well-defined, extended to, but do not open the interproximal contact region	Mesial or distal finish line is mo-derately noncontinuous or mode-rately lack of definition, at interproximal surface but do not extend to contact region	Mesial and distal finish lines are noncontinuous or lack of definition or aggressively prepared, at labial surface or open the contact

Group	Efficiency of preparation		Quality of preparation		Accuracy of preparation/mm
Group	Subjective visual analogue score	Time/s	Subjective visual analogue score	Expert evaluation	Incisal third	Middle third	Cervical third	Subjective visual analogue score
Control	7.15±1.73^a	430.10±163.04^ab	6.55±2.09^ab	12.20±1.67^ab	0.107±0.097^a	0.128±0.073^a	0.075±0.054^a	6.55±2.31^a
Loupes	8.10±0.91^a	393.90±157.27^a	7.85±0.99^a	12.50±1.70^a	0.142±0.118^a	0.113±0.105^a	0.068±0.044^a	8.60±1.10^b
Microscopic	5.40±2.04^b	441.95±164.18^b	6.25±1.77^b	11.35±2.60^b	0.123±0.087^a	0.125±0.077^a	0.058±0.047^a	5.80±2.07^a
P	<0.001	0.017	0.018	0.015	0.299	0.637	0.467	<0.001