根分叉病变患牙经牙周非手术治疗后5年失牙状况及多因素分析

doi:10.19723/j.issn.1671-167X.2019.05.020

摘要/Abstract

摘要：

目的:观察根分叉病变患牙经牙周非手术治疗后5年的失牙状况及失牙的影响因素。方法:纳入79例就诊于北京大学口腔医院牙周科的慢性牙周炎患者,经牙周非手术治疗纵向观察5年。比较分析双侧下磨牙初诊及5年后随访时探诊深度(probing depth,PD)、出血指数(bleeding index,BI)、根分叉病变等级(furcation index,FI)、牙松动度等临床指标,并利用根尖片评价初诊时根分叉区牙槽骨吸收量,以了解根分叉病变患牙治疗前后临床指标的变化及失牙状况,并进一步分析影响失牙的主要因素。结果:(1)非手术治疗对伴有根分叉病变的慢性牙周炎患牙PD的改善是显著有效的,但根分叉病变的存在会影响其PD值的改善。(2)初始根分叉区PD值、松动度以及影像学根分叉区垂直骨丧失量和根分叉病变部位骨吸收区域面积与失牙成明显正相关(P<0.001),且FI=3、FI=4亦显著增加了失牙风险(P=0.017,P=0.007),而年龄(P=0.703)、性别(P=0.243)、吸烟史(P=0.895)等在本研究中与失牙无显著相关。(3)FI=3或FI=4的失牙风险显著高于FI为2及2以下的患牙,5年存活率不足50%。结论:根分叉病变患牙失牙风险与根分叉病变密切相关,根分叉病变严重、根分叉区水平及垂直骨丧失量多会显著增加失牙风险。

关键词: 慢性牙周炎, 根分叉部缺损, 牙缺失, 预后

Abstract:

Objective: To evaluate the tooth loss status of mandibular molars with furcation involvements after 5-year non-surgical periodontal treatment,and to analyze the factors that affected the tooth loss. Methods: A retrospective analysis was conducted in 79 patients with chronic periodontitis, who had received non-surgical periodontal treatment and 5 years of periodontal maintenance treatment in Department of Periodontology, Peking University School and Hospital of Stomatology from 1988 to 2012. Their clinical indexes, including probing depth (PD), bleeding index (BI), furcation index (FI) and tooth mobility were both evaluated before treatment and at the last time of the maintenance treatment. Bone resorption at furcation area was measured at the first visit by periapical radiographs taken by professional doctors of medical imaging. The status of tooth loss after 5-year non-surgical periodontal treatment on mandibular molars with furcation involvement, and the factors that affected the tooth loss were analyzed. Results: (1) Non-surgical treatment was significantly effective on the changes of PD in the patients of chronic periodontitis with furcation involvement, while the presence of furcation involvement could affect the improvement of PD here. (2) PD at the furcation area, tooth mobility, vertical bone resorption, and bone resorption area were all significant risk factors of mandibular molar missing (P<0.001), and the same with FI=3 and FI=4 (P=0.017, P=0.007),while age (P=0.703), gender (P=0.243) and smoking history (P=0.895) were not related to the tooth loss in this study. (3) The risk of tooth loss in mandibular molars with FI≥3 were significantly higher than those with FI≤2, and the survival rate of the former was less than 50%. Conclusion: The loss of mandibular molars with furcation involvement was related to the furcation involvement, meanwhile the degree of furcation involvement and bone resorption can significantly increase the risk of tooth loss.

Key words: Chronic periodontitis, Furcation defects, Tooth loss, Prognosis

中图分类号:

R781.42

石姝雯,孟洋,焦剑,李文静,孟焕新,栾庆先,王万春. 根分叉病变患牙经牙周非手术治疗后5年失牙状况及多因素分析[J]. 北京大学学报（医学版）, 2019, 51(5): 913-918.

Shu-wen SHI,Yang MENG,Jian JIAO,Wen-jing LI,Huan-xin MENG,Qing-xian LUAN,Wan-chun WANG. Tooth loss and multivariable analysis after 5-year non-surgical periodontal treatment on molars with furcation involvement[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 913-918.

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参考文献 15

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Characteristics	Non-TL group (n=216)	TL group (n=17)	P
Age/years	41.51±9.92	42.53±5.60	0.677
Gender, n(%)			0.156
Female	102 (47.22)	5 (29.41)
Male	114 (52.78)	12 (70.59)
Smoking status, n(%)			0.466
Non-smoker	169 (78.24)	12 (70.59)
Smoker	47 (21.76)	5 (29.41)
PD_max/mm	4.26±1.57	6.65±2.37	<0.001
Plaque index, n(%)
≤2	46 (21.30)	1 (5.88)
=3	170 (78.70)	16 (94.12)
AL/mm	3.29±2.38	4.18±2.89	0.219
FI_max, n(%)			<0.001
0	59 (27.31)	4 (23.53)
Ⅰ	48 (22.22)	0
Ⅱ	100 (46.30)	7 (41.18)
Ⅲ	9 (4.17)	4 (23.53)
Ⅳ	0	2 (11.76)
BI_max, n(%)			0.383
0	5 (2.31)	0
1	0	0
2	24 (11.11)	1 (5.88)
3	68 (31.48)	3 (17.65)
4	119 (55.09)	13 (76.47)
Mobility, n(%)			<0.001
0	166 (76.85)	2 (11.76)
Ⅰ	28 (12.96)	5 (29.41)
Ⅱ	21 (9.72)	7 (41.18)
Ⅲ	1 (0.46)	3 (17.65)
Vertical bone resorption/%	11.48±11.28	29.79±16.20	<0.001
Bone resorption area/%	1.29±2.55	3.63±2.90	<0.001

	Non-TL group (n=216)	TL group (n=17)	Univariate analysis		Multivariable analysis
	Non-TL group (n=216)	TL group (n=17)	P	HR (95%CI)	P	HR (95%CI)
PD_max/mm	4.26±1.57	6.65±2.37	<0.001	1.63 (1.34, 1.98)	<0.001	1.63 (1.33, 1.99)
FI_max, n(%)
0	59 (27.31)	4 (23.53)
Ⅰ	48 (22.22)	0	0.997	0.00 (0.00, Inf)	0.010	0.00 (0.00, Inf)
Ⅱ	100 (46.30)	7 (41.18)	0.990	1.01 (0.29, 3.44)	0.867	1.11 (0.00, Inf)
Ⅲ	9 (4.17)	4 (23.53)	0.017	5,47 (1.36, 22.01)	0.002	12.80 (2.57, 63.72)
Ⅳ	0	2 (11.76)	0.007	10.59 (1.92,58.46)	0.002	22.85 (3.23, 161.68)
BI_max, n(%)
<4	97 (44.91)	4 (23.53)
=4	119 (55.09)	13 (76.47)	0.042	3.22 (1.04, 9.93)
Mobility, n(%)
0	166 (76.85)	2 (11.76)
Ⅰ	28 (12.96)	5 (29.41)	0.006	9.99 (1.93, 51.62)	0.002	15.70 (2.71, 91.1)
Ⅱ	21 (9,72)	7 (41.18)	<0.001	28.50 (5.85, 138.74)	<0.001	38.91 (7.16, 211.46)
Ⅲ	1 (0.46)	3 (17.65)	<0.001	66.51 (11.10, 398.57)	<0.001	76.12 (10.77, 537.97)
Vertical bone resorption/%	11.48±11.28	29.79±16.20	<0.001	1.08 (1.05, 1.11)	<0.001	1.09 (1.06, 1.12)
Bone resorption area/%	1.29±2.55	3.63±2.90	<0.001	1.22 (1.10, 1.35)	<0.001	1.29 (1.14, 1.46)