Dental Care

牙科护理
  • 文章类型: Systematic Review
    目的:本荟萃分析旨在评估光动力疗法(PDT)作为常规机械清创(CMD)辅助治疗种植体周围黏膜炎(p-iM)的有效性。
    方法:我们系统地搜索了四个数据库(PubMed,Embase,WebofScience,和CochraneLibrary)用于研究从开始到2023年3月13日的p-iM的PDTCMD的随机对照试验(RCT)。采用RevMan5.4软件进行Meta分析。
    结果:7项随机对照试验符合纳入标准。荟萃分析显示,PDT+CMD治疗在降低探查深度(PD)(平均差[MD]:-1.09,95%置信区间[CI]:-1.99至-0.2,P=0.02)和菌斑指数(PI)(MD:-2.06,95%CI:-2.81至-1.31,P<0.00001)方面比单独使用CMD更有效。然而,PDT+CMD组与CMD组之间探查出血(BOP)的改善无统计学意义(MD:-0.97,95%CI:-2.81至0.88,P=0.31)。
    结论:根据现有证据,这项荟萃分析表明,在p-iM治疗中,与单纯CMD相比,在CMD中加入PDT能显著改善PD和PI.然而,在改善BOP方面没有显著差异。
    OBJECTIVE: This meta-analysis was conducted to assess the effectiveness of photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (CMD) for the management of peri-implant mucositis (p-iM).
    METHODS: We systematically searched four databases (PubMed, Embase, Web of Science, and Cochrane Library) for randomized controlled trials (RCTs) investigating PDT + CMD for p-iM from their inception to March 13, 2023. Meta-analysis was performed using RevMan 5.4 software.
    RESULTS: Seven RCTs met the inclusion criteria. The meta-analysis revealed that PDT + CMD treatment was more effective than CMD alone in reducing probing depth (PD) (Mean Difference [MD]: -1.09, 95% Confidence Interval [CI]: -1.99 to -0.2, P = 0.02) and plaque index (PI) (MD: -2.06, 95% CI: -2.81 to -1.31, P < 0.00001). However, there was no statistically significant difference in the improvement of bleeding on probing (BOP) between the PDT + CMD groups and CMD groups (MD: -0.97, 95% CI: -2.81 to 0.88, P = 0.31).
    CONCLUSIONS: Based on the current available evidence, this meta-analysis indicates that the addition of PDT to CMD significantly improves PD and PI compared to CMD alone in the treatment of p-iM. However, there is no significant difference in improving BOP.
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  • 文章类型: Journal Article
    错牙合,被世界卫生组织(WHO)确定为三大口腔疾病之一,深刻影响牙颌面功能,面部美学,中国约2.6亿儿童的长期发展。除了它的物理表现,错牙合也显著影响这些孩子的心理社会福祉。及时干预错牙合可以营造有利于牙颌面发育的环境,并大大降低错牙合的发生率或降低永久性牙列错牙合的严重程度和复杂性,通过减轻异常环境影响对增长的负面影响。早期正畸治疗包括在牙颌面发育的各个阶段准确识别和治疗牙颌面形态和功能异常,从胎儿阶段到早期恒牙阶段。从经济和社会的角度来看,对儿童畸形进行有效的早期正畸治疗的紧迫性怎么强调都不为过,强调其深远的实践和社会重要性。这份共识文件讨论了儿童错牙合的特点和有害影响,强调早期治疗的迫切需要。它阐述了早期正畸的相应核心原则和基本方法,提出预防和拦截性正畸治疗的综合指导意见,为从事早期正畸治疗的临床医生提供参考。
    Malocclusion, identified by the World Health Organization (WHO) as one of three major oral diseases, profoundly impacts the dental-maxillofacial functions, facial esthetics, and long-term development of ~260 million children in China. Beyond its physical manifestations, malocclusion also significantly influences the psycho-social well-being of these children. Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition, by mitigating the negative impact of abnormal environmental influences on the growth. Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development, ranging from fetal stages to the early permanent dentition phase. From an economic and societal standpoint, the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated, underlining its profound practical and social importance. This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children, emphasizing critical need for early treatment. It elaborates on corresponding core principles and fundamental approaches in early orthodontics, proposing comprehensive guidance for preventive and interceptive orthodontic treatment, serving as a reference for clinicians engaged in early orthodontic treatment.
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  • 文章类型: Journal Article
    传统上,活髓疗法(VPT)主要用于年轻的恒牙。然而,近年来,VPT已越来越多地应用于成熟的恒牙。以前认为VPT仅对正常牙髓或可逆性牙髓炎的牙齿有效。然而,越来越多的证据表明,VPT可以成功治疗患有不可逆牙髓炎或根尖周炎的恒牙。这项工作讨论了哪些患有不可逆牙髓炎或根尖周炎的牙齿适合VPT,评估和选择这种情况的推荐方法,以及操作这种病例所涉及的临床程序。
    Traditionally, vital pulp therapy (VPT) is mainly indicated for young permanent teeth. However, in recent years, VPT has been increasingly applied to mature permanent teeth. VPT was previously thought to be effective only for teeth with normal pulp or reversible pulpitis. However, an increasing body of evidence has demonstrated that VPT can successfully manage permanent teeth with irreversible pulpitis or apical periodontitis. This work discusses which teeth with irreversible pulpitis or apical periodontitis are suitable for VPT, the recommended method to evaluate and select this kind of case, and the clinical procedure involved to operate such a case.
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  • 文章类型: Journal Article
    Anterior diastema and tooth defects are common clinical issues in restorative dentistry and are often restored by veneers or crowns based on the results of digital smile design and wax-up. Traditional direct resin restoration for closing a diastema is relatively minimally invasive but is time consuming and laborious, and shape control depends on experience. Digital technology can be used to design and transfer the shape of aesthetic restoration more accurately and quickly; thus, it could close anterior diastema and restore defects easily. According to the workflow, this technical process integrates virtual design and practical wax-up, transfers the designed restoration shape by templates, and injects through the preset channel after the template is in place. This clinical technique simplifies the clinical operation and saves clinical time, which can effectively improve the predictability and accuracy of the restoration and reduce technical sensitivity. This digital workflow provides a new technology for closing diastema quickly and effectively.
    前牙间隙或缺损是临床修复治疗中的常见问题,针对患牙的不同情况经过数字微笑设计、蜡型等预告技术确认后,常采用贴面、全冠等修复方式来关闭间隙,而传统树脂直接修复技术关闭间隙是目前比较微创的修复方案,但费时费力,外形控制更加依赖经验。运用数字化技术可以更加精确快速地进行美学修复空间的设计、转移,使便捷地关闭前牙间隙及修复缺损成为可能。该技术流程按照实操次序,先后整合了虚拟设计与实体蜡型、实体导板转移设计轮廓形态、就位导板后通过预设通道注射树脂等核心步骤,简化医生的临床操作步骤与时间,与传统手工涂塑技术相比有效地提高了修复效果的可预测性和精确度,降低了技术敏感性,节约椅旁操作时间,为快速关闭前牙间隙及修复缺损提供了新的技术方案。.
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  • 文章类型: Randomized Controlled Trial
    目的:比较口腔黏贴绷带与经典的压迫方法,并评估这种伤口敷料在提高术后舒适度方面的临床疗效。伤口愈合,和拔牙止血。
    方法:本研究设计为随机对照临床试验。共纳入120例患者,随机分为研究组和对照组。在研究小组中,口腔粘合绷带被用作伤口敷料。在对照组中,病人咬棉球和纱布,像往常一样。出血,comfort,术后1小时评估愈合水平,24h,和7天。还记录口腔粘性绷带的粘附时间。
    结果:口腔黏贴绷带的平均粘连时间为26.6h。口腔黏贴绷带组的止血水平明显高于对照组。口腔粘合绷带组的舒适度评分也明显高于对照组。两组的愈合水平和副作用相似。但口腔黏着绷带组伤口愈合的平均评分略高。
    结论:口腔黏贴绷带比棉球和纱布对拔牙伤口的止血和舒适效果更有效。
    结论:口腔黏贴绷带在治疗拔除伤口方面具有临床价值。
    OBJECTIVE: To compare oral adhesive bandages with the classic compression method and evaluate the clinical efficacy of this wound dressing material in improving postoperative comfort, wound healing, and hemostasis in tooth extraction.
    METHODS: The study was designed as a randomized controlled clinical trial. A total of 120 patients were recruited and randomly assigned to the study group and the control group. In the study group, oral adhesive bandages were used as wound dressing. In the control group, patients bit on cotton balls and gauze, as usual. Hemorrhage, comfort, and healing levels were evaluated at postoperative 1 h, 24 h, and 7 days. The adhesion time of the oral adhesive bandages was also recorded.
    RESULTS: The average adhesion time of the oral adhesive bandages was 26.6 h. At postoperative 1 and 24 h, the hemostatic levels of the oral adhesive bandage group were significantly higher than those of the control group. The oral adhesive bandage group also reported significantly higher comfort scores than the control group. Both groups had similar healing levels and side effects. But the mean score for wound healing was slightly higher in the oral adhesive bandage group.
    CONCLUSIONS: Oral adhesive bandages were more effective than cotton balls and gauze in providing hemostatic and comfort effects on extraction wounds.
    CONCLUSIONS: Oral adhesive bandages possess clinical value in the management of extraction wounds.
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  • 文章类型: English Abstract
    Improper diagnosis and design, misusing orthodontic technique, relapse after orthodontic treatment, and poor patient compliance may lead to treatment failure, requiring orthodontic retreatment. While in such cases, patients usually have already had their teeth extracted, or are with periodontal, joint, and other dental problems, which often require multidisciplinary treatment. The retreatment of orthodontic patients is difficult, and the treatment options are limited. The characteristics of clear aligner treatment, such as comfortable and beautiful appearance, high degree of digital precision, and personalized tooth arrangement to simulate the final outcome, make it popular in the orthodontic retreatment. This article discusses and summarizes the details of orthodontic design, case monitoring, and the application of clear aligner in orthodontic retreatment of failed cases. Before starting treatment, the difficulty assessment tool (clear aligner treatment complexity assessment tool) can be used to evaluate the difficulty of clear aligner treatment. Orthodontists are recommended to treat orthodontic patients with clear aligners within their ability to avoid treatment failure. The key to the success of the extraction case treatment with clear aligner is to make the correct diagnosis and select the right cases. In the treatment planning, attention should be paid to the restoration of anterior tooth torque, making good use of molar distalization to obtain the space, vertical control, and improving posterior tooth relationship. Proper selection of cases and reasonable design in clear aligner treatment are expected to obtain tooth alignment, good intercuspation, normal overbite and overjet, periodontal health, parallel roots, and to achieve the goal of aesthetic, functional, stable, and healthy orthodontic treatment.
    术者诊断设计不当、矫治技术应用失误、正畸治疗后的复发以及患者依从性较差无法配合矫治等原因可导致患者对矫治结果不满意,寻求二次矫治。此类患者通常已减数,或伴牙周、关节、牙体或缺牙等问题,常需多学科联合治疗,二次矫治难度较大,可选方案受限。无托槽隐形矫治舒适美观,具备数字化精准化程度高、可个性化排牙模拟矫治后终末状态等特点,使其在失败病例的二次矫治中具有一定优势。本文通过展示无托槽隐形矫治在二次矫治病例中的应用实例,对矫治设计和监控细节进行讨论和总结。建议医师在接诊前利用无托槽隐形矫治难度评估工具对患者情况进行评估,接诊自身诊疗能力范围内的病例,以获得满意的矫治疗效。无托槽隐形矫治技术治疗减数病例的成功关键在于诊断正确,选对病例。在方案设计上,二次矫治应注意前牙转矩的恢复,利用推磨牙向后获得间隙,做好垂直向控制,改善后牙咬合关系。在无托槽隐形矫治中正确选择、谨慎纳入、合理设计,有望在二次矫治的疑难病例中获得牙排列整齐、尖窝交错、覆(牙合)覆盖正常、牙周健康、牙根平行的矫治效果,达到美观、功能、稳定、健康的矫治目标。.
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  • 文章类型: English Abstract
    This article summarizes and organizes relevant publications in journals, along with a review of medical history, systematically summarizing the development process of dental alveolar surgery in China. The initial establishment phase (1935-1952) marked the starting point of Chinese Alveolar Surgery. Despite the impact of wars, it laid the foundation for subsequent research and practice. During the early development phase (1953-1966), the \"Chinese Journal of Stomatology\" was founded, which promoted the development of Alveolar Surgery. Research focused on tooth extraction methods and complications. Tooth Transplantation and Preprosthetic Surgery gradually began to take off. The stagnant phase (1967-1977) occurred due to the interruption of international exchanges, leading to an almost complete halt in the development of Alveolar Surgery. Entering the rapid catch-up phase (1978-1985), Alveolar Surgery scholars in China began striving to overcome the stagnation of the previous decade. While some progress was made, no significant innovative achievements emerged. In the scientific development phase (1986-2010), clinical research, basic experiments, and paper writing in modern Chinese Alveolar Surgery began to adhere to scientific standards with the rise of experimental medicine. The exploration and innovation stage (2011-2023) is the current development phase, during which Chinese Aveolar Surgery has reached its peak, making substantial progress in technology, clinical practices, and basic research, gradually reaching or even surpassing international advanced levels. Looking back at the development history in China, we can find the wisdom and hard work of the older generation of Alveolar Surgery scholars. However, contemporary challenges and issues, such as standardizing technology, promoting clinical practices, and talent cultivation, need to be addressed by present-day Alveolar Surgery professionals as they forge ahead.
    本文总结和梳理《中华口腔医学杂志》等发表的相关文章并结合医史探询,系统总结了中国牙槽外科的发展历程。初始创建阶段(1935—1952年)是中国牙槽外科发展的起点,尽管受到战争的影响,但为后来的研究和实践奠定了基础;起步发展阶段(1953—1966年),《中华口腔医学杂志》的创刊促进了牙槽外科的发展,研究集中在拔牙方法和拔牙并发症,牙移植和修复前外科逐渐起步;停滞不前阶段(1967—1977年),由于国际交流的中断,牙槽外科的发展几乎停滞;奋起直追阶段(1978—1985年),改革开放后,牙槽外科学者开始努力追赶前十年的停滞,虽取得了一定的进展,但无显著创新成果诞生;科学发展阶段(1986—2010年)中,随着实验医学的兴起,中国现代牙槽外科的临床研究、基础实验、论文撰写都开始进入科学规范的时代;探索创新阶段(2011—2023年)是当前的发展阶段,中国牙槽外科也迎来了发展的最高峰,在技术、临床、基础领域均取得了巨大的进步,逐步达到甚至赶超国际先进水平。回顾我国牙槽外科从无到有、从弱到强的学科发展历程,可见我国老一辈牙槽外科学者的智慧和汗水。然而,当下也面临着新的挑战和问题,如技术标准化、临床实践的推广和人才培养等,这需要当代牙槽外科人砥砺前行。.
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  • 文章类型: Journal Article
    经过25年的准备,在2014年世界卫生组织的倡导下,香港卫生局最近实施了该市的初级卫生保健蓝图。集成在其中的是初级口腔保健的方法。这篇评论提供了一个简短的背景,并讨论了香港初级口腔保健的发展。香港是亚洲以私人牙科服务为主的发达经济体。
    After two and a half decades of preparation, and prompted by advocacy from the World Health Organization in 2014, the Health Bureau of Hong Kong recently implemented the city\'s primary healthcare blueprint. Integrated within it is an approach to primary oral healthcare. This review provides a brief background and discusses the development of primary oral healthcare in Hong Kong - a developed economy in Asia dominated by private dental services.
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  • 文章类型: Journal Article
    目的:在5种主要正畸杂志上发表的比较观察性研究中,确定并总结牙科患者报告结局(dPR0s)和牙科患者报告结局指标(dPR0s)的存在和特征。
    方法:进行电子检索,以确定2015年至2021年在选定期刊上发表的干预(治疗或预防)相关比较观察研究。两位作者分别和一式两份地提取了每个纳入研究的特征,并总结了这些研究中使用的dPROs和dPROM。所有dPRO分为2种一般类型(口腔健康相关生活质量[OHRQoL]和其他类型),而dPROM分为3类(单项问卷,通用多项目问卷,和特定的多项目问卷)。此外,检查了dprom,如果他们评估了OHRQoL的4个维度(口腔功能,口面部疼痛,口腔外观,和社会心理影响)。
    结果:共有683项观察性研究符合条件,其中117项(17.1%)使用dPR0s和dPR0s。七个不同的dPR0s(OHRQoL,患者对治疗的满意度,preferences,关注,合规,持续时间,和不必要的事件)和33种不同的dPROM(包括8个单项目问卷,11份通用多项目问卷,和14个特定的多项目问卷)在这些研究中被确定。OHRQoL是最常用的dPRO(92/117,78.6%),而口腔健康影响概况14(OHIP-14)是最常用的dPROM(20/92,21.7%)。在研究设计方面,横断面研究使用dPRO的比例最高(62/148,41.9%),其次是队列研究(63/505,12.5%)和病例对照研究(1/30,3.3%).
    结论:在主要的正畸杂志上发表的比较观察研究中,只有六分之一可以反映患者的观点。正畸中的观察性研究需要通过使用dPROs和dPROM来提供更多对患者重要的信息。
    To identify and summarize the presence and characteristics of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs) within comparative observational studies published in 5 leading orthodontic journals.
    Electronic searching was performed to identify intervention (therapeutic or preventive) related comparative observational studies published in selected journals between 2015 and 2021. Two authors extracted the characteristics of each included study independently and in duplicate and summarized the dPROs and dPROMs used in these studies. All dPROs were classified into 2 general types (oral health-related quality of life [OHRQoL] and others), while dPROMs were divided into 3 categories (single-item questionnaires, generic multiple-item questionnaires, and specific multiple-item questionnaires). In addition, dPROMs were examined, if they evaluated the 4 dimensions of OHRQoL (oral function, orofacial pain, orofacial appearance, and psychosocial impact).
    A total of 683 observational studies were eligible and included of which 117 (17.1%) used dPROs and dPROMs. Seven different dPROs (OHRQoL, patients\' satisfaction with treatment, preferences, concerns, compliance, duration, and unwanted events) and 33 different dPROMs (including 8 single-item questionnaires, 11 generic multiple-item questionnaires, and 14 specific multiple-item questionnaires) were identified in these studies. OHRQoL was the most commonly used dPRO (92/117, 78.6%), while Oral Health Impact Profile 14 (OHIP-14) was the most frequently used dPROM (20/92, 21.7%). In terms of study design, cross-sectional studies had the highest proportion of dPRO usage (62/148, 41.9%), followed by cohort studies (63/505, 12.5%) and case-control studies (1/30, 3.3%).
    Only one-sixth of comparative observational studies published in leading orthodontic journals could reflect patients\' perspectives. Observational studies in orthodontics need to provide more patient-important information through the use of dPROs and dPROMs.
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  • 文章类型: Meta-Analysis
    背景:手术促进的正畸治疗策略最近已成为一种有希望的正畸治疗策略。因此,本荟萃分析旨在评估有关临床结局的现有科学证据,包括与这些外科手术相关的潜在有害影响,目的是为临床实践提供更多的循证信息。
    方法:对三个数据库进行电子搜索(PubMed,科克伦,和Embase),并对截至2023年5月发表的相关文章进行了手动搜索。包括使用具有临床和/或影像学结果的手术促进的正畸策略的临床试验(≥10名受试者)。进行Meta分析和亚组分析,分析标准化均差(SMD)或加权均差(WMD),以及记录变量的置信区间(CI)。
    结果:2012年10月至2023年5月发表的19项研究符合纳入标准。根据分析结果,皮质切开术治疗显着缩短了对准持续时间(WMD:-1.08个月;95%CI=-1.65,-0.51个月,P=0.0002),并加速了犬的运动(WMD:0.72mm;95%CI=0.63,0.81mm,P<0.00001)与传统正畸组比拟。与传统正畸治疗相比,牙周加速成骨正畸(PAOO)策略显着缩短了总治疗时间(SMD:-1.98;95%CI=-2.59,-1.37,P<0.00001),并增加了骨厚度(SMD:1.07;95%CI=0.74,1.41,P<0.00001)。
    结论:本研究表明,在皮质切开术和PAOO策略方面,促进正畸治疗可能是正畸患者有吸引力和有效的治疗策略。
    BACKGROUND: The surgically facilitated orthodontic strategy has been a promising strategy for orthodontic treatment recently. Therefore, the present meta-analysis was conducted to assess the available scientific evidence regarding the clinical outcomes, including the potential detrimental effects associated with these surgical procedures, with the aim of providing much more evidence-based information for clinical practice.
    METHODS: An electronic search of three databases (PubMed, Cochrane, and Embase) and a manual search of relevant articles published up to May 2023 were carried out. Clinical trials (≥ 10 subjects) that utilized surgically facilitated orthodontic strategies with clinical and/or radiographic outcomes were included. Meta-analyses and sub-group analyses were performed to analyze the standardized mean difference (SMD) or weighted mean difference (WMD), and confidence interval (CI) for the recorded variables.
    RESULTS: Nineteen studies published from Oct 2012 to May 2023 met the inclusion criteria. Based on the analysis outcomes, corticotomy treatment significantly decreased the alignment duration (WMD: -1.08 months; 95% CI = -1.65, -0.51 months, P = 0.0002), and accelerated the canine movement (WMD: 0.72 mm; 95% CI = 0.63, 0.81 mm, P < 0.00001) compared to the traditional orthodontic group. The periodontally accelerated osteogenic orthodontic (PAOO) strategy markedly reduced the total treatment duration (SMD: -1.98; 95% CI = -2.59, -1.37, P < 0.00001) and increased the bone thickness (SMD:1.07; 95% CI = 0.74, 1.41, P < 0.00001) compared to traditional orthodontic treatment.
    CONCLUSIONS: The present study suggests that facilitated orthodontic treatment in terms of corticotomy and PAOO strategy may represent attractive and effective therapeutic strategy for orthodontic patients.
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