背景:修复性牙科中的II类口腔制剂会对邻近牙齿造成医源性损害,因为它们会增加对龋齿的敏感性,并且需要额外的修复程序。虽然以前的研究已经通过体外和有限的体内研究探索了这个问题,在II类腔内准备过程中使用近端保护以防止医源性损伤的直接临床观察仍然有限。
目的:这项体内研究旨在通过放大下的直接目视检查来评估在II类空腔制备过程中,近端保护使用的发生率以及对相邻表面引起的医源性损伤的程度。
方法:数据是从监督四年级本科生的修复性牙科顾问那里收集的。关于腔准备的信息,近端保护使用,一旦完成II类空洞准备,通过直接临床观察,通过电子评估表收集医源性损伤。统计分析,包括序数逻辑回归模型,被用来调查关联并计算比值比(OR)。
结果:我们在体内环境中检查了与II类腔制剂相邻的82颗牙齿。近端保护使用的患病率为72%,虽然医源性损害的总体患病率为17.1%,不使用保护时增加到47.8%,使用保护措施时增加到5.1%。抛光和恢复引起的损害是主要的管理方法。采取保护措施,特别是矩阵带,显著降低医源性损伤的风险(P<0.05)。几个因素,包括拱门,齿面,时间,操作员性别,以及相邻牙齿在治疗前的状态,进行了检查,但没有产生统计学上显著的关联。
结论:我们的研究表明,大多数本科牙科学生在II类牙洞准备期间使用近端保护,这对于减少对相邻牙齿的医源性损伤具有重要意义。然而,文献显示,全科医生通常不使用近端保护.近端保护的使用应得到加强,甚至需要对近端腔进行成功和安全的治疗。需要进行更大,更多样化的样本的未来研究,以了解使用近端保护的障碍,并制定干预措施以促进其采用。
BACKGROUND: Class II cavity preparations in restorative dentistry pose a risk of iatrogenic damage to adjacent teeth as they could increase their susceptibility to caries and the need for additional restorative procedures. While previous research has explored this issue through in vitro and limited in vivo investigations, the direct clinical observation of proximal protection usage to prevent iatrogenic damage during class II cavity preparations is still limited.
OBJECTIVE: This in vivo study aimed to assess the prevalence of proximal protection usage and extent of iatrogenic damage induced to adjacent surfaces upon occurrence during class II cavity preparations via direct visual inspection under magnification.
METHODS: Data were collected from restorative dentistry consultants supervising fourth-year undergraduate students. Information regarding cavity preparations, proximal protection usage, and iatrogenic damage was gathered through an electronic evaluation form via direct clinical observations once class II cavity preparations were finished. Statistical analyses, including ordinal logistic regression models, were employed to investigate associations and compute odds ratios (ORs).
RESULTS: We examined 82 teeth adjacent to class II cavity preparations in in vivo settings. The prevalence of proximal protection use was 72%, while the prevalence of iatrogenic damage was 17.1% overall, increasing to 47.8% when not using protection and 5.1% when using protective measures. Polishing and restoration of the induced damage were the primary management approaches. The use of protective measures, particularly matrix bands, significantly reduced the risk of iatrogenic damage (P < 0.05). Several factors, including arch, tooth surface, time, operator gender, and the state of the adjacent tooth before treatment, were examined but did not yield statistically significant associations.
CONCLUSIONS: Our study shows that most undergraduate dental students use proximal protection during class II cavity preparations, which are significant in reducing iatrogenic damage to the adjacent tooth. However, the literature shows that general practitioners often do not use proximal protection. The use of proximal protection should be reinforced and even required for the successful and safe treatment of proximal cavities. Future research with larger and more diverse samples is needed to understand the barriers to the use of proximal protection and develop interventions to promote its adoption.