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クラウン＆ブリッジ作製時の隣接歯への異所性ダメージの評価
Assessment of iatrogenic damage to adjacent teeth during crown and bridge preparation.
PMID: 30900667 DOI: 10.4103/ijdr.IJDR_312_17.
抄録
はじめに:
歯冠準備中の隣接歯に対する異所性の損傷は、頻繁に起こる悲惨な影響です。本研究の目的は、第三次医療機関において、歯の罹患につながる歯冠・ブリッジ作製時の隣接歯への異所性損傷の種類、程度、場所の頻度を明らかにすることである。
Introduction: Iatrogenic damage to the adjacent tooth during crown preparation is a frequent disastrous effect. The aim of the study was, therefore, to determine the frequency of different types, degree and location of iatrogenic damage to the adjacent tooth during crown and bridge preparations in a tertiary care setting that lead towards the morbidity of tooth.
材料と方法:
アガ・カーン大学の歯科技工所で2ヶ月間の前向き研究が行われ、対象基準を満たした合計150個の歯型が非確率便利サンプリング法を用いて分析されました。3.5倍の拡大ルーペを用いて、MoonparとFaulknerの基準を用いて、準備された歯に隣接する近位表面の損傷の位置、程度、種類を調べた。データの分析には，SPSS version 22を用いた。カイ二乗検定を用いて，施術者の経験と隣接歯の損傷の程度との関連性を評価した。また，歯の位置と隣接歯の損傷の程度との関連性を調べるためにも使用した。検査者間の信頼性は、カッパ統計を用いて評価した。
Materials and Methods: A prospective study was conducted in Aga Khan University dental laboratory in two months period in which a total of 150 dental casts fulfilling the inclusion criteria were analyzed using non-probability convenient sampling technique. The casts were examined using 3.5x magnifying loupes for the location, degree and type of damage to the proximal surface adjacent to the prepared tooth using Moonpar and Faulkner criteria. Data were analyzed by using SPSS version 22. Chi square test was used to assess the association between the experience of practitioner and degree of damage to adjacent tooth. It was also used to determine the association between location of tooth and degree of damage to adjacent tooth. Inter-examiner reliability was assessed by using kappa statistics.
結果:
隣接歯の近位面の損傷は高い有病率（近位歯で78％，遠位歯で60.6％）を示し，大部分（32.6％）が軽度のカテゴリーに属していた。施術者の経験と支台歯の近心部の損傷との間には，統計的に有意な関連が認められた．しかし，上顎歯に比べて下顎歯では重度の損傷が見られた．
Results: A high prevalence of damage to the proximal surface of adjacent teeth (78% on mesial tooth and 60.6% on distal tooth) was observed, with the majority (32.6%) belonging to the mild categories. There were statistically significant associations between the experience of practitioner and the damage to the surface mesial to the preparation. However, more severe damages occurred in mandibular teeth preparations as compared to maxillary teeth preparations.
結論:
クラウン＆ブリッジ作業中には，隣接する歯に高い頻度で異所性の損傷が発生し，歯の中央部が最も影響を受けやすい部位であることがわかった．しかし，その多くは擦過傷程度の軽度のものであった．
Conclusions: A high frequency of iatrogenic damage to the adjacent teeth had been found during crown and bridge work with the middle of the tooth as the most susceptible site. However, the majority of damages were of milder type including only abrasions.