Emshoff R, Moschen I, Strobl H
Department of Oral and Maxillo-Facial Surgery, University of Innsbruck, Innsbruck, Austria.
Dent Traumatol. 2008 Feb;24(1):32-7. doi: 10.1111/j.1600-9657.2006.00494.x.
Splinting of traumatically displaced permanent teeth has been described as an effective modality in the treatment of patients with dental injuries. The purpose of this study was to (i) investigate whether dental injury diagnosis may predict adverse outcomes occurring 96 weeks after splint removal, and (ii) evaluate whether the severity of adverse outcome is related to laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF). In 206 trauma patients, 273 permanent maxillary incisors treated by repositioning and splinting, and the respective contralateral homologous control teeth were investigated clinically and radiographically, and by LDF to assess local PBF values. Dental displacement injuries were classified as grade I (subluxation), grade II (lateral or extrusive luxation) and grade III (avulsion or intrusive luxation). Outcomes were classified as 'absence of loss of sensitivity, periapical radiolucency, and/or grey discolouration of crown', type I (loss of sensitivity), type II (loss of sensitivity and periapical radiolucency or grey discoloration of crown) and type III (loss of sensitivity, periapical radiolucency and grey discoloration of crown). An adverse outcome was defined as the presence of 'periapical radiolucency and/or grey discoloration'. A multiple logistic regression analysis was used to compute the odds ratio (OR) for dental displacement injury for adverse outcome (n = 69) vs non-adverse outcome (n = 168). An ordinal stepwise regresssion was completed to assess the degree of association between PBF measurements and outcome groups. Significant increase in risk of an adverse outcome occurred with a grade II dental displacement injury (OR 14.3) (P = 0.000) and a grade III dental displacement injury (OR 19.9) (P = 0.000). PBF measurements that were significantly associated with more severe outcome were PBF levels of < or =3 perfusion units (PU) (OR 399.4) (P = 0.000), those of >3 PU and < or =6 PU (OR 100.5) (P = 0.000), and those of >6 PU and < or =9PU (OR 6.2) (P = 0.000). Diagnoses of displaced teeth predicted dental injury patients who went on to show adverse treatment outcomes of splinting. PBF measurements were related to the severity of adverse outcome.
对于创伤性移位的恒牙进行夹板固定，已被视为治疗牙外伤患者的一种有效方式。本研究的目的是：（i）调查牙外伤诊断是否可预测夹板拆除96周后出现的不良后果；（ii）评估不良后果的严重程度是否与牙髓血流（PBF）的激光多普勒血流仪（LDF）测量值相关。在206例创伤患者中，对273颗经复位和夹板固定治疗的上颌恒切牙及其对侧同名对照牙进行了临床、影像学检查，并通过LDF评估局部PBF值。牙齿移位损伤分为I级（牙震荡）、II级（侧向或脱出性牙脱位）和III级（牙脱臼或嵌入性牙脱位）。结果分为“无感觉丧失、根尖周透射影和/或牙冠变色”、I型（感觉丧失）、II型（感觉丧失和根尖周透射影或牙冠变色）和III型（感觉丧失、根尖周透射影和牙冠变色）。不良后果定义为存在“根尖周透射影和/或牙冠变色”。采用多元逻辑回归分析计算不良后果（n = 69）与非不良后果（n = 168）的牙齿移位损伤的比值比（OR）。完成有序逐步回归以评估PBF测量值与结果组之间的关联程度。II级牙齿移位损伤（OR 14.3）（P = 0.000）和III级牙齿移位损伤（OR 19.9）（P = 0.000）时，不良后果的风险显著增加。与更严重后果显著相关的PBF测量值为≤3灌注单位（PU）的PBF水平（OR 399.4）（P = 0.000）、＞3 PU且≤6 PU的PBF水平（OR 100.5）（P = 0.000）以及＞6 PU且≤9 PU的PBF水平（OR 6.2）（P = 0.000）。移位牙的诊断可预测夹板固定治疗后出现不良治疗结果的牙外伤患者。PBF测量值与不良后果的严重程度相关。
