口腔修复治疗效果主观评价—250 例调查分析

目的：研究口腔修复患者修复前后口腔健康相关生活质量（OHRQoL）状况,并结合其他主观指标探讨治疗效果。方法：以口腔健康影响程度量表（OHIP-14中文版）对修复治疗患者治疗前后的OHRQoL进行问卷调查,比较治疗前后患者生活质量变化。结果：量表各领域中”生理性疼痛”得分最高,该领域OHRQoL最差,其次为”生理障碍”。”吃什么东西都不舒服”是出现负面影响最多的条目（42．4％）,治疗后总体OHRQoL比治疗前提高,差异有统计学意义（P〈0．05）。结论：口腔健康状况对修复患者的影响主体现在生理性疼痛和生理障碍两个领域,修复治疗能改善患者口腔健康,提高患者口腔健康相关的生活质量。     

应用OHIP-14评价2种种植系统OHRQoL的差异

目的 研究2种种植系统修复治疗后口腔健康相关生活质量（OHRQoL）的差异,为临床种植系统的选择和治疗效果的评估提供参考。方法 临床收集门诊且符合纳入标准的种植义齿修复患者100例,其中50例A组行安多健（Anthogry）种植系统修复,50例B组行士卓曼（Straumann）种植系统修复。采用口腔健康影响程度量表（OHIP-14）中文版作为测量方法研究2种种植系统修复6个月后患者OHRQoL的得分情况,比较两种种植系统修复后患者的OHRQoL的差异。结果 A组："生理性疼痛"得分最高（P₅₀=3.00）,其次为"心理不适,心理障碍"（P₅₀=2.00）;"吃什么东西都不舒服"最常给牙列缺损患者带来负面影响。B组："生理性疼痛"、"心理不适"、"生理障碍"三者得分最高（P₅₀=2.00）,其次为"心理障碍"（P₅₀=1.5）;"对自己的饮食很不满意"最常给牙列缺损患者带来负面影响。治疗后Anthogry与Straumann量表总得分差异无统计学意义（P>0.05）。结论 2种种植系统均能改善患者口腔健康状况,患者对两种系统的整体主观感受并无明显差异。     

半程导板引导下颌“All-on-Four”种植修复一例

本文报道在半程导板引导下采用“All-on-Four”种植修复下颌牙列缺损一例,该患者下颌多颗牙缺失,伴有重度慢性牙周炎。术前对患者进行全面的口腔检查及影像学检查,确定数字化个性化种植方案,制作半程导板。术中拔除下颌余留牙,在截骨导板引导下行下前牙区截骨,增加前牙区修复空间,改善过深的spee曲线,在种植导板引导下行“All-on-Four”种植修复,即刻戴入下颌临时固定义齿。6个月后复查,见种植体骨结合良好,临时义齿功能良好,行下颌永久义齿修复。4个月后随访,见修复效果稳定。     

种植覆盖义齿修复牙列缺失的生活质量研究

目的研究下颌牙列缺失患者采用全口义齿（CD）和种植覆盖义齿（IOD）修复后的患者满意度以及口腔健康相关生活质量（OHRQoL）,探讨种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为是否存在积极的影响。 方法收集2016至2018年在中山大学附属口腔医院门诊就诊,50 ~ 80岁下颌牙列缺失,曾采用传统全口义齿修复且因义齿稳定性差而自愿行种植覆盖全口义齿修复的受试者19例,其中男8例,平均69.25岁;女11例,平均72.45岁。通过自身对照研究,每位受试者均先后佩戴在相同标准下制作的新传统全口义齿（CD）以及种植覆盖义齿（IOD）,并于戴用义齿3个月后完成口腔健康影响程度量表（OHIP-20）、老年口腔健康评价指数量表（GOHAI）和日常生活牙科影响量表（DIDL）调查,分析传统全口义齿和种植覆盖全口义齿修复对患者心理状态和生活质量的影响。数据采用Wilcoxon符号秩检验进行统计分析,P<0.05为差异有统计学意义,并计算CD组和IOD组OHRQoL得分的效应量（ES值）以评价其影响程度。 结果OHIP-20、GOHAI、DIDL量表均显示,IOD组在量表的功能限制、疼痛、心理不适、生理能力受限、心理能力受限、社交能力丧失、身心缺陷、美观、口腔舒适的各领域得分及总体得分上均明显优于CD组,差异具有统计学意义（P<0.05）。此外,根据DIDL量表评价标准得知,IOD修复可有效提提升患者满意度,并减少不满意人数的比例。3个量表在各领域及总得分的ES值均大于0.8,代表每个领域均受到高度影响,并以咀嚼能力（ES = 3.74）、生理能力受限（ES = 3.12）和功能限制（ES = 2.94）等生理功能改善最为显著。说明,IOD组比CD组对患者的生活质量改善较好,且对各方面的改善程度较高。 结论OHIP-20、GOHAI、DIDL量表调查结果反映种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为有积极的影响。     

540例颞下颌关节紊乱病患者口腔行为特点分析

目的: 初步测定中文版口腔行为检查问卷（oral behaviours checklist,OBC）的信度,系统观察颞下颌关节紊乱病（temporomandibular disorders,TMD）患者的口腔行为特点。方法: 对英文版OBC量表进行前向后向翻译,形成OBC中文版量表。纳入2017年7月—2018年4月治疗的TMD患者540例,填写中文版OBC,采用内部一致性系数Cronbach α评价中文版OBC量表的信度,分析患者中不同口腔行为所占的比例。采用SPSS 19.0软件包计算每种行为的发生频率;采用秩和检验比较不同性别TMD患者的口腔行为分布。结果: 中文版OBC的Cronbach α=0.771,信度较好。TMD患者存在一定的口腔习惯,如“睡眠时压住下颌骨（52.9%）”“单侧咀嚼食物（47.8%）”“不吃饭时牙接触（33.2%）”等。结论: 中文版OBC是评估口腔行为的可靠工具,TMD患者有一定的口腔行为习惯,需要进一步研究其与疾病发生的关系。     

“新净界漱口水”对放射性口腔黏膜炎的防治效果观察

目的： 前瞻性随机双盲研究“新净界漱口水”对放射性口腔黏膜炎的防治效果。方法：60例拟行放疗的口腔癌患者随机分为试验组和对照组;试验组30例,自放疗第1天起,每天使用“新净界漱口水”含漱4次,每次5 mL,含漱 5 min,直至放疗结束。对照组30例使用生理盐水含漱,方法同试验组。按RTOG口腔黏膜炎分级标准评价2组患者的口腔黏膜炎严重程度,记录疼痛程度,并照相存档。3级口腔黏膜炎视为终止指标,发生者给予其他药物治疗。应用Stata 12.0软件包对数据进行统计分析。结果：2组患者的年龄、性别、放疗技术和剂量无显著差异（P>0.05）。试验组首次观察到黏膜炎的发生时间较对照组晚（照射11.0次∶9.1次,P<0.05）,且试验组在早期出现疼痛的比例较对照组低（36.7%∶70.0%,P<0.05）。另外,试验组3级口腔黏膜炎的出现时间较对照组晚（照射18.9次∶15.9次,P<0.05）,发生率较对照组低（63.3%∶90.0%,P<0.05）。结论：“新净界漱口水”能延缓放疗所致口腔黏膜炎的发生时间,减轻患者的疼痛症状,并能减少3级口腔黏膜炎的发生率,值得临床使用。     

3D打印导板在上前牙种植中的精度评价

目的:评价3D打印导板在上前牙种植的精确度,探讨其临床效果。方法:选取2017年6月—2018年6月在青岛大学附属医院口腔种植科行上前牙区种植手术的60例患者,采用随机数字表法随机分为G组（导板组）和R组（常规组）,每组30例,均在术前拍摄锥形束CT（CBCT）,应用“Dentiq Guide种植导板软件”进行设计。G组制作3D打印导板辅助种植手术,R组行常规种植手术。术后即刻拍摄CBCT,应用“Dentiq Guide种植导板软件”将术前、术后CT重叠,测量术前设计与种植体实际位置差异,采用SPSS 24.0软件包对所得数据进行统计分析。结果:G组共植入46颗种植体,测量偏差角度(2.34±1.03)°,顶部(0.63±0.38)mm,根尖部(0.71±0.38)mm,深度(0.41±0.40)mm;R组共植入43颗种植体,测量偏差角度(6.72±3.65)°,顶部(1.59±0.35)mm,根尖部(2.05±0.92)mm,深度(0.77±0.63)mm。2组在角度、顶部、根尖部、深度的差异均有统计学意义（P<0.05）。结论:应用3D打印导板辅助上前牙种植手术,可提高手术精确度,满足种植修复需要,践行以修复为导向的精确种植理念。     

“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用

目的: 探讨“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用效果。方法: 选择口腔颌面部恶性肿瘤患者44例,均接受前臂游离皮瓣移植同期修复肿瘤切除术后缺损,采用腹部全厚皮片修复前臂供区缺损,分别应用“迷你”负压引流法（22例）和传统加压法（22例）。观察评估术后前臂区域引流量、移植皮片愈合情况和患者主观满意程度,采用SAS 9.4软件包对数据进行统计学分析。结果: “迷你”负压引流组22例患者中,20例皮片完全成活,创面平整,愈合良好,无结痂、渗出及感染;2例皮片边缘部分坏死,简单清理换药后痊愈。传统加压组22例患者中,18例皮片完全成活,4例出现部分坏死。术后随访6~10个月,“迷你”负压引流组皮片颜色接近正常皮色,手部运动、感觉功能正常,患者主观满意度显著高于传统加压组（P<0.05）。结论: “迷你”负压引流应用于前臂皮瓣制备后缺损的植皮修复,安全有效,成本低廉,患者满意舒适度高,值得临床推广应用。     

老年口腔门诊“一站式”服务的实践与效果评价

目的: 评价老年口腔门诊“一站式”服务的实施效果。方法: 于科室“一站式”服务实施的前后,分别选取60例老年患者作为研究对象,采用SPSS19.0软件包比较2组患者的平均就诊时间和缴费时间,并比较患者对就诊服务的满意度。结果: 采用一站式服务后,患者平均就诊时间和缴费时间大幅度缩短,前后对比差异具有显著性（P<0.01）。满意度由一站式服务前的90%上升为98%,满意度明显提高。结论: “一站式”服务能优化口腔疾病的治疗流程,提升老年患者就诊体验,满足老年口腔疾病患者的需求。     

口腔种植修复对牙列缺失患者生活质量及龈沟液AST、OPN水平的影响

目的: 探讨口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液天冬氨酸转氨酶（aspartate amino transferase,AST）、骨桥蛋白（osteopontin ,OPN）水平的影响。方法: 前瞻性选择2016年10月—2018年10月解放军中部战区总医院汉口院区口腔科收治的牙列缺失患者106例,采用随机数字表法将患者分为2组,实验组（53例）采用口腔种植修复治疗,对照组（53例）采用常规修复治疗。观察2组疗效以及患者生活质量、龈沟液AST、OPN水平的差异。采用SPSS 25.0 软件包对数据进行统计学分析。结果: 实验组总治疗有效率90.57%,显著高于对照组（P<0.05）。实验组治疗后龈沟液AST、OPN水平显著低于对照组（P<0.05）。实验组治疗后OHIP-14评分中,功能受限、生理性疼痛、心理不适、生理障碍、心理障碍、社会障碍、残疾评分均显著低于对照组（P<0.05）。结论: 口腔种植修复可明显改善牙列缺失患者的生活质量,对龈沟液AST和OPN水平影响较小。     

Fixed Orthodontic Appliance Therapy and Its Impact on Oral Health-Related Quality of Life in Chinese Patients

Objective:To determine changes in oral health-related quality of life (OHRQoL) during fixed orthodontic appliance therapy in Chinese patients.Materials and Methods:Two-hundred fifty Chinese orthodontic patients completed six distinct intervals of the 14-item Oral Health Impact Profile (OHIP-14, Chinese version): before treatment (T0); after the placement of the fixed appliance at 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4); and posttreatment (T5).Results:The overall response rate was 88.8% (222 of 250). Significant differences of overall OHIP-14 scores could be found between any two time points (P < .001), except for between T0 and T2 (P > .05) and between T3 and T4 (P > .05). Overall scores at T1 were significantly higher than the scores at the other intervals (P < .001), with a significant change in the scores on physical pain (P < .001), psychological discomfort (P < .001), and physical disability (P < .001). Scores at T5 were lowest among the six time points (P < .001).Conclusions:Fixed orthodontic appliance therapy did affect Chinese patients'' OHRQoL. Patients were considerably compromised in terms of their overall OHRQoL until approximately 1 month after insertion. The severity of the compromised condition in terms of overall OHRQoL was greatest at 1 week with the reported impact on physical pain, psychological discomfort, and physical disability. Patients'' OHRQoL was better after they completed the orthodontic treatment than before or during treatment.     

成人固定正畸治疗前后的口腔健康相关生活质量

目的 探讨错(牙合)畸形及正畸治疗对患者口腔健康相关生活质量(OH-QoL)的影响趋势和程度,分析可能影响患者生活质量的因素.方法 用口腔健康研究量表(OHIP-14中文版)测量不同类型错(牙合)畸形人群治疗前后的口腔健康生活质量.运用统计分析方法比较162例成人患者正畸治疗开始后1个月(T1)、3个月(T2)、6个月(T3)、12个月(T4)、治疗结束拆除矫正器(T5)、治疗结束后6个月(T6)的口腔健康生活质量变化,分析患者OH-QoL的变化趋势和可能的影响因素.结果 量表各领域中Angle Ⅰ类错殆组及Angle Ⅱ类错(牙合)组在心理不适(领域3)得分最高,而Angle Ⅲ类错(牙合)组在功能限制(领域1)得分最高,患者正畸治疗开始后1个月(T1)OHIP-14平均总得分最高(P＜0.05);同时T0与T1 、T1与T2、T2与T3、T4与T5、T5与T6比较差异均有统计学意义(P＜0.05).正畸治疗后(T6)得分低于治疗前(T0)(P＜0.05),即患者治疗后总体OH-QoL比治疗前提高.各条目中,正畸治疗前(T0)“其他人面前觉得不自在”最常给错(牙合)畸形患者带来负面影响,T1“出现过明显疼痛”、“吃什么东西都不舒服”、“在其他人面前觉得不自在”、“感到紧张不安”、“对自己的饮食不满意”给固定正畸患者带来负面影响最大,与正畸治疗前(T0)比较差异均有统计学意义(P＜0.05).结论 口腔健康状况对本研究患者OH-QoL的影响主要体现在心理不适领域,而对于AngleⅢ类错(牙合)畸形患者的负面影响主要体现在功能障碍方面;错(牙合)畸形的固定正畸矫治过程会对患者产生一定的消极影响,治疗后能改善患者口腔健康,提高患者的口腔健康相关生活质量.     

Impact of malocclusion on oral health–related quality of life in young adults

Objective:To assess oral health–related quality of life (OHRQoL) in young adult patients with malocclusion and to measure the association between orthodontic treatment need and OHRQoL.Materials and Methods:The study sample comprised 190 young adults aged 18 to 25 years who were attending orthodontic clinics at the Faculty of Dentistry. The Index of Orthodontic Treatment Need-Dental Health Component was used to measure orthodontic treatment need. Each participant was assessed for OHRQoL before and after treatment by using the Oral Health Impact Profile, Chinese version (OHIP-14).Results:Patients who had little or no, borderline, and actual need for orthodontic treatment represented 21.6%, 50.5%, and 27.9% of the total sample, respectively. OHRQoL (total OHIP-14 score and score for each domain) improved after treatment (P < .05). Significant differences in summary OHIP-14 scores were apparent with respect to orthodontic treatment need. Participants with high treatment need reported a significantly greater negative impact on the overall OHRQoL score. The greatest impact was seen in the psychological discomfort domain and the psychological disability domain.Conclusion:Malocclusion has a significant negative impact on OHRQoL. This is greatest for the psychological discomfort and psychological disability domains. The orthodontic treatment of malocclusion improves OHRQoL of patients.     

Esthetic Interim Acrylic Resin Prosthesis Reinforced with Metal Casting

Fabrication of an interim prosthesis is an important procedure in oral rehabilitation because it aids in determining the esthetics, phonetics, and occlusal relationship of the definitive restoration. The typical material (acrylic resin) used in interim prostheses commonly fails due to fractures. During extended oral rehabilitation with fixed partial prostheses, high strength interim prostheses are often required to protect hard and soft tissues, avoid dental mobility, and to allow the clinician and patient a chance to evaluate cosmetics and function before the placement of the definitive prosthesis. Furthermore, a satisfactory interim prosthesis can serve as a template for the construction of the definitive prosthesis. The maintenance of this prosthesis is important during treatment for protection of teeth and occlusal stability. Procedures to reinforce interim prostheses help to improve performance and esthetics in long-term treatment. Due to the low durability of acrylic resin in long-term use, the use of reinforcing materials, such as metal castings or spot-welded stainless steel matrix bands, is indicated in cases of extensive restoration and long-term treatment. This paper describes an easy technique for fabricating a fixed interim prosthesis using acrylic resin and a cast metallic reinforcement.     

Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study

Objectives

To evaluate the changes in oral health-related quality of life (OHRQoL) reported by subjects treated with conventional prostheses.

Methods

A consecutive sample of 153 patients seeking prosthodontic rehabilitation was recruited. Socio-demographic and prosthetic-related factors (Eichner Index; number of occlusal, aesthetic, and lost units) were registered. Baseline impacts on OHRQoL were collected using the OHIP-14 questionnaire. One month after treatment, the participants answered whether the prostheses had generated better, equal, or poorer effects within the 14 items of a retrospective scale (Post-OHIP). The study patients were compared with the reference population (P-population; n = 123) in terms of OHRQoL. Such P-population consisted of Spanish adults wearing conventional dental prostheses who were not seeking any dental treatment. The reliability and validity of the tests applied and the factor structure of the Post-OHIP were investigated. A Poisson regression model was calculated to predict what items would change favourably after treatment.

Results

Four prosthetic cohorts were established according to the types of rehabilitations performed: 1-FDPs: metal–ceramic fixed dental prostheses; 2-M-RPDs: metal-based removable partial dentures; 3-ADs: acrylic partial dentures and 4-CDs: complete dentures. Both tests confirmed adequate psychometric properties. Most items of the Post-OHIP consistently loaded on a single factor. Patients requiring ADs or CDs reported significantly lower baseline OHRQoL than those needing M-RPDs or FDPs. Pain/discomfort was the only hampering issue subsequent to removable rehabilitation. M-RPDs are expected to provide the significantly highest therapeutic improvements.

Conclusions

Patients perceived benefits in chewing ability, aesthetics and satisfaction with their mouth after receiving conventional dental prostheses.

Clinical significance

Conventional prosthetic therapy enhances patients’ overall well-being although it can cause discomfort and chewing dysfunction in more than 20% of subjects. Metal-based removable partial dentures are the most predictable in terms of patient satisfaction. The higher the clinical impairment felt by patients, the higher the increase in OHRQoL after rehabilitation.     

Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment

Chronic pain and functional impairment associated with temporomandibular joint (TMJ) disorders (TMD) considerably reduce oral health-related quality of life (OHRQoL). In the present study we have assessed the influence of prolotherapy in patients with TMD by the subjective measurement of QoL using the Oral Health Impact Profile-14 (OHIP-14). Twenty-five patients diagnosed with TMD (mean (range) age 38 (18 – 70) years) were included. They had all undergone dextrose prolotherapy to the TMJ at regular time intervals (four times at intervals of two weeks) using the method suggested by Hemwall-Hackett. They were asked to answer the OHIP-14 questionnaire before and two years after prolotherapy. Seven domains of OHRQoL were rated on a 5-point Likert scale from 0 (never) to 4 (very often). Domain scores and total OHIP-14 scores were compared using inferential statistics (chi squared and Wilcoxon signed rank tests). Prolotherapy was effective over time, as all the domains’ mean scores decreased considerably after treatment. The total mean score before prolotherapy was 21.20, which was extensively reduced to 13.08 after prolotherapy (p=0.001). There was statistically significant improvement in all domains, including functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap (p≤0.005 in all cases). We concluded that prolotherapy has a promising role in the improvement of OHRQoL of patients with TMD, and its beneficial effects persist at least two years after treatment.     

Effect of treatment with fixed and removable dental prostheses. An oral health-related quality of life study

The aim of the study was to evaluate patient-reported effects of treatment with fixed dental prostheses (FDP) and removable dental prostheses (RDP) and relate the change in Oral Health Related Quality of Life (OHRQoL) to the type of treatment and objective dental variables of aesthetics and mastication. Additionally, the purpose of the study was to identify aspects of impairment and improvement that the treatments caused. Fixed dental prostheses treatment was performed in 200 patients and RDP treatment in 107 patients. Gender, age, region of replacement, and number of teeth present and replaced were obtained. The participants completed the Oral Health Impact Profile 49 (OHIP-49) before and after treatment. A control group with no need for dental treatment also completed the OHIP-49. All participants had a significant improvement in OHRQoL. The improvement was higher for the RDP group than the FDP group. Removable dental prostheses that replaced only masticatory teeth did not improve the OHRQoL significantly. The improvement in OHRQoL for both the FDP and RDP groups was not at the level of the control group. Higher age was associated with lower improvement in OHRQoL. Higher age, being a woman and having teeth replaced in the aesthetic zone were associated with deterioration in OHRQoL. Both RDP treatment and FDP treatment were associated with a reduction in the problems most frequently reported before treatment. Treatment with RDP was associated with new problems caused by the RDP. Fixed dental prostheses and RDP treatments improved OHRQoL and reduced the number of problems. The RDP participants improved more than the FDP participants.     

Measuring patient-based outcomes: Is treatment satisfaction associated with oral health-related quality of life?

Objectives

To evaluate the level of association between patients’ denture satisfaction and oral health-related quality of life (OHRQoL) in edentate patients, and to identify the determinants of satisfaction that best predict OHRQoL. The effects of time and treatment type were also assessed.

Methods

Data from 255 edentate elders who participated in a randomised clinical trial were used. OHRQoL ratings were gathered using the Oral Health Impact Profile (OHIP-20) questionnaire. The McGill Denture Satisfaction Instrument was used to assess satisfaction with treatment (mandibular conventional denture or implant overdenture). Outcomes were measured prior to treatment, then 6 and 12 months after delivery of the new prostheses. Simple linear and multiple linear regression analyses were performed to statistically analyse the relationship.

Results

When the combined effect of all factors was assessed, only two variables of denture satisfaction ratings were significantly associated with OHRQoL: chewing ability (P = .005) and oral condition (P = .002). These two variables explained 46.4% of the variance in the OHIP change scores. This association varied with time, but the variables of importance remained the same. Type of treatment, gender, age and other socio-demographic variables were not significantly associated with improvement in OHRQoL once their effects were combined with denture satisfaction ratings.

Conclusions

Within the limitations of this study, a highly positive association exists between oral health-related quality of life and denture satisfaction. Chewing ability and oral condition are the determinants of denture satisfaction best associated with OHRQoL, predicting 46.4% of its improvement following a treatment.     

Association between general and oral health-related quality of life in patients treated for oral cancer

Background

Less is known about the association between general health-related quality of life (HRQoL) and oral HRQoL (OHRQoL) among patients with specific diseases. The aim of this study was to assess the association between patient-centered outcome measurements (HRQoL and OHRQoL) of oral cancer patients at least 6 months after treatment.

Material and Methods

HRQoL was measured with the 12-Item Short Form Health Survey (SF-12); OHRQoL was evaluated using the Oral Health Impact Profile (OHIP-14) and the Oral Impacts on Daily Performances (OIDP).

Results

Higher OHRQoL scores were associated with lower SF-12 domains scores. The OHIP-14 explained 16.5 % of the total variance of SF-12 Physical Component Summary (PCS) and the OIDP explained 16.1 %. In the SF-12 Mental Component Summary (MCS), the total variance explained was 23.9 % by the OHIP-14 and 21.8 % by the OIDP.

Conclusions

There was a significant association between long-term OHRQoL and HRQoL in oral and oropharyngeal cancer patients. These results may help to carry out new interventions aiming to improve patient´s life overall. Key words:Mouth neoplasms, quality of life, health status, oral health.