Επίδραση των Προκατασκευασμένων Μεταλλικών Στεφανών (ΠΜΣ) σε μόνιμους γομφίους στους περιοδοντικούς ιστούς σε παιδιά και εφήβους. Κλινικά και μικροβιολογικά στοιχεία
Creators: name: Κολεβέντη, Αικατερίνη Κωνσταντίνου
Publisher: name: Aristotle University of Thessaloniki
Year: 2017
Subjects: Υπενασβεστίωση γομφίων τομέων
Προκατασκευασμένες μεταλλικές στεφάνες
Ουλικός δείκτης
Stainless steel crown
Molar incisor hypomineralisation
Gingival index

description: Σκοπός: Ο σκοπός αυτής της μελέτης είναι να αξιολογήσει την κλινική και μικροβιολογική αλλαγή σε πρώτους μόνιμους γομφίους με υπενασβεστίωση έξι μήνες μετά την τοποθέτηση Προκατασκευασμένων Μεταλλικών Στεφανών (ΠΜΣ). Υλικό και Μέθοδος: Η μελέτη σχεδιάστηκε ως προοπτική, σύγκρισης ημιμορίων. Το δείγμα ήταν 14 ασθενείς ηλικίας 127.79 μηνών (± 38.18) με έναν πρώτο μόνιμο γομφίο που έχρηζε αποκατάστασης με ΠΜΣ και έναν πρώτο μόνιμο γομφίο του απέναντι ημιμορίου, στην ίδια γνάθο, χωρίς αποκατάσταση. Ορίστηκε ένας επεμβαίνων για τους 14 γομφίους και ένας ανεξάρτητος αξιολογητής που κατέγραψε την επίδραση της ΠΜΣ στους κλινικούς περιοδοντικούς δείκτες (Ουλικός Δείκτης, Δείκτης Πλάκας, Βάθος θυλάκου), την επιτυχία της αποκατάστασης και την υποουλική μικροβιακή αποίκιση δέκα σημαντικών υποουλικών μικροβίων πριν και έξι μήνες μετά από την ΠΜΣ. Αποτελέσματα: Για την πειραματική ομάδα, μεταξύ των δύο χρονικών στιγμών υπάρχει στατιστικά σημαντική αύξηση του Ουλικού Δείκτη, του Βάθους Θυλάκου και του αριθμού δύο περιοπαθογόνων μικροβίων, του P.gingivalis και της T.forsythia (p&lt;0,05)όχι όμως στον δείκτη πλάκας. Ακόμη ο A.actinomycetemcomitans εμφανίζει στατιστικά σημαντική διαφορά μεταξύ των δύο ομάδων στον εξαμηνιαίο επανέλεγχο. Τα υπόλοιπα περιοπαθογόνα μικρόβια εμφανίζουν αλλαγές όχι στατιστικά σημαντικές μεταξύ των ομάδων και των στιγμών. Συμπεράσματα: Η επιλογή της αποκατάσταση των πρώτων μόνιμων γομφίων με ΠΜΣ στους 6 μήνες της θεραπείας επιδεινώνει τον Ουλικό Δείκτη και το Βάθος Θυλάκου , όμως χρειάζεται πιο μακροχρόνια παρατήρηση για ασφαλή συμπεράσματα μιας και αυτό το είδος της αποκατάστασης μπορεί να έχει διάρκεια πολλών ετών.
description: Aim: Stainless steel crowns are the indicated mode of restoration for permanent molars with multiple surface breakdowns like severe molar incisor hypomineralisation with enamel breakdown. In the primary dentition stainless steel crowns are the gold standard for multifacial restoration although the periodontal health of the molars is concerning. The aim of the present study is to evaluate clinical and microbial changes after the rehabilitation with Stainless Steel Crowns (SSC) in first permanent molars (FPM) in children and in adolescents. Materials and method: This prospective study was carried out on 14 patients of both sexes (6 males, 8 females). They were all treated in the Postgraduate Clinic of the Department of Pediatric Dentistry at Thessaloniki Dental School. The study had a longitudinal prospective split mouth design. During the study period all subjects were given standard oral hygiene instructions according to the protocol used at the department and they all were right handed. The subjects and their parents were informed about the rationale and study design. Both subject consent and written parental assent were obtained before the procedures, according to the requirements of the Ethics Committee. Gingival index was the main variable. Pocket depth, plaque index, microbial changes, prosthetic criteria and the patient’s age were secondary variables. All the subjects fulfilled the following inclusion criteria: (1) good general health (2) no prior history of periodontitis or periodontal therapy, (3) no systemic or local antibiotics during the preceding 6 months, (4) nonsmokers, (5) one permanent first molar in 1 quadrant for treatment with stainless steel crowns, and (6) healthy tooth contra lateral with full eruption (7) contra lateral first molar or antagonist for study group without treatment or treatment only in the occlussal surface (8) absence of pain in permanent first molars which would be treated (9) good cooperation, Frankl scale (3,4). Two groups were made, study group, where molars needed crowns and control group with contra lateral healthy molars. The treatment with SSC was operated by a single independent post graduate student at the Pediatric Dentistry Department who gave the exact same instructions in the patients for their daily oral hygiene at their first appointment. At the second appointment the following clinical parameters were measured and sub gingival plaque was collected by a post graduate student of another department who was independent evaluator. The same data were measured six months after the rehabilitation of the molar with the stainless steel crown from both groups. The health status of periodontal tissues was determined by assessment of the pocket probing depth, measured to the nearest millimeter with a calibrated periodontal probe. The amount of supragingival plaque was evaluated according to Turesky index (PI) and gingival status with the Loe and Silness gingival index (GI) before the placement of the stainless steel crown and six months later. Sub gingival plaque samplings were gathered from the total gingival crevice of teeth in study and control group. After isolating with cotton rolls, drying, and removal of supragingival plaque, subgingival samples were taken by means of a sterile Gracey curette, placed in 100 mL of TE buffer (Tris HCL 10 mM, EDTA 1 mM, pH 7.5) and stored after treatment with an alkali solution (0.5M NaOH) at 201 C. A total of 56 samples were processed for ten bacterial species, using the ‘‘checkerboard’’ DNA–DNA hybridization technique as described in detail by Socransky et al. Results: Six months after the placement of the SSCs the gingival index had significant change at both groups, and in addition, the groups differ statistically significant when compared at both times points. The pocket depth and the microbial population of P.gingivalis and T.forsythia increased significantly (p&lt;0.05) in the study group. Furthermore A.actinomycetemcomitans at six months was statistically significant higher in study group compared with the control group. Plaque index had no statistical significant changes between the study and control group neither at the first appointment nor six months later. Another result of our study is that from the first appointment the study group had a statistically significant difference compared with the control group in gingival index. Poor oral hygiene, because of dental sensitivity, can be explained due to an enamel breakdown at the molars with MIH or due to caries at the molars with MIH. The results of the study reveal that the molars rehabilitated with PMC in 6 months show statistically significant increase of gingival index. Furthermore, the molars at 6 months show statistically significant difference of gingival index when compared to the molar of the study group. Conclusion: There is a big number of published papers in the literature regarding oral health in primary teeth with PMC showing that the periodontal status of teeth that rehabilitate with PMCs worsens, other papers reveal after the placement of most oral biomaterials like amalgam, resin, brackets, implants clinical and microbiological indicies worsen too. The results of our study show that six months after the placement of PMCs Gingival Index and Pocket Depth have display statistically significant increase in study group as well as two of the periopathogen microbes. Since PMC is a rehabilitation with long duration, the patients should be in compliance with recalls and daily oral hygiene.