张静兰 莫伟兰 刘芳 钱虹 麦志辉

【摘要】 目的 探討3种形式的间隙保持器对第一乳磨牙早失且第二乳磨牙龋坏患者的间隙保持效果。方法 选择第一乳磨牙早失且第二乳磨牙龋坏患儿99例（患牙105颗）为研究对象，根据第二乳磨牙的龋坏程度，分别制作铸造冠式间隙保持器（A组）、金属成品冠丝圈式间隙保持器（B组）和带环丝圈式间隙保持器（C组）。于治疗前以及治疗后6、12和24个月，测量间隙变化情况，检查间隙保持器的松动度、第一恒前磨牙的萌出情况及牙龈炎等，计算间隙保持器的失败率。结果 3种间隙保持器都保持乳磨牙的缺牙间隙，治疗前与治疗后6、12、24个月缺牙间隙差异均无统计学意义（P均> 0.05）。A组6、12、24个月的失败率分别是2.0%（1/51）、17.4%（8/46）和34.1%（15/44）;B组6、12、24个月的失败率分别是0.0%（0/35）、6.1%（2/33）和18.8%（6/32）;C组6、12、24个月的失败率分别是0.0%（0/18）、0.0%（0/16）和7.1%（1/14）。结论 3种形式的间隙保持器都良好维持缺牙间隙，带环丝圈式间隙保持器制作简单但失败率较高，铸造冠式间隙保持器的工艺复杂但失败率较低，金属成品冠丝圈式间隙保持器的失败率介乎两者之间。

【关键词】 间隙保持器;乳磨牙早失;错畸形; 磨牙龋坏

Evaluation of clinical efficacy of three types of space maintainers Zhang Jinglan， Mo Weilan， Liu Fang， Qian Hong， Mai Zhihui. Department of Pediatric Dentistry， Stomatological Hospital of Southern Medical University， Guangzhou 510280， China

Corresponding author， Mai Zhihui， E-mail： maiya2007@ 126. com

【Abstract】 Objectives To evaluate the clinical efficacy of three types of space maintainers in patients with early loss of the first primary molar complicated with caries in the second primary molar. Methods  A total of 99 children （105 teeth） were enrolled in this study. According to the caries degree of the second primary molars， 105 teeth were divided into three groups. In group A， patients wore casting crown space maintainer， those in group B were treated with metal manufactured crown space maintainer， and those in Group C wore traditional band and loop space maintainer. Before and 6， 12 and 24 months after treatment， the changes of space were measured， the looseness degree of space maintainer was examined， the growth of the first primary molar was observed， the incidence of gingivitis was noted and the failure rate of space maintainer was calculated. Results The missing tooth gap of the primary molars before and 6， 12 and 24 months after treatment did not significantly differ among three types of space maintainers （all P > 0.05）. After wearing space maintainer for 6， 12 and 24 months， the failure rates were calculated as 2.0% （1/51）， 17.4% （8/46） and 34.1% （15/44） in Group A， 0.0% （0/35）， 6.1% （2/33） and 18.8% （6/32） in Group B， 0.0% （0/18）， 0.0% （0/16） and 7.1% （1/14） in Group C， respectively. Conclusions Three types of space maintainers can properly maintain the missing tooth space. Traditional band and loop space maintainer is convenient to operate， whereas the failure rate is relatively high. The manufacturing process of casting crown space maintainer is complicated， whereas the failure rate is relatively low. The failure rate of metal manufactured crown space maintainer is moderate between the other two maintainers.

【Key words】 Space maintainer;Early loss of primary molar;Malocclusion; Malar caries

乳磨牙的龋病、牙髓炎及根尖周炎是儿童牙科的常见病，发病率在14.4% ～ 74.4%之间[1]。临床上发现同区域的乳磨牙往往同时龋坏，甚至其中一颗乳磨牙需要拔除，严重影响患者的咀嚼功能，大大增加恒牙列拥挤、牙弓不对称，甚至颜面部不对称的机会[2]。研究显示，近50%的第一乳磨牙及70%的第二乳磨牙早失伴有缺牙间隙不同程度的缩小甚至关闭[3]。因此……