Long-term Clinical Evaluation on Pulp Complication of Composite Resin Restorations with Self-etching Adhesives

目的：本研究的目的是对复合树脂修复的自蚀刻粘接剂系统进行长期评估，并验证该系统中保护层的缺失不是导致长期牙髓并发症的原因。方法：所有150例采用该类型修复体的患者在修复后至少2年后被召回。在47例患者中（31%），107例修复体，2.2至6.5岁，检查牙齿敏感性和牙髓活力。结果采用Fisher精确检验和多元logistic回归分析。结果：牙敏评估无阳性病例，有牙髓保护的深腔修复4例（3.7%）（术后短期敏感3例）因炎症导致取牙。多因素logistic回归分析估计的优势比95%置信区间为：腔深[1.54 ~∞](p=0.020<0.05)，提供保护层[0.02 ~∞](p=1>0.05)，术后短期敏感性[1.50 ~∞]（p=0.022<0.05）。结论：深腔和术后7天是否存在短期敏感性是本研究调查期间（2.2 - 6.5年）发生牙髓并发症的两个关键预测因素。常规牙髓保护的缺失并不是造成深层牙髓并发症的主要原因

Objective : The aim of the present study was to make a long-term assessment on self-etching adhesive system for composite resin restoration and to test the hypothesis that the absence of protective layers was not responsible for long-term pulp complication in this system. Methods : All 150 patients, who received this type of restorations, were recalled after at least 2 years from the time of restoration. Of 47 patients responded (31%), 107 restorations, 2.2 to 6.5 years old, were examined for tooth sensitivity and pulp vitality. The results were analyzed by Fisher's exact test and multivariate logistic regression analysis. Results : No positive case was found in the assessment of tooth sensitivity, while 4 restorations (3.7%) made in deep cavities with pulp protection (3 with short-term postoperative sensitivity) resulted in pulpectomy due to inflammation. The 95% confidence intervals for odds ratio estimated by the multivariate logistic regression analysis were [1.54 to ∞](p=0.020<0.05) for cavity depth, [0.02 to ∞](p=1>0.05) for provision of protective layer, and [1.50 to ∞](p=0.022<0.05) for short-term postoperative sensitivity. Conclusion : Deep cavity and the existence of short-term postoperative sensitivity originally assessed at 7 days were the two critical predictors for the occurrence of pulp complication for the duration (2.2 to 6.5 years) investigated in the present study. The absence of conventional pulp protection was not responsible for the pulp complication in deep cavities with the self-etching adhesive system