| Objective:The domestic repairing method of cavity classⅡof posterior teeth is mainly about intraoral stowing method and stabile repairing method.Intraoral stowing method usually includes silver amalgam stowing method and light-cured composite filling method,while stabile repairing method includes inlay repairing and casting full crown. As for silver amalgam obturator and light-cured composite obturator, the incidence rate of gingival inflammation caused by alloy inlay is very low, and its stability and durability is pretty good.Moreover, it can regain the adjacency relation and occlusal contact relation. In order to explore the application of medal inlay in cavity classⅡof posterior teeth and its clinical significance, the thesis used metal inlay to repair cavity classⅡof posterior teeth, the stimulating extent to gingiva and the incidence rate of gingivitis were compared with silver amalgam filling and light-cured composite filling.The gingival inflammation can be assessed by observing the variation of gingival color, appearance and texture clinically. There are many index to evaluate gingival inflammation extent, among of which gingival index (GI)is one of commonly used indexes for observing therapeutic effect and research, and is used in epidemiological research and clinical therapeutic effect evaluation. It is indicated that the amount of neutrophilic granulocytes and deciduous epithelial cells in gingival crevicular fluid will be changed evidently when gingival inflammation happens. Its concentration alteration is usually earlier than clinical representation, therefore it can be used as a more sensitive objective index of inflammation extent. In the aspect of clinical index and laboratory index, the aim of detecting gingival index (GI), the amount of neutrophilic granulocytes and deciduous epithelial cells in gingival crevicular fluid is to observe the influence of the three different kinds of methods to gingival tissue and to compare and evaluate the repairing effect of the three methods to guide reasonable selection of clinical prosthetic replacement.Methods:Patients who visited our department from April 2006 to April 2007 were chosen, among the total, male 45, female 45, 30-50 years old, and 90 teeth were chosen in all, respectively, premolars 30, molars 60. After patients were solicited to agree according to including criterion and precluding criterion. They were divided into 3 groups randomly, and the three different kinds of repairing modeths, which were medal inlay repairing, silver amalgam repairing, light-cured composite repairing, were applied respectively. They were inlay repairing group, silver amalgam repairing group, light-cured composite repairing group.After the cavity classⅡof posterior teeth of 30 instance of each group were repaired one year later, the amount of neutrophilic granulocytes and deciduous epithelial cells in gingival crevicular fluid, gingival index, plaque index were chosen as experimental group, and its opposite side isonym teeth or relative isonym teeth were chosen as control group.The chosen teeth in 3 groups were repaired respectively:①Inlay repairing group: the 30 instance cavity classⅡof posterior teeth were prepared under the prerequisite of removing detritus cleanly and preparing to orth-occlusion cavity. The proximal surface was cutted with carborundum bit, do pay attention to protecting adjacent teeth, expanding to self-cleaning area at buccoside and glossside, and the cervical part was preparing along cervical margin line, case-side cavity form, pulpal wall should low, gingival wall is equal to insertion path, vertical to pulpal wall,the occlusion side was prepared into dovetail form, and there is no undercut in each wall. The cast was obtained with silicone rubber modeling composition after the cavities were prepared, then patrix was gained by hyper- hard gypsum, then using nickel-chromium alloy for midrange-melting point casting, buffing, polishing and try-in by turns, pay attention to measure the contact and contact point between inlay and adjacent teeth. Eventually, buffing and polishing to complete the repairing.②silver amalgam filling group: the 30 instance cavity classⅡof posterior teeth were prepared under the prerequisite of removing detritus cleanly and preparing to orth-occlusion cavity. Defective teeth and adjacent teeth were isolated, fixed with matrix blade before filling, and silver amalgam were filled after underlaying with ZOP, following the sequence that proximal surface, occlusion surface after the proximal surface was compacted, and then carving knife was used to form and burnisher to polish.③light-cured composite repairing group: the 30 instance cavity classⅡof posterior teeth were prepared under the prerequisite of removing detritus cleanly and preparing to orth-occlusion cavity. Preparing cavity but there was no need to prepar open wide form. After acid etching, filled and light-cured resin in delamination, every layer resin was cured for 40s, then bit to check, adjusting occlusion and polishing.One year later, gingival crevicular fluid of the 3 group were extracted and smeared, the method is that isolating the prosthetic teeth from saliva, using number 7 injector to build in the gingival inside of prothetic teeth to draw gingival crevicular fluid, and using 10μl sample injector draw 10μl gingival crevicular fluid put into test tube, and putting 90μl Sodium Chloride to dilute 10 times to make suspension, and then using 10μl sample injector draw 10μl suspension to overlay on the slide to make Switzerland staining, mounting with cover glass, observing under microscope by 40 times amplified, using cello-counting plate to count cell population and implore cello-content. Following the same method, drawing subgingival gingival crevicular fluid of its opposite side isonym teeth or relative side isonym teeth, and implore cello-content. Using SPSS10.0 microsoft to treat the data, using t-test between each group and its control group and using q-test among each group.the test criterion isα=0.05.Results:1.GI,PI and the amount of neutrophilic granulocyte, deciduous epithelial cell in gingival crevicular fluid of the light-cured composite filling group and silver amalgam filling group are higher than the control groups;as for GI,PI and the amount of neutrophilic granulocyte, deciduous epithelial cell in gingival crevicular fluid, there is no difference between the inlay repairing group and its control group.2.Each index of inlay repairing group is lower than light-cured composite filling group and silver amalgam filling group; each index of light-cured composite filling group is lower than ilver amalgam filling group, but there is no differences between them.Conclusions:1.No matter what methods were used to repair cavity classⅡof Posterior teeth, all of them have stimulated gingiva, but have different extent. 2.Among of them,inlay repairing group have the smallest stimulus, light-cured composite repairing group is the second, and silver amalgam filling group have the strongest stimulus.There is significant difference between inlay repairing group and light-cured composite repairing group, and so is inlay repairing group and silver amalgam filling group, but there is no difference between light-cured composite repairing group and silver amalgam filling group.3.It is indicated that GI,PI and the amount of neutrophilic granulocyte, deciduous epithelial cell in gingival crevicular fluid can be used as indexes for evaluating gingival inflammation, and can be used to judge the dental prosthetic restoration effect for cavity classⅡof posterior teeth, and what is certificated is that inlay repairing is better than light-cured composite filling and silver amalgam filling.
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