根面覆盖美学评分的可靠性和准确性分析

doi:10.3969/j.issn.1674-8115.2022.05.007

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (5): 602-608.doi: 10.3969/j.issn.1674-8115.2022.05.007

根面覆盖美学评分的可靠性和准确性分析

孙文韬(), 谢玉峰(), 束蓉

上海交通大学医学院附属第九人民医院牙周病科，上海交通大学口腔医学院，国家口腔医学中心，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海 200011

收稿日期:2022-03-25 接受日期:2022-04-18 出版日期:2022-05-28 发布日期:2022-05-28
通讯作者: 谢玉峰 E-mail:swtswtwt@sina.com;yufengxie_123@163.com
作者简介:孙文韬（1991—），男，主治医师，硕士；电子信箱：swtswtwt@sina.com。
基金资助:
国家自然科学基金(81991500);上海市高水平地方高校创新团队(SSMUZDCX20180900);上海交通大学医学院附属第九人民医院临床研究助力计划(JYLJ201819);上海市自然科学基金(18ZR1422400)

Reliability and accuracy analysis of root coverage esthetic score

SUN Wentao(), XIE Yufeng(), SHU Rong

Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China

Received:2022-03-25 Accepted:2022-04-18 Online:2022-05-28 Published:2022-05-28
Contact: XIE Yufeng E-mail:swtswtwt@sina.com;yufengxie_123@163.com
Supported by:
National Natural Science Foundation of China(81991500);Innovative Research Team of High-level Local Universities in Shanghai(SSMUZDCX20180900);Clinical Research Program of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine(JYLJ201819);Natural Science Foundation of Shanghai(18ZR1422400)

摘要/Abstract

摘要：

目的·通过根面覆盖美学评分（root coverage esthetic score，RES）与视觉模拟评分（visual analogue scale，VAS）分别评价根面覆盖术后的美学效果，分析RES在临床应用中的可靠性和准确性。方法·纳入2020年1—12月就诊于上海交通大学医学院附属第九人民医院牙周病科的患者32例，共105颗伴有牙龈退缩（gingival recession，GR）的患牙。所有患牙均使用信封技术联合结缔组织移植术（connective tissue graft，CTG）进行根面覆盖。术后6个月检查患者的相关牙周状况，并分别由2名牙周专科医师通过RES，患者本人通过VAS对根面覆盖的美学效果分别进行评分。采用组内相关系数（intraclass correlation coefficient，ICC）和95%可信区间（95% confidence interval，95% CI）表示医师RES结果的一致性。采用t检验比较基线和术后6个月时角化牙龈（keratinized gingiva，KG）和GR的差异。采用方差分析检验VAS不同分级间各指标的差异。采用线性回归分析评估根面覆盖率（percentage of root coverage， PRC）与VAS、RES与VAS之间的关系。以VAS为结局变量，以RES的5个指标为自变量，进行多元线性回归分析。所有检查均为双侧检验，P<0.05表示差异具有统计学意义。结果·术后6个月KG较基线增加（1.19±1.28 ）mm，GR减少（1.77±1.21） mm。平均PRC为81.4%±39.9%，完全根面覆盖率（percentage of complete root coverage，PCRC）为69.5%。2名医师的RES评分比较差异无统计学意义（ICC=0.95，95%CI 0.92~0.96）。术后KG（P=0.008）、PRC（P=0.000）和PCRC（P_{=0.000）在VAS不同等级之间存在统计学差异。RES和VAS的分值呈线性相关（P=0.000）。多元线性回归分析显示VAS分值与RES评分系统中的龈缘位置（gingival margin，GM）、软组织轮廓（soft tissue texture，STT）和膜龈联合线（muco-gingival junction，MGJ）呈线性相关（P=0.000、P=0.000，P_{=0.006）。结论·RES在一定程度上与患者的美学判断一致。}}

关键词: 根面覆盖, 信封技术, 结缔组织移植术, 根面覆盖美学评分, 视觉模拟评分

Abstract:

Objective· To evaluate the reliability and accuracy of the root coverage esthetic score (RES) in clinical applications by comparing RES and the visual analogue scale (VAS) results after root coverage procedures.

Methods· Thirty-two patients who visited the Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2020 with a total of 105 gingiva recessions were enrolled in this study. All gingiva recessions were treated with envelope technique combined with connective tissue graft (CTG). The patients' periodontal conditions were examined 6 months after surgery and the esthetic results were scored by 2 periodontists through RES and patients themselves through VAS. Intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI) were used to represent the consistency of physician RES results. The differences of keratinized gingiva (KG) and gingival recession (GR) at baseline and 6 months after surgery were compared by using t-test. Analysis of variance was used to test the differences of each index among different VAS grades. Linear regression analysis was used to evaluate the relationship between percentage of root coverage (PRC) and VAS, RES and VAS. Multiple linear regression analysis was carried out with VAS as the outcome variable and 5 indexes of RES as independent variables. All tests were bilateral tests. The difference was statistically significant when P<0.05.

Results·In this study, KG increased by (1.19 ± 1.28) mm and GR decreased by (1.77±1.21) mm 6 months after surgery. The average PRC was 81.4%±39.9%, and the percentage of complete root coverage (PCRC) was 69.5%. There was no significant difference between the RES scores of the 2 periodontists (ICC=0.95, 95%CI 0.92?0.96). KG (P=0.008), PRC(P=0.000) and PCRC (P=0.000) varied significantly between different VAS grades. The RES and VAS scores were linearly correlated (P=0.000). Multiple linear regression analysis showed that VAS scores were linearly correlated with gingival margin (GM), soft tissue texture (STT) and muco-gingival junction (MGJ) (P=0.000, P=0.000,P=0.006).

Conclusion· To a certain extent, the results of RES are consistent with the patient's esthetic judgment.

Key words: root coverage procedure, envelop technique, connective tissue graft, root coverage esthetic score, visual analogue scale

中图分类号:

R781.4

孙文韬, 谢玉峰, 束蓉. 根面覆盖美学评分的可靠性和准确性分析[J]. 上海交通大学学报（医学版）, 2022, 42(5): 602-608.

SUN Wentao, XIE Yufeng, SHU Rong. Reliability and accuracy analysis of root coverage esthetic score[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(5): 602-608.

图/表 7

图1 左上尖牙与第一前磨牙的根面覆盖术Note：A. Gingival recession from the maxillary left canine to the first premolar. B. Envelope incision. C. Graft harvesting from the left palatal gingiva. D. Graft suturing. E. Flap suturing. F. Six months after surgery.

Fig 1 Root coverage of the maxillary left canine to the first premolar

表1 患者在基线和术后6个月时的临床指标比较

Tab1 Comparison of clinical indicators at baseline and 6 months postoperatively

Indicator	Baseline	6 months post-surgery	Difference	P value
KG/mm	2.16±1.09	3.04±0.97	1.19±1.28	0.000
GR/mm	2.21±1.15	0.44±0.85	-（1.77±1.21）	0.000

表2 不同分级的VAS间KG、GR、PRC、PCRC以及RES的比较

Tab 2 Comparison of VAS with KG，GR， PRC， PCRC and RES for different grades

Indicator		VAS				P value
Indicator		Excellent （n=53）	Good （n=37）	Fair （n=15）	Poor （n=0）	P value
KG /mm	Baseline	2.16±1.09	2.38±0.89	1.97±1.39	‒	0.412
	6 months post-surgery	3.67±0.94	3.05±0.74	3.27±1.28	‒	0.008
	Difference	1.52±1.35	0.68±0.81	1.30±1.62	‒	0.008
GR /mm	Baseline	2.20±1.10	2.01±0.31	2.79±1.61	‒	0.077
	6 months post-surgery	0.20±0.89	0.31±0.68	1.50±1.28	‒	0.000
	Difference	-（1.97±1.06）	-（1.79±1.17）	-（1.29±1.24）	‒	0.061
PRC/%	‒	92.6±15.8	80.4±53.2	44.4±41.0	‒	0.000
PCRC/%	‒	81.1	75.7	20.0	‒	0.000
RES/score	‒	9.12±1.52	8.31±1.91	‒	‒	0.000

表3 VAS不同分级间RES指标的比较

Tab 3 Comparison of each RES index among different VAS grades

Indicator	VAS
Indicator	Excellent （n=53）	Good （n=37）	Fair （n=15）	Poor （n=0）	P value
GM/score	5.35±1.23	5.11±1.71	2.40±2.32	‒	0.000
MTC/score	0.95±0.18	0.81±0.34	0.90±0.28	‒	0.043
STT/score	0.94±0.23	0.72±0.40	0.33±0.36	‒	0.000
MGJ/score	0.95±0.20	0.89±0.24	0.72±0.47	‒	0.015
GC/score	0.92±0.25	0.78±0.36	0.42±0.48	‒	0.000

表4 RES各指标与VAS的多元线性回归分析

Tab 4 Multiple linear regression analysis of RES and VAS

Indicator	Estimate	Standard error	P value
GM （β₁）	0.53	0.07	0.000
MTC （β₂）	0.17	0.55	0.763
STT （β₃）	2.42	0.53	0.000
MGJ（β₄）	1.73	0.61	0.006
GC （β₅）	-0.59	0.58	0.317

图2 术前和术后6个月的患牙比较（病例1）Note：A. Gingival recession of maxillay left canine. B. A keloid-like gingiva with poor color match.

Fig 2 Baseline and 6 months after root coverage procedure（Case 1）

图3 术前和术后6个月的患牙比较（病例2）Note：A. Gingiva recession of maxillary right canine. B. Partial root coverage with good tissue integration.

Fig 3 Baseline and 6 months after root coverage procedure（Case 2）

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根面覆盖美学评分的可靠性和准确性分析

Reliability and accuracy analysis of root coverage esthetic score

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