双膦酸盐性颌骨坏死：病例报告及文献复习

双膦酸盐类药物临床用于治疗骨质疏松症、变形性骨炎和其他代谢性骨病、多发性骨髓瘤以及与肿瘤转移相关的骨骼疾病。该类药物通过抑制破骨细胞介导的骨吸收而产生临床治疗作用。然而,双膦酸盐类药物,尤其是静脉用双膦酸盐类药物有致颌骨骨坏死的危险。目前,国内尚未有该类药物致下颌骨坏死的报道。作者报告1例口服双膦酸盐类药物阿仑膦酸钠（Alendronate,商品名福善美,Fosamax）致下颌骨骨坏死病例,并结合文献对双膦酸盐性颌骨坏死的发病机制、临床表现及其预防和治疗进行讨论。     

双膦酸盐颌骨坏死的机制研究进展

双膦酸盐性颌骨骨坏死（bisphosphonate related osteonecrosis of the jaws, BRONJ）发生于使用双膦酸盐治疗的骨质疏松症、骨转移癌和其他骨破坏性疾病患者中,是一种严重的颌骨坏死。双膦酸盐与骨组织中的矿物质有很强的亲和力,能在骨吸收的过程中进入破骨细胞并产生毒性作用,从而抑制破骨细胞的分化与代谢,因此双膦酸盐具有明显的抗骨吸收的作用。双膦酸盐根据其侧链的不同而分为含氮以及非含氮两大类,含氮类双膦酸盐比非含氮类双膦酸盐具有更强的抗骨吸收的作用。Marx在2003年首次报道了静脉注射唑来膦酸会导致颌骨坏死,从那以后双膦酸盐颌骨骨坏死在国际上引起了广泛的重视。然而关于双膦酸盐引起骨坏死的具体机制尚不明确,本文将对双膦酸盐颌骨骨坏死的机制进行综述。     

双膦酸盐对正畸牙根吸收和修复相关细胞作用的研究进展

牙根吸收是正畸治疗中常见并发症之一,其高发性已引起正畸医师的关注。双膦酸盐一类骨吸收抑制剂,能调节体内钙代谢。近年来,有研究证实双膦酸盐能有效缓解正畸导致的牙根吸收。本文就双膦酸盐的生物学性状和应用,以及对牙根吸收和修复相关细胞的影响进行综述。     

双膦酸盐相关性颌骨坏死1例报告及文献复习

双膦酸盐类药物被广泛用于治疗骨质疏松、恶性肿瘤骨转移等相关的骨骼疾病,引起颌骨骨坏死是其严重的并发症。这种并发症或自然发生,或发生于简单牙槽外科手术后。本文报告1例静脉使用双膦酸盐类药物唑来膦酸(zoledronic acid)致上颌骨骨坏死病例,并结合文献,对双膦酸盐相关性颌骨坏死的发病机制、临床表现、预防和治疗进行讨论。     

双膦酸盐类药物性颌骨坏死:1例病例报告及文献回顾

双膦酸盐类药物通过抑制破骨细胞介导的骨吸收,降低了病理性骨折的发生率,提高了有融骨性疾病患者的生活质量。临床上主要用于治疗妇女绝经后的骨质疏松症、多形性骨髓瘤、恶性肿瘤骨转移(乳腺癌、前列腺癌等)引起的高钙血和骨痛症、成骨不全等代谢性骨病。随着双膦酸盐类药物在临床上的广泛应用,出现了许多该类药物相关性颌骨坏死的报道。现报告我院1例双膦酸盐类药物性左下颌骨坏死的病例,并结合文献讨论双膦酸盐类药物性颌骨坏死(Bisphosphonate-related osteonecrosis of the jaw,BRONJ)的发病机制、预防及治疗方法。     

双膦酸盐及其相关性颌骨坏死的机制和治疗

双膦酸盐相关性颌骨坏死（BRONJ）是长期使用双膦酸盐治疗骨质疏松症,多发性骨髓瘤以及乳腺癌、前列腺癌和肺癌等其他恶性肿瘤骨转移所引起的骨相关性疾病的严重并发症。BRONJ的发生发展与一些因素密切相关,譬如双膦酸盐的效能、用药方式、牙拔除和不良义齿修复等。美国口腔颌面外科协会在2007年对BRONJ进行了定义、分级并颁布其治疗指南,在2009年和2014年进对其行了更新。尽管BRONJ在国际上引起了广泛的重视,但其发病机制仍不完全清楚,治疗措施也存在着较大的争议。本文就双膦酸盐及其相关性颌骨坏死的机制和治疗等研究进展作一综述。     

大鼠双膦酸盐相关性颌骨坏死模型的建立

随着双膦酸盐在治疗骨质疏松和骨恶性肿瘤等疾病方面的应用，双膦酸盐相关性颌骨坏死作为较严重的副作用受到广泛关注。双膦酸盐相关性颌骨坏死的动物模型是研究该疾病的良好途径，其中又以大鼠模型为常见。本文就大鼠双膦酸盐相关性颌骨坏死模型的建模方法和建模检测方式做综述。     

双膦酸盐相关性颌骨坏死并发腕部舟状骨骨髓炎1例

双膦酸盐类药物可以抑制破骨细胞功能,使颌骨骨密度升高,血流减少,发生骨坏死。双膦酸盐类药物相关性骨坏死多发于颌骨。本文报道1例双膦酸盐相关性颌骨坏死并发腕部舟状骨骨髓炎,并结合文献讨论双膦酸盐药物性颌骨坏死的发病机制、治疗与预防等。     

唑来膦酸并发的上颌骨坏死2例报告

<正>唑来膦酸(zoledronic acid,商品名择泰,Zometa)是一种强效含氮双膦酸盐,其咪唑环上含有两个氮原子,是目前已知作用最强的双膦酸盐,能抑制因破骨活性增加而导致的骨吸收,具有抑制恶性肿瘤骨     

双膦酸盐相关性颌骨坏死的发生机制与风险评估

双膦酸盐类(bisphosphonates,Bps)药物作为一种强有效的抗肿瘤和骨质疏松药广泛应用临床,但其引起的双膦酸盐相关性颌骨坏死(bisphosphonate-related osteonecrosis of the jaw,BRONJ)患者日渐增多,严重影响患者生存质量,国内外尚无有效对策,成为当今口腔医学界急需克服的难题。该文对该疾病的最新研究进展及风险评估进行阐述,以期为临床提供帮助。     

Electrodeposition of bilayers of dithiols

We report an electrochemical method to form a bilayer of dithiol. The cyclic voltammogram of the oxidative deposition of an aromatic dithiol on gold from an alkaline aqueous solution reveals two current peaks separated by more than 400 mV. The integrated charge of the oxidative current peak (B) at the most positive potential is twice that of the other oxidative current peak (A). These two oxidative current peaks were characterized by differential capacitance and electrochemical quartz crystal microbalance (EQCM) measurements. A decrease of the capacity by a factor of two, and an increase of the EQCM frequency change by a factor of two were observed when the potential was scanned from a value where only the first oxidative peak (A) is obtained, to a potential where both oxidative current peaks (A and B) are obtained. Infrared spectra show that the aromatic dithiols adsorb vertically at potentials corresponding to the current peak A and they become tilted for potentials corresponding to the current peak B. The simple relationships between the properties of the two oxidative current peaks are found to be compatible with a step-wise oxidative deposition of a bilayer of dithiol.     

Reconstruction of the curve of Spee

Summary  AIM: The construction of a flat occlusal plane or one showing a haphazard curvature does not correspond to the concept of "best practice" in restorative dentistry. Unlike a flat reconstruction, a correct occlusal curvature allows mandibular translation without occlusal interferences in the posterior segment, Furthermore masticatory efficiency on the working side is not lost. In this way, a better distribution of the axial load and protection against T.M.J. overloading is achieved. MATERIALS AND METHODS: A simple cephalometric was used to determine the optimal radius of the circle. This curvature was transferred using a template, which was then placed in the appropriate position on the articulator; in order to facilitate the prosthetic construction of an optimised Curve of Spee. CONCLUSION: An appropriately constructed template, when fitted to an articulator may be useful to guide a clinician when designing a wax-up or prosthetic construction. This could be of benefit when constructing a surgical stent for optimum implant placement. Correspondence: J. P. Ré, Université de la Méditerranée, Faculte d'Odontologie, 27 bd Jean Moulin, 13005 Marseille, France     

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.     

Comparison of different measurements of development of plaque and gingivitis in man

Abstract— The purpose of the present study was to compare efficiency of measurements commonly used to study the development of plaque and gingivitis in short-term clinical trials. Data from a recent experiment on the effect of mutanase on accumulation of plaque and development of gingivitis were used. Efficiency was compared using 1) level of significance and 2) minimum number of individuals necessary to obtain a statistically significant result at a given level of significance and with a given power of the test. Of all the measurements used, the gingival exudate measurement was the most efficient. Among the nonparametric indices, Plaque Index was the most efficient, especially on proximal surfaces in the mandible. Reduction of the scales for the nonparametric indices from a four-point scale to a two-point (dichotomous) scale slightly reduced experimental efficiency.     

Influence of the time of measurement of unstimulated human whole saliva on the diagnosis of hyposalivation

OBJECTIVE: An unstimulated whole saliva flow rate (UWSFR) of less than 0.1 mL/min is often related to symptoms of dry mouth. It is also used as a diagnostic criterion for Sjogren's syndrome, and for assessment of hyposalivation as a caries risk factor. The main hypothesis was that the circadian rhythm of salivary flow affects this diagnosis if saliva is collected at different morning time-points. DESIGN: UWSFR was tested at 7:30 and 11:30 a.m. in 108 individuals, age 15-46 years (mean 33+/-9). The participants were allocated to one of three groups (very low< or =0. 1/min, low 0.1-0.2 mL/min and normal>0.2 mL/min) based on the UWSFR at 7:30 a.m. Different aspects of the perception of oral dryness were rated using Visual Analog Scales. RESULTS: All three groups displayed a statistically significant increase in UWSFR at 11:30 a.m. compared with 7:30 a.m., all of similar magnitude (0.08-0.09 mL/min). In the group with very low UWSFR, 70% at 11:30 a.m. exceeded the 0.1 mL/min limit. There were significant difference in perception of oral dryness between the normal group and both the low and the very low groups. Only the subjects in the groups with a low or very low UWSFR perceived an increase in oral wetness at 11:30 a.m. CONCLUSIONS: It was concluded that the time of measurement strongly influences the diagnosis of hyposalivation. To control the influence of variations in the time of saliva collection, we suggest that unstimulated whole saliva tests are performed at a fixed time-point or in a limited time interval early in the morning.     

Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle

The most stable pattern of internal fixation for fractures of the mandibular condyle is a matter for ongoing discussion. In this study we investigated the stability of three commonly used patterns of plate fixation, and constructed finite element models of a simulated mandibular condylar fracture. The completed models were heterogeneous in the distribution of bony material properties, contained about 1.2 million elements, and incorporated simulated jaw-adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. This model was considerably larger and more complex than previous finite element models that have been used to analyse the biomechanical behaviour of differing plating techniques. The use of two parallel 2.0 titanium miniplates gave a more stable configuration with lower mean element stresses and displacements over the use of a single miniplate. In addition, a parallel orientation of two miniplates resulted in lower stresses and displacements than did the use of two miniplates in an offset pattern. The use of two parallel titanium plates resulted in a superior biomechanical result as defined by mean element stresses and relative movement between the fractured fragments in these finite element models.     

血链球菌细菌素对伴放线聚集杆菌和白色念珠菌生物膜作用的研究

目的:研究血链球菌细菌素分别对单独培养及混合培养的伴放线聚集杆菌(A.a)和白色念珠菌(C.a)生物膜的最小抑菌浓度(MIC)。利用激光共聚焦显微镜研究血链球菌细菌素对A.a及混合培养的A.a和C.a生物膜活性的影响。方法:通过低温高速离心,细胞破碎,盐析等方法提取血链球细菌素—血链素。采用二倍稀释法,测定血链素对单独和混合培养的A.a及C.a的MIC;血链素作用于A.a及混合培养的A.a和C.a后,利用激光共聚焦显微镜分别在2 h、6 h、12 h、24 h、48 h、72 h观察生物膜活性的变化。结果:血链素对单独培养的A.a的MIC为0.25 g/L;血链素对单独培养的C.a的MIC为0.125 g/L;血链素对混合培养的A.a及C.a的MIC为0.5 g/L。通过激光共聚焦显微镜观察,血链素对A.a生物膜活性有较强的抑制作用,最显著的时间在72 h;血链素对混合培养的A.a及C.a生物膜活性同样具有较强的抑制作用,最显著的时间在48 h。结论:血链素对A.a及混合培养的A.a及C.a生物膜活性均有抑制作用。     

Evidence of the validity of a model of determinants of quality of restorative dental care

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.     

Effect of inactivation of gtf genes on adherence of Streptococcus downei

The activity of glucosyltransferases (GTF), a group of enzymes that synthesize water-soluble and -insoluble glucans from sucrose, significantly contributes to the cariogenicity of mutans streptococci. Streptococcus downei produces four glucosyltransferases, GTFI, which produces insoluble glucan, and GTFS, GTFT, and GTFU, which synthesize soluble glucans. We have previously reported that inactivation of gtfS results in altered adherence and have now examined its interaction with other enzymes by constructing mutants which were gtfS, gtfS/gtfT, gtfS/gtfI and gtfI. The mutants were tested for their ability to accumulate on wires and on plastic microtiter trays in the presence of sucrose. The gtfS mutant displayed a reduced ability to adhere compared to the wild type but there was no further reduction of adherence in a gtfS/gtfT mutant. In contrast, the gtfS/gtfI double mutant showed a drastic reduction in adherence and when gtfI alone was inactivated, bacteria were unable to adhere to a hard surface. The results confirmed that insoluble glucan is required for strong adherence to a smooth surface but that the amount and structure of this glucan is dependent upon the availability of soluble glucans to act as primer molecules.     

Setting expansion of investment and accuracy of castings

Setting expansion of 4 phosphate-bonded investments was measured under 3 different conditions: a hygroscopic condition, a condition using a ring lined with a wet liner and a condition using a ring lined with a dry liner. Accuracy of castings of a Ni−Cr alloy made in each of the 4 investments in rings lined with a wet liner was measured. One investment exhibited negative potential for hygroscopic expansion. Expansion of all investments in wet-lined rings was not significantly different from their expansion under the hygroscopic condition. There was no significant difference in setting expansion between the investments when a wet liner was used. Significant differences in accuracy existed between castings produced in the different investments using a wet liner. The correlation between the setting expansion of the investments using a wet liner and the accuracy of castings produced using a wet liner was not high and was not significant. Comparison between investments with regard to their ability to produce accurate castings in terms of mould expansion by measurement of setting expansion is of no value.