上颌组牙三维有限元模型的建立及Carrière Distalizer矫治器的力学分析

目的建立一侧有效的自然排列的上颌尖牙和第一磨牙及周围牙槽骨的三维有限元模型,分析在Carrière Distalizer矫治器作用下,组牙的应力分布及其位移特点。方法通过螺旋CT扫描获得精确的组牙及颌骨DICOM格式的图像信息,采用Mimics三维建模软件和Ansys有限元分析软件建立及拟合上颌骨中正常位置的上颌组牙及其周围牙槽骨的三维有限元模型,模拟Carrière Distalizer矫治器的力学实验并进行相关分析。结果成功建立了上颌组牙及其周围牙槽骨的三维有限元模型。力学实验显示,尖牙和磨牙颈部剖面腭侧应力分布及位移明显小于颊侧、远中和近中,表现为类似旋转移动的柱状图形;而尖牙和磨牙整个远中剖面的应力分布及位移规律基本相同,均表现为自牙颈部向牙根部逐渐衰减的倾斜移动的曲线。结论本实验创建的上颌组牙及其周围牙槽骨的三维有限元模型,达到了几何外形和生物力学的相似性,可用于精确的生物力学分析;尖牙和磨牙在CD的作用下,应力分布及位移规律均呈现有旋转和倾斜移动的趋势。     

Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people

Smidt D, Torpet LA, Nauntofte B, Heegaard KM, Pedersen AML. Associations between oral and ocular dryness, labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 2011; 39: 276–288. © 2010 John Wiley & Sons A/S Abstract – Objective: To investigate the associations between age, gender, systemic diseases, medications, labial and whole salivary flow rates and oral and ocular dryness in older people. Methods: Symptoms of oral and ocular dryness, systemic diseases, medications (coded according to the Anatomical therapeutic chemical (ATC) classification system), tobacco and alcohol consumption were registered, and unstimulated labial (LS) and unstimulated (UWS) and chewing‐stimulated (SWS) whole salivary flow rates were measured in 668 randomly selected community‐dwelling elderly aged 65–95. Results: Presence of oral (12%) and ocular (11%) dryness was positively correlated. Oral dryness was associated with low UWS, SWS and LS, and ocular dryness with low UWS and SWS. Oral and ocular dryness was related to female gender, but not to age. Only four persons in the healthy and nonmedicated subgroups reported oral and ocular dryness. The numbers of diseases and medications were higher in the older age groups and associated with oral and ocular dryness, low UWS, SWS and LS. On average, women were slightly older, reported more oral and ocular dryness and had lower UWS, SWS, LS and higher numbers of diseases and medications. High prevalence and odds ratios for oral dryness were associated with metabolic, respiratory and neurological diseases and intake of thyroid hormones, respiratory agents (primarily glucocorticoids), psycholeptics and/or psychoanaleptics, antineoplastics, proton pump inhibitors, antidiabetics, loop diuretics, antispasmodics, quinine and bisphosphonates. Ocular dryness was especially associated with neurological diseases and intake of psycholeptics and/or psychoanaleptics. Intake of magnesium hydroxide, antithrombotics, cardiac agents, thiazides, beta‐blockers, calcium channel blockers, ACE inhibitors/angiotensin II antagonists, statins, glucosamine, paracetamol/opioids, ophthalmologicals and certain combination therapies was related to oral and ocular dryness. Conclusions: In older people, oral and ocular dryness are associated with low salivary flow rates, specific as well as high number of diseases and medications, but neither with age and gender per se nor with tobacco and alcohol consumption. New detailed information concerning associations between medications and oral and ocular dryness has been obtained using the ATC classification system.     

口腔颌面头颈肿瘤诊治的挑战

发生于口腔颌面部的肿瘤严重威胁身心健康,随着科学技术的进步与生活水平的提高,口腔颌面头颈肿瘤的诊治面临着新的机遇与挑战。本文通过回顾口腔颌面头颈-肿瘤学科的发展历史,从精准医学、多学科协作、功能康复及学科发展等多层面总结临床现状,以期为口腔颌面头颈肿瘤的诊疗提供新的思路。     

Plasma and saliva levels of nerve growth factor and neuropeptides in chronic migraine patients

Oral Diseases (2011) 17 , 187–193 Objectives: To investigate the level and interrelationship of nerve growth factor (NGF) and sensory neuropeptides [substance P (SP), calcitonin gene‐related peptide (CGRP)] in plasma and saliva of chronic migraine patients, and to analyze the association between pain intensity and their concentration. Materials and methods: Plasma and resting whole saliva were collected from 33 chronic migraine patients and 36 control subjects. NGF, SP, and CGRP concentrations were measured by enzyme immunoassay and pain intensity of each subject was measured using the Graded Chronic Pain Scale. Results: Chronic migraine patients showed higher NGF and neuropeptide levels in both plasma and saliva compared to the control subjects. Plasma NGF, and plasma and saliva levels of SP and CGRP were highly associated with pain intensity. There was a significant positive correlation between NGF and both neuropeptide levels in plasma, and between the neuropeptide levels in both plasma and saliva. Plasma levels of SP and CGRP were significantly correlated with their saliva level. Conclusions: The increased production of NGF and sensory neuropeptides may play an important role in the maintenance of pain in chronic migraine and analysis results of human saliva could act as an index of disease state and therapeutic outcome.     

益生菌防治口腔和胃肠道放化疗黏膜炎的研究进展

黏膜炎是放疗、化疗最为常见的副反应,是一种发病机制不明、临床表现多样、尚无有效治疗方法的炎症性疾病,在口腔常表现为局部黏膜烧灼样刺痛,在胃肠道多表现为恶心、呕吐、腹泻等。目前发现局部菌群失调可促进放化疗黏膜炎发生发展,益生菌可作为防治黏膜炎的新兴路径。本文就益生菌防治口腔和胃肠道放化疗黏膜炎的研究进展予以综述,重点关注微生物对黏膜炎的发病机理和治疗的影响。文献复习结果显示,黏膜炎的发生发展与局部菌群组成和功能改变有关,益生菌可通过调节局部微生态及宿主免疫等机制发挥防治作用。目前用于防治黏膜炎的益生菌多为乳杆菌、双歧杆菌等,多数临床试验证实益生菌防治黏膜炎有积极作用。但由于益生菌品种繁多、肿瘤治疗方案不同,可能造成部分研究未观察到防治作用,选择有效性及安全性高的益生菌、设计最佳菌种组合及干预方案是当前领域的研究热点。     

Comparative analysis of pubertal growth spurt predictors: Martins and Sakima method and Grave and Brown method

The aim of this study was to evaluate whether Martins and Sakima and Grave and Brown methods are useful for the study of pubertal growth spurt in children with cleft lip and palate. A total of 132 hand-wrist radiographs of patients from HRAC/USP aged 7 to 17 years old were analyzed, including girls and boys. Six radiographs of each age and gender were employed. These methods were applied to evaluating the stages of the hand-wrist ossification and epiphyseal formation, by graphic representation. The Martins and Sakima and the Grave and Brown methods revealed that the initial, peak and final stages of pubertal growth spurt occurred between 9 to 10, 12 and 15 years old, respectively, in the female gender. Similarly, in the male gender, both Martins and Sakima and Grave and Brown methods showed similar mean ages: 12, 14 and 16 years old for initial, peak and final stages of pubertal growth spurt, respectively. The Pearson's correlation test showed high and significant correlation (r = 0.99 and p < 0.001) between the methods investigated. In conclusion, the methods appeared to be highly and significantly correlated as regards the analysis of children with cleft lip and palate. Moreover, based on the literature and present results, it is possible to suggest that the two methods have shown similar pattern and may be used with equal efficiency for assessment of the pubertal growth spurt in children with cleft lip and palate.     

Cosmetic oral and maxillofacial surgery options

BACKGROUND: Dentistry and its related specialties have made exponential increases in the functional and cosmetic treatment of the maxillofacial region. Oral and maxillofacial surgeons historically have been involved in functional and cosmetic rejuvenation of the face, and newer technologies have enhanced the ability to make patients look and feel better. METHODS: Cosmetic oral and maxillofacial surgery is being taught in residency programs, is included in the oral and maxillofacial surgery board examinations and represents a part of contemporary oral and maxillofacial surgery. The author discusses common facial rejuvenation procedures with an emphasis on newer treatment technologies. RESULTS: Many oral and maxillofacial surgeons have the ability to improve the esthetics of the maxillofacial area and related structures. The large number of aging baby boomers and technological advances in cosmetic facial surgery have made these procedures easier to perform and more popular than ever. CONCLUSION: A global diagnosis and treatment plan to include facial esthetics can enhance cosmetic dentistry and serve to frame the work of the restorative dentist. The oral and maxillofacial surgeon can help the dentist and patient pursue both functional and cosmetic improvement with safe and effective procedures. CLINICAL IMPORTANCE: All dentists should be aware and abreast of advances in all areas of dentistry and have a basic understanding of available procedures that can benefit their patients. Cosmetic oral and maxillofacial surgery can enhance the work of the restorative dentist and improve facial esthetics, as well as enhance the well-being of the patient.     

3D打印术前设计和内镜辅助在颧骨颧弓骨折复位固定术中的应用

目的: 探讨3D打印术前设计和内镜技术应用于颧骨颧弓骨折复位固定手术的可行性及效果。方法: 选择4例B型颧骨颧弓骨折患者,均伴发颧弓骨折,面部凹陷明显伴开口受限。术前行CT扫描后将数据转化为STL格式,3D打印骨折模型和镜像模型,在模型上完成手术设计和钛板预弯制。手术采用耳屏前小切口和颧弓表面隧道手术入路,内镜辅助下完成颧弓骨折的复位及坚固内固定。结果: 所有患者术后面部恢复对称性,面部凹陷消失,开口度正常,面部瘢痕不明显,无感染和神经损伤等并发症。结论: 术前3D模型手术设计降低了内镜辅助下行颧弓骨折复位固定术的难度,提高了手术精准度,避免了头皮冠状切口,创伤小,美容效果好。     

Graves病合并牙周炎患者IL-6和TNF-α检测及意义

目的: 通过检测Graves病（GD）伴牙周炎(CP)患者龈沟液及血清中白介素6(IL-6)和肿瘤坏死因子α(TNF-α)的浓度,探讨Graves病与牙周炎之间的关系。方法: 采用双免疫酶联法检测30例健康志愿者、30例牙周炎患者、30例Graves病患者、30例Graves病伴牙周炎患者龈沟液及血清中IL-6和TNF-α含量。记录4组研究对象的牙周探诊深度（PD）、临床附着丧失(CAL)和龈沟出血指数（SBI）。采用SPSS 19.0软件包对数据进行统计学处理。结果: GD伴牙周炎组患者血清和龈沟液中IL-6和TNF-α的浓度显著高于单纯牙周炎组及GD组（P<0.05）,GD伴牙周炎组和GD组血清和龈沟液IL-6、TNF-α水平升高与FT3、FT4呈正相关（P<0.05）,且GD伴牙周炎组的相关性显著高于GD组。结论: Graves伴牙周炎组IL-6与TNF-α浓度高于单纯牙周炎组和Graves病组,表明在免疫机制方面,牙周炎与Graves病可能存在相互影响。     

大鼠髁状突发育和软骨细胞凋亡的研究

目的研究大鼠髁状突形成和发育过程,以及凋亡相关因子(Fas)和一氧化氮(NO)凋亡途径在其发育中作用。方法收集胎鼠及幼鼠的颞下颌关节标本,通过苏木精-伊红染色、原位末端脱氧核糖昔酞转移酶分析法(TUNEL)和Fas及诱导型一氧化氮合酶(iNOS)免疫组化检测髁状突发育特征。结果胚胎15.5d时髁状突和关节窝已基本出现,胚胎17.5d时髁状突出现完整的软骨细胞分层和软骨内成骨,胚胎19.5d时出现清晰的关节盘,各期均可见凋亡的软骨细胞,凋亡细胞在关节软骨表层细胞中所占比例高于深层细胞,Fas阳性细胞分布大致同凋亡细胞,而iNOS阳性细胞较少,主要分布在肥大层。结论髁状突的发育与软骨细胞凋亡密切相关,Fas和NO凋亡途径在其发育中均起到一定作用。     

Oral colonization of aerobic and facultatively anaerobic gram-negative rods and cocci in irradiated, dentate, xerostomic individuals

This study aimed at investigating the oral colonization of aerobic and facultatively anaerobic gram-negative rods and cocci in head- and neck-irradiated, dentate, xerostomic individuals. Subjects were recruited from a nasopharyngeal carcinoma clinic and were segregated into group A: <60 years (n=25, 48+/-6 years, 5+/-5 years post-irradiation) and group B: >or=60 years (n=8, 67+/-4 years, 2+/-2 years post-irradiation) and were compared with age- and sex-matched normal individuals, group C: <60 years (n=20, 44+/-12 years) and group D: >or=60 years (n=10, 70+/-3 years). Selective culture of the oral rinse samples was carried out to isolate, quantify and speciate (using API 20E kit) aerobic and facultatively anaerobic gram-negative rods and cocci recovery. All test subjects were put under comprehensive oral and preventive care for 3 months, and 12 group A and 5 group B subjects were recalled for reassessment of aerobic and facultatively anaerobic gram-negative rods and cocci colonization. All identical isolates, pre- and post-hygienic care, were phenotypically (Vitek, Hazelwood, MA and antibiogram profile) and genotypically (pulsed-field gel electrophoresis) evaluated. The aerobic and facultatively anaerobic gram-negative rods and cocci isolated from the first round oral rinse samples included: Acinetobacter, Neisseria, Chryseomonas, Flavimonas, Pseudomonas, Citrobacter, Enterobacter, Escherichia, Klebsiella, Flavobacterium and Weeksella species. The aerobic and facultatively anaerobic gram-negative rods and cocci isolation rate was high for irradiated individuals, and they were 64/25% and 100/80% for groups A/C and B/D, respectively. Recovery of aerobic and facultatively anaerobic gram-negative rods and cocci and Klebsiella pneumoniae subsp. pneumoniae in oral rinse samples were found to be significantly more prevalent in the irradiated subjects (groups A and B). Enterobacteriaceae were more frequently isolated from oral rinse samples of aged irradiated subjects (group B vs D, P<0.05), where the quantity of Citrobacter freundii (colony-forming units/ml oral rinse) was also significantly elevated. The isolation rate of aerobic and facultatively anaerobic gram-negative rods and cocci after hygienic care remained unchanged; 3 of 12 and 3 of 5 of the recalled subjects from groups A and B, respectively, harbored same aerobic and facultatively anaerobic gram-negative rods and cocci species. However, only two pairs of K. pneumoniae subsp. pneumoniae, sequentially isolated from same patients in group B, were found to be identical by pulsed-field gel electrophoresis. This may be due to reinfection of the microbes from the same source or permanent colonization. In conclusion, irradiation-induced xerostomia seems to favor frequent, repeated, transient intraoral colonization of aerobic and facultatively anaerobic gram-negative rods and cocci.     

正畸医生与正畸患者对面部美学的评价及其差别

目的 通过Q分类法来调查正畸医生与正畸患者对面部美学的评价及其差别,同时调查男性与女性对面部美学的评价及其差别。 方法 将96例正畸完成后的患者（男、女各48例）临床照片由20名经验丰富的正畸医生（男7名,女13名）和25例正畸患者（男13例,女12例）用Q分类法进行评价。Kappa检验和McNemar检验用来评估正畸医生和正畸患者之间,以及男女之间对面部美学评价是否一致和其差别。 结果 在对男性面部美观调查中,正畸医师与正畸患者的评价具有较高的一致性,男性与女性的评价具有较高的一致性。在对女性面部美观调查中,正畸医师与正畸患者的评价的一致性较差,男性与女性评价的一致性也较差。 结论 正畸医师与正畸患者对面部美观的评价基本一致;男性与女性对面部美学的评价基本不一致。     

口腔治疗中前牙区美学的考量因素

前牙区是口腔美学治疗的关键,前牙形态和位置的调整是系统性美学治疗的重要部分。临床诊疗中,口腔期望恢复天然牙形态使之与面型协调;关闭前牙间隙、调整中线位置使弓形美观、对称;通过垂直向和水平向控制使牙列与龈、颊组织关系协调,展现美丽微笑。完善的前牙美学治疗需要多学科联合、多种治疗方法介入,同时应考虑患者的文化背景和审美习惯,以实现最佳治疗效果。数字化诊疗技术为治疗前美学分析预测、治疗后美学评估提供了保障。该文结合国内外最新研究成果,从前牙位置、形态以及牙列与龈、颊等软组织关系等方面对口腔治疗中前牙美学考量因素作一综述,为美学区口腔治疗规划提供参考。     

Concurrent cervical and craniofacial pain: A review of empiric and basic science evidence

Because many patients present themselves for treatment with both craniofacial and craniocervical pain, 2 questions arise: (1) What are the sensory and motor consequences of dysfunction in either of these areas on the other? (2) Do craniofacial and craniocervical pain have a similar cause? These questions formed the impetus for this review article. The phenomenon of concurrent pain in craniofacial and cervical structures is considered, and clinical reports and opinions are presented regarding theories of cervical-to-craniofacial and craniofacial-to-cervical pain referral. Because pain referral between these 2 areas requires anatomic and functional connectivity between trigeminally and cervically innervated structures, basic neurophysiologic and neuroanatomic literature is reviewed. The published data clearly demonstrate neurophysiologic and structural convergence of cervical sensory and muscle afferent inputs onto trigeminal subnucleus caudalis nociceptive and non-nociceptive neurons. Moreover, changes in metabolic activity and blood flow in the brainstem and cervical dorsal horn of the spinal cord in both monkeys and cats have been demonstrated after electric stimulation of the V1-innervated superior sagittal sinus. In conclusion, the animal experimental data support the findings of human empiric and experimental studies, which suggest that strong connectivity exists between trigeminal and cervical motor and sensory responses.     

Predicting the size of unerupted canines and premolars of the maxillary and mandibular quadrants in an Iranian population

The aim of this investigation was to examine the accuracy of Moyers probability tables and the Tanaka and Johnston prediction equations in predicting the size of unerupted canines and premolars of the maxillary and mandibular quadrants in an Iranian population and to derive a standard formula for it. METHODS: Out of a sample of 280 subjects, 50 (25 males and 25 females) were selected by specific inclusion criteria. An electronic digital caliper was used to read the nearest 0.01 mm. The teeth measurements derived were compared with those predicted from Tanaka Johnston equations and Moyers probability tables and then standard regression were developed. RESULTS: Tanaka and Johnston regression equations overestimate the mesiodistal width of permanent canines and premolars. There were no statistically significant differences between actual mesiodistal width of canines and premolars and the predicted width from Moyers charts at 65% for the lower and upper arches in male subjects and for the lower arch in females but none of the probabilities has good accuracy for the upper arch in females. For the newly developed regression equations, the correlation coefficients between the sum of the mandibular incisors and the sum of the canine and premolars were 0.709 (for lower) and 0.539 (for upper) in subjects. CONCLUSIONS: Tanaka and Johnston overestimate the actual size for Iranian teeth widths. Moyers method can be used at 65% probability level for male subjects and at the 75% and 85% level for upper arch and the 50% and 65% level for lower arch in female subjects.     

一种新的牙齿记录法

目的:介绍一种新的牙齿记录法,以达到简便而准确地描述和记录牙齿的目的。方法:T或t作为记录牙齿的标识字符,T代表恒牙,t代表乳牙。用数字1～8和1～5从牙弓中线向远端对恒牙和乳牙编号。用"字母加数字"的方式对恒牙和乳牙、上颌牙和下颌牙、前牙和后牙以及牙位进行记录。结果:恒牙标记为T1～T8,乳牙标记为t1～t5。上、下颌恒牙分别标记为UT1～UT8和LT1～LT8。上、下颌乳牙分别标记为Ut1～Ut5和Lt1～Lt5。前牙、前磨牙和磨牙分别标记为T(1-3)、T(4、5)和T(6-8)。乳前牙和后牙分别标记为t(1-3)和t(4、5)。恒牙牙位用上下标牙位记录法或"UR、UL、LR、LL"加"T1～T8"标记。乳牙牙位用上下标牙位记录法或"UR、UL、LR、LL"加"t1～t5"标记。结论:新的牙齿记录法能简便而准确地标记牙齿、上下颌牙齿、前牙和后牙以及牙位。     

口腔微生物与肠道微生物的关系

口腔和肠道是人体消化道的重要组成部分。口腔微生物和肠道微生物的相互关系和致病共性已成为近年来人体微生物组研究的热点。本文结合近期研究进展,对口腔微生物和肠道微生物群落结构和功能,相互定植和致病作用,以及两者与系统性疾病的相关性进行综述。     

Caries experience of 5-6-year-old and 12-13-year-old schoolchildren in central and western Nepal

OBJECTIVE: To describe and analyse the caries experience and caries prevalence in the deciduous dentition of 5-6-year-old schoolchildren and in the permanent dentition of 12-13-year-old schoolchildren in western and central Nepal. Design: Non-randomised cross-sectional surveys conducted by trained and calibrated examiners. SETTING: Surveys were conducted in private and government rural and urban schools at 10 sites along the Terai and the foothills in eight districts of western and central Nepal. SUBJECTS: A total of 2,177, 5-6-year-old and 3,323, 12-13-year-old schoolchildren from urban and rural areas were examined under WHO Pathfinder methodology. OUTCOME MEASURES: Prevalence of caries and dental caries experience (dmft/DMFT). RESULTS: The caries prevalence and mean dmft score of 5-6-year-olds was 67% and 3.3 (urban 64% and 2.9; rural 78% and 4.0). The caries prevalence and mean DMFT score of 12-13-year-olds was 41% and 1.1 (urban 35% and 0.9; rural 54% and 1.5). The d/D-component constituted almost the entire dmft/DMFT index. CONCLUSION: The recorded prevalence of untreated dental caries in schoolchildren requires an appropriate oral health response based primarily on prevention and health promotion. Foremost in this regime would be the promotion and use of accessible and affordable fluoridated toothpaste.     

正常男性青、老年人上气道结构的矢状面测量分析

目的　探讨无鼾正常男性青年及老年人群上气道及周围组织 5 2项测量项目的正常值范围 ,比较两组间差异。方法　摄取无鼾正常男性青年 47名、老年 3 8名的X线头颅定位侧位片并使用开发软件测量上气道及周围结构 5 2个测量项目 ,对测量值进行统计学T检验。结果　两组人群多为低角面型。老年组下颌骨颏部靠后 ,会厌及舌骨靠前下方 ,上气道鼻咽径及会厌至咽后壁距较宽 ,悬雍垂尖至咽后壁距较窄 ,软腭长而肥厚 ,舌体厚而较直立 ,与软腭接触长度大 ,舌及软腭占口腔及上气道面积较大。结论　二组上气道结构有差异 ,应分年龄段建立上气道及周围结构的正常值范围     

Oral and maxillofacial surgery residency education

Oral and maxillofacial surgery is the recognized specialty of dentistry that is responsible for the diagnosis and surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the bone and soft tissues of the oral and maxillofacial region. This article will present a review of the educational process for residents in oral and maxillofacial surgery as it has evolved and current training standards.