上前牙区即刻种植修复的软组织效果评估

目的：评估上前牙区即刻种植联合即刻修复的软组织效果。方法上前牙区单牙即刻种植患者26例,微创拔牙后植入ZIMMER TSV种植体,获得良好初期稳定性并实施即刻修复,经过6～12个月骨结合和牙龈塑形后完成上部修复,观察负重6个月后牙龈组织情况。结果26例患者完成骨整合及最终修复,负重正常,无探诊出血、牙龈红肿,近中龈乳头、远中龈乳头及龈缘高度降低分别为（0．52±0．22） mm、（0．56±0．31） mm 和（0．71±0．34） mm,差异无统计学意义（F＝1．297,P＝0．29）。结论上前牙区单牙即刻种植联合即刻修复存在不同程度的软组织退缩。     

罗哌卡因切口周围局部浸润对大鼠慢性术后疼痛的抑制作用

目的 评价术中不同浓度罗哌卡因切口周围局部浸润对慢性术后疼痛的抑制作用. 方法 雄性SD大鼠30只,体重180 g～220 g,按随机数字表法分为5组,每组6只:假手术组(S组)、生理盐水组(R0组)、0.5％罗哌卡因组(R1组)、0.75％罗哌卡因组(R2组)、1％罗哌卡因组(R3组).按Flatters法制作皮肤/肌肉切开牵拉模型(skin/muscle incision and retraction,SMIR),S组大鼠除未进行SMIR之外其他操作均与其他组相同.应用yon Frey细丝法测定术前及术后1、3、7、10、14、17、21、24、28 d的机械缩足反射阈值(paw withdrawal mechanical threshold,PWMT). 结果 各组术前PWMT基础值差异无统计学意义(P＞0.05);与R0组比较,R1组PWMT于术后1、3、7、10、14、17、24d升高[(20.9±3.7)、(14.8±4.6)、(15.8±4.4)、(13.9±1.6)、(9.8±0.8)、(10.2±1.3)、(10.3±2.7) g](P＜0.05),R2组[(21.0±5.2)、(21.3±3.9)、(15.3±4.1)、(18.4±3.3)、(12.1±1.1)、(11.5±1.6)、(14.1±1.9)、(13.2±3.0)、(9.5±2.4)g]和R3组[(22.2±2.9)、(22.5±4.1)、(22.1±4.7)、(23.8±0.9)、(18.2±3.2)、(15.7±3.2)、(21.3±3.9)、(18.4±4.2)、(21.0±4.2) g]PWMT在术后所有时间点均升高(P＜0.05). 结论 术中罗哌卡因切口周围局部浸润可以抑制慢性术后疼痛.     

Comparative evaluation of surgical modalities for coverage of gingival recession: An Armed Forces Medical College perspective

Background

Esthetics represents an inseparable part of today''s oral therapy, and several procedures have been proposed to preserve or enhance it. Gingival recessions may cause hypersensitivity, impaired esthetics and root caries. Keeping in mind patient''s desire for improved esthetics and other related problems, every effort should be made to achieve complete root coverage.

Methods

Different types of modalities have been introduced to treat gingival recession including displaced flaps, free gingival graft, connective tissue graft, different type of barrier membranes and combination of different techniques. The aim of this study was to compare the commonly used techniques for gingival recession coverage and evaluate the results obtained. 73 subjects were selected for the present study who were randomly divided into four groups and were followed at baseline and 180 days where following parameters were recorded: (a) Assessment of gingival recession depth (RD); (b) Assessment of pocket depth (PD); (c) Assessment of clinical attachment level (CAL) and (d) Assessment of width of attached gingiva (WAG).

Results

Results of this study showed statistically significant reduction of gingival recession, with concomitant attachment gain, following treatment with all tested surgical techniques. However, SCTG with CAF technique showed the highest percentage gain in coverage of recession depth as well as gain in keratinized gingiva. Similar results were obtained with CAF alone. The use of GTR and other techniques showed less predictable coverage and gain in keratinized gingiva.

Conclusion

Connective tissue grafts were statistically significantly superior to guided tissue regeneration for improvement in gingival recession reduction.     

Strabismus genetics across a spectrum of eye misalignment disorders

Eye misalignment, called strabismus, is amongst the most common phenotypes observed, occurring in up to 5% of individuals in a studied population. While misalignment is frequently observed in rare complex syndromes, the majority of strabismus cases are non‐syndromic. Over the past decade, genes and pathways associated with syndromic forms of strabismus have emerged, but the genes contributing to non‐syndromic strabismus remain elusive. Genetic testing for strabismus risk may allow for earlier diagnosis and treatment, as well as decreased frequency of surgery. We review human and model organism literature describing non‐syndromic strabismus, including family, twin, linkage, and gene expression studies. Recent advances in the genetics of Duane retraction syndrome are considered, as relatives of those impacted show elevated familial rates of non‐syndromic strabismus. As whole genome sequencing efforts are advancing for the discovery of the elusive strabismus genes, this overview is intended to support the interpretation of the new findings.     

2型糖尿病患者龈沟液中基质金属蛋白酶-1的检测和临床意义

目的 比较T2DM患者、T2DM合并牙周病患者与正常对照者龈沟液（GCF）中基质金属蛋白酶-1（MMP-1）和GCF量,以及T2DM患者GCF中MMP-1量与糖代谢状况的关系. 方法 使用滤纸条法采集GCF.选取T2DM组、T2DM合并牙周病组各30例,正常对照组30名,ELISA测定GCF中MMP-1含量,运用高效液相色谱法检测HbA1c水平. 结果 T2DM、T2DM合并牙周病组GCF量高于正常对照组[（2.81±1.58）、（3.56±2.96）vs（1.02±0.65） μl/样本]（P＜0.01）.T2DM合并牙周病组GCF中MMP-1量高于T2DM、正常对照组[（5.02±0.16）vs（3.01土0.09）、（2.24±0.11） μl/样本]（P＜0.01）.T2DM组与正常对照组GCF中MMP-1量比较差异无统计学意义（P＞0.05）.T2DM合并牙周病组GCF中MMP-1量与HbA1c水平无相关性（r=0.153,P=0.151）. 结论 3组GCF及MMP-1水平在T2DM合并牙周病组中最高,在对照组最低,提示牙周炎症是影响结果的主要原因.MMP-1水平在T2DM组中低于T2DM合并牙周病组,提示T2DM患者不只是MMP-1水平改变而导致牙周病的易感,可能是多个因素共同作用的结果.     

Smile esthetics: the influence of posterior maxillary gingival margin position

Purpose: Successful replacement of posterior teeth using contemporary prosthodontic techniques in esthetically demanding cases relies upon visual replication of the natural posterior dentition and surrounding gingival architecture. There is currently little in the way of guidance for creating ideal or acceptable gingival relationships for posterior teeth. Materials and Methods: A cross‐sectional study was conducted comparing perceptions of four groups of individuals to six digitally manipulated images with various posterior teeth gingival margin position configurations. A total of 120 volunteers aged 12 years to 80 years, comprising 30 patients diagnosed with hypodontia, 30 patients diagnosed with periodontal disease, 30 patients without either condition, and 30 qualified dentists were recruited from the Eastman Dental Institute & Hospital, London. A ranked order of preference for each set was obtained, and this was repeated after a minimum time interval of 10 minutes. Results: Posterior gingival margin configurations from 0 mm to 2 mm (measured at the first premolar) were deemed most esthetic by the majority of the patient groups; dentists had a strong preference for the 1 mm configuration. Dentists appeared to be more perceptive to the alterations in gingival positions. Conclusions: Posterior gingival margin configurations where the first premolar margins were 1 mm lower than the canine margins were deemed the most esthetically pleasing; however, it is likely that a range of acceptability of 1 mm deviations from this ideal exists.     

排龈技术的临床应用与研究现状

排龈技术的应用,对提高修复体边缘的适合性、减少修复的并发症起到了重要的作用。本文就排龈技术的生理药理学基础、排龈材料的种类和剂型、临床上应用的各种排龈方法的技术特点进行综述,以期为排龈技术在临床中的应用提供指导。     

舌神经至不同下颌磨牙牙龈缘距离的关系分析

目的探讨舌神经至不同下颌磨牙牙龈缘的距离,为患者进行相关手术治疗提供可靠临床依据,尽量避免患者术后发生舌神经损伤情况,提高患者生活质量。方法在本院2000年至2012年之间所收集的成人头部标本中随机选取20例进行解剖,所有标本均已进行防腐固定措施,使用专用测量工具对标本左侧舌神经、右侧舌神经与下颌第1、2、3磨牙牙龈缘距离分别进行测量,记录测量结果并进行统计学分析,得出结论。结果左侧舌神经与右侧舌神经相距下颌第1、2、3磨牙牙龈缘水平距离、垂直距离以及45度角距离相近,且P>0.05,左侧舌神经与右侧舌神经相距下颌第1磨牙牙龈缘距离无统计学意义。结论在对患者进行下颌磨牙舌侧骨嵴修整术或阻生智齿拔除术治疗时,应根据人体舌神经解剖学知识,以及舌神经至不同下颌磨牙的牙龈缘距离范围,尽量避免对患者舌神经造成伤害,从而有效预防患者术后发生暂时性或永久性舍感觉丧失并发症,提高患者生活质量。