健康种植体咬合创伤后龈沟内Emmprin及其临床表现的变化

目的 探究种植体过度负载后，种植体龈沟液中Emmprin的表达情况以及与临床表现之间的关系。方法 选用3只雄性拉布拉多犬，在其下颌骨两侧分别植入3个种植体。待3个月愈合后，实验组采用高愈合帽模拟咬合创伤，对照组维持低愈合帽没有咬合。观察12周，每两周对种植体周围龈沟液进行滤纸条提取，-24 ℃保存，之后采用ELISA法检测各样本的Emmprin浓度；同时检测种植体周探诊深度（iPD）、牙龈指数（iGI）和出血指数（iBI）。采用配对t检验和方差分析进行数据统计。结果 实验组的Emmprin浓度在2~12周比对照组显著上升，其浓度先升后降，在6周达到峰值，而对照组基本呈稳定状态；两者之间具有统计学差异。同时，实验组的iPD、iGI以及iBI也都发生显著性改变，并在8~10周达到数值高峰。结论 咬合创伤使种植体周围龈沟液内Emmprin浓度发生改变，Emmprin浓度在过度负载后明显上升，在6周左右达到峰值，之后浓度下降；受过度负载的种植体的iPD、iGI和iBI都产生明显改变，并且在8~10周左右达到高峰；对于过度负载的种植体，Emmprin的升高较临床指征的出现更早，提示Emmprin可作为一种早期炎症因子对种植体周围炎症状况进行监测。

Changes of Emmprin in gingival crevicular and clinical indexes of implants after occlusal traumas

Objective To explore the expression of Emmprin in gingival crevicular fluid around implants and changes of clinical indexes as well as the relationship between them after implants′ overload.Methods 3 male adult Labradors were selected,with 3 implants on each side of their mandibles.After the healing 3 months later,the test groups were screwed with high level healing caps to simulate occlusal overload together with direct touch with teeth from upper jaws,while the control groups used low level healing caps as well as extraction of maxillary teeth.In altogether 12 weeks,gingival crevicular fluid around implants was extracted by periopaper every two weeks and preserved at-24 ℃.Then ELISA method was used to test Emmprin concentration in each specimen.Meanwhile,implant probing depth (iPD),implant gingival indexes (iGI) and implant blooding indexes (iBI) were tested.Data was statistically analyzed with paired t test and ANOVA.The significance level was 0.05.Results From 2nd week to 12th week,Emmprin of test groups increased obviously compared to control groups; the concentration increased before dropping,peaking at week 6.However,the concentration of control groups kept steady all along.The differences were significant.Besides,iPD,iGI and iBI of test groups altered significantly,with the values peaking between week 8 and 10.Conclusions Occlusal traumas can change the concentration of Emmprin in gingival crevicular fluid around the implants,which peaks at week 6.iPD,iGI and iBI of overloaded implants change significantly,peaking between week 8 and 10.Regarding the implants exposed to overload occlusal force,the increase of Emmprin concentration occurs ahead of other clinical indexes,which indicates that Emmprin can be a potential signal for peri-implantitis.