A型肉毒毒素治疗颞下颌关节紊乱病的临床研究

目的 评价A型肉毒毒素局部注射治疗颞下颌关节紊乱病（TMD）的临床疗效。方法 对11例经保守治疗无效的TMD患者，给予局部注射A型肉毒毒素150U，双侧嚼肌各50U，双侧颞肌各25U。分析治疗前后不同时期患 者的最大张口度、疼痛值、口颌功能及局部压值的变化。结果 治疗徨不同时期患者最大张口度、疼痛、口颌功能及局部压均较治疗前有显著改善（P＜0.05）。结论 A型肉毒毒素局部注射治疗TMD，能有效改善患者的张口度，缓解疼痛。     

咀嚼肌痉挛的分型与临床特征

目的 根据临床特征提出咀嚼肌痉挛的临床分型.方法 收集2000-2010年咀嚼肌痉挛病例36例,对患者的基本情况、临床表现、痉挛发作程度、发作频率、肌电图、治疗效果统计分析,并提出临床分型.结果 ①根据临床表现和肌电图将36例病例分为闭口型痉挛和开口型痉挛两型.闭口型痉挛18例,受累肌肉为咬肌和(或)颞肌,主要表现为痉挛发作时开口受限;开口型痉挛18例,受累肌肉为翼外肌,主要表现为闭口或紧咬牙困难.②闭口型痉挛18例,14例为20 ～ 50岁,间断性发作,单侧发病;开口型痉挛18例,50岁以上13例,多持续性发作,双侧受累13例.③闭口型肌电图可分为持续型、节律型和不规则型,开口型肌电图可分为自发型和运动诱发型.④接受肉毒毒素局部注射治疗12例,症状明显改善或痉挛消失.结论 咀嚼肌痉挛可分为闭口型和开口型,有各自的临床特征.     

肌电分析在TMD临床疗效评价中的应用

目的:探讨3种不同方法治疗伴有磨牙症TMD的咀嚼肌肌电特征差异,评价3种治疗方法的效果.方法:30例伴有磨牙症的TMD患者被随机分为3组,每组10例.A组进行内毒杆菌毒素A(BTX-A)双侧咬肌肌内注射治疗,B组进行功能训练治疗,C组进行弹性颌垫治疗.对3组研究对象在治疗前、治疗1、3、6个月分别采集双侧咬肌(MM)和颞肌前束(TA)在下颌姿势位(MPP)以及牙尖交错位(ICP)最大紧咬牙时的肌电图(EMG),采用SAS 5.0统计学软件分析比较3组的峰值电位(Amp)之间是否存在统计学差异.结果:横向比较中各个治疗时间段A组患者疼痛视觉模拟评分(VAS)显著低于B组和C组(P＜0.05),肌电显示MPP中A组在治疗过程中能显著降低双侧咬肌肌力(P＜0.05),ICP时A组在1、3个月时显著降低双侧咬肌肌力(P＜0.05),同时双侧颞肌肌力显著增强(P＜0.05).纵向比较中3组在治疗过程中均能明显降低疼痛(P＜0.05),但3组时间点不同,A组缓解疼痛时间较长,肌电图显示3组均可显著降低咬肌MPP肌力(P＜0.05),A、C组可降低ICP咬肌肌力(P＜0.05),A组双侧颞肌肌力可代偿增强(P＜0.05),B、C组颞肌肌力治疗前后均无统计学差异(P＞0.05).结论:临床症状与肌电图的结合使用能够对口颌系统行使功能过程中咀嚼肌的表现进行很好地观测,对TMD患者的咀嚼肌生物力学和结构方面有很好地理解.BTX-A肌内注射方法治疗伴有磨牙症的TMD可显著缓解患者疼痛,疗效持续时间较长.BTX-A肌内注射可显著降低咀嚼肌力,使目标肌肉(咬肌)疲劳得到缓解,促进咀嚼肌力平衡重建,较传统方式存在潜在优势.     

肉毒杆菌毒素对兔颞下颌关节骨关节病咀嚼肌肌电的影响

目的：研究肉毒杆菌毒素对颞下颌关节骨关节病咀嚼肌功能的影响,为应用肉毒杆菌毒素治疗该病提供依据.方法：30只兔作咀嚼肌肌电图检查,其结果作为肌电正常值,并应用胶原酶注射法制成颞下颌关节骨关节病动物模型,随机分为2组.实验组兔双侧嚼肌、颞肌注射肉毒杆菌毒素,对照组仅为骨关节病状态.分别于4、8、12周末对2组兔作咀嚼肌肌电图检查,分析对比2组兔肌电电位的变化.所得资料用SPSS11.0软件行团体t检验.结果：姿势位时,对照组各时间点肌电电位显著高于正常;实验组在4周、8周末低于正常,12周末与正常相比无显著差异（P＞0.05）.牙尖交错最大紧咬状态下,对照组各时间点肌电电位显著低于正常;实验组在4周、8周末略低于正常,12周末与正常相比无显著差异（P＞0.05）.结论：肉毒杆菌毒素能改变颞下颌关节骨关节病咀嚼肌的功能状态,促进肌功能恢复正常.     

A型肉毒毒素咬肌内注射联合颊脂垫切除面部轮廓塑形

目的：探索应用A型肉毒毒素咬肌内注射联合颊脂垫切除进行面部轮廓塑形的技术。方法：采用A型肉毒毒素咬肌内注射，使咬肌均匀萎缩变薄；同时经口内黏膜切口去除双侧颊脂肪垫。结果：本组78例，治疗1个月后面部轮廓开始变瘦，3个月获良好效果，随访49例3～12个月，效果稳定。结论：A型肉毒毒素咬肌内注射联合颊脂肪垫切除进行面部轮廓塑形，具有操作简单、创伤小、恢复快、安全有效等特点，对于胖圆脸该方法比单一的治疗方法效果更好、更稳定。     

口腔材料与器械

A型肉毒毒素治疗咀嚼肌群痉挛的远期疗效分析；3种黏结剂黏结釉质的界面微渗漏研究；苦参碱对唾液腺ACC-M细胞凋亡及Bcl-2、Bax表达的影响；两种光固化正畸黏结剂的黏结性能评价；钛的氧化行为对钛瓷结合力的影响     

RW-Splint对安氏Ⅱ类错牙合伴TMD患者咀嚼肌肌电的影响

目的:探讨安氏Ⅱ类错牙合畸形伴TMD患者经RW-Splint治疗1周和2个月后咀嚼肌肌电活动的改变。方法:采用EMGⅡ型表面肌电测量仪分别对12名患者RW-splint治疗前、治疗后1周及2个月的咀嚼肌肌电活动进行检测。结果:RW-splint治疗1周后患者的颞肌前束、咬肌在下颌姿势位、最大紧咬牙尖交错位时肌电幅值差异均无统计学意义;治疗2个月后最大紧咬牙尖交错位时颞肌前束、咬肌的肌电幅值的肌电幅值均降低,差异有统计学意义(P＜0.05),且颞肌前束的肌电幅值大于咬肌的肌电幅值,差异有统计学意义(P＜0.05)。但患者下颌姿势位时颞肌前束、咬肌肌电幅值差异均无统计学意义。结论:RW-splint通过戴用时间的加长能降低咀嚼肌的肌电值,但改善其对称性作用不明显,可能与RW-splint改变了患者的牙位而呈现出原本有的早接触或牙合干扰有关。     

正畸与正颌联合治疗成人骨性反(牙合)后咀嚼肌肌电变化

目的:检查对比分析成人骨性反(牙合)正畸与正颌手术联合矫治前后的主要咀嚼肌肌电,揭示正畸与正颌手术联合矫治后咀嚼肌功能的变化规律.方法:20名正畸与正颌手术联合治疗的成人骨性反(牙合)患者,利用肌电图仪测试治疗前后咬肌、颞肌前束、二腹肌前腹在功能活动中肌电变化.结果:正畸与正颌手术联合矫治对咬肌、颞肌前束、二腹肌前腹的功能活动均有不同程度的影响,其中对咬肌的功能影响最明显.结论:正畸与正颌手术联合治疗成人骨性反(牙合),咀嚼肌的异常肌张力多数得到纠正,但咀嚼肌的功能未能得到满意的恢复,咀嚼肌的功能恢复是一个复杂而长期的过程,还需要较长的功能锻炼恢复期.     

16 例半侧咀嚼肌痉挛肌电图类型分析

目的对半侧咀嚼肌痉挛(HMS)患者的不同肌电图表现进行分型。方法对16例半侧咀嚼肌痉挛的患者进行双侧咬肌、颞肌前束表面电极肌电图检查,并对其不同肌电图表现进行分析。结果16例患者中,14例为牙齿接触状态时出现痉挛,发作时其运动单位电位呈持续型发放8例(57.2%),节律型3例(21.4%),不规则型3例(21.4%)。而下颌休息位时出现痉挛为2例。结论HMS患者肌痉挛可呈不同形式运动单位电位发放且以持续型为主,多在牙齿接触状态时出现。     

稳定性咬合板治疗颞下颌关节紊乱病的咀嚼肌肌电图研究

目的：通过对颞下颌关节紊乱病（Temporomandibular disorders,TMD）患者进行稳定性咬合板的可逆性咬合治疗,然后利用肌电图仪测量治疗前后患者的咀嚼肌（TA和MM）的肌电情况,分析探讨用稳定性咬合板对颞下颌关节紊乱病患者咀嚼肌肌电图的影响。方法：选取来我院就诊的10例咀嚼肌功能紊乱患者,在稳定性咬合板治疗前和治疗后3个月时,分别用肌电图仪对其咀嚼肌（TA和MM）进行肌电检查,并通过比较治疗前后的咀嚼肌活动不对称指数情况。结果：戴入稳定性咬合板3个月后,颞肌前束与咬肌的MPP和ICP高电位降低（P〈0.05）;最大紧咬时双侧咀嚼肌总体不对称性指数（Astot）、双侧颞肌不对称性指数（ASTA）和双侧咬肌不对称性指数（ASMM）均降低（P〈0.05）。结论：颞下颌关节紊乱病患者通过稳定性咬合板进行咬合治疗后,使患者双侧咀嚼肌的MPP和ICP高电位较治疗前有明显的降低,最大紧咬时双侧咀嚼肌活动不对称性得到明显的改善。     

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.     

Experimental evidence of formation of imines in the course of reduction of hydrazones

The reduction of hydrazones is generally suggested to proceed through a reductive cleavage of the nitrogen–nitrogen bond followed by a reduction of the carbon–nitrogen bond. This sequence of reduction processes is here supported for fluorenone (V) and benzophenone (VI) hydrazones as well as by a comparison of the reduction of fluorenone and benzophenone hydrazonium ions (I,III) with corresponding imines (II,IV). Another proof of the presence of imines as intermediates is the splitting of four-electron waves of hydrazones V and VI and hydrazonium ions I and VIII into two waves at pH < 2. This has been interpreted as due to differences in slopes dE_1/2/dpH and pK_a-values of protonated hydrazine derivatives on one side and corresponding imines on the other. In this pH-range imines formed in reductions of VI and VIII are reduced in a single two-electron wave, those of I and V in two one-electron steps. Fluorenone imine (II) is sufficiently stable to allow recording of time-independent current–voltage curves between pH 6 and 11. In this pH-range the imine (II) is reduced in two one-electron steps. Benzophenone imine (IV) has been found stable between pH 4.6 and 12. At pH 4.6–8 the reduction of the imine IV takes place in a single two-electron step, at pH 8–12 in two one-electron steps. Final proof of the initial cleavage of the N–N bond is presented by comparison with the reduction of nitrones.     

不同剂型玻璃离子水门汀溶解性比较研究

目的:研究、比较不同剂型玻璃离子水门汀的溶解性和表面微观形态改变,为临床使用提供依据.方法:将3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)及GC玻璃离子水门汀(双糊剂型)分别在人工唾液中浸泡30 d,冷热循环15000次,烘干测重,比较前后质量变化,计算溶解率,并用扫描电镜观察表面微观改变.结果:不同剂型的玻璃离子水门汀溶解率由高到低分别为3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(双糊剂型).3种玻璃离子水门汀经浸泡溶解后,SEM扫描表面微观形态可观察到GE玻璃离子水门汀(双糊剂型)表面形态改变较少,其他2组玻璃离子水门汀表面微观改变较多.结论:双糊剂型玻璃离子水门汀理化性能及溶解率均低于传统水粉剂型,是未来临床修复治疗的的良好选择.     

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.     

Evaluation of efficacy of chemiluminescence for diagnosis of leukoplakia

ObjectiveLeukoplakia is the most common potentially malignant disorder preceding oral cancer. Chemiluminescence has been developed as an adjunct to conventional examination for the diagnosis of these potentially malignant disorders. This study was conducted to assess the efficacy of chemiluminescence in the diagnosis of leukoplakia and to compare the results with histopathological examination.Study designA total of 50 patients with leukoplakia were included from the outpatients attending the Department of Oral Medicine and Radiology, Dental Hospital, Bengaluru, Karnataka, India. These patients were subjected to conventional oral examination followed by chemiluminescent examination with Vizilite (Zila, Fort Collins, CO, USA) and biopsy for histopathological confirmation.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of chemiluminescence were 93.75%, 55.56%, 78.95%, and 83.3%, respectively. The overall accuracy of chemiluminescence was 80%. A statistically significant association was observed between histopathology results and chemiluminescence results.ConclusionAlthough it is an easy, safe, minimal time consuming, and noninvasive technique, it has only adjunctive utility and it does not replace biopsy for the diagnosis of leukoplakia.     

颌骨动静脉畸形的栓塞治疗

目的：总结直接穿刺结合经血管内介入栓塞治疗颌骨动静脉静脉畸形的经验。方法：收治凳骨动静脉畸形患者6例,均进行了介入栓塞治疗。采用的栓塞材料为附凝血棉纤毛的螺圈,聚乙烯醇泡沫微粒和二氰基丙烯酸对丁酯。数字减影颈动脉造影在PHILIPSV300下完成。结果6例颌骨动静脉畸形患者中4,例急性出血得到了快速、有效控制,1例慢性渗血的右下 骨动静脉畸形患者,介入栓塞治疗,拔除松动的右下凳第一磨牙,有效地控制了出血,另1例伴局部软组织搏动性膨隆的上凳骨动静脉畸形患者,介入治疗后膨隆的搏动性得到明显改善,栓塞治疗后分别随访3－24个月,均未发现有口腔内渗血或出血。随访的X线片上,病灶区可见新骨形成。结论：局部穿刺结合经血管内介入栓塞治疗颌骨动静畸形是一种安全、有效的治疗方法。     

正畸患者切牙影像失真发生情况分析

目的研究正畸患者曲面体层片上的切牙影像失真发生情况，并分析其原因。 方法从中山大学附属口腔医院放射科影像数据库中选取500例正畸患者的曲面体层片和头影测量侧位片，所有曲面体层片均采用咬合杆投照，分别从切牙牙体影像放大、缩小、牙根变短、根尖模糊等评价指标分析上下颌切牙影像失真的发生情况，在头影测量侧位片上测量中切牙根尖-对颌切牙切缘的距离，探讨切牙影像失真发生的原因。采用SPSS 19.0统计软件对所得数据进行统计学检验。 结果500例患者中，切牙牙体影像正常者共417例，切牙牙体影像失真者共83例，影像失真发生率16.6%，其中切牙牙体影像放大17例、牙体影像缩小0例、牙根变短30例，牙根影像变短伴模糊36例。影像失真患者的根尖-切缘距离大于影像正常的患者，差异有统计学意义（F = 5 187.18，P = 0）；影像失真患者的覆盖值大于影像正常的患者，差异有统计学意义（F>477，P = 0）。 结论严重牙颌面畸形如反 、深覆盖是导致曲面体层片的切牙影像失真的主要原因之一。     

正常青年Monson球面半径的测量研究

目的测量正常青年Monson球面半径。方法选择60名(男30名,女30名)正常青年制取全口印模,应用立体摄影成像的原理与方法对Monson球面半径进行测量和统计学处理。结果Monson球面的半径平均为10.173 cm,大于理论值10.160 cm,差异有显著性(P<0.01);男、女性球面半径差异无显著性。结论本实验所得到的数据可作为全口义齿修复中记录颌位关系的一个参量。     

鼻测量法的进展

唇裂术后继发畸形是指唇裂修复术后,仍遗留或继发于手术操作和生长发育变化而表现出来的一类畸形[1]。包括唇畸形、鼻畸形和颌骨畸形。其修复较原发性唇裂修复更复杂,更灵活多变。而导致其修复复杂性的一个重要原因即是局部组织结构复杂变异和缺乏可靠的三维测量手段[2],鼻畸形     

《口腔医学》杂志2007年度有关信息的分析

目的通过对《口腔医学》2007年全年文献的回顾和分析,了解我国口腔临床医学的研究现状。方法阅读2007年《口腔医学》全年的文献,对各种信息进行了分类汇总,根据设计类型对临床一次性文献进行了分类,并对其中的试验性研究文章进行质量分析。结果《口腔医学》2007年全年的一次性文献274篇,基础和临床文献分别为108和166篇,以临床文献为主(60.58%)。在临床研究文献中,属于观察性、分析性和试验性的文献分别为97、9和60篇,观察性文献所占比例为36.14%,高于以往的报道。60篇观察性文献中,全都设有对照;统计方法应用得当者44篇;真正做到随机、盲法的分别只有4和2篇。结论我国口腔临床方面的研究水平近年来提高明显,但设计的科学性方面有待提高。