脱位牙再植的研究进展

牙脱位是一种少发但涉及多种组织的复合性损伤 ,牙再植是保存脱位牙的有效方法。在以往的报道中脱位牙再植成功率较低 ,约为 4 %～ 5 0 % [1] 。许多学者对可能引起失败的原因进行了研究 ,并提出了许多措施以保证脱位牙再植的成功。因此 ,充分了解影响再植牙愈合的因素及各因素     

Vitapex糊剂预防全脱位再植牙牙根吸收的效果评价

目的:研究Vitapex糊剂在预防全脱位牙再植后牙根吸收的效果.方法:选择急诊因外伤致上前牙完全脱位5h内牙根发育完成的患者30例,患牙36颗.用生理盐水冲洗完全脱位牙及牙槽窝,局麻下复位,不锈钢丝加树脂夹板固定患牙.2周后行牙髓摘除及常规根管预备和消毒,1周后,随机分为A、B 2组,A组采用氢氧化钙糊剂暂时根充,B组采用Vitapex糊剂暂时根充.每3个月复诊,拍摄牙片,观察评价牙根吸收程度并更换充填糊剂.1.5a后,X线片观察牙根吸收稳定后改作永久性根管充填.采用SPSS12.0软件包对数据进行X2检验.结果:比较2组不同时间点的成功率,尽管氢氧化钙在随访1.5a后成功率略高(分别为88.9%和83.3%),但2组差异无统计学意义.Vitapex糊剂具有氧氧化钙和碘仿两者的优点,碘仿的X线阻射性便于充填效果及药物吸收情况的观察,而且操作方便.结论:本研究表明,Vitapex糊剂具有较好的预防脱位牙牙根吸收的效果,值得临床推广使用.     

辅助治疗方法对脱位再植牙愈合和疗效的影响

目的：观察氢氧化钙根管内封药、引导性组织再生术（guided tissue regeneration,GTR)和高压氧（hyperbaric oxyen,HBO）治疗联合应用对再植牙的疗效。方法：选择脱位时间超过6小时的358颗前牙，随机分成实验组和对照组，前者以Ca(OH)2根管内封药后在再植术中配合使用不全胶原膜行GTR术，术后给予HBO治疗10天；后者常规根管充填后进行常规牙再植术。对两组手术后临床指标和牙根吸收及失牙情况进行跟踪观察并分析其原因。结果：术后3、6、12个月实验组探诊深度减少和附着获得与对照组差异显著；牙根吸收率、2年失牙率和再植牙总成功率两组亦有非常明显的差异。结论：配合Ca(OH)2根管内封药和GTR、HBO治疗可使脱位离体时间较长牙再植术获得较好疗效。     

富血小板血浆对大鼠牙周组织再生的影响

目的：探讨富血小板血浆对大鼠牙周组织再生的作用。方法：人工构建36只雄性SD大鼠下颌左右侧第一磨牙颊侧牙周骨缺损模型（共72个）;随机分为4组,分别在缺损内填入富血小板血浆、富血小板血浆-Bio—Oss复合物、Bio—Oss（空白组不加任何材料）,最后在所有缺损上盖Bio—Gide再生膜。分别在术后第7,14,21天处死动物,取组织标本,行HE、Masson染色,观察牙周组织修复情况,并测量14、21d时HE切片中各组新生骨面积。结果：14、21d时牙周新生骨面积（mm^2）分别为：富血小板血浆组0．158±0．010,0．355±0．043;富血小板血浆-Bio—Oss组0．103±0．006,0．145±0．020;Bio—Oss组：0．060±0．005,0．111±0．010;空白组0．103±0．011,0．243±0．036;富血小板血浆组效果明显优于其它3组（P〈0.05）。结论：应用PRP能有效促进大鼠牙周组织缺损的再生。     

富血小板血浆与富血小板纤维蛋白在牙周组织再生中的应用

富血小板血浆（platelet-rich plasma,PRP）与富血小板纤维蛋白（platelet-richfibrin,PRF）因其促进组织再生的能力,在临床口腔创伤及缺损的修复中逐渐被重视及应用,并取得了令人较为满意的效果,鉴于PRP与PRF的制作较简便,且不易出现疾病传染及免疫排斥的不良反应,两者在口腔临床中的应用越来越广泛。牙周炎是目前造成牙周骨缺损最为常见的疾病之一,国内外的学者们为了探寻促进牙周组织再生的方法,将PRP与PRF用于牙周治疗中,本文即将近年来有关PRP与PRF在牙周组织再生中的临床应用作一综述。     

富血小板血浆与富血小板纤维蛋白在牙周组织再生中的应用

富血小板血浆(platelet-rich plasma,PRP)与富血小板纤维蛋白(platelet-rich fibrin,PRF)因其促进组织再生的能力,在临床口腔创伤及缺损的修复中逐渐被重视及应用,并取得了令人较为满意的效果,鉴于PRP与PRF的制作较简便,且不易出现疾病传染及免疫排斥的不良反应,两者在口腔临床中...     

脱位牙再植的远期临床观察

脱位牙再植的远期临床观察兰州军区乌鲁木齐总医院口腔科（８３００００）刘金忠，李旭自体脱位牙再植术是指将因受外伤打击或外科手术时意外损伤造成的牙体牙根完整、牙周膜保存完好、牙槽窝损伤不大、骨壁良好、无严重骨折的患者的脱位牙齿重新植入原来牙槽窝内的一种手...     

再植牙牙根替代性吸收的发生与防治

近年来由于交通事故不断上升 ,使外伤脱位牙的发生率逐渐上升。据报道 ,在所有外伤中 ,造成恒牙脱位的占 0 .5 %～ 1 6 % [1] 。牙外伤脱位最常用的治疗方法是牙再植术。在临床上 ,牙根替代性吸收是再植牙常见的一个并发症。本文进一步阐明牙根替代性吸收发生的机制以及相应的防治措施综述如下。1　牙根替代性吸收的发生机制　　造成牙再植失败的原因很多 ,其中炎症性吸收和替代性吸收是造成牙再植失败的主要原因。根骨粘连也叫替代性吸收。根骨粘连的过程是在牙糟壁上形成的骨小梁 ,逐渐生长 ,越过牙周膜间隙 ,与牙根表面融合。然后这些骨…     

脱位牙再植远期疗效的临床观察

关于外伤脱位牙再植,已有许多报道,但远期疗效达１０年以上者论述较少,我们收集追踪观察脱位牙再植１０年以上病例,观察其临床特点,分析成功的相关因素,为临床提供有用之借鉴。材料和方法１材料１．１一般情况来自作者所在医院１９７６～１９８７年门急诊患者共２１...     

外源性纤维粘连蛋白对即刻再植牙愈合影响的实验

为研究外源性纤维粘连蛋白对再植牙愈合的影响，作者选用２只成年猕猴，拔除上中切牙，实验组牙用０．５ｍｇ／ｍｌ的纤维粘连蛋白溶液处理，以其同名牙作为对照。牙齿即刻原位再植，术后４周、８周时分别切取标本，行普通光学显微镜形态学观察和图像处理分析。结果显示：纤维粘连蛋白的应用不仅可以明显促进再植牙牙周纤维的再附着、降低牙根吸收率，而且可以明显减轻愈合过程中的炎症反应。     

Effect of lyophilized autologous plasma on periodontal healing of replanted teeth

The purpose of this histologic and autoradiographic study of replanted teeth was to evaluate the beneficial effect, if any, of lyophilized autologous plasma (LAP) application on periodontal healing and to re-examine rates of repair in different areas of the associated periodontium following replantation. Maxillary and mandibular incisors and premolars of three rhesus monkeys were used. Teeth were extracted with forceps and placed in sterile physiologic saline. After 5 minutes each tooth was returned to its socket and immobilized by interproximal acid-etch splints. Splints were removed after 1 week. Of the 48 replants performed, 24 (controls) were replanted as described. Of the 24 experimental teeth, during the 5 minute interval between tooth extraction and replantation, the root surface and the inner socket walls were bathed with 1 ml of the reconstituted LAP-saline solution (800 mg/ml). Replants and animal sacrifice were scheduled to provide observations at 1, 3, 7, 14, 28 and 45 days following replantation. One hour prior to sacrifice, each monkey received an intravenous injection of tritiated thymidine, 1 microCi/gm body weight. Tissue specimens were processed for evaluation following standard procedures. Eight replanted teeth were available for evaluation for each of the six time-points. Four teeth were treated with LAP and four without it. Histologically, tissue sections were examined for epithelial proliferation and attachment, periodontal fibers organization and maturation, inflammatory cell types, presence or absence of cementum resorption and dentoalveolar ankylosis and degree of vascularity of the tissues. For autoradiographic evaluation, the periodontium associated with the replanted tooth was divided into nine spatial cell compartments. In each compartment, labeled tissue cells, epithelial or connective, were counted and recorded. Differences between the control (untreated) replanted teeth and the LAP-treated teeth, at each time-point and within each compartment, were analyzed for significance using the paired t-test. The findings of this study indicate that LAP use enhanced healing by early replacement of the fibrin clot, increased connective tissue cell proliferation, reduction of the inflammatory response and inhibition of root cementum resorption. Periodontal healing and repair occurred more rapidly in the supracrestal or transseptal connective tissue region than within the periodontal membrane space.     

Local dexamethasone improves periodontal healing of replanted dogs' teeth

Abstract— The purpose of the present investigation was to evaluate histologically the effect of dexamethasone on root resorption in stored and replanted dogs' teeth. Twenty-nine roots from three beagle dogs were endodontically treated to prevent subsequent inflammatory root resorption of pulpal origin. The teeth were extracted and randomly assigned to three groups for 18-h storage. Group 1: control group teeth ( n = 13) were stored in vials containing ViaSpan only; Group 2: topical treatment teeth ( n =10) were stored in vials containing ViaSpan and dexamethasone (16 μg/ml); and Group 3: systemic treatment teeth ( n =6) were stored in bids containing ViaSpan without any additives. Dexamethasone was administered intramuscularly (0.5 mg/kg body weight) 2 days prior to, on the day of, and every other day after extraction and replantation for two administrations. After 12 weeks, the dogs were sacrificed, and the teeth histologically prepared and evaluated according to the analysis of Andreasen. Significant differences were found for complete healing ( P= 0.0583) and inflammatory root resorption ( P= 0.0568) but not for replacement resorption ( P= 0.1952). In addition, comparing local to systemic administration of dexamethasone (Group 2 vs. Group 3), statistically significant differences were found for healing, 85% (Group 2) vs. 67% (Group 3) ( P =0.0125) and inflammatory root resorption, 13% (Group 2) vs. 28% (Group 3) ( P =0.0126). This study indicated that topical use of dexamethasone enhances healing and results in fewer resorption complications.     

富血小板血浆促进软组织损伤修复的实验研究

目的观察富血小板血浆（platelet-rich plasma,PRP）对犬软组织损伤的修复作用,探讨其促进软组织修复的机制。方法杂种犬4只,体重：18kg～24kg,雌雄不限。随机选择每只犬的一侧后腿的大腿内侧分别制作两个直径为4cm×3cm椭圆形创面和长度为3cm的直线伤口,深及皮下筋膜层,再随机选择一个椭圆形创面和直线伤口为实验创面,用PRP凝胶覆盖创面,对照组创面任其渗血在创面凝固,两组都用3M愈肤膜覆盖损伤处。分别于术后7天、14天、21天、28天通过大体观察和组织学观察对比两侧创伤愈合情况。结果术后7天,对照组创面少许肉芽组织生长,伤口周围有炎症反应;实验组创面清洁,有较多肉芽组织生长,伤口周围无明显炎症反应。术后7～28天,两组的椭圆形创面逐渐缩小,但实验组创面缩小明显并无明显瘢痕;实验直线伤口于术后14～21天完全愈合,无明显瘢痕,对照组可见到明显瘢痕。组织学观察：实验组创面愈合较快,至术后28天,形成比较成熟的皮肤组织,而对照组创面可见到较多瘢痕组织;实验组直线伤口术后14～21天即形成较成熟的皮肤组织,对照组直线形伤口于21～28天形成较成熟的皮肤组织,但瘢痕组织较多。结论 PRP能加快犬软组织损伤的愈合,并能减少瘢痕。     

The effect of Emdogain gel on periodontal healing in replanted monkeys' teeth

OBJECTIVE: We sought to histologically evaluate the effect of Emdogain gel on periodontal healing in monkeys' teeth undergoing delayed replantation.Study design Mature monkey teeth simulating avulsion were endodontically treated before extraction. Negative control teeth (group N = 10 roots) underwent immediate replantation, whereas the rest were bench-dried for 1 hour and treated in one of the following ways before replantation: the positive control teeth (group P = 12 roots) had no further treatment; group C teeth (4 roots) had the periodontal ligament removed; group D teeth (10 roots) were treated with Emdogain gel; group E teeth (6 roots) had the periodontal ligament removed before the application of Emdogain gel; and group F teeth (7 roots) had the periodontal ligament removed, the root surface conditioned, and Emdogain gel applied. Periodontal healing was evaluated after 16 weeks by undertaking histomorphometric analysis. RESULTS: The Kruskal-Wallis and Mann-Whitney U tests revealed that group N teeth had a statistically higher occurrence of complete healing than did all other groups, whereas group P was not significantly different in any of the healing categories from D, E, and F, the groups in which Emdogain gel was used. Group C teeth had a significantly higher occurrence of replacement root resorption than did the teeth in groups P and F-but were not significantly different from teeth in groups D and E. CONCLUSION: Emdogain gel did not appear to significantly reduce replacement resorption in monkeys' teeth that had undergone delayed replantation.     

富血小板血浆用于牙周组织再生的研究Ⅰ、PRP的提取及对PDLFs增殖的影响

目的建立富血小板血浆(PRP)提取的方法,以探讨作为自身复合生长因子来源的可行性,并研究其对牙周膜成纤维细胞(PDLFs)增殖的影响.方法利用二次离心(1000 rpm×15 min;3000 rpm×8 min)分离全血,获得PRP.将PRP设5个浓度组(5%,10%,20%,30%,50%),与对照组(不含PRP)比较,观察它们对PDLFs增殖的影响.结果所获得的血小板浓度均超过全血的4倍,实验组各浓度的PRP均可促进PDLFs增殖,实验组间及与对照组相比差异均具有显著性(p<0.01).当PRP浓度在5%～30%时促增殖作用呈剂量依赖性.结论二次离心法是一种简单易行的提取PRP的方法.PRP可促进PDLFs的增殖.     

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth

Abstract – The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.     

Effect of delayed calcium hydroxide treatment on periodontal healing in contaminated replanted teeth

The effect of delayed intracanal calcium hydroxide treatment on experimentally induced extensive inflammatory root resorption in monkeys was studied. A significant shift from inflammatory resorption to ankylosis was noted following calcium hydroxide treatment. Furthermore, calcium hydroxide treatment appeared to change the pattern of ankylosis over time, although the total ankylotic area remained the same. Ankylosis preceded by root resorption (replacement resorption) increased, while ankylosis not associated with root resorption decreased. It was concluded that intracanal calcium hydroxide treatment of teeth with compromised PDM may cause unnecessary replacement resorption if left in the root canal for a long time or changed repeatedly.     

Comparison of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) in rabbit-skull defect healing

Objectives

The objective of this study was to evaluate the effect of platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF) on bone healing.

Study design

Twelve rabbits were included in this randomized, blinded, prospective study. 15-mm × 10-mm-sized defects were created in the parietal bone, filled with PRP, PRF, CGF, and void. The bone mineral density and bone volume were analyzed with microscopic computed tomography (micro-CT) and histomorphometrics at the 6th and 12th week.

Results

In micro-CT analysis, bone mineral density and bone volume were greater in the experimental group than in controls at both 6th and 12th week, but not among the experimental groups. Similarly, histomorphometric examination revealed that more bone formation was seen in the experimental group.

Conclusion

The addition of PRP, PRF, and CGF had significantly increased bone formation at the 6th week. The effect of PRP, PRF, and CGF was similar and may be useful in the future to increase the success rate of bone grafting.     

Endodontic infection and calcium hydroxide-treatment. Effects on periodontal healing in mature and immature replanted monkey teeth

Abstract Large experimental defects with marginal communication, and small isolated experimental defects were created on the root surfaces of extracted monkey lateral incisors with either open or closed apices. The pulp tissue was either infected or removed, and calcium hydroxide placed in the root canal. The teeth were then replanted and the healing pattern evaluated histomorphometrically after 20 weeks. From the results, it was concluded that (1) an intrapulpal infection promotes marginal epithelial down-growth on a denuded dentin surface irrespective of tooth developmental stage, and that (2) the periodontal healing potential after calcium hydroxide-treatment appears to be higher in teeth with open apices compared with teeth with closed apices, where ankylosis was promoted as opposed to teeth with open apices where significantly more reparative cementum was found.