激光联用洁治改善固定正畸患者牙周状况的临床研究

目的:评价Nd:YAG激光辅助改善固定正畸患者牙周状况的效果.方法:选择60例接受固定正畸治疗的男性患者,以右下颌第一磨牙为实验牙,左下颌第一磨牙为对照牙,分别比较它们在正畸治疗开始前、激光、超声洁牙和两者联用治疗前以及3种治疗1周和6个月后的龈沟液(GCF)量、天门冬氨酸氨基转移酶(AST)与碱性磷酸酶(ALP)水平的变化.结果:激光治疗、超声洁治术以及两者联用均能在短期内降低GCF量、ALP及AST水平(P＜0.05),但激光治疗和两者联用后局部GCF量、AST及AL P水平较超声洁牙后降幅更大(P＜0.05);3组6个月后GCF量、ALP及AST水平均有所提高(P＜0.05),但联用组提高较少(P＜0.05).结论:Nd:YAG激光可应用于固定正畸患者以改善其牙周状况,若能配合超声洁治,效果更理想.     

脉冲Nd:YAG激光照射剂量对牙周组织中SOD、MDA含量的影响

目的:探讨脉冲Nd:YAG激光不同照射剂量对大鼠实验性牙周炎牙周组织中超氧化物歧化酶(SOD)、丙二醛(MDA)含量的影响.方法:健康Sprague-Dawley大鼠共56只,随机分为7组,其中1组作为正常对照组,6组建立大鼠牙周炎动物模型.按照分组给予不同剂量激光照射,末次治疗24 h后测量牙周临床指标.采用分光光度仪测定大鼠牙周组织中SOD、MDA的含量.结果:实验剂量范围内,1.5 W、2.0 W 20 pps剂量组SOD含量较未照射组(P组)显著增高(P＜0.05).1.5 W、2.0 W、2.5 W 20 pps组较P组MDA活性均显著降低(P＜0.05).结论:在1.5～2.0 W 20 pps剂量范围内,采用脉冲Nd:YAG激光牙周袋内照射能有效增加牙周组织中SOD含量,减少MDA含量,起到治疗牙周炎的作用.     

脉冲Nd：YAG激光照射对实验性大鼠慢性牙周炎的作用

目的:探讨脉冲Nd:YAG激光照射对大鼠实验性牙周炎牙周临床指标及牙周组织中一氧化氮(NO)含量的影响.方法:健康Sprague-Dawley大鼠共64只,随机分为8组,正常对照组(N组),药物对照治疗组(D组),牙周炎阳性对照组(P组),其余5组按照给予不同剂量激光照射治疗.末次治疗15 d后测量牙周临床指标牙龈指数(GI),牙槽骨吸收值ABL(Alver bone loss),菌斑指数(plaque index,PLI),采用分光光度仪测定大鼠牙周组织中NO的含量.结果:各剂量组ABL、NO值较末照射组(P组)显著降低(P＜0.05).1.5～2.0 W 20 pps剂量组激光照射后牙周指数均较P组显著降低(P＜0.05),与D组无显著差异.结论:在1.5～2.0 W 20pps剂量范围内,采用脉冲Nd:YAG激光牙周袋内照射能有效改善牙周指数,降低实验大鼠牙周组织中NO含量,起到治疗牙周炎的作用.     

慢性牙周炎患者龈沟液OPG和RANKL的变化及意义

目的:探讨慢性牙周炎患者龈沟液中核因子-κB受体活化子配体(receptor activator for NF-κB ligand.RANKL)和骨保护素(osteoprotegerin,OPG)的变化及意义.方法:采用滤纸条法收集23例正常对照者和34例慢性牙周炎患者龈沟液(gingival crevicular fluid,GCF)标本,ELISA法测定上清液RANKL和OPG含量,利用Optimas 5.0图像分析软件对检测牙的根尖片进行灰度分析.结果:对照组和慢性牙周炎组临床指标(PD、AL、PLI和SBI)之间存在显著性统计学差异(P<0.01).2组GCF中RANKL、OPG和RANKL/OPG比值之间存在显著性统计学差异(P<0.01).慢性牙周炎组GCF中OPG浓度与PD和AL之间存在负相关关系(分别为P<0.01和P<0.05),RANKL浓度及RANKL/OPG比值与根尖片灰度值之间存在负相关关系(P<0.05).GCF中RANKL和OPG浓度及RANKL/OPG比值与PLI和SBI之间无相关关系(P>0.05).结论:RANKL和OPG在慢性牙周炎患者的牙槽骨组织破坏过程中发挥作用.     

脉冲Nd:YAG激光照射剂量对口腔溃疡组织中SOD活性和MDA含量的影响

目的:探讨脉冲Nd:YAG激光不同照射剂量对大鼠试验性口腔黏膜溃疡组织中超氧化物酶(SOD)、丙二醛(MDA)含量的影响.方法:健康Sprague-Dawley大鼠共56只,随机分为7组,1组作为正常对照组,6组建立口腔黏膜溃疡动物模型.按照分组给予不同剂最激光照射,末次治疗24 h后观察溃疡愈合时间.采用分光光度仪测定大鼠口腔黏膜组织中SOD活性、MDA的含量.结果:1.5 W 60 mJ、1.5w 80mJ激光组较溃疡组SOD活性显著增高(P<0.05).试验剂量范围内,1.5 w 60 mJ、1.5w 80 mJ激光组较溃疡组MDA的含量显著降低(P<0.05).1.5 W 60 mJ、1.5 W 80 mJ激光组与正常对照组SOD活性和MDA含量则没有显著性差异(P<0.05).结论:适合的剂量参数,采用适量脉冲Nd:YAG激光照射口腔黏膜溃疡能有效增加SOD活性.减少MDA含量,起到治疗口腔黏膜溃疡的作用.     

慢性牙龈炎及慢性牙周炎治疗前后患牙龈沟液中t-PA及PAI活性的比较

目的 :比较慢性牙龈炎、慢性牙周炎患牙治疗前后龈沟液中t PA及PAI活性。方法 :选择慢性龈炎(n =2 8)及慢性牙周炎 (n =5 2 )患牙两组 ,在治疗前及治疗后收集龈沟液 (GCF)并记录临床指标 ,用发色底物法测定GCF中t PA及PAI的活性。结果 :t PA活性在牙龈炎组治疗前后差异无显著性 ,在牙周炎组治疗前后差异有显著性 ;PAI活性在牙龈炎组及牙周炎组治疗前后差异均有显著性 ;PAI/t PA比值在牙周炎组治疗前后差异有显著性 ,牙龈炎组治疗前后差异无显著性。结论 :PAI可以作为判断牙龈炎症程度及治疗效果较为客观的指标 ;牙周炎组中治疗后PAI/t PA显著降低的部位是否预示较差的预后 ,尚需进一步纵向研究。     

慢性牙周炎患者龈沟液中EMMPRIN及其配体CyPA的表达及意义

目的:通过检测慢性牙周炎患者龈沟液中EMMPRIN及其配体CyPA的表达,探索两者与牙周炎症的关系.方法:收集慢性牙周炎患者(牙周炎组)以及无缺牙、无牙周炎患者(对照组)的天然牙龈沟液,并进行临床检查.以ELISA法检测龈沟液中EMMPRIN及CyPA的表达,应用SPSS 17.0软件包分析两者与牙周炎的关系,比较2组之间的差异.结果:牙周炎组中,GCF总量与EMMPRIN总量、CyPA总量以及GI、SBI、AL呈显著正相关;EMMPRIN总量与GCF总量、CyPA总量以及GI、SBI、AL呈显著正相关,与吸烟情况呈负相关(P＜0.05);CyPA总量与GCF总量、EMMPRIN总量以及GI、SBI、AL呈显著正相关.对照组中,GCF、EMMPRIN及CyPA三者总量两两间均呈显著正相关.在牙周炎组与对照组之间,GCF、EMMPRIN及CyPA三者总量的组间差异均有统计学意义(P＜0.05).结论:EMMPRIN及其配体CyPA在牙周健康患者、慢性牙周炎患者的龈沟液中均有表达,当牙周炎症临床症状较重时,分泌的龈沟液量明显增多,龈沟液中EMMPRIN及CyPA的表达也增多.     

脉冲Nd:YAG激光联合锶强化生物活性玻璃对牙本质过敏症的疗效评价

目的观察脉冲Nd:YAG激光联合锶强化生物活性玻璃治疗牙本质过敏症的临床效果。方法将89例患者156颗患牙随机分为3组,试验组(52颗):患牙涂锶强化生物活性玻璃并加用Nd:YAG激光照射;对照A组(49颗):仅用脉冲Nd:YAG激光照射;对照B组(55颗):仅涂抹锶强化生物活性玻璃。对比3组在治疗后即刻、1个月及3个月的疗效差异。结果3组患牙治疗后即刻疗效比较差异无显著性(P>0.05);随访1、3个月试验组总有效率优于对照A、对照B组,差异均有统计学意义(P<0.05,P<0.01),同时1个月及3个月时对照A组的有效率优于单纯生物凝胶组(P<0.05)。VAS疼痛值检测显示出不同时段试验组较两对照组治疗效果差异明显(P<0.05)。结论脉冲Nd:YAG激光联合锶强化生物活性玻璃治疗牙本质过敏症比单一的治疗方法具有更佳的临床效果。     

Er∶YAG激光治疗慢性牙周炎对龈沟液中Dickkopf-1水平和ALP活性的影响

目的:检测龈沟液中Dickkopf-1 (DKK1)水平和碱性磷酸酶(alkaline phosphatase,ALP)活性,比较Er∶YAG激光辅助超声龈下刮治联合根面平整术(scaling and root planing,SRP)与单纯SRP对慢性牙周炎(chronic periodontitis,CP)疗效的影响.方法:采取半口对照设计方案,纳入11例CP患者,19对38颗患牙,以超声洁治后1周作为基线.按照随机原则,一侧(实验侧)应用Er:YAG激光辅助SRP,另一侧(对照侧)仅采用SRP.分别在基线、治疗完成后1周、1个月、3个月收集龈沟液并通过酶联免疫吸附法检测龈沟液中DKK1水平及磷酸苯二钠法检测ALP活性;并于基线、刮治后1个月、刮治后3个月记录受试牙出血指数(bleeding index,BI)、牙周探诊深度(probing depth,PD)、临床附着丧失(clinical attachment loss,CAL).采用SPSS19.0软件包对实验数据进行统计学分析.结果:无论是激光组还是对照组,治疗后1个月及治疗后3个月,BI、PD、CAL较基线均明显下降,但2组之间临床指标比较无显著差异(P＞0.05).实验组基线、治疗1周、治疗后1个月和治疗后3个月龈沟液中ALP活性逐渐下降,分别为(396.19±150.55)、(386.69±146.42)、(341.22±171.62)、(249.27±98.72) U/L;DKK1浓度亦逐渐下降,分别为(307.12:±45.63)、(297.32±91.34)、(265.87±41.40)、(244.43±43.09)μg/L.对照组同期ALP活性分别为(394.09±±120.25)、(374.72±131.27)、(344.42±127.80)、(252.36±90.4)U/L,DKK1浓度分别为(305.33±47.40)、(310.34±±84.68)、(270.04±±55.14)、(247.31±56.99) μg/L,ALP及DKK1均呈下降趋势,但2组同期ALP活性及DKK1水平无显著差异(P＞0.05).DKK1与CAL呈显著正相关(r=0.675,P=0.00).结论:Er:YAG激光作为非手术方法辅助SRP治疗慢性牙周炎安全有效,远期疗效有待进一步观察.     

三种金属烤瓷冠对基牙牙周组织影响的定量研究

目的研究3种金属烤瓷冠对基牙龈沟液（gingival crevicular fluid,GCF）量、GCF中天冬氨酸转氨酶（aspartate aminotransferase,AST）和碱性磷酸酶（alkalinephosphatase,ALP）水平的影响。方法磨牙行烤瓷单冠修复的患者90例,分成3组,分别行镍铬合金、钴铬合金、金合金烤瓷冠修复,于修复前及修复后1周、1个月、6个月检测基牙GCF量、GCF中AST和ALP活性水平。结果3组修复前GCF量、龈沟液AST活性、龈沟液ALP活性的差异无统计学意义（P〉0.05）。镍铬合金组修复后1周、1个月和6个月的GCF量（t=2.738、t=2.694、t=2.501,P〈0.05）、龈沟液AST活性（t=2.537、t=2.463、t=2.389,P〈0.05）、龈沟液ALP活性（t=2.359、t=2.278、t=2.046,P〈0.05）较修复前均增加。钴铬合金组修复后6个月,GCF量（t=0.791）、龈沟液AST活性（t=1.380）、龈沟液ALP活性（t=1.195）与修复前的差异无统计学意义（P〉0.05）。金合金组修复后1个月,GCF量（t=0.759）、龈沟液AST活性（t=1.431）、龈沟液ALP活性（t=1.106）同修复前的差异无统计学意义（P〉0.05）。结论金合金是理想的金属烤瓷冠材料,钴铬合金烤瓷冠对牙周健康影响较小。     

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