排龈技术在固定修复中的联合应用

目的：研究固定修复中龈下牙体预备时,如何保护龈沟底上皮附着,采集准确印模,确保牙周的生物学宽度不受侵犯。方法：对86例患者242颗牙行冠桥修复时,干备牙术中排龈线排龈及龈挡保护周围组织,术后排龈膏排龈。结果：排龈及止血效果良好,肩台与龈沟处印模清晰程度均取得良好的结果。结论：排龈技术的合理应用,避免了牙体预备时对牙龈组织的损伤及出血,能迅速打开龈沟,并且牙龈收缩是完全可逆的过程。     

不同排龈取模方式对固定修复临床效果研究

目的：比较不同排龈取模技术对固定修复模型质量效果的影响。方法：在对门诊金属烤瓷全冠修复患者107例144颗牙中,随机分为3组,分刖采用不同排龈取模技术,制取印模,完成修复体。对排龈止血效果、牙预备体肩台、模型清晰程度进行评价。结果：备牙前排龈组与备牙后排龈组的牙体预备有显著性差异,备牙前排龈组印模质量明显高于备牙后排龈组。结论：正确应用排龈技术可减少牙体预备对牙龈组织的损伤及出血,能帮助取得清晰的印模。     

排龈技术在固定修复中的应用

当固定修复中修复体的边缘设计于龈缘下方时，如何在牙体预备时尽量避免损伤牙龈组织，以及取得清晰完整的印模，是修复过程中的难点。排龈技术很大程度上解决了这一问题，得到广泛应用。本文对排龈技术的应用情况作一综述，主要介绍了5种常用的排龈技术：机械方法、机械化学方法、旋转磨除法、电刀手术法和激光切除法。     

排龈膏在老年人口腔固定修复中的应用

目的：评价糊剂型排龈材料在老年人固定修复中的临床使用效果。方法：在对60例门诊患者140颗牙进行固定修复时，采用Expasyl排龈膏于取模过程压排牙龈。对排龈止血效果、印模清晰程度、修复体就位后与牙体的适合性进行评价。结果：采用排龈糊剂压排牙龈的患牙，在排龈止血效果、印模清晰程度及修复体与牙体的吻合程度方面，取得良好效果。结论：应用糊剂型排龈材料进行老年人固定修复临床排龈操作，高效省时、减少椅旁操作时间、提高修复体质量，是一种较好的方法。     

双排龈技术在CAD/CAM全瓷修复中的临床应用

目的：评价双排龈技术在CAD/CAM全瓷修复中的临床应用效果。方法：对30例48单位前牙行CAD/CAM全瓷修复,牙体预备后采用双排龈技术进行排龈,检查牙龈及预备体、光学印模以及修复体边缘情况。结果：双排龈技术的满意率分别为97.91%,95.83%,100.0%。结论：双排龈技术在CAD/CAM全瓷修复时具有很好的应用效果。     

一种新型排龈材料的临床应用

目的：对Expasyl排龈膏的临床效果进行评估。方法：21名患者的38颗上前牙区患牙在固定修复牙体预备后,使用Expasyl排龈膏进行牙龈处理2分钟,排龈膏去除后取硅橡胶印模,观察牙龈出血的状况和评估模型上牙龈排开的效果。结果：牙龈止血的有效率为90％,排龈有效率为58％。结论：Expasyl排龈膏有较好的止血性能,对于较薄的牙龈有较好的排龈效果。     

双线排龈技术在固定修复中的应用

目的：通过双线排龈获取精细印模，减轻牙龈损伤，保护牙周组织健康，提高固定修复体的质量。方法：62例冠桥修复病例168个牙随机分成两组，31例按常规单线排龈，另31例牙体预备时，取模前使用双线压排龈法排龈。结果：97．7％双线排龈的印模非常清晰，边缘线均匀连续，模型肩台与游离龈之间出现肉眼可见间隙。修复体戴入后边缘适合性及美观效果均较单线组好。观察6—10个月后软组织健康状况良好。结论：应用双线排龈法，可取得清晰的印模，减少牙龈出血，可提高修复体质量。     

Expasyl排龈膏的临床应用

Expasyl排龈膏是一种膏体状的牙龈退缩剂。作者对58例112颗牙齿采用Expasy1排龈膏进行取模前的牙龈压排，其中105颗牙齿达到满意标准，7颗牙未达满意标准，有效率达到93．7％。取模前用Expasy1排龈膏可以减少牙体预备对牙龈组织的损伤和出血，并获得较清晰的印模和模型。     

排龈术的发展及应用状况

排龈技术在口腔临床中,尤其是在固定义齿修复临床中的应用非常广泛,同时也可应用于楔状缺损修复时,以获得良好的充填体边缘[1]。固定义齿修复成功取决于良好的设计及精密的制作。牙体预备及印模制取是修复成功的关键,而排龈又是牙体预备及印模制取过程中必不可少的环节。作者就近年来排龈术的发展及应用状况,作一简要的概述。     

三种排龈方法的临床疗效观察

目的比较三种排龈方法的排龈效果、患者疼痛反应程度以及对牙周健康的影响。方法收集龈下边缘单冠修复患牙90颗,随机分为三组：Ⅰ组采用排龈线排龈法;Ⅱ组采用排龈线加止血剂排龈法;Ⅲ组采用Er,Cr：YSGG激光排龈法。通过20倍体式显微镜对印模、石膏模型牙预备体进行满意度评价,采用国际通用的数字分级法（NRS）对患者进行疼痛调查,采用牙龈指数（GI）、牙周袋深度（PD）、牙周附着水平（AL）指数测定对修复后1周、3个月后基牙牙龈及牙周组织健康状况进行评价。结果三种方法排龈所获得的牙预备体与印模满意率均达到90%以上,各组间无统计差异（P〉0.05）。Er,Cr：YSGG激光排龈组90%患者反应为无痛,排龈线排龈组83.3%患者与排龈线加止血剂排龈组90%患者反应为轻度疼痛。修复1周后与3个月后,各组基牙GI值间无统计学差异（表2,P〉0.05）,均无PD〉3mm及附着丧失病例发生。但修复1周后各组均有牙龈轻度炎症病例出现,3个月后各组牙龈轻度炎症病例较1周时有增加。结论排龈线、排龈线加止血剂与Er,Cr：YSGG激光排龈均可以获得良好、稳定的排龈效果。Er,Cr：YSGG激光排龈法患者疼痛反应小,引起的牙龈炎症反应轻,恢复更快。     

Maintaining and enhancing gingival architecture in fixed prosthodontics

The long-term success of fixed prosthodontic restorations is greatly dependent upon the health and stability of the surrounding periodontal structures. This article deals with the interrelationship between fixed prosthodontic procedures and the stability and health of the periodontium. The commonly encountered problem of alterations in gingival architecture is examined in relation to tooth preparation as well as soft tissue preparation. In addition, the ability of the provisional restoration to guide soft tissue form is discussed as well as the role of the final restoration in providing long-term tissue maintenance. Key factors such as margin placement, tissue damage during tooth preparation, the role of the provisional restoration, tissue injury during impression procedures, crown contour, pontic design, and embrasure design are covered in detail.     

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目的 分析国产排龈线对冠桥修复后牙体、牙龈、牙周组织、修复体边缘的适合性。方法 选择2006年1月至2008年12月南阳市口腔医院收治的因前牙缺损或缺失做冠桥修复的患者52例（109颗基牙）,随机分为3组,进行常规牙体预备。阴性对照组32颗牙,不排龈;阳性对照组37颗牙,备牙后采用美国进口的UltraPak排龈线排龈;试验组40颗牙,采用南阳齿康研究所研制的国产排龈线排龈。完成灌注印模后,通过肉眼及探针对牙预备体、牙龈和修复体模型进行评价。结果 采用国产排龈线、进口排龈线和未采用排龈技术的满意率：牙预备体分别为93%、95%、17%;牙龈分别为83%、76%、14%;模型分别为80%、81%、14%;修复体边缘分别为88%、86%、12%。国产排龈线和进口排龈线满意率相当。结论 国产排龈线与进口排龈线临床应用对比差异无统计学意义,可以替代进口排龈线,且成本低,副反应小,安全性能好。     

Exposure of subgingival margins by nonsurgical gingival displacement

A procedure has been outlined in which (1) gingival displacement is accomplished prior to subgingival tooth preparation and (2) the margins thus created can be very readily registered with commonly used elastic impression materials. Although the technique involves the placement of three cords, the benefits of better visibility and not having to cope with bleeding tissues result in a saving of time during the preparation appointment. The predictability of tissue contours results in fewer remakes and more esthetic and biologically acceptable restorations.     

Tooth brushing and gingival abrasion

It has been known for some time that tooth brushing can have unwanted effects on the gingiva and hard dental tissues. The aim of this study is to evaluate two factors that may be of influence on the incidence of gingival abrasion during tooth brushing. The first factor being the possible influence of feedback through oral sensory perception and the second the possible abrasive effects of dentifrice. From the sensory feedback experiment it became clear that a significantly greater number of abrasions occurred when the test subjects would brush their own teeth than when they would have their teeth brushed by a dental hygienist. From the dentifrice experiment it became clear that the use of dentifrice has no significant effect on the occurrence of gingival lesions.     

排龈膏和排龈线在固定义齿修复中应用的系统评价

目的：评价排龈膏和排龈线在固定义齿修复中对牙龈保护、牙体预备、印模清晰度及修复体适合性的作用。方法：检索中国生物医学文献数据库、维普数据库、中国期刊全文数据库和万方数据库;同时手工检索纳入文献的参考文献及中文口腔医学杂志。偏倚风险评价由2位评价者使用Cochrane协作网推荐的标准独立完成,同时独立进行数据提取。运用Revman 5.1软件进行Meta分析。结果：共纳入9篇随机对照试验,涉及患者1153例,9个研究均为中度偏倚风险。Meta分析结果显示,排龈膏能够明显保护基牙牙龈健康[RR=1.05,95% CI (1.00,1.11),P=0.04],提高临床医师对牙体预备满意度[RR=1.17,95% CI (1.07,1.28),P=0.0008],提高印模及模型清晰度[RR=1.08,95% CI(1.03,1.13),P=0.0009],且与排龈线相比,有相似的修复体适合性[RR=1.07,95% CI (0.96,1.19),P=0.21]。结论：排龈膏在保护基牙牙龈健康、提高口腔医师对牙体预备满意度和提高印模及模型清晰度方面优于传统排龈线,在提高修复体适合性上也不逊色于传统排龈线,但还需要多的临床随机对照试验予以验证。     

Gingival health associated with porcelain veneers on maxillary incisors.

The possible detrimental effect of acid-etched resin-bonded prostheses and porcelain veneers on plaque accumulation and gingival health is currently disputed. Some workers recommend no tooth preparation prior to veneering whilst others recommend tooth preparation to prevent adverse gingival soft tissue reactions. In order to test the possible gingival effects of veneers placed without tooth preparation, this study was set up to compare gingival health on veneered and non-veneered maxillary incisors within the same individual during periods of normal tooth cleaning and of no tooth cleaning. No significant differences were noted in plaque or gingival indices, or in gingival crevicular fluid volume, between the 72 veneered and non-veneered sites during either study period. The results of this study suggest that placing porcelain veneers on unprepared teeth does not increase the risk of gingivitis.     

Toothbrushing and gingival recession

AIM: To review the hypothesis that toothbrushing leads to gingival recession. Gingival recession develops due to anatomical and pathological factors. The prevalence of recession is dependent on the age and characteristic of the population because it usually presents in individuals with periodontal disease or those who practise zealous or improper oral hygiene methods. Gingival trauma and gingival abrasion from toothbrushing is thought to progress directly to gingival recession. Case studies documenting recession from toothbrush trauma are speculative. Short-term studies suggest that gingival trauma and gingival abrasion may result from toothbrushing, but the direct relationship between traumatic home care and gingival recession is inconclusive. Long-term studies remain elusive or do not support the development of recession following toothbrushing. Nevertheless, tooth abrasion may be an integral part in the aetiology of recession. Toothbrush abrasion also may cause wear at the cemento-enamel junction resulting in the destruction of the supporting periodontium leading to recession.     

Inhibition of bovine gingival laminin receptor by bacterial lipopolysaccharide

A laminin receptor was isolated from bovine gingival epithelial-cell membrane. After solubilization with octylglucoside, the receptor was subjected to affinity chromatography on laminin-coupled Sepharose and eluted with cation-free EDTA buffer yielding on SDS-PAGE a 67 kDa protein band. After radioiodination, the protein was incorporated into liposomes which displayed specific affinity towards laminin-coated surfaces, as well as to tooth cementum. The binding of receptor protein to cementum was inhibited by lipopolysaccharide from Bacteroides gingivalis. Preincubation of cementum with the lipopolysaccharide decreased the binding of the liposomal laminin-receptor preparation by 35.8%, while a 59.2% decrease in binding occurred when the lipopolysaccharide was preincubated with the receptor, suggesting that the lipopolysaccharide interfered with the laminin binding site on the receptor. The results demonstrate the existence of a specific gingival cell-surface laminin receptor, show that it is capable of binding to cementum, and provide evidence for the disruption of this process by bacterial lipopolysaccharide. This mechanism may account for the loss of gingival attachment in the pathogenesis of periodontal disease.     

The effects of orthodontic tooth movement on the glycosaminoglycan components of gingival crevicular fluid

Abstract In this study, gingival crevicular fluid (GCF) was collected from around a canine tooth, in children, before and during orthodontic tooth movement. The aim was to identify and quantify the glycosaminoglycan (GAG) components of GCF and relate them to tooth movement, gingival inflammation, plaque accumulation, pocket probing depth and GCF volume recorded at the site of sampling. GAG in GCF samples, collected for a 15-min period into microcapillary tubes, were separated electrophoretically, stained with Alcian blue and quantified using a laser densitometer. 2 GAG components of hyaluronic acid (HA) and chondroitin sulphate (CS) were identified. The increase in GCF volume during orthodontic tooth movement was only partly due to increased gingival inflammation, GAG levels varied with different types of orthodontic tooth movement. In GCF, levels of CS, in particular, may reflect the changes in the deeper periodontal tissues which could be monitored during orthodontic tooth movements.