低强度脉冲超声在下颌骨骨折愈合过程中的应用

目的:观察低强度脉冲超声(low intensity pulsed ultrasound, LIPUS)促进下颌骨骨折临床愈合的效果.方法:下颌骨骨折病例分为LIPUS治疗组和对照组,每组各20例,所有病例采用颌间固定或微型钛板内固定,于术后3d开始治疗组行LIPUS治疗,1次/d×4周.分别记录骨折临床愈合时间,同时在伤后2周、4周、6周分别摄下颌骨正侧位片,观察骨折线愈合情况,将两组病例的骨折临床愈合时间及X线片骨折线愈合定量检查结果进行统计学分析.结果:LIPUS治疗组骨折临床愈合时间明显短于对照组,X线片骨折线愈合定量检查结果表明LIPUS治疗组4～6周时骨折愈合明显优于对照组.结论:应用LIPUS治疗能够促进下颌骨骨折愈合.     

颌骨骨折错位愈合100例临床分析

目的 总结和分析颌骨骨折错位愈合的原因，临床特点，及治疗方法。方法 对100例颌骨骨折错位愈合病例进行回顾性研究。结果 本组病例采用手术治疗58例，包括切开断端复位，钛板或钢丝结扎内固定20例及运用正颌外科技术截骨内固定38例。本组保守治疗42例，其中颌间牵引及附加颅颌牵引20例、牙面运用复合树脂粘贴拉钩颌间牵引22例。结论 颌骨骨折伴严重合并伤病例，早期救治生命的同时不应忽视凳骨骨折的早期处理。对已形成错位愈合病例，应采取正确的治疗方法进行二期整复。     

TGFβ1mRNA在颌骨骨折愈合过程中的表面及意义

为了进一步探讨ＴＧＦβ在骨生长和骨愈合中的作用，建立了颌骨骨折愈合的动物模型，利用原位杂交方法检测骨折愈合过程中ＴＧＦβ１ｍＲＮＡ的表达。结果发现，在骨折愈合过程中的软骨形成和膜内骨骨化阶段，ＴＧＦβ１的转录水平较高，在膜内成骨时转录水平较低，而在伤后即刻反应阶段无ＴＧＦβ１的转录。说明ＴＧＦβ在骨折修复过程中最初的形态发生，随后的细胞增殖及最终的组织重建中起着重要的作用。     

颌骨骨折错位愈合的正颌外科治疗

目的 :应用正颌外科原理及方法 ,治疗 8例颌骨骨折错位愈合的病人。方法 :按正颌外科常规 ,术前摄头颅定位正侧位片 ,取模 ;头影测量及模型外科等 ;采用正颌外科常用术式进行手术 ,微、小型钛板内固定 ;术后颌间固定 2周。结果 :伤口一期愈合 ,颌牙合关系及外观基本恢复伤前状况。结论 :应用正颌外科原理及方法治疗颌骨骨折错位愈合 ,能基本恢复病人伤前的咀嚼功能及外观。     

脉冲电磁场与种植体的骨结合

口腔种植修复技术日益广泛应用于临床,如何进一步提高种植体的骨结合一直是国内外学者研究的主要课题.大量实验研究显示局部应用脉冲电磁场可促进种植体周围骨的重建,提高种植体的骨结合.本文通过细胞实验研究、动物实验研究和临床应用三个方面综述了脉冲电磁场促进种植体骨结合愈合的研究进展.     

32例复杂性颌骨骨折错位愈合的治疗分析

目的：应用保守治疗、切开复位固定、正颌外科治疗32例复杂颌骨骨折错位愈合患者，探讨各种治疗方法的适应证，并评价其临床效果。方法：保守治疗以牙弓夹板颌问固定为主，切开复位系按手术常规，切开、复位、钢丝或钛板固定，正颌外科系按正颌外科常用术式手术，术后颌问结扎2～3周。结果：伤口均一期愈合，无并发症，咬合关系及外观满意或基本满意。结论：根据颌骨骨折错位愈合的部位、时间、程度、患者年龄等因素综合考虑，选择治疗手段，可最大限度地恢复患者的咀嚼功能及外形。     

脉冲电磁场对鼠牙移动的影响

错(牙合)矫正已有二百多年的历史,但疗程过长的问题一直未能得到满意的解决,学者们试图找到一种有效的方法以加快正畸牙移动的速度,缩短矫正后的保持时间。目前主要采用机械力和肌能力来完成牙移动,它们能激活骨细胞体系,刺激骨的改建,产生有效的正畸牙移动。一些化学和物理因素如激素、药物、磁和电也能激活骨细胞体系行使特定的功能,这些因素可能协助机械力和肌能力促进牙移动。本文通过动物实验观察脉冲电磁场对正畸牙移动的影响。     

明胶海绵复合生长因子加速颌骨骨折愈合的实验研究

目的 探索明胶海绵复合生长因子缓释系统加速颌骨骨折愈合的作用和机制,为临床加速颌骨骨折愈合提供新的方法。方法 按每100 μg基因重组人骨形态发生蛋白（BMP）-2用1 mL重组牛碱性成纤维细胞生长因子（bFGF）液完全溶解后,取40 μL滴加到明胶海绵（0.5 cm×0.5 cm×1.0 cm）组织块中,冻干后制成bFGF/BMP/明胶海绵缓释系统。在12只新西兰大白兔两侧下颌制造线样骨折,左侧为对照组,只用钛板固定;右侧为实验组,钛板下放置bFGF/BMP/明胶海绵。术后2、4、12周行大体观察、X线检查、组织学检查。结果 术后2周,实验组较对照组在骨折断端处可见更多纤维组织长入;术后4周,实验组骨折间隙可见到纤维性骨痂,对照组可见纤维组织和血管长入;12周后实验组和对照组骨折均已完全愈合。结论 bFGF/BMP/明胶海绵能加速骨折愈合,提高骨折愈合效果。     

微型钢板在颌骨骨折固定术应用

微型钢板在颌骨骨折固定术应用徐州市第四医院口腔科单国萍我科自１９８９年从第四军医大学口腔医学院学习引进微型钢板固定器,用于颌骨骨折内固定手术治疗,几年来取得满意效果,在临床上发挥一定的社会效益和经济效益。现报告如下：临床资料１性别和年龄：２１例中,男...     

Radiodensitometric Assessment of the Effect of Pulsed Electromagnetic Field Stimulation Versus Low Intensity Laser Irradiation on Mandibular Fracture Repair: A Preliminary Clinical Trial

Purpose

Closed reduction of mandibular fractures usually entails a relatively long period of immobilization, with the subsequent delay of rehabilitation. Therefore, shorter immobilization period with various approaches to protect or enhance bone healing have been investigated. The aim of this study was to analyze the effects of pulsed electromagnetic field (PEMF) and low intensity laser irradiation (LILI) on the fracture healing process, through radiodensitometric assessment of the bone callus.

Patients and Methods

Eighteen patients with mandibular fractures at the tooth bearing area participated in this prospective study. They were treated by closed reduction using maxillo–mandibular fixation (MMF) and were consecutively assigned into 1 of 3 groups. In group A, the fracture sites were exposed to PEMF for 2 h daily for 12 days. In group B, the fracture sites were exposed to LILI on the tenth and twelfth postoperative days (2 sessions of 6 min per day 2 h apart). The fracture sites in group C acted as controls. MMF was maintained for 2 weeks in group A and 4 weeks in groups B and C. The bone fracture healing was evaluated clinically by investigating the union of the fractured segments and radiographically using computerized densitometry. The union of the fractured segments was tested by manual manipulation and the occlusion was assessed upon removal of MMF. Standardized digital panoramic radiographs were performed for each patient, immediately postoperatively as well as at 2 and 4 weeks. The digital images were manipulated using the IDRISI software. A rectangular area of 10 × 15 mm was drawn along the center of the fracture line. The obtained densitometry values were expressed in gray levels from 0 to 256. The collected data were then tabulated and statistically analyzed.

Results

After releasing the MMF, the bimanual mobility test of the fractured segments in all patients showed stability of the segments. The preinjury occlusion was maintained in all patients. The postoperative radiographs of all patients revealed good bony alignment of the bony segments. In all groups, comparison between the study intervals with respect to both means and changes percentages of the bone density values showed insignificant differences. At 2nd postoperative week, the mean bone density at the fracture sites decreased by 4.74, 6.6 and 27.89 % in groups A, B and C respectively. The period from the 2nd to the 4th postoperative weeks showed increase in the bone density by 1.49, 1.95 and 14.12 % in groups A, B and C respectively. Insignificant difference was found between the means of bone densities of group A and B throughout the study intervals. On the other hand, both groups showed insignificant difference with group C immediately postoperative and significant increase in bone density at the 2nd and 4th postoperative weeks.

Conclusions

Short period immobilization of mandibular fractures for 2 weeks supplemented with PEMF is recommended. Further studies are needed to evaluate the efficacy of LILI as a supplement to reduce the mandibular fracture immobilization period.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations of these teeth are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning, and follow up are important for achieving a favorable outcome. Guidelines should assist dentists and patients in decision making and in providing the best care possible, both effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed these Guidelines as a consensus statement after a comprehensive review of the dental literature and working group discussions. Experienced researchers and clinicians from various specialties and the general dentistry community were included in the working group. In cases where the published data did not appear conclusive, recommendations were based on the consensus opinions of the working group. They were then reviewed and approved by the members of the IADT Board of Directors. These Guidelines represent the best current evidence based on literature search and expert opinion. The primary goal of these Guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines cover the management of fractures and luxations of permanent teeth. The IADT does not, and cannot, guarantee favorable outcomes from adherence to the Guidelines. However, the IADT believes that their application can maximize the probability of favorable outcomes.     

Comparison Between Two Techniques for the Treatment of Mandibular Subcondylar Fractures: Closed Treatment Technique and Transoral Endoscopic-Assisted Open Reduction

Purpose

The endoscopic-assisted technique for the treatment of subcondylar fractures has been used successfully and its acceptance develops as more surgeons gain experience. We present the short term results of this technique in a randomized prospective clinical trial.

Methods and Materials

A total of 40 patients with mandibular subcondylar fracture were included in our study in two groups randomly. Patients of first group were treated by closed treatment technique and patients of second group by transoral endoscopic-assisted open reduction. All patients were followed for minimum of 12 weeks and occlusion, Mandibular Anterior Opening (MAO), mandibular deviation, and posterior ramal height were assessed.

Results

In the endoscopic group the MAO was significantly greater and mandibular deviation was lesser at 2nd and 4th week of follow up. Posterior ramal height showed significant increase in the endoscopic group rather than closed treatment group.

Conclusion

The transoral endoscopic-assisted technique is a reliable and successful technique to address subcondylar fractures. The patients who were treated by this technique showed better results in the fields of mandibular function and patient satisfaction and comfort, although it is time consuming and needs expensive instruments.     

International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 1. Fractures and luxations of permanent teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.     

可吸收聚对二氧六环酮线的制作及骨折内固定的实验研究

目的　利用自行合成的可吸收聚对二氧六环酮(PDS)线固定家兔下颌骨体部骨折,观察骨折愈合及内固定线降解吸收情况。方法　以亚乙基二醇及金属钠等为原料,合成对二氧六环酮单体;在一定温度、压力及催化剂条件下将单体开环聚合而得PDS;将压出成形,拉伸成线的PDS用于实验组12只成年雄性新西兰兔的单侧下颌骨体部骨折内固定,以每2周为一个时间点处死2只动物直至12周。对照组相同骨折而不作任何内固定的6只动物仍按相同时间点处死。通过X线片和组织学观察骨折愈合及内固定线降解吸收情况。结果　实验组所有动物骨折愈合良好,骨折区域外骨痂形成明显,膜内成骨及软骨内成骨均存在;PDS在体内先发生强度的衰减,继之缓慢吸收。不作内固定的对照组动物骨折均不能愈合。结论　自行合成的PDS线是一种可吸收并具有一定强度及柔韧性的无色热塑性单丝纤维,可通过环氧乙烷薰蒸灭菌而不影响其强度,可有效地进行下颌骨骨折的内固定,有进一步研究的价值。     

Beagle犬后牙完全性纵折粘结再植的实验研究

目的：探讨建立Beagle犬后牙完全性纵折口外粘结再植模型方法。方法：选取32颗Beagle犬前磨牙,劈裂牙冠后完整拔出,体外完成根管治疗,Super Bond C＆B粘结剂粘结两纵折片,植入牙槽窝,Ribbond弹力纤维固定实验牙。通过大体检查和X线放射检查观察实验牙8周。结果：劈冠后拔牙口外粘结再植成功率为71.9%。结论：Beagle犬前磨牙可作为建立后牙完全性纵折口外粘结再植的动物模型。