根尖诱导成形术与牙髓血运重建术治疗年轻恒牙根尖周病变的临床疗效比较

目的比较年轻恒牙根尖周病变应用根尖诱导成形术与牙髓血运重建术治疗的临床疗效。方法选取86例年轻恒牙根尖周病变患者为研究对象,按照随机数表法分为研究组与对照组,每组各43例。对照组采取根尖诱导形成术治疗,研究组采取牙髓血运重建术治疗。观察两组患者术后6个月牙龈相关生长因子水平变化,并分析比较术后6个月两组患者临床疗效及并发症发生情况。结果术后6个月,研究组患者治疗总有效率明显高于对照组(P<0.05);术后6个月,两组患者VEGF、bFGF水平均较术前显著升高,且研究组明显高于同一时间对照组(P<0.05);术后6个月,研究组患者感染、牙根折断及微渗漏发生率均略低于对照组,但无明显统计学意义(P>0.05),但总并发症发生率明显低于对照组(P<0.05)。结论牙髓血运重建术可有效治疗年轻恒牙根尖周病变,利于患者牙龈生长,且安全性良好。     

乳牙根尖周病变根管治疗术的疗效观察

目的 评价乳牙根尖周病变根管治疗术的临床效果.方法 常规根管治疗术,vitapex 糊剂作为乳牙根尖周病变的根管充填剂.结果 随着根管治疗术后时间的延长,治疗成功率大大上升,经治疗的120个牙,在术后12个月的随访109个,成功率为90.8%.结论 乳牙根尖周病变用完善的根管治疗术可取得较好的临床效果.     

药物涂层预防种植体周围炎的研究与进展

背景：种植体/基台表面药物涂层可实现局部抗菌、促骨结合和促软组织封闭形成,预防种植体周围炎的发生,从而提高种植成功率。目的：归纳总结不同药物涂层预防种植体周围炎发生的研究现状和进展。方法：应用计算机检索中国知网、万方数据、PubMed及维普数据库,以“种植体周围炎、载药材料、涂层、抗菌、骨结合、软组织封闭”为中文检索词,以“peri-implantitis,drug loading materials,coating,antibacterial,osseointegration,soft-tissue integration/soft tissue sealing”为英文检索词,按照纳入和排除标准对文献进行筛选,最终纳入79篇文献进行综述分析。结果与结论：(1)目前的药物载体具有良好的机械、热化学和生物性能,能够通过加载和释放药物来改善种植体/基台表面抗菌、促骨结合及软组织封闭形成等功能,实现种植体周围炎的直接和/或间接预防,为种植体周围炎的预防提供了新的研究方向;例如基台表面载抗菌肽涂层既可抑制细菌的聚集和黏附,又可促进种植体软组织封闭的形成,阻止细菌侵犯下方的牙槽骨、避免骨组织的炎...     

种植体结构设计与种植体边缘的骨吸收:现状与争议

背景:种植体边缘骨吸收直接影响着种植义齿的长期稳定及美观,除了过度负荷及病理性炎症两大因素外,种植体结构设计也是至关重要的因素目的:综述种植体结构设计与种植体边缘骨吸收的关系。方法:应用计算机检索PubMed数据、SCI数据库、中国知网数据库有关种植体结构设计及种植体边缘骨吸收的文献。英文检索词为implant design,marginal bone loss,bone loss,bone defect,中文检索词为种植体设计;边缘骨吸收;骨吸收;骨缺损。排除本综述无关及重复性研究的文献,最后按纳入标准筛选43篇文献进行综述。结果与结论:在口腔种植治疗中,避免种植体边缘骨是能确保种植体周围软硬组织健康及美学修复效果基本要求,优化种植体形态结构设计对种植体周围骨吸收有极大的影响。故种植修复时应尽量考虑到以下因素:合理匹配种植体的尺寸,不同种植体选择合理的颈部设计,一体式种植体,基台设计及种植体-基台连接等。     

钛种植体基台与种植体上部结构合金的耐腐蚀性能

背景:国内有学者运用动电位极化技术测定常用牙科金属自腐蚀电位值来评价低贵金属的腐蚀性能,发现合金的贵金属含量是影响其耐腐蚀性能的主要原因。目的:评价TA2型商业纯钛、金合金、钴铬合金、钛合金及镍铬合金的体外耐腐蚀性能。方法:将TA2型商业纯钛、金合金、钴铬合金、钛合金及镍铬合金分别浸入人工唾液中,运用动电位极化技术测量5种材料在人工唾液中的自腐蚀电位和自腐蚀电流密度。结果与结论:5种合金的自腐蚀电位值由大到小排列顺序为金合金、商业纯钛、钛合金、钴铬合金、镍铬合金;金合金与纯钛电位较正,不易发生腐蚀;钛合金和钴铬合金居中,由于可以形成稳定氧化膜,具有较强的抗孔蚀和缝隙腐蚀能力;镍铬合金电位较负,则较容易发生溶解。5种合金的自腐蚀电流密度值排列顺序为金合金商业纯钛钛合金钴铬合金镍铬合金;金合金与纯钛电流密度值较小,达10-8,这表明金合金和纯钛的腐蚀速度较小,镍铬合金的腐蚀速度最大。结果说明金合金、纯钛是耐腐蚀性较好的材料,镍铬合金的腐蚀速度最大,应尽量避免用镍铬合金作为种植体上部结构。     

显微根尖手术联合引导骨再生技术治疗难治性根尖炎的临床疗效

目的 探讨显微根尖手术联合引导骨再生技术（GBR）治疗难治性根尖炎的临床疗效及对咀嚼功能的影响。方法选取2019年6月至2021年9月本院收治的难治性根尖炎患者82例作为研究对象,按照随机数字表法分为对照组和联合组,每组41例。对照组采用显微根尖手术治疗,联合组采用显微根尖手术联合GBR治疗。对比2组患者的临床疗效、咀嚼功能和骨吸收标志物[Wnt3a、骨保护素（OPG）、核因子-κB受体活化因子配体（RANKL）]水平。结果 联合组总有效率（100%）高于对照组（85.37%）,差异有统计学意义（P<0.05）。术后3、6、12个月,2组患者的咀嚼效率提高,咬合力逐渐增强（P<0.05）,且联合组上标指标均优于对照组（P<0.05）;术后3、6、12个月,2组患者的牙齿松动度均逐渐降低,且联合组患者术后3、6个月牙齿松动度低于对照组（P<0.05）。术后1周,2组患者的Wnt3a和OPG水平均升高,且联合组高于对照组（P>0.05）;2组患者的龈沟液RANKL水平均降低,且联合组低于对照组（P>0.05）。结论 采用显微根尖手术联合GBR治疗难治性根...     

影响微种植体正畸治疗成功率的因素

文题释义：支抗：正畸矫治中,任何施于被矫治牙使其移动的力必然产生一个反向、等大的反作用力,能抵抗该力的结构成为“支抗”。支抗控制对于正畸和颅颌面矫形的成败至关重要。多年来,正畸学者和临床医师设计了多种口外和口内支抗系统,但由于各种原因,实际临床应用不尽如人意。与传统支抗相比,微种植体具有体积小、植入移除简单、成本低、能行即刻或早期加载等明显优势,在正畸临床的应用越来越广泛。骨整合&临床成功率：即显微镜下骨与种植体间的直接接触,是种植体生物学稳定性和临床成功率的决定因素。骨整合的程度主要由种植体自身设计、手术操作、应力载荷、临床用途及患者身体状况等多因素决定。影响微种植体骨整合乃至临床成功率的相关因素亟待进一步深入、系统的研究。背景：在正畸治疗过程中,影响微种植体临床成功率的潜在危险因素的相关报道结果不尽一致,一些临床医师非常关注的影响因素未全部纳入研究,且动物实验所得结论难以直接运用于临床实践。因此,究竟哪些因素影响微种植体的临床成功率,亟待进一步深入、系统的研究。目的：研究影响正畸支抗用微种植体临床成功率的相关因素。方法：试验纳入114例口腔种植患者,其中男42例,女72例,年龄(19.26±9.19)岁,共植入253枚微种植体作为正畸支抗。纳入以下影响因素：包括性别、年龄、垂直和矢状骨面型、植入位点、植入牙弓、植入部位软组织类型、口腔卫生状况、微种植体的直径和长度、植入方式、植入角度、应力加载时机和强度及临床用途,运用logistic回归分析研究成功率和所有变量间的相关性,方差分析检测各变量对成功率的影响。试验方案经过四川大学伦理委员会批准。结果与结论：①253枚微种植体的总临床成功率为88.54%,平均应力加载时长为9.5个月,其中29枚植入失败,植入失败微种植体的平均加载时长为2.3个月;②在卡方检验、Fisher精确检验和logistic回归分析中,年龄、口腔卫生状况、垂直骨面型及植入位点与临床成功率显著相关(P < 0.05),而性别、矢状骨面型、植入牙弓、植入部位软组织类型、微种植体的直径和长度、植入方式、植入角度、应力加载时机和强度及临床用途11个变量与种植成功率无显著相关性(P > 0.05);③结果提示为了最大程度降低微种植体失败率,需给予患者正确的口腔卫生保健指导和有效监督,特别是年轻(<12岁)、高角、下颌骨植入微种植体的患者。ORCID: 0000-0003-2318-3199(吴也可)中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

种植体材料钛与种植体上部结构合金间电偶的腐蚀性

背景：大多数和钛种植体接触的牙科金属修复部分,会引起电偶腐蚀的发生。偶对在种植体界面产生带正电的局部环境,这会直接影响组织状况,尤其是骨吸收。 目的：评价TA2型商业纯钛分别与金合金、钴铬合金、钛合金及镍铬合金在体外的电偶腐蚀行为。 方法：在人工唾液中体外模拟TA2型商业纯钛分别与金合金、钴铬合金、钛合金及镍铬合金接触时的回路, 测量其作用15 h的混合电位和电偶电流值并描绘电流时间曲线。 结果与结论：4组合金接触8 h后电流达到稳定,稳定后电偶电流值排列顺序为钛/金合金<钛/钴铬合金<钛/钛合金<钛/镍铬合金。提示钛/金合金组电偶腐蚀最小,金合金是最适合作为种植义齿上部结构的材料;钛/镍铬合金组电偶腐蚀最大,镍铬合金是最不适合作为种植义齿上部结构的材料。     

矮身材的预防与治疗

身高、对少年儿童来说，这是衡量健康与否的标准；对成人（特别是年轻人）来说，是形象的标志（它关系到人的审美、就业与男女婚恋等问题）对国家与民族来说，是一个反映国家与民族素质及体质的重要指标。过去在这方面研究较少，但随着社会的进步与人类个子的进一步增高，近年来这问题已渐被提到议事日程上来与受到不少人的关注，特别是受矮小人群的关注，为此本文想就矮身材的预防与治疗作一探讨与论述。     

瘢痕的预防与治疗进展

瘢痕是手术和外伤不可避免的结局,有多少手术外伤的患者就会有多少瘢痕的患者。预防和治疗瘢痕是一项复杂的、综合性的工程。在早期,应关注手术切口的设计以及标准的缝合方案;在伤口愈合的过程中可以尝试使用硅凝胶制品、局部激素注射以及减轻切口周围张力等方案来预防瘢痕的增生;在病理性瘢痕形成后可尝试局部治疗、注射治疗、物理疗法、手术治疗、局部脂肪移植等单一或多方案联合治疗瘢痕。本文将结合近年来最新文献对瘢痕预防和治疗作简要综述。     

Accessory mental foramina and nerves: Application to periodontal,periapical, and implant surgery

Recent studies investigating accessory mental foramina using developments in diagnostic imaging have primarily defined the morphology of the foramina; however, few studies have described the structures passing through them. Additional clinical knowledge of the foramina is therefore required for preoperative diagnosis prior to surgery, including implant, periodontal and periapical surgery. In this study, we investigated the accessory mental foramina and the associated nerves and arteries in donated cadaveric mandibles using anatomical and radiological observation methods. We examined 63 mandibles with overlying soft tissue by cone‐beam computed tomography and noted the existence of the accessory mental foramina. Mandibles with accessory mental foramina were subsequently analyzed. Additionally, the neurovascular bundles passing through these foramina were dissected using anatomical methods.The incidence of accessory mental foramina was 14.3%. The larger foramina tended to be located anteriorly or superiorly and proximal to the mental foramen, while the smaller foramina tended to be located posterosuperiorly and distal to the mental foramen. The mental foramen ipsilateral to the accessory mental foramen was smaller than the one contralateral to it. The comparatively distant and large accessory mental foramen included an artery.This study elucidated the relationship between accessory mental foramina and the associated nerves and arteries. We believe that the results will contribute to the clinical dentistry field. Clin. Anat. 29:493–501, 2016. © 2015 Wiley Periodicals, Inc.     

Effects of sympathectomy on experimentally induced pulpal inflammation and periapical lesions in rats

The role of sympathetic nerves in bone physiology is largely unknown. Recent studies have shown a correlation between sympathectomy and bone remodeling. The present experiments were aimed to study the effects of unilateral sympathectomy on bilateral experimentally induced pulpitis and periapical lesions in the rat maxilla and mandible. Adult male Sprague-Dawley rats were used. Experimental rats (n=11) had the right superior cervical ganglion surgically removed (SCGx) and control rats (n=5) had sham surgery. Pulpal inflammation and periapical bone lesions in the maxilla and mandible were created 14 days later in both experimental and control rats by exposing the dental pulp in the first and second molars and leaving them open to the oral microflora. The rats were perfused 20 days thereafter and the jaws processed for immunohistochemistry with neuropeptide Y (NPY) and ED1 as primary antibodies. Sympathectomy resulted in an almost complete loss of NPY-immunoreactive (IR) fibers in the right SCGx jaws. In the non-sympathectomized (non-SCGx) left side and in the control rats, sprouting of NPY-IR fiber was observed in the inflamed pulp tissue adjacent to reparative dentin formation and in the apical periodontal ligament of the partially necrotic first molars. Significantly more ED1-IR osteoclasts were found in the resorptive lacunae lining the periphery of the periapical lesions on the SCGx side compared with the non-SCGx side (P<0.04) and the controls (P<0.03). The size of the periapical lesions were larger on the SCGx side compared with the non-SCGx side (P<0.03) in the mandible, but not in the maxilla. We conclude that inflammation causes sprouting of NPY-IR nerve fibers and that unilateral removal of the SCG increases both the area of the periapical lesions and the number of osteoclasts in the inflamed region.     

Light microscopic study of periapical lesions associated with asymptomatic apical periodontitis.

The purpose of the study has been to evaluate the degree of chronic inflammation in tissues surrounding the apex of the tooth root in patients with apical periodontitis in the remission phase. The material included 37 apical granulomas and radicular cysts obtained as a result of apiectomy, and 20 teeth which were removed together with the focus of the periapical inflammation. Routine histological techniques, as well as the immunofluorescent and immuno-chemical methods were used to examine the material. Despite the absence of clinical symptoms in 23 of 57 cases, the morphological signs of chronic inflammation were observed in the apical area of the tooth root. Morphological signs of viral invasion of epithelial and stromal cells in the radicular cyst wall were revealed in six cases. The presence of the virus of Herpes simplex I in epithelial cells (five cases) and adenoviral invasion (one case) was confirmed by immuno-fluorescent and immuno-chemical methods. Histological examination often reveals morphological signs of an active inflammatory process in the periapical tissues of patients treated during clinical remission. In our opinion, the presence of viruses in the epithelial cells of the radicular cyst may contribute to the persistence of the active stage of the inflammatory process.     

Immunological and ultrastructural characterization of plasma cells of human periapical chronic inflammatory lesions (granulomas)

Despite many studies on the topic, plasma cells found in human periapical chronic inflammatory lesions (granulomas) continue to present unresolved issues. In this study, we tried to assess quantitatively and qualitatively the nature of plasma cells of 4 human periapical granulomas. Samples were analyzed for relative amounts of IgG-, IgM-, IgA-, and IgE-positive plasma cells by immunohistochemistry, and for morphological changes by transmission electron microscopy (TEM). By immunohistochemistry, many plasma cells stained positively with anti-IgG and anti-IgM antibodies; fewer cells reacted with anti-IgE and anti-IgA. Russell Bodies, controversial aspects of plasma cell maturation, showed positive reactivity of the superficial layer only to antibodies against IgG and IgM. By TEM analysis, phenotypes of normal and dysfunctional plasma cells (Mott cells) were evident. Russell Bodies appeared as intra- or extracellular round vesicles, with an homogeneous internal core, and an external membrane, resembling rough endoplasmatic reticulum (RER). We can conclude that mucosal immune response is not the predominant type in the periapical lesions examined. Positive immunoreaction for IgG and IgM of Russell Bodies may be due to the residual RER membrane, whereas components of yet unidentified nature may occupy the internal core.     

Mesenchymal stem cells from periapical lesions modulate differentiation and functional properties of monocyte‐derived dendritic cells

Immunoregulatory mechanisms within periapical lesions (PLs) are as of yet unexplored. Considering the crucial role of DCs in controlling the immune response within PLs, the immunomodulatory properties of mesenchymal stem cells (MSCs), and the colocalization of MSCs and DCs in situ, we wondered whether MSCs from PLs modulate the development and functions of DCs. Using a model of monocyte‐derived DCs, we showed that PL‐MSCs inhibited differentiation of DCs via soluble factors, of which IL‐6 had a minor effect, but did not impair their subsequent maturation induced by pro‐inflammatory cytokines. However, upon maturation such DCs favored the production of Th2/Th17 cytokines by allogenic CD4⁺ lymphocytes in coculture, compared with mature DCs differentiated without PL‐MSCs. PL‐MSC‐differentiated DCs, cultivated with pro‐inflammatory cytokines and PL‐MSCs, although phenotypically mature, exhibited poor allostimulatory activity, induced anergy, Th2 polarization, differentiation of suppressive CD4⁺CD25^highCD39⁺ Treg‐cell subsets via IDO‐1‐, ILT‐3‐, and ILT‐4‐dependent mechanisms, and increased production of TGF‐β in the coculture. In contrast, DCs cultivated with PL‐MSCs only during maturation stimulated proliferation and Th1 polarization of CD4⁺ T cells in an IL‐12‐independent manner. In conclusion, PL‐MSCs significantly modulate the development and functions of DCs, depending on the phase of DCs development during which the interaction occurs.     

Prevention and treatment of corticosteroid-induced osteoporosis

Osteoporosis is one of the most serious complications of corticosteroid treatment. Loss of bone mineral density (BMD) and fractures occur early in the course of corticosteroid treatment, and thus early recognition of fracture risk and effective intervention based on evidence-based-medicine (EBM) are needed. A study of meta-analysis representing the highest level in a hierarchy of evidence showed that when the outcome measure of interest was limited to changes in lumbar spine BMD, bisphosphonates were the most effective of the agents studied in comparison with no therapy or treatment with calcium, and were also more efficacious than either vitamin D or calcitonin; the efficacy of bisphosphonates was enhanced when used in combination with vitamin D. Randomized controlled trials (RCTs) representing the second level in a hierarchy of evidence showed that bisphosphonates stabilized BMD not only in the lumbar spine, but also in the hip, and that parathyroid hormone (PTH) markedly increased lumbar spine BMD. According to the EBM, bisphosphonates and possibly PTH are suggested to be the most efficacious for preserving BMD. The efficacy of these agents in reducing the incidence of vertebral fractures in patients exposed to corticosteroids remains to be established in meta-analysis studies, although some RCTs have demonstrated the anti-fracture effects of etidronate, alendronate, and risedronate in the spine. Further RCTs of fracture prevention conducted on a large number of patients and their meta-analysis are needed to confirm the efficacy of bisphosphonates, PTH, or other agents in preventing vertebral and nonvertebral fractures.