正畸-膜龈手术联合治疗正畸后的牙龈退缩

本文介绍一例年轻患者正畸后下前牙出现严重龈退缩的跨学科治疗病例。MillerⅢ度龈退缩患牙常伴有严重的牙根异位,这类牙的根面覆盖术的预期效果往往是不确定的。治疗方案应包括：①牙齿邻面去釉获得牙弓间隙;②受累牙在颌骨内移动;③膜龈手术根面覆盖。该患者固定矫治后7个月复查时,可见异位牙已得到矫正,根面暴露处的根方角化龈组织已开始形成,变成了Miller度龈退缩,这时可认为根面覆盖术的可预测性将得到改善。根面覆盖术中采用上皮下结缔组织移植技术。术后1年的临床检查见根面已完全覆盖,牙龈颜色与邻近的组织协调,唇侧龈厚度增加。正畸-牙周联合技术,用在严重的膜龈异常牙的治疗上,可以达到理想的牙周美学效果。     

正畸治疗对牙龈萎缩的影响

目的：研究年轻成人中牙龈萎缩的比例,并探讨与正畸治疗的关系。方法：在大学生中随机抽取806名学生,记录年龄、是否抽烟、有无正畸治疗史。临床检查包括牙龈炎症,菌斑情况和牙龈萎缩的状况。分析牙龈萎缩与其他因素间的关系。结果：14．6％的学生有不同程度的牙龈萎缩,接受过正畸治疗学生的牙龈萎缩的比例明显高于无正畸治疗的学生,牙龈萎缩与性别、抽烟没有关系。结论：部分年轻成人有牙龈萎缩,有正畸治疗史的个体牙龈萎缩的比例比没有正畸治疗史的高。     

软组织移植用于治疗正畸后牙龈退缩的临床疗效分析

目的:用软组织移植的方法治疗正畸后牙龈退缩,通过统计相关临床指标来评估软组织移植治疗正畸治疗后牙龈退缩的临床效果.方法:收集正畸治疗后发生牙龈退缩的患者12例,均为MillerⅠ类、MillerⅡ类牙龈退缩,采用冠向复位瓣+结缔组织移植或游离龈移植的方法治疗牙龈退缩,在基线和术后1年随访时分别记录每颗牙牙龈退缩深度(R...     

成人上颌快速扩弓后牙龈退缩状况的研究

目的　探讨上颌快速扩弓对成人牙龈退缩的影响。方法　测量成人上颌快速扩弓组 (RME组 )和非上颌快速扩弓矫治病例组 (对照组 ,C组 )治疗前后牙牙合石膏模型临床牙冠高度的变化。结果　矫治前后第一磨牙、第二前磨牙、第一前磨牙临床牙冠高度的差值与C组矫治前后同名牙临床牙冠高度的差值比较 ,男性RME组无统计学意义 ,女性RME组第二前磨牙无统计学意义 ,第一磨牙和第一前磨牙的差值有统计学意义。结论　成人上颌快速扩弓不会加速和 (或 )导致成人牙龈退缩。     

Gingival Condition Associated with Partial Orthodontic Treatment

A longitudinal clinical study on gingival condition was made on seventy-five patients treated with fixed orthodontic appliances in one or both dental arches. Fifty-three non-treated subjects of comparable age were included for further reference. The prevalence and severity of gingivitis about the maxillary teeth were compared for partial (i.e. banding of all maxillary teeth) and full (i.e. banding of all maxillary and mandibular teeth) orthodontic treatment. Plaque accumulation and gingival status were assessed according to the Plaque and Gingival Index systems. Gingival hyperplasia was recorded by linear measurements using pocket probes.

The results demonstrated that all patients developed generalized gingivitis during the period of active treatment. The proximal areas were invariably more affected than the buccal areas, and posterior teeth more than anterior teeth. Although the GI, PII and pocket depth values were constantly lower when treatment was limited to the maxillary teeth, the differences were small and generally not significant. Also the healing of the gingiva after removal of the appliances was more rapid when partial treatment was used. In neither orthodontic group, however, any permanent damage to the periodontal tissues could be demonstrated with the methods used.     

隐形矫治器对患者龈沟液中AST和ALP水平的影响

目的:探讨无托槽隐形矫治器与固定矫治器对正畸患者龈沟液中天门冬氨酸转氨酶(AST)和碱性磷酸酶(ALP)水平的影响。方法:选取16~35岁正畸患者30例,随机分为两组,每组各15例。实验组采用隐形矫治器,对照组采用直丝弓固定矫治器。分别在治疗前和治疗后6个月,检测各组患者菌斑指数(PLI)、牙龈指数(GI)和探诊深度(PD);收集患者龈沟液,检测AST、ALP水平。结果:矫治后6个月,实验组患者牙周指数、AST、ALP水平均明显低于对照组,差异具有统计学意义(P<0.05)。结论:观察期内,隐形矫治器较固定矫治器更有利于维护患者牙周健康。     

不同民族固定矫治所致牙龈炎和前牙牙龈增生的临床研究

目的:探讨牙龈增生、牙龈炎在不同社会背景下的固定矫治患者中发病率及相关因素。方法:收集正畸治疗中或刚刚拆除矫治器的患者250名,随机分为2组。在接受矫治6~12个月和≥12个月时,由牙周专科医师检查菌斑及牙龈指数、牙周袋深度、附着丧失及牙龈增生程度。患者的社会经济背景,正畸治疗持续时间,正畸过程中牙线使用情况被记录下来。之间的相关性建立泊松回归模型,并使用多元性回归分析法进行分析。结果:牙龈出血(RR 1.02; 95% CI 1.01-1.02)和托槽周围多余的树脂残留(RR 1.04; 95% CI 1.04-1.05)跟牙龈增生有高度相关性。社会背景跟牙龈增生无相关性。结论:在正畸治疗患者中前牙牙龈出血和托槽周围多余树脂残留跟牙龈增生程度成正相关。     

固定矫治器双弓丝结扎治疗外伤性牙脱位的临床观察

目的 :观察固定矫治器双弓丝结扎治疗外伤性牙脱位的临床疗效。方法 :选择35例外伤性牙脱位的患者,采用固定矫治器双弓丝结扎,固定3⁶个月,对比分析治疗前后外伤牙齿的松动度、牙周状况和咬合关系。结果:患者外伤牙均达到良好的愈合,患牙与对牙有稳定的咬合关系,牙周组织状况良好,牙无松动,牙槽骨及牙根无明显吸收,牙齿冠根比无明显改变。结论:固定矫治器治疗外伤性牙脱位安全、疗效良好,值得临床推广应用。     

The Influence of Occlusal Trauma on Gingival Recession and Gingival Clefts

The aim of this study was to investigate the centric occlusal contact pattern in maximum intercuspation and to study the nature of occlusal contacts during maximum intercuspation to protrusive, lateroprotrusive and lateral excursive movements. Fifty subjects having gingival recession and ten subjects having gingival clefts belonging to age group of 18–25 years were selected after obtaining informed consent from the student’s population. The selected subjects were examined and the location and extent of gingival recession, gingival clefts and occlusal wear facets were recorded. The type of occlusion and the nature of occlusal contact in maximum intercuspation and eccentric mandibular movements were also recorded using articulating foil and shimstock. Chi square test, Fisher’s exact test (F) and Z test were used to statistically analyse the data obtained. Among the three occlusal concepts, gingival recession was more commonly related to group function than to canine protected occlusion. Canine protected occlusion was associated with gingival recession on the labial surface while in group function occlusion; the recession was distributed equally on the facial surface of the anterior as well as posterior teeth. Nearly all subjects showed interferences in protrusive, lateroprotrusive and lateral excursive movements on teeth showing gingival recession and gingival clefts. Occlusal wear was seen on all teeth having gingival clefts and on most teeth having gingival recession. These results suggest that occlusal interferences in maximum intercuspation and eccentric movements in one form or the other and absence of mutually protected occlusion can contribute to gingival lesions such as gingival recession and clefts.     

正畸治疗中牙根吸收的原因分析

目的：探讨患者的年龄、性别在正畸治疗中对牙根吸收的影响。方法：选用128例经直丝弓矫治器矫治完成的病例,患者治疗前后分别拍摄全口曲面断层片,测量不同年龄、性别组治疗前后上、下颌前牙的牙根长度变化。结果：成人组与儿童组上颌前牙正畸治疗前后牙根吸收差别无统计学意义,而下颌前牙正畸治疗前后牙根吸收差别有统计学意义（P〈0.05）;不同性别组上、下颌前牙正畸治疗前后牙根吸收差别无统计学意义。结论：年龄是正畸治疗中影响牙根吸收的一个重要因素。     

Efficacy of Collagen Membrane Seeded With Autologous Gingival Fibroblasts in Gingival Recession Treatment: A Randomized,Controlled Pilot Study

Background: Gingival recession (GR) is one of the most common esthetic concerns associated with periodontal tissues. Recently, tissue engineering technology has been developed and applied in periodontology for the treatment of GR. The aim of this study is to compare the clinical efficacy of collagen membrane with or without autologous gingival fibroblasts under a coronally advanced flap for root coverage. Methods: In this split‐mouth, controlled clinical study, 22 sites are selected from 11 patients with Miller Class I recessions affecting canines or premolars in the maxillary arch. One tooth in each patient was randomized to receive either a collagen membrane (CM) (control group) or a collagen membrane seeded with autologous gingival fibroblasts (CM+GF) (test group) under a coronally advanced flap. Thickness of the gingiva, GR, and percentage of root coverage (PRC) were recorded by a calibrated examiner at baseline and 3, 6, and 12 months postoperatively. Furthermore, GR and PRC were evaluated using photogrammetric analysis at baseline and 3, 6, and 12 months. Results: Both treatments resulted in a significant gain in root coverage compared with baseline. A statistically significant increase was detected in PRC in the test group compared with the control group. No significant difference was noted between the test and control sites regarding the thickness of the gingiva. Conclusions: The results indicated that CM+GF prepared by tissue engineering technology can be considered an alternative method for the treatment of Miller Class I recession defects.     

正畸拔牙矫治病例中出现牙龈折痕的临床研究

目的: 探讨正畸拔牙矫治病例出现牙龈折痕原因,为临床预防牙龈折痕的发生提供依据。方法: 在拔除前磨牙进行固定矫治的错牙合畸形患者中,筛查出发生的牙龈折痕病例87例,选择其中一侧出现牙龈折痕,另一侧未出现的病例65例,将出现牙龈折痕的一侧作为实验侧,未出现牙龈折痕的一侧作为对照侧,通过CBCT测量分析,比较两侧牙槽骨宽度、高度及骨密度的变化与出现牙龈折痕的相关性。结果: 牙龈折痕多发生在下颌,牙周探针牙龈折痕深度下颌均大于上颌。牙龈折痕侧牙槽骨宽度减小、高度降低以及密度减小均明显大于对照组,两组数据统计结果有显著性差(P<0.05)。结论: 正畸拔牙矫治病例中牙龈折痕的出现与牙槽骨宽度、高度及骨密度的变化具有相关性,拔牙间隙关闭过程中牙槽骨吸收,对软组织支持的丧失,可能是出现牙龈折痕的解剖学因素。     

大鼠牙龈退缩模型的建立

目的:在大鼠上颌磨牙区建立牙龈退缩模型。方法:使用牙科涡轮机和慢速手机,磨除大鼠右侧(实验侧)上颌第一磨牙近中端牙槽骨,缝合牙龈及黏膜组织。2月后处死大鼠,取其上颌双侧磨牙及牙周组织,分别测量从第一磨牙牙合平面远中边缘到第一磨牙近中牙龈上端距离。结果:实验侧牙龈相对对照侧牙龈有明显退缩(P<0.01)。结论:牙龈退缩是临床常见症状,牙龈退缩的大鼠动物模型建立成功,为进一步治疗牙龈退缩提供了更好的动物实验模型。较既往实验中所用的大型动物,节约了实验室空间、实验费用,便于大量实验的开展。     

固定矫治器对牙龈状况与龈沟液中内毒素含量影响的研究

目的：探讨固定矫治对牙龈状况的影响和有效控制牙龈炎症的方法。方法：将临床就诊采用固定矫治器进行治疗的患者作研究对象，临床就诊的100例患者，分别于矫治前，矫治后1、3、6个月，矫治结束前，结束后3个月的牙龈炎症指数，龈沟液细菌内毒素进行测试比较，统计学处理。结果：1)牙龈炎症指数：固定矫治器戴于后1个月牙龈指数最高，3个月后趋于稳定，此时牙龈炎症指数接近正常，6个月后至矫治结束时基本无明显变化，矫治结束后3个月牙龈组织恢复完全正常；2)细菌内毒素：细菌内毒素含量与牙龈炎症指数呈正相关关系。结论：1)固定矫治器对牙龈组织的健康有一定的影响，但患者只要掌握正确的刷牙方法，养成良好的口腔卫生习惯，就可以是牙龈组织的炎症得到有效控制。2)固定矫治过程中的牙龈炎性反应同细菌内毒素含量有非常密切的正相关关系，而细菌内毒素是G^-菌的裂解产物，故对于固定矫治过程中出现的牙龈炎症，可以应用对G^-菌有效的抗菌素进行有效控制。     

正畸加力后牙周疼痛与龈沟液中生物活性物质变化的相关研究

目的 观察正畸患者正畸加力后疼痛的时间变化规律，了解正畸加力前后龈沟液中生物活性物质的变化特点，以及两者之间的相关性。方法 采用放射免疫测定法，测定正畸患者50例样本上颌侧切牙受唇向倾斜力前和后12h、24h、48h、72h龈沟液中前列腺素E2(PGE2)、P物质(SP)、白细胞介素-6(IL-6)和巨噬细胞集落刺激因子(GM—CSF)的浓度变化，记录并描述正畸加力后疼痛的时间规律。对正畸加力后疼痛与生物活性物质的变化进行相关分析。结果 正畸加力后12h左右开始出现疼痛，24h左右疼痛程度最高，72h左右明显减轻。正畸加力后12h左右PGE2、SP、IL-6和GM—CSF的浓度升高，24h后SP、PGE2达到高峰，而IL-6和GM—CSF的浓度无明显变化；72h，IL-6和GM—CSF保持较高水平，而PGEa、SP的浓度明显下降。结论 正畸牙加力后疼痛呈规律性变化，而这种变化与牙周某些局部生物活性物质如SP和PGE2的浓度变化相关。