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目的采用微弧氧化(micro-arc oxidation,MAO)技术,在纯钛表面制备含锌(Zn)活性涂层,并评价其对成骨细胞活性的影响。方法本实验于2009年10月至2010年10月在中国医科大学附属口腔医院中心实验室进行。以机械抛光纯钛试样作为对照组(CP组);经MAO技术处理的纯钛涂层试样根据钙(Ca)含量不同分为高钙组(H-Ca组)、低钙组(L-Ca组),以及在低钙组的涂层中加入锌元素的低钙加锌组(L-Ca-Zn组)。每组32个试件。将4组试样材料与MG63细胞复合培养,利用扫描电子显微镜(SEM)观察、噻唑蓝(MTT)比色试验、碱性磷酸酶(ALP)活性测定及酶联免疫吸附试验(ELISA)等方法,评价材料对成骨细胞黏附、增殖、分化及矿化的影响。所得数据采用SPSS13.0软件进行单因素方差分析(α=0.05)。结果在实验检测期间,H-Ca组试样对成骨细胞的生长增殖、分化、矿化作用均优于L-Ca组,差异有统计学意义(P<0.05)。比较L-Ca-Zn组与H-Ca组可以看出,在实验检测初期H-Ca组试样对成骨细胞的生长增殖、分化、矿化作用优于L-Ca-Zn组;随着观察时间的延长,L-Ca-Zn组试样细胞的增殖水平和ALP活性与H-Ca组间差异无统计学意义(P>0.05)。比较L-Ca-Zn组和L-Ca组可以看出,在实验检测初期L-Ca-Zn组试样对成骨细胞的作用与L-Ca组差异无统计学意义(P>0.05);随着观察时间的延长,L-Ca-Zn组试样显示出较L-Ca组试样具有更好的提高成骨细胞活性的作用(P<0.05)。结论采用MAO技术制备的含锌活性涂层纯钛可在一定程度上促进成骨细胞黏附、增殖、分化及矿化,具有良好的生物相容性。     

正畸配合根尖下截骨术治疗严重双牙弓前突的临床研究

目的探讨骨性双牙弓前突患者经正畸正颌联合治疗后,颌面部硬组织、软组织在矢状方向上的变化及其相互关系,为临床矫治方法的选择提供参考。方法临床选择10例安氏Ⅰ类重度骨性双牙弓前突符合正颌手术的患者,术前正畸矫治完成后实施上、下前颌部截骨后退术（术中去除上下第一前磨牙牙骨块）,术后进一步正畸治疗以改善咬合关系。通过手术前后头影测量分析,比较颌面部硬组织,软组织在矢状方向上后退量及其相互关系。结果10例重度骨性双牙弓前突患者,经正畸一正颌联合矫治后,效果非常显著。上颌切牙平均后退7．13mm,上颌牙槽骨平均后退6．48mm,上颌软组织唇突点平均后移5．66nm。上颌硬、软组织后退的比例为1：0．87;下颌切牙平均后退6．62mm,下颌牙槽骨平均后退6．91mm,下颌软组织唇突点平均后移5．89mm。硬软组织后移的比值为1：0．85。结论重度骨性的双牙弓前突患者,应首选正畸正颌联合治疗,可彻底纠正前突的面型,上、下颌的硬软组织显著的内收,达到十分满意的疗效。     

Jadad量表与Cochrane偏倚风险评估工具在随机对照试验质量评价中的应用与比较

目的:探索系统评价中对纳入随机对照试验(randomized controlled trial,RCT)的评价工具(Jadad量表和Cochrane偏倚风险评估工具)的应用。方法:以诱导化疗在头颈鳞癌中的作用为例,在MEDLINE和EMBASE数据库中检索文献,对检索结果分别采用Jadad量表和Cochrane偏倚风险评估工具进行评价,并对评价结果进行列表分析。结果:纳入的37个RCT中,以Jadad量表评价,应排除23个低质量RCT;以Cochrane偏倚风险评估工具评价,应排除7个具有"High bias"的RCT。但产生差异被Jadad量表评价为低质量的16个RCT中,绝大多数是未描述盲法和随机序列产生方法,并不影响这些RCT的质量,可纳入到系统评价中。结论:为了提高系统评价的质量,尤其是开放式RCT,建议使用合理的RCT评价工具,推荐使用Cochrane偏倚风险评价工具。     

口腔颌面部异物36例临床分析

目的:探讨口腔颌面部异物伤的诊断与治疗及影像学诊断的重要性。方法 :选择2003-01—2010-12期间收治的,影像和病历资料完善的口腔颌面部异物存留伤36例。分析异物类型,并对临床疗效进行评估。结果:36例异物存留伤患者中,金属异物12例,非金属异物24例。择期异物取出26例;需要急诊清创者10例,而清创术可一期取出异物者6例,4例延期取出。30例经常规X线片检查后,需经CT或三维CT检查进一步定位,评估手术取出的可行性及风险。其中26例经手术取出,4例保留并观察。结论:三维CT在非金属异物存留伤诊疗中起到重要的作用;必须根据异物大小、部位及与周围大血管的毗邻关系,患者全身情况等综合因素判定是否手术及手术时机。     

120例口腔淋巴上皮囊肿临床分析

目的:探讨口腔淋巴上皮囊肿的临床表现、鉴别诊断、治疗和预后。方法:回顾性分析1993-2010年治疗的120例口腔淋巴上皮囊肿患者的临床资料,包括性别、年龄、部位、症状、体格检查、治疗和预后。结果:120例患者中,男37例,女83例;年龄2～75岁,平均44.1岁。病程2个月～10a,平均8个月,75.8%的患者少于6个月。病变常发部位是舌(50%)和口底(38.3%)。所有患者接受手术治疗。术后平均随访5.2a,无复发病例。结论:口腔淋巴上皮囊肿无特异性临床表现,其首选治疗为手术切除,预后较好。     

锁骨上动脉岛状瓣的解剖研究及其修复舌缺损的初步报告

目的 为临床应用锁骨上动脉岛状瓣提供解剖学依据,评价其修复舌部缺损的可靠性.方法 用成人尸体10例(20侧)经锁骨下动脉灌注氧化铅-明胶溶液的标本,观测颈横动脉和锁骨上动脉的分支、起始位置、行程、长度和管径,观察其静脉回流情况.用锁骨上动脉岛状瓣修复4例舌癌切除术后缺损,通过观察舌部形态和功能恢复及供区并发症等,评价修复效果.结果 颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支.锁骨上动脉由颈横动脉浅支发出.颈横动脉起点至锁骨上动脉起点距离约4.3 cm,锁骨上动脉起点至其分支穿深筋膜点的距离约3.6 cm.颈横动脉起点处血管外径约2.7 mm,锁骨上动脉起点处血管外径约1.1 mm.两条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉.4例用于修复舌部缺损的皮瓣中,3例全部成活,1例小部分皮岛坏死,肩功能运动不受影响.结论 以锁骨上动脉为营养血管的锁骨上动脉岛状瓣带蒂转移适于修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管制作游离皮瓣.     

Detection accuracy of proximal caries by phosphor plate and cone-beam computerized tomography images scanned with different resolutions

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.     

Clinical efficacy of four kinds of desensitizers in the treatment of dentin hypersensitivity

目的 比较4种脱敏剂对牙本质敏感症治疗的临床疗效.方法 临床随机选择咬合面磨耗导致牙本质过敏症的患者55例,217颗患牙,分别用含有Novamin的舒适达专业修复牙膏、75%氟化钠甘油、极固宁和gluma脱敏剂4组脱敏剂进行治疗.观察即刻、1周和3、6个月的疗效.结果 4组脱敏剂的即刻、1周、3个月的疗效均为75%氟化钠甘油组较差,与其他组比,差异有统计学意义(P<0.05).6个月时,舒适达组和gluma组比另2组疗效好,差异有统计学意义(P<0.05).结论 舒适达和gluma的脱敏效果优于其他两种,舒适达操作更简便.     

The association between complete absence of post-treatment periapical lesion and quality of root canal filling

Aim

The technical quality of a root canal treatment is clinically judged by the apical extension and homogeneity of the filling material imaged by periapical radiographs (PA). The aim of this experiment was to evaluate the association between the technical quality of the root canal filling and treatment outcome.

Materials and methods

In 234 teeth (268 roots) that underwent root-canal treatment, the quality of the root canal filling as well as the outcome of the treatment were assessed with both PA and cone-beam computed tomography (CBCT) 2?years after treatment. Satisfactory root filling on PA was defined as 0–2?mm within the radiographic apex without voids; on CBCT scans, the apical end of the canal replaced the radiographic apex. The outcome predictors were analyzed using multivariate logistic regression.

Results

At recall, periapical radiolucent areas were absent in 198 (74%) roots on PA and 164 (61%) roots on CBCT scans. The presence of preoperative periapical radiolucency and the quality of root filling and coronal restoration were identified by both PA and CBCT as outcome predictors (p?<?0.01). Complete absence of post-treatment periapical radiolucency was observed in CBCT scans in 81% and 49% of satisfactory and unsatisfactory root fillings, respectively, as compared to 87% and 61% revealed by PA.

Conclusion

Satisfactory root fillings were associated with a favorable outcome, confirmed by both PA and CBCT.

Clinical relevance

The outcome of root canal treatment is improved once the filling is 0–2?mm from the apex, and no voids could be detected. Technical skills and performance of root canal filling procedures should be emphasized, and suitable methods should be developed in order to achieve more compacted filling materials without voids and at the correct length.     

生物可降解聚碳酸丁二醇酯电纺膜生物相容性的研究

目的:对一种新型生物可降解聚碳酸丁二醇酯(poly butylene carbonate,PBC)电纺膜的生物相容性进行研究。方法:以聚己内酯(polycaprolactone,PCL)电纺膜为对照,检测2种膜的表面接触角,然后分别在其上接种MC3T3-E1细胞,使用场发射扫描电子显微镜对电纺膜的原始形貌和接种细胞1d后的形貌进行表征,使用甲基噻唑基四唑(MTT)比色法和碱性磷酸酶(alka-line phosphatase,ALP)活性法检测电纺膜对测试细胞增殖和分化的影响。结果:PBC电纺膜的接触角值低于PCL电纺膜,且差异显著(P<0.05);接种1d后细胞在两种电纺膜的表面都铺展良好,结合紧密;PBC电纺膜和PCL电纺膜对细胞增殖活性的影响在1d和7d都没有显著差异(P>0.05);接种7d时,PBC电纺膜组的ALP活性高于PCL电纺膜组,且差异显著(P<0.05)。结论:与电纺PCL膜相比,电纺PBC膜在亲水性和促进细胞分化方面性能更佳,可以进一步研发其在生物医学领域的应用。