半导体激光辅助直接盖髓术在龋源性露髓患牙中的效果评价

目的：探讨半导体激光联合氢氧化钙行直接盖髓术是否可以提高深龋露髓患牙的保髓成功率。方法：选取深龋露髓患牙100例,随机分为试验组和对照组,每组各50例。试验组以功率1.5 W、波长808 nm、直径320 μm、距离2~3 mm、连续波激光照射露髓点2 s,控制出血;以功率1 W、波长808 nm、直径320 μm、距离2~3 mm、连续波激光每2 mm照射1 s,进行窝洞净化,用氢氧化钙制剂盖髓;对照组直接采用氢氧化钙制剂盖髓。随访观察1年后,评价2组患牙的牙髓活力。采用SPSS 19.0软件包对数据进行统计学分析。结果：试验组 50例患牙,失访3例,1年后成功率为89.4%;对照组50例患牙,失访5例,1年后成功率为73.3%,2 组之间差异显著（P<0.05）。结论：半导体激光联合氢氧化钙用于深龋露髓患牙直接盖髓术,可明显提高保髓成功率,值得推广应用。     

Does the Etiology of Pulp Necrosis Affect Regenerative Endodontic Treatment Outcomes? A Systematic Review and Meta-analyses

ObjectiveTo evaluate if there is a connection between the causes of pulp necrosis (eg, caries, trauma, dental anomaly) and the success of regenerative endodontic treatment.MethodsElectronic databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Embase) were searched for studies on regenerative endodontic treatment, which used both clinical and radiographic evaluation of root maturation after at least 6 months of follow-up. The search terms “necrotic pulp”, “regenerative endodontic treatment”, “revascularization”, and “revitalization” were combined using Boolean operators. The main journals on endodontics and dental traumatology were additionally hand-searched. Studies were included if they specified the causes of pulp necrosis. The primary question under review was, “Does the cause of pulp necrosis affect the outcome of regenerative endodontic treatment?” Other factors such as tooth type, intracanal medicament, irrigation protocol, use of a collagen matrix, and the type of scaffold were evaluated for possible relation with the outcome. The risk-of-bias assessment for randomized and nonrandomized studies was performed separately, using a modified Cochrane Collaboration's tool and risk of bias in non-randomized studies of interventions-I tool, respectively. Meta-analysis was performed, when possible, between studies comparing treatment outcomes of teeth whose pulp necrosis had different etiology. The search strategy yielded 1197 items. After screening, 18 studies reporting 445 regenerative endodontic treatment cases were included.ResultsThe overall success rate for 274 teeth with trauma etiology was 94.8%, for 95 teeth with dens evaginatus etiology was 93.1%, and for 24 teeth with caries etiology was 96%. No significant difference was found between the results of regenerative endodontic treatment among teeth with trauma, dens evaginatus, and caries etiology (P = .055). Meta-analysis of studies comparing teeth with caries vs dens evaginatus and those with trauma vs caries confirmed that there was no evidence for difference in outcomes.ConclusionFurther randomized studies specifically testing such hypothesis are needed to confirm the preliminary results of this review.     

Systemic BMSC homing in the regeneration of pulp-like tissue and the enhancing effect of stromal cell-derived factor-1 on BMSC homing

Pulp regeneration caused by endogenous cells homing has become the new research spot in endodontics. However, the source of functional cells that are involved in and contributed to the reconstituting process has not been identified. In this study, the possible role of systemical BMSC in pulp regeneration and the effect of stromal cell-derived factor-1 (SDF-1) on stem cell recruitment and angiogenesis were evaluated. 54 mice were divided into three groups: SDF-1 group (subcutaneous pockets containing roots with SDF-1 absorbed neutralized collagen gel and the green fluorescent protein (GFP) positive BMSCs transplantation via the tail vein), SDF-1-free group (pockets containing roots with gel alone and GFP + BMSCs transplantation) and Control group (pockets containing roots with gel alone). The animals were sacrificed after the roots were implanted into subcutaneous pockets for 3 weeks. Histomorphometric analysis was performed to evaluate the regenerated tissue in the canal by hematoxylin and eosin (HE) staining. The homing of the transplanted BMSCs was monitored with a fluorescence microscope and immunohistochemical analysis. The expression of ALP in new formed tissue was detected immunohistochemically. Dental-pulp-like tissue and new vessels were regenerated and GFP-positive BMSCs and expression of ALP could be observed in both SDF-1 group and SDF-1-free group. Furthermore, more GFP+ cells, stronger expression of ALP and stronger angiogenesis were found in the SDF-1 group than in the SDF-1-free group. To conclude, systemic BMSC can home to the root canal and participate in dental-pulp-like tissue regeneration. Intracanal application of SDF-1 may enhance BMSC homing efficiency and angiogenesis.     

两种根管充填糊剂充填效果的比较

目的比较两种根管充填糊剂充填治疗牙髓坏死和慢性根尖周病的临床疗效。方法将164例患者共198颗患牙随机分为治疗组和对照组,治疗组采用Cortisomol糊剂加牙胶尖侧压行一次性根管充填;对照组用氧化锌糊剂加牙胶尖侧压根管充填,观察两组术后疗效。结果两组疗效比较差异有非常显著性,治疗组优于对照组。结论Cortisomol糊剂一次性根管充填疗法能减轻疼痛,疗效满意。     

两种不同盖髓剂对人牙髓细胞毒性的体外研究

目的:研究丁香酚及Dycal对人牙髓细胞的毒性。方法:体外组织块法培养人牙髓细胞,采用噻唑蓝比色法(MTT法)及台盼蓝染色活细胞计数法来评价不同浓度及不同时间段丁香酚及Dycal对牙髓细胞细胞毒性,比色法测定丁香酚干预组细胞内总谷胱甘肽含量。结果:0.1mmol/L浓度的丁香酚及0.1%浓度的Dycal对人牙髓细胞毒性明显,其对细胞毒性反应成浓度及时间依赖性改变。各丁香酚组细胞内谷胱甘肽含量低于对照组,第3天丁香酚最低浓度组细胞内谷胱甘肽含量高于高浓度组。结论:高浓度丁香酚及Dycal对牙髓细胞毒性明显,细胞毒性与浓度及作用时间有关。低浓度丁香酚可能通过谷胱甘肽的参与抵抗氧化应激,从而起到对细胞的保护作用。Dycal可能更加适合用于间接盖髓。     

刮痧联合拔罐改善心脾两虚型失眠患者睡眠质量的效果

目的探讨刮痧联合拔罐改善心脾两虚型失眠患者睡眠质量的疗效。方法将60例心脾两虚型失眠患者随机分为西药组及中医组各30例,西药组给予口服艾司唑仑片治疗,中医组采用刮痧联合拔罐治疗。连续治疗8周后,比较两组睡眠质量改善效果。结果治疗后,中医组匹兹堡睡眠质量指数(PSQI)得分显著低于西药组,临床疗效显著优于西药组(P0.01,P0.05)。结论刮痧联合拔罐改善心脾两虚型失眠患者睡眠效果优于西药治疗,中医外治法合用可增强安眠效果。     

颌骨囊肿开窗减压术后受累牙牙髓活力变化的临床研究

目的研究探讨颌骨囊肿开窗减压术后受累牙牙髓活力的变化,为临床该类患牙的处理提供处理依据。方法选择2013年7月至2013年12月在我院就诊的颌骨囊肿患者100例,采用开窗减压术进行治疗,术后1个月、3个月定期随访,观察囊肿受累牙的牙髓活力状态的数值术前、术后的变化情况。结果 100例患者术后均愈合良好。共测量患牙130颗,正常牙130颗,术前电测牙髓无活力或活力显著降低者共96颗,占所有被累及患牙的73.8%。术后1³个月,部分牙髓活力降低的患牙其牙髓活力获得恢复,术后3个月随访时,共有12例患牙的牙髓活力恢复了正常。术后13个月,部分牙髓活力降低的患牙其牙髓活力获得恢复,术后3个月随访时,共有12例患牙的牙髓活力恢复了正常。术后1³个月,亦有部分牙髓活力降低的患牙其牙髓活力进一步减退,术后3个月随访时,共有4例患牙的牙髓丧失了活力。结论在进行颌骨囊肿开窗减压术前,对牙齿进行牙髓活力测试,可为牙齿的保留和处理提供参考。     

Dentin Phosphophoryn-Derived Peptide Promotes Odontoblast Differentiation In Vitro and Dentin Regeneration In Vivo

The purpose of the present study was to investigate the effect of a peptide (i.e., SESDNNSSSRGDASYNSDES) derived from dentin phosphophoryn (DPP) with arginine-glycine-aspartic acid (RGD) motifs on odontoblast differentiation in vitro and to compare it with calcium hydroxide—a material used conventionally for vital pulp therapy—in terms of reparative dentin formation and pulp inflammation in vivo. Alkaline phosphatase activity assay and alizarin red S staining were performed to evaluate odontoblast-differentiation in cell culturing experiments. To observe the reparative dentin formation and pulp inflammation animal experiment was performed and examined by histological methods. The difference between the experimental group and the control group was analyzed statistically using a one-way ANOVA test. The results revealed that the DPP-derived RGD-containing peptide triggered odontoblast differentiation and mineralization in vitro. In rats undergoing direct pulp capping, the DPP-derived RGD-containing peptide was found to induce intensively formed reparative dentin with high compactness at week 4. On histological and morphometrical examinations, a smaller degree of pulpitis was observed in the specimens treated with the peptide than in those treated with calcium hydroxide. This study suggests that the DPP-derived RGD-containing peptide is a biocompatible, biodegradable and bioactive material for dentin regeneration.