局麻下牙髓失活术与直接拔髓治疗磨牙急性牙髓炎的疗效对比

【摘要】目的 探讨局麻下牙髓失活术治疗磨牙急性牙髓炎的临床疗效,以及对患者围手术期指标、急症的影响。方法 选取2016年1月～2020年1月成都医学院第二附属医院收治的磨牙急性牙髓炎患者167例,采用随机数字表法分为观察组84例和对照组83例。对照组患者予以局麻下直接拔髓,观察组患者予以局麻下牙髓失活术。比较两组患者临床缓解率、围术期指标视觉模拟评分（VAS）、首诊治疗时间、术后急症（IAE）等级及发生率、复诊时根管内探痛等级差异性。结果 两组患者临床缓解率、IAE等级及发生率比较差异无统计学意义（P＞0.05）;首诊、复诊治疗后,两组患者VAS评分均较治疗前降低（P＜0.05）,组间比较差异无统计学意义（P＞0.05）;观察组患者首诊治疗时间短于对照组（P＜0.05）,复诊时根管内探痛等级低于对照组（P＜0.05）。结论 局麻下牙髓失活术和直接拔髓治疗磨牙急性牙髓炎均有较好的止痛效果,但无法避免IAE发生。与直接拔髓比较,牙髓失活术首诊治疗时间较短,复诊时根管内探痛较轻,更适宜于临床应用。     

上颌磨牙牙根及根管解剖形态的锥形束CT研究

目的:通过锥形束CT(cone-beam computed tomography,CBCT)图像分析上颌恒磨牙牙根和根管的解剖形态.方法:对2012年5～9月因牙体牙周疾病行CBCT检查的患者资料进行回顾性分析.健康、未经过治疗、发育良好的630颗上颌第一磨牙、519颗上颌第二磨牙被纳入本研究,分析每颗磨牙的牙根数目、根管数目及根管形态,采用Venucci分类法对根管构型进行分类描述.将Vertucci Ⅰ型计为常规形态,其他类型计为变异形态,计算变异率.结果:上颌第一磨牙中,2.38％有2个独立牙根,97.14％有3个牙根,0.48％有4个牙根.上颌第二磨牙中,10.41％为单根牙,15.22％有2个牙根,73.60％有3个牙根,0.77％有4个牙根.存在3个牙根的612颗上颌第一磨牙中,近中颊根变异率为30.88％;存在3个牙根的382颗上颌第二磨牙中,近中颊根变异率为13.87％.结论:CBCT精确地显示了关于牙根及根管数目与形态的三维图像,这为疑难根管治疗提供了直观而准确的信息.     

人类年轻恒牙牙髓干细胞体外多向分化的能力

目的:从人类的年轻恒牙中分离、培养牙髓间充质细胞,并探讨其基本的干细胞生物学特性及体外的多向分化能力.方法:对人类的正畸减数年轻恒前磨牙中分离培养的牙髓细胞进行相差显微镜和透射电镜观察,利用流式细胞仪分析牙髓间充质细胞表型特征和细胞周期时相,并在体外进行定向诱导.结果:从年轻恒牙牙髓中分离培养得到的牙髓间充质细胞为成纤维样;细胞器发育较好;有间充质干细胞的表面特征:CD90,CD44和CD147阳性细胞的比例很高,CD34,CD38,CD45和 HLA-DR的阳性比例很低;有很强的增殖生长能力;经体外诱导年轻牙髓细胞可在体外向成骨细胞、脂肪细胞和神经细胞分化,但不能被诱导成为软骨细胞.结论:从人类年轻恒牙牙髓中可以分离培养得到的牙髓间充质干细胞,具有较高的增殖能力和间充质干细胞表面特征,在体外诱导下能分化为成骨细胞、脂肪细胞和神经元,具有多向分化的潜能.     

Assessment of the position and level of mental nerve for placement of implants using cone-beam computed tomography & panoramic radiograph in the Saudi population

Background and objectiveIn surgical dentistry, shape, location, position, and extent of the anterior loop of mental foramen plays a deliberately imperative landmark during an osteotomy procedure. To evade any neurological disturbance during implant surgery radiological assessment is compulsory. Therefore, the aim of the study was to assess the position and level of mental nerve for placement of implants using Cone-beam computed tomography & Panoramic radiography in the Saudi population.Materials and methodsA total of 150 CBCT and Panoramic radiographs were taken from the patients who visited the Department of Oral Medicine and Radiology. The data collection was done by using the same radiographic pieces of equipment for both CBCT and Panoramic radiographs. CBCT images taken from Kodak 9000 3D, Carestream Health, Inc., New York, USA, and Panoramic Radiographs taken from Panoramic Planmeca ProMax, Helsinki, Finland (Vujanovic-Eskenazi et al., 2015). The Chi-square test student test was used for statistical analysis.ResultsThe most frequent shape and location of mental foramen in both CBCT and Panoramic radiographs were oval and in between the first and second premolar, both in CBCT & PR views. The visibility of mental loop on CBCT & PR view showed that; visibility of mental loop in CBCT was higher with 42(56%) as compared with PR view 26(34.66%) with statistically significant p-value 0.014. The mean length of the mental loop on CBCT was statistically significant (p = 0.001). But the mean distance from the lower point of the mental foramen to the lower border of the mandible was not statistically significant.ConclusionBased on the results of the present study; the visibility of the mental loop and its extension is more in CBCT as compared with PR views. Therefore, we recommended CBCT, during of implant surgery.     

直接数字摄影技术在前磨牙邻面龋诊断中的应用

目的：探讨直接数字摄影系统图像处理技术在邻面龋诊断中的临床价值,为邻面龋的临床诊断和治疗提供参考。方法：选择邻面龋的患者拍摄数字化X线片,经过降噪处理,按患者的计算机编号随机排列,每次由3位观察者选用1种图像格局（共有正片、负片、伪3D和伪彩4种格局）共同阅片,不同图像格局的阅片间隔1周以上,以排除记忆干扰。将4种格局的阅片结果和临床诊断结果进行比较。结果：①第一前磨牙：4种图像处理格局下邻面龋的检出结果与临床诊断结果的符合率高,差异无统计学意义（P＞0.01）;②第二前磨牙:负片和伪彩图像格局下邻面龋的检出结果与临床诊断结果的符合率高,差异无统计学意义（P＞0.01）;③正片和伪3D图像格局检出结果和临床诊断结果的符合率低（P＜0.01）。结论:直接数字化X线摄影系统的图像处理技术可以用于邻面龋临床辅助诊断。     

河南省12岁儿童口腔健康流行病学调查

目的了解河南省12岁儿童口腔健康状况及常见口腔疾病的变化趋势,为有效开展儿童口腔保健工作提供依据。方法采用多阶段分层等容量随机抽样方法,选取河南省郑州市中原区、平顶山市湛河区、项城市、汝州市、濮阳县、唐河县784名12岁儿童,进行口腔疾病患病状况及口腔健康行为的流行病学研究。结果河南省12岁儿童恒牙龋齿患病率为19.13%,恒牙龋均为0.29,龋齿充填率为4.0%。牙龈出血检出率为29.61%,牙结石检出率为48.85%。结论河南省12岁儿童恒牙龋齿患病率和充填率都较低。应加强龋病的早期检查和治疗,控制儿童青少年的龋齿发病率,并大力加强农村口腔疾病的预防及治疗工作。     

Contemporary multilevel analysis of the effectiveness of water fluoridation in Australia

Aims: Water fluoridation was extended in Queensland, Australia, across 2009–2011. A research program was commenced to inform the rationale for and the outcome of this program, to estimate the effectiveness of water fluoridation in preventing caries and to predict changes in caries experience as a result of the extension of fluoridation. Methods: Queensland children were selected through a stratified random sample selection in 2010–2012. Oral epidemiological examinations provided individual‐level outcomes for decayed, missing or filled primary or permanent tooth surfaces: dmfs (among 5–8‐year‐olds) and DMFS (9–14‐year‐olds). Explanatory factors at the individual‐level, school‐level and area‐level fluoridation status were derived. Data were weighted to represent the population. Three‐level multilevel multivariable models were sequentially specified for negative binomial distribution of dmfs/DMFS to estimate rate ratios (RR). The effectiveness of area‐level water fluoridation was evaluated in the full models controlling for other factors. Results: Data from 2,214 5–8 year‐olds and 3,186 9–14 year‐olds from 207 schools in 16 areas were analysed. Queensland's average dmfs was 4.23 and DMFS 1.47. The lowest levels of dental caries were observed in long‐term fluoridated Townsville. In the full models, Townsville children had significantly lower caries experience (RR for dmfs: 0.61 (95%CI: 0.44–0.82); RR for DMFS 0.60 (95%CI: 0.42–0.88)) compared with children in non‐fluoridated areas. Conclusion: Comparison of caries experience of children at the time of the extension of water fluoridation supported the rationale for this population health measure.     

743名学龄前儿童乳牙龋病患病情况调查及防治

目的了解学龄前儿童乳牙患龋情况,制定相应的防治措施。方法对旗政府所在地的1所幼儿园434名和5个乡镇农牧区305名学龄前儿童进行口腔检查,统计患龋率、龋均及刷牙对龋病的影响。结果743名学龄前儿童患龋率为26.78%,龋均为1.28,男童和女童的患龋率差异无统计学意义,患龋率随年龄增长而增高,坚持早、晚刷牙幼儿患龋率明显低于不刷牙者,城镇学龄前儿童患龋率高于农村。结论患龋情况不容忽视,应加强对低龄幼儿的口腔保健,预防龋病要从儿童抓起,预防儿童龋病要从乳牙抓起。     

现代口腔医疗诊室设计应注意的问题

随着我国经济实力和人民生活水平的不断提高,患者对就医环境和设施有了更高的要求。很多医院正在或准备对口腔科的环境进行改善,包括诊室用房的装修和设备的更新,甚至是把口腔科整体搬迁。在这个过程中,需要对口腔科进行重新设计,这种设计不仅仅是建筑或装饰装璜意义上的,还要充分考虑到口腔科临床和口腔设备的特点。本文从口腔整体布局、管道设计、设备定位、气源设计四个方面进行详细阐述,与同行共同探讨现代口腔医疗诊室设计应注意的四问题。     

深圳市不同生源构成学校小学生患龋比较研究

目的探索不同生源构成学校小学生患龋情况,为提出针对性的龋齿预防健康教育措施和干预提供依据。方法通过分层随机整群抽样的方法获取样本,采用口腔健康检查的方法收集研究数据,利用描述性统计学方法进行比较分析。结果深圳市农民工子女就读学校小学生乳牙和恒牙患龋率分别为39.6%和16.4%,而其他学校的学生乳牙和恒牙患龋率仅分别为30.5%和15.9%;农民工子女就读学校小学生龋齿充填率分别为乳牙7.6%、恒牙8.0%,其他学校小学生龋齿充填率分别为乳牙25.6%、恒牙20.7%。结论农民工子女就读学校小学生患龋率高于其他学校学生,充填率低于其他学校学生。