制备脱细胞真皮基质的实验研究

目的 采用高渗盐一胰蛋白酶法制备脱细胞真皮基质(Acellular dermal matrix,ADM)并进行组织学观察和微生物学检测,探讨这种方法的可行性和机制。方法 SD大鼠4只,分别麻醉后以8％硫化钠溶液脱去躯干部皮毛,常规消毒铺巾,切取大鼠背部全层皮肤制成厚约0.4mm的中厚皮,1mol／LNaCl溶液37℃浸泡48h分离表真皮,以0．25％胰蛋白酶 0.1％乙二酸二乙胺(EDTA)溶液37℃分别热消化60、70、80、90min脱去细胞成分,并进行冷冻干燥处理。ADM作光镜、电镜观察和微生物学检测并比较分析每只大鼠不同时间消化处理的ADM的差别和不同大鼠经相同处理得到的ADM的差别。结果消化时间不同的ADM均具有柔软、一定的柔韧性和伸展性、弹性好、弯曲不断裂的特点,组织学观察见表皮细胞均完全去除,但是消化90min,ADM的基底膜(Basement membrane complex,BMC)和胶原纤维的结构与排列有不同程度的破坏;消化60、70min的ADM虽然基底膜和胶原纤维的结构与排列正常存在,但脱细胞不完全;消化80min制备的ADM组织学检查基底膜完整连续．胶原纤维、弹力纤维结构及排列完整规则,没有细胞成分存在。不同SD大鼠经同样的处理所得的ADM一般形状和组织学没有明显差别。微生物学检测没有细菌生长。结论采用高渗盐一胰蛋白酶法制备脱细胞真皮基质的方法能达到既完全脱去细胞成分又使基底膜完整连续,胶原纤维和弹力纤维结构及排列正常的双重目标,ADM柔韧性好、不断裂,无细菌生长。     

GI-Ⅱ型渗透陶瓷底层冠适合性及轴面聚合度对适合性的影响研究

目的　研究GI-Ⅱ型渗透陶瓷底层冠的适合性以及牙体预备时轴面聚合度对适合性的影响。方法分别为 1 5个具有三种不同聚合度 (5 、1 0 、1 5 )的上前磨牙制备GI -Ⅱ型渗透陶瓷底层冠 ,粘结后测定底冠适合性。结果　 5 、1 0 、1 5 聚合度牙体预备底层冠绝对边缘间隙量分别为 1 0 5μm、66 .2 0 μm、69.37μm。聚合度从 5 增加到 1 0 时适合性显著提高 ,1 0 以上则提高不显著。结论　GI -Ⅱ型渗透陶瓷底层冠具有良好的适合性 ,牙体预备时聚合度对GI -Ⅱ型渗透陶瓷底层冠适合性有显著影响     

Subcritical crack growth behavior and life data analysis of two types of dental Y-TZP ceramics

Objectives

The aim of this study was to evaluate the mechanical properties and the subcritical crack growth behavior of a presintered dental Y-TZP (Kavo Everest ZS) and a hot isostatic pressed Y-TZP (Kavo Everest ZH) and to perform life data analysis.

Methods

For each material 150 bending bars were produced. The initial fracture strength was determined in a four-point bending test. The subcritical crack growth parameters n and A were determined in a dynamic fatigue method at four decreasing loading rates from 110 MPa/s to 0.11 MPa/s in distilled water at 38 °C. For each loading rate Weibull statistics were performed and the Weibull moduli m and characteristic strengths σ₀ were calculated. Using these data, strength-fracture probability-life time (SPT) predictions were derived for 1 day, 1 year, 5 years and 10 years, based on a static crack growth mechanism.

Results

The “hipped” Y-TZP ceramic exhibited a higher initial strength (σ_c = 1618.18), characteristic strength (σ₀ = 837.15) and fracture toughness (K_IC = 4.52 MPa/m^1/2) than the pre-sintered ceramic (σ_c = 1431, σ₀ = 745.46 and K_IC = 3.17 MPa/m^1/2, respectively). Fatigue parameters, n and A, were 28.5 and 7.97 × 10⁻²⁴ for Everest ZH and 30.15 and 5.47 × 10⁻²⁰ for Everest ZS. The predicted fracture stress at 5% failure probability for a lifetime of 10 years was 259.34 MPa for Everest ZH and 263.2 MPa for Everest ZS.

Conclusions

Although the “hipped” Y-TZP showed favorable initial mechanical properties, no significant difference could be found in the susceptibility of both ceramics to subcritical crack growth and their long-term strength.     

Evaluation of bond strength of various margin ceramics to a zirconia ceramic

OBJECTIVE: This study evaluated the bond strengths of four different margin ceramics based on fluoroapatite and feldspath to a zirconia ceramic. METHODS: Zirconia cores (Zirconzahn) (N=28, n=7/margin ceramic group) were fabricated according to the manufacturers' instructions (diameter: 4mm; thickness: 2mm) and ultrasonically cleaned. Four different margin ceramics (thickness: 5mm) (Cerabien Zr, Noritake; Ceramco PFZ, Ceramco; e.max, Ivoclar Vivadent and Triceram, Dentaurum) were vibrated and condensed in a stainless steel mould and fired onto their zirconia cores. After trying the specimens in the mould for minor adjustments, they were again ultrasonically cleaned and embedded in PMMA. The specimens were stored in distilled water at 37 degrees C for 1 week and shear bond strength (MPa+/-S.D.) tests were performed in a universal testing machine (crosshead speed: 0.5mm/min). Failure modes were recorded under SEM. RESULTS: Significant effect of margin ceramic types were found on the bond strength values (P<0.05). The mean bond strength values of Ceramco margin ceramic to zirconia was significantly lower (25.4+/-4.5MPa) (P<0.05) than those of Cerabien (31.6+/-6.4MPa), e.max (35.9+/-8.4MPa), and Triceram margin ceramic (38.8+/-7.1MPa) systems. CONCLUSIONS: Margin ceramics, compatible with zirconia framework material tested in the present study, exhibited high bond strength values. Variations in thermal expansion coefficients might influence their bond strength values.     

CEREC陶瓷修复体的临床应用

在临床修复中，传统的瓷嵌体等修复体的制作，至少需要二次就诊时间。随着光学扫描方法和计算机辅助制作嵌体技术的应用，省去了目前操作的印模、灌模、蜡型等技术。CEREC系统运用光学印模方法以及CAD-CAM技术，将一预成陶瓷块铣磨成修复体，使牙科医生能在牙体预备后即制作一个色泽自然的陶瓷修复体，并即时粘固于预备牙上，这不仅提高了工作效率，更重要的是提高了修复体的质量。该系统不仅可以制作嵌体和高嵌体，而且还可制作各种贴面。本文的目的是介绍和描述CEREC系统制作修复体的方法步骤，并就临床应用中的有关问题加以探讨。     

瓷基台在前牙种植修复中的临床应用

目的：评估氧化铝或氧化锆瓷基台支持的种植全瓷修复体的近期临床疗效.方法：病例包括由相同的临床操作者连续完成的10例患者共17颗种植全瓷修复体.考察瓷基台有无松动及瓷基台支持的全瓷冠有无破损、折裂,同时观察全瓷修复的美学效果.观察时间为完成修复后4个月到22个月.结果：10例患者17颗瓷基台全瓷冠修复体在4～22个月内疗效良好.瓷基台及全瓷冠无松动.全瓷冠未见折裂、破损现象.患者均对全瓷修复的美学效果满意.结论：氧化铝或氧化锆瓷基台支持的种植全瓷修复方法可行,美学效果满意,其长期效果有待进一步观察.     

Gingival fluid IL-1 and IL-6 levels in refractory periodontitis

Abstract Selected gingival bacteria and cytokine profiles associated with patients who did not respond to conventional periodontal therapy (refractory) were evaluated. 10 subjects with a high incidence of post-active treatment clinical attachment loss (>2% sites/year lost ≥ 3 mm) were compared to 10 age-, race-, and supragingival plaque-matched patients with low post-treatment clinical attachment loss (<0.5% sites/year) relative to the following parameters at 2 sites/patient with the deepest probing depths: (1) presence of 3 selected periodontal pathogens (Actinobacillus antinomycetemcomitans, Porphyromonas gingivalis. Eikenella corrodens) in subgingival plaque as determined by selective culturing, and (2) gingival crevicular fluid (GCF) levels of 3 cytokines associated with bone resorption (IL-1 alpha, IL-1 beta, IL-6) as determined by two-site ELISA. Results indicated no significant differences in any clinical measurement (except incidence of clinical attachment loss), in the presence of any bacterial pathogen, or in GCF cytokine levels between refractory subject sites versus stable subject sites. However, when sites producing the greatest total GCF cytokine/patient were compared, sites from refractory patients produced significantly more IL-6 (30.1 ± 4.0 versus 15.4 ± 2.8 nM, p<0.01). The subgingival presence of each of the 3 bacterial pathogens was associated with elevated GCF IL-1 concentrations. These data suggest that gingival IL-1 and IL-6 production is different in response to local and systemic factors associated with periodontitis, and that IL-6 may play a role in the identification and mechanisms of refractory periodontitis.     

三种陶瓷酸蚀剂对Cerinate瓷和树脂粘结强度的影响

目的 :比较三种陶瓷酸蚀剂及不同酸蚀时间对Cerinate瓷与树脂粘结强度的影响。方法 :将Cerinate瓷试件分为 4组 ,一组不使用酸蚀剂 ,其余三组分别使用自制A型 (含 2 .5 %氢氟酸 )、B型 (含 6%氢氟酸 )及C型(含 10 %氢氟酸 )陶瓷酸蚀剂 ,分别酸蚀 3 0s～ 180s ,每 3 0s为一间隔 ,与树脂粘结后测试剪切强度。结果 :C配方陶瓷酸蚀剂在 3 0s时粘结强度最大 ,达 2 7.64MPa ,相应瓷表面形态最适于粘结。结论 :C配方 (含 10 %氢氟酸 )陶瓷酸蚀剂具有较好的临床应用价值。     

A one-year clinical study of indirect and direct composite and ceramic inlays

The aim of this study was to evaluate the clinical performance of four types of tooth-colored inlays. The systems included 15 direct ceramic inlays (CEREC Vita-Blocks), 15 direct composite inlays (Brilliant D.I., Coltène), 14 indirect ceramic inlays (Vita Dur N), and 14 indirect composite inlays (Estilux) in 37 patients. The inlays were evaluated clinically 1 wk (base line) and 6 and 12 months after cementation. The clinical assessments were supported by bitewing radiographs. One Vita Dur N inlay fractured after 1 yr of service, and one Brilliant D.I. inlay had to be replaced because of secondary caries. No apparent increase in plaque accumulation or gingival inflammation could be related to treatment with inlays. At base line and throughout the observation period, the Vita Dur N inlays received the highest ratings for morphology and color match. The Brilliant D.I. inlays showed the smoothest surface texture, whereas the Estilux inlays showed the roughest texture. After 6–12 months of observation, all types of inlays showed varying degrees of disintegration of the composite luting cement. Within the observation period, all inlay systems appeared to be clinically acceptable.