含钛合金和金铂合金烤瓷熔附金属对犬牙龈组织形态学的影响

Effects of titanium alloy and gold-platinum alloy porcelain-fused-to-metal on canine gingival tissue morphology

背景:临床病例中很少有同一患者采用两种金属进行全冠修复,因此实验利用犬为动物模型,同时进行上、下颌修复,为牙龈组织形态分析提供了方便。目的:比较钛合金和金铂合金两种金属烤瓷修复体对犬牙龈组织超微结构的影响。设计、时间及地点:组织形态学对比观察,实验于2006-09/2008-05在辽宁医学院第二临床医院口腔修复实验室完成。材料:钛合金(含钛4%～6%的Tilite合金)由美国Talladium公司提供、金铂合金(含金86.8%,铂11.7%,锢、铱<1%)由深圳美冠达牙科技术有限公司提供。方法:选择健康成年杂种犬3只,每只犬为42颗恒齿。每只犬右侧上颌选8颗犬牙制作钛合金烤瓷熔附金属修复体冠,右侧下颌选8颗犬牙制作金铂合金烤瓷熔附金属修复体冠,左侧为正常对照组。主要观察指标:通过光镜和透射电镜观察犬牙龈组织的超微结构,用TUNEL方法检测细胞凋亡情况。结果:钛合金修复体组光镜下可见牙龈组织有炎性细胞浸润,局部血管出血;金铂合金修复体组牙龈组织未见炎性细胞浸润及局部血管出血。钛合金修复体组电镜下可见细胞凋亡,凋亡指数(43.34±18.27)%,有细胞核固缩等反应;金铂合金修复体组细胞凋亡很少,凋亡指数(26.90±17.35)%。统计分析显示钛合金组和金铂合金组的凋亡指数与正常对照组比较差异有显著性意义(P<0.05),钛合金组凋亡指数显著高于金铂合金组(P<0.05)。结论:金铂合金烤瓷熔附金属修复体对犬牙龈组织超微结构的影响较小。选用金铂合金作为烤瓷熔附金属修复体基底冠的临床效果更好。

BACKGROUND： There are few patients who used two kinds of metal for complete coronal restoration. Thus, this study selected dogs as animal models for supramaxillary and mandibular repair, and provided convenience for analysis of tissue and morphology of gingival. OBJECTIVE： To compare the effects of titanium alloy and gold-platinum alloy porcelain-fused-to-metal on ultrastructure of canine gingival tissue. DESIGN, TIME AND SETTING： The histomorphological controlled study was performed at the Laboratory of Mouth Rehabilitation, Second Clinical Hospital, Liaoning Medical University between September 2006 and May 2008. MATERIALS： Titanium alloy porcelain-fused-to-metal （Ti 4% 6% Tilite） was provided by Talladium, USA. Gold-platinum alloy （Au 86.8%, Pt 11.7%, Co, Ir 〈 1%） was provided by Mecodent Company Limited of Shenzhen City. METHODS： Three healthy adult hybrid dogs （42 permanent teeth in each dog） were selected. Eight canine teeth at right upper mandible from each dog were used to establish titanium alloy porcelain-fused-to-metal, and eight teeth at right lower mandible were selected to establish gold-platinum alloy porcelain-fused-to-metal. Left sides served as normal controls. MAIN OUTCOME MEASURES： The ultramicrostructure of canine gingival tissue was observed under the optical microscope and transmission electron microscope. Apoptosis was detected by TUNEL. RESULTS： Under the optical microscope, inflammatory cells infiltrated and partial angiorhagia could be seen in the titanium alloy porcelain-fused-to-metal, and no inflammatory cell infiltration or angiorhagia was determined in the gold-platinum alloy porcelain-fused-to-metal. Under transmission electron microscope, there were many reactions such as apoptosis with apoptotic index of （43.34 ＋_ 18.27）% and karyopyknosis in titanium alloy porcelain-fused-to-metal. Less apoptosis could be seen in the gold-platinum alloy porcelain-fused-to-metal, with apoptotic index of （26.90 ＋ 17.35）%. There were significant differences in apoptotic index between the titanium alloy porcelain-fused-to-metal and gold-platinum alloy porcelain-fused-to-metal （P 〈 0.05）. Apoptotic index was significantly greater in the titanium alloy porcelain-fused-to-metal compared with the gold-platinum alloy porcelain-fused-to-metal （P 〈 0.05）. CONCLUSION： The gold-platinum alloy porcelain-fused-to-metal had less influence on the ultramicrostructure of canine gingival tissue. Clinical outcome was better in gold-platinum alloy porcelain-fused-to-metal as basal crown.