1型糖尿病条件下拔牙窝愈合规律初探

A primary study on the healing rule of tooth extraction socket in the subjects with type 1 diabetes mellitus

目的:探究1型糖尿病(T1DM)条件下拔牙窝的愈合规律。方法:将成年雄性新西兰兔分为正常组和T1DM建模组,每组15只。分别拔除双侧上颌切牙,拔牙后3d、1周、2周、4周和8周分别处死3只取材。拍摄microCT观察骨愈合情况;HE染色观察牙槽窝组织炎症程度与血管生成,Masson染色和番红-固绿染色观察牙槽窝骨组织形成;免疫组化检测TNF-α和CD31的表达。结果:术后3d时T1DM组拔牙窝较正常组炎性细胞浸润显著增多(P<0.01),TNF-α表达水平显著升高(P<0.01);1周时T1DM组拔牙窝较正常组血管数量显著减少(P<0.01),CD31表达水平显著下降(P<0.01);2、4和8周时T1DM组拔牙窝较正常组骨形成更差,骨体积分数(BV/TV)与骨小梁数量(TbN)显著降低(P<0.05)。结论:T1DM个体拔牙窝愈合过程中,早期炎症程度显著,血管生成较差,影响前期骨形成与后期骨改建,导致拔牙窝骨愈合不佳。

Objective:To investigate the healing rule of tooth extraction socket in the subjects with type 1 diabetes mellitus(T1DM).Methods:Adult male new zealand rabbits were divided into normal and T1DM modeling groups(n=15).Bilateral maxillary incisors were extracted,and 3 rabbits were sacrificed at 3 days,1,2,4 and 8 weeks respectively after extraction.Micro CT was taken to observe bone healing.HE staining was used to observe the degree of inflammation and angiogenesis of alveolar fossa tissue.Masson staining and Saffron-solid green staining were used to observe the formation of alveolar fossa bone.The expression of TNF-αand CD31 was detected by immunohistochemistry.Results:3 days after operation,the infiltration of inflammatory cells was increased in the T1DM group compared with the normal group(P<0.01),the expression level of TNF-αwas increased(P<0.01).1 week after operation,the number of blood vessels in the extraction socket of T1DM group was lower than that in the normal group(P<0.01),the expression level of CD31 decreased(P<0.01).2,4 and 8 weeks after operation,the bone formation in the T1DM group was worse than that in the normal group,and the bone volume fraction(BV/TV)and trabecular bone number(TbN)were significantly decreased(P<0.05).Conclusion:The early inflammation is more significant in the healing process of tooth extraction socket in the subjects with T1DM,which leads to poor angiogenesis and affects the bone formation in the early stage and bone remodeling in the late stage,and ultimately leads to poor bone healing in tooth extraction socket.