显微牙周手术后犬齿周软组织早期愈合过程的组织学研究

Histological evaluation of early soft tissue healing after periodontal microsurgery in canines

目的:比较显微牙周手术与传统牙周手术术后软组织早期愈合方面的差异。方法:选择4只成年家犬(12~14月龄,体质量为6~7千克),共24个颊侧牙龈手术位点,随机分为对照组和显微组。对照组使用传统手术器械、采取肉眼下操作,显微组使用显微器械、在手术显微镜下操作。分别在术前,术后即刻,术后1、3、5 d观察并记录创口情况,术后3、5 d对术区取样并固定,垂直于切口制作组织切片,进行HE染色、抗角蛋白14免疫组化染色、天狼星红染色,经高分辨率病理切片扫描分析系统扫描并进行组织学观察。另外,在腭侧黏膜上选择2个对称位点进行切口形态观察,对照组在肉眼下实施手术操作,显微组在手术显微镜下实施手术操作。结果:超景深显微镜观察显示,显微组切口切缘组织损伤较少,无明显撕裂痕迹。大体观察,两组均无感染,对照组组织水肿程度较重,切口处痕迹明显,术后5 d早期切口愈合指数达到1级的比例,对照组为33%,显微组为83%。术后3 d,对照组组织炎症反应较为明显,炎症反应评分高于显微组(P<0.05)。术后5 d,显微组组织上皮封闭较好,结构较完整,再上皮化评分高于对照组(P<0.05)。偏振光显微镜观察天狼猩红染色组织,术后5 d,显微组组织中Ⅲ型胶原纤维面积占比较对照组高,两组间具有统计学差异(P<0.05)。结论:显微牙周手术相较于传统手术技术,对组织的损伤较小,组织反应较轻,能够较好的保存组织结构;有利于切口封闭,手术后愈合速度较快,愈合质量较高。

AIM:This study aimed to compare the differences in early soft tissue healing between periodontal microsurgeries and traditional periodontal surgeries.METHODS:Four adult dogs(age:12~14 months,weight:6~7 kg)were used in the study.Twenty-four buccal gingival surgical sites were randomly assigned to a control group and a microsurgical group.The control group underwent surgery using traditional surgical instruments and performed under direct vision,while the microsurgical group underwent surgery using microsurgical instruments under an operating microscope.The surgical sites were observed and recorded preoperatively,immediately postoperatively,and at 1,3,and 5 days postoperatively.Tissue samples were taken and fixed at 3 and 5 days postoperatively.Vertical tissue sections were made perpendicular to the incisions and subjected to HE staining,cytokeratin 14 immunohistochemical staining,and Sirius Red staining.Tissue sections were scanned and analyzed using a high-resolution pathological section scanning and analysis system.In addition,two symmetrical sites were selected on the palatal mucosa for incision morphology observation.The control group underwent surgery under direct vision,while the microsurgical group underwent surgery under an operating microscope.RESULTS:Observation using a super depth-of-focus microscope showed minimal tissue damage and no significant tearing observed in the microsurgical group.Macroscopic observation revealed no infections in either group;however,the control group exhibited greater tissue swelling and more evident incision marks.The proportion of early healing incisions achieving a healing index score of 1 at 5 days postoperatively was 33%in the control group and 83%in the microsurgical group.At 3 days postoperatively,the control group exhibited more pronounced inflammatory reactions,with higher inflammation scores than the microsurgical group(P<0.05).At 5 days postoperatively,the microsurgical group showed better epithelial closure with a more intact structure,and higher re-epithelialization scores compared to the control group(P<0.05).Observation using polarized light microscopy of Sirius Red-stained tissue at 5 days postoperatively demonstrated a higher proportion of type III collagen fiber area in the microsurgical group compared to the control group,with statistical significance(P<0.05).CONCLUSION:Periodontal microsurgeries result in minimal tissue damage,reduced tissue reaction,preservation of tissue structure,improved incision closure,faster postoperative healing,and higher-quality healing compared to traditional periodontal surgeries.