褪黑素促进骨再生机制及在口腔种植中的应用

背景:牙槽骨的缺损会危害患者的口颌功能和身心健康。褪黑素因具有促进骨再生特性,可用于预防和治疗骨缺损疾病,对与口腔种植相关的骨结合及种植体周围炎症也有重要应用。目的:探讨褪黑素促进骨再生机制、褪黑素在口腔种植领域的潜在应用,为在口腔种植中发挥褪黑素促骨生成特性提供新的思路。方法:以“褪黑素,骨缺损,成骨细胞,破骨细胞,活性氧,牙周炎,骨结合,种植体周围炎”为中文检索词,以“melatonin,bone defect,osteoblast,osteoclast,ROS,periodontitis,osseointegration,periimplantitis”为英文检索词,应用计算机检索中国知网、PubMed数据库收录的相关文献。检索时限重点为2019年1月至2024年8月,同时纳入少数经典远期文献。通过阅读文题和摘要进行筛选,最终纳入91篇文献进行综述。结果与结论:①褪黑素促进骨再生,机制是促进成骨细胞、软骨细胞和血管内皮细胞的增殖和分化,抑制骨吸收,限制氧化应激。②褪黑素作为骨形成的促进剂,在口腔种植中起到促进骨结合和预防种植体周围炎的作用。③未来还需要更多的研究完整地揭示褪黑素的成骨机制,并作出褪黑素在骨结合和种植体周围炎方面的最佳给药条件和安全性指南。

不同骨质条件下超短种植体应用于下颌后牙区的有限元分析

背景:有研究利用三维有限元方法分析了种植体在不同皮质骨厚度中的应力情况,得出皮质骨厚度影响种植体-骨界面位移值、等效应力值及种植体各部件等效应力值的结果。目前超短种植体在不同下颌骨骨质中的临床应用还存在不确定性。目的:利用三维有限元法分析超短种植体在下颌骨不同骨质中的应力分布及骨组织的应力分布情况。方法:选取1名下颌第1磨牙缺失患者的CT影像资料,利用Mimics软件创建下颌骨第1磨牙区域的模型,根据超短种植体奥齿泰系统中5 mm×5 mm TSⅢ型号绘制出所需要的植体及上部修复体模型,使用Geomagic Studio的偏置命令获取下颌4类不同骨质的模型(Ⅰ、Ⅱ、Ⅲ、Ⅳ类),将所有模型整合并交叉组合,给予不同方向载荷,分析各类模型受力后的范氏等效应力分布。结果与结论:(1)垂直载荷时:皮质骨最大应力在Ⅰ、Ⅱ、Ⅲ类骨质中相对于Ⅳ类骨更趋向于稳定,力也从分散于种植体周围到Ⅳ类骨时逐渐集中至种植体颈部与皮质骨连接处;Ⅰ类骨中最大等效应力峰值在中央螺丝区域,Ⅱ、Ⅲ、Ⅳ类骨中最大应力峰值则统一在种植体颈部与基台连接处。(2)侧向载荷时:皮质骨最大应力随着骨质条件的减弱呈逐渐增大的趋势;Ⅰ-Ⅳ类骨质中,最大应力峰值都集中在种植体与基台连接处,Ⅰ-Ⅲ类骨中种植体本身所受应力随着骨质的减弱表现出逐渐增大的趋势,到Ⅳ类骨时应力有所减小,此规律同样适用于修复体基台以及松质骨所受应力。(3)各类骨质中侧向载荷时所受到的最大应力值比垂直向载荷更大。

3D打印技术在口腔医学、颌面外科修复重建中的作用与优势

背景:3D打印技术独特的优势为口腔医学的发展开拓了新的思路。目的:总结3D打印技术在口腔医学中的应用进展。方法:利用计算机检索中国知网和PubMed数据库,以“3D打印,口腔科学”为中文检索词进行分类检索,以“Three-Dimensional printing,stomatology,Dentistry,prosthodontics,oral implant,orthodontics,oral and maxillofacial surgery,dental pulp disease,periodontitis”为英文检索词进行关键词检索,经阅读初步排除与文章主题不相符的文献,根据纳入标准和排除标准,最终纳入54篇文献进行汇总。结果与结论:在口腔医学领域,3D打印技术的应用范围正迅速拓展,逐步取代传统的临床诊断和治疗方式,通过结合数字化技术和先进的材料科学,3D打印可以精确地创建三维模型,为口腔疾病治疗提供了个性化解决方案,确保医师能够在手术前进行详尽的规划和预览,提高手术的安全性。3D打印技术在定制化义齿制作、个性化种植、无托槽隐形矫治等多方面呈现出了显著优势,基于此项技术,医师可以根据患者口腔结构和需求实行精准设计与制作,为患者带来良好的治疗体验和预后效果。3D打印技术在微创牙髓治疗及牙周组织再生方面也展现出了巨大潜力,3D打印的支架和植入物可为干细胞提供适宜环境,促进牙周组织的再生和修复,但目前3D打印在再生治疗仍处于发展阶段,还需更多的研究和实践来验证其临床应用的效果和安全性。

Adhesion-enhancing coating embedded with osteogenesis-promoting PDA/HA nanoparticles for peri-implant soft tissue sealing and osseointegration

Following dental implantation,the characteristic bacterial milieu of the oral cavity may lead to peri-implant inflammation,which can negatively impact osseointegration and cause implant failure.To improve soft tissue sealing around the implant,enhance osseointegration,and improve implant success rates,this paper proposes a composite multifunctional coating(PHG)prepared using gelatin and polydopamine/hydroxyapatite nanoparticles,investigates the effects of this novel coating on cell adhesion,proliferation,antibacterial activity,osteogenic differentiation,and evaluates its immune-related properties.The PHG coating was proved to have satisfactory hydrophilicity and wettability for cell attachment.Furthermore,it improved the expression of adhesion-related genes and proteins in human gingival fibroblasts,indicating its adhesion-promoting effect.Additionally,bone marrow mesenchymal stem cells exhibited strong osteogenic differentiation potential and mineralization on PHG-coated surfaces.Notably,the PHG coating exhibited antibacterial activity against Streptococcus mutans,as well as anti-inflammatory effects,potentially via the regulation of macrophages.Therefore,the proposed PHG coating may promote soft tissue sealing and bone bonding,providing a potential strategy for the surface modification of dental implants.

Study of Tissue Engineered Dental Implants of human alveolar Bone-Evaluations on their osteogenic activities invitro

The development of the activated cellular bony implant, in light of the principle on tissue engineering, has brought about a new era to the fields of dental maxillofacial implantation. The present study separated the osteoblast like cells from human alveolar bone and seeded them into 3 types of biodegradable scaffold to form the complexes and then evaluated their osteogenic activities in vitro, in order to acquire experimental data that are essential to future clinical practice of this new type of therapeutical procedure in oral and maxillofacial surgery. Material and methods: Human alveolar bone origin cells were separated from alveolar bone around the third impacted teeth of 3 patients by enzyme digestion and went on cultures with α MEM containing β glycerophosphate and Dexamethasone at 5% CO2 ,37℃ for 21 28 days. Confirmed osteoblasts like cells were then seeded onto 3 types of degradable biomaterials of polyglycolic acid scaffold, collagen sponge, and L lactic acid/ε caprolactone to form cell matrices complexes. The 3 types of complex were continued to culture for 21 28 days in vitro at the same conditions with the single layer cultured cells. The cell proliferation, morphological changes, ALPase activity and mineral nodules formation on scaffolds were measured and observed at 3 days intervals to evaluate the affinities & the osteogenic activities of the human alveolar osteoblast like cells in the 3 different complexes. Result and discussion: The results indicated that the cultured human alveolar bone origin cells from 3 patients could successfully express the osteoblasts phenotype in single layered culturing in vitro after stimulated by β glycerophosphate and Dexamethasone. It has been shown that the cultured osteoblast like cells seeded on PGAS matrix had the highest attachmental, proliferative and osteogenic activities, suggesting a good bio affinity between the human alveolar osteoblast like cells and the PGAS matrix. The statistical analysis (ANOVA) showed that there were significant differences between PGAS osteoblasts complex and CLGS or LACT complexes on osteogenic activities. (P<0.05). It was also noticed that cultured human alveolar osteoblasts seeded in biodegradable materials had a delayed peak period on cell proliferation and PLAase production ,suggesting the osteoblasts seeded on scaffolds need a period of time to adjust themselves before they can normally proliferate and expres their phenotypes. Conclusion: PGAS osteoblasts complex is worth to be further developed into a tissue engineered cellular artificial bony implant for reconstructing the oral maxillofacial bony defects in a more effective way in the future.

Mineralized and Osteoid Tissue from Dental Pulp Stem Cells on Micro-arc Oxidation Titanium in vitro

The presence of insufficient bone volume affects the implant healing and success.The aim of this study was to evaluate osteogenic capacity of dental pulp stem cells(DPSCs) on micro-arc oxidation(MAO) titanium surface.DPSCs were challenged at MAO and smooth titanium surface separately for different durations,and the bone marrow mesenchymal stem cells(BMSCs) served as the positive controls.The osteogenic capacity of DPSCs on MAO titanium surface was assessed by using scanning electron microscopy,energy dispersive spectroscopy,biochemical tests and real-time quantitative PCR.Data showed that DPSCs differentiated into osteoblasts and expressed bone morphogenetic genes on MAO titanium surface.The results of this study revealed that DPSCs had good potential to generate mineralized tissue on MAO titanium plates.The differential potential of DPSCs may be regulated by MAO titanium surface.The osteogenesis potential of DPSCs on the MAO titanium was similar with BMSCs.

Study of the bones tissue reparation using nanostructured titanium implants with hydroxylapatite coatings by scanning electron microscopy

A method of medical implants (biocomposites) preparation based on nanostructured titanium with nanocrystalline bioactive hydroxylapatite coatings is developed. The operative treatment using these implants improves the regeneration of bone tissue for rats, as compared to the “false-operated” animals. The morphological data at 7, 14, 21, 45 days are obtained by means of scanning electron microscopy and discussed.

MRI-Induced Tissue Heating at Metallic Sutures (Cerclages)

Magnetic resonance imaging (MRI) has become an important diagnostic tool with an ongoing dynamic development towards application of increasing static magnetic flux densities and consequently, exposures to electromagnetic fields (EMF) of increasing radio frequencies (RF). This raises particular concern metallic implants could lead to excess tissue heating and consequently, to thermal tissue damage. In thorax surgery the intersected sternum is reconnected by metallic sutures (cerclages). To investigate whether patients with such implants can be accepted for MRI and whether there may be limitations with regard to static magnetic fields, by numerical anatomical and thermal modelling MRI induced tissue heating was assessed for magnetic flux densities 1.5 T, 3 T, 4 T and 7 T. Results show that overall tissue temperature increased with increasing RF EMF frequency. However, even for setting MRI exposure parameters at maximum permissible level partial body heating remained marginally affected and even at local level the additional contribution of the presence of the metallic cerclage remained below 1°C. This allows concluding that from a heating point of view metallic sutures as used to fix the sternum after thorax surgery are no contraindication for MRI with static magnetic flux densities up to 7 T.

The Tissue Reactions and Changes of a Surface of Various Metal Implants after Their Introduction in a Bone Tissue in Experiment

Screw metal implants (3S, Israel) with rough or smooth polished surface were introduced in a tibial proximal condyle of not purebred rabbits. The condition of surrounding tissues in 2 and 6 months after implantation was compared by light microscopy and X-ray methods. Within 6 months after operation the considerable distinctions of radiological and morphological data were revealed not. 2 months later after introduction of implants with a rough surface the effort enclosed for its twisting is, much more, than for removal of the polished product. However, stability of fixing of implants was practically made even at 6 months. On remote rough implants there is a set of tissue scraps whereas on products with a smooth surface the tissue remains were much less. Surrounding tissues strongly join a rough surface, grow into cavities, and during removal of such products there is a considerable trauma of tissues round an implantation place. Smooth implants have the smaller area of contact with organism tissues, they are fixed due to bicortical implantation, during removal easily get out and don’t break off surrounding tissues. The signs of inflammation and formation of merged multinuclear macrophages were not found at all cases, which give evidence to the inertness of material of the mentioned articles for living organism. In some observations however and by implantation of the rough article and by introduction of polished implants, metal particles were found, but after use of the foreign body with grit-blasted treatment of surface metal was found more frequently, and its fragments had larger volume.

GUIDED TISSUE REGENERATION AROUND DENTAL IMPLANTS IN IMMEDIATE EXTRACTION SOCKETS:COMPARISON OF RESORBABLE ANDNONRESORBABLE MEMBRANES

This study was per formed to compare the efficacy of guided tissue regeneration (GTR) around dentalimplants immediately placed into extraction sockets by resorbable of nonresorbable membranes. Mandibular. P2, P3, and P4 of four aduIt beagle dogs were extracted bilaterally, and buccal standard defects were cre-ated and measured. Eighteen commercially pure titanium Steri-Oss implant fixtures were placed into thefresh extraction sockets. Four implants were untreated controls, four implants received polytetrafluoro-ethylene (e-PTFE, Gore-Tex) membranes, five implants received collagen membranes (ParaGuide), andfive implants received polyglactin 910 mesh (Vicryl). After l4 weeks, clinical measurements were takenand the dogs were sacrificed and all specimens retrieved for histologic and histomorphometric evaluation.The average gain in bone height was 2. 1mm for untreated control sites, 3. 3mm for Gore-Tex sites,3. 8mm for collagen sites, and 1. 3mm for polyglactin 910 sites. The greatest gain in bone height and volume was seen for two sites that received Gore-Tex membranes and remained covered for the entire evalua-tion interval. The results of this study indicate that Gore-Tex and collagen membrane preduced gdri re-sults for GTR around Implants immediately placed into extraction sockets. Since collagen membrane doesnot cause obvious infection and does not need the surgical reentry for membrane removal, it can be a validalternative to Gore-Tex membrane to improve bone regeneration around dental implants, while polyglactin910 mesh seems not suitable to be used as GTR membrane in immediate implantation for its hIgh infectionrate.

内窥镜辅助龈下刮治联合赤藓糖醇龈下喷砂治疗种植体周围炎的疗效评价

目的:研究内窥镜辅助龈下刮治联合赤藓糖醇龈下喷砂技术治疗种植体周围炎的临床疗效,为种植体周围炎的有效治疗提供理论依据。方法:选择本院牙周科就诊并接受治疗的种植体周围炎患者,按就诊时间共有58例种植体周围炎患者陆续进入观察,按随机数字表法分为对照组(28例)和微创组(30例);对照组患者采用传统盲视龈下刮治治疗,微创组患者采取内窥镜辅助龈下刮治联合赤藓糖醇龈下喷砂治疗。分析2组患者治疗前后探诊深度(PD)、改良菌斑指数(mPLI)和改良龈沟出血指数(mSBI)以及龈沟液中白细胞介素1β(IL-1β)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平。结果:治疗前2组患者PD、mPLI和mSBI及龈沟液中IL-1β、IL-6和TNF-α水平比较差异无统计学意义(P>0.05),具有可比性。治疗后2组患者PD、mPLI和mSBI,龈沟液中IL-1β、IL-6和TNF-α水平均较治疗前明显下降(P<0.05)。与对照组比较,微创组患者治疗后PD、mPLI和mSBI明显降低(P<0.05);龈沟液中IL-1β、IL-6和TNF-α水平也明显降低(P<0.05)。结论:在短期内采用内窥镜辅助龈下刮治联合赤藓糖醇龈下喷砂技术治疗种植体周围炎更有助于控制种植体周围组织的炎症,改善临床症状。

黄连素治疗大鼠种植体周围炎的机制

目的探讨黄连素治疗大鼠种植体周围炎的作用以及对Toll样受体4(Toll-like receptor 4,TLR4)/核因子κB(nuclear factorκB,NF-κB)信号通路的影响。方法建立SD大鼠种植体周围炎大鼠模型,随机分为模型组、黄连素低剂量组、黄连素高剂量组和抗生素组,另设阴性对照组。黄连素低、高剂量组予以100、200 mg·kg^(-1)黄连素,抗生素组予以200 mg·kg^(-1)阿莫西林胶囊和100 mg·kg^(-1)甲硝唑片,模型组和阴性对照组予以等体积生理盐水,连续干预4周。观察各组大鼠种植体一般情况,用牙周探针测量大鼠种植体探诊深度(probing depth,PD)和牙龈指数(gingival index,GI);计算机断层扫描(computed tomography,CT)测量大鼠种植体周围骨高度与骨密度;用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测大鼠种植体周围牙龈组织中肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-6(interleukin-6,IL-6)的含量;蛋白印迹法(Western blotting)检测大鼠种植体周围牙龈组织中TLR4/NF-κB信号通路相关蛋白的表达情况。结果模型组、黄连素低剂量组、黄连素高剂量组、抗生素组及阴性对照组大鼠PD和GI指数逐渐降低,种植体周围骨高度、骨密度逐渐升高,牙龈组织中TNF-α、IL-1β水平逐渐降低,种植体龈沟液中Ⅱ型胶原(collagen-Ⅱ,COL-Ⅱ)和基质金属蛋白酶13(matrix metalloproteinase-13,MMP-13)活性逐渐升高(P<0.05)。模型组、黄连素低剂量组和黄连素高剂量组及阴性对照组,大鼠种植体周围牙龈组织中TLR4、MyD88和p-NF-κB-65蛋白的相对表达量逐渐降低(P<0.05)。结论黄连素对大鼠种植体周围炎有一定治疗作用,其机制可能与抑制TLR4/NF-κB信号通路有关。

光动力疗法辅助治疗种植体周炎的短期非随机对照临床研究

目的探究使用光动力疗法(photodynamic therapy,PDT)辅助机械性龈下清创(mechanical debridement,MD)治疗种植体周炎(peri-implantitis)的短期临床疗效。方法根据2018牙周病新分类标准,纳入临床上诊断为种植体周炎的单颗种植体(单冠修复)患者,治疗前记录种植体周探诊深度(probing depth,PD)、改良龈沟出血指数(modified sulcus bleeding index,mSBI)和改良菌斑指数(modified plaque index,mPLI),以mSBI≥1的位点作为治疗位点。MD组为对照组,仅对治疗位点行机械性龈下清创;PDT组为治疗组,在龈下清创后即刻和治疗后1周,共行两次辅助性光动力治疗。结束治疗后6周、12周复查,检查所纳入患者种植体治疗位点的PD、mSBI和mPLI的变化。结果本研究共纳入35例患者,发生种植体周炎的植体38枚,共计154个治疗位点。PDT组和MD组各纳入20枚和18枚植体,其中PDT组纳入治疗位点共78个,PD≥6 mm的位点共51个,PD<6 mm的位点共27个;对照组纳入治疗位点共76个,PD≥6 mm的位点共53个,PD<6 mm的位点共23个。基线时两组的PD、mSBI和mPLI均无统计学差异,治疗后6周及12周复查时,两组各临床指标与基线相比均获得显著改善(P<0.05),其中PDT组治疗后6周的mSBI显著低于MD组(P<0.05)。在PD≥6 mm的位点中,PDT组的mSBI在治疗后6周、12周复查时均显著低于MD组(P<0.05)。PDT组和MD组在12周复查时达到治疗终点的植体百分比分别为70.00%和55.56%,无统计学差异(P>0.05)。结论光动力疗法辅助机械清创可以有效治疗种植体周炎,是一种安全有效的辅助治疗手段,对改善深种植体周袋(PD≥6 mm)的炎症以及mSBI具有显著疗效。

Clinical Study on the Relationship between Fixation of Prosthesis and Health of Surrounding Tissues

[Objectives] To explore the effect of mouth outside bonding screw fixation and inside bonding fixation in implanting the prosthesis( crown or bridge) on the health of surrounding tissues,to provide a certain reference for the selection of fixation methods for clinically implanting the prosthesis. [Methods]160 cases of patients needing implanting the prosthesis due to dental arch deficiency were selected. They had excellent alveolar bone. They did not smoke,had no diabetes,and their bone tissue healing was at the early stage. They were randomly divided into A and B groups,80 cases in each group. Group A: the mouth inside and abutment of prosthesis was bonded to a single abutment crown or a single abutment bridge; the bonder on the surface of prosthesis was completely removed and then moved into the implant,and fixed with central retaining screw,this group was called " mouth outside bonding group". Group B: the abutment was located in the implant and fixed using central retaining screw,then the prosthesis( crown or bridge) was bonded to the abutment,the bonder on the surface of prosthesis was removed,and this group was called mouth " mouth inside bonding group". The health condition was compared between two fixing methods for the surrounding tissues of the implant in 24-36 months after restoration. [Results] Group A: the surrounding tissues of the implants for 126 teeth of 80 patients were healthy without occurrence of peripheral inflammation; Group B: in the implants of 112 teeth of 80 patients,7 teeth suffered the peripheral inflammation. Dental implant examination found that there was residue of bonder in the bonding of prosthesis and abutment,3 teeth exfoliated,and 4 teeth were restored after treatment. Through the X2 test,there was significant difference between Group A and Group B( P < 0. 05). [Conclusions] Implant-supported denture often adopts the mouth inside bonding. Since the bonder can not be removed completely,its residue will remain in gingival trough and stimulate the surrounding tissues of the implant and bring about the inflammatory reaction,and even lead to exfoliation of the implant; the mouth inside and abutment of prosthesis was bonded to a single abutment crown or a single abutment bridge,the bonder on the surface of prosthesis was completely removed and then moved into the implant,and fixed with central retaining screw. This method is an effective method for preventing the peripheral inflammation and increasing the success rate of dental implant.

微种植体支抗加力方式对上颌前突患者关闭拔牙间隙后颌面部软、硬组织影响的研究

目的:探讨微种植体支抗加力方式对上颌前突患者关闭拔牙间隙后颌面部软、硬组织的影响。方法:选取2020年4月-2023年6月在上海交通大学医学院附属第九人民医院口腔外科、口腔颅颌面科收治的156例上颌前突患者作为研究对象。所有患者均需拔除上颌双侧第一前磨牙并使用微种植体支抗内收上前牙,采用随机数字表法将患者分入A组(予以短牵引钩和直接支抗法,n=52例)、B组(予以长牵引钩和直接支抗法,n=52例)和C组(予以短牵引钩和间接支抗法,n=52例)关闭拔牙间隙。比较三组治疗前后颌面部软硬组织变化。结果:关闭间隙前,三组患者颅颌软组织、硬组织指标比较差异无统计学意义(P>0.05),但B组鼻根点与上、下齿槽座点三者连线的夹角(ANB)大于A组、C组(P<0.05)。关闭间隙后,三组患者蝶鞍点与鼻根点,上齿槽座点三者连线的夹角(SNA)、蝶鞍点与鼻根点,下齿槽座点三者连线的夹角(SNB)、下颌平面角(SN-MP)、上中切牙内收量(U1-SN)、鼻唇角、牙冠舌向移动量(U1c-Sv)、覆盖、上颌第一磨牙近中颊尖点、近中根尖点压低量(U6c-H、U6r-H)变化值比较差异无统计学意义(P>0.05),ANB、颌平面角(SN-OP)、上颌第一磨牙内收量(U6-SN)、牙根舌向移动量(U1r-Sv)、上中切牙切缘点、牙根尖点压低量(U1c-H、U1r-H)、上颌第一磨牙近中颊尖点、近中根尖点与Sv距离(U6c-Sv、U6r-Sv)、上颌第一磨牙近中颊尖点、近中根尖点压低量(U6c-H、U6r-H)、覆(牙合)变化值比较差异有统计学意义(P<0.05);且B组ANB、Ls-E线变化值大于C组(P<0.05),A组SN-OP、U6-SN、U1c-Sv变化值大于C组(P<0.05);B组U1r-Sv、U1c-H变化值大于A组、C组,且C组大于A组(P<0.05);B组U1r-H变化值大于A组、C组,且A组大于C组(P<0.05);C组U6c-Sv变化值大于B组(P<0.05);A组U6c-H、U6r-H变化值大于B组(P<0.05);B组覆(牙合)变化值大于A组、C组(P<0.05)。结论:三种不同的微种植体支抗加力方式用于上颌前突患者均具有较好的支抗效果,可改善上颌硬组织的形态,并引起相应软组织的改变。其中,短牵引钩配合直接支抗法能明显压低磨牙、使冠远中倾斜,且(牙合)平面顺时针旋转;长牵引钩配合直接支抗法可获得更好的前牙控根移动和压低效果,且对上前牙垂直向改变效果也较好,有益于覆(牙合)控制,与短牵引钩配合间接支抗法均可获得较好的滑动内收力,稳定(牙合)平面。

TSLP、HIF-1α、RANKL在义齿修复后种植体周围炎患者龈沟液中的表达及意义

目的研究胸腺基质淋巴细胞生成素(TSLP)、缺氧诱导因子1α(HIF-1α)、核因子-κB受体活化因子配体(RANKL)在义齿修复后种植体周围炎(PI)患者龈沟液中的表达及意义。方法回顾性选取2019年8月至2023年8月大同市第五人民医院收治的义齿修复患者86例作为研究对象,根据术后3个月是否发生PI将患者分为预后良好组(n=61)和预后不良组(n=25)。比较两组患者的临床资料及术前龈沟液TSLP、HIF-1α及RANKL水平,采用多因素Logistic回归分析对龈沟液TSLP、HIF-1α及RANKL水平与义齿修复患者术后发生PI的关系进行分析,采用受试者操作特征(ROC)曲线分析TSLP、HIF-1α及RANKL水平对义齿修复患者的预后评估价值。结果两组患者临床资料(性别、年龄、病程、义齿种植原因及种植颗数)比较,差异均无统计学意义(P>0.05)。预后良好组患者的龈沟液中TSLP、HIF-1α、RANKL水平分别为(122.57±11.30)ng/L、(417.79±115.43)ng/mL、(116.02±13.45)pg/μL,均明显低于预后不良组[(138.93±12.70)ng/L、(576.55±177.60)ng/mL、(133.24±15.69)pg/μL],差异均有统计学意义(P<0.05)。Logistic回归分析义齿修复患者预后,结果显示龈沟液中TSLP水平升高、HIF-1α水平升高和RANKL水平升高是义齿修复患者术后发生PI的独立危险因素(OR=1.119,95%CI:1.048~1.195;OR=1.007,95%CI:1.002~1.013;OR=1.065,95%CI:1.016~1.117;P<0.05)。ROC曲线分析龈沟液中TSLP、HIF-1α、RANKL水平预测义齿修复患者预后的价值,结果显示曲线下面积(AUC)值分别为0.833、0.786和0.809。其中,RANKL具有最高的特异度(0.852),而HIF-1α具有最高的敏感度(0.800),具有较好的预测价值(P<0.05)。结论龈沟液中TSLP、HIF-1α、RANKL水平升高是义齿修复患者术后并发PI的独立危险因素,且均具有较高的预测义齿修复患者预后的价值。

微螺钉支抗治疗对口腔正畸患者牙龈指标及牙根周组织的影响分析

目的分析微螺钉支抗治疗对口腔正畸患者牙龈指标及牙根周组织的影响。方法选取100例口腔正畸患者,随机分为对照组(50例)与研究组(50例)。对照组选择非种植体支抗治疗,研究组则选择微螺钉支抗治疗。比较两组的临床疗效、牙龈指标[牙菌斑指数(PLI)、牙龈指数(GI)以及龈沟出血指数(SBI)]、牙根周组织损伤情况。结果研究组的总有效率96.0%显著高于对照组的82.0%(P<0.05)。相比于治疗前,两组治疗后的PLI、GI及SBI均明显下降(P<0.05);且研究组治疗后的PLI(1.28±0.25)分、GI(1.06±0.11)分、SBI(1.15±0.14)分均明显低于对照组的(1.87±0.34)、(1.43±0.14)、(1.68±0.15)分(P<0.05)。研究组的牙根周组织受损率24.0%显著高于对照组的8.0%(P<0.05)。结论选择微螺钉支抗治疗口腔正畸患者能取得显著疗效,能对牙龈情况进行显著改善,但是却会在一定程度上影响、损伤牙根周组织,所以在实际的临床治疗中应严格遵循相关的规范开展各项操作,以减少操作失误。

基于Langer线的穿刺体位对肿瘤化疗患者输液港难免性医用黏胶相关皮肤损伤的预防效果研究

目的探究基于Langer线的无损伤针穿刺体位对肿瘤化疗患者输液港难免性黏胶相关皮肤损伤的预防效果。方法通过平行胸部Langer线对床头抬高60~90°和平卧位穿刺进行皮肤软组织力学、表皮屏障功能理论分析,然后选取2019年5月至2020年5月南京医科大学第一附属医院肿瘤科79例植入胸壁输液港、既往应用Ⅳ3000及液体敷料皮肤保护性屏障仍出现输液港黏胶相关性皮肤损伤的患者为研究对象。采用前瞻性自身前后对照,干预前采用平卧位穿刺,干预后床头抬高60~90°穿刺,比较两种穿刺体位对输液港黏胶相关性皮肤损伤预防效果和带针期间舒适度的影响。结果干预后患者输液港黏胶相关性皮肤相关性损伤总发生率较干预前显著降低(P<0.001),机械性损伤发生率、接触性皮炎发生率较干预前显著降低(均P<0.05),输液港带针期间舒适度较干预前明显提高(P<0.001),且不增加患者穿刺时的疼痛感(P=0.692)。结论床头抬高60~90°穿刺可降低肿瘤化疗患者输液港难免性黏胶相关皮肤损伤,提高患者带针期间的舒适度。

3D打印假体在上肢围关节骨缺损治疗中的研究进展

因传统的骨缺损治疗手段在围关节区应用受限,肿瘤、创伤、感染和翻修等多种原因造成的上肢围关节骨缺损的临床处理是骨科医生面临的棘手难题。应用3D打印假体植入直接修复骨缺损的治疗方法已在临床逐渐获得接受与推广,然而目前多数研究停留于病例报告,缺少相关综述报道。本文于国内外数据库检索和收集2010—2022年间发表的相关文献,汇集3D打印假体治疗上肢围关节骨缺损的相关临床研究,从假体结构、重建解剖部位、临床应用背景及临床疗效等角度进行综述分析,旨在总结3D打印假体在上肢围关节骨缺损治疗中的应用现状,并明确该治疗方法的优势及不足,为未来的3D打印骨科材料及临床研究提供指导。

基于随机森林和人工神经网络构建种植体周炎的诊断模型

目的 本研究旨在揭示种植体周炎发生发展过程中参与调控的关键基因,并通过随机森林(RF)和人工神经网络(ANN)构建种植体周炎的诊断模型。方法本研究从GEO数据库中获取GSE33774、GSE106090和GSE57631数据集。对GSE33774和GSE106090数据集进行差异表达和功能富集分析,通过蛋白质互作网络(PPI)和RF筛选出关键基因,利用ANN建立种植体周炎的诊断模型,并在GSE33774和GSE57631数据集中进行验证。同时,构建转录因子-基因相互作用网络和转录因子-微小RNA (miRNA)调控网络。结果 本研究共筛选出124个参与调控种植体周炎的差异表达基因(DEGs)。富集分析结果表明,DEGs主要和免疫受体活性蛋白及细胞因子受体活性相关,主要参与白细胞和中性粒细胞迁移的过程。PPI和RF筛选出6个关键基因,分别为CD38、CYBB、FCGR2A、SELL、TLR4和CXCL8。受试者操作特征曲线(ROC)表明ANN模型具有较好的诊断性。本研究还发现FOXC1、GATA2和NF-κB1可能是种植体周炎中重要的转录因子,hsa-miR-204可能是关键的miRNA。结论 RF和ANN构建的种植体周炎的诊断模型可信度高,CD38、CYBB、FCGR2A、SELL、TLR4和CXCL8是潜在的诊断标志物。FOXC1、GATA2和NF-κB1可能是种植体周炎中重要的转录因子,hsa-miR-204作为关键的miRNA在其中扮演着重要角色。