Pulp Revascularization: Future Therapy of Tooth with Open Apex

Introduction: The endodontic management of necrotic permanent immature teeth is a challenge for the practitioner. These teeth are treated by apexification. However, because of the complications associated with this treatment, researchers have developed other therapies. Currently, a new technique called pulp revascularization has emerged. This technique allows the continuation of root completion thanks to a healthy tissue newly formed at the intra root canal level. Material and method: A literature search of articles dealing with pulp revascularization of immature permanent teeth was conducted using two types of search strategy, a literature search using keywords on databases and then a manual “bottom-up” search of references of previously identified articles. Results: 112 articles were identified based on inclusion and exclusion criteria. Discussion: This work showed that pulp revascularization is a new therapy that aims to restart root development on an immature permanent tooth. It is based on the principle of tissue engineering and uses the differentiation potential of stem cells. Conclusion: Currently, the literature values revascularization as it allows root development, sidewall thickening, apical closure and a decrease in periapical lesion and ensures a good sealing. Clinical and radiographic success rates appear to be encouraging, except that factors influencing treatment must be taken into consideration.

Evaluation of the local inflammatory stress response and pain mediator secretion after impacted wisdom tooth extraction with high-speed turbine drill combined with original luxator

Objective: To study the local inflammatory stress response and pain mediator secretion after impacted wisdom tooth extraction with high-speed turbine drill combined with original luxator. Methods: Patients who received impacted wisdom tooth extraction in the First People's Hospital ofYunnan Province between March 2014 and June 2017 were selected as the research objects and randomly divided into the observation group who accepted impacted wisdom tooth extraction with high-speed turbine drill combined with original luxator and the control group who accepted impacted wisdom tooth extraction with traditional chisel. The contents of inflammatory mediators, stress mediators and pain mediators in gingival crevicular fluid were measured before surgery and 3 days after surgery. Results: Three days after surgery, PTX3, ICAM1, MPO, PGE2, PPARγ, ROS, MDA, 5-HT, CGRP, SP, Gal and ATP contents in gingival crevicular fluid of both groups were higher than those before surgery whereas GPx and T-AOC contents were significantly lower than those before surgery, and PTX3, ICAM1, MPO, PGE2, PPARγ, ROS, MDA, 5-HT, CGRP, SP, Gal and ATP contents in gingival crevicular fluid of observation group were lower than those of control group whereas GPx and T-AOC contents were significantly higher than those of control group. Conclusions: The impacted wisdom tooth extraction with high-speed turbine drill combined with original luxator can reduce the local inflammatory stress response and inhibit the secretion of pain mediators.

口腔无托槽隐形矫治联合牙周基础治疗对牙周病致前牙扇形移位患者口腔健康及炎症反应的影响分析

目的分析口腔无托槽隐形矫治联合牙周基础治疗对牙周病致前牙扇形移位患者口腔健康及炎症反应的影响,以期为临床治疗牙周病致前牙扇形移位提供参考依据。方法选取60例牙周病致前牙扇形移位的患者作为观察样本,按照计算机分组法分为对照组与观察组,每组30例。对照组开展牙周夹板固定联合牙周基础治疗,观察组开展口腔无托槽隐形矫治联合牙周基础治疗。对比两组治疗前后牙周指标、口腔健康情况、炎性反应指标、牙齿功能。结果两组治疗前牙周袋深度、牙槽骨高度、牙覆盖距离、龈沟出血指数对比无差异(P>0.05);观察组治疗后牙周袋深度(2.65±0.51)mm、牙覆盖距离(1.78±0.25)mm、龈沟出血指数(1.56±0.42)分显著低于对照组的(4.73±0.62)mm、(3.19±0.35)mm、(3.07±0.30)分,牙槽骨高度(5.71±0.29)mm高于对照组的(5.55±0.20)mm(P<0.05)。两组治疗前独立能力、心理不适、疼痛与不适、功能受限评分对比无差异(P>0.05);观察组治疗后独立能力评分(1.86±0.31)分、心理不适评分(1.63±0.21)分、疼痛与不适评分(1.86±0.19)分、功能受限评分(1.58±0.20)分均显著低于对照组的(2.16±0.40)、(2.07±0.38)、(2.33±0.30)、(2.17±0.15)分(P<0.05)。两组治疗前C反应蛋白(CRP)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平对比无差异(P>0.05);观察组治疗后CRP(4.32±0.30)mg/L、IL-1β(167.26±19.32)pg/ml、IL-6(8.75±1.80)pg/ml均显著低于对照组的(5.20±0.41)mg/L、(210.38±17.95)pg/ml、(10.34±1.23)pg/ml(P<0.05)。两组治疗前牙齿色泽、牙齿形状、边缘密合度及咬合关系评分对比无差异(P>0.05);观察组治疗后牙齿色泽、牙齿形状、边缘密合度及咬合关系评分分别为(6.82±0.46)、(7.12±0.50)、(7.81±0.34)、(7.68±0.22)分,均显著高于对照组的(5.63±0.37)、(5.69±0.38)、(6.19±0.24)、(6.10±0.33)分(P<0.05)。结论口腔无托槽隐形矫治联合牙周基础治疗为牙周病致前牙扇形移位患者提供了一种更舒适的牙齿矫正方式,不仅能够减少炎症反应,还有助于更高效、更精确地矫正患者的牙齿,帮助其恢复正常的口腔健康状态。

纤维桩+复合树脂+氧化锆全瓷冠修复根管治疗后后牙楔状缺损的疗效分析

目的:探究纤维桩+复合树脂+氧化锆全瓷冠修复根管治疗后后牙楔状缺损患者的效果及美观满意度。方法:纳入2022年1月-2023年1月在笔者医院就诊的102例后牙楔状缺损患者,根据患者自主选择意愿分为研究组(n=50)和对照组(n=52),对照组行金属桩核+金属烤瓷冠修复,研究组行纤维桩+复合树脂+氧化锆全瓷冠修复。6个月后,对比两组临床疗效,观察两组牙周健康情况(牙龈指数、菌斑指数、龈沟出血指数),检测牙周炎症[肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白细胞介素-4(Interleukin-4,IL-4)、白细胞介素-6(Interleukin-6,IL-6)],调查美观满意度[美国公共健康服务标准(United states public health service,USPHS)]和实用度(咀嚼功能、咬合情况、语言功能),比较两组并发症发生情况。结果:治疗后,研究组治疗有效率达92.00%,高于对照组的76.92%(P<0.05);两组牙周健康相关指数及TNF-α、IL-4、IL-6均较治疗前降低,且研究组降低幅度大于对照组(P<0.05);治疗后,研究组牙齿表面形态、色泽协调性、边缘着色满意度均高于对照组(P<0.05),两组咀嚼功能、咬合情况、语言功能均较治疗前提高,但差异无统计学意义(P>0.05);两组并发症发生率比较治疗组低于对照组(P<0.05)。结论:采用纤维桩+复合树脂+氧化锆全瓷冠修复根管治疗后后牙楔状缺损能够减轻炎症反应,提升患者牙周健康,增加美观满意度及实用度,疗效显著,安全性高。

基于TLR4/NF-κB通路对固齿牙粉联合针刺疗法治疗牙周炎的机制研究

目的 研究固齿牙粉联合针刺疗法对实验性牙周炎大鼠的抗炎作用及作用机制,为中药治疗牙周炎提供实验依据。方法 以钢丝结扎大鼠上颌右侧第一磨牙、涂布牙龈卟啉单胞菌和饲喂高糖软饲料的方法建立实验性大鼠牙周炎模型。将60只大鼠随机分正常组、模型组、牙粉组、牙粉+针刺组、针刺组以及替硝唑组,每组10只。造模成功后,各药物组大鼠在牙齿上涂布相应药物,模型组大鼠涂布等体积生理盐水,每日3次,连续7 d。HE染色观察牙龈和牙槽骨组织形态学变化;RT-PCR法检测牙龈组织中肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、Toll样受体4(TLR4)以及核因子κB p65(NF-κB p65)的m RNA表达水平;采用酶联免疫吸附法检测牙龈组织中TNF-α、IL-1β、IL-6的表达水平;采用Western Blot法测定大鼠牙龈组织中TLR4、NF-κB p65和p-NF-κB p65蛋白表达量。结果 与模型组比较,牙粉组以及牙粉+针刺组大鼠牙龈炎性浸润明显减少,牙龈组织TNF-α、IL-1β、IL-6含量以及TLR4、NF-κB p65和p-NF-κB p65蛋白表达水平均显著降低(P <0.05)。而牙粉组和牙粉+针刺组上述指标差异无统计学意义(P>0.05)。结论 固齿牙粉联合针刺疗法可促进牙周炎模型大鼠的牙周炎症状减轻,具有一定的抗炎作用,其机制可能与抑制TLR4/NF-κB信号通路、减少炎症反应有关。

先天性缺牙治疗的研究进展

先天性缺牙是人类最常见的牙发育异常,影响患者的咀嚼、发音、美观及颌面部发育。由于该疾病的特殊特点,其治疗历时久、花费高,给患者带来心理和经济的双重负担。治疗方法包括儿科、正畸、颌面外科、修复、种植等多学科协作的序列治疗,以及靶向分子治疗和组织工程技术等新兴手段。本文综述了先天性缺牙的疾病特点、传统治疗方式的新进展以及新兴的治疗方法,简述了不同治疗方法的治疗效果,旨在为先天性缺牙患者的临床治疗提供有意义的信息。

嵌入性牙脱位牙根吸收治疗1例

一名11岁儿童因外伤导致上前牙嵌入性脱位,患者及时就诊复位、固定、完善根管治疗。在外伤14个月出现牙根吸收,笔者通过患者CBCT研究,针对不同部位牙根吸收先后采用两种不同方法给予治疗,术后随访观察2年无新窦道形成。

自体牙本质颗粒联合Nd:YAG激光在前牙区牙周炎患者拔牙术后中的应用效果

【目的】探讨自体牙本质颗粒联合Nd:YAG激光在前牙区牙周炎患者拔牙术后中的应用效果。【方法】选取2021年5月至2023年3月本院收治的123例前牙区牙周炎拔牙术后患者,按治疗方法不同分为观察组(n=63,63颗牙)和对照组(n=60,60颗牙),对照组采用Nd:YAG激光治疗,观察组在对照组基础上加用自体牙本质颗粒治疗,比较两组治疗效果。【结果】治疗后1年,观察组种植成功率显著高于对照组(P<0.05),但两组美学效果比较,差异无统计学意义(P>0.05);治疗后7 d,两组疼痛程度均下降,且观察组低于对照组(P>0.05)。治疗后1年,两组菌斑指数(PLI)、出血指数(SBI)、牙龈指数(GI)、牙周袋深度(PD)均下降(P<0.05),且观察组PLI、SBI、GI、PD低于对照组。观察组并发症总发生率显著低于对照组(χ^(2)=0.230,P=0.631)。【结论】自体牙本质颗粒联合Nd:YAG激光应用于前牙区牙周炎拔牙术后患者中,可显著提高患者咀嚼效率、美学效果,改善牙周功能,且并发症发生率较低,值得临床推广应用。

正畸疗法联合口腔修复治疗先天性缺牙患者的临床研究

目的探讨正畸疗法联合口腔修复治疗先天性缺牙患者的临床效果。方法选取我院2020年12月至2022年12月收治的62例先天性缺牙患者随机分为两组,参照组接受口腔修复治疗,联合组接受正畸疗法+口腔修复治疗,比较两组的临床疗效、不良情绪、发音功能以及口腔功能。结论联合组的治疗总有效率为96.77%,明显高于参照组的74.19%(P<0.05)。治疗后1个月,联合组的SAS、SDS评分均明显低于参照组,发音及口腔功能评分均明显高于参照组(P<0.05)。结论正畸疗法联合口腔修复可有效缓解先天性缺牙患者的不良情绪,提高患者的发音功能、口腔功能,具有显著的治疗效果。

一次性根管治疗牙体牙髓病的临床效果分析

目的:分析一次性根管治疗牙体牙髓病的临床效果。方法:选取2022年5月—2023年5月上海市金山区廊下镇社区卫生服务中心收治的牙体牙髓病患者90例作为研究对象,按照随机数字表法分为对照组和观察组,各45例。对照组进行多次根管治疗,观察组进行一次性根管治疗。比较两组治疗效果、炎性因子水平、咀嚼功能。结果:观察组治疗总有效率较对照组高(P=0.003)。治疗前,两组C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05);治疗后,两组CRP、IL-6、TNF-α水平均低于治疗前,且观察组低于对照组(P<0.05)。治疗前,两组咀嚼效率和咬合力比较,差异无统计学意义(P>0.05);治疗后,两组咀嚼效率和咬合力高于治疗前,且观察组高于对照组(P<0.05)。结论:一次性根管治疗牙体牙髓病的临床效果较好,能够减轻患者的炎性反应,改善其牙齿咀嚼功能。

全瓷高嵌体修复根管治疗后牙体缺损的临床效果分析

目的:探讨全瓷高嵌体修复根管治疗后牙体缺损的临床效果。方法:选取2021年1月—2023年1月绥阳县人民医院收治的86例根管治疗后牙体缺损患者作为研究对象,按照随机数字表法分为两组,各43例。对照组行氧化锆全瓷冠修复,观察组行全瓷高嵌体修复。比较两组修复效果。结果:观察组修复体完整度、边缘密合度、咬合力与咀嚼效率高于对照组,菌斑指数、牙龈指数、龈沟出血指数、口腔生理功能、心理功能、行为影响、疼痛与不适评分以及不良事件总发生率低于对照组,差异有统计学意义(P<0.05)。结论:全瓷高嵌体修复根管治疗后牙体缺损的临床效果显著,可改善患者牙周状况、咀嚼功能与生活质量,减少不良事件。

全瓷高嵌体与复合树脂填充对根管治疗后牙牙体缺损修复效果的临床比较

目的:比较全瓷高嵌体与复合树脂填充对根管治疗后牙牙体缺损修复的临床效果。方法:选取2019年12月至2021年12月医院收治的60例后牙牙体缺损患者作为研究对象,所有患者根据随机数字表法分为对照组和观察组,各30例。两组患者进行根管治疗后,对照组以复合树脂填充治疗,观察组以全瓷高嵌体治疗,共随访6 m。比较两组患者治疗前、治疗后6 m的牙龈指数及出血指数,以及两组治疗后6 m的修复效果(边缘适合性、外形、表面质地及颜色匹配)、修复成功率及满意度。结果:治疗后6 m,两组牙龈指数、出血指数均降低,且观察组低于对照组(P<0.05);观察组边缘适合性、外形、表面质地及颜色匹配A级占比均高于对照组(P<0.05);观察组修复成功率明显高于对照组(P<0.05);观察组总满意度明显高于对照组(P<0.05)。结论:与复合树脂填充比较,全瓷高嵌体对根管治疗后牙牙体缺损较复合树脂填充修复效果更好,可降低患者牙龈指数和出血指数,且修复成功率及满意度更高。

上颌窦内提升术联合短种植体治疗上颌后牙缺失伴轻度骨量不足的疗效观察

目的:观察上颌窦内提升术联合短种植体治疗上颌后牙缺失伴轻度骨量不足的疗效。方法:选择2019年1月至2020年6月本院收治的176例上颌后牙缺失伴轻度骨量不足患者作为研究对象。根据患者选择的治疗方式将患者分成对照组(91例)和试验组(85例)。对照组使用上颌窦内提升术加常规种植体治疗,试验组采用上颌窦内提升术联合短种植体进行治疗。全部患者均完成18 m随访。分析对比修复术后1 w、1 m、6 m、1 y、1.5 y种植体颈部边缘骨吸收量、种植体存留率、不良反应发生率及患者治疗满意度。结果:两组颈部边缘骨吸收量相比差异无统计学意义(P>0.05)。两组患者的种植体存留率对比无显著差异(P>0.05)。试验组不良反应发生率低于对照组(P<0.05)。试验组治疗总满意度高于对照组(P<0.05)。结论:使用上颌窦内提升术联合短种植体对上颌后牙缺失伴轻度骨量不足患者治疗可提升患者安全性,减少不良反应,提高治疗满意度。

TOOTH EXTRACTION UNDER DIGITAL ACUPOINT PRESSURE ANESTHESIA IN 60 CASES

Tooth extraction was performed in 60 cases under digital acupoint pressure anes-thesia with a remarkable curative effect. The curative effect was higher for loose teeth. The effectiverate was 100%. The tooth extraction under digital acupoint pressure anesthesia has many advantages.Tooth extraction can be performed only by pressing a certain acupoint with safety, convenience and e-conomy. The method avoids the side effects of narcotic and reduces the patient’s fear of an injectionof narcotic.

PHOTOTHERAPY OF GINGIVITIS:PILOT CLINICAL STUDY

The goal of this work was to evaluate the safety and efficacy of the Red Light Emitted Toothbrush(R-LETB)emitting at wavelength of 663 nm with power density of 3.3mW/cm2 in combination with 0.1%-methylene blue(MB)solution for the reduction of plaque and treatment of gingivitis.A microbiological in vitro study and a pilot clinical study were conducted.The microbiological study has shown total suppression of pathogenicflora after a 3-min exposure to the dye solution followed by a 20-sec treatment with the R-LETB.For the clinical study,37 subjects of both sexes with gingivitis were enrolled and randomly assigned to one of two groups.Subjects in thefirst(treatment)group were instructed to rinse their mouth with MB solution provided for 1 min and then brush the teeth with the R-LETB and standardized toothpaste.The second(control)group used only the toothpaste and a regular toothbrush.Subjects in both groups followed their respective procedures 2 times a day(morning and evening)for 30 days.Indices of plaque,gingival bleeding,and inflammation were evaluated at 14-day and 30-day timepoints.In the both groups,all indices improved in comparison with baseline.However,the treatment group demonstrated more pronounced improvement of the studied indices that was attributed to additional anti-microbial action of red light and MB on gum tissue.Thus,the use of R-LETB with MB appears to have a multifactor therapeutic action on oral pathological microflora:mechanical removal of the bacteria and suppressing action on microorganisms due to photodynamic reaction.

Effect evaluation of artemisia desertorum spreng on ability of daily life after extraction of impacted tooth

AIM:To investigate the effect of locally used Shahaosan on preventing the complication of extraction of impacted tooth.METHODS:274 cases patients with extraction of impacted teeth were randomly devided into 3 groups named A,B and C.Shahaosan and Yunnan white drug were processed into drug A and B by department of pharmacy with the same color, shape and quality which are blind to doctors and patients.When the impacted teeth were extracted, administed group A(92 cases) with drug A,group B(86 cases) with drug B and group C(96 cases ) was a blank control. After the operation,incidence and severe intensity of dry socket in each group were observed and evaluated by scores.RESULTS:The incidence of dry socket in group A,B and C were 0.09%(1/92),2.32%(2/86),8.33%(8/96).There was no significant difference between group A and B, group B and C, while a significant difference showed between group A and C.The PoSSe score in group A, B and C was 19.36,27.80 and 22.83 respectively.Afer the experiment the department of pharmacy informed that drug A is Shahaosan and drug B is Yunnan white drug.CONCLUSTON:Compiments of dry socket induced by extracting of lower jaw impacted teeth can be prevented by locally administered with Shahaosan, but no significant effect of alleviating the symptom of dental extraction.

抗栓治疗患者不停药拔牙的临床观察

目的观察长期抗栓治疗患者不停药拔牙出血、愈合情况,评价拔牙后局部止血效果。方法选取该院MDT拔牙门诊抗栓治疗不停药拔牙患者74例,分为抗血小板治疗组(37例)和抗凝血治疗组(37例),随机选择50例未经抗栓治疗拔牙者为对照组,均拔除单颗牙,观察术后不同时间段出血情况以及术后7 d创口愈合情况。结果3组均未出现不可控制出血。抗血小板治疗组和对照组出血率差异无统计学意义(P>0.05)。抗凝血治疗组和对照组拔牙后30 min出血率差异有统计学意义(P<0.001),抗凝血治疗组高于对照组。拔牙后7 d三组间愈合率有统计学差异(P=0.034),对照组愈合率高于抗凝血治疗组。抗血小板治疗组和对照组间的愈合率不存在差异(P>0.05)。结论抗栓患者做好术前风险评估、术中规范操作和术后密切监测,在不停药情况下可以拔牙,局部止血可达到目的。

根管治疗联合全冠修复治疗牙隐裂的效果分析

目的:探讨牙隐裂患者实施根管治疗联合全冠修复治疗的效果。方法:选取2020年8月—2022年8月临沂市兰山区人民医院收治的84例牙隐裂患者作为研究对象,采用随机数字表法分为观察组与对照组,各42例。对照组给予高嵌体根管治疗,观察组给予根管治疗联合全冠修复。比较两组治疗效果、咬合功能、咀嚼功能及并发症发生情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.048)。治疗后,两组最大咬合接触面积、最大咬合力大于治疗前,且观察组大于对照组,两组咬合力不对称指数小于治疗前,且观察组小于对照组,差异有统计学意义(P<0.05);两组龈沟出血指数、牙龈指数低于治疗前,且观察组低于对照组,两组咀嚼效率高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P=0.026)。结论:根管治疗联合全冠修复治疗牙隐裂的效果良好,可改善患者咬合功能与咀嚼功能,降低并发症发生率。

Photobiomodulation therapy assisted orthodontic tooth movement:potential implications,challenges,and new perspectives

Over the past decade,dramatic progress has been made in dental research areas involving laser therapy.The photobiomodulatory effect of laser light regulates the behavior of periodontal tissues and promotes damaged tissues to heal faster.Additionally,photobiomodulation therapy(PBMT),a non-invasive treatment,when applied in orthodontics,contributes to alleviating pain and reducing inflammation induced by orthodontic forces,along with improving tissue healing processes.Moreover,PBMT is attracting more attention as a possible approach to prevent the incidence of orthodontically induced inflammatory root resorption(OIIRR)during orthodontic treatment(OT)due to its capacity to modulate inflammatory,apoptotic,and anti-antioxidant responses.However,a systematic review revealed that PBMT has only a moderate grade of evidence-based effectiveness during orthodontic tooth movement(OTM)in relation to OIIRR,casting doubt on its beneficial effects.In PBMT-assisted orthodontics,delivering sufficient energy to the tooth root to achieve optimal stimulation is challenging due to the exponential attenuation of light penetration in periodontal tissues.The penetration of light to the root surface is another crucial unknown factor.Both the penetration depth and distribution of light in periodontal tissues are unknown.Thus,advanced approaches specific to orthodontic application of PBMT need to be established to overcome these limitations.This review explores possibilities for improving the application and effectiveness of PBMT during OTM.The aim was to investigate the current evidence related to the underlying mechanisms of action of PBMT on various periodontal tissues and cells,with a special focus on immunomodulatory effects during OTM.

服用抗凝剂对心脏瓣膜置换术后行拔牙术的临床观察

目的:探讨心脏瓣膜置换术后服用抗凝剂的患者,行拔牙术的围手术期用药及安全性。方法:对南京市第一医院口腔科于2019年1月至2021年12月心脏瓣膜置换术后需拔除磨牙的患者采用病例对照研究。研究组(n=66例)为心脏瓣膜置换术后服用华法林行抗凝治疗的患者;对照组(n=150例)为未使用抗凝药物使用者。2组患者在进行围手术期用药及止血处理后,比较其拔牙后出血及创口愈合情况。结果:2组患者术后出血率、术后7 d拔牙创愈合情况比较,差异无统计学意义(P>0.05)。结论:对服用抗凝剂后需要拔牙的患者采用低分子肝素替代治疗,既能保证围手术期的安全,又可预防因停药导致的并发症。