改良型富血小板纤维蛋白修复下颌智齿拔除后邻牙远中骨缺损
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摘要
背景:改良型富血小板纤维蛋白的提取方法已经确定,其组织结构及成分也得到研究。已有动物实验证实改良型富血小板纤维蛋白可以与成骨细胞有协同作用,促进新骨形成。目的:提取改良型富血小板纤维蛋白,观察改良型富血小板纤维蛋白凝胶对下颌智齿拔除后相邻下颌第2磨牙远中骨缺损修复的影响。方法:选取安徽医科大学附属安庆医院口腔科的48例单侧下颌第3磨牙近中阻生或水平阻生患者。随机将患者分为改良型富血小板纤维蛋白组和对照组,采用相同方法拔除第3磨牙,清理拔牙窝,改良型富血小板纤维蛋白组同期在第2磨牙远中面放入由患者自体血制成的改良型富血小板纤维蛋白凝胶;对照组拔牙后不放任何材料。治疗后1,2,3,4个月复诊,评估患者相邻下颌第2磨牙牙周情况,包括牙周探诊和影像学分析。治疗后第4个月拍摄全口曲面断层片及锥形术CT。采用SPSS21.0统计软件对试验数据进行统计分析。结果与结论:①改良型富血小板纤维蛋白组和对照组在相邻第2磨牙远中牙周探诊深度上没有统计学意义;②治疗后第4个月,改良型富血小板纤维蛋白组骨密度显著高于对照组(P <0.05),骨获得量显著大于对照组(P <0.05);③结果说明,改良型富血小板纤维蛋白在下颌智齿拔除后下颌相邻第2磨牙远中骨缺损修复中有良好的促进成骨的作用。
BACKGROUND: Extraction method of modified platelet-rich fibrin has been determined, and its structure and constitutes have been investigated. Animal experiments have shown that modified platelet-rich fibrin can cooperate with osteoblasts to promote osteogenesis. OBJECTIVE: To extract modified platelet-rich fibrin and to explore the effect of modified platelet-rich fibrin gel on the repair of distal bone defect of adjacent mandibular second molar after extraction of mandibular wisdom tooth. METHODS: Forty-eight patients with proximal or horizontal obstruction of unilateral mandibular third molar were selected from the Department of Stomatology of Anqing Hospital Affiliated to Anhui Medical University. Patients were randomly divided into modified platelet-rich fibrin group and control group. The third molar was removed and the tooth extraction socket was cleared by the same method. Modified platelet-rich fibrin gel made from the patient's own blood was put into the distal surface of the second molar in the modified platelet-rich fibrin group at the same time. The control group did not put any materials after tooth extraction. All patients were followed up at 1, 2, 3 and 4 months after surgery to evaluate the periodontal status of adjacent mandibular second molars, including periodontal examination and imaging analysis. Full-oral curved tomography and cone-beam CT were taken at 4 months after surgery. Statistical analysis was conducted on SPSS 21.0 software. RESULTS AND CONCLUSION:(1) There was no significant difference in the periodontal depth of the adjacent second molars between modified platelet-rich fibrin and control groups.(2) At 4 months after surgery, the bone mineral density and bone yield in the modified platelet-rich fibrin group were significantly higher than those in the control group(both P < 0.05).(3) In summary, modified platelet-rich fibrin can promote osteogenesis of mandibular proximal second molar after mandibular wisdom tooth extraction.
BACKGROUND: Extraction method of modified platelet-rich fibrin has been determined, and its structure and constitutes have been investigated. Animal experiments have shown that modified platelet-rich fibrin can cooperate with osteoblasts to promote osteogenesis. OBJECTIVE: To extract modified platelet-rich fibrin and to explore the effect of modified platelet-rich fibrin gel on the repair of distal bone defect of adjacent mandibular second molar after extraction of mandibular wisdom tooth. METHODS: Forty-eight patients with proximal or horizontal obstruction of unilateral mandibular third molar were selected from the Department of Stomatology of Anqing Hospital Affiliated to Anhui Medical University. Patients were randomly divided into modified platelet-rich fibrin group and control group. The third molar was removed and the tooth extraction socket was cleared by the same method. Modified platelet-rich fibrin gel made from the patient's own blood was put into the distal surface of the second molar in the modified platelet-rich fibrin group at the same time. The control group did not put any materials after tooth extraction. All patients were followed up at 1, 2, 3 and 4 months after surgery to evaluate the periodontal status of adjacent mandibular second molars, including periodontal examination and imaging analysis. Full-oral curved tomography and cone-beam CT were taken at 4 months after surgery. Statistical analysis was conducted on SPSS 21.0 software. RESULTS AND CONCLUSION:(1) There was no significant difference in the periodontal depth of the adjacent second molars between modified platelet-rich fibrin and control groups.(2) At 4 months after surgery, the bone mineral density and bone yield in the modified platelet-rich fibrin group were significantly higher than those in the control group(both P < 0.05).(3) In summary, modified platelet-rich fibrin can promote osteogenesis of mandibular proximal second molar after mandibular wisdom tooth extraction.
引文
[1]裴蕊琼.下颌第3磨牙阻生伴邻近第2磨牙病变的相关研究[D].太原:山西医科大学,2015.
[2]邓天阁.应用曲面断层片和CBCT对比分析下颌阻生第3磨牙和下颌管的解剖关系[D].西安:第四军医大学,2013.
[3]Kugelberg CF.Impacted lower third molars and periodontal health.An epidemiological,methodological,retrospective and prospective clinical,study.Swed Dent J Suppl.1990;68:1-52.
[4]热比亚木·哈德尔.下颌阻生智齿拔除后第2磨牙远中牙槽骨变化的临床研究[J].世界最新医学信息文摘,2017,17(32):59.
[5]戈旌,杨驰,郑家伟,等.下颌阻生第3磨牙拔除术后第2磨牙远中骨质缺损治疗进展[J].中国口腔颌面外科杂志,2016,14(1):86-92.
[6]Pons-Vicente O,Valmaseda-Castellón E,Berini-Aytés L,et al.Effect on pocket depth and attachment level of manual versus ultrasonic scaling of lower second molars following lower third molar extraction:a randomized controlled trial.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2009;107(3):e11-e19.
[7]罗涛,邹玲.引导组织再生术在根尖外科手术中的应用进展[J].口腔疾病防治,2018,196(3):59-64.
[8]Karapataki S,Hugoson A,Falk H,et al.Healing following GTRtreatment of intrabony defects distal to mandibular 2nd molarsusing resorbable and non-resorbable barriers.J Clin Periodontol.2000;27(5):333-340.
[9]张兆强,王启朋,江穗,等.冻干同种异体下颌骨复合自体松质骨移植修复下颌骨缺损[J].全科口腔医学电子杂志,2018,5(7):11-12,14.
[10]胡宏悻,步子恒,刘忠堂.组织工程技术治疗骨软骨缺损的研究进展[J].转化医学电子杂志,2017,4(12):11-16.
[11]董红宾,张悦,张琴,等.PRF复合组织工程骨修复牙周骨缺损中基因的表达及意义[J].口腔医学,2017,37(11):14-20.
[12]d'Aquino R,De Rosa A,Lanza V,et al.Human mandible bonedefect repair by the grafting of dental pulp stem/progenitor cellsand collagen sponge biocomplexes.Eur Cells Mater.2009;18:75-83.
[13]Ortel TL,Mercer MC,Thames EH,et al.Immunologic impact and clinicaloutcomes after surgical exposure to bovine thrombin.AnnSurg.2001;233(1):88-96.
[14]Choukroun J,Adda F,Schoefer C,et al.An opportunity inperioimplantology:The PRF.Implantodontie.2001;42:55-62.
[15]Ghanaati S,Booms P,Orlowska A,et al.Advanced platelet-rich fibrin:anew concept for cell-based tissue engineering by means of inflammatorycells.J Oral Implantol.2014;40(6):679-689.
[16]Kobayashi E,Flückiger L,Fujioka-Kobayashi M,et al.Comparative release of growth factors from PRP,PRF,andadvanced-PRF.Clin Oral Investig.2016;20(9):2353-2360.
[17]毛俊丽,王拓,孙勇,等.PRF的制备及保存方法的研究进展[J].西南国防医药,2016,26(3):326-327.
[18]张璐,王频,郭玲,等.富自体浓缩生长因子纤维蛋白液在口腔骨缺损种植引导骨再生后的骨量变化[J].中国组织工程研究,2017,21(8):44-49.
[19]Kobayashi E,Flückiger L,Fujioka-Kobayashi M,et al.Comparativerelease of growth factors from PRP,PRF,and advanced-PRF.Clin Oral Investig.2016;20(9):2353-2360.
[20]练铁,毛俊丽,孙嵩,等.A-PRF与PRF的成分及超微结构观察[J].西南国防医药,2017,27(6):4.
[21]焦志立,谢晓玲,付冬梅,等.改良型富血小板纤维蛋白在兔颅骨诱导成骨中的组织学观察[J].中国组织工程研究,2017,21(14):2208-2214.
[22]Nishiyama K,Okudera T.Basic characteristics of plasma rich in growth factors(PRGF):blood cell components and biological effects.Clin Exp Dent Res.2016;2(2):96-103.
[23]Simonpieri A,Choukroun J,Del Corso M,et al.Simultaneoussinuslift and implantation using microthreaded implants andleukocyte-and platelet-rich fibrin as sole grafting material:asix-year experience.Implant Dent.2011;20(1):2-12.
[24]Chenchev IL,Ivanova VV1.Application of Platelet-Rich Fibrin and Injectable Platelet-Rich Fibrin in combination of Bone Substitute Material for Alveolar Ridge Augmentation-a Case Report.Folia Med(Plovdiv),2017;59(3):362-366.
[25]吕敏,雷志敏,严加林,等.富血小板纤维蛋白在促进智齿拔除后下颌骨腔隙性缺损修复的研究[J].临床口腔医学杂志,2017,33(9):50-53.
[26]高朵朵.富自体生长因子纤维蛋白凝胶(膜)促进拔牙创愈合的临床研究[D].石家庄:河北医科大学,2015.
[27]付冬梅.改良型富血小板纤维蛋白促进兔颅骨骨再生的实验研究[D].泸州:西南医科大学,2016.
[28]王晖.CBCT在评价慢性牙周炎牙周基础治疗前后牙槽骨变化的应用研究[D].合肥:安徽医科大学,2017.
[29]刘丹,李雅彬,王海佳,等.锥形束CT不同切片方法对下颌后牙区骨测量结果对比观察[J].人民军医,2016,(11):1172-1174.
[30]邵云敏,孙颖.CBCT在牙周病学研究中的应用[J].口腔医学,2018,38(5):457-461.
[31]Kim DG.Can dental cone beam computed tomography assess bonemineral density?.J Bone Metab.2014;21(2):117-126.
[32]赵娜,陈鑫,孙超,吴大明.锥形束CT测量牙齿及颌骨准确性的研究进展[J].医学综述,2018,24(9):1822-1827.
[33]Timock AM,Cook V,Mcdonald T,et al.Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging.Am JOrthod Dentofacial Orthop.2011;140(5):734-744.
[34]朱越广,钟志海,常少海.下颌阻生智齿拔除的缝合方式对邻牙远中牙周组织的影响[J].吉林医学,2014,35(17):88-89.
[2]邓天阁.应用曲面断层片和CBCT对比分析下颌阻生第3磨牙和下颌管的解剖关系[D].西安:第四军医大学,2013.
[3]Kugelberg CF.Impacted lower third molars and periodontal health.An epidemiological,methodological,retrospective and prospective clinical,study.Swed Dent J Suppl.1990;68:1-52.
[4]热比亚木·哈德尔.下颌阻生智齿拔除后第2磨牙远中牙槽骨变化的临床研究[J].世界最新医学信息文摘,2017,17(32):59.
[5]戈旌,杨驰,郑家伟,等.下颌阻生第3磨牙拔除术后第2磨牙远中骨质缺损治疗进展[J].中国口腔颌面外科杂志,2016,14(1):86-92.
[6]Pons-Vicente O,Valmaseda-Castellón E,Berini-Aytés L,et al.Effect on pocket depth and attachment level of manual versus ultrasonic scaling of lower second molars following lower third molar extraction:a randomized controlled trial.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2009;107(3):e11-e19.
[7]罗涛,邹玲.引导组织再生术在根尖外科手术中的应用进展[J].口腔疾病防治,2018,196(3):59-64.
[8]Karapataki S,Hugoson A,Falk H,et al.Healing following GTRtreatment of intrabony defects distal to mandibular 2nd molarsusing resorbable and non-resorbable barriers.J Clin Periodontol.2000;27(5):333-340.
[9]张兆强,王启朋,江穗,等.冻干同种异体下颌骨复合自体松质骨移植修复下颌骨缺损[J].全科口腔医学电子杂志,2018,5(7):11-12,14.
[10]胡宏悻,步子恒,刘忠堂.组织工程技术治疗骨软骨缺损的研究进展[J].转化医学电子杂志,2017,4(12):11-16.
[11]董红宾,张悦,张琴,等.PRF复合组织工程骨修复牙周骨缺损中基因的表达及意义[J].口腔医学,2017,37(11):14-20.
[12]d'Aquino R,De Rosa A,Lanza V,et al.Human mandible bonedefect repair by the grafting of dental pulp stem/progenitor cellsand collagen sponge biocomplexes.Eur Cells Mater.2009;18:75-83.
[13]Ortel TL,Mercer MC,Thames EH,et al.Immunologic impact and clinicaloutcomes after surgical exposure to bovine thrombin.AnnSurg.2001;233(1):88-96.
[14]Choukroun J,Adda F,Schoefer C,et al.An opportunity inperioimplantology:The PRF.Implantodontie.2001;42:55-62.
[15]Ghanaati S,Booms P,Orlowska A,et al.Advanced platelet-rich fibrin:anew concept for cell-based tissue engineering by means of inflammatorycells.J Oral Implantol.2014;40(6):679-689.
[16]Kobayashi E,Flückiger L,Fujioka-Kobayashi M,et al.Comparative release of growth factors from PRP,PRF,andadvanced-PRF.Clin Oral Investig.2016;20(9):2353-2360.
[17]毛俊丽,王拓,孙勇,等.PRF的制备及保存方法的研究进展[J].西南国防医药,2016,26(3):326-327.
[18]张璐,王频,郭玲,等.富自体浓缩生长因子纤维蛋白液在口腔骨缺损种植引导骨再生后的骨量变化[J].中国组织工程研究,2017,21(8):44-49.
[19]Kobayashi E,Flückiger L,Fujioka-Kobayashi M,et al.Comparativerelease of growth factors from PRP,PRF,and advanced-PRF.Clin Oral Investig.2016;20(9):2353-2360.
[20]练铁,毛俊丽,孙嵩,等.A-PRF与PRF的成分及超微结构观察[J].西南国防医药,2017,27(6):4.
[21]焦志立,谢晓玲,付冬梅,等.改良型富血小板纤维蛋白在兔颅骨诱导成骨中的组织学观察[J].中国组织工程研究,2017,21(14):2208-2214.
[22]Nishiyama K,Okudera T.Basic characteristics of plasma rich in growth factors(PRGF):blood cell components and biological effects.Clin Exp Dent Res.2016;2(2):96-103.
[23]Simonpieri A,Choukroun J,Del Corso M,et al.Simultaneoussinuslift and implantation using microthreaded implants andleukocyte-and platelet-rich fibrin as sole grafting material:asix-year experience.Implant Dent.2011;20(1):2-12.
[24]Chenchev IL,Ivanova VV1.Application of Platelet-Rich Fibrin and Injectable Platelet-Rich Fibrin in combination of Bone Substitute Material for Alveolar Ridge Augmentation-a Case Report.Folia Med(Plovdiv),2017;59(3):362-366.
[25]吕敏,雷志敏,严加林,等.富血小板纤维蛋白在促进智齿拔除后下颌骨腔隙性缺损修复的研究[J].临床口腔医学杂志,2017,33(9):50-53.
[26]高朵朵.富自体生长因子纤维蛋白凝胶(膜)促进拔牙创愈合的临床研究[D].石家庄:河北医科大学,2015.
[27]付冬梅.改良型富血小板纤维蛋白促进兔颅骨骨再生的实验研究[D].泸州:西南医科大学,2016.
[28]王晖.CBCT在评价慢性牙周炎牙周基础治疗前后牙槽骨变化的应用研究[D].合肥:安徽医科大学,2017.
[29]刘丹,李雅彬,王海佳,等.锥形束CT不同切片方法对下颌后牙区骨测量结果对比观察[J].人民军医,2016,(11):1172-1174.
[30]邵云敏,孙颖.CBCT在牙周病学研究中的应用[J].口腔医学,2018,38(5):457-461.
[31]Kim DG.Can dental cone beam computed tomography assess bonemineral density?.J Bone Metab.2014;21(2):117-126.
[32]赵娜,陈鑫,孙超,吴大明.锥形束CT测量牙齿及颌骨准确性的研究进展[J].医学综述,2018,24(9):1822-1827.
[33]Timock AM,Cook V,Mcdonald T,et al.Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging.Am JOrthod Dentofacial Orthop.2011;140(5):734-744.
[34]朱越广,钟志海,常少海.下颌阻生智齿拔除的缝合方式对邻牙远中牙周组织的影响[J].吉林医学,2014,35(17):88-89.