拔牙创不同处理方式对其牙槽骨变化影响的比较
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摘要
在口腔修复临床工作中,为了保证较好的近远期修复效果,常需拔除无保留价值的牙齿。义齿修复时机需等到拔牙创牙槽嵴吸收变化基本稳定后方可进行,在创口愈合的早期,如果拔牙创受到外部刺激因素的干扰,将会影响甚至延缓创口愈合。临床拔牙术后常用的拔牙创处理方式是咬压止血,缝合或填塞药物明胶海绵。目前,充填纳米羟基磷灰石(nanometer hydroxyapatite,nano-HA)的方法日渐普及。其中缝合、填塞碘仿明胶海绵,充填羟基磷灰石的方法能起到较好封闭拔牙创,防止并发症的作用,但这些不同处理方式对于拔牙后牙槽骨愈合方面影响的深入比较,目前尚未见报道。
目的:比较nano-HA、缝合、碘仿明胶海绵三种处理方式与常规压迫止血在促进拔牙创早期愈合、防止牙槽嵴吸收方面的效果;比较缝合、碘仿明胶海绵两种处理方式与目前研究较多的纳米羟基磷灰石充填的处理方式之间在促进拔牙创早期愈合、防止牙槽嵴萎缩方面是否有差别。
方法:采用同体对照的方法,将每只狗的下颌双侧第3、5、7牙位的牙齿分成三组,用相同的手法拔除所设定牙位的牙齿,左侧为实验侧,分别采取置入nano-HA、缝合、置入碘仿明胶海绵三种不同处理方法,右侧为对照侧,全部采取常规咬压止血。于第1,2,4,8,12,24周各处死动物两只,取下颌骨作标本,行数字牙片机拍摄X线片后,将以拔牙创为中心的组织于10%福尔马林溶液中浸泡2天后,脱钙2周,乙醇系列脱水,石蜡包埋,切片,常规HE染色,光镜下观察拔牙创愈合的变化。
结果:1.采用三种不同方式处理的拔牙创在促进新骨形成、防止牙槽骨吸收方面与单纯压迫止血者比较,差异有统计学意义(P＜0.05)。
2.三个实验组比较:①在防止牙槽嵴吸收方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较,差异有统计学意义(P＜0.05),缝合组与碘仿明胶海绵组之间比较有统计学差异(P＜0.05)。
②在骨密度方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较,差异有统计学意义(P＜0.05),缝合组与碘仿明胶海绵组之间比较无统计学差异(P＞0.05)。
③在促进新骨形成方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较有统计学差异(P＜0.05)。缝合组与碘仿明胶海绵组之间,无统计学差异(P＞0.05)。
结论:1.三种实验侧处理方式均可以减少拔牙创口与外界的接触面积并可有效阻止异物进入,从而促使形成质量较好的血凝块,有利于拔牙创的早期愈合,减少牙槽嵴的吸收量。
2.缝合、填塞碘仿明胶海绵处理方式对拔牙后牙槽窝早期愈合和防止牙槽嵴高度降低方面的效果介于单纯压迫止血和nano-HA的处理方式之间。
3.对拔牙后牙槽窝的处理效果由好至差依次为:充填nano-HA,碘仿明胶海绵、缝合,单纯压迫止血。
In oral clinical, in order to restore patient's mastication function and obtain better long-term effects of restoration, we need to extract some loose tooth. The artificial denture will not be repaired until the alveolar ridge absorption change stably, only then carries on. In the early wound healing, if a tooth extraction stimulated by external factors, wound healing even will be delayed. After tooth extraction, pressure to stop bleeding is commonly used in clinical, suture or packing iodoform gelatin sponge is always used for impacted tooth extraction. At present, nano-HA filling after tooth extraction is used increasely. Suture, packing iodoform gelatin sponge, filling the hydroxyapatite can play a better part on closing extraction and preventing complications, but the comparing of these different ways on regeneration of alveolar bone has not been reported currently.
Objectives: To compare the effect of the three treatments with that of pressure to stop bleeding on the promotion of early healing of extraction socket and preventing the alveolar ridge from atrophy after extraction; To compare the effect of sutures and iodoform gelatin sponge with that of nano-HA on the promotion of early healing of extraction socket and preventing the alveolar ridge from atrophy after extraction.
Methods: Each dog will be extracted bilateral the third lower incisor, the first and third premolars. All the teeth were extracted with the same ways. The right side was kept vacant after teeth extraction as the control group, the other side was dealt with three different methods as experimental side: implanting nano-HA artificial bone, suture and iodoform gelatin sponge. 1, 2, 4, 8, 12, 24 weeks later, the animals were killed. The specimens were examined by digital X-ray, light microscope.
Results: 1. There were significantly different between each different method and compression to stop bleeding on preventing the absorption of alveolar bone and new bone formation (P<0.05).
2. Three experimental groups:①On preventing absorption of alveolar bone: There was significantly different between nano-HA group and other experimental groups(suture group and iodoform gelatin sponge group) (P<0.05);There was also different between the suture group and iodoform gelatin sponge group(P<0.05).②On bone density: There was significantly different between the nano-HA group and suture group(P<0.05); There was significant difference between the nano-HA group and iodoform gelatin sponge group(P<0.05); There was no difference between the suture group and iodoform gelatin sponge group(P>0.05).③In the promotion of new bone formation: There was significantly different between the nano-HA group and suture group (P<0.05); There was significantly different between the nano-HA group and iodoform gelatin sponge group(P<0.05); There was no difference between the suture group and iodoform gelatin sponge group (P>0.05).
Conclusions: 1: The three methods can reduce the wound area of contacting with the outside world, prevent the entry of foreign matter effectively, in order to form a clot with better quality. It is helpful for the early healing of tooth extraction and reducing the absorption of alveolar ridge.
2: On the effects of the early healing and preventing absorption of alveolar bone, suture and iodoform gelatin sponge were better than compression to stop bleeding, but worse than nano-hydroxyapatite.
3. The effect after a tooth extraction from good to poor: filling nano-HA,iodoform gelatin sponge, suture, oppression simply to stop bleeding.
目的:比较nano-HA、缝合、碘仿明胶海绵三种处理方式与常规压迫止血在促进拔牙创早期愈合、防止牙槽嵴吸收方面的效果;比较缝合、碘仿明胶海绵两种处理方式与目前研究较多的纳米羟基磷灰石充填的处理方式之间在促进拔牙创早期愈合、防止牙槽嵴萎缩方面是否有差别。
方法:采用同体对照的方法,将每只狗的下颌双侧第3、5、7牙位的牙齿分成三组,用相同的手法拔除所设定牙位的牙齿,左侧为实验侧,分别采取置入nano-HA、缝合、置入碘仿明胶海绵三种不同处理方法,右侧为对照侧,全部采取常规咬压止血。于第1,2,4,8,12,24周各处死动物两只,取下颌骨作标本,行数字牙片机拍摄X线片后,将以拔牙创为中心的组织于10%福尔马林溶液中浸泡2天后,脱钙2周,乙醇系列脱水,石蜡包埋,切片,常规HE染色,光镜下观察拔牙创愈合的变化。
结果:1.采用三种不同方式处理的拔牙创在促进新骨形成、防止牙槽骨吸收方面与单纯压迫止血者比较,差异有统计学意义(P＜0.05)。
2.三个实验组比较:①在防止牙槽嵴吸收方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较,差异有统计学意义(P＜0.05),缝合组与碘仿明胶海绵组之间比较有统计学差异(P＜0.05)。
②在骨密度方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较,差异有统计学意义(P＜0.05),缝合组与碘仿明胶海绵组之间比较无统计学差异(P＞0.05)。
③在促进新骨形成方面:nano-HA组分别与缝合组、碘仿明胶海绵组比较有统计学差异(P＜0.05)。缝合组与碘仿明胶海绵组之间,无统计学差异(P＞0.05)。
结论:1.三种实验侧处理方式均可以减少拔牙创口与外界的接触面积并可有效阻止异物进入,从而促使形成质量较好的血凝块,有利于拔牙创的早期愈合,减少牙槽嵴的吸收量。
2.缝合、填塞碘仿明胶海绵处理方式对拔牙后牙槽窝早期愈合和防止牙槽嵴高度降低方面的效果介于单纯压迫止血和nano-HA的处理方式之间。
3.对拔牙后牙槽窝的处理效果由好至差依次为:充填nano-HA,碘仿明胶海绵、缝合,单纯压迫止血。
In oral clinical, in order to restore patient's mastication function and obtain better long-term effects of restoration, we need to extract some loose tooth. The artificial denture will not be repaired until the alveolar ridge absorption change stably, only then carries on. In the early wound healing, if a tooth extraction stimulated by external factors, wound healing even will be delayed. After tooth extraction, pressure to stop bleeding is commonly used in clinical, suture or packing iodoform gelatin sponge is always used for impacted tooth extraction. At present, nano-HA filling after tooth extraction is used increasely. Suture, packing iodoform gelatin sponge, filling the hydroxyapatite can play a better part on closing extraction and preventing complications, but the comparing of these different ways on regeneration of alveolar bone has not been reported currently.
Objectives: To compare the effect of the three treatments with that of pressure to stop bleeding on the promotion of early healing of extraction socket and preventing the alveolar ridge from atrophy after extraction; To compare the effect of sutures and iodoform gelatin sponge with that of nano-HA on the promotion of early healing of extraction socket and preventing the alveolar ridge from atrophy after extraction.
Methods: Each dog will be extracted bilateral the third lower incisor, the first and third premolars. All the teeth were extracted with the same ways. The right side was kept vacant after teeth extraction as the control group, the other side was dealt with three different methods as experimental side: implanting nano-HA artificial bone, suture and iodoform gelatin sponge. 1, 2, 4, 8, 12, 24 weeks later, the animals were killed. The specimens were examined by digital X-ray, light microscope.
Results: 1. There were significantly different between each different method and compression to stop bleeding on preventing the absorption of alveolar bone and new bone formation (P<0.05).
2. Three experimental groups:①On preventing absorption of alveolar bone: There was significantly different between nano-HA group and other experimental groups(suture group and iodoform gelatin sponge group) (P<0.05);There was also different between the suture group and iodoform gelatin sponge group(P<0.05).②On bone density: There was significantly different between the nano-HA group and suture group(P<0.05); There was significant difference between the nano-HA group and iodoform gelatin sponge group(P<0.05); There was no difference between the suture group and iodoform gelatin sponge group(P>0.05).③In the promotion of new bone formation: There was significantly different between the nano-HA group and suture group (P<0.05); There was significantly different between the nano-HA group and iodoform gelatin sponge group(P<0.05); There was no difference between the suture group and iodoform gelatin sponge group (P>0.05).
Conclusions: 1: The three methods can reduce the wound area of contacting with the outside world, prevent the entry of foreign matter effectively, in order to form a clot with better quality. It is helpful for the early healing of tooth extraction and reducing the absorption of alveolar ridge.
2: On the effects of the early healing and preventing absorption of alveolar bone, suture and iodoform gelatin sponge were better than compression to stop bleeding, but worse than nano-hydroxyapatite.
3. The effect after a tooth extraction from good to poor: filling nano-HA,iodoform gelatin sponge, suture, oppression simply to stop bleeding.
引文
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