笑气吸入镇痛用于小儿埋藏牙拔除的临床研究

目的　观察吸入 5 0 %笑气 (N2 O)辅助小儿埋藏牙拔除的镇痛效果 ,探讨高浓度笑气能否安全有效地应用于门诊辅助小儿拔牙镇痛。方法　 15 6例埋藏牙小儿病例吸入 5 0 %笑气后 ,连续测定拔牙时心率 (HR )及末梢血氧饱和度 (SpO2 ) ,根据Kuttner ,Lepage面部表情法测量小儿镇痛程度 ,与拔牙前测量值进行比较。结果　小儿在拔牙时的HR轻度增快 ,SpO2 变化不大 ,镇痛评分在拔牙前和拔牙时无统计学意义。结论　吸入 5 0 %笑气辅助小儿埋藏牙拔除具有良好的镇痛效果 ,可使小儿顺利渡过埋藏牙神经阻滞不完善时的镇痛     

笑气吸人镇痛用于小儿埋藏牙拔除的临床研究

目的 观察吸入50％笑气(N2O)辅助小儿埋藏牙拔除的镇痛效果，探讨高浓度笑气能否安全有效地应用于门诊辅助小儿拔牙镇痛。方法 156例埋藏牙小儿病例吸入50％笑气后，连续测定拔牙时心率(HR)及末梢血氧饱和度(SpO2)，根据Kuttner，Lepage面部表情法测量小儿镇痛程度，与拔牙前测量值进行比较。结果 小儿在拔牙时的HR轻度增快，SpO2变化不大，镇痛评分在拔牙前和拔牙时无统计学意义。结论 吸入50％笑气辅助小儿埋藏牙拔除具有良好的镇痛效果，可使小儿顺利渡过埋藏牙神经阻滞不完善时的镇痛。     

氧化亚氮/氧气混合气吸入镇静镇痛在口腔门诊小手术中的临床应用研究

[摘要] 目的 观察比较氧化亚氮/氧气混合气吸入镇静镇痛在口腔门诊小手术中的临床应用情况。方法 对口腔颌面外科门诊就诊的患者,分别采用氧化亚氮/氧气混合气吸入配合局麻和单纯局部麻醉,进行治疗。通观察患者心率,血氧饱和度等临床指标的变化。结果 2组患者在整个手术过程中的心率及血氧饱和度的变化情况,注射局麻时的VAS疼痛评分比较,术中疼痛程度和镇静程度比较,差异均有显著性。结论 氧化亚氮/氧气混合气吸入配合局麻具有安全、有效的特点,对于复杂牙拔除、阻生牙拔除等口腔门诊小手术具有很好的辅助效应。     

笑气吸入对控制儿童局部麻醉注射疼痛的影响

目的 观察笑气吸入对儿童上前牙区埋伏多生牙拔除术前局麻注射疼痛的影响。方法 对60例需行上前牙区埋伏多生牙拔除术的患儿（6～10岁）采用随机、双盲、安慰剂对照的方法进行研究。随机分为2组：笑气吸入组(A组,n=30)和氧气吸入组（B组,n=30）。局部麻醉过程中监测患儿的心率（HR）、呼吸频率（RR）及血氧饱和度（SPO2）,根据Frankl治疗依从性量表评价患儿的配合程度,改良警觉与镇静评分评价镇静深度,FLACC疼痛行为量表评价患儿镇痛程度。结果 局麻操作过程中Frankl治疗依从性评分A组优于B组（P<0.05）,A组FLACC疼痛行为量表值低于B组,A组患儿镇静程度优于B组（P<0.05）,2组HR、RR及SPO2变化无统计学差异（P＞0.05）。结论 笑气吸入可以明显减轻局麻过程中患儿的疼痛程度。     

笑气吸入对阻生齿拔除术局麻药镇疼效果的影响

目的:观察笑气吸入对阻生齿拔除术前局麻注射疼痛的影响及治疗依从性的作用。方法:110例门诊阻生齿拔除患者随机分为2组,试验组75例,对照组35例。试验组随机分为3组,在不同浓度笑气吸入镇静加局麻下拔牙,对照组只在局麻下拔牙。拔牙过程中监测患者的生命体征,拔牙结束后调查2组患者对整个拔牙过程的感受,对局麻注射时、阻生齿拔除时和拔牙后5 min 3个时间点进行疼痛VAS评分并对整个过程进行Houpt行为量表评分。结果:3个时间点的VAS评分试验组均低于对照组(P<0.05);25%笑气吸入组与在3个时间点VAS得分平均值均大于30%笑气吸入组(P<0.05),35%笑气吸入组与30%笑气吸入组VAS平均值差异无统计学意义(P>0.05)。试验组和对照组Houpt行为量表评分分别为5.40±0.60和4.60±0.77(P<0.05)。结论:笑气吸入可以减轻神经阻滞麻醉的注射疼痛,缓解患者拔牙前的紧张情绪,使其更好的配合治疗。多数患者在30%笑气浓度时获得满意的镇静、镇痛效果。     

笑气吸入清醒镇静法用于拔牙术的临床研究

目的总结笑气吸入清醒镇静法用于拔牙术的临床效果。方法实验组１１２例，随机分为四组，在笑气吸入清醒镇静辅以局部麻醉下拔牙。对照组５１例，仅在局部麻醉下拔牙。结果实验组术后有７４．１１％患者焦虑评分下降，与对照组相比，两者手术前后焦虑变化差异有非常显著性（Ｐ＜０．０１）。实验组均获得一定程度的镇静，６７．８６％患者部分遗忘。大多数患者（８６．６１％）接受笑气吸入清醒镇静。实验组四组间手术前后焦虑变化情况、镇静评分、健忘评分差异无显著性（Ｐ＞０．０５）。结论笑气吸入清醒镇静具有较好的抗焦虑、镇静、健忘作用，能够减轻或解除患者的焦虑心理，减少非牙科焦虑患者产生医源性牙科焦虑心理。     

笑氧混合气吸入与局麻联合用于阻生牙拔除术的临床观察

目的：总结笑氧混合气吸入镇静加局部麻醉用于阻生牙拔除术的临床效果。方法：114例低位阻生或水平阻生牙拔除病例应用笑氧混合气吸入镇静加局部麻醉拔除阻生牙患者进行临床研究,测定笑气吸入前、后及手术中的心率（HR）、血氧饱和度（SPO2）,并进行Ramsay镇静评分,满意度调查数据进行统计学处理。结果,笑氧混合气吸入镇静下均顺利完成阻生牙拔除手术,吸入笑氧前、后和术中心率、血氧饱和度、相比无显著差异（P〉0.05）。结论：笑氧混合气吸入清醒镇静加局部麻醉在阻生牙拔除术中可以取得满意的效果。     

氧化亚氮-氧气混合吸入镇静在老年 口腔治疗中的应用

目的 探讨氧化亚氮-氧气混合吸入镇静在老年口腔治疗中的临床应用效果.方法 以134例老年口腔临床治疗患者为研究对象,按治疗方式分为2组,对照组采取单纯局部麻醉方式,研究组采取局部麻醉配合氧化亚氮-氧气混合吸入镇静.通过心电监护仪观察患者治疗过程中的心率、血压、血氧饱和度,对患者进行Ramsay镇静评分、VAS疼痛评分DAS焦虑评分,比较两种治疗方式的镇静、镇痛、减轻焦虑效果以及安全性.结果 研究组患者术中同术前比较,心率明显减慢,血氧饱和度明显增加,血压稳定,同对照组相比有显著差异(P<0.05).对照组轻度疼痛者(VAS疼痛评分<4)63人(94.03％),研究组轻度疼痛者仅为11人(16.42％),研究组镇痛效果有明显优势(P<0.05).对照组和研究组Ramsay镇静程度评分分别为1.12±0.16和2.34±0.18,研究组的镇静状态显著高于对照组(P<0.05).DAS焦虑程度评分,对照组患者<15分者42人(62.69％),研究组<15分者64人(95.52％),研究组的焦虑程度要明显低于对照组(P<0.05).结论 氧化亚氮-氧气混合吸入镇静在老年口腔临床应用中镇痛、镇静效果好,能缓解老年人焦虑状态,提高治疗的安全性和舒适性.     

笑气吸入清醒镇静法用于拔牙术的临床观察

目的 探讨笑气吸入清醒镇静法下实施拔牙术的临床效果。方法 将需拔牙的患者60例随机分为2组,实验组32例在笑气清醒镇静加局麻下拔牙,对照组28例只在局麻下拔牙,观察拔牙过程中,2组患者血压、心率等临床指标的变化。结果 2组患者在整个过程中的血压及心率变化情况、注射局麻时的VAS疼痛评分比较,差异均有显著性(P<0.05)。2组均无严重并发症发生。结论 笑气吸入清醒镇静法具有良好的抗焦虑止痛作用,术中具有良好的稳定血压的效果,安全性较大。     

采用不同麻醉方法拔除上前磨牙的临床对比

目的 比较拔除上前磨牙时采用单牙无痛局部麻醉系统(STA)行牙周韧带(PDL)内注射麻醉和常规金属注射器颊腭双侧局部浸润麻醉在注射及拔牙过程中疼痛情况和麻醉效果.方法 选择100例因为正畸需要拔除双侧上前tEi磨牙的患者为研究对象,随机选择其中一侧作为试验牙,另一侧作为对照牙:实验组应用计算机控制STA进行盐酸阿替卡因PDL内注射麻醉,对照组采用常规金属注射器进行盐酸阿替卡因颊腭双侧局部浸润麻醉.麻醉5 min后进行拔牙手术.利用直观模拟标度尺(VAS)及问卷获得患者麻醉注射及拔牙时的痛觉数据和颊部软组织是否麻木不适数据.结果 实验组和对照组麻醉注射疼痛感觉VAS值分别是(0.4011±0.556)、(4.1038 4±1.512),两组注射疼痛感觉比较差异有统计学意义(P<0.01);而实验组与对照组在麻醉镇痛成功率方面比较差异无统计学意义(P>0.05);实验组只有2%患者有颊侧软组织麻木不适感,而对照组100%患者有颊侧软组织麻木不适感,两者差异有统计学意义(P<0.01).结论 在上前磨牙拔除中.应用STA-PDL注射麻醉可以达到良好的麻醉效果,同时麻醉注射时疼痛轻微,对邻近颊部软组织功能影响小,麻醉药物用量较少.     

替牙期骨性Ⅲ类错牙合患者颞下颌关节特征的锥形束CT研究

目的:采用锥形束CT(CBCT)研究替牙期骨性Ⅲ类错牙合患者颞下颌关节的影像学特征,探讨Ⅲ类功能状态下,颞下颌关节的生长、改建机制。方法:从就诊于昆明医科大学附属口腔医院正畸科的患者中选取符合纳入标准的替牙期骨性Ⅲ类错牙合患者及骨性Ⅰ类错牙合患者各20名,使用NNT viewer 5.3图像处理软件进行三维重建及线距和角度的测量,并进行统计学分析。结果:替牙期骨性Ⅲ类错牙合患者组和替牙期骨性Ⅰ类错牙合患者组对比结果为:矢状面双侧关节前间隙偏小、双侧关节上间隙偏小、双侧关节结节斜度偏小;冠状面双侧关节内间隙偏小,双侧关节上间隙偏小,双侧关节外间隙偏小,右侧髁状突角度偏小;横截面右侧髁状突前后径偏小。结论:替牙期骨性Ⅲ类错牙合患者颞下颌关节发育不充分,呈现髁状突,关节窝深度,关节结节斜度;冠状面关节内、外间隙均较小的特征。骨性Ⅲ类错牙合患者髁状突在关节窝中处于前置近关节窝顶位置。骨性Ⅲ类错牙合患者颞下颌关节影像学特征与其功能状态相适应。     

柠檬精油对牙周致病菌抑制作用及其安全性初步研究

目的:探讨柠檬精油对牙周致病菌的体外抗菌活性及对细胞增殖的影响。方法:采用微量液体稀释法测定柠檬精油对Pg、Fn、Aa、Pi的最小抑菌浓度(minimal inhibitory concentration,MIC)及最小杀菌浓度(minimum bactericidal concentration,MBC);以较低浓度的MIC为标准稀释LEO作为实验组,采用MTT法测定柠檬精油对HUVECs的毒性作用,明确抑菌浓度下LEO的安全性。结果:柠檬精油对牙周主要致病菌均有抑菌作用,Pg、Fn、Aa、Pi的MIC分别是9.0 g/L、4.5 g/L、4.5 g/L、9.0 g/L,Aa、Fn的 MBC是9.0 g/L,Pg、Pi的MBC未测得。1/2MIC、1/20MIC浓度的LEO能够抑制人脐静脉内皮细胞的生长,而低于1/200MIC浓度的LEO则对人脐静脉内皮细胞的生长没有影响,其中1/200MIC浓度的LEO作用明显优于0.02%的CHX。结论:体外环境中,柠檬精油对牙周致病菌Pg、Fn、Aa、Pi具有抗菌活性,低浓度应用对机体相对安全。     

Computer-assisted planning for maxillofacial prosthodontic rehabilitation

Computerized tomography (CT) planning and the use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects.     

Clinical and pathological aspects on some odontogenic tumors

Odontogenic tumors constitute a very diverse group of lesions that reflects the complex processes of odontogenesis. Controversies over their classification/subtyping, terminology and diagnosis have been persisted, which has direct bearings on therapeutic and/or prognostic implications.     

Ghlorhexidine as a root canal medicament for treating inflammatory lesions in the periodontal space

Abstract— The purpose of the present study was to investigate the therapeutic effect of intra-canal application of chlorhexidine on inflammatory root resorption. Dental pulps from monkey incisors were infected and resealed prior to extraction of the teeth. Root dentin was mechanically exposed and the teeth were replanted under aseptic conditions. After 4 weeks, the experimental teeth were dressed with chlorhexidine gel and resealed. Animals were sacrificed 4 weeks later, and their jaws prepared for histologic examination. Results showed that both marginal and apical periodontal inflammation and resorption were reduced in the chlorhexidine-treated teeth. It was concluded that the use of intra-canal chlorhexidine may be a useful adjunct in the treatment of inflammatory root resorption, but further human trials need to be undertaken before its clinical use can be recommended.     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

小鼠牙髓干细胞同种异体移植后体内免疫反应初探

目的:初步探究小鼠牙髓干细胞同种异体移植后的全身免疫反应。方法:牙髓干细胞分离获得自C57BL/6 小鼠牙髓组织,培养至第3 代,与纳米羟基磷灰石(n-HA)复合培养形成复合物,扫描电镜观察其生长黏附情况。40只4周龄的C57BL/6 小鼠随机分成两组。实验组将复合物移植入上背部皮下,对照组将纳米羟基磷灰石植入上背部皮下,术后均使用外科方法严密缝合创口。两组动物术后均观察4周、6周处死,分离脾脏,制成脾淋巴细胞悬液,流式细胞仪测定CD4⁺、CD8⁺的值。结果:牙髓干细胞在体外与纳米羟基磷灰石结合良好;免疫组化染色实验组4周、6周均可见牙本质涎蛋白(dentin sialoprotein,DSP)阳性表达;实验组与对照组相比,术后4周、6周CD4⁺/CD8⁺值均无明显差异。结论:牙髓干细胞同种异体移植后,尚不能够引起机体的免疫排斥反应,其在体内仍具有低免疫原性,有望成为组织工程同种异体种子细胞来源。     

Can you be too old for oral implants? An update on ageing and plasticity in the oro‐facial sensorimotor system

This review focuses on the capacity of the brain for plasticity and the utility and efficacy of oral implants in helping to restore oro‐facial sensorimotor functions, especially in elderly patients. The review first outlines the components of the oro‐facial sensorimotor system which encompasses both oro‐facial tissues and a number of brain regions. One such region is the sensorimotor cortex that controls the activity of the numerous oro‐facial skeletal muscles. These muscles are involved in a number of functions including reflexes and the more complex sensorimotor functions of mastication, swallowing and speech. The review outlines the use by the brain of sensory inputs from oro‐facial receptors in order to provide for exquisite sensorimotor control of the activity of the oro‐facial muscles. It highlights the role in this sensorimotor control played by periodontal mechanoreceptors and their sensory inputs to the brain, and how oral implants in concert with the plastic capacity of the brain may, at least in part, compensate for reduced sensorimotor functioning when teeth are lost. It outlines findings of ageing‐related decrements in oro‐facial sensorimotor functions and control. The changes in oro‐facial tissues and the brain that underlie these ageing‐related functional alterations are also considered, along with adaptive and compensatory processes that utilise the brain's capacity for plasticity. The review also notes the evidence t hat rehabilitation that incorporates adjunctive approaches such as sensorimotor training paradigms in addition to oral prostheses such as implants may enhance these processes and help maintain or facilitate recovery of sensorimotor functioning in the elderly.     

Cytokine-induced endogenous procollagenase stored in the extracellular matrix of soft connective tissue results in a burst of collagen breakdown following its activation

Numerous data strongly suggest the involvement of cytokines and the matrix metalloproteinase collagenase (MMP-1) in the pathogenesis of periodontitis. Recently, we have demonstrated that, upon culturing under the influence of IL- lα+EGF, a large amount of inactive procollagenase (MMP-1) is stored in the extracellular matrix of periosteal tissue. We now show that this endogenous reservoir of proenzyme can be operative after activation with plasmin and is able to induce a rapid and almost complete breakdown of the collagenous extracellular matrix. The level of collagen degradation following activation showed a strong correlation with the amount of proenzyme that was incorporated in the tissue. The highest levei of degradation (70% of the total amount of collagenous proteins) was found with the IL-lα+EGF-treated explants, followed by those treated with IL-1α alone (35%). Explants cultured with EGF or in the absence of cytokines, containing only small amounts of procollagenase, showed little collagen breakdown following plasmin activation (7%). Inhibition of metalloproteinases by EDTA, or blockage of plasmin by PMSF, prevented the degradation in all explants irrespective of the amount of proenzyme present in the tissue. Our findings demonstrate that endogenous proenzyme stored in a native connective tissue matrix can be activated at a later time interval which results in a massive breakdown of the tissue. This study shows a possible pathway of collagenase-induced breakdown without recent de novo synthesis of the enzyme. Such a sequence may be operative in chronic inflammatory diseases, such as periodontitis, where production of procollagenase under the influence of cytokines spans a longer time period, whereas breakdown is often characterized by a cyclic behaviour.