可变方矩形脉冲Er:YAG激光在牙龈黑色素脱色中的临床观察

目的:评价可变方矩形(variable square pulse,VSP)脉冲Er:YAG激光在牙龈黑色素沉着治疗中的有效性和安全性。方法:采用VSP脉冲Er:YAG激光治疗23例牙龈黑色素沉着患者,选择激光波长2.94μm,脉冲宽度100ms,脉冲能量60m J,频率10Hz,光斑直径1mm,1次Er:YAG激光治疗为1个疗程。疗程结束后1、6、12个月随访观察效果,依据牙龈颜色和形态变化两个客观体征和患者主观评价对牙龈黑色素沉着治疗效果进行评估。结果:术后12个月回访结果显示,牙龈色素沉着消退明显,总有效率为90.0%,患者满意率达到90.0%。结论:VSP脉冲Er:YAG激光在口腔临床去牙龈色素沉着手术过程中疗效显著,感染几率低,激光仪器操作简单,安全,是一种理想的牙龈黑色素脱色治疗方法。     

Er:YAG激光治疗6例牙龈黑色素沉着的临床效果观察

目的观察Er:YAG激光治疗牙龈黑色素沉着的临床效果。方法采用Er:YAG激光(R14手机)对6例牙龈黑色素沉着患者进行黑色素去除治疗。记录患者术后24 h内肿胀、出血、疼痛情况,术后1、12、24个月随访,观察牙龈颜色和形态的变化。结果术后有2例患者出现轻微疼痛,1个月后随访均未复发;术后12个月,随访6例患者,有1例复发;术后24个月随访,5例患者完成,有2例复发。结论用Er:YAG激光进行牙龈黑色素去除治疗,短期内效果好,但长期效果有待继续观察。     

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=牙龈黑色素沉着（gingival melanin pigmentation，GMP）是由于黑色素母细胞分泌的黑色素颗粒沉积在牙龈黏膜的基底层及固有层所导致。虽然在多数情况下它不是病理性症状，但却给许多患者，尤其是露龈笑的患者造成美观上的困扰。本文对GMP的治疗方法及研究进展做一综述。     

特发性牙龈纤维瘤病病例报道及文献回顾

目的探讨特发性牙龈纤维瘤病的病因、临床表现、诊断、鉴别诊断及治疗方法,为临床诊疗提供参考。方法对1例发生于口腔的特发性牙龈纤维瘤病病例的临床资料及相关文献进行回顾性分析。结果该病例行全口牙周基础治疗,前牙区牙周手术治疗后,牙龈形态得到改善。特发性牙龈纤维瘤病是一种罕见的以牙龈组织增生为主要特征的疾病,病因及发病机制不明。该病可在幼儿时就发病,一般发生在恒牙萌出后,表现为牙龈广泛地逐渐增生,可累及全口的牙龈缘、龈乳头和附着龈,甚至达膜龈联合处,病理变化的特点是牙龈上皮的棘层增厚,上皮钉突明显增长,结缔组织体积增大,充满粗大的胶原纤维束和大量成纤维细胞,血管相对较少,炎症不明显。在临床上需与药物性牙龈增生、以增生为主要表现的慢性龈炎等疾病相鉴别。目前特发性牙龈纤维瘤病的治疗以牙龈切除术为主。该病手术后易复发,复发率与口腔卫生维护有关,复发后可再次手术治疗。结论特发性牙龈纤维瘤病较为罕见,诊断主要依靠病史询问、临床表现和病理检查,治疗方法主要为手术切除,今后的研究方向应致力于寻找更有效的治疗方法。     

牙龈肥大疾病的鉴别诊断及治疗策略

牙龈肥大已成为临床上较为常见的口腔表征,严重者影响咀嚼。同样表现为牙龈肥大,但疾病的性质可能截然不同,有可治愈的牙龈疾病,也有恶性疾病在口腔的表现,不同疾病的治疗策略和方法迥异,因此需要仔细鉴别。本文将介绍如何鉴别各种牙龈肥大性疾病,并介绍对牙龈肥大性疾病的治疗策略。     

膜龈手术在牙龈乳头保留与重建中的应用

牙周组织丧失所导致的前牙牙龈乳头退缩是影响口腔美学的重要原因。牙龈乳头退缩还会引起食物嵌塞、牙龈乳头炎症,甚至影响发音。牙龈乳头退缩的治疗包括手术治疗与非手术治疗。膜龈手术中保留牙龈乳头的切口设计能避免龈乳头高度丧失,上皮下结缔组织移植术结合特殊的翻瓣术式是重建牙龈乳头的重要途径。牙龈乳头保留或重建成功的关键在于良好的血供。本文就膜龈手术方式在保留和重建牙龈乳头中的作用作一综述,以期为临床诊疗提供借鉴。     

牙龈卟啉单胞菌在龈下菌斑中的分布

研究牙龈卟啉单胞菌在牙周炎患者病变部位和健康部位龈下菌班中的分布情况,方法：选择６４例成年牙周炎患者,取龈下菌斑,经厌氧培养,挑战产黑色素菌落,经多聚酶链反应鉴定牙龈卟啉单胞菌。结果：产黑色素Ｇ＾－厌氧杆菌和牙龈卟啉单胞菌的患者检出率分别是６７．２％和６０．９％。牙龈卟啉单胞菌在病变部位和健康部位的检出率分别是３５．９％和２８．１％,二者差异无统计学意义;牙龈卟啉单胞菌在病变部位和健康部位的检出株     

高频电刀在老年人牙龈切除术中的应用

目的:比较高频电刀与常规牙周手术在口腔修复临床治疗中的牙龈切除术的疗效。方法:61例需要作牙龈切除的老年口腔修复患者随机分成2组,分别使用高频电刀和常规牙周手术法作组织修形。分别在术后即刻、1周观察牙龈状况。结果:高频电刀组(30例)术后即刻达到修复的要求。1周后27例牙龈状况稳定(90.0%)。常规牙周手术组(31例)均需要牙周塞治,无法作即刻修复。1周后29例牙龈稳定(93.5%)。手术后即刻修复,2组间疗效存在显著性差异(P<0.01),术后1周无显著性差异。结论:高频电刀组织修形是在口腔修复治疗中能即刻达到修复要求的一种成功、可靠的牙龈切除治疗方法。     

牙龈病损的临床和组织病理学研究（2485例龈活检资料分析）

作者对２４８５例牙龈活检资料进行了回顾性分析，探讨了现有病检资料中牙龈病的种类，并重新观察了牙龈病损的病理实质。研究表明，２４８５例龈检中有牙龈病损６９种，包括：龈固有疾病１４种，肿瘤和瘤样病变２９种，皮肤病和粘膜病在牙龈的表现５种，牙周病的龈表现２种，系统病在牙龈的表现和其它１９种。其中５ｌ种牙龈病文献中已有报告，１８种是文献中未见报告的。本研究根据临床表现将龈病损分为７大类。     

CO2激光和传统手术牙龈成形术的比较

目的　对CO2 激光牙龈成形术与传统牙龈成形术方法的效果及优缺点进行比较。方法　选择临床上牙龈肥大、增生患者 42例 ,随机分成 2组 ,一组行激光龈成形术 ,另一组采用手术龈成形术。结果　所有患者近期效果满意 ,远期疗效有待进一步观察。结论　激光牙龈成形术具有操作简便 ,出血少 ,成形形态好的优点。     

Cryosurgical depigmentation of the gingiva

Gingival melanin pigmentation (GMP) occurs in all races of man. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with moderate GMP. The present study was undertaken to test the effectiveness of cryosurgical destruction of the gingival epithelium in the removal of gingival melanin pigmentation. The patient was a fair-skinned Ashkenazi Jew with moderate GMP who demanded any possible "cosmetic therapy" which would convert her "black gums" to "normal". Gingival cryosurgery was carried out by segments. A gas expansion cryoprobe cooled to -81 degrees C was applied to the gingiva for 10 s. Frozen sites thawed spontaneously within 1 min. Superficial necrosis became apparent within a week. Treated sites were covered by epithelium within 2 weeks following freezing and keratinization was completed after 3-4 weeks. The treated gingiva appeared normal and remained depigmented until the present time, 20 months following freezing. It is concluded that cryosurgery may prove to be the treatment of choice when gingival depigmentation is indicated.     

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia

Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10‐year‐old female patient presented with a 1‐month history of an asymptomatic, firm, and pinkish‐red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.     

Pigmented lichenoid drug eruption secondary to chloroquine therapy: an unusual presentation in lower lip

Antimalarial drugs, like chloroquine, may produce hyperpigmentation of the oral mucosa, affecting most commonly the palate. Its pathogenesis is not clear; an increased production of melanin is currently believed to be the cause of this oral manifestation. The purpose of this study was to report a case of atypical oral mucosal hyperpigmentation secondary to antimalarial therapy. A 66-year-old, dark skinned woman was evaluated for oral pigmentation. The patient had a history of chloroquine therapy, and presented a diffuse blue-gray pigmentation in the hard palate and, mainly, in the lower lip. Diagnostic hypothesis were of physiologic pigmentation, drug-induced pigmentation, pigmentation associated with systemic diseases, smoker's melanosis and post-inflammatory pigmentation. Incisional biopsy was conducted and histopathological examination revealed lichenoid dermatitis and pigment incontinence. Fontana-Masson staining was positive for melanin, but Perl's iron staining was negative. The histopathological diagnosis was consistent with melanin incontinence related to drug-induced lichenoid reaction secondary to chloroquine therapy. Adequate correlation of clinical and microscopic aspects was essential for the definitive diagnosis, especially in atypical cases. This diagnosis is of great relevance for the patient, since the oral manifestation might be an early sign of ocular complications due to antimalarial therapy. Therefore, the identification of these oral manifestations indicates regular evaluations by an ophtalmologist, preventing greater complications of antimalarial therapy for the patient.     

Gingival melanin pigmentation and its treatment with the CO2 laser

OBJECTIVE: There are only a few reports in the literature evaluating the effects of the carbon dioxide (CO2) laser on gingival melanin pigmentation (GMP). This study was performed to evaluate the effects of the CO2 laser at superpulse mode, applied for gingival depigmentation. STUDY DESIGN: GMP at the anterior maxillary and mandibular gingiva of 10 patients was treated using the superpulsed CO2 laser (10 watts, 0.8 mm spot size, 20 Hz, 10 milliseconds). Pigmented areas were measured on pre- and postoperative standard digital images by the aid of an image- analyzing software. Statistical analysis of the data was performed by Mann Whitney U test. RESULTS: Ablation of the hyperpigmented gingiva was accomplished with minimal carbonization and almost no bleeding. Postoperative healing was uneventful with no significant postoperative pain. Two cases of partial repigmentation were observed during 24-month follow-up. Statistical analysis of the data revealed a significant difference between pre- and postoperative measurements of pigmented area. CONCLUSION: Application of the superpulse mode of CO2 laser appears to be an effective and safe method for the elimination of GMP.     

Elevation of collagen type I in fibroblast-keratinocyte cocultures emphasizes the decisive role of fibroblasts in the manifestation of the phenotype of cyclosporin A-induced gingival overgrowth

Background and Objective: Collagen type I elevation in cyclosporin A‐induced gingival overgrowth supports evidence that gingival fibroblasts play a decisive role in the manifestation of the phenotype. To analyze the role of gingival fibroblasts under more in vivo‐like conditions, we evaluated the effect of cyclosporin A on collagen type I gene and protein expression in gingival overgrowth‐derived gingival fibroblasts established as cocultures with gingival keratinocytes as well as in matched gingival fibroblast monolayers. Material and methods: Monolayers and cocultures of primary gingival fibroblasts were treated with cyclosporin A for 6 and 72 h. The expression of collagen type I mRNA was analyzed by quantitative real time polymerase chain reaction, while expression and secretion of collagen type I protein was analyzed by indirect immunofluorescence and western blotting. Results: Compared with controls, significant elevation of collagen type I mRNA was restricted to cocultures after 6 and 72 h of treatment with cyclosporin A. In keratinocytes, collagen type I remained undetectable. In monolayers and cocultures, indirect immunofluorescence showed a slightly higher level of collagen type I protein in gingival fibroblasts in response to stimulation with cyclosporin A. Semiquantitative detection of collagen type I by western blotting demonstrated a nonsignificant increase for cell extracts in monolayers and cocultures. For secreted collagen type I, western blot analysis of the supernatants revealed elevated protein levels in cultures stimulated with cyclosporin A. Compared with the corresponding monolayers, the stimulatory effect of cyclosporin A on protein secretion was significant only in coculture. Conclusion: Our results indicate that collagen type I is a target of cyclosporin A and that gingival fibroblasts are decisive for the manifestation of the gingival overgrowth‐phenotype. Furthermore, the results suggest that cocultures of gingival overgrowth‐derived gingival fibroblasts and gingival keratinocytes permit analysis of cyclosporin A‐induced effects under more in vivo‐like conditions.     

Vaporization of melanin in oral tissues and skin with a carbon dioxide laser: A canine study

PURPOSE: This study tested the efficacy of carbon dioxide (CO2) laser vaporization in ablating gingival, oral mucosal, and cutaneous melanin in dogs. MATERIALS AND METHODS: Three mongrel dogs with pigmentation of the oral mucosa, gingivae, and skin were used. Biopsy specimens from the melanin sites were obtained from all 3 dogs before laser application. Removal of the melanin sites was performed by using a 3 W continuous-wave CO2 laser. Biopsies of the treated areas were performed 1, 2, 4, and 6 weeks after laser treatment in all 3 dogs and also, at 11 weeks in 1 dog. The histologic sections were stained with hematoxylin and eosin and Masson-Fontana dye. A computerized morphometric program calculated the average percentage of the melanin layer in the Masson-Fontana-stained sections. RESULTS: Clinical and histologic examination showed the CO2 laser to be effective in eliminating the pigmented areas in all tissues treated. No recurrence of melanin was detected in either the oral mucosa or gingiva at any of the follow-up times. In the skin, however, a small amount of melanin repigmentation was noticeable. CONCLUSIONS: CO2 laser surgery proved an effective tool for obliterating superficial melanin discoloration. To prevent recurrence of the pigmentation, the area must be cleared completely of melanin, directing the laser beam carefully along the visible margins of the area.     

正畸治疗与牙周软组织健康的关系及处理

牙周健康与正畸的关系密不可分。良好的正畸治疗可以改善患者的口颌系统功能,排列整齐的牙齿有利于口腔卫生清洁,降低龋病及牙周病的发生风险;但是如果正畸治疗过程忽略定期牙周评估,也可能出现牙周软硬组织不良等临床问题。本文通过阐述正畸治疗中常见的牙周软组织异常,主要包括牙龈炎、牙龈肥大、牙龈退缩、牙龈内陷的发生原因、预防及处理原则,以期保护正畸患者的牙周健康,辅助正畸治疗方案的顺利实施。