糖尿病患者牙髓组织病变及IL-8、VEGF表达的研究

目的研究糖尿病患者(diabetes mellitus,DM)和正常人牙髓血管形态结构及IL-8含量、VEGF表达的差异。方法DM组30例为Ⅱ型DM患者因阻生拔除的外观完好无牙髓病症状的第三磨牙,对照组30例为正常人因阻生拔除的健康牙齿。采用酶联免疫吸附试验(ELISA)分别检测2组牙髓组织中IL-8的含量。光镜下观察2组牙髓组织的结构特点,并对牙髓标本进行血管内皮生长因子(VEGF)的免疫组化染色,通过Image pro-plus 6.0图像分析软件对牙髓组织中VEGF染色进行定量分析。应用SAS6.12软件包对试验数据进行统计分析。结果 DM组牙髓中IL-8含量高于正常牙髓(P=0.0455<0.05)。光镜下DM组牙髓中可见毛细血管壁增厚。VEGF在对照组和DM组牙髓中都有表达,DM组牙髓中的表达增强(P<0.01,成牙本质细胞P<0.001,成纤维细胞P<0.01,血管内皮细胞P<0.01)。结论 DM患者即使是无龋坏、无创伤缺损、无症状的牙齿牙髓也出现了炎症反应。VEGF在DM患者牙髓中的高表达提示其牙髓发生了损伤与修复过程,发生在DM患者外周微血管的病变同样也发生在了牙髓中,提示DM与其牙髓病变具有相关性。     

下颌第三磨牙阻生伴第二磨牙牙髓病变同期治疗的临床观察

目的探讨下颌第三磨牙阻生伴第二磨牙牙髓病变同期治疗的可行性。方法对80例下颌阻生第三磨牙引起邻牙牙髓病变的患者在局麻下同期行第二磨牙的一次性根管治疗和阻生第三磨牙拔除术,根据患者反应和X线片检查评价其疗效。结果80例患者经联合治疗,成功率达91.3%。结论下颌第三磨牙阻生伴第二磨牙牙髓病变同期治疗可以缩短疗程,减轻患者痛苦。     

下颌第三磨牙阻生伴邻近第二磨牙病变临床治疗

下颌第三磨牙阻生常导致邻近第二磨牙发生病变,第二磨牙病变程度的不同决定了阻生的第三磨牙拔除与否。本文旨在对下颌第三磨牙阻生伴邻近第二磨牙病变的临床治疗方法做一综述,以期为牙体牙髓科医生的临床操作提供指导。     

下颌第三磨牙拔除与下颌第二磨牙同期治疗57例

<正> 下颌第三磨牙阻生在临床上引起诸多并发症,因邻牙远中龋或牙髓根尖病变而拔除的占20％以上。我科从1998年至今应用高速涡轮机辅助拔除第三磨牙,并同期治疗邻牙57例,效果良好,现报告如下。l 资料和方法 选取门诊下颌第三磨牙阻生致邻牙远中龋或牙髓根尖周病变者57例,男31例,女26例,均为单侧。患者年龄ZI-43岁,平均31.5岁。近中阻生占87％,水平阻生占13％。     

超短波理疗预防下颌阻生第三磨牙拔除术后肿痛的探讨

目的 探讨超短波理疗预防下颌阻生第三磨牙拔除术后肿痛的效果.方法 选取拔除下颌低位阻生或埋伏阻生第三磨牙的患者28例32颗牙,随机分为超短波理疗试验组和对照组,观察术后肿胀、疼痛和伤口愈合情况.结果 术后第1天、第3天的肿胀和疼痛程度两组间差异有统计学意义.术后第7天肿胀、疼痛程度两组间差异无统计学意义.结论 超短波理疗能减轻下颌阻生牙拔除术后伤口肿胀、疼痛的程度.     

正常人牙髓中血红素氧合酶-1的免疫组化研究

研究血红素氧合酶-1(HO-1)在正常人牙髓组织中的表达,探讨其分布与功能的关系。方法临床因阻生或正畸拔除的健康第三磨牙或前磨牙的牙髓,用免疫组织化学SABC法进行染色,检测HO-1在牙髓组织中的表达情况。结果 HO-1在牙髓血管内皮细胞和成牙本质细胞呈现阳性表达,在部分牙髓成纤维细胞和幼稚牙髓细胞中呈阳性或弱阳性表达。结论提示HO-1在牙髓血流调控、牙本质形成及牙髓细胞代谢和分化中可能起一定的作用。     

下颌第三磨牙水平阻生导致第二磨牙远中根严重吸收的正畸治疗

随着人类进化和食品日益精细,下颌第三磨牙阻生越来越普遍。下颌第三磨牙阻生易导致第二磨牙的龋坏已被重视,而第三磨牙阻生引起第二磨牙根吸收是其另一个不良后果,能占拔除阻生牙数的2．74％。对此类患者的治疗多采用拔除阻生的第三磨牙,第二磨牙的牙髓牙体治疗、试保留。     

臭氧油在下颌阻生第三磨牙拔除术后应用效果研究

目的    观察下颌阻生第三磨牙拔除术后局部涂抹臭氧油的临床效果。方法    选取2019年1-9月就诊于南京大学医学院附属口腔医院并拟拔除双侧下颌阻生第三磨牙患者45例,共计患牙90颗。采用随机自身对照的方法,将所有患牙分为臭氧油组和对照组。所有患者均采用微创牙拔除术,术后连续3 d,臭氧油组在手术创面及创面周围涂抹臭氧油,对照组给予抗生素口服。于术后1、3、7 d评估患者疼痛、肿胀、张口受限程度等舒适度相关指标。结果   术后1、3、7 d,臭氧油组患者的疼痛及肿胀程度明显低于对照组,臭氧油组患者的张口度明显优于对照组,差异均有统计学意义（均P < 0.05）。结论    局部涂抹臭氧油能够有效缓解下颌阻生第三磨牙拔除术后的疼痛、肿胀和张口受限程度。     

电动式微动力系统与气动式手机拔除下颌阻生第三磨牙的临床效果比较

目的 比较电动式微动力系统和气动式手机在下颌阻生第三磨牙拔除术中的临床效果。方法 对106例患者的212颗下颌双侧第三磨牙分2次拔除,采用随机、交叉、自身对照方法,分别采用电动式微动力系统和气动式手机进行阻生牙拔除术。记录并比较患者手术时间及术中、术后并发症发生情况。采用SPSS 21.0 软件包对数据进行统计学分析。结果 电动式微动力组手术时间较短,术后第1天肿胀、疼痛程度均轻于气动式手机组（P<0.05）。结论 电动式微动力系统拔除下颌阻生第三磨牙优于气动式手机,值得临床应用。     

改良法拔除下颌阻生第三磨牙

目的：下颌完全埋伏阻生第三磨牙的患者运用改良法拔除,研究患者的心理状态、拔牙时间及术后并发症的发生率。方法：对符合标准的患者用传统法先拔除一侧下颌阻生第三磨牙,1个月后用改良法拔除患者对侧下颌阻生的第三磨牙,以自身对比研究2种拔牙方法对患者心理状态的影响及两者拔牙时间、术后并发症发生率。结果：通过实验可知,改良法能减轻患者的紧张、焦虑、疼痛,得到患者认可。在术后并发症中除了干槽症的与传统法无显著性差异外,术后肿胀、疼痛、张口受限等的差异均有显著性。结论：改良法拔除下颌完全埋伏阻生第三磨牙是一种符合现代医学行为模式的方法,值得临床推广应用。     

Diabetes mellitus and the dental pulp

This study attempts to evaluate the oral manifestations of and the limited available dental pulp information on diabetes mellitus, a common metabolic disorder of carbohydrate and lipid metabolism affecting over 16 million Americans. Diabetics are particularly prone to bacterial or opportunistic infections. This vulnerability is caused by a generalized circulatory disorder whereby the blood vessels are damaged by the accumulation of atheromatous deposits in the tissues of the blood vessels lumen. In addition, blood vessels, particularly capillaries, develop a thickened basement membrane, which impairs a leukotactic response, and there is a decrease in the polymorphonuclear leucocyte microbicidal ability and failure to deliver the humoral and cellular components of the immune system. Because the dental pulp has limited or no collateral circulation, it is more prone to be at risk for infection. Clinical and radiographic studies by other investigators have shown that there is a greater prevalence of periapical lesions in diabetics than in nondiabetics. In a study of 252 diabetics with poor glycemic control, a high rate of asymptomatic tooth infection was found. Inflammatory reactions are greater in diabetic states, and the increased local inflammation causes an intensification of diabetes with a rise in blood glucose, placing the patient in an uncontrolled diabetic state. This often requires an increase in insulin dosage or therapeutic adjustment. Removal of the inflammatory state in the periodontium created a need for a lesser amount of insulin for glycemic control. Thus, it is essential to remove all infections including those of the dental pulp. When diabetes mellitus is under therapeutic control, periapical and other lesions heal as readily as in nondiabetics.     

Immunohistochemical localization of type IV collagen and laminin in the gingival capillary basement membrane of the diabetic rat.

Distribution of type IV collagen and laminin in the gingival capillary basement membrane from streptozotocin-induced diabetic rats was investigated using immunoelectron microscopy. Both type IV collagen and laminin were found throughout the basement membrane. Quantitative analysis revealed that the immunoreactive area for laminin did not change with age, and the width of laminin deposition remained constant, even when diabetes was induced in the animals. However, the immunoreactive area for type IV collagen thickened with age. Further, the width of type IV collagen in the basement membrane increased markedly 36 weeks after diabetes was induced. It was concluded that the thickening of the gingival capillary basement membrane in experimentally induced diabetic rats was due an increase of type IV collagen deposition.     

The effect of age and the duration of diabetes mellitus on the width of the basement membrane of small vessels

A bstract — Measurement shows that the basement membrane of small vessels from nine diabetic patients and eight non-diabetic patients aged 9–20 years, is larger in the diabetic patient and that the membrane widens with increased duration of diabetes mellitus rather than the aging of the patient.     

A histological study of changes in the lingual papillae of streptozotocin-induced diabetic rats.

This study examined the effect of experimental diabetes mellitus on the dorsal tongue of rats which were made diabetic by tail-vein injections of streptozotocin (50 mg/kg) and then raised for either 5 or 10 months. Lingual papillae were observed by scanning electron microscopy (SEM) and light microscopy. Morphological changes in lingual mucosal capillaries in 10-month diabetic rats were observed by electron microscopy (TEM). In the study of cellular movement in the lingual dorsal epithelium, bromodeoxyuridine (BrdU) was applied as a tracer for studying DNA replication. In diabetic rats, lingual papillae showed morphological atrophic changes. The lingual mucosal capillaries' alterations included endothelial cells with numerous cell projections into the lumen, degenerated cell organs, increased basement membrane width, and narrowed capillary lumen. BrdU labeling index among the basal cells was reduced in diabetic rats which indicates a possible retardation of their epithelial-tissue activity. In diabetes mellitus, direct metabolic disturbances to the epithelia because of insulin deficiency first occurred, successively diabetic microangiopathy appeared on the lingual mucosal capillaries. The appearance of diabetic microangiopathy caused tissue hypoxia, which induced atrophic changes to the epithelia.     

糖尿病对大鼠牙齿磨耗影响研究

目的    研究糖尿病对大鼠牙齿磨耗程度的影响。方法    本研究于2013年4—5月在沈阳药科大学动物实验中心和中国医科大学实验设备处进行。将6 ~ 8周SD大鼠20只,随机分为2组：糖尿病组与对照组,每组10只。糖尿病组采用腹腔一次性注射链脲佐菌素方法建立大鼠糖尿病模型。两组大鼠相同条件下饲养,8周后处死后取上下颌骨,水浴干燥后体式显微镜下观察大鼠磨牙磨耗情况,数字显微成像仪相同观察条件下采集图像,观察牙齿磨损情况。采用图像分析软件测量每个磨牙各个牙尖的高度,即沿牙尖至对应牙根的牙体长轴上牙尖至釉牙骨质界的长度,对两组结果进行统计学分析。结果    形态学观察可见糖尿病大鼠牙本质暴露面积更大,牙尖高度有所降低,第三磨牙更为显著,牙尖相对尖锐陡峭。牙尖高度测量结果显示糖尿病组较对照组磨牙牙尖高度有所降低,相对而言上颌第三磨牙与下颌第一磨牙降低更为明显,上颌牙舌尖与下颌牙颊尖降低更为明显（P＜0.05）。结论    糖尿病大鼠在相同饮食条件下,牙齿磨耗较正常大鼠更为明显,糖尿病可促进大鼠牙齿磨耗。     

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??Objective    To study the effect of diabetes mellitus on tooth wear in rat molars. Methods    Twenty SD rats of 6 ~ 8 weeks were randomly divided into 2 groups?? the diabetes mellitus group and health group. The rats of diabetes mellitus group were given one-time abdominal streptozocin??STZ??injection to establish the diabetes mellitus animal model. The rats of both groups were raised for 8 weeks under the same condition. Rats were killed and then maxillary and mandible bones were taken. The degree of tooth wear of the rat molars was observed under stereo microscope. The height of tooth cusp was measured and compared between the diabetes mellitus rats and health rats. The results were anlalyzed by statistical method. Results    Morphological observation showed that the exposure dentin area of diabetic rats was larger??the tooth cusp height decreased??especially the third molar??and the tooth cusp was relatively sharp and steep. Tooth cusp height measurement results showed that the height of diabetes mellitus group decreased. Maxillary third molars and mandibular first molar showed more obvious reduction??and the height of lingual cusp of maxillary teeth and buccal cusp of mandibular teeth decreased more obviously??P < 0.05??. Conclusion    For diabetic rats under the condition of the same diet??tooth abrasion is more distinct than normal rats. Diabetes mellitus may promote the tooth wear of rat molar.     

Diabetes and its effects on dental pulp

Uncontrolled or poorly controlled diabetes mellitus may be a risk factor for the development of oral complications. The objective of this investigation was to determine the effect of diabetes mellitus progression on inflammatory and structural components of dental pulp. Male Wistar rats were given a single injection of Streptozotocin (STZ), and induction of diabetes was confirmed 24 h later. Dental pulp tissue samples were taken from central incisors and molars of diabetic rats 30 and 90 days after the STZ treatment. Plasma glucose levels in diabetic rats 30 and 90 days after STZ treatment were significantly increased when compared to control rats (P < 0.001). Nitrite and kallikrein levels in dental pulp tissue were higher in diabetic rats 30 days after STZ treatment than in controls, while only nitrite were decreased 90 after of STZ treatment. Myeloperoxidase activity showed changes 30 and 90 days after STZ injection when compared to controls. The activity of alkaline phosphatase showed significant changes 30 and 90 days after STZ treatment. On the other hand the concentration of collagen was decreased in diabetic rats 30 and 90 days after STZ injection. These results suggest that diabetes is a critical factor that has profound effects upon oral tissues, resulting in expression of inflammatory mediators and modifications of structural components of dental pulp.     

人牙髓淋巴管相关标志物的表达和超微结构分析

目的：探讨健康牙髓中是否存在淋巴管。方法：选择因正畸拔除的牙30颗,取出牙髓,以健康牙龈组织做阳性对照,利用淋巴管特异性标志物D2-40和LYVE-1以及血管标志物CD31和CD34进行免疫组织化学染色,Western印迹法检测D2-40的表达,透射电镜进行超微结构分析。结果：健康牙髓组织中,管腔结构的内皮细胞均显示CD31和(或)CD34阳性,D2-40除成牙本质细胞弱阳性表达外,管腔结构均阴性表达。Western印迹法检测显示,用胶原酶去除牙髓成牙本质细胞后,D2-40所对应的分子量40 kDa的条带消失。牙髓管腔结构的内皮细胞电镜检测显示出血管而不是淋巴管的特征,即由单层内皮细胞组成,外有周细胞围绕,基底膜完整。结论：在人正常牙髓组织中可能不存在淋巴管,淋巴系统是否参与牙髓炎症的引流过程尚有待进一步研究。     

Vascular architecture of cat pulp using corrosive resin cast under scanning electron, microscopy

Vascular casts of cat premolar pulps in various stages of growth were made by injection of low-viscosity resin into the pulpal blood vessels. Examination under a scanning electron microscope revealed that, in the young pulp, the main arterioles ascend in the center of the pulp and venules run along the side of the root canal space. The subodontoblastic vascular plexus of the pulp could be distinguished by its characteristic three layers: 1. the terminal capillary network located in the odontoblastic layer; 2. a second layer of the capillary network which is composed of pre- and postcapillaries running parallel to each other; and, finally, 3. the venular network which has a lattice type appearance. The pulp cavity is reduced in size with age (maturation stage), in which the characteristic three vascular layers are changed into a one-layer coarse terminal capillary network which converges directly with the main venules. At this stage the blood vessels, especially the main venules, are also fewer in number.