Email Alert | RSS

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (5): 927-935. doi: 10.19723/j.issn.1671-167X.2022.05.020

• 论著 • 上一篇    下一篇

改良牙冠延长术后组织愈合的动物实验研究

甄敏1,孟焕新1,胡文杰1,*(),武登诚2,危伊萍1   

  1. 1. 北京大学口腔医学院·口腔医院牙周科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，北京 100081
    2. 北京大学口腔医学院·口腔医院中心实验室，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，北京 100081
  • 收稿日期:2022-05-31 出版日期:2022-10-18 发布日期:2022-10-14
  • 通讯作者: 胡文杰 E-mail:huwenjie@pkuss.bjmu.edu.cn
  • 作者简介:胡文杰，教授，主任医师，博士研究生导师，北京大学口腔医学院牙周科副主任(教学主任)，中华口腔医学会牙周病学专业委员会第四届至第六届常务委员、口腔种植专业委员会常务委员、口腔美学专业委员会常务委员，北京市口腔医学会种植专业委员会常务委员，美国牙周病学会国际会员，国际牙科研究会会员，北京市健康科普专家，国家自然基金委员会同行评议专家等，2011—2012年美国华盛顿大学牙医学院高级访问学者，北京大学口腔医院住院医师规范化培训基地和牙周专科医师规范化培训基地主任。
    医疗专长：复杂牙周病的各学科综合治疗设计、牙周病患者的种植治疗、前牙美学治疗、CBCT在疾病诊断和治疗中的应用、各种牙冠延长术(改良牙冠延长术的提出和推动者)。
    主要研究：牙周病多学科综合治疗和设计、牙周病种植治疗相关临床和基础研究、微笑美学和前牙美学系列临床和基础研究、CBCT在牙周疾病诊断和治疗中的作用、口腔微生物组学和代谢组学研究、牙周医学研究。作为第一负责人承担国家自然科学基金4项，省部级科研项目10项，获首批北京大学临床科学家计划专项，院内临床新技术新疗法、教学改革和青年科研基金项目20余项；发表中英文论文178篇(SCI 35篇)，主编、参编和翻译专著17部，获实用新型专利3项，国家发明专利1项
  • 基金资助:
    首都临床特色应用研究(Z131107002213174)

Healing of the dento-gingival junction following modified crown lengthening procedure in beagle dogs

Min ZHEN1,Huan-xin MENG1,Wen-jie HU1,*(),Deng-cheng WU2,Yi-ping WEI1   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing 100081, China
    2. Central Laboratory, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing 100081, China
  • Received:2022-05-31 Online:2022-10-18 Published:2022-10-14
  • Contact: Wen-jie HU E-mail:huwenjie@pkuss.bjmu.edu.cn
  • Supported by:
    the Capital Foundation for Clinical Characteristics and Application Research(Z131107002213174)

RICH HTML

   

PDF (PC)

摘要：

目的: 明确改良牙冠延长术后的组织愈合方式, 为改良牙冠延长术的临床推广应用提供生物学基础。方法: 对5只比格犬的右上中切牙、左上中切牙和左上第一侧切牙分别进行翻瓣术、常规牙冠延长术和改良牙冠延长术, 右上第一侧切牙为对照牙, 不进行手术, 术后36周获取标本进行组织学观察。结果: 颊舌向软硬组织切片苏木素-伊红(hematoxylin-eosin, HE)染色发现翻瓣术的愈合方式为再附着, 与对照组一致。常规牙冠延长术组5只比格犬的根面均存在薄片状的牙骨质缺损, 其中4只比格犬的组织愈合为新附着, 表现为牙骨质缺损区内有新牙骨质形成, 胶原纤维呈一定角度插入其中; 另1只比格犬的组织愈合方式为长结合上皮愈合, 表现为长结合上皮根向移位止于牙骨质缺损区的根方水平。改良牙冠延长术组中4只比格犬根面存在牙骨质缺损(薄片状和浅台阶样缺损各2只), 其中3只比格犬的组织愈合为新附着, 但胶原纤维与根面平行, 1只比格犬的愈合方式为长结合上皮愈合; 另外1只比格犬因组织块未能完整分切而无法观察组织愈合方式。结论: 改良牙冠延长术后的组织愈合方式与常规法相似, 包括新附着和长结合上皮愈合两种方式, 根面处理(根面平整或根面改形)以及根面缺损的类型(薄片状或浅台阶样牙骨质缺损)并未影响组织的愈合方式。

关键词: 牙冠延长, 牙周组织, 伤口愈合, 截骨术

Abstract:

Objective: To evaluate the type of wound healing following modified crown lengthening surgery in dog model to provide a biological basis for its clinical application. Methods: Flap surgery, traditional crown lengthening procedure and modified crown lengthening procedure were performed on the right maxillary central incisor, the left maxillary central incisor and the left maxillary first lateral incisor respectively of five male beagle dogs. The right maxillary first lateral incisors with no surgical intervention were used as controls. Thirty-six weeks after the experimental procedure, tissue blocks were harvested and prepared for histological examination and analysis. Results: Histometric examination of buccolingual sections stained with hematoxylin-eosin demonstrated that the type of wound healing in the flap surgery group was re-attachment, similar to the control group. For the traditional crown lengthening surgery group, all of the five beagle dogs had lamellar cementum defects on root surface, the wound healing of four beagle dogs was new attachment accompanied by new cementum formation at cementum defect areas and the suprac-restal connective tissue was functionally oriented perpendicular to the new cementum. The wound healing of the other beagle dog was long junctional epithelial attachment, in which the junctional epithelium extended to the apical terminus of the cementum defect. In the modified crown lengthening surgery group, four beagle dogs had cementum defects on root surface (two lamellar cementum defects and two shallow platform-like cementum defects), the wound healing of three beagle dogs was new attachment, however, the supracrestal connective tissue was parallel to the root surface. The type of wound healing of another one beagle dog was long junctional epithelial attachment. Wound healing of one beagle dog in this group could not be characterized due to incomplete dissection. Conclusion: Wound healing in the modified crown lengthening surgery group was similar to the traditional crown lengthening surgery group, and two types of wound healing were observed: new attachment and long junctional epithelium attachment. Neither type of root treatment procedure (root planing or root reshaping) nor root surface defect pattern (the lamellar cementum defect or shallow platform-like cementum defect) influenced the observed type of wound healing.

Key words: Crown lengthening, Periodontium, Wound healing, Osteotomy

中图分类号: 

  • R782.1

图1

术后36周比格犬术区唇侧观"

表1

5只比格犬4组牙术前和术后36周临床检查指标对比"

Items Probing depth/mm, ${\bar x}$± s Bleeding index Keratinized gingiva width/mm, ${\bar x}$± s
Preoperative Postoperative P# Preoperative Postoperative P# Preoperative Postoperative P#
Control 2.2±0.45 2.2±0.76 NS 3 4 NS 3.8±0.45 4.2±0.76 NS
Flap 2.2±0.45 2.2±0.45 NS 3 4 NS 3.5±1.00 4.3±0.84 NS
Traditional 2.4±0.55 2.2±0.45 NS 3 4 NS 3.7±0.97 4.7±0.97 NS
Modified 2.6±0.55 2.3±0.45 NS 3 4 NS 3.7±0.67 4.8±1.35 NS
P* NS NS NS NS NS NS

表2

5只比格犬各组术牙的愈合方式"

No. Flap Traditional Modified
1 RA NA NA
2 RA NA NA
3 RA NA NA
4 RA NA -
5 RA LJE LJE

图2

1号比格犬对照组唇侧龈牙组织(颊舌向切片，HE染色)"

图3

1号比格犬翻瓣术组唇侧龈牙组织/再附着(颊舌向切片，HE染色)"

图4

1号比格犬常规牙冠延长术组唇侧龈牙组织/新附着(颊舌向切片，HE染色)"

图5

5号比格犬常规牙冠延长术组唇侧龈牙组织/长结合上皮愈合(颊舌向切片，HE染色)"

图6

1号比格犬改良牙冠延长术组唇侧龈牙组织/新附着(颊舌向切片，HE染色)"

图7

3号比格犬改良牙冠延长术组唇侧龈牙组织/新附着(颊舌向切片，HE染色)"

图8

5号比格犬改良牙冠延长术组唇侧龈牙组织/长结合上皮愈合(颊舌向切片，HE染色)"

1 Brägger U , Lauchenauer D , Lang NP . Surgical lengthening of the clinical crown[J]. J Clin Periodontol, 1992, 19 (1): 58- 63.
doi: 10.1111/j.1600-051X.1992.tb01150.x
2 欧阳翔英. 有助于残根修复的牙冠延长术[J]. 中华口腔医学杂志, 2004, 39 (3): 205- 207.
doi: 10.3760/j.issn:1002-0098.2004.03.008
3 Gargiulo AW , Wentz FM , Orban B . Dimensions and relations of the dentogingival junction in humans[J]. J Periodontol, 1961, 32 (3): 261- 267.
doi: 10.1902/jop.1961.32.3.261
4 Melker DJ , Richardson CR . Root reshaping: an integral component of periodontal surgery[J]. Int J Periodontics Restorative Dent, 2001, 21 (3): 296- 304.
5 胡文杰, 李连生, 张豪, 等. 牙根改形结合少量去骨: 一种改良的牙冠延长术[J]. 北京大学学报(医学版), 2008, 40 (1): 83- 87.
doi: 10.3321/j.issn:1671-167X.2008.01.022
6 甄敏, 胡文杰, 张豪, 等. 改良牙冠延长术术后1至6年疗效观察[J]. 中华口腔医学杂志, 2012, 47 (4): 203- 207.
doi: 10.3760/cma.j.issn.1002-0098.2012.04.003
7 Zhen M , Wang C , Hu WJ , et al. Periodontal evaluation of crown-root fractured teeth following modified crown lengthening surgery[J]. Br Dent J, 2017, 222 (1): 21- 25.
doi: 10.1038/sj.bdj.2017.25
8 da Cruz MK , Martos J , Silveira LF , et al. Odontoplasty associated with clinical crown lengthening in management of extensive crown destruction[J]. J Conserv Dent, 2012, 15 (1): 56- 60.
doi: 10.4103/0972-0707.92608
9 甄敏, 危伊萍, 胡文杰, 等. 不同冠延长术式处理上中切牙冠根折并桩核冠修复的三维有限元比较[J]. 中华口腔医学杂志, 2016, 51 (6): 362- 367.
doi: 10.3760/cma.j.issn.1002-0098.2016.06.009
10 Wang C , Jia XT , Zhen M , et al. Success rate of fractured teeth receiving modified crown lengthening surgery and restorations[J]. BMC Oral Health, 2022, 22 (1): 99.
doi: 10.1186/s12903-022-02143-z
11 王翠, 贾雪婷, 胡文杰, 等. 改良牙冠延长术后长期临床疗效评价及其影响因素分析[J]. 中华口腔医学杂志, 2017, 52 (3): 182- 187.
doi: 10.3760/cma.j.issn.1002-0098.2017.03.011
12 Oakley E , Rhyu IC , Karatzas S , et al. Formation of the biologic width following crown lengthening in nonhuman primates[J]. Int J Periodontics Restorative Dent, 1999, 19 (6): 529- 541.
13 Selvig KA , Torabinejad M . Wound healing after mucoperiosteal surgery in the cat[J]. J Endod, 1996, 22 (10): 507- 515.
doi: 10.1016/S0099-2399(96)80008-2
14 Carnevale G , Sterrantino SF , Di Febo G . Soft and hard tissue wound healing following tooth preparation to the alveolar crest[J]. Int J Periodontics Restorative Dent, 1983, 3 (6): 36- 53.
15 Levine HL , Stahl SS . Repair following periodontal flap surgery with the retention of gingival fibers[J]. J Periodontol, 1972, 43 (2): 99- 103.
doi: 10.1902/jop.1972.43.2.99
16 Claffey N , Motsinger S , Ambruster J , et al. Placement of a porous membrane underneath the mucoperiosteal flap and its effect on periodontal wound healing in dogs[J]. J Clin Periodontol, 1989, 16 (1): 12- 16.
doi: 10.1111/j.1600-051X.1989.tb01605.x
17 Steiner SS , Crigger M , Egelberg J . Connective tissue regeneration to periodontally diseased teeth. Ⅱ. Histologic observations of cases following replaced flap surgery[J]. J Periodontal Res, 1981, 16 (1): 109- 116.
doi: 10.1111/j.1600-0765.1981.tb00954.x
18 Caton J , Nyman S . Histometric evaluation of periodontal surgery. Ⅲ. The effect of bone resection on the connective tissue attachment level[J]. J Periodontol, 1981, 52 (8): 405- 409.
doi: 10.1902/jop.1981.52.8.405
19 Wilderman MN , Pennel BM , King K , et al. Histogenesis of repair following osseous surgery[J]. J Periodontol, 1970, 41 (10): 551- 565.
doi: 10.1902/jop.1970.41.10.551
20 Lindskog S , Blomlöf L . Mineralized tissue-formation in periodontal wound healing[J]. J Clin Periodontol, 1992, 19 (10): 741- 748.
doi: 10.1111/j.1600-051X.1992.tb02164.x
21 Middleton CT , Bowers GM . Histologic evaluation of cementogenesis on periodontitis-affected roots in humans[J]. Int J Periodontics Restorative Dent, 1990, 10 (6): 428- 435.
[1] 汪琪伟, 包鹏宇, 洪士皓, 杨昕, 王宇, 曹永平. 改良股骨颈截骨术在伴严重屈曲畸形强直性脊柱炎患者手术治疗过程中的疗效[J]. 北京大学学报（医学版）, 2024, 56(5): 884-889.
[2] 张雯,刘筱菁,李自力,张益. 基于解剖标志的鼻翼基底缩窄缝合术对正颌患者术后鼻唇部形态的影响[J]. 北京大学学报（医学版）, 2023, 55(4): 736-742.
[3] 郭玉兴,张建运,王佃灿,郭传瑸. 药物相关颌骨骨坏死的病理特点及临床治疗策略[J]. 北京大学学报（医学版）, 2022, 54(6): 1190-1195.
[4] 刘恒，李卓扬，曹永平，崔云鹏，吴浩. 胫骨侧徒手截骨的膝关节置换术后力线测量及其影响因素分析[J]. 北京大学学报(医学版), 2018, 50(5): 850-854.
[5] 曹婕1，孟焕新. 锥形束CT用于评估牙槽骨骨缺损的情况和骨再生区域骨密度的变化[J]. 北京大学学报(医学版), 2018, 50(1): 110-116.
[6] 吴煜，李自力,王兴, 伊彪, 马莲. 腭侧入路改良Le Fort Ⅰ型截骨术矫正唇腭裂继发上颌骨发育不足的临床初步应用[J]. 北京大学学报(医学版), 2016, 48(3): 550-554.
[7] 赵旻暐，田华，曾琳，李邦国，张峰霖，李凌宇. 中国人采用胫骨结节及胫前肌腱定位的髓外截骨法术后胫骨假体冠状位力线的测量与分析[J]. 北京大学学报(医学版), 2016, 48(2): 351-355.
[8] 杨胜松，黄雷，滕星，王陶，王满宜. 外固定架辅助髓内钉治疗膝外翻或膝内翻畸形[J]. 北京大学学报(医学版), 2016, 48(2): 244-249.
[9] 何伟， 谢晓艳， 王兴， 王晓霞， 傅开元， 李自力. 上颌Le FortⅠ型分块截骨术及双侧下颌升支矢状劈开术对骨性Ⅲ类错牙合畸形患者髁突位置的影响[J]. 北京大学学报(医学版), 2015, 47(5): 829-833.
[10] 白洁, 赵玉鸣, 秦满. 儿童恒牙全脱出牙周组织预后的回顾性研究[J]. 北京大学学报（医学版）, 2015, 47(2): 312-316.
[11] 褚亚明, 周一新, 寇玉辉, 杨德金. 股骨转子下截骨全髋置换术治疗Hartofilakidis C1和C2型髋关节发育不良的对比研究[J]. 北京大学学报（医学版）, 2015, 47(2): 232-236.
[12] 王宗琦, 王晓霞, 李自力, 伊彪, 梁成, 王兴. 3种缝合方法控制上颌Le Fort Ⅰ型截骨术后鼻翼宽度的效果比较[J]. 北京大学学报（医学版）, 2015, 47(1): 104-108.
[13] 欧阳翔英, 阳雯. 转化医学及其在牙周干细胞研究中的应用[J]. 北京大学学报（医学版）, 2013, 45(1): 152-155.
[14] 朱卫东, 侯建霞, 刘凯宁, 孟焕新, 唐晓琳. 自体牙周膜细胞和釉基质蛋白修复猴下后牙Ⅲ度根分叉病变[J]. 北京大学学报（医学版）, 2009, 41(1): 56-61.
[15] 李淳德, 李宏, 刘宪义. 后路脊柱截骨矫形治疗重度僵硬后凸型脊柱侧凸[J]. 北京大学学报（医学版）, 2007, 39(4): 399-402.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部