本文關鍵詞： 骨皮質切開術 微種植體支抗 磨牙壓低 免疫組化染色　出處：《重慶醫(yī)科大學》2016年碩士論文　論文類型：學位論文

【摘要】：磨牙的壓低移動是正畸臨床中常見的牙移動方式,但也是最難實現的牙移動方式之一。微種植體支抗(Mini-implant anchorage MIA)的應用為正畸醫(yī)生提供了新思路,操作簡單、舒適度高、力量可控等優(yōu)勢,使臨床醫(yī)生更愿意選擇采用MIA對磨牙進行壓低。然而很多研究發(fā)現,磨牙的壓低與其他牙移動方式相比,更易出現根尖及根分叉區(qū)域的牙根吸收。同時由于磨牙的壓低耗時較長,出現齲齒、牙周病的風險更高。因此,縮短壓低磨牙的時間,有利于降低上述風險的發(fā)生。有系統(tǒng)評價通過文獻分析各種加速牙移動的方法,明確指出骨皮質切開術應用于正畸治療安全并且明顯加速牙移動。骨皮質切開術是通過外科手術的手段在牙周圍的骨皮質行切口,以使牙移動的早期出現活躍的骨吸收和骨形成,從而加速正畸牙移動。目前,骨皮質切開術輔助正畸牙移動的文獻報道主要集中于臨床病例的效果評價,基礎研究證據尚不充足;特別是在牙齒垂直向移動方面,相關研究較為匱乏。因此,本研究建立骨皮質切開術輔助MIA快速壓低磨牙的動物模型,并且評估其在壓低過程中的牙根吸收及牙周組織改建情況。目的:評價骨皮質切開術對磨牙壓低移動過程中的加速機制,同時探討骨皮質切開術對磨牙壓低過程中的牙周組織改建及牙根吸收的影響。方法:本實驗選擇8只成年雄性beagle犬為實驗對象,通過自身對照的原則,利用mia為支抗,并用鎳鈦螺旋拉簧加力,同時壓低實驗動物下頜的雙側第三前磨牙(thethirdpremolar,p3)、第四前磨牙(thefourthpremolar,p4)。實驗側,在p3的近中、p4的遠中和根尖下方行骨皮質切開術,聯合mia同時壓低p3、p4;而對照側直接用mia壓低實驗牙,不施加骨皮質切開術。在建立骨皮質切開術聯合mia快速壓低磨牙的動物模型之后,通過組織學、免疫組織化學等觀察實驗牙壓低過程中在組織學基礎上的牙周組織改建情況、根尖區(qū)域牙根的吸收情況及牙周組織中骨鈣素(osteocalcin,ocn)和破骨細胞分化因子(receptoractivatorfornuclearfactor-κbligand,rankl)的表達。結果:1、實驗側根尖區(qū)域的牙周組織出現的破骨細胞始終更多,牙槽骨表面出現的骨吸收陷窩更多,提示實驗側的骨吸收活動始終比對照側活躍。2、在加力后的第2周,對照側的牙周膜中出現了玻璃樣變性,對照側牙周膜中的玻璃樣變性在加力后的第4周消失,然而在實驗側并沒有出現。在沒有進行骨皮質切開術組,加力早期牙周膜中便出現玻璃樣變性,以致于減慢牙齒壓低的速度。3、he染色顯示在同一時間點,施加骨皮質切開術的根尖區(qū)域牙根吸收嚴重程度比對照側要輕。4、骨皮質切開術輔助牙齒壓低過程中,OCN的表達在第2周時明顯增強,在第4周時達到高峰,隨后逐漸降低,到12周時最弱。未施加骨皮質切開術的牙齒壓低過程中,OCN的隨時間的變化規(guī)律與實驗側相似,但均低于實驗側的表達(P0.05)。5、骨皮質切開術輔助牙齒壓低過程中,RANKL的表達水平在第2周時達到高峰,在第4周、8周、12周逐漸降低。未施加骨皮質切開術的牙齒壓低過程中,RANKL的表達在第4周時達到高峰,隨后逐漸降低,但均低于實驗側的表達(P0.05)。綜上所述,本實驗可以得出以下結論:1、骨皮質切開術對正畸牙的壓低移動過程中,可以促進成骨細胞和破骨細胞的活躍性,從而加快壓低過程中的骨吸收和骨形成過程,實驗側的破骨活動和成骨活動更活躍是加速牙壓低移動的關鍵原因之一。2、骨皮質切開術能降低Beagle犬前磨牙壓低移動過程中出現的牙根吸收的嚴重程度。因此骨皮質切開術可以作為一種潛在的、有效的方法對磨牙進行輔助壓低。
[Abstract]:Molar intrusion is a common way of orthodontic tooth movement, but one of the tooth movement is the most difficult to achieve. The micro implant anchorage (Mini-implant anchorage MIA) application provides a new idea for orthodontic doctors, simple operation, high comfort, power control and other advantages, so that clinicians prefer to use MIA on the left were down. However, many studies have found that, compared with other lower molar tooth movement, more prone to root and root resorption of the bifurcated region. At the same time due to low pressure when the molar teeth appear longer, dental caries, periodontal risk is higher. Therefore, shortening the molar down time, help to reduce the risk evaluation system. Through the analysis of various methods accelerated tooth movement, clearly pointed out that the cortical incision used in orthodontic treatment and safety significantly accelerated tooth movement. Incision of bone cortex The surgical methods in the cortical bone around dental incision, so that early tooth movement has active bone resorption and bone formation, thus accelerate the orthodontic tooth movement. At present, the effect evaluation of the corticotomy assisted surgery reported orthodontic tooth movement mainly focused on the basic research of clinical cases, the evidence is not enough; especially in the teeth of vertical movement, relevant research is scarce. Therefore, this study established the animal model of corticotomy assisted MIA fast down molars, and evaluate the depression in the process of root resorption and periodontal tissue remodeling. Objective: To evaluate the cortical incision on molar intrusion mobile acceleration mechanism in the process, and to explore the effect of corticotomy on periodontal tissue remodeling and root molar intrusion during the absorption. Methods: in this experiment, 8 adult male beagle dogs to Like, through its own control principle, the use of MIA for anchorage, and nickel titanium spiral spring force, bilateral third premolars and suppress experimental animal mandible (thethirdpremolar, P3), fourth premolars (thefourthpremolar, P4). In the experimental side, near P3, P4 and apical incision far below for the bone cortex, combined with Mia and P4; down P3, while the control side directly with MIA down the experimental teeth, without cortical incision. After setting up the animal model of cortical bone incision surgery combined with MIA fast down molars, by histology, immunohistochemistry and observation of experimental tooth down in the process of histological basis the periodontal tissue remodeling, apical root resorption area of osteocalcin and periodontal tissues (osteocalcin, OCN) and osteoclast differentiation factor (receptoractivatorfornuclearfactor- kappa bligand, RANKL) expression. Results: 1, the root tip region 鍩熺殑鐗欏懆緇勭粐鍑虹幇鐨勭牬楠ㄧ粏鑳?yōu)濮嬀l堟洿澶，

本文編號：1550824