本文選題：牙周組織齦溝液　切入點：種植體周溝液　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的本研究通過測量種植牙患者不同時間點牙周組織齦溝液(gingival crevicular fluid,GCF)和種植體周溝液(perio-implant crevicular fluid,PICF)中骨保護素(Osteoprotegerin,OPG)及核因子κB受體活化因子配體(receptor activator of nuclear factor kappa B ligand,RANKL)的水平,檢測種植體穩(wěn)定性ISQ(implant stability quotient)值。分析OPG、RANKL水平和OPG/RANKL比值與ISQ之間的關(guān)系。方法對2014年10月至2016年10月期間到我院口腔種植科就診的患者進行篩選,最終入選患者共有78例,其中男性43例,女性35例,患者年齡范圍在20-62歲之間,平均年齡41.6±14.2歲,根據(jù)患者的影像學(xué)檢查和專科檢查結(jié)果,對種植位點進行全面評估,制定詳細的種植計劃,共植入78顆種植體。術(shù)前用吸潮紙尖分別吸取種植位點相鄰兩個天然牙的GCF,稱量法測量取樣前、后吸潮紙尖吸取齦溝液的重量(AE240電子天平,METTLER,Sweden),-70℃凍存。手術(shù)在局部麻醉和無菌條件下進行,所有患者均按照標(biāo)準(zhǔn)手術(shù)步驟,完成Straumann軟組織水平種植體植入,結(jié)合X線片及手術(shù)過程中種植窩預(yù)備鉆所受阻力大小,對患者牙槽骨的骨質(zhì)進行評估和分類。術(shù)后1、2、3、4、6、8及12周復(fù)診,以相同的方法取得PICF和相鄰天然牙GCF并測量記錄ISQ值。.測量ISQ時,使用種植體穩(wěn)定性測量儀(Osstell ISQTM(瑞典))在種植體近中、頰側(cè)和舌側(cè)各1次,以三次ISQ值的均值作為該種植體的ISQ值。術(shù)前及每次術(shù)后復(fù)查時,均記錄種植體鄰牙及種植體的菌斑指數(shù)和牙齦指數(shù)。在術(shù)后即刻、12周復(fù)查時拍攝種植體的根尖片,檢查種植體周圍有無暗影和骨吸收。每次復(fù)查時,均對患者進行口腔衛(wèi)生指導(dǎo)。依據(jù)Buser提出標(biāo)準(zhǔn)檢查種植體的留存率。此外,ELISA方法檢測每次所收集的GCF和PICF樣本中OPG和RANKL的水平,通過比較術(shù)后1、2、3、4、6、8及12周復(fù)查時OPG和RANKL水平的變化,分析OPG、RANKL水平、OPG/RANKL比值與ISQ的關(guān)系。結(jié)果種植體直徑分為3.3mm、4.1mm和4.8mm三種,對應(yīng)的種植人數(shù)分別為13、36和29人。手術(shù)后,所有種植體骨結(jié)合均良好,無明顯的牙齦紅腫等牙周炎癥反應(yīng)。78顆種植體均未發(fā)現(xiàn)種植體折斷、松動和脫落等現(xiàn)象,影像學(xué)根尖片檢查顯示,種植體周圍無透射陰影和骨吸收,種植體存留率為100㳠。對不同時間點檢測到的GCF和PICF中的OPG和RANKL進行重復(fù)測量方差分析,結(jié)果顯示,術(shù)后第二周GCF和PICF中OPG的含量均有所升高,以PICF中OPG升高最明顯,顯著高于其他時間點的OPG水平(P0.05)。第二周時,GCF中OPG的含量也顯著高于其他時間點(P0.05)。同時分析相同時間點GCF和PICF中OPG的差異,結(jié)果顯示,其差異無統(tǒng)計學(xué)意義(P0.05)。而術(shù)后GCF和PICF中RANKL含量呈現(xiàn)不同的變化趨勢。GCF中RANKL含量是先降后升,第3、4、5周時GCF中RANKL水平顯著低于第12周(P0.05),而PICF中RANKL水平在第3周時最高,第1、4、6、8和12周,RANKL水平均顯著低于第3周(P0.05)。分析相同時間點GCF和PICF中RANKL的差異,結(jié)果顯示,其差異無統(tǒng)計學(xué)意義(P0.05)。依據(jù)不同時間點的OPG和RANKL數(shù)據(jù),計算不同時間點GCF和PICF中OPG/RANKL比值。第1周時,PICF中的OPG/RANKL比值顯著高于GCF中OPG/RANKL比值(P=0.0340.05)。其他時間點兩組數(shù)據(jù)間無顯著差異。對比不同時間點的ISQ值,術(shù)后即進行了ISQ測量,值為63,術(shù)后1周ISQ略微升高,之后降低,在第四周時降到最低,為62.2±0.9,隨后逐漸升高。統(tǒng)計學(xué)分析結(jié)果顯示,術(shù)后第1周、第2周、第6周、第8周和第12周ISQ值均顯著高于第4周,差異具有統(tǒng)計學(xué)意義(P0.05)。上頜后牙缺失和下頜牙缺失患者種植后,統(tǒng)計結(jié)果顯示,在不同時間點種植體穩(wěn)定性之間具有顯著差異,下頜牙位點種植體穩(wěn)定性普遍高于上頜后牙位點的種植體,尤其是在3周、6周、8周和12周時,兩組之間的差異顯著(P0.05)。GCF中OPG和RANKL的變化與ISQ的變化相關(guān)性更強,OPG變化趨勢與ISQ變化趨勢大致相反,而RANKL的變化與ISQ的變化呈現(xiàn)相同趨勢,PICF中OPG和RANKL變化的出現(xiàn)早于ISQ的變化。GCF中OPG/RANKL的變化趨勢也與ISQ變化趨勢相同。PICF中OPG/RANKL比值的變化依然早于ISQ值的變化,較其變化早1周。結(jié)論1.由于OPG和RANKL生物學(xué)作用的不同,在種植術(shù)后的恢復(fù)過程中,OPG和RANKL的變化趨勢不同。因此與ISQ的變化趨勢相比也呈現(xiàn)不同的關(guān)系。OPG與ISQ的變化趨勢相反,而RANKL與ISQ變化趨勢相同。2.GCF中OPG和RANKL的變化要早于PICF,因此GCF的敏感性要高于PICF。
[Abstract]:The purpose of this study is through the measurement of dental implant in different time points in patients with periodontal tissue and gingival crevicular fluid (gingival crevicular, fluid, GCF) and peri implant crevicular fluid (perio-implant crevicular, fluid, PICF) osteoprotegerin (Osteoprotegerin, OPG) and receptor activator of nuclear factor kappa B ligand (receptor activator of nuclear factor kappa B ligand. RANKL) the level of detection of implant stability of ISQ (implant stability quotient). OPG value analysis, the relationship between RANKL level and the ratio of OPG/RANKL and ISQ. Methods during the period from October 2014 to October 2016 in our hospital department of oral implant patients were screened, and ultimately selected patients with a total of 78 cases, including 43 cases of male, 35 cases female, age range of patients at the age of 20-62, the average age of 41.6 + 14.2 years, according to the inspection and examination results with the imaging of implant sites to conduct a comprehensive assessment, detailed The planting plan, a total of 78 implants were placed before operation with absorbent paper points from each implant sites adjacent two teeth GCF, measuring and sampling weighing method before and after absorbent paper points draw the gingival crevicular fluid weight (AE240 electronic balance, METTLER, Sweden, -70) C operation in cryopreservation. Local anesthesia and aseptic conditions, all patients were in accordance with the standard operation procedures, the completion of Straumann soft tissue implants, combined with X-ray and surgery in the process of planting bed preparation by the resistance drill size on alveolar bone in patients with osteoporosis were evaluated and classified. After 1,2,3,4,6,8 and 12 weeks, PICF and adjacent natural the tooth GCF and measured and recorded ISQ value. Measurement of ISQ in the same way, using the implant stability measuring instrument (Osstell ISQTM (Sweden)) in implant mesial buccal and lingual 1 times each, on average three times the ISQ value as the implant preoperative and ISQ value. Every time after the operation, were recorded for implant adjacent tooth and implant plaque index and gingival index. In the immediate postoperative, taken root implants 12 weeks check, check there is no shadow around the implant and bone resorption. Each follow-up time, all oral hygiene instruction for patients on the basis of. Buser proposed standard check implant retention rate. In addition, OPG and RANKL ELISA for the detection of each collection of GCF and PICF in the sample level change, OPG and RANKL levels compared with 1,2,3,4,6,8 after operation and 12 weeks after review RANKL level analysis, OPG, OPG/RANKL and ISQ. The relationship between the ratio of the implant the diameter is divided into 3.3mm, 4.1mm and 4.8mm three, the number of planting the corresponding 13,36 and 29 respectively. After the operation, with all the good implant bone, no obvious gingival swelling and other inflammation reaction of.78 implants were not found in implant fracture, loosening and shedding So, the imaging examination showed that the dental implant without transmission, shadow and bone resorption and implant survival rate was 100?. at different time points to detect GCF and PICF in OPG and RANKL analysis of variance of repeated measurement results showed that the content of GCF and PICF were second weeks in OPG increased after the operation, with PICF OPG increased the most obviously, significantly higher than the other time points in the OPG level (P0.05). At second weeks, the content of GCF in OPG was significantly higher than that in other time points (P0.05). At the same time, analyze the difference, at the same time GCF and PICF OPG results showed that the difference was not statistically significant (P0.05). While the content of RANKL and PICF in GCF after RANKL.GCF in different trend is the rise after the first drop, 3,4,5 weeks RANKL level of GCF was significantly lower than that of twelfth weeks (P0.05), while the level of RANKL PICF in third weeks when the highest, 1,4,6,8 and 12 weeks, the levels of RANKL were significantly low In the third week (P0.05). Analyze the difference, at the same time GCF and RANKL PICF results showed that the difference was not statistically significant (P0.05). According to the different time points of OPG and RANKL data, calculate the ratio of OPG/RANKL at different time points of GCF and PICF. At first weeks, the ratio of OPG/RANKL in PICF was significantly higher than that of OPG/RANKL the ratio of GCF (P=0.0340.05). There was no significant difference between the other time points between two groups of data comparison. At different time points ISQ value after the operation of ISQ measurement value is 63, 1 weeks after operation, ISQ slightly increased and then decreased, in the fourth week to a minimum of 62.2 + 0.9, then increased gradually. The results of statistical analysis showed that first weeks after surgery, second weeks, sixth weeks, eighth weeks and twelfth weeks, ISQ values were significantly higher than the fourth week, the difference was statistically significant (P0.05). Maxillary posterior teeth missing and mandibular edentulous patients after planting, the statistical results show that the implant stability at different time points Significant differences between the mandibular implant site implant stability is generally higher than that of maxillary posterior sites, especially in the 3 week, 6 weeks, 8 weeks and 12 weeks, the difference between the two groups was significant (P0.05) between OPG and RANKL and ISQ more changes in.GCF, OPG and trend the change trend of ISQ approximately opposite changes of RANKL and ISQ showed the same trend, changes of OPG/RANKL changes.GCF earlier than ISQ in the trend of changes of OPG and RANKL in PICF and ISQ have the same trend as OPG/RANKL.PICF ratio still earlier than the ISQ value, the change is 1 weeks earlier. Conclusion OPG and RANKL 1. due to different biological effects, in the recovery process after implantation in different trends of OPG and RANKL. So with the change trend of ISQ compared with the trend of the relationship between.OPG and ISQ of different RANKL and ISQ on the contrary, trend The change of OPG and RANKL in the same potential.2.GCF is earlier than that of PICF, so the sensitivity of GCF is higher than that of PICF..

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R783.6

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9 黃云梅;基于RANKL/RANK/OPG軸的絕經(jīng)后骨質(zhì)疏松癥發(fā)病機制及健骨顆粒干預(yù)研究[D];福建中醫(yī)藥大學(xué);2014年

10 唐振寧;RANKL/RANK途徑對人乳腺癌細胞遷移作用及其調(diào)節(jié)機制的研究[D];第三軍醫(yī)大學(xué);2011年

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9 李鋒;非天然氨基酸插入法構(gòu)建小鼠突變RANKL蛋白的克隆、原核表達及抗血清制備[D];第四軍醫(yī)大學(xué);2015年

10 李一鳴;RANKL和OPG對不同骨移植材料行位點保存中骨構(gòu)建的作用[D];新疆醫(yī)科大學(xué);2015年

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