本文選題：創(chuàng)口愈合 + 細(xì)胞因子��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景:牙齦增生是牙周疾病常見的臨床特征之一,可由菌斑生物膜或其它因素引起。臨床上,牙齦增生經(jīng)牙周基礎(chǔ)治療后通常采取手術(shù)治療。傳統(tǒng)的手術(shù)治療包括采用手術(shù)刀和電刀進(jìn)行牙齦切除術(shù)、成形術(shù),但存在術(shù)后術(shù)區(qū)腫脹、舒適度欠佳、影響咀嚼說話等缺點(diǎn)。激光作為一種新的治療手段,具有手術(shù)視野清晰、術(shù)中術(shù)后止血效果好、術(shù)后舒適度較高等優(yōu)點(diǎn),已在醫(yī)學(xué)領(lǐng)域開展運(yùn)用,并已有大量研究報(bào)道。Genius激光,又稱水冷型Nd:YAG激光,已運(yùn)用于牙齦切除、成形術(shù)等牙周軟組織手術(shù)。激光照射牙周組織,無論激光波長的長短,均可影響GCF及其所含的細(xì)胞因子的濃度水平,以及被照射組織的愈合速度。GCF中含有大量與疾病活動(dòng)相關(guān)的細(xì)胞和生化分子,如中性粒細(xì)胞、抗體、補(bǔ)體蛋白、細(xì)胞因子等。生化分析GCF是判斷牙周有無炎性反應(yīng)的重要手段之一。GCF中的細(xì)胞因子由活化的免疫細(xì)胞和某些基質(zhì)細(xì)胞分泌,其主要功能為介導(dǎo)和調(diào)節(jié)免疫及炎癥反應(yīng)。其中,IL-8、IL-1β水平與牙周病的嚴(yán)重程度呈正相關(guān),也可作為監(jiān)測牙周翻瓣術(shù)后傷口愈合的重要指標(biāo)。TGF-β1是重要的抗炎因子之一,并且在傷口愈合中起重要的作用。MMP-8是組織發(fā)生炎癥最早開始變化的生化指標(biāo)。目的:本研究旨在研究Genius激光與傳統(tǒng)的手術(shù)刀、電刀行牙齦切除術(shù)、牙齦成形術(shù)相比,短期內(nèi)患者術(shù)后創(chuàng)口的炎癥反應(yīng)、創(chuàng)口愈合速度及舒適度的區(qū)別,為臨床醫(yī)生的選擇提供一定的理論指導(dǎo)依據(jù)。方法:本實(shí)驗(yàn)一共收集43名患者,共計(jì)270顆前牙,進(jìn)行隨機(jī)分口自身對(duì)照實(shí)驗(yàn)(a randomized controlled clinical trial with split-mouth design),分為激光組、手術(shù)刀組和電刀組,每組分別含有95顆、95顆和80顆牙。分別收集術(shù)前、術(shù)后一周和術(shù)后兩周GCF,并測定GCF的量以及GCF中IL-8、IL-β1、MMP-8和TGF-β1表達(dá)水平。同時(shí),術(shù)后一周內(nèi)回訪三組的疼痛度(“VAS”分值表),以及是否出血的情況。結(jié)果:激光組術(shù)后一周和術(shù)后兩周的GCF的量和GCF中IL-1β、MMP-8水平,較手術(shù)刀組和電刀組低(P0.05,P0.05;P0.05,P0.01;P0.05,P0.05),且差異具有統(tǒng)計(jì)學(xué)意義。激光組術(shù)后一周GCF中IL-8和TGF-β1的水平較手術(shù)刀組和電刀組均低(P0.05,P0.05),且差異具有統(tǒng)計(jì)學(xué)意義,術(shù)后兩周,二組無明顯差異(P0.05,P0.05)。在術(shù)后7天的回訪中,激光組的疼痛值在術(shù)后三天內(nèi)顯著低于手術(shù)刀組和電刀組(P0.05),差異具有統(tǒng)計(jì)學(xué)意義,術(shù)后第4天到第7天無明顯差異(P0.05)。手術(shù)刀組在術(shù)后第一天有3例患者術(shù)后出血,其余兩組未見。結(jié)論:研究結(jié)果表明與傳統(tǒng)手術(shù)方式相比,Genius激光行牙周軟組織手術(shù)具有術(shù)后創(chuàng)口炎性反應(yīng)低、創(chuàng)口愈合較快、舒適度高等優(yōu)點(diǎn),可以作為臨床醫(yī)師的優(yōu)選方案。
[Abstract]:Background: gingival hyperplasia is one of the common clinical features of periodontal diseases, which can be caused by plaque biofilm or other factors. Clinically, gingival hyperplasia is usually treated surgically after periodontal basic treatment. The traditional surgical treatment includes gingivectomy with scalpel and electric knife, but there are some shortcomings such as swelling of operation area, poor comfort and influence on chewing and speaking. As a new treatment method, laser has many advantages, such as clear operation visual field, good hemostatic effect after operation and high postoperative comfort. It has been widely used in medical field, and has been widely reported. Genius laser, also called water-cooled Nd:YAG laser, has been widely used in the field of medicine. Has been used in gingival resection, plastic surgery and other periodontal soft tissue surgery. Laser irradiation of periodontal tissue, regardless of the length of the laser wavelength, can affect the concentration of GCF and its cytokines, and the healing rate of irradiated tissue. GCF contains a large number of cells and biochemical molecules associated with disease activity. Such as neutrophil, antibody, complement protein, cytokine and so on. Biochemical analysis of GCF is one of the important means of judging periodontal inflammatory response. Cytokines are secreted by activated immune cells and some stromal cells. Its main function is to mediate and regulate the immune and inflammatory responses. The level of IL-8 and IL-1 尾 was positively correlated with the severity of periodontal disease, and could also be used as an important index to monitor wound healing after periodontal flap flap. TGF- 尾 1 was one of the important anti-inflammatory factors. And it plays an important role in wound healing. MMP-8 is the earliest biochemical indicator of tissue inflammation. Objective: the purpose of this study was to study the difference of inflammatory reaction, wound healing speed and comfort between Genius laser and conventional surgical scalpel, electrosurgical resection and gingival plasty. To provide a theoretical basis for the selection of clinicians. Methods: a total of 43 patients (270 anterior teeth) were randomly divided into three groups: laser group, scalpel group and electric scalpel group. Each group contained 95 teeth and 80 teeth. The levels of GCF, IL-8 and TGF- 尾 1 in GCF were measured before, one week and two weeks after operation, respectively. At the same time, the pain degree ("VAS" score) of the three groups was reviewed within one week after operation. Results: the quantity of GCF and the level of IL-1 尾 -MMP-8 in GCF in laser group were lower than those in scalpel group and electric scalpel group one week and two weeks after operation, and the difference was statistically significant. The levels of IL-8 and TGF- 尾 _ 1 in the laser group were lower than those in the scalpel group and the electric scalpel group one week after operation, and the difference was statistically significant. Two weeks after operation, there was no significant difference in IL-8 and TGF- 尾 _ 1 between the two groups. The pain value of the laser group was significantly lower than that of the scalpel group and the electric scalpel group within 3 days after operation, and the difference was statistically significant. There was no significant difference between the laser group and the electric scalpel group from the 4th to the 7th day after operation (P 0.05). Bleeding was found in 3 patients in the scalpel group on the first day after operation, but not in the other two groups. Conclusion: compared with the traditional operation, Genius laser has the advantages of lower inflammatory response, faster wound healing and higher comfort. It can be used as the best choice for clinicians.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R781.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前9條

1 丁一;肖詩夢;楊恒;孟姝;;Nd:YAG激光在口腔醫(yī)學(xué)中的應(yīng)用[J];華西口腔醫(yī)學(xué)雜志;2015年05期

2 Amit Arvind Agrawal;;Gingival enlargements: Differential diagnosis and review of literature[J];World Journal of Clinical Cases;2015年09期

3 陳春芝;徐凌;胡常紅;張漪;黃楠楠;;種植體周圍炎齦溝液中SOD、GP-x、MDA水平的初步研究[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2015年03期

4 潘亞萍;;激光在牙周治療中的應(yīng)用[J];口腔醫(yī)學(xué);2015年01期

5 陳海波;李俊;鄧敏;何鋼清;黎淑芳;;Er,Cr:YSGG激光在牙冠延長術(shù)中的應(yīng)用效果[J];右江醫(yī)學(xué);2013年04期

6 陳峰;童慧;喬佳云;;水激光在前牙美容性冠延長術(shù)中的應(yīng)用效果觀察[J];口腔醫(yī)學(xué);2013年06期

7 陳智濱;孫曉軍;欒慶先;;濾紙條與吸潮紙尖采集齦溝液樣本比較[J];現(xiàn)代口腔醫(yī)學(xué)雜志;2008年02期

8 秦彪,馬云虎;二氧化碳激光法與傳統(tǒng)手術(shù)齦成形術(shù)的組織學(xué)改變[J];口腔醫(yī)學(xué);2000年01期

9 秦彪,馬云虎;CO_2激光和傳統(tǒng)手術(shù)牙齦成形術(shù)的比較[J];上�？谇会t(yī)學(xué);2000年01期

，

本文編號(hào)：1856844