【摘要】：目的：全脫位牙延期再植前需要去除其根面壞死的牙周膜，以預(yù)防炎性吸收。去除的方法有很多種，但是目前仍沒有公認的最佳方法，故本研究的主要目的在于尋求一種去除根面壞死牙周膜的最佳方法。 材料和方法：取35顆因正畸需要拔除的健康右下第一前磨牙，室溫下干燥保存超過1小時，隨機平均分為5組；分別進行以下處理：1、陰性對照組，2、手術(shù)刀片刮除根面壞死牙周膜，3、1%次氯酸鈉溶液浸泡實驗牙5分鐘，4、2%次氯酸鈉溶液浸泡實驗牙5分鐘，5、1%次氯酸鈉溶液浸泡實驗牙10分鐘。然后每組隨機取兩顆牙，用戊二醛固定，電鏡下觀察牙周膜殘留和牙骨質(zhì)缺損情況；剩余5顆牙用中性福爾馬林固定，鹽酸甲酸脫鈣，包埋，取根中、根尖1/3，連續(xù)橫切片，HE染色，光鏡下觀察，ImagePro軟件計算統(tǒng)計分析牙周膜殘留和牙骨質(zhì)缺損情況。所得數(shù)據(jù)經(jīng)方差齊性檢驗后，用組間單因素方差分析和Tukey's檢驗來判斷顯著性差異。 結(jié)果：牙周膜殘留方面，陰性對照組有62.33%的區(qū)域存在殘留，刀片刮除組有22.42%殘留，次氯酸鈉溶液處理組殘留分別為1%次氯酸鈉溶液浸泡5分鐘組0.885%，2%次氯酸鈉溶液浸泡5分鐘組0.386%，1%次氯酸鈉溶液浸泡10分鐘組0.237%；陰性對照組顯著高于刀片刮除組和三個次氯酸鈉溶液處理組（P＜0.05），刀片刮除組顯著高于三個次氯酸鈉處理組（P＜0.05），但三個不同濃度和時間的次氯酸鈉溶液處理組之間沒有統(tǒng)計學(xué)差異（P＞0.05）。牙骨質(zhì)缺損方面，，陰性對照組為0.031%，刀片刮除組為7.90%，次氯酸鈉溶液處理組分別為1%次氯酸鈉溶液浸泡5分鐘組0.084%，2%次氯酸鈉溶液浸泡5分鐘組0.065%，1%次氯酸鈉溶液浸泡10分鐘組0.057%；刀片刮除組顯著高于陰性對照組和三個次氯酸鈉溶液處理組（P＜0.05）；而陰性對照組和三個次氯酸鈉溶液處理組之間沒有統(tǒng)計學(xué)差異（P＞0.05）。 結(jié)論：在本實驗的條件下，刀片刮除法既無法去凈根面壞死牙周膜，又會導(dǎo)致根面牙骨質(zhì)層的破壞，故不值得推薦。次氯酸鈉溶液處理法能在有效去除根面牙周膜的同時很好地保持牙骨質(zhì)層的完整性，是一種理想的方法；但是具體最佳的處理濃度和時間有待進一步研究。
[Abstract]:Objective: to prevent inflammatory absorption, the periodontal membrane of root surface necrosis should be removed before delayed replantation of total dislocation teeth. There are many ways to remove periodontal membrane, but there is still no accepted optimal method, so the main purpose of this study is to find the best way to remove the root surface necrotic periodontal membrane. Materials and methods: 35 healthy lower right first premolars which needed to be extracted due to orthodontics were dried for more than 1 hour at room temperature and were randomly divided into 5 groups. The experimental teeth were treated as follows: 1, negative control group, 2, operation blade scraping root surface necrotic periodontal membrane, 3% sodium hypochlorite solution immersion experimental teeth for 5 minutes, 4% sodium hypochlorite solution immersion experimental teeth for 5 minutes, 2% sodium hypochlorite solution for 5 minutes, and 2% sodium hypochlorite solution for 5 minutes. The teeth were immersed in 1% sodium hypochlorite solution for 10 minutes. Then two teeth in each group were randomly selected and fixed with glutaraldehyde. The residual periodontal membrane and cementum defect were observed under electron microscope. The remaining 5 teeth were fixed with neutral formalin, decalcified with formic acid, embedded, taken from root, 1 / 3 of root tip, continuous transverse slice, HE staining, observed under light microscope, the residual periodontal membrane and cementum defect were calculated and analyzed by ImagePro software. After homogeneity test of variance, significant difference was judged by univariate ANOVA and Tukey's test. Results: there were 62.33% residual areas in negative control group, 22.42% in blade scraping group and 0.885% in sodium hypochlorite solution treatment group, respectively. 2% sodium hypochlorite solution immersion for 5 min group 0.386% sodium hypochlorite solution immersion 10 minutes group 0.237; Negative control group was significantly higher than blade scraping group and three sodium hypochlorite solution treatment group (P < 0.05), blade scraping group was significantly higher than three sodium hypochlorite treatment group (P < 0.05). However, there was no significant difference among the three sodium hypochlorite solution groups (P > 0.05). For cementum defect, 0.031 in negative control group, 7.90 in blade curettage group, 0.084 in sodium hypochlorite solution treatment group, respectively, in 5 minutes immersion group with 1% sodium hypochlorite solution, 0. 084% sodium hypochlorite solution for 5 minutes, and 0. 084% sodium hypochlorite solution for 5 minutes. Immersion in 2% sodium hypochlorite solution for 5 minutes in 0.065% sodium hypochlorite solution for 10 minutes in group 0.057; The blade curettage group was significantly higher than the negative control group and the three sodium hypochlorite solution treatment groups (P < 0.05), but there was no statistical difference between the negative control group and the three sodium hypochlorite solution treatment groups (P > 0.05). Conclusion: under the condition of this experiment, the method of blade curettage can not only remove the periodontal membrane of root surface necrosis, but also lead to the destruction of root surface cementum layer, so it is not worthy of recommendation. Sodium hypochlorite solution treatment method can effectively remove the root periodontal membrane and maintain the integrity of cementum layer, which is an ideal method, but the specific optimal treatment concentration and time need to be further studied.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782.12

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