【摘要】：研究背景和目的：隨著對美觀與功能的意識進(jìn)一步增強(qiáng)，正畸治療中成年患者的比例正在逐漸升高，但相對處于生長發(fā)育期的青少年患者，成人患者代謝速率與牙齒移動都較為緩慢，治療周期明顯延長。較長的矯治時(shí)間易帶來美觀、疼痛及牙周問題，造成患者不必要的困擾。而縮短療程最直接的方法，就是加速正畸牙的移動，而目前臨床使用的方法費(fèi)用高風(fēng)險(xiǎn)大，找到一種綠色健康的加速正畸牙移動的方法顯得十分緊迫。 牙齒移動的生理基礎(chǔ)是骨組織的改建，包括骨的吸收和形成兩個(gè)方面，是一系列分子所參與調(diào)節(jié)的循環(huán)過程，主要參與細(xì)胞包括骨細(xì)胞、成骨細(xì)胞、破骨細(xì)胞等，分別發(fā)揮啟動骨改建、骨基質(zhì)形成、骨吸收等作用，而研究表明骨細(xì)胞、成骨細(xì)胞、破骨細(xì)又作為雌激素的靶細(xì)胞，受到雌激素直接或者間接調(diào)節(jié)。核因子κB受體活化因子配體（RANKL）、骨保護(hù)素（OPG）、骨鈣素（OCN）等骨代謝因子也受雌激素影響。 女性體內(nèi)雌激素水平隨著生理周期的改變而呈現(xiàn)波動性變化，因此本研究通過在成年女性月經(jīng)周期中的不同時(shí)期對正畸牙加力，研究齦溝液內(nèi)雌激素（雌二醇E2）、OCN、RANKL、OPG的時(shí)效性表達(dá)及與牙齒自身移動的周期節(jié)律的相互作用。從而為臨床選擇最佳加力時(shí)機(jī)提供理論依據(jù)。 方法： 1.選取18-28周歲雙側(cè)對稱拔除第一恒前磨牙青年女性恒牙合患者24人。隨機(jī)選取其中12人為月經(jīng)期加力組，12人為排卵期加力組。 2.右側(cè)尖牙使用NITI拉簧施加水平向150g正畸力使之遠(yuǎn)中移動。 3.使用牙周濾紙分別于加力前(T0)，加力后14天(T1),28天（T2），42天（T3）取右側(cè)尖牙遠(yuǎn)中（壓力側(cè)）齦溝液樣本。 4.電化學(xué)發(fā)光法測定齦溝液中E2,OCN的活性水平。使用ELISA酶聯(lián)免疫法檢測齦溝液中RANKL及OPG的活性水平。 結(jié)果： 1.月經(jīng)期加力組E2水平在加力后28天水平最低，加力后42天達(dá)到高峰。排卵期加力組E2水平在加力后14天水平最低，在加力后28天達(dá)到高峰，然后呈下降趨勢�？傮w水平上排卵期加力組E2水平顯著高于月經(jīng)期加力組（F=15.242, P＜0.05）；加力前后不同時(shí)間之間有顯著差異（F=3.049, P＜0.05）；加力后42天齦溝液內(nèi)E2水平顯著高于未加力時(shí)齦溝液內(nèi)E2水平（P＜0.05）。 2.不同生理周期加力對女性齦溝液內(nèi)骨鈣素OCN水平的影響：月經(jīng)期加力組及排卵期加力組齦溝液OCN水平皆于加力后逐漸升高，于加力后28天水平達(dá)到峰值，后呈回落趨勢�？偹缴吓怕哑诩恿MOCN水平顯著高于月經(jīng)期加力組（F=15.67, P＜0.05）；加力前后不同時(shí)間之間有顯著差異（F=5.75, P＜0.05）;加力后14天、28天、42天后齦溝液內(nèi)OCN水平顯著高于加力前水平（P＜0.05），加力后14天、28天、42天互相之間無顯著差異（P＞0.05）。 3.女性月經(jīng)周期中不同時(shí)期加力，齦溝液中RANKL水平未產(chǎn)生顯著差異（P＞0.05）；女性月經(jīng)周期中不同時(shí)期加力，也不對齦溝液中OPG水平產(chǎn)生顯著影響(P＞0.05)。齦溝液中RANKL水平于加力后即呈現(xiàn)升高趨勢，加力后平均水平高于未加力時(shí)。而OPG于加力后呈現(xiàn)降低趨勢，加力后平均水平低于未加力時(shí)水平，提示加力后骨保護(hù)趨勢的減弱。RANKL/OPG比值并不受不同加力時(shí)期的影響，但加力后數(shù)值呈現(xiàn)上升趨勢。 結(jié)論： 1.在成年女性月經(jīng)周期中不同階段進(jìn)行正畸加力，牙周微環(huán)境中的雌激素E2水平有差異，排卵期加力組E2水平高于月經(jīng)期加力組水平。提示女性正畸患者在月經(jīng)期加力，牙周微環(huán)境中較低的雌激素水平有利于牙齒的快速移動。 2.在成年女性月經(jīng)周期中不同階段進(jìn)行正畸加力，牙周局部OCN水平有顯著差異，其總體水平可能受到E2水平變化的影響。 3.在成年女性月經(jīng)周期中不同階段進(jìn)行正畸加力，牙周微環(huán)境中RANKL、OPG水平并無體現(xiàn)出顯著差異，但加力后水平與未加力水平有顯著差異，提示RANKL、OPG受月經(jīng)周期激素水平波動影響不大，但受到較多加力的影響。RANKL/OPG比值結(jié)果與RANKL、OPG結(jié)果一致，提示加力后破骨活動的增強(qiáng)。 4.女性正畸拔牙患者于雌激素水平較高的排卵期施加正畸力，骨保護(hù)因子E2，OCN表達(dá)增強(qiáng)，不利于牙槽骨改建，牙齒移動較為緩慢。而于月經(jīng)期加力，上述因子表達(dá)減弱，，可能有助于牙齒快速移動。
[Abstract]:The research background and purpose: With the further enhancement of the consciousness and function, the proportion of adult patients in the orthodontic treatment is increasing, but the metabolic rate of adult patients and the movement of the teeth are slow, and the treatment period is obviously prolonged. The long treatment time is easy to bring beauty, pain and periodontal problems, and causes unnecessary trouble of the patient. And the most direct method for shortening the course of treatment is to accelerate the movement of the orthodontic tooth, and the current method for clinical use is high in risk, and a green and healthy method for accelerating the orthodontic tooth movement is very urgent. The physiological basis of tooth movement is the remodeling of bone tissue, including the absorption and formation of bone. It is a circulating process involved in the regulation of a series of molecules. The effects of bone resorption, etc., show that the bone cells, osteoblasts, osteoclasts, and the target cells of the estrogen are directly or indirectly modulated by an estrogen. The bone metabolism factors such as the nuclear factor B receptor activating factor ligand (RANKL), the osteoprotegerin (OPG), the osteocalcin (OCN), and the like are also reflected by the estrogen In response to the change of the estrogen level in the female body with the change of the physiological period, this study is to study the estrogen (Estradiol E2), OCN, and RA in the gingival crevicular fluid by applying a force to the orthodontic tooth during different periods of the menstrual cycle of the adult female. The time-sensitive expression of NKL and OPG and the phase of the periodic rhythm with the movement of the teeth Mutual action. It provides the best time for clinical selection. On the Basis of Methods:1.1 1-28-year-old two-sided symmetrical extraction of the first permanent premolar young female 24 of the patients with occlusion were randomly selected,12 of which were of the menstrual period of the menstrual period,12 for the ovulatory force group.2. Right-hand cusp use the NITI tension spring to apply a level of 150 g 3. Use the periodontal filter paper before the application (T0),14 days after the application (T1),28 days (T2) and 42 days (T3) to take the right sharp tooth far. Middle (pressure side) gingival crevicular fluid sample.4. Electrochemical luminescence method to measure the gingival sulcus The activity level of E2 and OCN in the liquid was measured by ELISA. ANK The activity level of L and OPG. Results:1. The E2 level in the menstrual cycle of the menstrual period was 2% after the application of the force. The 8-day level is the lowest, and the peak is reached 42 days after the application of force. The E2 level of the booster group in the ovulatory period is the lowest at 14 days after the application of the force, and at the same time, the level of E2 in the The level of E2 was significantly higher than that of the group (F = 15.242, P <0.05). There was a significant difference between the different time before and after the application (F = 3.049, P <0.05). 2. The effect of different physiological cycles on the level of OCN of the gingival crevicular fluid in the gingival crevicular fluid was the same as that of the gingival crevicular fluid (P <0.05). The level of OCN was significantly higher than that of the group (F = 15.67, P <0.05). There was a significant difference (F = 5.75, P <0.05) between the different time before and after the application. The OCN in the gingival crevicular fluid was 14 days,28 days and 42 days after the application. The level is significantly higher than the pre-applied level (P <0.05),14 days after application,28 days,4 There was no significant difference between 2 days (P> 0.05).3. There was no significant difference in the level of RANKL in the gingival crevicular fluid during the different period of the female's menstrual cycle (P> 0.05). The level of OPG in the gingival crevicular fluid was significantly affected (P> 0.05). In other words, the rising trend is presented, the average level of the post-stress is higher than that of the non-applied force, and the OPG shows a lower trend after the application of the force, and the average level of the post-application is low The RANKL/ OPG ratio is not affected by a decrease in the trend of bone protection after stress augmentation when no stress is applied. same force Conclusion:1. In the different stages of the menstrual cycle of the adult female, the effects of orthodontics, estrogen and E2 in the periodontal micro-environment The level of E2 in the stage of ovulatory period is higher than the level of the force group in the menstrual period. It is suggested that the female orthodontics should be applied to the menstrual period. And the lower estrogen level in the periodontal micro-environment is beneficial to the rapid movement of the teeth. 3. The level of RANKL and OPG in the periodontal micro-environment did not show a significant difference in the level of RANKL and OPG during the different stages of the menstrual cycle of the adult female, but there was a significant difference in the post-stress level and the unstressed level. the difference, prompting the ran kl, OPG was not significantly affected by menstrual cycle hormone levels but was affected by more stress. RANKL/ OPG ratio Results The results were consistent with the results of RANKL and OPG. The expression of the protective factor E2 and OCN is enhanced, which is not conducive to the reconstruction of the alveolar bone, and the movement of the teeth is more
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 郭洪敏,杜靖遠(yuǎn);維生素K_2對成骨細(xì)胞增殖和分化的影響[J];中華老年醫(yī)學(xué)雜志;1998年02期

本文編號：2505470