本文選題：Micro-CT + 半導(dǎo)體激光　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:隨著我國居民生活條件的改善,近年來進(jìn)行口腔正畸治療的患者越來越多,但療程一般兩年多,有的甚至更長。在此期間,患者不注意口腔衛(wèi)生,會引起牙齦炎、牙周炎、齲齒等疾病。在口腔正畸臨床醫(yī)治過程當(dāng)中,牙齒移動的速度多數(shù)為每個(gè)月1毫米,為了加速牙齒移動,正畸學(xué)者們進(jìn)行了大量研究,探討加速牙齒移動的方法。目前加速牙齒移動的方法分為四類:手術(shù)治療方法、基因治療方法、藥物治療方法和物理治療方法。手術(shù)方法具有一定的創(chuàng)傷性,基因治療方法目前不太成熟,藥物治療方法可能會引起一些副作用。而激光照射屬于物理治療方法的一種,它主要通過加快破骨細(xì)胞和成骨細(xì)胞的形成達(dá)到加速牙齒移動的目的。其中半導(dǎo)體激光涵蓋了其他類激光的應(yīng)用范圍,具有體積小、壽命長、成本低和使用安全等多種優(yōu)點(diǎn),作為一種沒有創(chuàng)傷、操作簡單方便的加速牙移動方法,更容易被患者和醫(yī)生接受。在半導(dǎo)體激光照射下,牙槽骨骨結(jié)構(gòu)發(fā)生了怎樣的變化尚不清楚。有關(guān)牙齒移動的動物實(shí)驗(yàn)對象多為大鼠,通常用游標(biāo)卡尺測量大鼠牙齒移動距離,結(jié)果不夠精確,誤差較大。在觀察牙槽骨改建和牙根吸收時(shí),常用組織學(xué)切片的方法,切片只能從二維角度進(jìn)行觀測。Micro-CT是空間分辨率高達(dá)1-10μm的醫(yī)學(xué)CT,它可以從三維角度更加全面和精確的觀察正畸牙齒移動距離、牙槽骨骨結(jié)構(gòu)的變化和牙根吸收情況。本實(shí)驗(yàn)采用Micro-CT觀測在半導(dǎo)體激光照射下正畸牙齒移動速度、牙槽骨微觀結(jié)構(gòu)變化和牙根吸收的情況,探討半導(dǎo)體激光對牙移動的影響,從而為半導(dǎo)體激光在正畸臨床上加速牙齒移動提供理論參考。方法:1建立大鼠牙移動模型10%水合氯醛腹腔麻醉(300-350mg/kg),上頜切牙與第一磨牙間使用鎳鈦螺旋拉簧加力。通過上頜兩切牙作為支抗,牽引雙側(cè)上頜第一磨牙向近中移動,每側(cè)力值為10g,見Fig.1。2半導(dǎo)體激光照射異氟烷吸入麻醉,見Fig.2。牙齒加力后1-14天,每天使用半導(dǎo)體激光照射(波長980nm,能量密度10J/cm2)右側(cè)上頜第一磨牙區(qū)域,見Fig.3和Fig.4。3 Micro-CT掃描大鼠心臟灌注處死后,制取標(biāo)本。用Micro-CT(Sky Scan1076,比利時(shí))對標(biāo)本進(jìn)行掃描,掃描參數(shù)為每次旋轉(zhuǎn)0.7°,總共旋轉(zhuǎn)180°,73k V,142μA,層厚為18μm,圖像大小為1024×1024像素。每個(gè)標(biāo)本掃描時(shí)間大約為30分鐘。然后運(yùn)用Micro-CT自帶的程序進(jìn)行圖片的重構(gòu),每個(gè)樣本重構(gòu)時(shí)間約40分鐘,得到圖片1000張左右,見Fig.5。使用CTAn軟件,進(jìn)行牙齒移動距離、牙根長度和牙槽骨骨結(jié)構(gòu)各項(xiàng)參數(shù)的測量,見Fig.6和Fig.7。4制作組織學(xué)切片將標(biāo)本放置于EDTA溶液中脫鈣,石蠟包埋,制作以上頜第一磨牙為中心的、近遠(yuǎn)中方向的組織切片,常規(guī)HE染色。光鏡下觀察組織學(xué)變化。5統(tǒng)計(jì)分析采用SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析。計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(Mean±SD)表示,對正態(tài)分布且方差齊的數(shù)據(jù)采用單因素方差分析(one-factor ANOVA),兩組間均數(shù)比較采用獨(dú)立樣本t檢驗(yàn),四組間均數(shù)比較采用方差分析,兩兩比較采用LSD檢驗(yàn)。若非正態(tài)或方差不齊采用非參數(shù)的秩和檢驗(yàn)Kruskal-Wallis H檢驗(yàn)。取α=0.05作為檢驗(yàn)水準(zhǔn),P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1牙齒移動距離第3天,激光組牙齒移動距離與對照組相比無統(tǒng)計(jì)學(xué)差異(P0.05);第7天、14天兩組均有顯著差異(P0.05),激光組(7d:203.27±32.28μm,14d:320.80±33.82μm)明顯大于對照組(7d:166.93±15.46μm,14d:259.40±30.01μm)。兩組的牙齒移動距離在第0、3、7、14天時(shí)兩兩比較均存在顯著性差異(P0.05)。第3-7天期間,兩組牙齒移動速率均比第0-3天時(shí)慢;第7-14天期間,兩組牙齒移動速率均比3-7天時(shí)快,見Fig.8和Table1、9、10。2牙根吸收情況第3天、7天,激光組牙根長度與對照組相比無統(tǒng)計(jì)學(xué)差異(P0.05);第14天,激光組牙根長度(1.93±0.10mm)顯著大于對照組牙根長度(1.84±0.12mm)(P0.05)。激光組牙根長度在第0、3、7、14天時(shí)兩兩比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。第14天,對照組牙根長度小于第0天、3天時(shí)的牙根長度(P0.05),見Fig.9和Table 2、9、10。3牙槽骨骨結(jié)構(gòu)參數(shù)3.1壓力側(cè)牙槽骨骨密度(Bone Mineral Density,BMD)第3天,兩組BMD值無統(tǒng)計(jì)學(xué)差異(P0.05);第7天、14天,激光組BMD值顯著低于對照組(P0.05)。從0天-14天兩組BMD值呈降低趨勢,見Fig.10和Table 3、9、10。3.2壓力側(cè)骨體積分?jǐn)?shù)(Bone Volume Fraction,BV/TV)第3天,兩組BV/TV值無統(tǒng)計(jì)學(xué)差異(P0.05);第7天、14天,激光組BV/TV值顯著低于對照組(P0.05)。從0天-14天兩組BV/TV值呈下降趨勢,見Fig.11和Table 4、9、10。3.3壓力側(cè)骨小梁間隙(Trabecular Separation,Tb.Sp)第3天,兩組Tb.Sp值無統(tǒng)計(jì)學(xué)差異(P0.05);第7天、14天,激光組Tb.Sp值顯著高于對照組(P0.05)。從0天-14天兩組Tb.Sp值呈上升趨勢,見Fig.12和Table 5、9、10。3.4張力側(cè)牙槽骨骨密度(BMD)第3天,激光組BMD值低于對照組(P0.05);第7天、14天,激光組BMD值顯著高于對照組(P0.05)。從0天-14天兩組BMD值呈先降低后升高的趨勢,見Fig.13和Table 6、9、10。3.5張力側(cè)骨體積分?jǐn)?shù)(BV/TV)第3天、7天,兩組BV/TV值無統(tǒng)計(jì)學(xué)差異(P0.05);第14天,激光組BV/TV值顯著高于對照組(P0.05)。從0天-14天兩組BV/TV值呈先降低后升高的趨勢,見Fig.14和Table 7、9、10。3.6張力側(cè)骨小梁間隙(Tb.Sp)第3天、7天,兩組Tb.Sp值無統(tǒng)計(jì)學(xué)差異(P0.05);第14天,激光組Tb.Sp值顯著低于對照組(P0.05)。從0天-14天兩組Tb.Sp值呈先升高后降低的趨勢,見Fig.15和Table 8、9、10。4組織學(xué)觀察4.1張力側(cè)第3天時(shí)可以觀察到兩組牙周膜間隙增寬,牙槽骨出現(xiàn)凹坑狀吸收,周圍可見少量破骨細(xì)胞,牙周膜纖維沿著牽引力的方向排列。激光組可見更多的血管擴(kuò)張充血,少量新生牙槽骨。第7天時(shí),兩組血管數(shù)量增多,成纖維細(xì)胞增多。激光組牙槽骨表面成骨細(xì)胞數(shù)量顯著多于對照組,成骨非�；钴S,牙槽骨邊緣小的陷窩變平滑,表面骨基質(zhì)沉積可見新骨形成。第14天時(shí),兩組都有明顯的新骨形成。激光組的新骨形成多于對照組,見Fig.16、17、18。4.2壓力側(cè)第3天時(shí)激光組和對照組牙周膜受壓變窄、可見牙槽骨淺的吸收陷凹處有破骨細(xì)胞出現(xiàn),激光組破骨細(xì)胞較對照組多。對照組牙周膜出現(xiàn)透明樣變,血管腔隙變窄。激光組,未見玻璃樣變,血管無明顯變化。第7天時(shí)激光組和對照組牙周膜寬度有所恢復(fù),牙槽骨表面可見大量吸收陷凹。激光組牙槽骨表面破骨細(xì)胞數(shù)量顯著增多,較對照組破骨更活躍,吸收陷凹更多、更深。激光組偶見牙根吸收,僅累及牙骨質(zhì),對照組牙根吸收可達(dá)牙本質(zhì)。第14天時(shí)激光組破骨細(xì)胞明顯減少。對照組,透明樣變已經(jīng)基本被清除,可見部分牙根吸收深達(dá)牙本質(zhì),見Fig.19、20、21。結(jié)論:1半導(dǎo)體激光照射可以加快牙齒移動速度。2半導(dǎo)體激光照射可以減少牙齒移動過程中的牙根吸收。3半導(dǎo)體激光照射加速牙齒移動過程中牙槽骨的改建。4 Micro-CT掃描技術(shù)可以從三維方向獲取精確的牙槽骨微觀骨結(jié)構(gòu)參數(shù)、牙齒移動距離和牙根長度等數(shù)據(jù)。
[Abstract]:Objective: with the improvement of living conditions in our country, more and more patients have been treated with orthodontic treatment in recent years, but the course of treatment is more than two years and some even longer. During this period, the patients do not pay attention to oral hygiene and cause gingivitis, periodontitis, caries and other diseases. In the process of orthodontic clinical treatment, the rate of tooth movement is mostly in the mouth cavity. For 1 millimeters per month, in order to accelerate tooth movement, orthodontic scholars have done a lot of research to explore the method of accelerating tooth movement. At present, the methods of accelerating tooth movement are divided into four categories: surgical treatment, gene therapy, drug therapy and physical therapy. The methods of hand operation have certain traumatic and gene therapy. It is not too mature before the drug therapy may cause some side effects. Laser irradiation is one of the physical therapy methods, which mainly accelerates the movement of the teeth by accelerating the formation of osteoclasts and osteoblasts. The semiconductor laser covers the application range of other lasers, with small size, long life and cost. It is more easy to be accepted by patients and doctors as a free and convenient method of accelerating tooth movement, such as low and safe use. It is not clear how the bone structure of the alveolar bone has changed under the irradiation of semiconductor laser. The animal experiments on tooth movement are mostly rats, usually measured with a vernier caliper. In the observation of alveolar bone remodeling and root resorption, the method of histological section is commonly used to observe.Micro-CT, a medical CT with a spatial resolution of up to 1-10 m, which can be used to observe the orthodontic tooth moving distance more comprehensively and accurately from the three-dimensional angle. In this experiment, the velocity of orthodontic tooth movement, the change of the microstructure of the alveolar bone and the absorption of the root were observed by Micro-CT, and the effect of semiconductor laser on the tooth movement was discussed in this experiment, thus providing the reason for the semiconductor laser to accelerate the tooth movement in orthodontic clinic. Reference. Methods: 1 the rat tooth movement model was established by 10% chloral hydroflal abdominal anesthesia (300-350mg/kg), the maxillary incisor and the first molar using the nickel titanium spiral spring added force. Through the maxillary two incisors as the anchorage, the bilateral maxillary first molars moved toward the middle, and each side of the force was 10g. Fig.1.2 semiconductor laser irradiation isoflurane inhalation anesthesia At 1-14 days after the Fig.2. teeth were added, the right maxillary first molar region was irradiated with semiconductor laser (wavelength 980nm, energy density 10J/cm2) on the right side of the maxillary first molar area. The specimens were obtained after the cardiac perfusion of Fig.3 and Fig.4.3 Micro-CT scans in rats. The specimens were scanned with Micro-CT (Sky Scan1076, Billy), and the scanning parameters were 0.7 degrees each time. A total of 180 degrees, 73k V, 142 mu A, the thickness of 18 mu m, and the image size of 1024 x 1024 pixels. The scanning time for each specimen is about 30 minutes. Then the image is reconstructed with the Micro-CT program. Each sample reconfiguration time is about 40 minutes, and the picture is about 1000. The Fig.5. uses CTAn software to carry out the tooth moving distance and the root length. And the measurement of the parameters of the bone structure of the alveolar bone, see Fig.6 and Fig.7.4 to make tissue sections to place the specimen in EDTA solution decalcified, paraffin embedded, make the maxillary first molar as the center, the near far middle direction of the tissue section, the routine HE staining. The statistical analysis of the histological changes of the histological changes under the light microscope uses the statistical software of SPSS 21 for the number of statistical analysis. According to the analysis, the measurement data were expressed with mean standard deviation (Mean + SD). Single factor variance analysis (one-factor ANOVA) was used for the data of normal distribution and homogeneity of variance. The average number of the two groups was compared with independent sample t test. The average number of the four groups was compared with the variance analysis, and the 22 ratio was compared with the LSD test. If the non normal state or the variance was not homogeneous, the non parameter was used. Kruskal-Wallis H test of rank sum test. Taking alpha =0.05 as a test level, P0.05 was statistically significant. Results: 1 tooth movement distance third days, laser group tooth movement distance compared with the control group no statistical difference (P0.05); seventh days, 14 days two groups have significant difference (P0.05), laser group (7d:203.27 + 32.28 u m, 14d:320.80 + 33.82 U) M) was significantly greater than that of the control group (7d:166.93 + 15.46 m, 14d:259.40 + 30.01 m). There was a significant difference in the movement distance between the two groups at 0,3,7,14 days (P0.05). During the 3-7 day, the two groups of tooth movement rates were slower than the 0-3 day; during the 7-14 day, the movement rate of the two groups was faster than that of 3-7 days, and Fig.8 and Table1,9, 10.2 the root resorption of 10.2 days, 7 days, the length of the root of the laser group had no significant difference compared with the control group (P0.05). On the fourteenth day, the length of the root (1.93 + 0.10mm) in the laser group was significantly greater than that of the control group (1.84 0.12mm) (P0.05). The length of the root of the laser group was not statistically different (P0.05) at 0,3,7,14 days (P0.05). Fourteenth days, the control group. Root length less than zeroth days, 3 days of root length (P0.05), Fig.9 and Table 2,9,10.3 alveolar bone structure parameters 3.1 pressure side alveolar bone mineral density (Bone Mineral Density, BMD) third days, two groups of BMD values of no statistical difference (P0.05), seventh days, 14 days, the laser group BMD value was significantly lower than the control group (P0.05) from 0 days two groups decreased two groups decreased values showed a decrease from 0 days of day two group two group values decreased The trend, Fig.10 and Table 3,9,10.3.2 pressure side bone volume fraction (Bone Volume Fraction, BV/TV) third days, two groups BV/TV value of no statistical difference (P0.05); seventh days, 14 days, the laser group BV/TV value was significantly lower than the control group (P0.05). From the two group of 0 days -14 days, the decline trend of the two groups Liang Jianxi AR Separation, Tb.Sp) third days, the two groups of Tb.Sp values were not statistically significant (P0.05); seventh days, 14 days, the laser group Tb.Sp value was significantly higher than the control group (P0.05). From the 0 day -14 day two group Tb.Sp values increased, see Fig.12 and Table 5,9,10.3.4 tension side alveolar bone density (third days), laser group values lower than the control group; seventh days, 14 days, laser The BMD value of the group was significantly higher than that of the control group (P0.05). From the two groups of 0 days -14 days, the BMD value decreased first and then increased, and the tension side bone volume fraction (BV/TV) of Fig.13 and Table 6,9,10.3.5 was third days, 7 days, and the two groups of BV/TV values were not statistically different (P0.05). The fourteenth days, the laser group BV/TV value was significantly higher than the control group (P0.05). Two groups of 0 days from the 0 days decreased first. The trend of lower elevation was found in Fig.14 and Table 7,9,10.3.6 tension side Liang Jianxi (Tb.Sp) third days, 7 days, and there was no statistical difference between two groups (P0.05), and fourteenth days, the Tb.Sp value of the laser group was significantly lower than that of the control group (P0.05). The Tb.Sp value of the two group of 0 days -14 day two increased and then decreased, and the Fig.15 and Table histology observed 4.1 tension. On the side of third days, the gap between the two groups could be observed. The alveolar bone was absorbed by the alveolar bone, a small amount of osteoclasts were seen around the periodontal ligament, and the periodontal ligament was arranged along the direction of traction. The laser group showed more vascular dilatation and congestion and a small amount of new alveolar bone. In the seventh day, the number of blood vessels increased in two groups, and the number of fibroblasts increased. Laser group teeth were increased. The number of osteoblasts on the surface of the alveolar bone was significantly more than that of the control group. The bone formation was very active, the small lacunae on the edge of the alveolar bone became smooth and the surface of the bone matrix was formed to form a new bone. In the fourteenth day, the two groups had obvious new bone formation. The new bone formation in the laser group was more than the control group. The laser group and the control group were seen at the Fig.16,17,18.4.2 pressure side at third days. The compression and narrowing of the membrane showed that there was osteoclast in the absorption notch of the alveolar bone, and there were more osteoclasts in the laser group than the control group. The periodontal membrane of the control group was transparent and narrow. The laser group had no glass change and no obvious changes in the blood vessels. The width of the periodontal membrane was recovered and the surface of the alveolar bone was visible at seventh days. The number of osteoclasts on the surface of the alveolar bone in the laser group increased significantly, and the osteoclasts were more active than the control group. The absorption of the resorption was more and deeper. The laser group found the root absorption, only the cementum, the root absorption of the control group reached the dentin. In the fourteenth day laser group, the osteoclasts of the laser group decreased obviously. The control group, the transparent sample change already basically cleared. Fig.19,20,21. conclusion: 1 semiconductor laser irradiation can accelerate tooth movement speed.2 semiconductor laser irradiation can reduce tooth root absorption in the process of tooth movement, it can reduce tooth movement process,.3 semiconductor laser irradiation can accelerate tooth movement process, and the reconstruction of alveolar bone in the process of tooth movement,.4 Micro-CT scanning technology can be obtained from three dimensional square Accurate alveolar bone microstructure parameters, tooth movement distance and root length data were obtained.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R783.5

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