高速气涡轮切割手机联合专用加长裂钻对拔除下颌阻生第三磨牙的效果分析

目的:探讨牙科高速气涡轮切割手机配合阻生牙专用加长裂钻拔牙对口腔外科门诊需要拔除下颌阻生第三磨牙患者的影响。方法:选取我院收治的59例需要拔除下颌阻生第三磨牙患者,按照随机数字表法将所有患者随机分为试验组和对照组两组。其中试验组患者采用牙科高速气涡轮切割手机辅助阻生牙专用加长裂钻进行拔牙,而对照组患者则采取传统的劈骨分牙法,通过两组患者的术后复诊对患者的下唇麻木、断根等发生率以及张口受限、疼痛、肿胀等情况进行评价。结果:根据我院对两组患者的术中情况及术后并发症情况进行统计分析,结果显示试验组患者的手术时间为(25.68±6.83)min,明显低于对照组患者[(35.23±14.23)min,t=3.962,P=0.000]。试验组患者中仅有1例术后出现断根情况,无其他并发症出现;而对照组患者术后则有3例断根情况和1例下唇麻木患者(后逐渐缓解)、1例下颌关节疼痛以及1例舌侧骨板骨折患者。根据我院对两组患者术后1d的临床资料进行统计分析,结果显示试验组患者术后1d面部肿胀程度明显比对照组患者轻(P0.05);试验组患者的疼痛情况明显优于对照组患者(P0.05);试验组患者的张口受限程度明显比对照组患者轻(P0.05)。结论:牙科高速气涡轮切割手机配合阻生牙专用加长裂钻拔牙对口腔外科门诊需要拔除下颌阻生第三磨牙患者具有较好的临床治疗效果,值得在临床上加以广泛推广和运用。     

拔除下颌第三磨牙对下颌角区形态影响的CBCT 研究

目的:探讨下颌第三磨牙的拔除会否造成下颌角区骨骼形态的变化以及这种变化对面型的影响。方法:30例因矫治需要拔除下颌第三磨牙的成人正畸患者,在拔牙前和拔牙后6个月拍摄CBCT片,采用三维测量软件mimics10.01测量下颌第三磨牙所在的下颌角区牙槽骨骨质的宽度、高度和长度,利用SPSS18.0统计软件分析前后数值有无差异。结果:下颌第三磨牙拔除前后下颌角区骨质宽度和高度减小,差异有统计学意义(P<0.05),下颌角区骨质前后向长度未见明显差异。结论:拔除下颌第三磨牙能从一定程度上减小下颌角区骨质高度和宽度,但是前后向长度度基本没有变化。     

安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的：研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响。方法：从直丝弓矫治的AngleⅠ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例（A组）,非拔牙矫治患者15例（B组）,经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理。结果：拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03mm;上下唇的长度也平均增加0.51和1.58mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异。结论：拔牙矫治有利于减小上下唇突度从而改善软组织侧貌。     

下颌第二恒磨牙C 形根管的离体实验研究

目的:寻找一种预备C形根管的有效器械,提高下颌第二恒磨牙的治愈率。方法:选用80颗具有C形根管的下颌第二恒磨牙,选择四种器械进行根管预备,第一组用不锈钢K锉,第二组用不锈钢K锉和手用镍钛器械,第三组用机用镍钛器械,第四组用超声根管治疗仪,预备中均用3%双氧水和生理盐水交替反复冲洗根管,预备后用Vitapex糊剂和牙胶尖冷侧压方法充填根管,观察根充后X线片和根尖微渗漏情况,评价充填效果。结果:四种器械根充后微渗漏有明显差异(P<0.05)。结论:不锈钢K锉和手用镍钛器械联合应用及超声根管治疗仪为预备C形根管的有效器械。     

安氏I类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的:研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响.方法:从直丝弓矫治的Angle Ⅰ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例(A组),非拔牙矫治患者15例(B组),经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理.结果:拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03 mm;上下唇的长度也平均增加0.51和1.58 mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异.结论:拔牙矫治有利于减小上下唇突度从而改善软组织侧貌.

Abstract：

Objictive: To investigate the effect of Angle Class Ⅰ malocclusion after orthodontic treatment, with and without extractions on lip position changes. Methods: 30 patients with Angle Class Ⅰ malocclusion were chosen. 15 patients were treated by 4 first-premolars extraction (Group A) and 15 patients were treated without extraction (Group B). The soft tissue X-ray cephalometric of the patients were measured before and after the treatment and compared statistically. Results: After the extraction treatment, the upper and lower projecting lip reduced by 1.42 mm and 2.03, mmrespectively. The length of the upper and lower lips increased by 0.51mm and 1.58mm, respectively. For the group B, the nasolabial angle, the lower lip protrusion, the length of upper and lower lips had been increased, though there had no statistical significance before and after treatment. Conclusions: After extraction treatment the upper and lower projecting lips decreased. The patients with extractment treatment had the facial aesthelics.     

单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙的临床观察

目的:观察单纯上牙槽后神经阻滞麻醉在上颌第三磨牙拔除中的镇痛效果,为临床应用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙提供依据.方法:选择463例患者,共拔除500颗上颌第三磨牙,以500例上颌第三磨牙拔除术临床资料为研究对象,将其随机分为试验组(n=300)和对照组(n=200).试验组采用单纯上牙槽后神经阻滞麻醉拔除上颌第三磨牙,对照组加用腭前神经阻滞麻醉和腭侧浸润麻醉.进行视觉模拟量表(VAS)评分,分析并比较两组患者麻醉镇痛效果.结果:试验组与对照组疼痛感觉无显著差异(P0.05);对照组与试验组间VAS评分比较,差异无统计学意义(P0.05).结论:仅用单纯上牙槽后神经阻滞麻醉可满足临床上颌第三磨牙拔除的镇痛要求.     

PRP 与CPC 应用于拔牙后种植位点保存的实验研究

目的:探讨磷酸钙骨水泥(CPC)与富血小板血浆(PRP)混合物应用于拔牙后种植位点保存的可行性。方法:拔除6只犬下颌双侧第三切牙与一侧第一切牙,并于每只犬的3个拔牙窝颊舌侧骨壁分别制造2 mm×2 mm×3 mm缺损,随机在两个牙槽窝内分别植入CPC或CPC与PRP的混合物,第三个不加处置作对照,在术后4、8、12周各处死两只动物,行大体、X线、显微镜观察,比较各组的新骨生成情况。结果:术后4周时CPC/PRP混合物组骨形成早于其他组,8、12周时CPC/PRP混合物组新骨生成明显优于CPC组和对照组。结论:CPC混合PRP可促牙槽窝新骨生成并能保证成骨的高度和颊舌向宽度,从而为后期种植义齿修复提供了必要的条件。     

冠心病患者静息心率与血小板活性相关研究

目的:探讨冠心病患者静息心率与血小板活性的相关研究。方法:选择2013年1月至2014年9月于我院住院患者474例,按静息心率快慢分为三组,心率70 bmp为第一组(Q1)150例,心率位于70~85 bmp为第二组(Q2)265例,心率85 bmp为第三组(Q3)59例,三组患者均于病情稳定时行血栓弹力图(TEG)中MA值检测,同时随访3个月,观察和比较三组患者MA值变化及预后。结果:三组患者MA值分别为61.16±7.29 mm、62.02±7.46 mm、65.32±6.56 mm,第三组患者MA值与第一组或第二组患者MA值比较差异均存在统计学意义(P0.05),通过血栓弹力图检测三组经花生四烯酸(AA)途径的血小板抑制率和经二磷酸腺苷(ADP)途径的血小板抑制率发现,静息心率高低与抗血小板药物作用疗效无相关关系(P0.05)。随访3个月,三组患者心绞痛、再住院、脑血管病及死亡的总发生率分别为28%、28.68%、40.67%。结论:冠心病患者静息心率越快,MA值越大即血小板活性越高,静息心率的高低与抗血小板药物作用疗效无关。     

北京地区青少年恒牙先天数目异常的分析

本文调查了北京地区青少年先天缺失牙和多生牙的发生率、好发部位,探讨先天牙齿数目异常与人类进化之间的关系。观察和分析了429名全颌曲面体层X线片,年龄为12—23岁,均无恒牙拔牙史或牙齿损伤史。结果表明先天缺失牙(包括第三磨牙)的发生率为42．19％,第三磨牙的缺失发生率为35．43％,缺失牙的好发部位依次为：上颌第三磨牙、下颌第三磨牙、下颌第二双尖牙、下颌中切牙、上颌第二双尖牙等;多生牙发生率为3．50％,好发部位是上颌切牙区。牙齿先天缺失在人群中的发生率明显高于多生牙,缺失牙主要发生在功能相对弱的牙位上;遗传因素对牙齿数目异常起主导作用。在人类进化过程中,缺失某些牙齿是咀嚼器官退化的趋势,而多生牙可能是一种返祖遗传现象。     

下颌第二恒磨牙C形根管的离体实验研究

目的：寻找一种预备C形根管的有效器械,提高下颌第二恒磨牙的治愈率。方法：选用80颗具有C形根管的下颌第二恒磨牙,选择四种器械进行根管预备,第一组用不锈钢K锉,第二组用不锈钢K锉和手用镍钛器械,第三组用机用镍钛器械,第四组用超声根管治疗仪,预备中均用3％双氧水和生理盐水交替反复冲洗根管,预备后用Vitapex糊剂和牙胶尖冷侧压方法充填根管,观察根充后X线片和根尖微渗漏情况,评价充填效果。结果：四种器械根充后微渗漏有明显差异（P〈0．05）。结论：不锈钢K锉和手用镍钛器械联合应用及超声根管治疗仪为预备C形根管的有效器械。     

Inferior alveolar nerve reconstruction with a polyglycolic acid bioabsorbable nerve conduit.

A custom-designed polyglycolic acid (PGA) bioabsorbable nerve conduit was used to reconstruct a 25-mm defect in the right inferior alveolar nerve. The initial nerve injury, following a dental extraction, resulted in loss of lower lip sensation and severe facial pain. Sixteen months after tooth extraction, with no improvement in symptomatology, the alveolar canal was enlarged in diameter by means of mandibular osteotomy to accommodate a 2-mm-diameter polyglycolic acid tube. The proximal end of the inferior alveolar nerve was sutured into the polyglycolic acid tube. The mental nerve was sutured into the distal end of the tube. Pain of neural origin was relieved in the early postoperative period. Two years following nerve reconstruction, pain relief remains excellent and perception of pressure and vibration is similar to the thresholds for these perceptions on the contralateral lip.     

Comparative evaluation of ropivacaine and lidocaine as dental pulp anaesthesia

Root canal therapy linked to pulpal diseases or trauma is common in modern dental care. The 2% Lidocaine which is considered as the gold standard has some drawbacks in pulpal anaesthesia. Ropivacaine has beneficial anaesthetic effects on pulpal anaesthesia. Therefore, it is of interest to compare and evaluate the pulpal aesthetic effect using 0.5% Ropivacaine and 2% Lidocaine in symptomatic irreversible pulpitis. A double blinded randomized controlled clinical trial consisting of 110 lower molar and premolar tooth with irreversible pulpitis cases for root canal therapy were selected and randomly divided into 2 groups. Group A: 2% lidocaine with epinephrine and Group B: 0.5% ropivacaine. The pulp sensibility tests with heat test, cold test and electric pulp test were completed. The preoperative pain score was measured with Visual Analogue Scale (VAS) pain scale. The classical inferior alveolar nerve block (IANB) technique was administered to all patients by a single operator. Subjects were asked for lip numbness and presence or absence of lip numbness. Postoperative pain scores were recorded during access opening and on placing files in the canal. There is no statistical difference between the groups during pre operative conditions. The mean pain scores within group A and group B is recorded. The difference was found to be statistically significant with p value ≤ 0.05. Significant difference between the mean values after and before the treatment is observed. However, there is no statistical significance between the mean pain scores between the access and pulp. The 0.5% Ropivacaine and 2% Lidocaine with epinephrine does not have any significant difference during access opening. However, 0.5% Ropivacaine groups were effective while placing the file in the canal. Thus, 0.5% Ropivacaine showed better results even though it was not statistically significant for further consideration in this context.     

不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛应用于无痛分娩的效果观察

目的:探讨不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛(PCEA)应用于无痛分娩的临床价值。方法:选择2019年1月~12月于北京协和医院拟行自然分娩的初产妇180例,按随机数余数法分为A、B、C三组,每组60例,分别采用0.75%罗哌卡因0.33 m L(2.50 mg)、0.50 m L(3.75 mg)、0.67 m L(5.0 mg)复合地佐辛PCEA分娩镇痛,宫口开至2~3 cm时进行无痛分娩,L2~L3间隙穿刺,头侧置管行PCEA,宫口开全时停止PCEA。比较三组镇痛前(T0)、镇痛15 min(T1)、宫口全开(T2)、胎儿娩出(T3)、胎盘娩出(T4)及缝合会阴(T5)视觉模拟评分(VAS),采用改良Bromage评分评估下肢运动神经阻滞效果,统计各组镇痛起效时间、镇痛开始至宫口全开时间、第一产程、第二产程和第三产程时间,统计各组达目标麻醉平面时镇痛药物用量及产妇镇痛泵按压次数,记录各组产后出血量及最终分娩方式,采用新生儿阿氏评分法(Apgar)评定新生儿窒息情况,并行脐血血气分析,统计各组分娩期间不良反应发生情况。结果:T1~T5时点三组VAS评分均较T0时点降低(P<0.05),B、C组T1~T5时点VAS评分均低于A组(P<0.05);三组改良Bromage分级分布比较差异有统计学意义(P<0.05);B、C组镇痛起效时间较A组更快,第二产程时间、第三产程时间较A组缩短,达目标麻醉平面镇痛药物用量、镇痛泵按压次数、有效按压次数均较A组减少(P<0.05),B、C组以上指标对比差异无统计学意义(P>0.05);三组产后出血量、最终分娩方式、新生儿出生1 min、5 min Apgar评分、pH值、血氧分压(PO2)、二氧化碳分压(PCO2)和不良反应发生率比较差异无统计学意义(P>0.05)。结论:0.75%罗哌卡因0.50 m L(3.75 mg)复合地佐辛PCEA分娩镇痛在无痛分娩中镇痛效果满意,对产程、宫缩、母婴影响小,具有运动神经阻滞、感觉神经阻滞分离优势,不良反应少,安全性高。     

苦碟子注射液辅助治疗对2型糖尿病伴周围神经病变患者微循环的影响

目的:探讨苦碟子注射液辅助治疗对2型糖尿病伴周围神经病变患者微循环影响及安全性。方法:收集我院80例2型糖尿病伴周围神经病变患者,随机分为实验组和对照组,每组40例。对照组患者给予甲钴胺治疗,实验组患者给予苦碟子注射液治疗。观察并比较两组患者治疗前后微循环水平、周围神经评分、不良反应发生率及治疗效果。结果:与治疗前相比,治疗后两组患者管袢形态、管袢流态、袢周状态以及周围神经评分水平较低,差异具有统计学意义(P0.05);与对照组相比,实验组患者治疗管袢形态、管袢流态、袢周状态以及周围神经评分水平较低,差异具有统计学意义(P0.05);实验组并发症的发生率低于对照组,而临床治疗有效率高于对照组,差异均具有统计学意义(P0.05)。结论:苦碟子注射液辅助治疗能够改善患者的微循环以及周围神经情况,临床疗效较好,安全性高。     

碱性成纤维细胞生长因子对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响

目的:探讨碱性成纤维细胞生长因子对对下颌阻生牙手术患者血清IL-6水平及牙槽骨密度的影响。方法:收集我院就诊的104例行下颌阻生牙手术患者,随机分为实验组和对照组,每组52例。所有患者均行下颌阻生牙手术。对照组患者术后注射生理盐水,实验组患者术后注射碱性成纤维细胞生长因子。观察并比较两组患者血清白介素6(IL-6)、牙槽骨密度水平、临床治疗有效率以及不良反应发生情况。结果:与治疗前相比,两组患者治疗后的骨密度水平均升高,IL-6水平均下降,差异具有统计学意义(P0.05);与对照组相比,实验组患者的牙槽骨密度水平及临床治疗有效率均较高,IL-6水平较低,差异具有统计学意义(P0.05)。实验组患者未出现不良明显反应。结论:碱性成纤维细胞生长因子可显著提高下颌阻生牙术后患者的创口恢复,且有效预防感染的发生。     

丹蛭降糖胶囊联合硫辛酸、依帕司他对气阴两虚夹瘀型糖尿病周围神经病变患者血糖水平和下肢神经功能的影响

摘要 目的：探讨丹蛭降糖胶囊联合硫辛酸、依帕司他治疗气阴两虚夹瘀型糖尿病周围神经病变（DPN）的临床疗效,并分析其对血糖和下肢神经功能的影响。方法：按照随机数字表法将81例DPN患者分成对照组40例和观察组41例,对照组在2型糖尿病治疗基础上使用硫辛酸静滴联合依帕司他口服治疗,观察组在对照组治疗基础上,加用丹蛭降糖胶囊口服治疗。比较两组治疗前后中医证候积分、双下肢肌电图[腓总神经运动神经传导速度（MCV）、腓肠神经感觉神经传导速度（SCV）]、电流感觉阈值（CPT值）、血糖指标[空腹血糖（FPG）、餐后2小时血糖（2 hBG）、糖化血红蛋白（HbA1c）]水平变化,并对比两组总有效率和治疗方案安全性。结果：观察组总有效率为90.24%（37/41）,明显高于对照组的70.00%（28/40）,差异有统计学意义（P＜0.05）;治疗8周后,两组肢体麻木、肢体末梢疼痛、神疲乏力、气短懒言、腰膝酸软、失眠烦躁积分,FPG、2 hBG、HbA1c水平均明显降低（P＜0.05）,且观察组各项中医证候积分和血糖指标水平均明显低于对照组（P＜0.05）;治疗8周后,观察组相同频率正弦交流电刺激下的第一脚趾远端趾节甲小皮基部近端的CPT值均明显低于对照组（P＜0.05）,腓总神经MCV、腓肠神经SCV均明显高于对照组（P＜0.05）;两组治疗过程中均未发生明显药物不良反应。结论：丹蛭降糖胶囊口服联合硫辛酸、依帕司他治疗气阴两虚夹瘀型DPN,能够有效缓解患者的临床症状和体征,控制血糖水平,改善下肢神经功能,疗效明显优于单纯西药治疗,且安全性高。     

The influence of incompetent lip seal on the growth and development of craniofacial complex

Abnormal orofacial functions in the period of growth and development can cause morphological anomalies of the craniofacial complex. The aim of this study was to determine the correlation between open mouth posture and morphology of craniofacial complex. The shape, size and relationships of skeletal parts of craniofacial complex were determined by analysis of lateral cephalograms in the sample of 84 children--45 girls and 39 boys (aged 8.96 +/- 0.66 years). The sample was divided into two groups--lip competence and lip incompetence group. Differences in cephalometric values between observed groups were found. The values of inclination of lower central incisors (angle ILi/NB), interbasal angle (NL/NSL), angle between occlusal and mandibular plane and anterior lower facial height were significantly higher in the group with open mouth posture. It can be concluded that lip incompetence plays an important role in growth and development of craniofacial complex.     

AgNOR quantification in cells of normal oral mucosa exposed to smoking and alcohol. A cytopathologic study

OBJECTIVE: To evaluate cell proliferative activity by counting and measuring argyrophilic nucleolar organizer regions (AgNORs) per nucleus in cell smears from mucosa clinically exposed to smoking and alcohol. STUDY DESIGN: Group 1 (control) consisted 17 patients, group 2 (smoking) of 25 and group 3 (smoking and alcohol) of 18. Cell smears collected from the mucosa of the lower lip, border of the tongue and floor of the mouth underwent AgNOR staining. Mean number and mean area of AgNORs per nucleus were calculated for the first 50 cells in each smear. ANOVA and the Tukey test were used for statistical analyses at a 5% significance level. RESULTS: Statistical analyses revealed a greater mean number and larger mean area of AgNORs per nucleus in groups 2 (smoking) and 3 (smoking and alcohol). Samples from the border of the tongue had the lowest mean values for number and area of AgNORs per nucleus in comparison with samples from the lower lip and floor of the mouth in the 3 groups. CONCLUSION: Anatomic sites exposed to smoking or to smoking and alcohol had increased cellular proliferative activity.