种植体周骨沟液代谢相关因子与种植体稳定性相关性分析

发布时间：2018-03-21 22:16

本文选题：牙周组织龈沟液　切入点：种植体周沟液　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的本研究通过测量种植牙患者不同时间点牙周组织龈沟液(gingival crevicular fluid,GCF)和种植体周沟液(perio-implant crevicular fluid,PICF)中骨保护素(Osteoprotegerin,OPG)及核因子κB受体活化因子配体(receptor activator of nuclear factor kappa B ligand,RANKL)的水平,检测种植体稳定性ISQ(implant stability quotient)值。分析OPG、RANKL水平和OPG/RANKL比值与ISQ之间的关系。方法对2014年10月至2016年10月期间到我院口腔种植科就诊的患者进行筛选,最终入选患者共有78例,其中男性43例,女性35例,患者年龄范围在20-62岁之间,平均年龄41.6±14.2岁,根据患者的影像学检查和专科检查结果,对种植位点进行全面评估,制定详细的种植计划,共植入78颗种植体。术前用吸潮纸尖分别吸取种植位点相邻两个天然牙的GCF,称量法测量取样前、后吸潮纸尖吸取龈沟液的重量(AE240电子天平,METTLER,Sweden),-70℃冻存。手术在局部麻醉和无菌条件下进行,所有患者均按照标准手术步骤,完成Straumann软组织水平种植体植入,结合X线片及手术过程中种植窝预备钻所受阻力大小,对患者牙槽骨的骨质进行评估和分类。术后1、2、3、4、6、8及12周复诊,以相同的方法取得PICF和相邻天然牙GCF并测量记录ISQ值。.测量ISQ时,使用种植体稳定性测量仪(Osstell ISQTM(瑞典))在种植体近中、颊侧和舌侧各1次,以三次ISQ值的均值作为该种植体的ISQ值。术前及每次术后复查时,均记录种植体邻牙及种植体的菌斑指数和牙龈指数。在术后即刻、12周复查时拍摄种植体的根尖片,检查种植体周围有无暗影和骨吸收。每次复查时,均对患者进行口腔卫生指导。依据Buser提出标准检查种植体的留存率。此外,ELISA方法检测每次所收集的GCF和PICF样本中OPG和RANKL的水平,通过比较术后1、2、3、4、6、8及12周复查时OPG和RANKL水平的变化,分析OPG、RANKL水平、OPG/RANKL比值与ISQ的关系。结果种植体直径分为3.3mm、4.1mm和4.8mm三种,对应的种植人数分别为13、36和29人。手术后,所有种植体骨结合均良好,无明显的牙龈红肿等牙周炎症反应。78颗种植体均未发现种植体折断、松动和脱落等现象,影像学根尖片检查显示,种植体周围无透射阴影和骨吸收,种植体存留率为100㳠。对不同时间点检测到的GCF和PICF中的OPG和RANKL进行重复测量方差分析,结果显示,术后第二周GCF和PICF中OPG的含量均有所升高,以PICF中OPG升高最明显,显著高于其他时间点的OPG水平(P0.05)。第二周时,GCF中OPG的含量也显著高于其他时间点(P0.05)。同时分析相同时间点GCF和PICF中OPG的差异,结果显示,其差异无统计学意义(P0.05)。而术后GCF和PICF中RANKL含量呈现不同的变化趋势。GCF中RANKL含量是先降后升,第3、4、5周时GCF中RANKL水平显著低于第12周(P0.05),而PICF中RANKL水平在第3周时最高,第1、4、6、8和12周,RANKL水平均显著低于第3周(P0.05)。分析相同时间点GCF和PICF中RANKL的差异,结果显示,其差异无统计学意义(P0.05)。依据不同时间点的OPG和RANKL数据,计算不同时间点GCF和PICF中OPG/RANKL比值。第1周时,PICF中的OPG/RANKL比值显著高于GCF中OPG/RANKL比值(P=0.0340.05)。其他时间点两组数据间无显著差异。对比不同时间点的ISQ值,术后即进行了ISQ测量,值为63,术后1周ISQ略微升高,之后降低,在第四周时降到最低,为62.2±0.9,随后逐渐升高。统计学分析结果显示,术后第1周、第2周、第6周、第8周和第12周ISQ值均显著高于第4周,差异具有统计学意义(P0.05)。上颌后牙缺失和下颌牙缺失患者种植后,统计结果显示,在不同时间点种植体稳定性之间具有显著差异,下颌牙位点种植体稳定性普遍高于上颌后牙位点的种植体,尤其是在3周、6周、8周和12周时,两组之间的差异显著(P0.05)。GCF中OPG和RANKL的变化与ISQ的变化相关性更强,OPG变化趋势与ISQ变化趋势大致相反,而RANKL的变化与ISQ的变化呈现相同趋势,PICF中OPG和RANKL变化的出现早于ISQ的变化。GCF中OPG/RANKL的变化趋势也与ISQ变化趋势相同。PICF中OPG/RANKL比值的变化依然早于ISQ值的变化,较其变化早1周。结论1.由于OPG和RANKL生物学作用的不同,在种植术后的恢复过程中,OPG和RANKL的变化趋势不同。因此与ISQ的变化趋势相比也呈现不同的关系。OPG与ISQ的变化趋势相反,而RANKL与ISQ变化趋势相同。2.GCF中OPG和RANKL的变化要早于PICF,因此GCF的敏感性要高于PICF。
[Abstract]:The purpose of this study is through the measurement of dental implant in different time points in patients with periodontal tissue and gingival crevicular fluid (gingival crevicular, fluid, GCF) and peri implant crevicular fluid (perio-implant crevicular, fluid, PICF) osteoprotegerin (Osteoprotegerin, OPG) and receptor activator of nuclear factor kappa B ligand (receptor activator of nuclear factor kappa B ligand. RANKL) the level of detection of implant stability of ISQ (implant stability quotient). OPG value analysis, the relationship between RANKL level and the ratio of OPG/RANKL and ISQ. Methods during the period from October 2014 to October 2016 in our hospital department of oral implant patients were screened, and ultimately selected patients with a total of 78 cases, including 43 cases of male, 35 cases female, age range of patients at the age of 20-62, the average age of 41.6 + 14.2 years, according to the inspection and examination results with the imaging of implant sites to conduct a comprehensive assessment, detailed The planting plan, a total of 78 implants were placed before operation with absorbent paper points from each implant sites adjacent two teeth GCF, measuring and sampling weighing method before and after absorbent paper points draw the gingival crevicular fluid weight (AE240 electronic balance, METTLER, Sweden, -70) C operation in cryopreservation. Local anesthesia and aseptic conditions, all patients were in accordance with the standard operation procedures, the completion of Straumann soft tissue implants, combined with X-ray and surgery in the process of planting bed preparation by the resistance drill size on alveolar bone in patients with osteoporosis were evaluated and classified. After 1,2,3,4,6,8 and 12 weeks, PICF and adjacent natural the tooth GCF and measured and recorded ISQ value. Measurement of ISQ in the same way, using the implant stability measuring instrument (Osstell ISQTM (Sweden)) in implant mesial buccal and lingual 1 times each, on average three times the ISQ value as the implant preoperative and ISQ value. Every time after the operation, were recorded for implant adjacent tooth and implant plaque index and gingival index. In the immediate postoperative, taken root implants 12 weeks check, check there is no shadow around the implant and bone resorption. Each follow-up time, all oral hygiene instruction for patients on the basis of. Buser proposed standard check implant retention rate. In addition, OPG and RANKL ELISA for the detection of each collection of GCF and PICF in the sample level change, OPG and RANKL levels compared with 1,2,3,4,6,8 after operation and 12 weeks after review RANKL level analysis, OPG, OPG/RANKL and ISQ. The relationship between the ratio of the implant the diameter is divided into 3.3mm, 4.1mm and 4.8mm three, the number of planting the corresponding 13,36 and 29 respectively. After the operation, with all the good implant bone, no obvious gingival swelling and other inflammation reaction of.78 implants were not found in implant fracture, loosening and shedding So, the imaging examination showed that the dental implant without transmission, shadow and bone resorption and implant survival rate was 100?. at different time points to detect GCF and PICF in OPG and RANKL analysis of variance of repeated measurement results showed that the content of GCF and PICF were second weeks in OPG increased after the operation, with PICF OPG increased the most obviously, significantly higher than the other time points in the OPG level (P0.05). At second weeks, the content of GCF in OPG was significantly higher than that in other time points (P0.05). At the same time, analyze the difference, at the same time GCF and PICF OPG results showed that the difference was not statistically significant (P0.05). While the content of RANKL and PICF in GCF after RANKL.GCF in different trend is the rise after the first drop, 3,4,5 weeks RANKL level of GCF was significantly lower than that of twelfth weeks (P0.05), while the level of RANKL PICF in third weeks when the highest, 1,4,6,8 and 12 weeks, the levels of RANKL were significantly low In the third week (P0.05). Analyze the difference, at the same time GCF and RANKL PICF results showed that the difference was not statistically significant (P0.05). According to the different time points of OPG and RANKL data, calculate the ratio of OPG/RANKL at different time points of GCF and PICF. At first weeks, the ratio of OPG/RANKL in PICF was significantly higher than that of OPG/RANKL the ratio of GCF (P=0.0340.05). There was no significant difference between the other time points between two groups of data comparison. At different time points ISQ value after the operation of ISQ measurement value is 63, 1 weeks after operation, ISQ slightly increased and then decreased, in the fourth week to a minimum of 62.2 + 0.9, then increased gradually. The results of statistical analysis showed that first weeks after surgery, second weeks, sixth weeks, eighth weeks and twelfth weeks, ISQ values were significantly higher than the fourth week, the difference was statistically significant (P0.05). Maxillary posterior teeth missing and mandibular edentulous patients after planting, the statistical results show that the implant stability at different time points Significant differences between the mandibular implant site implant stability is generally higher than that of maxillary posterior sites, especially in the 3 week, 6 weeks, 8 weeks and 12 weeks, the difference between the two groups was significant (P0.05) between OPG and RANKL and ISQ more changes in.GCF, OPG and trend the change trend of ISQ approximately opposite changes of RANKL and ISQ showed the same trend, changes of OPG/RANKL changes.GCF earlier than ISQ in the trend of changes of OPG and RANKL in PICF and ISQ have the same trend as OPG/RANKL.PICF ratio still earlier than the ISQ value, the change is 1 weeks earlier. Conclusion OPG and RANKL 1. due to different biological effects, in the recovery process after implantation in different trends of OPG and RANKL. So with the change trend of ISQ compared with the trend of the relationship between.OPG and ISQ of different RANKL and ISQ on the contrary, trend The change of OPG and RANKL in the same potential.2.GCF is earlier than that of PICF, so the sensitivity of GCF is higher than that of PICF..

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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