正畸—牙周联合治疗中重度牙周炎早期龈沟液骨钙素水平的研究

发布时间：2019-07-06 15:38

【摘要】：牙周病的病因除菌斑微生物、局部刺激因素及自身免疫反应造成的牙周组织破坏以外,过大的咬合力、异常的咬合力方向、早接触、牙齿排列不齐等咬合问题都能加重牙周组织的破坏。当牙周组织被破坏,牙槽骨高度降低,牙周支持力不足,牙齿特别是前牙会出现病理性牙移位,其中以前牙的扇形漂移为主,病理性的牙移位又会进一步使牙承担咬合创伤,形成恶性循环,给患者造成心理和生理上的双重影响。牙周病是由细菌感染引发的疾病的观点已得到了人们的公认。牙周病的发展过程中,机体会针对病原微生物发生一系列免疫反应,同时会使局部的组织发生病理性改变。这些变化的产物会在龈沟液中表现出来。因此,通过对龈沟液中的宿主反应产物、细菌产物以及组织破坏产物中寻找牙周病各时期的标志是牙周病学研究的一个重要方面。骨钙素是成骨细胞产生并分泌的一种激素样多肽,它可以激活前破骨细胞,从而加速诱导骨吸收细胞的分化,促进骨的吸收速率,是代表骨代谢速率瞬间变化的一个特异且灵敏的生化指标。龈沟液中的骨钙素水平反映了局部牙槽骨的变化和炎症程度。因此,通过对龈沟液中骨钙素水平的定量分析,可以检测牙周炎患者的牙周组织受到正畸力后的反应,同时探究正畸治疗对于牙槽骨的改建情况,为临床治疗提供一定的指导。目的：通过检测中重度牙周炎患者正畸治疗早期牙周临床指标以及首次加力后龈沟液中骨钙素水平的变化,研究其变化规律,为监控正畸治疗早期的牙周组织反应提供实验依据。方法：选择15例中重度牙周炎患者为实验组,在牙周治疗前、正畸治疗前以及接受正畸治疗后1个月、2个月分别检测牙周临床指标(菌斑指数,龈沟出血指数,牙周袋探诊深度),并用电化学发光法检测牙周治疗前、正畸治疗前以及首次加力后1h、1d、2d、7d龈沟液中骨钙素水平,同时选择对照组15例牙周健康的正畸患者,对照组于正畸加力前记录牙周临床指标,并于正畸加力前、加力后1个月、2个月检测龈沟液中骨钙素水平。结果：实验组患者通过牙周治疗,各项牙周检测指标均低于治疗前水平(P0.05),实验组患者在正畸治疗过程中各项牙周临床指标与正畸治疗前无明显差异(P0.05)；实验组患者正畸加力后骨钙素水平较加力前明显升高(P0.05),24h达到峰值,7d降至加力前水平；对照组患者骨钙素水平加力后明显升高,24h达到峰值,7d降至加力前水平；实验组与对照组骨钙素水平的变化规律一致。结论：龈沟液中骨钙素的浓度能够反映牙周组织的炎症程度,参与牙槽骨的改建,通过正畸—牙周联合治疗的方法治疗中重度牙周炎可以改善患者牙周状况,牙周炎并未因正畸治疗而加重。
[Abstract]:In addition to plaque microorganisms, local stimulants and autoimmune reactions, excessive occlusal force, abnormal occlusal force direction, early contact, uneven arrangement of teeth and other occlusal problems can aggravate the destruction of periodontal tissue. When periodontal tissue is destroyed, alveolar bone height is reduced, periodontal support is insufficient, teeth, especially anterior teeth, will appear pathological tooth displacement, in which the fan drift of anterior teeth, pathological tooth displacement will further make teeth bear occlusal trauma, forming a vicious circle, resulting in dual psychological and physiological effects on patients. The idea that periodontal disease is caused by bacterial infection has been recognized. In the development of periodontal disease, the body will have a series of immune reactions against pathogenic microorganisms, and at the same time, it will cause pathological changes in local tissues. The products of these changes are shown in the gingival crevicular fluid. Therefore, it is an important aspect of periodontal disease research to find out the signs of periodontitis in the host reaction products, bacterial products and tissue destruction products in the gum crevicular fluid. Osteocalcin is a hormone-like polypeptide produced and secreted by osteoblasts, which can activate preosteoclasts and accelerate the differentiation of bone resorption cells and promote bone resorption rate. it is a specific and sensitive biochemical index that represents the transient change of bone metabolism rate. The level of osteocalcin in gingival crevicular fluid reflects the changes of local alveolar bone and the degree of inflammation. Therefore, through the quantitative analysis of osteocalcin level in gingival crevicular fluid, we can detect the response of periodontal tissue to orthodontic force in patients with periodontitis, and explore the reconstruction of alveolar bone by orthodontic treatment, so as to provide some guidance for clinical treatment. Objective: to study the changes of osteocalcin in gum crevicular fluid after orthodontic treatment in patients with moderate and severe periodontitis, and to provide experimental basis for monitoring periodontal tissue response in the early stage of orthodontic treatment by detecting the clinical indexes of periodontitis in the early stage of orthodontic treatment and the changes of osteocalcin level in gingival crevicular fluid after the first force. Methods: fifteen patients with moderate and severe periodontitis were selected as experimental group. Periodontal clinical indexes (plaque index, gingival crevicular bleeding index, periodontal bag probing depth) were measured before periodontal treatment, before orthodontic treatment and 1 month and 2 months after orthodontic treatment, and osteocalcin levels in gingival crevicular fluid were measured before periodontal treatment, before orthodontic treatment and 1 day, 2 days and 7 days after orthodontic treatment. At the same time, 15 healthy orthodontic patients in the control group were selected. The periodontal clinical indexes were recorded before the orthodontic force, and the osteocalcin level in the gingival crevicular fluid was measured before the orthodontic force, 1 month and 2 months after the orthodontic force. Results: the periodontal test indexes of the experimental group were lower than those before orthodontic treatment (P 0.05), but there was no significant difference between the experimental group and the orthodontic treatment (P 0.05). The osteocalcin level of the experimental group was significantly higher than that before orthodontic treatment (P 0.05), reached the peak at 24 h, and decreased to the pre-orthodontic level at 7 d. The osteocalcin level in the control group increased significantly after adding strength, reached the peak at 24 h and decreased to the pre-loading level on the 7th day, and the change of osteocalcin level in the experimental group was consistent with that in the control group. Conclusion: the concentration of osteocalcin in gingival crevicular fluid can reflect the degree of inflammation in periodontal tissue and participate in the reconstruction of alveolar bone. The treatment of moderate and severe periodontitis by orthodontic and periodontal treatment can improve the periodontal condition of patients, and periodontitis is not aggravated by orthodontic treatment.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.5

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