【作者】 楼北雁； 田也； 吴红崑； 朱运握； 杨阳；

【Author】 Lou beiyan;Tianye;Wu hongkun;Zhu yunwo;Yangyang;West China School of Stomatology SiChuan University;

【机构】 四川大学华西口腔医学院；

【摘要】 目的:牙周膜的再生、牙根吸收和粘连情况直接影响外伤脱位牙的存活几率。目前已经有报道人类干细胞和富血小板血浆用于伤口的愈合和组织的再生。本研究混合脂肪干细胞和富血小板血浆,将其共同应用于再植之前的脱位的切牙牙根,通过临床效果和影像学结果评价其疗效。方法:选择36名男性,16名女性(年龄14-20岁)共52颗外伤脱位的切牙,带抗体的生理盐水中保存,并行体外行根管治疗。通过自动血小板凝集系统提取每个样本的富血小板血浆。干细胞来自健康女性脂肪组织,通过干细胞生物标记物进行鉴定,再放入带有PRP的消毒的胶原海绵中。再植前,牙根用含混合物的胶原海绵覆盖后,植入到预备好的牙槽窝内,通过牙周夹板与邻牙固定。在1、3、6、12、18、24和36个月观察再植牙临床和影像学结果。结果:36个月的放射学检查表明共有40颗牙齿(77%)出现正常的牙周膜的愈合,7颗牙齿(13%)有牙根粘连,3颗牙齿(6%)有牙根吸收,2颗牙齿(4%)在12-18个月后再植失败。存在的50颗牙齿均呈现天然牙色。90%的牙齿显示MI动度,无牙龈退缩、临床附着丧失的表现,没有位点探诊深度大于3mm。脱位牙牙周膜愈合的成功率高于其他术式。结论:富血小板血浆和脂肪干细胞的联合应用,可以填满脱位牙的牙槽窝间隙,诱导牙周膜愈合,减少牙根吸收和粘连的可能。更多还原

【Abstract】 Objective: The survival of avulsed permanent teeth is affected by regeneration of periodontal ligament(PDL), development of root resorption, ankylosis. Human adiposetissue-derived stem cells(HADSCs) and platelet-rich plasma(PRP) have been reported to contribute to wound healing and tissue regeneration. In this study we mixed HADSCs with PRP, applying to the roots of avulsed incisors before replantation. Methods: 52 avulsed central incisors were collected from 36 males and 16 females(age 14-20), they were stored and transported in milk to dental clinic. Root canal treatment was conducted in vitro, the teeth were immersed in physiological saline with antibiotics. The PRP was obtained from each subject by an automated platelet concentration system. HADSCs had been isolated from healthy females’ adipose-tissue and identified with stem cell biomarkers. The cells were seeded into sterile collagen sponge mixed with prepared PRP. The roots of avulsed incisors were covered with mixed gel and inserted into prepared alveolar socket, the teeth were fastened to adjacent teeth by a splint. The tooth was monitored clinically and radiologically at 1, 3, 6, 12, 18, 24 and 36 months after replantation. Results: The radiological examination at 36 months revealed 40 teeth(77%) with PDL healing, 7(13%) developed root ankylosis, 3(6%) with root resorption and 2(4%) failed after 12-18 months. The existing 50 teeth demonstrated natural color of appearance. 90% of the teeth showed MI mobility, absence of gingival recession, clinical attachment loss and no sites with probing depth >3 mm. Successful regeneration of avulsed teeth with PDL healing was shown to be significantly higher than other forms of replantation. Conclusions: Mixed HADSCs and PRP applied to the roots may fill the gap of avulsed teeth, inducing PDL healing and reducing the chance of root resorption and ankylosis. Preparation of HADSCs and PRP are easy and safe, it can be widely used in replantation and transplantation.更多还原