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The Biocompatibility Study and Clinical Trial of Polylatic Acid Intracanal Post for the Restoration of Deciduous Teeth

Author: ZouYanPing
Tutor: YangFuSheng；XuanKun
School: Fourth Military Medical University
Course: Clinical Stomatology
Keywords: Infant caries Polylactic acid root canal Bioabsorbable material Biocompatibility Clinical trials
CLC: R788.1
Type: Master's thesis
Year: 2011
Downloads: 38
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Abstract

Residual crown and root cause severe infant caries restorative treatment is still a clinical problem. Permanent teeth residual roots and crowns of treatment is usually applied metal or fiber pile (nuclear) root canal to enhance retention, to restore the tooth morphology and function, but will affect the repair can not be absorbed for deciduous teeth residual crown and root replacement of primary and permanent teeth. CNP is special physiological phenomenon of childhood one deciduous teeth to a certain period of time with the development of the permanent tooth germ, the root will be gradually absorbed and replaced by the eruption of the permanent teeth. CNP fixed prosthesis in severe caries deciduous root canal treatment must take into account the impact on whether the eruption of the permanent teeth. The domestic literature shows that most deciduous teeth residual roots and crowns usually select symptomatic treatment or unplug, but conservative treatment is not only beautiful and developmental impact on children, the more serious is the successor permanent normal eruption and growth and development of the jaw, become Malocclusion the occurrence of incentives. To solve this problem, choose the root canal fixtures severely decayed deciduous teeth morphology, function and physiological characteristics repair is the need to address the important issue of the children's dentist. Recent medical bio-absorbable material used in clinical treatment, fixtures such as orthopedic and surgical scaffold. Bioabsorbable materials have good tissue compatibility, certain plasticity and mechanical properties, the appropriate biological degradation properties, for treatment or replacement of the human body, tissues and organs, and enhance the function or promote healing. Polylactic acid become the most studied materials have excellent physical, chemical and biological properties. In this study, conducted by the original polylactic acid absorption root canal compatibility experiments of cell biology and animal model experiments to investigate the application feasibility of deciduous dedicated root canal can absorb, and thus by its clinical application infant caries observation and assessment of children, and to explore the deciduous teeth residual crown and root function to repair the clinical efficacy, and provide a new therapeutic approach for the treatment of infant caries, lay the experimental basis for clinical application specification root canal can absorb. The basic experimental research in this experiment experiment poly lactic root canal biocompatibility First use of polylactic acid material bioabsorbable root canal, and thus prepared the extracts of different concentrations of poly lactic root canal. Dental follicle cells in vitro isolation and culture and CNP closely related physiological processes, deciduous teeth periodontal ligament cells and primary teeth pulp cells, using immunohistochemical methods and preliminary identification of cells. Then through the corresponding concentration polylactic acid root canal extracts three cell culture medium and incubated for a certain period of time, using histological methods, MTT analysis by flow cytometry and detection of dental follicle cells, deciduous teeth periodontal ligament cells, milk morphological changes of the dental pulp cells, cell toxicity and apoptosis. Experimental results show that: the to adding poly lactic acid the root canal extracts the experimental group and negative control cytotoxic levels of each concentration group in the experimental group were a comparison, cell morphology showed no abnormal growth in good condition; cytotoxicity assessment, with the negative control group, no significant difference; flow cytometry analysis showed that early apoptosis and late apoptosis in experimental group, no significant difference between the apoptotic index and the negative control group. The polylactic acid root canal followed by the use of different concentrations of extracts, Kunming mice by intraperitoneal injection randomized, at the same time set the saline-injected animals for the control group. Observation and recording of acute toxicity behavioral responses, further analysis by quantitative enzyme-linked interleukin -1 (IL-1) detection method (Elisa) changes in the activity of the experimental animal serum inflammatory factors, in addition to conventional histological method for the preparation of mouse liver specimens, HE staining was observed after hepatocyte toxicity of polylactic acid material. The results show that: the experimental group of mice had no significant acute toxicity behavior reaction; no significant difference between serum inflammatory molecules IL-1 activity analysis, the experimental group and the control group; liver histology observed no significant cell swelling or necrosis, congestion infiltration of inflammatory cells such as abnormal. The results suggest that, Preparation of polylactic acid root canal of human primary and permanent teeth to replace the biological behavior of the cells of no significant impact, has good biocompatibility, biological toxic effects in experimental animals, meet biosafety requirements can be used for further clinical studies. Animal studies in this experiment, experiment dimerization of lactate Pile applications to 3-month-old puppies as experimental animals, the use of polylactic acid root canal, choose fixed restoration of deciduous anterior teeth root canal was prepared experimental model. On a regular basis through a detailed oral examination, observation of clinical manifestations of deciduous teeth and periodontal tissue repair and the restoration of the situation, the changes in the organization of radiological examination apical weeks. After 2 months, painless experimental model animals were sacrificed, cut contains deciduous and permanent tooth germ of the jaw tissue sample, prepared by conventional methods specimen, histological sections, and HE staining polylactic acid root canal deciduous root absorption and inherited permanent dentition Embryo eruption, as well as deciduous teeth periapical tissue biological reaction. The experimental results found: the poly lactic root canal within fixtures restoration of deciduous anterior teeth, no significant pathological tooth loose gums hyperemia, periodontal abscess and other clinical abnormalities, dental restorations intact; X-ray deciduous teeth periapical film chamber to detect clear, no abnormal inflammatory shadows and pathological absorption below the permanent tooth germ developed normally; histological staining find repair deciduous root physiological uptake permanent tooth germ inherited gradually normal eruption, the progress of the CNP was no significant difference between the teeth, deciduous teeth periapical tissue no clear organizational structure disorders, capillary congestion, inflammatory cell infiltration, tissue necrosis and other abnormal pathological manifestations healthy controls. Results of animal experiments suggest that the application of the poly lactic root canal internal fixation repair of primary and permanent physiological replacement had no significant effect. The experimental trimer lactate the pipe pile clinical application test preliminary study of this experiment using SmartPin ^{TM medical bioabsorbable rods (Linvatec, Finland) as the primary teeth repair of clinical trial material, it is woven through unique brushed The patented technology synthesis of the polylactic acid polymer having a high strength and tenacity characteristics. First, the diameter of 2mm SmartPin ^{TM medical bioabsorbable rods through a sterile cutting growing degree of the prepared root canal of 10 mm, sterile, storage at room temperature and set aside. Clinical study to select the 48 indications 3 to 4-year-old children with severe carious deciduous molars front teeth and conventional treatments can not be repaired, a total of 100 teeth. Premise of informed consent, the first by a traditional root canal treatment of residual crown and root treatment and processing, and then within the implantation and bonding polylactic acid root canal root canal, based on composite resin bonded repair crown to complete the treatment. Children six months regularly reviewed by clinical examination methods and USPHS Ryge evaluation criteria, observation and analysis of polylactic acid root canal before restoring deciduous teeth and root, the success rate and repair effects of residual crown; using radiological observation and analysis of clinical sequelae or complications repair deciduous teeth may appear (apical inflammation, primary teeth disease rational absorption, abnormal eruption of permanent tooth germ, etc.). Review the results of a year the Conservation and Restoration of the teeth a success rate of 96.8%, and 6.3% incidence of deciduous teeth periapical inflammation, and no other abnormal symptoms. An effective treatment, while CNP results suggest polylactic acid root canal to save residual roots and crowns of deciduous teeth need to continue the long-term observation and assessment.}}

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