葡萄糖胺對拔牙後齒槽修復之影響：動物實驗評估

Effect of glucosamine on alveolar bone repair following tooth extraction: evaluation with an animal model

沈泰宇(Tai-Yu Shen)

指導教授 ： 陳羿貞

國立臺灣大學/牙醫專業學院/臨床牙醫學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.02057

摘要

近年來由於齒顎矯正治療日益普及，成年矯正病患的人數比例也隨之增加，不過成年病患在尋求矯正治療的同時，往往合併有牙周破壞的狀況，讓矯正醫師在進行牙齒移動時遭受到更大的挑戰。臨床上引導組織再生的技術已十分成熟，也有許多材料被證實可以有效恢復齒槽嵴的高度與寬度，便利矯正治療時牙齒的移動或補綴物的製作。本研究即在探討微觀下葡萄糖胺單體是否具有骨誘導的能力？能否促成骨髓間葉細胞的分化？能否增進拔牙後齒槽骨的癒合？以及觀察齒槽修復時骨生成的進行機制。本實驗以兩隻小獵犬為研究對象，實驗設計如下：（1）dog A下顎拔除第一至第四小臼齒，在第二及第三小臼齒近心齒槽窩填入葡萄糖胺及骨髓混合物為實驗組I，在第二及第三小臼齒遠心齒槽窩僅填入葡萄糖胺為實驗組II，第一小臼齒及第四小臼齒近心齒槽窩則不填入材料當成對照組，實驗期間為六個月；（2）dog A及B的上顎拔除第一至第三小臼齒，在第二小臼齒近心齒槽窩填入葡萄糖胺及骨髓混合物為實驗組I，在第二小臼齒遠心齒槽窩僅填入葡萄糖胺為實驗組II，第三小臼齒近心齒槽窩則不填入材料當成對照組，實驗期間四個月；（3）dog B的下顎實驗設計與dog A下顎相同，但實驗期間則為一個月。實驗期間每隔三星期實施骨頭標定。動物犧牲後將齒槽窩及其周圍骨頭樣本取下，以顯微鏡觀察齒槽骨癒合情形。實驗結果發現：（1）單純充填葡萄糖胺的齒槽骨修復速度比充填葡萄糖胺及骨髓混合物的齒槽骨修復速度慢；（2）有充填材料的實驗組其形成的骨小樑寬度皆比未充填材料的對照組寬；（3）齒槽骨的修復是由外圍至中心，由根尖部至牙冠部；（4）實驗組與對照組的長期觀察結果並無顯著差異，皆形成成熟之骨組織。

關鍵字

葡萄糖胺 ； 齒槽嵴保存 ； 動物實驗

並列摘要

In recent years, the number of adult patients seeking orthodontic treatment has increased significantly, therefore the orthodontists face challenges in moving the dentition with compromised periodontal support. The orthodontic tooth movement could be facilitated if the alveolar ridge is preserved after tooth extraction. The techniques of guided tissue regeneration have been extensively used in periodontal regeneration. Many biomaterials can provide necessary mechanical support and cell adhesion for bone tissue regeneration, whereas they cannot guide cellular phenotype as growth factors can. Chitosan, a natural polysaccharide biomaterial, exhibits nontoxicity, biodegradability, biocompatibility, and antibacterial properties. The aim of this animal study was to assess the effect of glucosamine, i.e. chitosan monomer, on alveolar bone healing of extraction socket. The study was conducted on the teeth (p1~p4 in mandible and p1~p3 in maxilla) of 2 Mongrel dogs in a split-mouth design. Immediately after tooth extraction, the mesial sockets of the second and third mandibular premolars and the second maxillary premolar were filled with the mixture of glucosamine powder and bone marrow aspirate from femur (experiment group I). The distal sockets of the second and third mandibular premolars and the second maxillary premolar were filled with glucosamine powder only (experiment group II). For each group, the experimental procedures were dome at different time for histomorphometric examination at 3 observation time-point of 30, 120, and 180 days. The extraction sockets at contra-lateral side without glucosamine fillings served as a control group. Moreover, the process of bone repair in extraction socket was examined by using the technique of fluorochrome sequential labeling. After the animals were sacrificed, the specimens were processed for examination by fluorescence microscopy and for paraffin sections and stained with haematoxylin-eosin. The results showed: (1) In the experimental sockets, especially filled with glucosamine and bone marrow aspirate (group I), the signs of bone formation were obvious and the number of proliferating cells were higher than that in control group. (2) The size of bone trabeculae in experimental sockets was larger compared to the control group. (3) Both the histological examinations and the observations via fluorochrome labeling revealed that the alveolar sockets heal from peripheral to the central and from apical to the coronal part of the socket. (4) All the sockets healed completely, and no significant difference was noted among the experimental and control groups after an observation period of 180 days.

並列關鍵字

glucosamine ； alveolar ridge preservation ； animal model

參考文獻

方紹威. 1990. 幾丁質及幾丁聚糖在廢水處理，生化，食品和醫藥上之研究發展現況. 藥物食品檢驗局調查研究年報 8: 20-30.

巫冠誼. 2009. 以動物實驗探討不同方向扭力對迷你骨釘卸除扭力的影響台灣大學.

林佳妏等. 2001. 幾丁聚糖於生醫材料之應用與特性. 化工 48: 84-91.

Amler MH. 1969. The time sequence of tissue regeneration in human extraction wounds. Oral Surg Oral Med Oral Pathol 27: 309-318.

Araujo MG, Lindhe J. 2005. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol 32: 212-218.