牙科麻醉水膠敷料於拔牙傷口之活體評估

In Vivo Evaluation of Dental Anesthetic Hydrogel Dressing in Post-Extraction Wound Management

羅怡君(Yi-June Lo)

指導教授 ： 楊正昌 ； 李勝揚

臺北醫學大學/口腔學院/口腔科學研究所/碩士(2005年)

摘要

本計畫所採用之新型牙科麻醉水膠(dental anesthetic hydrogel, DAH)敷料，係利用其吸水後膨脹而對拔牙傷口提供立即性之加壓止血功能，並緩慢釋出lidocaine麻醉劑，以舒緩病患在拔牙後3-5小時之局部麻藥消退後的疼痛高峰，研究之目的是應用米格魯犬之動物試驗模式，探討DAH之lidocaine藥物釋出動力學，及以活體評估拔敷料之止血時間、臨床及組織學上傷口癒合效果。 在lidocaine藥物釋出方面，於拔牙後分別於不同的傷口置放水膠敷料，並於30、60、90、120、150分鐘時取出水膠分析其殘餘的lidocaine重量以計算釋放出lidocaine之百分比。在拔牙傷口止血方面，四隻米格魯犬，其上或下顎每顎各拔三顆門齒，隨機分成三組：不放任何敷料之控制組、放商品止血敷料Spongostan?之對照組 、及放DAH敷料之試驗組，在不同時間點觀察拔牙傷口之止血效果。至於在拔牙傷口癒合的觀察方面，上述四隻米格魯犬之後分別於時間點1週、2週、4週及12週作傷口癒合之臨床及組織學的觀察。 結果顯示lidocaine在2~3小時時約釋放出40~50%。至於止血方面：hydrogel大多在1分鐘內可達到止血的效果，略優於不放敷料的控制組，但hydrogel置入的體積大小明顯會影響止血的效果。至於傷口癒合方面：在傷口癒合初期，DAH膨脹率太大會造成齒槽脊的萎縮，而在組織學觀察中DAH對組織沒有明顯不良反應發生，DAH在組織內的生物相容性佳，DAH在2週內就完全降解，DAH傷口癒合在4週時略有延遲的情形，但是在12週時和控制組則沒有差別。

關鍵字

水膠 ； 敷料 ； 拔牙齒槽 ； 組織學 ； 傷口癒合

並列摘要

A novel Dental Anesthetic Hydrogel (DAH) dressing for wound care and pain management after tooth extraction was developed. The water absorbing then swelling behavior of DAH offers mechanical force to compress extraction sockets for hemostasis. In addition, the lidocaine anesthetic agent was diffused out up to 3-5 hours for relieving the post-extraction pain peak after subsiding of local anesthesia. The purpose of the study was to evaluate DAH’s lidocaine releasing pharmacokinetics, hemostatic effect, clinical and histological wound healing in post-extraction sockets using a beagle model. For investigating the lidocaine releasing profile, DAHs were placed in extraction sockets and removed in different time intervals of 30, 60, 90, 120, and 180 minutes. The residual lidocaine in DAH was analyzed and calculated for the lidocaine release percentage. For evaluation of DAH hemostatic effect, four beagles with three incisors in each arch were selected for extraction. Post-extraction sockets were randomized for each treatment modality：no dressing control group, Spongostan? dressing control group, and DAH dressing experimental group. The bleeding status was recorded at every minute until achieving hemostasis. All animals were sacrificed later at the designed time period of 1, 2, 4, and 12 weeks for further clinical and histological evaluations. The results showed that lidocaine in DAH can release up to 40~50% at 2~3 hours. DAH dressing sockets could achieve hemostasis within 1 minute and was statistically significantly superior to the sockets without dressing. The hemostatic effect was affected by the volume of the hydrogel. Although extensive swelling ratio of DAH might cause the alveolar ridge resorption at early stage of extraction sockets, the biocompatibility of residual DAH was quite good without any adverse reaction in histological tissue sections. The DAH was degraded within 2 weeks. The wound healing of DAH dressing sockets was slightly delayed in 4 weeks but little differences were observed in 12 weeks compared to control groups.

並列關鍵字

hydrogel ； dressing ； extraction socket ； histology ； wound healing

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