拔牙窝炎性肉芽组织的转归和调控  

Prognosis and regulation of inflammatory granulation tissue in tooth extraction socket

作　　者：张武阳 薛洋 胡开进 ZHANG Wuyang;XUE Yang;HU Kaijin(State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Department of Oral and Maxillofacial Surgery,School of Stomatology,The Fourth Military Medical University,Xi'an 710032,China;School of Stomatology,Xi'an Medical University,Stomatological Hospital of the Third Affiliated Hospital of Xi'an Medical University,Xi'an 710065,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,第四军医大学口腔医院颌面外科,陕西西安710032 [2]西安医学院口腔医学院,西安医学院第三附属医院口腔病院,陕西西安710065

出　　处：《口腔疾病防治》2024年第10期737-745,共9页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金(81970954);陕西省科技厅社发项目(2024SF-YBXM-434)。

摘　　要：牙周炎、根尖周炎常导致牙槽骨进行性吸收,是牙齿松动和缺失的主要原因。在局部炎性因素的长期作用下,毛细血管和成纤维细胞增生,中性粒细胞、淋巴细胞等炎细胞浸润,炎性肉芽组织替代周围骨组织,传统观念认为炎性肉芽组织属于病理性组织,应在拔除患牙的同时将其彻底刮除,以避免拔牙术后出血、感染、骨组织愈合不良等问题。虽然炎性肉芽组织的再生修复能力降低,但当机体抵抗力增强或病原刺激消除(拔除患牙、根管治疗等)后,炎性肉芽组织中纤维成分逐渐增多,浸润的炎细胞逐渐减少,最终转化为修复性肉芽组织进而成骨,且即刻种植中利用拔牙窝的炎性肉芽组织进行创口关闭或软组织重建亦获得良好的临床效果,同时组织学研究证实炎性肉芽组织含有间充质干细胞群体,因此炎性肉芽组织需要彻底刮除的传统观念需要改变。炎性肉芽组织在合适的干预措施下可进行成骨转化,调控炎性肉芽组织转化为修复性肉芽组织成骨再生成为牙槽骨炎性病损再生修复的新策略,具有广阔的临床应用前景,亦是未来重要的研究方向。针对拔牙窝炎性肉芽组织转化为修复性肉芽组织的关键调控因素如活性氧、NOD样受体热蛋白结构域相关蛋白3、组织蛋白酶K等,以及修复性肉芽组织成骨的关键调控因素如骨形态发生蛋白2、血管内皮生长因子等的分子机制研究将有助于筛选促进牙槽骨炎性病损修复的合适靶点以进行相关生物治疗技术和药物材料的研发,以期能为牙周炎等导致的牙槽骨炎性病损提供更微创、更有效的治疗方式,但目前该方面研究仍处于起步阶段,距离临床转化应用尚有距离。Periodontitis and periapical periodontitis have a high incidence rate and often result in the progressive ab-sorption of alveolar bone.This is one of the main causes of tooth loosening and loss.Prolonged local inflammation leads to the proliferation of capillaries,fibroblasts,and inflammatory cells such as neutrophils and lymphocytes.This process results in the replacement of surrounding bone tissue with inflammatory granulation tissue.Traditionally,it has been ad-vocated that inflammatory granulation tissue is pathological and should be completely removed from the extraction sock-et to avoid complications such as bleeding,infection,and poor bone healing after tooth extraction.Although the regener-ative capacity of inflammatory granulation tissue is reduced,it can be enhanced by increasing the body’s immunity or by eliminating pathogenic stimuli(such as tooth extraction and root canal treatment).As a result,the fibrous components in the inflammatory granulation tissue gradually increase,while infiltrating inflammatory cells gradually decrease.Ulti-mately,this transformation leads to the formation of reparative granulation tissue,followed by ossification.Furthermore,the use of granulation tissue from the tooth extraction socket for immediate implantation to facilitate wound closure or soft tissue reconstruction has yielded favorable clinical outcomes,and histological studies simultaneously confirmed the presence of mesenchymal stem cells within the inflammatory granulation tissue.Therefore,it is necessary to reconsider the traditional belief that inflammatory granulation tissue must be completely removed.Given the potential of inflamma-tory granulation tissue to undergo osteogenic transformation under appropriate interventions,regulating the transforma-tion of inflammatory granulation tissue into reparative granulation tissue with osteogenic potential represents a novel strategy for the regenerative treatment of dental alveolar inflammatory lesions.This approach holds broad clinical appli-cation prospects and is

关 键 词：拔牙窝 牙槽骨 愈合过程 炎性肉芽组织 间充质干细胞 转归 修复性肉芽组织 炎性病损 骨再生 

分 类 号：R78[医药卫生—口腔医学]