臺灣博碩士論文加值系統

指導教授推薦書…………………………………………………………………
口試委員會審定書………………………………………………………………
誌謝………………………………………………………………………………iii
中文摘要……………………………………………………………………… iv
英文摘要………………………………………………………………………… v
目錄…………………………………………………………………………… vi
圖目錄…………………………………………………………………………… x
表目錄…………………………………………………………………………… xii
CHAPTER I INTRODUCTION…………………………………………. 1
1.1 Background………………………………………………………….. 1
1.1.1 Alveolar bone graft…………………………………………... 1
1.1.2 Interdental distraction osteogenesis………………………….. 2
1.1.3 Orthodontic tooth movement………………………………… 3
1.1.4 Injection of osteogenetic materials…………………………... 4
1.2 Review of related studies : Platelet-rich plasma……..………… 5
1.2.1 Content of PRP…………………………………….……….... 5
1.2.2 Systematic review of PRP…………………………………... 7
1.3 Hypothesis and objective of the study………..………………………. 12
CHAPTER II MATERIAL AND METHOD…………………………… 13
2.1 Experimental animal model: beagle dogs…………..…………… 13
2.1.1 Dogs-raising……………………………………………..… 13
2.2 Surgical simulation of bilateral alveolar cleft……..………………… 14
2.3 Orthodontic tooth movement……………..………..………….… 14
2.3.1 Split mouth method………………………………...……… 15
2.3.2 Bracket and wire………………………………………………. 15
2.3.3 Force and duration…………………………………………….. 15
2.4 PRP preparation………………………..……………..…..… 16
2.4.1 Supra-periosteal injection of PRP…………………………. 16
2.5 Radiographic examinations and measurements……..…… 17
2.5.1 Cone-bean CT images………………………………………..... 17
2.5.2 Measurements of alveolar bone height…………………... 17
2.6 Histological examinations and measurements…..…........……....… 18
2.6.1 Specimen preparation………………………………………….. 18
2.6.2 Examination of histological slides………………………… 19
2.6.3 Linear measurements of new bone formation……….…….. 19
2.6.4 Area measurements of new bone formation…….……………... 20
2.7 Statistic analysis………..…………………………..…....…...……. 20
CHAPTER III RESULTS……………………………..………………. 22
3.1 Orthodontic tooth movement……………………………………… 22
3.2 Platelet and WBC counts of PRP…...…………………………...…….. 22
3.3 Radiographic measurements………………..……..……….…………... 23
3.3.1 Alveolar bone height at T1 and T2………………………...…… 23
3.3.2 Comparisons of alveolar bone heights…………..……….……. 23
3.4 Histological measurements…………………………..…………… 23
3.4.1 Results of linear measurements…………………………… 23
3.4.2 Comparison of linear new bone formation……………..... 24
3.4.3 Result of area measurements………………….……………….. 25
3.4.4 Comparison of area new bone formation……….……............... 25
3.5 New bone formation at the tension side………………………………25
CHAPTER IV DISSCUSION……………………….. ………..…………. 27
4.1 Factors affect PRP application…………………………………... 27
4.2 Timing of injection and duration of effects……………………… 28
4.3 Correlation of PRP folds and new bone formation: dose-dependent effect………………………………………………...……………… 29
4.4 PRP effect: more compensatory bone formation………………... 30
4.5 CBCT images conforming to histological results…………………… 31
4.6 The limitations in this study……………………..….……………….. 32
CHAPTER V CONCLUSIONS……..………………….……………………. 33
REFERENCES………………………………...………………………….… 34
FIGURE 1~15….…………………...…………………………………….... 43
TABLE 1~8……………………………………………………………........ 58
APPENDIX………………………………………………………………… 71


Figure List
Figure 1. Surgical simulation of the bilateral alveolar cleft was done by removal of
the maxillary 3rd
incisors and bone blocks. The wounds were closed with 4-0 vicryl
suture. …………………………………………………………………….…… 43
Figure 2. Six weeks after surgical simulation of the bilateral alveolar cleft, the wound
healed well. ………………………………………………………………….... 44
Figure 3. Orthodontic brackets and 0.016” NiTi wire for the initial alignment and
leveling. …………………………………………………………………….…. 45
Figure 4. A 0.017×0.025 low friction TMA maxillary arch wire and light-forced (120
gm) NiTi open coil springs were placed between the maxillary 1st
incisors and 2nd

incisors for moving maxillary 2nd
incisors into alveolar cleft. ………………... 46
Figure 5. After active tooth movement for 3 months, one ml of PRP or one ml of
normal saline was injection at the pressure (cleft) side of the maxillary 2nd
incisor
(T1). …………………………………………………………………………… 47
Figure 6. Six weeks after PRP or placebo was injected, dogs were sacrificed
(T2). ………………………………………………………………………….... 48
Figure 7. The image in the software Simplant. To standardize the orientation, the
maxillary 2nd
incisors were placed at the center of root canals in the transverse plane
and parallel with long axis of root canals in sagittal and coronal planes. The picture at
right bottom revealed the bony defect healed without bone filling after surgery and
similar to an alveolar cleft. (write arrow). …………………………………….. 49
Figure 8. A horizontal reference line tangent to the root apex and perpendicular to the
long axis of the maxillary 2nd
incisor was set up for the measurements. The mesial
(tension side) and distal (pressure side) bone heights of the maxillary 2nd
incisors
were the distance from the horizontal reference line to the mesial and distal alveolar
crest respectively. ………………………………………………………...…… 50
Figure 9. The pressure side of the sham control group 40×. The independent images
of the three different fluorochrome bone labels: blue, red and green colors; the right
bottom image reflected the combination image of the three different bone
labels. ………………………………………………………………….……… 51
Figure 10. The pressure side of the experimental group 40×. The independent images
of the three different fluorochrome bone labels: blue, red and green colors; the right
bottom image reflected the combination image of the three different bone
labels. ……………………………………………………………………..…… 52
Figure 11. Illustration of the histomorphometric measurements for the crestal new
bone height, the new bone thickness at the crestal, middle, and apical thirds on the
periodontal and periosteal sides. ………………………………………………. 53
Figure 12. Illustration (Left) and schematic diagram (Right) of the histomorphometric
measurements for the periodontal new bone area (1, green color) and periosteal new
bone area (2, red color). ………………………………………………………. 54
Figure 13. The comparison of the amount of orthodontic tooth movement between the
sham control group and experimental group by Mann-Whitney U tests
(p<0.05)…………………………………………………….………………….. 55
Figure 14. The comparisons of the platelet count of PRP to the baseline (blood)
platelet count (A), and the WBC count of PRP to the baseline (blood) WBC count (B)
by Mann-Whitney U tests (p<0.05). ……………………..……………………. 56
Figure 15. The new bone formation of the experimental (A) was significantly more
than those of the sham control (B). ……………...…………………………….. 57


Table List
Table 1. The summery of review articles. ………………………………… 58~63
Table 2. The amount of the orthodontic tooth movement (n=5). …….……….. 64
Table 3. The platelet counts and the WBC counts in the blood and PRP
(n=5). …………………………………………………………………………… 65
Table 4. The result of the radiographic evaluation and the comparison of the mesial
(tension side) bone height between the sham control and experiment
(n=5). ………………………………………………………………..………… 66
Table 5. The result of the radiographic evaluation and the comparison of the distal
(pressure side) bone height between the sham control and experiment
(n=5). ………………………………………………………………………….. 67
Table 6. The comparison of the new bone thickness in the sham control and the
experimental by the Mann-Whitney U tests (p<0.05). Overall: periodontal +
periosteal. ……………………………………………………………………… 68
Table 7. The comparison of new bone formation area in the sham control and the
experimental by the Mann-Whitney U tests (p<0.05).
1 mm2= 1x 106 µm2, Overall: periodontal + periosteal. …………………...…… 69
Table 8. The correlation coefficients (R) between the new bone area and PRP fold in
the experimental side (Spearman correlation analysis, p<0.05). …………….... 70

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