Näsström K
Department of Oral Radiology, Faculty of Odontology, Lund University, Malmö, Sweden.
Swed Dent J Suppl. 1996;115:1-45.
The overall aim of this series of studies was to determine whether the extensive narrowing of the dental pulp chamber seen in dental radiographs of patients with end stage renal disease was related to the method of treatment of the renal disease. The treatments studied were immunosuppression, renal transplantation and hemodialysis. A strong correlation was found between narrowing of the dental pulp chamber and renal transplantation. In the immunosuppression group and in the renal transplantation group, the patients received immunosuppressive drugs, mainly corticosteroids and azathioprine. Significantly higher doses of corticosteroids had been given to patients showing narrowing of the dental pulp chamber than to patients without such narrowing. The total plasma clearance of the corticosteroids received was measured among transplanted patients. The total plasma clearance was lower in patients with narrowing of the dental pulp chamber than in patients without narrowing. The morphology of the corticosteroid induced dentin in premolars from five deceased patients who had received one or more renal transplants each was compared with that in extracted teeth from five healthy individuals. The results of this study showed that dentin formation after high dose corticosteroid treatment in humans seems to start with a widening of the predentin zone, followed by extensive mineralisation causing substantial reduction of the dental pulp chamber within a few years after the start of treatment. In an experimental study on rats, it was shown that intravenous administration of high doses of corticosteroids induced dentin formation along the pulp chamber walls in the molars. Energy dispersive X-ray microanalysis was used for estimation of the calcium and phosphorus content of the dentin in rat teeth. The calcium and phosphorus composition of the corticosteroid induced dentin was found to be equal to that of normal dentin in control rat molars, which might imply that the mineralisation process was not affected by the corticosteroid treatment and thus the quality of the corticosteroid induced dentin might be equal to normal dentin regarding the calcium and phosphorus composition. In a scanning microscopy study of the morphology of the corticosteroid induced dentin in rat incisors, it was found to be equal to that of normally formed dentin.
这一系列研究的总体目标是确定在终末期肾病患者的牙科X光片中所见到的牙髓腔广泛变窄是否与肾病的治疗方法有关。所研究的治疗方法包括免疫抑制、肾移植和血液透析。研究发现牙髓腔变窄与肾移植之间存在强烈关联。在免疫抑制组和肾移植组中，患者接受免疫抑制药物治疗，主要是皮质类固醇和硫唑嘌呤。牙髓腔变窄的患者所接受的皮质类固醇剂量显著高于未出现这种变窄的患者。对接受移植的患者测定了所接受皮质类固醇的总血浆清除率。牙髓腔变窄的患者的总血浆清除率低于未变窄的患者。将五名每位都接受过一次或多次肾移植的已故患者的前磨牙中皮质类固醇诱导的牙本质形态与五名健康个体的拔牙中的形态进行了比较。这项研究的结果表明，人类在高剂量皮质类固醇治疗后牙本质形成似乎始于前期牙本质区增宽，随后是广泛矿化，导致治疗开始后几年内牙髓腔大幅缩小。在一项对大鼠的实验研究中，结果显示静脉注射高剂量皮质类固醇会诱导磨牙牙髓腔壁形成牙本质。能量色散X射线微量分析用于估算大鼠牙齿中牙本质的钙和磷含量。发现皮质类固醇诱导的牙本质的钙和磷组成与对照大鼠磨牙中的正常牙本质相同，这可能意味着矿化过程不受皮质类固醇治疗影响，因此就钙和磷组成而言，皮质类固醇诱导的牙本质质量可能与正常牙本质相同。在一项对大鼠切牙中皮质类固醇诱导的牙本质形态的扫描显微镜研究中，发现其与正常形成的牙本质形态相同。
