临时固定桥早期应用的临床研究

目的 研究拔牙后早期应用临时固定桥进行即刻修复的临床效果。方法 选择12例患者，上切牙拔除3～5天后即牙体预备（龈上边缘）、临时固定桥修复，拔牙术后2～3个月重新牙体预备（龈下边缘）、永久修复，并且重新制作临时固定桥。所有基牙均为上颌切牙，对戴用两次临时固定桥前后基牙的牙周状况进行检查。结果 早期应用采用龈上边缘的临时固定桥对基牙的牙周状况没有明显影响；常规应用的采用龈下边缘的临时固定桥对基牙的牙周状况有一定不利影响，表现为龈沟出血指数明显增加。结论 拔牙后早期应用临时固定桥（采用龈上边缘设计）进行即刻修复不会对基牙牙周组织产生不利影响，在临床是可行的。     

早期应用卵圆形桥体成形缺牙区软组织形态的临床研究

目的评价拔牙后早期应用卵圆形桥体成形缺牙区软组织形态的临床效果。方法选择上颌前牙区拟拔除患牙后行固定局部义齿修复的患者16例,于拔牙后1～2周行基牙牙体预备并制作树脂临时固定桥,桥体设计为卵圆形,拔牙后3～4个月制作永久修复体。修复完成后第3、6、12和24个月复诊。记录桥体处牙龈乳头指数、龈缘水平、角化龈宽度、改良菌斑指数及改良出血指数。结果本研究随访期内所有义齿行使功能良好。拔牙前及修复后24个月时近中牙龈乳头指数分别为2．19和2．38．远中牙龈乳头指数为2．13和2．31．改良菌斑指数为1．81和0．63,改良出血指数为1．13和0．25,龈缘水平位为10．59mm和10．88mm,角化龈宽度为3．66mm和3．53mm。牙龈乳头指数、龈缘水平和角化龈宽度的差异均无统计学意义（P〉0．05）;而改良菌斑指数和改良出血指数均降低,差异有统计学意义（P〈0．01）。结论拔牙后早期应用卵圆形桥体成形缺牙区软组织形态町获得良好的临床效果。     

脱细胞真皮基质用于前牙即刻种植扩增角化龈的临床研究

目的研究脱细胞真皮基质用于前牙即刻种植扩增角化龈的临床效果。方法唇侧骨板垂直缺损不超过牙根长度1/3的单颗前牙即刻种植病例20例,拔除患牙即刻种植,利用异种脱细胞真皮基质双层封闭植牙创口,并与周围黏膜加压严密缝合,2～3周拆线,8～12周行冠修复。冠修复后3、6个月,从龈缘高点到膜龈联合线测量种植牙角化龈的宽度,和邻牙及术前角化龈的宽度进行比较,并对种植牙的龈乳头进行美学评价。结果 20颗种植牙的角化龈宽度与种植前相比无明显差异,与相邻牙也无明显差异,膜龈联合线自然;17例种植牙的龈乳头达到Jemt氏分类的2级、3级。种植前,20颗种植牙的角化龈宽度为（4.460±0.220）mm,冠修复后3个月为（4.451±0.245）mm,正常邻牙是（4.410±0.189）mm。冠修复后3个月,种植位点角化龈平均宽度与正常邻牙比较（t=1.283,P=0.215）、与术前比较（t=0.584,P=0.566）,差异均无统计学意义。冠修复后6个月,种植位点角化龈宽度为（4.448±0.223）mm,正常邻牙为（4.404±0.197）mm,种植位点角化龈宽度与正常邻牙比较（t=1.620,P=0.122）、与术前比较（t=1.144,P=0.267）,差异均无统计学意义。结论脱细胞真皮基质可用于前牙即刻种植的创口封闭,能作为屏障膜有效引导骨组织再生,并能很好地保持种植位点的角化龈宽度,龈乳头的美学效果好。     

下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的临床观察

目的　探讨下颌后牙区“香肠技术”植骨后颊侧角化龈宽度的变化及其与植骨量的相关性,并评价颊侧角化龈宽度不足患者进行游离龈移植术后的临床效果。方法    选择2019年4月至2020年9月在大连市口腔医院种植科因牙列缺损行下颌后牙区“香肠技术”植骨后种植修复患者24例。测量所有患者植骨前后的颊侧角化龈宽度以及植骨后当天植骨量,对植骨前后的角化龈宽度进行比较,并分析植骨后角化龈宽度变化与植骨量的相关性。对植骨后6个月颊侧角化龈宽度不足2 mm的患者进行腭部游离龈移植术,移植术后3个月复查,对获得的种植体颊侧角化龈宽度、龈瓣收缩率进行观察和评价。结果     24例患者平均植骨量为（629.30 ± 226.42）mm3,植骨后角化龈宽度平均减少量为（1.15 ± 0.82）mm,植骨量与角化龈宽度减少量呈正相关。12例进行游离龈移植术患者的术后角化龈宽度增加,移植术后3个月龈瓣收缩率为（22.89 ± 2.85）%。结论    “香肠技术”植骨术后角化龈宽度有所减小,与植骨量呈正相关;游离龈移植后龈瓣收缩较少,可显著增加种植体周围角化龈宽度。     

根向复位瓣技术重建种植牙颊侧角化龈的临床探讨

目的 探讨在口腔种植修复中应用根向复位瓣技术重建颊侧角化龈的方法,评价其应用效果.方法 选择上颌后牙区单颗牙种植术后颊侧角化龈缺失或过窄的患者13例,在种植Ⅱ期手术时同期行根向复位瓣术进行角化龈重建,术后1个月取模行冠修复.测量并比较术前、冠修复后1个月、6个月、12个月术区转移角化组织的宽度及厚度,记录牙龈指数(gingival index,GI)和龈沟探诊出血(bleeding on probing,BOP)情况.结果 冠修复后1、6、12个月,转移组织角化特征明显,组织健康,质地色泽与邻牙一致.3次测量宽度均值分别(3.25±0.40)mm、(3.04±0.34)mm、(2.97±0.32)mm;厚度均值分别为(2.05±0.20)mm、(1.91±0.23)mm、(1.84±0.25)mm;与邻牙角化龈的宽度(3.19±0.42)mm和厚度(1.96±0.23)mm的差异无统计学意义(P>0.05).GI和BOP阳性率与邻牙接近,呈健康牙龈形态.结论 在种植Ⅱ期手术时同期采用根向复位瓣技术能有效重建种植体周围的附着龈,效果可靠.     

固定桥不同桥体龈端形态修复下颌第一磨牙的三维有限元分析

目的　应用三维有限元分析法探讨不同桥体龈端形态对固定桥基牙及牙周膜应力分布的影响。方法　利用健康成人牙列的锥形束CT（CBCT）原始数据，通过三维建模软件建立下颌第一磨牙缺失，第二前磨牙与第二磨牙为基牙的双端固定桥，并模拟三种不同桥体龈端形态，即改良鞍式、改良盖嵴式、船底式。利用Ansys 17.0对已建立的三种不同龈端形态的固定桥有限元模型加载垂直向载荷，分析固定桥基牙牙本质、牙周膜的应力分布情况。结果　①三种龈端形态的固定桥在相同载荷条件下第二前磨牙牙周膜应力均较第二磨牙应力值大；②桥体龈端形态均不会影响单个基牙应力分布的规律；但与其他两种形态的修复体相比，船底式龈端形态的单根基牙综合应力值更小，且双根牙综合应力值更大；③固定桥受垂直载荷时三组桥体基牙牙周膜综合应力分布大小依次为：改良鞍式＜改良盖嵴式＜船底式，但三者应力均未超出基牙牙周储备力，只是随着桥体龈端面积减小，基牙动用的牙周储备力增加。结论　①磨牙是比较理想的基牙，在修复时，应首先考虑的是前磨牙的牙周支持力是否充足；②船底式固定桥修复后更有利于保护单根基牙，改善固定桥应力分布；③三种龈端修复形态下基牙牙周支持组织都能承担日常咬合力，对基牙牙周膜健康无影响。     

改良3/4冠应用于基牙倾斜的固定桥修复

目的 研究改良3/4冠应用于基牙倾斜的固定桥修复的效果.方法 对18例需将倾斜磨牙用作基牙的牙缺失患者,采用改良3/4冠修复,观察修复效果.结果 18例固定桥修复后固位、舒适性及咬合关系良好,半年～1年后复查,无1例患者出现基牙松动、固定桥松动、牙龈炎症等情况.结论 改良3/4冠用于基牙倾斜的固定桥修复效果肯定.     

固定桥基牙预备的平行尺

固定桥修复在基牙制备时,不仅要求各个基牙的各个轴壁在(牙合)、切龈方向彼此平行而且还要求所有基牙的轴壁相互平行,以取得固定桥各固位体的共同就位道。采用目侧     

后牙固定义齿修复后基牙继发牙髓炎的临床观察

后牙作为基牙进行固定义齿修复时,由于牙体组织的磨损等因素,导致固定桥修复一段时间后,有些基牙产生牙髓炎症状。本文就近几年收集的后牙固定桥修复后基牙出现牙髓炎的病例进行病因分析及再处理的临床疗效观察。 材料和方法 1.一般情况 1997～2000年,笔者共修复后牙固定桥159例患者228件固定桥修复体527颗基牙,其中出现牙髓炎症状的基牙31颗。诊断标准为:就诊时,患者自述有自发性疼痛,冷热测痛,基牙周围肿胀。X线示:患牙根尖周围有或无明显的骨质破坏。患牙牙位分布见表1。     

下颌侧切牙缺失固定桥设计基牙受力情况的实验研究

目的比较双端及单端固定桥修复下颌侧切牙缺失时基牙的受力情况。方法应用ANSYS软件,通过三维有限元法建立4种固定桥模型,分别以中切牙和尖牙、中切牙、尖牙、尖牙和第一前磨牙为基牙模拟下颌侧切牙缺失,分析基牙最大受力部位和大小。结果单端固定桥修复模型中,以中切牙作为单一基牙时,基牙根尖受力值最大;双基牙单端桥基牙根尖受力最小;双端固定桥两基牙根尖受力分布最均匀。结论下颌侧切牙缺失患者以双端固定桥修复时,基牙受力最合理;单基牙单端桥设计,中切牙受力大于尖牙,而双基牙的单端桥修复形式较单基牙理想。     

Inflammation associated with implants with different surface types

OBJECTIVES: The aim of this study was to determine the nature of the inflammatory infiltrate associated with different transmucosal implant surfaces in dogs. METHODS: Three experimental and one control single-stage implants were randomly placed on each side of the jaw in eight dogs. The transmucosal portion of the test implants consisted of an acid-etched surface (type A), a machined surface with a circumferential groove (type C) and a surface prepared by mild anodic oxidation (type D). The control was a standard machined surface (type B). In order to determine the response to the different surfaces, plaque control was carried out twice weekly following placement of the implants for the entire period of the experiment. At 6 months, gingival biopsies and plaque samples were obtained. The area of inflammatory infiltrate and the nature of the infiltrating cell types were determined using immunohistology. Real-time polymerase chain reaction was used to identify putative periodontal pathogens. RESULTS: Inflammatory infiltrates were associated with all implant surfaces and were commonly found subepithelially and perivascularly. T cells were the predominant infiltrating cell type in all lesions, associated with the different surfaces. In all lesions the CD4 : CD8 ratio was approximately 2 : 1. Statistical analysis showed that the type C surface (machined surface with a groove) had significantly larger inflammatory infiltrates than the type B surface (machined surface without a groove; P<0.05). No statistically significant differences were found with respect to the size of the inflammatory infiltrates or in terms of the nature of infiltrating cells. However, despite the intensive plaque control regime, plaque was present on all implant surfaces at the time of biopsy 6 months after placement. All implants had similar numbers of Tannerella forsythia, Fusobacterium nucleatum and Porphyromonas gingivalis. Actinobacillus actinomycetemcomitans, was not detected in any sample. CONCLUSIONS: These results suggest that the development of inflammation associated with implants is independent of surface type, but is nevertheless associated with the presence of plaque. The different surfaces had no influence on the nature of the infiltrate, with T cells being the predominant cell type in all lesions. Finally, the different implant surface types seemed not to influence the peri-implant microbiota. However, the presence of the circumferential groove tended to be associated with larger infiltrates. Whether this is due to increased plaque accumulation remains to be determined.     

Clinical experiences with patients with facial bone deformities associated with hemifacial microsomia.

Eighteen adult patients with hemifacial microsomia were treated with a combination of skeletal and augmentation surgery. Three typical cases are presented. In principle, skeletal and augmentation surgery have recently been performed in combination in a single stage. Groin flaps and scapular or scapular ostocutaneous flaps have mainly been employed for augmentation surgery.     

Recurrent intraoral pyogenic granuloma with satellitosis treated with corticosteroids

The development of recurrent pyogenic granulomas as multiple satellite lesions has not been reported in the oral cavity. This report describes an unusual case of intraoral pyogenic granuloma recurring multiple times after surgical excisions with the formation of satellite lesions. Due to failure of surgical management, an alternative approach was taken. We illustrate how the lesions were successfully treated with a series of intralesional corticosteroid injections.     

Oral tuberculosis associated with a treatment with anti-rheumatic drugs

BACKGROUND: The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications. METHOD: We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared. RESULTS: The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis. CONCLUSIONS: The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.     

Vasovagal syncope with asystole associated with intravenous access

Two cases of vasovagal syncope (VVS) during venous access are reported. Both patients had a history of fainting episodes and experienced bradycardia with asystole, hypotension, and fainting. Pain and phobic stress during venous access triggered an increase in parasympathetic tone, resulting in bradycardia with asystole and hypotension in both cases. Hypotension and bradycardia likely caused cerebral hypoperfusion, leading to fainting. The intense parasympathetic tone triggered by somatic or emotional stress was likely responsible for directly depressing the sinus node, leading to asystole and bradycardia. Bradycardia with asystole progressing to syncope is a potentially fatal dysrhythmia in patients with cardiovascular disease or older patients with decreased cardiac function. Appropriate treatment for VVS includes the administration of intravenous fluids, vagolytics, ephedrine, and the rapid use of the Trendelenburg position. Intravenous fluids and atropine were used to treat the present patients.