半程导板引导下颌“All-on-Four”种植修复一例

本文报道在半程导板引导下采用“All-on-Four”种植修复下颌牙列缺损一例,该患者下颌多颗牙缺失,伴有重度慢性牙周炎。术前对患者进行全面的口腔检查及影像学检查,确定数字化个性化种植方案,制作半程导板。术中拔除下颌余留牙,在截骨导板引导下行下前牙区截骨,增加前牙区修复空间,改善过深的spee曲线,在种植导板引导下行“All-on-Four”种植修复,即刻戴入下颌临时固定义齿。6个月后复查,见种植体骨结合良好,临时义齿功能良好,行下颌永久义齿修复。4个月后随访,见修复效果稳定。     

“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用

目的: 探讨“迷你”负压引流在前臂游离皮瓣移植供区缺损修复中的应用效果。方法: 选择口腔颌面部恶性肿瘤患者44例,均接受前臂游离皮瓣移植同期修复肿瘤切除术后缺损,采用腹部全厚皮片修复前臂供区缺损,分别应用“迷你”负压引流法（22例）和传统加压法（22例）。观察评估术后前臂区域引流量、移植皮片愈合情况和患者主观满意程度,采用SAS 9.4软件包对数据进行统计学分析。结果: “迷你”负压引流组22例患者中,20例皮片完全成活,创面平整,愈合良好,无结痂、渗出及感染;2例皮片边缘部分坏死,简单清理换药后痊愈。传统加压组22例患者中,18例皮片完全成活,4例出现部分坏死。术后随访6~10个月,“迷你”负压引流组皮片颜色接近正常皮色,手部运动、感觉功能正常,患者主观满意度显著高于传统加压组（P<0.05）。结论: “迷你”负压引流应用于前臂皮瓣制备后缺损的植皮修复,安全有效,成本低廉,患者满意舒适度高,值得临床推广应用。     

微种植钉辅助无托槽隐形矫治器控制“过山车”效应的疗效分析

目的： 探讨微种植钉辅助无托槽隐形矫治器长距离内收上前牙、关闭间隙过程中控制“过山车”效应的临床疗效。方法： 选择双颌前突成人患者16例,男5例,女11例,平均年龄（25.1±2）岁。所有患者均拔除4颗第一前磨牙且采用无托槽隐形矫治器矫治,所有病例均采用G6设计,其中实验组（8例）在治疗初始即采用微种植钉进行牙的三维控制,对照组（8例）采用常规G6方案,出现明显的“过山车”效应时植入微种植钉辅助解决。采用 Graphpad Prism 6.0 软件包对治疗前、后数据及组间数据进行配对 t 检验。结果： 所有拔牙间隙均顺利关闭,面型获得明显改善。治疗中,实验组前牙转矩控制良好,未出现“过山车”效应;对照组6例在治疗中前牙明显舌倾（P<0.05）,后牙开,前牙区微种植钉施加压低力后,咬合关系改善。结论： 微种植钉能有效预防、消除无托槽隐形矫治器长距离关闭间隙过程中发生的“过山车”效应。     

“青马工程”实施背景下高校学生骨干培育径探析

高校学生骨干是大学生中的典型代表,也是“青年马克思主义者培养工程”的主要培育对象。为了更好地推进“青马工程”,发挥其对高校学生骨干培育的重要作用,本文主要采取文献研究和调查研究的方法,对“青马工程”实施背景下高校学生骨干培养的重要意义、现状进行剖析,进而从模式、方法和保障等方面探讨培养路径,以期提升高校学生骨干培养的科学性、系统性和有效性。     

自制“V”形支架在眶内侧壁骨折复位术中的应用

目的 探讨鼻内镜下自制“V”形支架在眶内侧壁骨折复位术中的应用效果。方法 回顾性分析15例眶壁骨折患者,均在鼻内镜辅助下经鼻窦入路整复,并以“V”形支架进行支撑,观察临床疗效。结果 15例手术患者均成功整复到位,术后随访3~12个月,全部患者无并发症发生,临床疗效满意。结论 在眶壁骨折复位治疗中,应用自制“V”形支架,可以取得满意疗效。     

老年口腔门诊“一站式”服务的实践与效果评价

目的: 评价老年口腔门诊“一站式”服务的实施效果。方法: 于科室“一站式”服务实施的前后,分别选取60例老年患者作为研究对象,采用SPSS19.0软件包比较2组患者的平均就诊时间和缴费时间,并比较患者对就诊服务的满意度。结果: 采用一站式服务后,患者平均就诊时间和缴费时间大幅度缩短,前后对比差异具有显著性（P<0.01）。满意度由一站式服务前的90%上升为98%,满意度明显提高。结论: “一站式”服务能优化口腔疾病的治疗流程,提升老年患者就诊体验,满足老年口腔疾病患者的需求。     

种植盾构术的研究进展

上前牙美学区在拔牙或即刻种植后,唇侧骨板因拔牙创伤或者血运降低,常发生唇侧牙槽骨的吸收塌陷,从而极大的影响前牙区的美学效果,甚至造成种植体的失败。为了避免唇侧软硬组织的吸收,获得更好的美学效果,近年来有学者提出了"盾构术"的概念,即在即刻种植手术中通过保留唇侧健康牙根片来保留牙周膜,从而避免唇侧骨板因为血运的减少而发生吸收。本文回顾了盾构术的相关文章,能帮助口腔临床医生更加全面的理解该技术。     

基于解剖学的“五点八线”皮瓣设计用于半舌缺损精确修复的效果评价

目的: 使用“五点八线”技术（five-point eight-line segment, FIPELS）设计半舌缺损修复皮瓣,并比较“五点八线”技术与传统皮瓣移植方法的临床疗效。方法: 80例半舌缺损修复重建患者随机分为2组,分别为FIPELS组（42例）和传统皮瓣移植组（38例）,使用Likert量表比较2组患者的术后功能恢复及美观效果。采用SPSS 18.0软件包进行统计学分析。结果: FIPELS组的皮瓣与半舌缺损匹配度更高,术中无需修整皮瓣,手术时间较传统皮瓣移植组更短（P=0.02）。FIPELS组的术后吞咽功能、语言清晰度和美观度优于传统皮瓣移植组（P<0.05）。结论: 相比传统皮瓣移植方法,FIPELS设计的皮瓣用于半舌缺损修复具有更好的功能和美观效果。     

“新净界漱口水”对放射性口腔黏膜炎的防治效果观察

目的： 前瞻性随机双盲研究“新净界漱口水”对放射性口腔黏膜炎的防治效果。方法：60例拟行放疗的口腔癌患者随机分为试验组和对照组;试验组30例,自放疗第1天起,每天使用“新净界漱口水”含漱4次,每次5 mL,含漱 5 min,直至放疗结束。对照组30例使用生理盐水含漱,方法同试验组。按RTOG口腔黏膜炎分级标准评价2组患者的口腔黏膜炎严重程度,记录疼痛程度,并照相存档。3级口腔黏膜炎视为终止指标,发生者给予其他药物治疗。应用Stata 12.0软件包对数据进行统计分析。结果：2组患者的年龄、性别、放疗技术和剂量无显著差异（P>0.05）。试验组首次观察到黏膜炎的发生时间较对照组晚（照射11.0次∶9.1次,P<0.05）,且试验组在早期出现疼痛的比例较对照组低（36.7%∶70.0%,P<0.05）。另外,试验组3级口腔黏膜炎的出现时间较对照组晚（照射18.9次∶15.9次,P<0.05）,发生率较对照组低（63.3%∶90.0%,P<0.05）。结论：“新净界漱口水”能延缓放疗所致口腔黏膜炎的发生时间,减轻患者的疼痛症状,并能减少3级口腔黏膜炎的发生率,值得临床使用。     

上颌前牙区根盾术即刻种植与常规即刻种植的临床效果评价

目的 比较上颌前牙美学区根盾术即刻种植与常规即刻种植唇侧骨量的厚度变化及临床效果,探讨根盾术的临床操作要点。方法 收集2017年9月—2019年3月行上颌前牙美学区即刻种植患者48例,随访18~36个月,其中26例为常规即刻种植组（RI组）,22例为保留唇侧牙根片的根盾术即刻种植组（SS组）,比较2组患者种植体成功率,距种植体肩台0 mm（I0）、3 mm（I3）、6 mm（I6）的唇侧骨量厚度变化,术后18个月时粉色美学指数（PES）、改良龈沟出血指数（mSBI）以及临床满意度。采用SPSS 25.0软件包对数据进行统计学分析。结果 2组种植体成功率均为100%。术后6个月及18个月,SS组唇侧骨量厚度变化量低于RI组,在I0、I3处有统计学差异（P小小小0.05）; SS组PES评分高于RI组,但无统计学差异;改良龈沟出血指数无统计学差异,2组均获得较高的患者满意度。结论 相对于常规即刻种植,根盾术即刻种植在短时间内可以较好地维持种植体颈部唇侧骨量及软组织轮廓,对成功率无明显影响,建议将牙根片制备至平齐骨面,厚度约1 mm,种植体唇侧保留约1~2 mm“跳跃间隙”,植入低替代率骨移植材料,但临床操作要求较高。     

种植盾构术修复前牙外伤1例

在上颌前牙区唇侧骨板血供主要来自牙周膜及牙龈。当该位置牙缺失后,因为牙周膜来源的血供丧失,唇侧骨板常发生不同程度的吸收,从而造成唇侧软硬组织的塌陷,为最终的美学修复带来极大挑战。为了避免牙缺失后唇侧软硬组织的缺损,口腔医生以及研究人员提出了多种解决方案。其中,Hürzeler团队在2010年提出的"盾构术"(socket shield technique)的方式取得了较好的临床效果。本文报告笔者应用该技术对1例前牙外伤患者进行治疗,成功保留了患者软硬组织三维轮廓的完整性,实现了较好的美学效果。     

“盾构术”的临床应用及潜在风险

上前牙拔除后唇侧牙槽骨迅速发生吸收,不仅降低上前牙区种植修复的美学效果,骨量不足也会影响种植体的长期成功率。近年来国内外报道“盾构术”在上前牙区应用实现了牙槽嵴轮廓的保持,成为一个新的美学区种植的治疗方案。但也有部分文献指出“盾构术”或其相关改良术式出现一些近远期并发症:如局部炎症、牙槽骨吸收、骨结合失败等。本文对“盾构术”相关文献进行综述,研究表明“盾构术”虽然在不少个案中获得良好的临床效果及短期成功率,但由于该技术缺乏长期及大量临床文献支持,在实际操作过程中存在许多不统一的意见,如牙片的厚度、牙片在牙槽骨内深度、牙片与植体间是否需要植骨等,操作具有技术敏感性,因此在临床应用中应谨慎采用该项技术,减少无法预料的风险。     

牙片屏障即刻种植术与常规即刻种植临床效果比较的Meta分析

目的:系统评价牙片屏障即刻种植术(socket shield technique,SST)与常规即刻种植在美学及骨组织保存方面的临床效果。方法:检索Pubmed、Embase、Cochrane library、知网、万方、CBM数据库及中国、美国临床试验注册中心2020-09-20日前发表的比较牙片屏障即刻种植术与常规即刻种植效果的随机对照临床试验(randomized controlled trials,RCT)和临床对照试验(controlled clinical trials,CCT)。纳入研究的结局指标包括红色美学指数评分(Pink Esthetic Score,PES)、唇侧骨厚度、唇侧骨高度变化,应用Review Manager5.4版软件进行meta分析。结果:共检索到文献823篇,经筛选后最终纳入6篇研究定量分析,其中5篇RCT, 1篇CCT。Meta分析结果显示,与常规即刻种植组相比,牙片屏障即刻种植术组的PES在术后12个月时(WMD=1.37, 95%CI=0.96~1.78, P<0.00001)明显高于对照组,而且在术后6-12个月时,唇侧牙槽骨的厚度(WMD=-0.13, 95%CI=-0.15~-0.11, P<0.00001)和高度(WMD=-0.49, 95%CI=-0.62~-0.36, P<0.00001)变化也明显少于对照组。结论:短期观察的结果显示,与常规即刻种植比较,牙片屏障即刻种植术术后前牙区美学效果更好,唇侧骨厚度和高度的吸收更少。     

Using the support immersion endoscope for socket assessment

BACKGROUND: The purpose of this study was to determine the indications, efficacy, and advantages of the support immersion endoscope (SIE) method for extraction socket assessment. METHODS: Twelve patients (four women and eight men; mean age: 28 years) in need of extraction with implant placement participated in the study. The teeth extracted included eight upper central incisors and six upper lateral incisors. Extraction sockets were evaluated with a conventional extraction site evaluation (CESE) method alone or with CESE + SIE. CESE includes: visual evaluation; periodontal probing; ridge mapping with calipers, dental mirror, and orthopantomogram; and diagnostic wax-up. RESULTS: CESE + SIE had significantly better accuracy in examining extraction socket labial plate vertical position, labial plate thickness, and bone quality compared to CESE alone. The results obtained from CESE assessment were inconsistent because of poor visualization. CONCLUSION: The SIE can be used as an adjunct tool in assessing extraction socket morphology and bone conditions without flap elevation.     

Alveolar bone remodelling pattern of the rat incisor under different functional conditions as shown by minocycline administration

Remodelling of the socket surrounding the continuously growing and erupting rat incisor was examined in teeth under normo, hyper and hypofunctional conditions. Cross-sections of the mandible were observed under fluorescence microscopy, where minocycline labelling evidenced bone remodelling. Animals had received minocycline (10 mg/day) during the experimental period. Control animals (from all three groups) received vehicle alone and samples from these animals were not fluorescent. Minocycline did not interfere with the eruption rates in any of the functional conditions studied. Normofunctional (impeded) incisors showed constant osteogenic activity in the alveolar bone facing the periodontal ligament in all regions of the incisor. Under hypofunctional (unimpeded) and hyperfunctional (impeded) conditions, osteogenesis in the region close to the alveolar crest was markedly increased in the mesial wall of the socket. The labial alveolar bone, facing the enamel-related periodontium, was almost entirely formed during the experimental period in all the groups, but in hyper and hypofunctional teeth the newly formed bone was thicker and contained a substantial amount formed before the experimental period. In the more apical regions of the socket no marked differences between the three functional conditions were found. The similar bone remodelling shown in hypo and hyperfunctional teeth might indicate that there are common factors causing this pattern. Consideration of possible factors appear to rule out the eruption rate, which is very different under these two functional conditions.     

微手术辅助正畸治疗牙槽骨开裂的效果评价

目的:定量评估微手术辅助正畸治疗对下前牙区牙槽骨开裂的效果。方法:从佛山市口腔医院正畸科2014年8月~2015年8月就诊的成人病例中,选取下前牙区有牙槽骨开裂的错牙合畸形患者8例作为研究对象。在充分告知的前提下,选取患者下前牙区进行微手术正畸治疗,通过锥形束计算机体层摄影术(CBCT)评价不同治疗阶段中下前牙区牙周状况。采用SPSS 21.0软件包对数据进行统计学处理。结果:手术前及术后半年下前牙舌侧牙槽骨厚度高度无显著差异。术后半年下前牙区唇侧牙槽骨厚度显著增加(P<0.05),下前牙区唇侧牙槽骨高度在术后半年显著增加(P<0.05)。结论:微手术正畸治疗下前牙区牙槽骨开裂疗效显著,下前牙区唇侧牙槽骨厚度高度在术后半年显著增加,牙周组织健康。     

Interrelation between alveolar bone and periodontal ligament repair after replantation of mature permanent incisors in monkeys

Interrelation between alveolar bone and periodontal ligament repair was studied in green Vervet monkeys. Maxillary central incisors were extracted. The storage medium for the extracted teeth was saline in an 18 min. extra-alveolar group and dry storage in a 120 min. extra-alveolar group. In the experimental groups, the labial bone plate was removed surgically and the teeth replanted. In the control groups, teeth with similar extra-alveolar periods were replanted into sockets with intact labial bone, The animals were sacrificed 8 weeks after replantation and the replanted teeth examined histometrically. Root resorplion and the position of the labial bone in relation to the cemento-enamel junction were registered for each tooth. A significant relationship was found between the extent of labial bone repair and the extra-alveolar period. Thus, teeth with I8 min. extra-alveolar period showed almost complete repair of the labial bone plate, whereas teeth with an extra-alveolar period of 120 min. showed a mean position of labial bone 3.7 mm from the pocket epithelium. The extent of root resorption was influenced by the extra-alveolar period alone and not by the presence or absence of alveolar bone. It is concluded that a vital periodontal ligament upon replanted mature teeth is able to induce the formation of new alveolar bone.     

The socket-shield technique at molar sites: A proof-of-principle technique report

The socket-shield technique for avoiding postextraction tissue alteration was first described in 2010. The technique was developed for hopeless teeth in anterior esthetic sites but has not yet been described for molar sites. Managing postextractive ridge changes in the posterior region by prevention or regeneration remains a challenge. The socket shield aims to offset these ridge changes wherever possible, preserving the patient’s residual tissues at immediate implants. This technique report describes the molar socket-shield step by step.     

Corticotomy facilitated orthodontics: Review of a technique

Corticotomy found to be effective in accelerating orthodontic treatment. The most important factors in the success of this technique is proper case selection and careful surgical and orthodontic treatment.Corticotomy facilitated orthodontics advocated for comprehensive fixed orthodontic appliances in conjunction with full thickness flaps and labial and lingual corticotomies around teeth to be moved. Bone graft should be applied directly over the bone cuts and the flap sutured in place. Tooth movement should be initiated two weeks after the surgery, and every two weeks thereafter by activation of the orthodontic appliance.Orthodontic treatment time with this technique will be reduced to one-third the time of conventional orthodontics. Alveolar augmentation of labial and lingual cortical plates were used in an effort to enhance and strengthen the periodontium, reasoning that the addition of bone to alveolar housing of the teeth, using modern bone grafting techniques, ensures root coverage as the dental arch expanded.Corticotomy facilitated orthodontics is promising procedure but only few cases were reported in the literature. Controlled clinical and histological studies are needed to understand the biology of tooth movement with this procedure, the effect on teeth and bone, post-retention stability, measuring the volume of mature bone formation, and determining the status of the periodontium and roots after treatment.