藓患者前牙区运用牙冠延长术及冠修复恢复功能和改善美观（附1例报告）

前牙区的美学修复及相关治疗在日常诊疗过程中一直备受关注,而罹患口腔黏膜病患者的不良软组织状态无疑会增加口腔治疗的难度,常需要多学科共同治疗。文章通过1例运用牙冠延长术结合全冠修复以恢复上前牙区功能并改善美观的病例,对口腔扁平苔藓患者牙冠延长术及修复时机的选择进行探讨,并为多学科综合治疗上前牙美学区问题提供经验。     

上颌前牙区即刻种植临床研究现状

上颌前牙区是十分重要的美观区,在人们社交生活中起着十分重要的作用,长时间的缺牙,可降低患者的心理舒适感和生存质量。即刻种植可最大限度地缩短患者的无牙时间,恢复患者的生理需求和提高患者的自信心。因此,口腔即刻种植技术成为近年来上颌前牙区缺牙后修复的重要研究和发展方向。     

执业医师维权与自律ⅩⅥ.医疗纠纷诉讼中的举证责任(十)

本讲介绍一起与口腔颌面外科专业和种植专业相关的诉讼案例. 案例报告 患者,女性,28岁.因上前牙缺失到某医院口腔种植科就诊.自诉6年前上前牙因畸形拔除,现要求种植修复.检查2/123缺失,前牙反(牙合)3/4/3/4对刃(牙合);面中1/3塌陷;张口度、开口型正常,后牙咬合关系良好;缺牙区牙槽骨宽度约7 mm,黏膜组织未见异常.X线片示上前牙牙槽骨较下前牙明显后缩,缺失区牙槽骨严重吸收.     

口腔种植外科推动口腔种植技术的二次发展

口腔种植经过近3 0年的发展,已发展成为一项独立、成熟的新技术。区别于传统口腔修复学方法,口腔种植技术是利用植于缺牙区牙槽骨内、并实现骨结合的牙种植体(又称人工牙根)为基础,最终完成缺牙修复。与传统可摘义齿和固定义齿修复方法相比,口腔种植技术具有突出的优点,具体表现在:①无需磨切周围天然牙齿,邻牙远期无继发龋风险;②具有独立的人工牙根,义齿受力合理,不增加基牙负担;③对邻牙无损伤;④能够长期维持牙槽突的丰满度,防止因缺牙引起的牙槽突废用性萎缩;⑤远期成功率高;⑥功能与美学良好,等等。因此,种植义齿被誉为“人类的第三副…     

前牙区骨缺损伴缺牙患者植骨同期行牙种植即刻负重的临床应用

目的:探讨前牙区骨缺损伴缺牙患者植骨并行同期牙种植即刻负重的临床效果.方法:对河北医科大学口腔医院口腔种植中心就诊的14例17-41岁前牙区骨缺损伴缺牙患者(其中1例牙槽突隐裂),采用Bio-oss人工骨粉植入加Bio-Gide骨引导膜修复前牙区骨缺损并同期行人工牙种植体植入术,共植入HBIC纯钛人工牙种植体14颗,术后立即行聚丙烯酸树脂冠临时修复,即刻负重,修复后追踪观察3-46个月.以临床检查和影像学检查评价修复治疗效果.结果:观察3-46个月,14例患者种植体均未见松动,种植体周围软组织健康;局部牙槽骨丰满,所植骨粉无感染和排出,植骨后鼻底及上唇塌陷畸形明显改善.根尖片显示种植体周围骨质无明显吸收.结论:对于较大年龄前牙区骨缺损伴缺牙患者进行植骨修复时可尝试行同期牙种植术、术后即刻负重.     

外胚层发育不全患者的口腔修复治疗

外胚层发育不全(ectodermal dysplasia,ED)是一组由外胚层结构发育不全而导致发育缺陷的先天性遗传病,症状可为少汗、毛发稀少、指甲异常、先天缺牙或无牙等。大部分患者存在先天缺牙或无牙颌的典型症状,而对于缺牙的修复治疗,目前临床上治疗方法不尽相同,也尚无相关共识指导。这篇综述从外胚层发育不全患者缺牙的修复、颌面外形的改善等方面概括了截至目前该病的口腔临床治疗手段,为更加规范、全面地为患者提供口腔治疗和干预方案提供参考。     

口腔种植学进展

现代口腔种植技术始于二十世纪中叶 ,“骨结合”(Os-seointegration)理论的提出以及为口腔种植学的形成奠定了基础 ,使一度因临床失败率高而濒于被否定的牙种植技术重新获得了新生 ,实现了牙种植的第一次飞跃。近二十年 ,围绕种植体植入术发展起来的种植外科为口腔种植学带来了第二次飞跃 ,使种植区的局部因素不再是绝对的禁忌症 ,同时也在最大范围内实现了种植义齿功能与美学的修复 ,为日后口腔种植成为义齿修复的主导技术奠定了坚实的基础。口腔种植修复已从仅针对传统方法难以修复的无牙颌及游离端缺牙发展到可以修复所有类型的缺牙。概…     

当代口腔种植学的进展及其临床意义

口腔种植学在过去40年里,无论是在种植体本身的设计研究,还是其临床应用都取得了令人瞩目的进展。据粗略统计,仅在2005年里,在美国FDA、欧洲CE注册的牙种植系统达140多种,2005年美国消耗牙种植体达100万套,而欧洲则达180万套。牙种植修复不仅彻底更新了传统口腔修复学的内容与概念,解决了传统修复学里长期难以解决的难题,如:游离端缺失的修复、重度牙槽突萎缩无牙颌的牙列修复、伴有骨缺损的牙列缺损修复、牙周病患者的缺牙修复,而且成功地用于肿瘤手术上下颌骨切除后的功能性颌骨重建,用于面部器官缺失后的赝复体修复等。口腔种植修复在…     

即刻负重技术的研究进展

上个世纪六十年代Branemark教授提出了经典的口腔种植修复理论，在过去的四十年中，口腔种植技术已广泛应用于牙列缺损和牙列缺失的病例，大大改善了患者的生存质量。然而，经典种植学要求4～6个月无负重愈合期，以便使种植体和骨之间形成骨性结合，这个过程中种植体需要在零负荷状态下进行骨整合，由于缺牙时间较长，很难满足患者对于美学和功能的要求，     

种植固位体在先天性全口缺牙患者义齿修复中的应用

目的 :采用种植技术修复先天性全口缺牙或多数牙缺失。方法 :对 3例先天性全口缺牙或多数牙缺失病例 ,下颌骨植入MDIC种植体 ,行下颌覆盖种植可摘义齿修复。结果 :经种植修复后 3 -6个月的随访发现义齿在固位、咀嚼、语言功能及美观等方面的修复效果良好 ,患者满意。结论 :对因外胚层发育不全致牙齿及颌骨发育严重异常 ,常规方法无法进行义齿修复者 ,采用种植修复技术可以获得良好的修复效果     

Oral health care for patients with Alzheimer's disease: An update

Alzheimer's disease and related disorders (ADRD) are among the age‐associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full‐time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well‐being of people with ADRD, from excruciating local pain to life‐threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients’ individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.     

Oral squamous cell carcinoma around dental implants.

It is well documented that oral squamous cell carcinoma (OSCC) is related to risk factors such as smoking and alcohol consumption as well as premalignant lesions and conditions such as leukoplakia, oral lichen planus (OLP), and previous malignancy of the upper respiratory system and gastrointestinal tract. Osseointegrated dental implants are rarely reported in association with OSCC. This article presents 2 cases of OSCC adjacent to dental implants in patients at risk for oral cancer--1 was a heavy smoker with OLP; the other had a history of previous oral and colon cancer. Six additional cases of malignancy adjacent to dental implants were retrieved from the literature; the majority of cases had at least 1 recognized risk factor for oral cancer. Although such cases are rarely reported, patients at risk for oral cancer, especially those with multiple existing risk factors, that present with failing dental implants should be thoroughly evaluated to rule out the presence of malignancy disguised as peri-implant disease.     

Oral candidosis and the therapeutic use of antifungal agents in dentistry

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudo-membranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.     

Health Outcomes Reported by Dental Patients

To assess the impact of care on patients, patient-reported outcomes (PROs) are essential because they characterize patients' suffering. Patient-reported outcome measures (PROMs) are the instruments to assess PROs. Any report of the patient's oral health condition that comes directly from the patient is a dental patient-reported outcome (dPRO). Similar to oral health being a component of health in general, dPROs are a part of PROs. dPROs target four major areas of patients' suffering because dental patients typically seek care to improve oral function and orofacial appearance as well as to decrease pain and psychosocial impact related to oral conditions. dPROs capture what matters to dental patients. They characterize the specific influences of oral health on patients' lives. Dental patient–reported outcome measures (dPROMs) capture this influence and express it numerically in a score. Consequently, dPROs in general and Oral Function, Orofacial Appearance, Orofacial Pain, as well as Psychosocial Impact (related to oral conditions) in particular are the major targets for dental interventions in clinical practice as well as for oral health research.     

Autofluorescence imaging in recurrent oral squamous cell carcinoma

The survival of patients with oral cancer is decreased by locoregional recurrence after an initial multimodal treatment. In order to identify lesions in the oral cavity for a possible recurrence, clinical evaluation as well as MRI or CT scanning is advised. The evaluation of mucosa lesions is hampered by changes related to radio- and chemotherapy as well as reconstruction with tissue flaps. Several techniques for easier identification of tissue abnormalities in the oral cavity have been advocated as adjuncts in order to facilitate identification. Especially methods using altered tissue fluorescence have gained much interest during the last decade. The aim of our prospective study was to evaluate fluorescence properties of undiagnosed mucosa lesions with the VELscope device in patients with multimodal treated oral cancer prior to histological confirmation. In total, 41 patients with a history of oral squamous cell carcinomas (OSCC) (19 females and 22 males) with undiagnosed mucosa lesions where included in the study. After clinical evaluation, examination and documentation using the VELscope® device were performed. Then, an incisional biopsy was performed. An autofluorescence loss indicating a malignant or dysplastic mucosa condition could be detected in six patients (14.6 %); however, only one OSCC and one SIN revealed a complete autofluorescence loss. In four patients, OSCC was present in lesions with retained autofluorescence. Sensitivity and specificity for the VELscope® examination to identify malignant oral lesions by autofluorescence were 33.3 and 88.6 %, respectively. The positive and negative predictive values were 33.3 and 88.6 %, respectively. No statistical correlation between gender and lesion appearance versus autofluorescence loss could be detected. In contrast to mucosa lesions in patients with no prior treatment, the autofluorescence evaluation with the VELscope reveals no additional information in our analysis. Accordingly, invasive biopsies as gold standard are still needed to get sufficient evidence regarding potential malignancy in patients after multimodal treatment for oral cancer.     

Clinical significance of total and lipid bound sialic acid levels in oral pre-cancerous conditions and oral cancer

BACKGROUND: Altered glycosylation of glycoconjugates is among the important molecular changes that accompany malignant transformation. The purpose of our study was to investigate clinical usefulness of circulatory levels of total and lipid bound sialic acid for early diagnosis and management of oral cavity cancer patients. METHODS: Blood samples were collected from 41 untreated oral cancer patients, 20 patients with oral pre-cancerous conditions (OPC) and 20 healthy subjects. Serum sialic acid (total and lipid bound) levels were measured spectrophotometrically. RESULTS: Serum levels of total and lipid bound sialic acid were significantly elevated (P < 0.001) in untreated oral cancer patients as compared to healthy individuals as well as patients with OPC. Multivariate analysis documented that the progressive rise in total and lipid bound sialic acid was significantly associated (P = 0.0001 and 0.039, respectively) with stage of malignant disease. CONCLUSION: The data revealed significant elevations in sialic acid levels in oral cancer patients and suggested potential utility of these parameters in diagnosis as well as determining clinical stage of the malignant disease.     

Oral hygiene instruction of adults by means of a self-instructional manual

Abstract The need for improved oral cleanliness in adults presents a large scale resource requirement for professional manpower if oral hygiene instruction is to be accomplished conventionally on an individual basis at the chairside. Therefore a self-instructional manual in oral hygiene measures, to be used by the patients at home, has been designed. The effect on oral hygiene of periodontal patients following instruction by means of this manual has been compared with the effect of one instruction carried out by a dental hygienist as well as with the effect of minimal instruction by the aid of a short brochure. Thirty-seven patients (25–64 years of age) were allocated to three groups matched with regard to baseline scares of dento-gingival plaque, age and sex. Presence of disclosed dento-gingival plaque (Plak-lite®) and gingival bleeding on probing were recorded at the start, 1,2 and 6 weeks, 3 and 6 months. Toothbrushing performance of the patients was evaluated at each visit by a “brushing test”. The treatment of all the patients consisted of scaling and polishing of the teeth at the start and after 3 months as well as the patients being supplied with the necessary oral hygiene aids including a lighted mouth mirror, a toothbrush, toothpicks and disclosing tablets. The baseline mean plaque and bleeding scores of 64 and 40% decreased during the first 6 weeks to a level of 20 and 14%. This improvement was maintained during the 6-month study period. Among the three groups no significant differences were observed in oral hygiene and gingival health. The results indicate that an oral hygiene instructional mode relatively independent of professional manpower may be equally effective as one single personal instruction. Furthermore the results suggest that factors other than the instruction per sc are important for obtaining improvements in oral home care.     

口腔癌早期诊断的研究现状

口腔癌是第6位常见的癌症,预后较差,5年生存率在50%左右,早期诊断和早期治疗是提高患者生存率和生存质量的关键。但当患者出现如疼痛、出血、溃疡、肿块、影响语言或吞咽疼痛等临床症状时,肿瘤可能已经出现了浸润和转移。因此,如何在患者出现临床症状前,筛选出口腔癌高危人群,实现早期诊断,是所有临床医师努力的目标。临床上除了常规的检查口腔病变(包括由口腔科医师、耳鼻咽喉科医师和内科医师检查)外,口腔组织的活体染色、光谱分析和刷取活检等手段有望实现口腔癌的早期诊断。     

The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy

OBJECTIVE: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population. DESIGN: Cross-sectional study. SUBJECTS: Forty-two dentate CRF patients--aged 25-52 years old--were matched with a reference group of 808 dentate subjects. METHODS: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self-reported dental problems. Student t-tests and chi-square tests were performed to compare the CRF patients with the controls. RESULTS: All index-scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 +/- 2.6) than in controls (3.0 +/- 2.9). The self-reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08). CONCLUSIONS: For most dental aspects, the oral health of CRF patients is comparable with controls.