骨皮质切开术加速正畸牙移动的治疗技术

骨皮质切开术是一种有效加快正畸牙移动的技术,能使正畸治疗时间缩短至传统正畸治疗时间的1／3-1／4,同时也能增加牙槽骨宽度,提高正畸术后稳定性,减少牙根吸收等。该技术理论基础是通过局部加速现象（ RAP）来加速正畸牙移动。本文将从骨皮质切开术的发展历史和加快正畸牙移动的理论基础及其临床应用进行综述。     

牙周加速成骨正畸临床应用效果的研究进展

牙周加速成骨正畸(PAOO)是指对牙槽骨进行骨皮质切开,并在切开骨表面进行颗粒骨移植以辅助正畸治疗。骨皮质切开诱导的局部加速现象可诱导破骨活性增加,加速骨代谢,从而有效加速正畸牙移动,缩短疗程,并可以减少牙根吸收等正畸并发症的发生。颗粒骨的植入能扩大正畸牙的移动范围,拓宽正畸治疗的适应证,保证牙周健康,提高治疗稳定性。本文就PAOO对正畸治疗中牙移动速率、骨增量效果以及牙根吸收的临床效果作一综述,以便为该技术的临床应用提供参考。     

骨皮质切开术辅助正畸治疗的临床研究

目的探讨骨皮质切开术辅助正畸治疗的临床应用。方法研究临床接受骨皮质切开术辅助治疗的正畸患者48例,男14例,女34例。骨皮质切开术应用于正畸临床:辅助扩弓,拔牙患者的前牙内收,修复前正畸治疗的磨牙前移、残冠牵引,根骨粘连牙齿的移动等。结果在正畸治疗中,辅助骨皮质切开术可以解除骨皮质阻力,加速正畸牙齿移动,增加牙周支持组织及骨覆盖,减少牙根吸收。结论骨皮质切开术辅助正畸治疗不仅可以加速牙齿移动,而且能够有效解决正畸临床的一些疑难问题。     

骨皮质切开术及其辅助正畸牙齿垂直向控制研究进展

成人患者多伴有牙周、关节等问题,正畸治疗机制复杂、疗程较长,患者不仅对疗效要求高,对正畸治疗的疗程也颇为关注。骨皮质切开术,通过切开牙齿周围的骨皮质,辅助加速牙齿移动,缩短疗程,为成人正畸提供了一种新的治疗理念与思路。术中辅助植骨,可减轻治疗风险,同时可改善患者的牙周状况。骨皮质切开术日趋成熟,作为一种牙周辅助快速正畸技术在国外已应用于临床。本文将对骨皮质切开术在正畸牙齿垂直向控制中的临床应用、发展、优缺点以及一般临床程序等做一综述。     

牙槽骨增量骨皮质切开术的发展现状

错畸形是临床常见疾病,需要正畸治疗。有些患者存在牙槽骨量不足,牙根外露,无法进行牙移动,严重限制了正畸治疗的开展。因此,增加牙槽骨量以及促进牙的排齐移动就显得尤为重要。牙槽骨增量骨皮质切开术（augmented corticotomy-assisted surgical orthodontics）能有效增加牙槽骨量,扩大正畸治疗适应证,加速正畸牙移动,缩短治疗时间,减少骨开窗、骨开裂等并发症,提高患者满意度。本文对牙槽骨增量骨皮质切开术的生物学基础及发展做一综述。     

骨皮质切开术辅助正畸治疗的研究进展

近年来,寻求正畸治疗的成年患者数量日益增多,如何加速正畸牙齿移动、缩短正畸疗程,并同时降低与正畸治疗时间较长相关的牙体、牙周疾病风险成为医生和患者共同关注的焦点。目前已报道的加速牙齿移动的方法中,经基础和临床研究证实,骨皮质切开术可有效加速正畸牙移动、缩短疗程并减少与正畸时间相关的牙体、牙周疾病,且其术式也随着临床操作、手术设备、计算机技术的更新和进步而变得更加微创、简便、精确、有效。文章就骨皮质切开术辅助正畸治疗的历史起源与发展、加速正畸牙齿移动的原理、术式变化、适应证与禁忌证、临床应用等方面做一综述。     

辅助正畸扩弓治疗的上颌后牙区牙周软硬组织增量1例

目的 本病例报道1例牙周软硬组织增量在正畸治疗过程中出现骨开裂及根面暴露的临床应用。诊治经过：一位26岁男性患者在正畸扩弓治疗过程中出现右上后牙牙龈退缩,遂停止正畸加力,要求牙周治疗。临床检查显示7-5牙Miller Ⅲ类牙龈退缩,CBCT检查显示$\underline{7-5}\rvert$牙颊侧根中1/3-根颈1/3牙槽骨吸收。一期通过膜龈手术完成根面覆盖及角化龈增量后,二期采用骨皮质切开+骨增量手术治疗$\underline{7-5}\rvert$牙颊侧骨开裂。结果 术后1年随访,正畸治疗顺利结束,$\underline{7-5}\rvert$牙根面覆盖效果稳定,颊侧骨充盈良好。结论 治疗正畸过程中出现骨开裂及根面暴露时,基于上皮下结缔组织移植的根面覆盖术联合骨皮质切开+骨增量技术能够取得满意效果,然而其长期稳定性仍有待进一步探究。     

Micro-CT对骨皮质切开术中区域性加速现象的分析

目的:Micro-CT观测骨皮质切开辅助正畸治疗中牙齿移动速率和牙槽骨结构的改变。方法:选用75只4~6周龄的雄性SD大鼠,随机分为3组:组1:牙槽骨皮质切开辅助正畸(CO+TM),组2:传统正畸(TM),组3:单纯牙槽骨皮质切开(CO),按照时间点(加力4、7、14、21、28 d后)处死实验动物并进行Micro-CT扫描,测量牙移动距离;三维重建后测量牙颈部、根中部、根尖部3个平面张力侧及压力侧共6个区域的牙槽骨骨密度及骨体积。结果:1)牙移动距离:初期TM组高于CO+TM组,在第14、21、28天时,CO+TM组明显高于TM组(P<0.05)。速率:4~7 d时TM组大于CO+TM组,之后小于CO+TM组,组间比较P<0.05。2)骨密度:4、7、21、28 d时远中骨密度CO+TM组与CO、TM组比较持续下降,TM组则先下降后上升,CO组稳定于0左右(P<0.05)。3)骨体积:CO+TM组近中骨体积始终呈下降趋势,TM组近中骨体积自加力4 d后持续缓慢升高。结论:牙槽骨骨皮质改良切开术辅助正畸可以在术后14~28 d内增加正畸牙移动距离;牙槽骨远中侧骨密度降低明显,压力侧骨体积下降,张力侧骨体积上升,骨改建活跃,区域性加速现象在21 d时最明显。     

颌骨骨皮质切开加速正畸牙齿移动的研究进展

目前颌骨骨皮质切开术在临床牙颌面畸形的治疗过程中已被广泛应用,大量基础实验研究及临床病例观察不仅为骨皮质切开术提供了理论依据,而且证实了其临床可行性及显著优点,它的主要特点是缩短治疗过程,降低治疗风险,并增加正畸治疗的稳定性。该文就颌骨骨皮质切开术加速正畸牙齿移动这一临床技术的理论基础、基本临床操作、临床应用等作一综述。     

牙周骨皮质切开术式的研究进展

随着社会的发展,寻求正畸治疗的成年人逐年增多,如何缩短正畸疗程成为近年来的研究热点。目前加速牙齿移动的方法中,牙周骨皮质切开术经临床及基础研究均被证实有效,不仅可以加速牙齿移动,还可以有效增加成骨潜能。在其发展的百年间,术式几经改良,本文就牙周骨皮质切开术的历史起源及近年来的术式进展等进行综述,为骨皮质切开术的临床应用提供参考。     

Clinical and pathological aspects on some odontogenic tumors

Odontogenic tumors constitute a very diverse group of lesions that reflects the complex processes of odontogenesis. Controversies over their classification/subtyping, terminology and diagnosis have been persisted, which has direct bearings on therapeutic and/or prognostic implications.     

Can you be too old for oral implants? An update on ageing and plasticity in the oro‐facial sensorimotor system

This review focuses on the capacity of the brain for plasticity and the utility and efficacy of oral implants in helping to restore oro‐facial sensorimotor functions, especially in elderly patients. The review first outlines the components of the oro‐facial sensorimotor system which encompasses both oro‐facial tissues and a number of brain regions. One such region is the sensorimotor cortex that controls the activity of the numerous oro‐facial skeletal muscles. These muscles are involved in a number of functions including reflexes and the more complex sensorimotor functions of mastication, swallowing and speech. The review outlines the use by the brain of sensory inputs from oro‐facial receptors in order to provide for exquisite sensorimotor control of the activity of the oro‐facial muscles. It highlights the role in this sensorimotor control played by periodontal mechanoreceptors and their sensory inputs to the brain, and how oral implants in concert with the plastic capacity of the brain may, at least in part, compensate for reduced sensorimotor functioning when teeth are lost. It outlines findings of ageing‐related decrements in oro‐facial sensorimotor functions and control. The changes in oro‐facial tissues and the brain that underlie these ageing‐related functional alterations are also considered, along with adaptive and compensatory processes that utilise the brain's capacity for plasticity. The review also notes the evidence t hat rehabilitation that incorporates adjunctive approaches such as sensorimotor training paradigms in addition to oral prostheses such as implants may enhance these processes and help maintain or facilitate recovery of sensorimotor functioning in the elderly.     

Tumor microenvironment in oral cancer: novel approaches for immunotherapy

Squamous cell carcinoma of the head and neck (SCCHN), which arises from the squamous mucosal epithelium of the oral cavity, pharynx and larynx, is a major health problem in the US and other parts of the world, especially in developing countries.     

牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形远期疗效评价

目的：评价牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形的远期疗效。方法伴牙槽骨缺损的成人错畸形3例,平均年龄29岁。经正颌-正畸联合会诊制订治疗计划,按照牙槽骨再生正畸及正颌-正畸联合治疗模式,分别进行系统治疗并随访2~3 a。结果3例患者均顺利完成治疗,面型及咬合关系获得良好改善;牙槽骨缺损区正畸牙移动到位且未见医源性牙周并发症,牙槽骨缺损区骨量增加明显且远期效果稳定。结论针对伴牙槽骨缺损的成人患者,牙槽骨再生正畸是一种较为理想的技术。     

Management of acute open flexor tendon injuries of the hand and wrist: basic sciences,surgical factors and rehabilitation pertinent to optimizing outcome

Flexor tendon injuries to the hand and wrist represent a significant resource burden to the UK NHS. A good understanding of tendon basic science and repair techniques is crucial for the surgeon undertaking their repair and rehabilitation. Furthermore, this is a common topic assessed in the FRCS(Orth) examination. This article will summarize the basic science relating to tendon structure, physiology and injury. Additionally, it will present key surgical and rehabilitation factors relevant to clinical outcomes.     

伴囊肿的上颌埋伏阻生中切牙早期引流助萌治疗

目的:探讨采用引流助萌的方法对伴囊肿的上颌埋伏阻生中切牙的早期治疗。方法:选取单侧上颌中切牙埋伏阻生、处于替牙早期伴囊肿的患者8例。外科囊肿切除同时对埋伏阻生上颌中切牙引流助萌治疗。治疗前后拍摄CBCT,Dolphin11.0软件测量矫治前后阻生牙及对侧正常同名牙的冠根长度。结果:8例患者的埋伏阻生上颌中切牙平均矫治时间6.7个月。矫治后阻生牙和对侧正常同名牙的冠根长度均有生长。阻生牙冠根长度较对侧正常同名牙明显短(P<0.05)。结论:本研究所采用引流助萌方法为埋伏阻生牙的矫治提供了一个安全、有效的新途径。     

In vitro calibration and validation of a digital subtraction radiography system using scanned images

OBJECTIVES: To calibrate and validate a digital subtraction radiography system using scanned images for quantification of alveolar bone changes by means of computer-assisted densitometric image analysis (CADIA) in vitro. MATERIALS AND METHODS: Noise levels were determined using 10 standardized periapical radiographs of the same lower molar region in a human dry skull. For validation of the system, radiographs were taken before and after bovine bone particles in measures with increments of 2 mg weighing from 2 to 20 mg were added into each socket of three dry skulls. Radiographs were developed and scanned into a computer with a flatbed scanner. After digitization, the images were subjected to alignment, normalization and subtraction. Appropriate regions of interest (ROIs) were selected and their CADIA values were calculated for the determination of noise levels, and correlations between the CADIA values and the actual bone mass were performed. RESULTS: When the threshold value was 7, the percentage of pixels deviating from the set threshold value was small (0-11.3%). There were statistically significant correlations between the actual bone mass and the CADIA value for anterior sockets (p<0.001, r2=0.89) and posterior sockets (p<0.001, r2=0.9). For pooled data of both anterior and posterior sockets, the correlation was also statistically significant (p<0.001, r2=0.88). CONCLUSIONS: A high and statistically significant correlation between the actual bone mass and CADIA value was obtained, which suggests that the system could be suitable for the detection of small alveolar bone changes.     

CBCT与RVG对下颌恒切牙根管形态评估的对比研究

目的:对比CBCT法与数字化X线成像法(RVG)对下颌恒切牙根管形态评估的差异。方法:对101颗离体牙进行唇舌向及近远中向数字化X线片拍摄和CBCT高清牙列模式扫描,对图像进行根管数目、Vertucci根管分型、根管钙化和根尖口开口位置的评估,并通过CBCT图像建立偏角度投照的三角函数模型,计算偏向投照的角度。结果:CBCT法显示有30颗为双根管,RVG近远中向投照显示有36颗为双根管,卡方检验显示对根管数目和Vertucci根管分型两种方法均具有显著性差异(P<0.05)。两种方法对根管钙化和根尖口开口位置的评估均不具有显著性差异。30颗双根管牙中下颌恒切牙唇舌向双根管的最大距离(LaL)在0~1.5 mm之间的,85.7%的为Vertucci III型,LaL在1.5~2 mm之间的,66.7%为Vertucci IV和V型。以根尖片上双根管显示距离为1 mm计算,LaL在1~2 mm之间的,偏向投照角度为26.6°~45.0°,LaL在0.1~1 mm之间的,偏向投照角度为45.0°~84.3°。结论:CBCT高清牙列模式扫描和RVG投照对于根管数目和Vertucci根管分型的评估具有显著性差异,对于根管钙化和根尖口开口位置的评估不具有显著性差异。LaL在1~2 mm之间时,偏角度投照的临床可操作性较强。     

Fabrication and characterisation of a novel biomimetic anisotropic ceramic/polymer-infiltrated composite material

Objective

To fabricate and characterise a novel biomimetic composite material consisting of aligned porous ceramic preforms infiltrated with polymer.