Comparison of Maxillary Implant-Supported Prostpesis in Irradiated and Non-Irradiated Patients

Summary:In order to investigate the influence of radiation therapy after the treatment of maxillaryimplant-supported prostheses,27 patients received a total of 131 implants in maxilla after oral cancertreatment and/or reconstructive surgery.Among them,25 received maxillary implant-supportedprostheses.The cumulative survival rates of implants and prostheses were evaluated by the product-limit-estimates method according to Kaplan-Meier.The cumulative survival rate of implants andprostheses in irradiated patients was compared with that in non-irradiated patients by statistical Log-rank test.The results showed that 112 implants were observed after implant loading.The implantscumulative survival rate was approximately 65％ for overall patients.The cumulative prosthesis suc-cessful rate was approximately 88％ for all 25 patients.Log-rank test analysis revealed that therewas a significant difference in cumulative implants survival rates between non-irradiated and irradiat-ed maxillary bone(P<0.01).It was concl     

Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction

Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants respectively. The main reasons for failure of the dental proliferation. The fibula flap presents many advantages for implant-supported prosthetic rehabilitation difficult. placed into the fibula bone grafts were 95% and 87%, replants were infection, tumor recurrence and soft tissue implant placement, but its limited height sometimes makes Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.     

Evaluation of success rates of immediate and delayed implants after tooth extraction

Objective To evaluate the success rates of immediate and delayed placement of implants with respect to the causes of tooth extraction and implant positions.Methods A total of 310 dental implants (immediate implants : delayed implants =76 :234) were inserted into 80 patients. The types, sizes and positions of the implants and the causes of tooth extraction were recorded. We then investigated the relationship of implant loss with the causes of tooth extraction and placement methods.Results A higher failure rate was found for the implants in the posterior region of the maxilla, and when periodontitis was cited as a reason for tooth extraction. The overall success rates were 93.4% and 95.7% in the immediate and delayed implant placement groups, respectively, after a 2-year follow-up. No obvious relationship of success rate was observed with the implant placement method,cause of tooth extaction, and implants‘ position.Conclusion The immediate placement of implants into fresh extraction sockets could offer advantages over the delayed implant placement. It seems to be a safe and predictable method forpatients.     

Investigation of Maxillary Preprosthetic Situations after Oral Tumor Treatment

In order to investigate the maxillary preprosthetic situation after oral tumor treatment and/or reconstructive surgery, based on the review of case history and the clinical records 47 cases were analyzed after oral tumor treatment and/or reconstruction, including residual maxillary bone, intermaxillary relationships, defection of maxilla and oral situation after radiation therapy. The resuits showed that the residual maxillary bone was useful for implantation in the front alveolar bone and zygoma area. The maxillary preprosthetic situation after tumor treatment and/or reconstructive surgery was difficult due to maxillary resection, intermaxillary relationships, unsuitable soft and hard tissue transfer and the irradiation. It is suggested that the maxillary preprosthetic situation after oral tumor treatment is getting worse not only due to maxillary resection and/or irradiation, but surprisingly also due to mandibular resection and/or irradiation.     

Correlation between Endometrial Endothelin and Irregular Uterine Bleeding after Implant Insertion

Objective To investigate endometrial endothelin type Ⅰ (ET-Ⅰ) level during menstru-al cycle and its change after implant insertionfrom 27 healthy women using radio-immunity technology. ET-Ⅰ level in proliferationperiod and secretion period were measured and compared. ET-Ⅰ level before and 3 to 7months after implant insertion were also compared. The side effect of long term use ofimplant was also study by measuring the ET-Ⅰ level among women 24 to 36 monthsafter implant insertion.Results ET-Ⅰ level in proliferation period was 2. 76± 1.25 pg/mg, which was sig-nificantly(P＜ 0. 05) lower than that in secretion period (3. 90±1.30 pg/mg). ET-Ⅰlevel in 14 women, from whom samples before and 3 to 7 months after implant insertionwere obtained, were3.38±1. 17 pg/mg and 10. 86± 3. 93 pg/mg respectively, withsignificant statistical difference (P＜ 0. 001). At different periods of implant inser-tion, the average ET-Ⅰ level was 10. 86± 3. 93 pg/mg within 2 to 3 years after im-plant insertion, significantly higher than that of women have implant insertion formore than 24 to 36 months year.Conclusion ET-Ⅰ level changes periodically. ET-Ⅰ level 3 to 7 months after implantinsertion was significantly higher than that before insertion, and drops as time goes.The increase of ET-Ⅰ level is possibly related to irregular uterine bleeding after the useof implant.     

Investigation of peri-implant status and risk variables for implant failure in body of maxilla after oral tumor surgery

The aim of this study was to assess the peri-implant parameters and evaluate the clinical status with the survival of dental implants in body of maxilla after treatments of oral tumor. A follow-up examination included 27 patients who underwent the ablative tumor and （or） reconstructive surgery during a 5-year period. The follow-up protocol included clinical examination, radiological evaluation, and an interview using a standardized questionnaire. The reasons related to implant failure were studied by comparing the amount of failure with the value of marginal bone resorption, probing pocket depth, and plaque index using statistical t-test. The relationship between smoking and implant failure was analyzed statistically by chi-square test. The results showed among the 112 implants observed after implant loading, 29 have failed with the failure rate being 22.14 %. There was no significant correlation between the peri-implant status and the implant failure （P〉0.05）, however, the association of smoking and implant failure was statistically tested （P〈0.05）. It was suggested that the association of peri-implant status and implant failure in the maxilla after tumor surgery can＇t be statistically tested, however smoking was still a mainly significant factor.     

Modification of the right subclavian vein catheterization and its anatomic basis and techniques

Background Several million subclavian-vein catheters are placed in patients each year to enable caregivers to administer chemotherapy, total parenteral nutrition, or long-term antibiotics or to manage preoperative fluids. Subclavian venipuncture requires the position of a deep vein to be identified with only surface landmarks. But the traditional right subclavian vein (RSV) catheterization (primitive procedures) is not the answer for all patients. The precise location of the vein is not known, and it is important to select the most appropriate method to achieve central venous access safely in any given patient. To modify the primitive procedures of the RSV catheterization for greater success and reduce the complications, anatomic studies and ultrasonography were conducted and clinical applications were validated. Methods Anatomical observation and measurement of the RSV and its adjacent structures were performed on 20 adult cadavers according to modified procedures. The RSV catheterization of 2900 cases was carried out by the modified procedure, 500 of these cases were observed by ultrasonography after the operation. Results The anatomical studies and clinical application showed that the insertion point differs from the bodily form of fatness or leptosome. The clinical data revealed that in the 2900 cases which were performed with the modified approach, the success rate was 98.90% (2868 cases), the failure rate was 1.10% (32 cases), and the complication rate is 0.79% (23 cases), and the catheterization time is (31.2±10.5) minutes. Five hundred and sixty cases of the RSV catheterization were carried out by the recommended insertion procedure; the results were compared with the modified approach and the traditional approach. The successful rate of the traditional approach was 73.0%, of which the complication rate was 6.1%; the two approaches were significantly different (successful rate: χ2=626.642, P&lt;0.01; complication rate: χ2=80.708, P&lt;0.01). Conclusions The modified RSV catheterization is characterized with a higher success rate and less complications, and the insertion procedure differs from the bodily form of fatness or leptosome.     

Primary Clinical Evaluation of the Joint Replacement for the Treatment of the First Metatarsophalangeal Arthritis

Objective To retrospectively assess the primary clinical results of a cohort of the first metatarsophalangeal joint replacement with double-stemmed hinge silicone implant.Methods A total of 12 patients (15 feet) received the joint replacement with double-stemmed hinge silicone implant.There were 2 males and 10 females with a mean age of 61.4 (range,56-75) years old.Of them,9 cases (11 feet) were hallux valgus with osteoarthritis;1 case (2 feet) was rheumatic arthritis;2 cases (2 feet) were traumatic arthritis.The subjective and objective results were evaluated during follow-up.Results All of the patients were followed up regularly with an average of 24.7 months,ranging from 12 to 38 months.Ten patients were completely satisfied with the operation;1 patient showed partial satisfaction,and 1 patient was not satisfied because of the first matatarsophalangeal joint pain due to severe hyperosteogeny surrounding the cut bone surface 3 years after the operation.Osteolysis around the implant occurred in 2 cases without clinical symptoms,and no special treatment was given.Conclusion The joint replacement is a preferable method in alleviating pain and improving walking function with proper indication.     

Complications of transsphenoidal surgery for sellar region: intracranial vessel injury

Background Intracranial vessel injury is a severe complication of transsphenoidal surgery （TSS） for lesions of sellar region. The purpose of this study was to improve recognition of the complication.
Methods The clinical data of 400 cases of TSS for sellar region from 1964 to 2004 were reviewed retrospectively. Ten patients with complications of intracranial vessel injury were included in this study, 7 underwent transsphenoidal microsurgery and 3 underwent endoscopic TSS. Subarachnoid hemorrhage （SAH） occurred in 8 cases, hemorrhage of cavernous sinus in one, and post-operative cerebral hemorrhagic infarction caused by thrombosis of injured right internal carotid artery in one. The clinical data of all the patients were analyzed.
Results The SAH resulted from hemorrhage of residues of tumor in 2 patients and from damaged sellar and arachnoidea in 6 patients. The cause of hemorrhage of anterior intercavernous sinus was malformation of anterior intercavernous sinus. The reason of thrombus of internal carotid artery was manipulation of operation. Three patients died and six patients were cured. One patient lived with hemiplegia.
Conclusions The cause of intracranial vessels injury of TSS is complicated. Detailed anatomic knowledge of seller and skilled operation is helpful to reduce the complication.     

Eleven dental implants placed in a liver transplantation patient: a case report and 5-year clinical evaluation

Due to an increased risk of infection, dental implant in organ transplantation patients has long been considered questionable, particularly when the restoration is complicated. Five-year follow-up data of a 45-year-old liver transplant recipient with long-term immunosuppressive therapy was reported. One year after liver transplantation, 11 Brånemark implants were inserted in the maxilla and mandible, using minimally invasive surgery. Oral clinical parameters included peri-implant bone absorption, probing depth, and implant mobility. The measured fifth-year parameters were within normal ranges indicating a stable osseointegration with moderate vertical bone loss. This case report suggests that immunocompromised patients can be successfully rehabilitated with dental implants through careful examination, suitable antibiotic administration, and minimally invasive dental implant procedure.     

Xive种植体的临床疗效分析

目的分析和评价Xive种植体临床应用3年的效果。方法应用Xive系统种植体对139例缺牙患者进行了219颗种植修复，并采用Albretsson的评价标准进行临床疗效分析。结果Xive种植体3年的成功率为97.26%（213/219）。其中，即刻种植11颗，占5.01%；上颌窦底提升种植15颗，占6.85%；失败率2.74%（6/219）。失败的原因有种植区骨缺损过多，种植体周围炎和原因不明的持续性疼痛。结论Xive系统种植体修复各种牙齿缺失，具有良好的临床疗效；即刻种植疗程短，疗效好，值得推广。     

闭合式上颌窦底提升同期牙种植体植入术疗效研究

目的 探讨闭合式上颌窦底提升同期牙种植体植入术的临床疗效.方法 进行23例闭合式上颌窦底提升同期牙种植体植入术,以23例上颌后牙常规牙种植体植入术为对照,术后1周及1、3、6个月检查种植体稳定性、上颌窦和种植体骨结合情况.结果 两组均未见种植体松动、脱落或上颌窦炎症发生,各时期X线片检察种植体骨结合良好.术后6个月均完成上部义齿修复.经不同时间随访,临床效果良好.结论 闭合式上颌窦底提升同期牙种植体植入术同上颌后牙常规牙种植体植入术一样具有良好的治疗效果,可显著扩大牙种植体植入术适应证.     

OSSTEM（奥齿泰）系统短种植体在后牙区骨高度不足病例中修复的临床效果

目的探索短种植体在后牙区骨髙度不足病例中修复的临床应用。方法选取本院56例患者,均为上、下颌后牙区高度不足的病例（4.5～7.5mm）,分别植人OSSTEM短种植体（长度6～7mm）,其中下颌植人54枚种植体,上颌共植入40枚种植体。其中上颌后牙区牙槽骨髙度不足的患者行上颌窦内提升术同期植入种植体。3～6个月后完成永久修复。结果经12个月的临床观察,有54例92枚OSSTEM短种植体临床检査种植体稳定,X线检査,种植体骨结合良好。有2例患者上颌2枚种植体二期手术时松动脱落,种植成功率为97.87%。结论在后牙区骨髙度不足的病例,通过植入OSSTEM系统短种体,扩大了种植适应证,治疗成功率较髙,值得临床推荐。     

上颌窦底水囊冲压内提升同期种植修复单牙缺失36例临床观察

目的：：评价水囊冲压技术在上颌窦内提升同期种植修复单牙缺失的临床应用疗效。方法：选择满足适应证的36例上颌后牙单牙缺失患者,其缺牙区牙槽嵴高度在3.0~7.0 mm,采用微创不翻瓣结合水囊冲压技术,共植入种植牙36颗。术后定期复诊、随访,观察种植牙稳定性和牙周组织状况。结果：随访1年未发现种植牙松动或上颌窦炎症,牙周组织健康,种植牙骨结合良好,上颌窦提升骨高度稳定。结论：水囊冲压技术在上颌窦内提升同期种植牙中的应用短期临床效果较为理想。     

不同方式上颌窦底内提升同期种植修复的临床评估

目的 评估2种上颌窦内提升后种植修复3年的临床效果.方法 回顾分析经2种不同的上颌窦内提升方式后种植修复3年的临床情况,如种植体存留率、种植体周围骨吸收等.结果 2种不同的上颌窦内提升方式后种植修复3年的种植体存留率与种植体周围骨吸收比较差异均无统计学意义(P＜0.05).结论 上颌窦内提升加骨与否可能对种植修复的远期临床效果不起重要作用.     

经牙槽嵴顶上颌窦底二次提升术可改善上颌后牙区骨高度严重不足

目的评价上颌后牙区骨高度严重不足即上颌窦底剩余牙槽嵴垂直骨高度（RBH）≥1 mm且≤3 mm时行经牙槽嵴顶上颌 窦底二次提升术的长期临床效果。方法选取南方医科大学口腔医院种植中心2012年3月~2014年12月就诊的上颌后牙缺失 拟行上颌窦提升种植修复的患者78例,符合RBH≥1 mm且≤3 mm,牙槽嵴宽度≥5 mm,采用经嵴顶二次提升法,共植入种植体 148枚,术后6个月行上部结构修复,随访1~5年,行临床及影像学检查,评价患者满意度、种植体稳定性、种植体存留率、软组织 情况、窦底骨高度变化及种植体周边缘骨吸收情况。结果术中发生3 例上颌窦底黏膜破裂,穿孔率为3.85%（3/78）。23 例 （30.67%）存在轻微疼痛,52例（69.33%）无头痛发热,无明显疼痛及肿胀反应。种植体稳定性系数ISQ值术后即刻和术后半年 分别为58.39±1.39,81.88±1.22,两组差异有统计学意义（P<0.05）。随访率100%,愈合期及随访过程中无一种植体脱落,种植体 存留率为100%。比较随访时间1年和5年的种植体周探诊深度,改良龈沟出血指数,差异均无统计学意义（P>0.05）。平均上颌 窦底提升高度及种植体周边缘骨吸收术后1年和术后5年差异均有统计学意义（P<0.05）。结论与侧壁开窗式上颌窦提升术相 比, 经牙槽嵴顶上颌窦底二次提升术植骨手术创伤小、患者不适感明显减轻,有效解决上颌后部牙槽骨高度严重不足的问题并 取得良好的长期临床效果。     

487例牙种植治疗的临床分析

目的:回顾性分析487例牙种植患者临床病例资料,评估其临床效果.方法:选择2006年2月到2010年2月郑州大学口腔医学院种植科接受种植治疗的487例种植患者,共植入种植体1 026颗,其中包括ITI系统703例、四川大学的CDIC系统257例,Anthogyr系统66例.461例患者采用切开翻瓣法,26例使用微创手术...     

自体骨复合多孔支架上颌窦提升同期种植体植入的实验研究

目的:观察聚乳酸材料PLA/PGA在同期植入种植体时的成骨效应及种植效果。方法:将预制成形的PLA/PGA材料,通过上颌窦提升术植入新西兰兔的上颌窦中,同期植入钛种植体,术后4、8、12周进行X线检查观察成骨情况,12周全部处死通过大体、组织学及电镜观察成骨及种植效果。结果:在所有植入PLA/PGA材料的兔上颌窦都有新鲜成熟骨形成,在同期植入的种植体稳定与新形成骨紧密结合,同时材料本身完全吸收。结论:自体骨复合多孔支架上颌窦提升同期种植体植入具有简便高效易行的优点。     

上颌磨牙区新鲜拔牙创骨质条件不良的即刻种植

目的探讨在上颌磨牙区上颌窦底骨质菲薄的拔牙创,开展即刻种植的可行性。方法收集上颌磨牙区上颌窦底骨质间隔 菲薄的拔牙病例,实施同期上颌窦底内提升并即刻种植,观察植体初期稳定性的形式及效果,观察伤口生长及植体愈合情况,观 察上颌窦的变化情况。术后六个月制作并佩戴种植牙冠,观察咀嚼功能恢复情况,MCT观察牙槽骨质生长情况并测试比较手 术前后牙槽骨的变化。结果共收集32例上颌窦底骨质薄弱的上颌磨牙区拔牙病例实施即刻种植,平均年龄59.8岁。植体长 度8.5~10 mm,直径4.5~5.5 mm。植体的最小就位扭力仅依靠手指就位能够维持静立不动,最大就位扭力达到30 Ncm。术后 过程平稳,无植体松动失败。术后6月,上颌窦未见异常表现,完成种植牙冠制作佩戴,恢复咀嚼功能良好。随访时间12~96月, 成功率100%。治疗前后,颊、腭及近、远中牙槽嵴高度变化差值分别为0.8069±0.6253（t=1.2904, P>0.1）、0.5275±0.3331（t= 1.5836, P>0.05）、0.5416±0.4048（t=1.3379, P>0.05）、0.5172±0.3874（t=1.3351, P>0.05）mm,牙槽嵴宽度变化差值为0.5522± 0.4381（t=1.2604, P>0.1）mm,术前后牙槽骨尺寸变化差异没有统计学意义（P>0.05）。结论在上颌磨牙区拔牙创骨质条件欠 佳、上颌窦底骨质薄弱的情况下实施即刻种植,即可以避免损伤上颌窦底粘膜又能达到良好的种植效果。手术过程简单、创伤 小,充分利用了现存牙龈以及牙槽嵴的有利条件,维持了牙槽嵴的形态,避免了延期种植的缺陷和不足。