两种上颌窦底提升术的短期临床效果研究

目的    研究上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm时，行经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的短期临床效果。方法    选择2016年1月至2018年12月于西安交通大学口腔医院种植科行经牙槽嵴顶上颌窦底提升和侧壁开窗上颌窦底提升同期种植体植入的患者45例（50侧上颌窦，上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm），于术前、术后当日或术后第2天及术后6 ~ 9个月的愈合期后行影像学检查，比较两种术式的上颌窦底新骨形成高度、上颌窦底黏膜穿孔率及种植体早期成功率。结果   采用经牙槽嵴顶上颌窦底提升或侧壁开窗上颌窦底提升同期种植体植入的分别有19例和26例（上颌窦分别为21、29侧）患者；上颌窦底黏膜穿孔率分别为4.76%和0，差异无统计学意义（P > 0.05）。经过6 ~ 9个月的愈合期，两种术式上颌窦底新骨形成高度分别为（5.18 ± 0.48）mm和（7.32 ± 0.84）mm，差异有统计学意义（P < 0.05）；两种术式种植体早期成功率分别为95.83%和100%，差异无统计学意义（P > 0.05）。结论    当上颌后牙区剩余牙槽骨高度为3 ~ < 4 mm时，两种术式均安全可靠，早期成功率高。     

口腔手术显微镜联合锥形束CT辅助治疗上颌第一前磨牙遗漏远颊根管1例报告

遗漏根管是根管治疗失败的常见原因,避免根管遗漏对提高根管治疗成功率至关重要。上颌第一前磨牙根管解剖形态变异较大,多为颊腭双根管或单根管,极少存在三根管[1]。研究表明,汉族人上颌第一前磨牙三根管的发生率为0.2%~1.8%[2-4]。如何识别可能存在的遗漏第三根管是上颌第一前磨牙根管治疗过程中的难点。本文报道了1例口腔手术显微镜联合锥形束CT(CBCT)辅助治疗上颌第一前磨牙根管治疗中远颊根管遗漏的病例,以期为临床治疗提供参考。     

上颌窦内提升术在口腔种植修复治疗对患者种植体成功率和牙周健康状况影响

目的 探讨口腔种植修复中采用上颌窦内提升术对种植体成功率及牙周健康指标的影响。方法 选取2014年6月—2016年1月山东省青岛疗养院收治的上颌前磨牙或磨牙缺损实施口腔种植修复治疗的患者80例进行回顾性分析。根据治疗方法分为A组40例（采用上颌窦内提升术实施种植修复）、B组40例采用常规种植修复技术。对比两组术后1年、2年种植体留存率、术后不同时间点种植体周围骨吸收量、牙周菌斑指数、探诊深度、龈沟出血指数。结果 术后1个月、术后6个月和术后12个月A组患者的种植体周围骨吸收量显著的高于B组；术后24个月，A组和B组患者的种植体周围骨吸收量差异不具有统计学意义；术后6个月，A组患者的牙周菌斑指数、探诊深度、龈沟出血指数均显著的低于B组；术后1年，A组和B组患者的种植体留存率比较，差异不具有统计学意义；术后2年，A组患者的种植体留存率96.00%高于B组患者的83.02%。 结论 口腔种植修复中采用上颌窦内提升术有利于促进种植体周围骨吸收、提高种植体的留存率、降低种植修复对牙周健康的损害程度。     

Surgically assisted rapid maxillary expansion: a systematic review of complications

A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing ‘maxillary expansion’, ‘palatal expansion’, ‘SARME’, or ‘SARPE’ and that reported sufficient data for ‘complication’ were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.     

Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor

ObjectivesThis study correlates objective and subjective measurements associated with obstructive sleep apnea (OSA) to define the efficacy of Distraction Osteogenesis Maxillary Expansion (DOME) to treat adult OSA patients with narrow maxilla and nasal floor.MethodsThis is a retrospective study reviewing cases from September 2014 through April 2018 with 75 eligible subjects. Inclusion criteria required OSA confirmed by attended polysomnography (PSG). Pre- and Post-operative clinical data were measured at the Stanford Sleep Medicine and Stanford Sleep Surgery Clinics. DOME is a two-step process starting with insertion of custom-fabricated maxillary expanders anchored to the hard palate by mini-implants followed by minimally invasive osteotomies. After maxillary expansion was complete, orthodontic treatment to restore normal occlusion was initiated. Perioperative Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Nasal Obstruction Symptom Evaluation (NOSE), and Oxygen Desaturation Index (ODI) were measured for 43, 72, 72, and 34 subjects respectively. Statistical analysis was performed using paired T-test with significance set at p-value < 0.05.ResultsThe mean age of test subjects was 30.5 ± 8.5 years with a gender distribution of 57 males and 18 females. There was a significant reduction in pre and post-operative NOSE score (10.94 ± 5.51 to 3.28 ± 2.89, p < 0.0001), mean ESS score (10.48 ± 5.4 to 6.69 ± 4.75, p < 0.0001), and AHI (17.65 ± 19.30 to 8.17 ± 8.47, p < 0.0001) with an increased percentage of REM sleep (14.4 ± 8.3% to 22.7 ± 6.6%, p = 0.0014). No significant adverse effects were identified.ConclusionsDOME treatment reduced the severity of OSA, refractory nasal obstruction, daytime somnolence, and increased the percentage of REM sleep in this selected cohort of adults OSA patients with narrow maxilla and nasal floor.     

外科正畸联合治疗对上颌埋伏尖牙的疗效分析

目的：探讨和分析外科正畸联合治疗对上颌埋伏尖牙的疗效。方法将85例上颌埋伏尖牙患者随机分为观察组和对照组，观察组45例，采用外科正畸联合治疗的方式矫正上颌埋伏尖牙；对照组40例，采用正畸固定技术矫正上颌埋伏尖牙。对2组患者的治疗效果进行比较和分析。结果观察组全部患者在手术后3～10个月内埋伏尖牙矫正至正常位置，平均萌出时间为（6.1±2.0）个月，出现1例牙周附着不足，2例龈缘萎缩。对照组25例患者在术后3～11个月内埋伏尖牙矫正至正常位置，平均萌出时间为（6.6±2.4）个月，15例患者埋伏尖牙未萌出，无1例并发症发生。2组患者埋伏尖牙的萌出率相比差异具有统计学意义（P<0.05）。结论外科正畸联合治疗上颌埋伏尖牙萌出率高，埋伏尖牙可得到有效矫正，值得临床推广使用。     

上颌骨性扩弓器在上颌骨横向发育不足中的应用及优势

文题释义： 上颌骨横向发育不足：是许多错牙合畸形的常见伴发症状，青少年发病率为8%-23%，成人正畸患者发病率约为10%，常表现为上颌基骨及牙弓狭窄、腭盖高拱、单侧或双侧后牙反或对刃、颊廊过大等。 上颌骨性扩弓器：通过4颗穿透双层骨皮质(腭骨和鼻底)的微种植体的辅助，将特制的螺旋扩弓器固定在硬腭后部，使螺旋扩弓器产生的扩弓力直接作用于上颌骨而不是牙列，从而产生骨性扩弓效应。 背景：上颌骨性扩弓器是一项上颌骨非手术扩弓技术，与传统的上颌快速扩弓器、微种植体辅助上颌快速扩弓和外科手术辅助上颌快速扩弓截然不同，为上颌骨横向发育不足的矫治提供了新思路、新方法，尤其为生长发育完成的成年患者提供了高效且微创的骨性扩弓效果。 目的：通过检索、筛选和阅读大量文献的方法，对上颌骨性扩弓器在上颌骨横向发育不足中的应用及优势进行系统性综述，为该类患者临床治疗方案确定提供科学的参考依据。 方法：对Cochrane图书馆、PubMed、Embase、Web of Science、中国学术期刊全文数据库(CNKI)、万方数据库(Wanfang)、中国生物医学文献数据库(CBM)等国内外常用数据库进行计算机检索，全面收集2019-05-31之前发表的与上颌骨性扩弓器相关的中英文文献。 结果与结论：上颌骨性扩弓器是矫治上颌骨横向发育不足的一种有效方法，其扩弓不受年龄限制，对于成人依然有良好的骨性扩弓效果。上颌骨性扩弓器使整个面中部结构扩张，导致腭中缝接近平行扩大，翼腭缝裂开，颧骨间宽度增加，包括鼻骨上区在内的整个鼻腔变宽，且牙齿颊倾、牙槽骨高度降低等不良反应较小。 ORCID: 0000-0001-7741-6045(张肖雅) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程