种植牙修复牙列缺损30例临床效果观察

目的:观察ITI Straumann等常用牙种植系统在常见牙列缺损修复中的临床效果.方法:牙列缺损患者30例.植入ITI Straumann等常用牙种植体60枚,其中3例行上颌窦内提升术.2～6个月后行上部结构修复,定期随访,检查种植体骨结合状况、种植体周围软组织与修复体情况.结果:本组病例经修复后1～3年的临床观察,种植成功率100%,仅一例患者上部修复体在修复后1年出现基台松动,其余患者各项评价指标良好.结论:牙种植技术在常见牙列缺损修复方面具有美观舒适、不损伤余留牙、咀嚼效果好等优点,是一种良好的修复方法.     

SLA表面种植体修复牙列缺损8年疗效观察

目的:评价SLA表面种植体固定修复牙列缺损的8年临床应用效果.方法:对130例在烟台市口腔医院种植科要求种植修复牙列缺损的患者,植入SLA表面处理种植体191颗,定期临床及放射学检查,记录种植体存留率、成功率、种植体周围软、硬组织状况及上部结构的稳定性.采用SPSS 17.0软件包对数据进行统计学分析.结果:24例患者的31颗种植体失访,1颗种植体在术后5个月时因松动取出,4颗种植体出现种植体周围炎,种植体失访率、存留率、成功率分别为18.46％、99.38％和96.88％.种植成功的155颗种植体,8年内未出现明显的生物学并发症,种植体边缘骨吸收平均为(1.34±0.52)mm.8年内共25颗种植体出现螺丝松动、冠脱落、崩瓷、种植体折断等机械性并发症,修复体成功率为83.87％.结论:SLA表面种植体不仅能够达到较好的骨结合,而且种植体周围软组织及上部结构能够长期保持健康稳定的状态,临床应用效果较好.     

迷你种植系统修复前牙牙列缺损的应用分析

目的 临床评价应用迷你(MS)种植体修复前牙区窄小牙槽嵴部位牙列缺损的临床疗效。方法 选择2008年1月—2009年12月在我院种植中心接受前牙区窄小牙槽嵴部位种植MS种植体的患者39例,共42颗种植体,其中男18例、女21例,年龄25～55岁。术后每3个月复查1次,观察MS种植体植入后种植体周围软组织愈合情况、骨结合及骨吸收的多少等。连续观察1～2年。结果 42颗MS种植体未发现有松动或脱落,MS种植体周围软组织稳定、愈合良好,未见发生种植体周围组织病变。种植义齿修复后外形良好,患者满意。结论 MS种植体用于修复前牙区窄小牙槽嵴部位的临床疗效良好,值得推广。     

Replace种植系统的临床应用及效果评价

目的探讨Replace种植系统的临床修复效果。方法57例患者植入Replace Select Tapered种植体102枚,3～4个月(下颌)或4～6个月(上颌)后行固定义齿修复,评价修复效果。结果植入3年后,1例因反复感染并发种植体周围炎性骨吸收而予以拔除,其余均获成功,成功率为99.02%。结论Replace种植系统行固定义齿种植修复能获得满意的效果,是一种有效的牙列缺损(缺失)修复方法。     

15例上颌前牙种植的美学临床研究

目的：评价ITI种植系统用于上颌前牙列缺损修复的临床应用和短期疗效并总结牙种植治疗中的经验教训。方法：50例患者的缺牙区植入ITI种植体78颗并完成义齿修复,临床观察12～36个月,其中15例为上颌前牙区种植美学修复。6例上颌植入区骨量不足者,用Bio-Oss人工骨粉植入缺损区及Bio-Gide可吸收生物膜覆盖。结果：50例患者总共78颗种植体稳固无松动,种植部位无疼痛或不适,短期种植成功率100%。2颗上颌前牙种植修复后牙龈乳头缺失。患者满意度为92.3%。结论：ITI种植系统在牙列缺损修复中有的成功率很高,但患者对前牙缺损修复美学效果要求也越来越高,软组织的处理对最后的美学效果十分重要。     

上置法植骨延期种植13例临床报道

目的:评价上置法植骨延期种植的临床效果,提高种植的成功率。方法:选择牙槽骨骨量不足的牙列缺损患者,采用上置法植骨,并延期完成种植义齿修复,观察种植义齿周围骨、累积成功率的变化。结果:采用上置法植骨延期种植的13例患者的牙槽骨垂直高度增加了3.4mm±0.46mm,牙种植体周围骨吸收小于0.1mm/年,累积成功率为95.2%。结论:上置法植骨延期种植有利于提高牙槽骨高度不足的种植患者的成功率。     

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提要：口腔种植在牙列缺损、牙列缺失的修复中能获得良好的功能性、稳定性及美观性。尽管种植技术已经非常成熟,但在临床上仍出现一些影响种植体存活时间和使用效果的并发症。其中种植体周围骨吸收作为常见并发症之一,如不能及时控制,将严重影响种植体的成功率及存活率。本文就种植体周围骨吸收原因进行分析并提出一些处理的办法。     

自主式口腔种植机器人牙列缺损种植修复的临床回顾性研究

目的:回顾性分析自主式口腔种植机器人(ADIR)牙列缺损种植修复随访1年的临床疗效。方法:纳入20例自主式口腔种植机器人牙列缺损种植病例,分析术后种植体的肩部偏差、颈部偏差和角度偏差。测量并记录修复后即刻、修复后6、 12个月种植体边缘骨高度和种植体周围软组织情况。结果:20颗种植体的肩部偏差、根部偏差以及角度偏差分别是(0.34±0.11) mm,(0.34±0.15) mm,(0.82°±0.38°),且不同种植体直径和长度的对精度的影响无统计学意义(P>0.05)。随访期内,所有植体周围边缘骨高度稳定,均获得良好骨结合,种植体周围软组织情况良好。结论:ADIR在牙列缺损种植修复1年内应用效果良好,但仍需长期的随访研究验证。     

Ankylos小直径种植体修复后牙区牙列缺损的效果评价

目的评价Ankylos小直径种植体修复后牙医牙列缺损的临床效果,探讨小直径种植体应用于后牙区的适应证及注意事项、、方法选择后牙区牙列缺损需行种植修复而无法植入标准直径种植体的患耆24例．植入商径3．5mm Ankylos种植体兵35枚,3～4个月后行金属烤瓷冠单冠或联冠修复,修复完成后1、3、6个月复诊,之后每半年复诊1次。复诊时检测种植体周围边缘骨水平、软组织健康状况及各种机械并发症。结果随访时间为完成修复后6～30个月。随访期内所有种植体行使功能良好,种植体周围边缘骨水平为－0．6mm至＋0．3mm,软组织健康状况良好,未发现机械并发症。结论应用Ankylos小直径种植体修复后牙Ⅸ牙列缺损可获得良好的短期临床效果;窄牙槽嵴、缺牙区近远中修复间隙不足和邻牙牙根间距离近是小直径种植体的主委适应证.     

BLB种植系统的临床应用及疗效观察

目的评价BLB种植系统的临床效果.方法用BLB种植系统进行延期或即刻种植,采用一期埋入,二期暴露的二次手术方式,对337例患者植入555枚种植体.金属烤瓷冠修复,其中6例患者20枚行全口义齿的球帽及杆卡可摘义齿修复,临床随诊观察一至四年.结果种植成功率95.4%,种植体周围齿槽骨水平吸收＜0.2 mm/年.修复基台松动7枚,烤瓷冠中央螺丝松动38枚,烤瓷冠崩瓷6枚,种植体周围炎24例;球帽式总义齿修复有2例4枚半年后义齿固位力下降,球基台发生磨损;杆卡式总义齿修复效果良好.结论 BLB种植体适合于常见的牙列缺损及牙列缺失的种植修复.     

The causes of early implant bone loss: myth or science?

The success of dental implants is highly dependent on integration between the implant and intraoral hard/soft tissue. Initial breakdown of the implant-tissue interface generally begins at the crestal region in successfully osseointegrated endosteal implants, regardless of surgical approaches (submerged or nonsubmerged). Early crestal bone loss is often observed after the first year of function, followed by minimal bone loss (< or =0.2 mm) annually thereafter. Six plausible etiologic factors are hypothesized, including surgical trauma, occlusal overload, peri-implantitis, microgap, biologic width, and implant crest module. It is the purpose of this article to review and discuss each factor Based upon currently available literature, the reformation of biologic width around dental implants, microgap if placed at or below the bone crest, occlusal overload, and implant crest module may be the most likely causes of early implant bone loss. Furthermore, it is important to note that other contributing factors, such as surgical trauma and penimplantitis, may also play a role in the process of early implant bone loss. Future randomized, well-controlled clinical trials comparing the effect of each plausible factor are needed to clarify the causes of early implant bone loss.     

前牙美学区即刻种植即刻美学修复的临床观察

目的：探讨前牙关学区即刻种植即刻美学修复的临床特点及修复后的美学效果。方法：18例患者22枚m和Replace种植体前牙区即刻种植即刻临时冠修复,对种植体成功率及周围牙龈附着状况进行观察,6个月后永久冠修复。结果：1枚种植体在愈合期内脱落,其余种植体在修复后12个月时均有骨结合,临床效果良好。结论：前牙美学区即刻种植即刻美学修复时多因素可影响种植体的成功率及软组织美学效果,严格掌控适应证,才能获得理想的美学效果。     

A 10-year prospective study of ITI dental implants placed in the posterior region. I: Clinical and radiographic results

OBJECTIVES: To evaluate the long-term fixture success rate, crestal bone loss and peri-implant soft tissue parameters around ITI dental implants placed in the posterior region of partially edentulous patients. MATERIAL AND METHODS: A total of 192 ITI dental implants were consecutively placed in premolars and molars of 83 partially edentulous patients admitted for treatment at Geneva Dental School. All implants were restored by means of ceramic-to-metal fused fixed partial dentures and single crowns. Patients were followed as part of a prospective longitudinal study focusing on implant success. Surgical, radiographic and clinical variables were collected at the 1-year recall after implant placement and at the most recent clinical evaluation. RESULTS: The mean observation time was 6 years (range 5-10 years). Four implants failed, yielding a 10-year cumulative survival rate of 97.9%. The mean annual crestal bone loss was -0.04+/-0.2 mm. Hollow-cylinder implants displayed more crestal bone loss (-0.13+/-0.24 mm) than hollow-screw implants (-0.02+/-0.19 mm; P=0.032). Clinical parameters such as age, gender, implant length and bone quality did not affect crestal bone levels. Increase in recession depth (P=0.025) and attachment level (P=0.011) were significantly associated with crestal bone loss. CONCLUSIONS: ITI dental implants placed in the posterior jaw demonstrate excellent long-term clinical success. Hollow-cylinder implants seem to display a higher risk for crestal bone loss. Recession depth and attachment levels appear to be good clinical indicators of peri-implant bone loss.     

Scalloped dental implants: a retrospective analysis of radiographic and clinical outcomes of 17 NobelPerfect implants in 6 patients

Background: The scalloped dental implant (NobelPerfect^TM, Nobel Biocare, Yorba Linda, CA, USA) is designed to biologically guide and facilitate interproximal bone remodeling during healing and to maintain bone height and papillae during functional loading. The design features of the scalloped implant include hard and soft tissue apposition areas, which are parallel to each other and mirror the cementoenamel junction. The hard tissue surface area is intended for osseointegration. The soft tissue surface area is meant to support the connective tissue zone and to provide a space for the subgingival margin of the restoration. Current literature on the clinical performance of the scalloped dental implant is limited. Purpose: The aim of this study was to evaluate whether the scalloped dental implant maintains interproximal bone and the overlying soft tissue. Materials and Methods: Radiographs for six patients (mean age 40.5 years) treated with 17 implants (NobelPerfect) were reviewed for an 18‐month follow‐up evaluation of bone response. Orthodontic movement and/or autogenous bone augmentation had been provided to obtain the best possible soft and hard tissue dimensions prior to implant placement. A surgical guide was used for an optimal implant placement. No surgical flap was reflected, and implants were placed a minimum of 2 mm and a maximum of 3 mm apical (midbuccally) to the most apical portion of the surgical guide. Final optimal rotational alignment was achieved in all cases by not exceeding 45 Ncm. Implants were immediately restored with provisional crowns. Photographic documentation provided the basis for analysis of papillary response. Radiographic change in the interproximal bone level was obtained by computer analysis (ImageJ for Windows, National Institutes of Health, Bethesda, MD) by measuring the distance from the interproximal shoulder of the scalloped implant to the crest of the bone. Results: When the scalloped implants were placed adjacent to existing natural dentition, the average bone level at placement and at 6, 12, and 18 months was ?1.7, ?3.5, ?3.8, and ?3.9 mm, respectively, compared with ?1.0, ?3.6, ?4.3, and ?4.4 mm respectively, when placed adjacent to other scalloped implants. Papillae formation exhibited no differences from the configuration that typically results after placement of conventional dental implants. Moreover, bone loss around the scalloped implants was notably greater than that expected after traditional implant placement. Conclusion: This chart review of 17 scalloped implants, followed for 18 months, determined that the scalloped implant design resulted in bone loss that was more severe than that associated with properly placed conventional dental implants. Further, the design showed no evidence of exceptional capacity to increase or maintain soft tissue height.     

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.     

Impact of excessive occlusal load on successfully‐osseointegrated dental implants: a literature review

The aim of the present study was to review the available evidence on the response of the peri‐implant bone when subjected to excessive occlusal forces. The search strategy included papers published in English in the Medline database and the Wiley Online Library from January 1991 to December 2011. Experimental or review papers reporting the conditions of the peri‐implant bone of dental implants submitted to excessive occlusal loading in the presence of a controlled oral hygiene regime were eligible for inclusion. The knowledge regarding the response of the peri‐implant bone when the dental implant is excessively loaded is limited, and the level of evidence is poor. With animal experimental studies showing conflicting results, it is unclear whether occlusal overload might cause marginal bone loss or total loss of osseointegration to already osseointegrated dental implants when the applied load exceeds the biologically‐acceptable limit. This biological limit is also unknown. Furthermore, higher remodeling activity of the peri‐implant bone is found around implants subjected to high loading forces.     

Trausim种植体植入早期骨结合性能评价

目的:研究Trausim骨内种植体植入早期骨改建过程,检测该骨内种植体的骨结合性能,为其表面处理技术的改进及临床应用提供依据。方法:全麻下拔除14条成年Labrador犬双侧下颌第一前磨牙至第一磨牙(PM1-M1),待拔牙创愈合3个月后,每条犬双侧下颌骨植入6颗骨内种植体,其中一侧为实验组,植入Trausim种植体3颗;对侧为对照组,植入Straumann种植体3颗,非埋入式缝合。实验犬分别于2、4、8、12周处死,取含种植体的骨块,经处理后,行硬组织切片。染色后,行组织学检查,计算骨-种植体结合率(bone-implant contact,BIC%)。采用SPSS 19.0软件包对数据进行统计学处理。结果:84颗种植体在植入时都取得了良好的初期稳定性,愈合良好,无脱落。骨-种植体结合率在8周时达到最高值,Trausim种植体为71.64%±6.66%,Straumann种植体为72.98%±8.97%。第12周稍有降低,达到稳定。2种种植体在不同时期的骨结合率无显著差异(P>0.05)。结论:Trausim种植体在植入早期愈合过程与Straumann种植体骨结合率相似,为其临床应用奠定了坚实基础。     

Effects of Flapless Implant Surgery on Soft Tissue Profiles: A Prospective Clinical Study

Background: Flapless implant surgery has been suggested as a suitable treatment modality for the preservation of soft tissue after implant placement. Purpose: The purpose of this study was to determine the extent of soft tissue profile changes around implants after flapless implant surgery. Materials and Methods: A total of 44 patients received 76 implants using a flapless implant procedure. The marginal level of the peri‐implant soft tissue was evaluated using dental casts 1 week, 1 month, and 4 months after implant placement. Results: The mean soft tissue levels around implants showed 0.7 ± 0.3 mm of coronal growth 1 week after surgery. At 1 month, the levels were 0.2 ± 0.2 mm coronal growth and at 4 months, the values were 0.0 ± 0.3 mm. Soft tissue profiles assessed 4 months after flapless implant placement were similar to profiles assessed immediately before implant placement. Conclusion: Flapless implant surgery is advantageous for preserving mucosal form surrounding dental implants.     

创伤性牙缺失伴骨缺损的种植修复临床探讨

目的:观察口腔颌面部严重创伤后牙缺失伴骨缺损的种植修复临床效果。方法:颌面部严重创伤后牙缺失伴骨缺损患者20例,其中多颗牙连续缺失者12例,共植入ITI Straumann等常用牙种植体65枚,其中5例行骨劈开+骨挤压+骨引导再生(guided bone regeneration,GBR)技术。2～6个月后行上部结构修复,定期随访,检查种植体骨结合情况、种植体周围软组织与修复体情况。结果:本组病例修复后经1～5年的临床观察,除1例所植入的5枚种植体中的1枚,在修复后3年脱落,其余患者各项评价指标均良好,种植体存留率为98%。结论:颌面部严重创伤后的牙列缺损,尤其多颗牙的连续缺失,很难采用其他固定修复方法来完成。种植修复具有不损伤余留牙、美观舒适、咀嚼效果好等优点,是一种良好的修复方法。