下颌无牙颌萎缩牙槽嵴的种植义齿修复

目的：探索对下颌无牙颌严重萎缩牙槽嵴的修复方法，以提高该类患者的生活质量。方法：采用CDIC种植体，对下颌无牙颌进行杆卡式种植覆盖义齿修复。结果：经过5年的临床观察．种植体稳固，义齿功能优良．明显提高了患者的生活质量。结论：对下颌无牙颌严重萎缩牙槽嵴的患者，采用种植覆盖义齿进行修复，通过精心的设计和优良的手术，能有效地恢复功能，并能使种植体长期稳固于口腔内行使功能。     

松软牙槽嵴无牙颌的全口义齿修复

目的 探讨松软牙槽嵴无牙颌的全口义齿修复要点.方法 选择松软牙槽嵴无牙颌患者31例.修复前询问患者义齿使用习惯,检查口腔及旧义齿情况,进行必要的修复前手术,择期重新修复.在修复后6个月、1年、2年后复查,根据病历记录检查患者口腔和义齿情况是否有改变.结果 义齿修复后的2年中,牙槽嵴的松软范围没有明显扩大,义齿使用效果良好.结论 伴有松软牙槽嵴的无牙颌全口义齿修复时,应该注重印模的准确性、前牙与牙槽嵴顶的位置、前牙的覆(牙合)与覆盖,指导患者正确使用义齿并定期复查,可取得良好治疗效果.     

用盘钻经牙槽嵴提升上颌窦底手术的临床效果观察

目的 观察并评估应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术的临床效果.方法 上颌后牙缺失患者37例,种植区剩余牙槽骨高度为3～8 mm,平均(5.61±1.61) mm,应用盘钻行上颌窦底提升,同期植入种植体51枚,评估手术安全性及舒适度.术后3～6个月行上部结构修复,随访3～24 个月,观察种植体稳定性、骨结合及种植体周围骨量变化情况.结果 本组术中提升上颌窦底高度2～8 mm,平均(4.75±1.55) mm;所有病例均未发生上颌窦黏膜穿孔,患者主观感觉良好,痛苦指数为(2.22±0.98).随访期内,所有病例均未出现上颌窦感染等并发症,骨结合良好,种植体及修复体无松动、脱落,留存率100%.种植体根方骨量于术后6个月趋于稳定,术后1年颈部骨吸收(1.20±0.72) mm.结论 应用盘钻行经牙槽嵴上颌窦底提升同期种植体植入术,近期效果满意.

Abstract：

Objective To evaluate the clinical effect of the disk-up sinus reamer (DSR) applied to transcrestal maxillary sinus floor elevation with simultaneous placement of implants. Methods Thirty-seven patients underwent transcrestal maxillary sinus floor elevation with fifty-one implants placed simultaneously using the DSR. The residual bone height(RBH) was 3 to 8 mm, (5.61±1.61) mm on average. The safety of this technique and the pain index during the operation was evaluated. The final prostheses were restored in 3-6 months postoperatively. The follow-up period was 3 to 24 months. The stability and osseointegration of the implants were clinically evaluated, and the endo-sinus bone gain around the implants were measured. Results The elevation height ranged from 2 to 8 mm, with an average of (4.75±1.55) mm. There was no detectable sinus membrane perforation, no serious suffering or uncomfortable subjective sensation in any patients during operation with a pain index of (2.22±0.98). During the follow-up period, no sinus complication was observed. Favorable osseointegration was obtained. There were no implants or prostheses which were loose or lost. The survival rate was 100%. The radiographic results demonstrated that the endo-sinus bone gain tended to reach stabilization after 6 months and the marginal bone loss was(1.20±0.72) mm after 12 months. Conclusions Transcrestal maxillary sinus floor elevation with simultaneous implant placement by DSR is a safe, invasive and handy technique, with higher elevation height,fewer clinical complications and less pain. It shows satisfactory clinical results in short term and a long-term observation is still needed.     

增强无牙颌牙槽嵴低平义齿固位的体会

全口义齿修复足口腔修复治疗的重要组成部分.而牙槽嵴低平或牙槽嵴条件差,又无经济条件做牙槽嵴增高术或种植牙者而又要使修复后的全日义齿达到患者满意,则是全口义齿修复领域的重要课题.我科自1995年到1999年对口腔修复门诊52例此类病人进行厂修复与跟踪,积累了一些经验和体会.今就此类修复困难病例的处置方法及修复效果报导如下:     

骨挤压钻法穿牙槽嵴上颌窦底提升的临床效果观察

目的 观察并评估应用骨挤压钻法穿牙槽嵴上颌窦底提升的临床效果。方法 收集2022年5月至2023年5月就诊于重庆医科大学附属口腔医院种植科,应用骨挤压钻法行穿牙槽嵴上颌窦底提升并同期植入种植体的病例39例,女性21例,男性18例,年龄21～73岁,平均（51.67±11.68）岁。术后6个月行永久修复。术前（T0）、术后即刻（T1）及术后6个月（T2）拍摄锥形束CT(cone beam computed tomography, CBCT),对种植位点的窦底剩余骨高度（residual boneheight,RBH）、骨密度（bonedensity,BD）及窦底垂直骨高度（verticalboneheight,VBH）等进行测量并比较。功能负荷前测量种植体稳定性（implantstability,IST）、计算上颌窦底黏骨膜穿孔率以及种植体留存率并进行统计学分析。结果 39例患者共植入种植体53颗。T0牙槽骨高度为3.38～9.40 mm,平均（6.16±1.00） mm,T1和T2的牙槽骨高度分别为（11.25±1.10） mm和（10.36±0.99） mm。不同时间点观测的牙槽骨高...     

上颌窦开放式提升牙槽嵴骨增量技术应用体会

目的：总结上颌窦开放式提升临床应用体会。方法：8例患者11个上颌窦进行了上颌窦开放式提升并植入骨替代材料。其中7个上颌窦采用自体骨加Bio-Oss小牛骨粉混合后植入，4个上颌窦单纯采用Bicr-Oss小牛骨粉植入．术后1、3、6、9个月摄颌骨全景片观察骨再生和改建情况。结果：术后6—9个月，X光片显示上颌窦内骨替代材料完成骨改建、单纯采用小牛骨粉植入者骨的再生和改建略慢于混合植入者。所有患者皆6—9个月内顺利完成了种植体植入及修复。结论：采用开放式提升技术进行上颌骨后部的骨增量是一种很有效的手术方式。     

细小种植体在剩余牙槽嵴吸收的无牙颌患者的成功率

目的：在剩余牙槽嵴吸收的无牙下颌上进行修复治疗，目前对临床医生仍然是一个巨大的挑战。尽管对此类病例种植体支持的义齿有很好的稳定性和实用性，开展治疗往往仍存在问题。问题不仅限于此类病例往往存在义齿承托区过窄的困难，而且老年病人往往无法接受采用进一步手术来改善牙槽嵴条件。     

52例牙槽嵴重度吸收的全口义齿修复效果观察

目的：对牙槽嵴重度吸收的无牙颌患者，采用试排牙时闭口式二次印模法，针对性的精细排牙以及良好的基托磨光面形态，观察修复效果。方法：选取52例牙槽嵴重度吸收的无牙颌患者，用托牙基底板做颌托基托，采用试排牙时闭口式二次印模法，人工排牙时注意中性区位置，基托磨光面形态呈凹面型，完成注塑全口义齿修复，观察临床效果。结果：通过该方法制作的全口义齿固位力明显增强，很少发生黏膜压痛，取得了较满意的临床效果。结论：对牙槽嵴重度吸收的无牙颌患者，采用试排牙时闭口式二次印模法，细致的个性排牙，以及良好的基托磨光面的形态，有助于提高全口义齿的固位功能、封闭功能和舒适性。     

牙槽嵴黏骨膜扩增术应用于牙槽嵴增高的研究

目的 :了解牙槽嵴黏骨膜扩增术对牙槽嵴增高的长期或短期效果的影响及相关影响因素。方法 :170只新西兰大耳白兔建立萎缩性牙槽嵴模型和卵巢切除术模型 ,按牙槽嵴黏骨膜扩张模式和类型随机分成 18组 ,采用Teflone扩张器进行黏骨膜扩张 ,并对各观察时段牙槽骨骨组织和软组织的变化进行比较研究。结果 :植入区牙槽嵴软硬组织的变化与扩张强度和扩张频率呈正相关性 ,卵巢切除组各观察时段内牙槽嵴软硬组织变化均显著高于非卵巢切除组。结论 :黏骨膜扩增术对植入区牙槽嵴软硬组织均存在一定程度的不利影响 ,适宜的黏骨膜下扩张模式的选择对于牙槽嵴增高效果具有重要意义     

翼上颌区种植体联合前部种植体修复萎缩上颌无牙颌的临床回顾研究

目的 评估翼上颌区种植体联合前部种植体修复后部萎缩的上颌无牙颌的短期临床效果及患者的满意度.方法 回顾性研究筛选25例行前部和翼上颌区种植体支持的上颌固定修复并随访1年以上的上颌无牙颌患者作为研究对象,观察种植体存留率、种植体周软组织状态(包括探诊深度,改良龈沟出血指数,菌斑指数)、边缘骨吸收以及患者的满意度.结果 前...     

上颌中空式赝复体的改良制作

目的:降低赝复体的制作难度,提高赝复体的临床疗效.方法:选择单侧上颌骨缺损的患者11名,应用改良式赝复体修复缺损,评价疗效.结果:11名患者均对外观的恢复效果表示满意;口鼻腔通道封闭严密.制作技师认为降低技工室的制作难度.有利于临床医师制取理想颌位记录.结论:采用改良方式制作赝复体可较容易地获得一完整的中空式赝复体,降低了赝复体的制作难度.是一种对临床医师和技师均具有实用意义的修复体制作技术.     

Quality of life assessment in patients with implant-supported and resin-bonded fixed prosthesis for bounded edentulous spaces

OBJECTIVES: Dental implants have become increasingly popular in the prosthetic rehabilitation of patients with bounded edentulous spaces. Oral condition-related quality of life (QOL) levels have rarely been assessed in these patients. MATERIAL AND METHODS: Two groups of subjects with bounded edentulous spaces were studied: an implant-supported fixed prosthesis group (11 patients) and a resin-bonded fixed prosthesis group (33 patients). The two groups were well matched in terms of sex, age, missing units and location of missing units. The patients were requested to answer a self-administered QOL questionnaire with two major subscales - oral condition- and general condition-related QOL scores. The test-retest reliability of each question was pre-examined and found acceptable (mean Spearman rank correlation coefficient was 0.55 +/- 0.16). Mean QOL score differences between the two groups were analyzed by the Mann-Whitney U-test. RESULTS: Mean oral condition-related QOL scores of the implant-supported and resin-bonded fixed prosthesis groups were 87.8 +/- 9.5 and 87.1 +/- 12.3% (P = 0.85), and mean general condition-related QOL scores were 73.8 +/- 14.8 and 71.6 +/- 15.2% (P = 0.95), respectively. No significant QOL differences between the two groups were observed in the two subscales. CONCLUSION: In patients with bounded edentulous spaces, multidimensional QOL levels of patients with an implant-supported fixed prosthesis do not exceed those of patients with a resin-bonded fixed prosthesis in a short follow-up period.     

下颌牙列缺失固定种植修复的(牙合)学研究

目的 探讨下颌牙列缺失固定种植修复的咬合及肌电特点,为无牙颌固定种植修复的治疗提供参考。方法 选取60例下颌牙列缺失固定种植修复的患者,其中A组上颌为固定种植修复,B组上颌为天然牙列,C组上颌为可摘局部义齿,每组20例患者。使用T-scan记录4种颌位的咬合特点,采用肌电仪记录静息状态及牙尖交错位最大紧咬时颞肌前束和咬肌的电位变化,探讨咬合与肌电之间的联系。结果 咬合分析结果：C组的咬合接触时间、最大咬合力时左右侧咬合力平衡度及咬合力中心左右向偏移度、咬合力中心位移、前伸颌及侧方颌的咬合分离时间均大于A、B两组（P<0.05）,3组最大咬合力时咬合力中心前后向偏移度及前牙区咬合力百分比的差异均无统计学意义（P>0.05）。肌电分析结果：C组的静息状态下肌电幅值、牙尖交错位最大紧咬时咀嚼肌不对称指数大于A、B两组（P<0.05）,A、B组的牙尖交错位最大紧咬时肌电幅值大于C组（P<0.05）。结论 在下颌牙列缺失固定种植修复中,当上颌为可摘局部义齿时,咬合不稳定程度及咬合力中心偏移大于上颌为固定种植修复和天然牙列的患者。咬合与肌电息息相关,上颌可摘局部义齿可造成肌电活动增加,降低咀嚼肌的潜力,双侧肌电的不对称与咬合不平衡有关。     

全颌固定式种植义齿

目的：牙列缺失的种植义齿修复多采用覆盖义齿方式，但某些患者仍希望得到固定修复。Branemark的可拆卸固定全颌种植义齿技术复杂，美观清洁卫生等也不理想。本研究要建立一种牙列缺失的固定种植我齿修复模式。方法：11例有条件的无牙颌患者，在CDIC种植体支持基础上，用常规烤瓷溶附冠桥技术完全成颌固定式种植义齿修复。结果：1至5年的观察表明，该修复模式在咀嚼功能，美观性，舒适感及清洁卫生维护均获得满意结果。     

锥形束CT结合简易种植导板应用于上颌无牙颌种植修复的探讨

目的探讨锥形束CT（cone beam computed tomography,CBCT）影像结合简易种植导板定位应用于上颌无牙颌种植修复的效果。方法对8例拟行种植修复的上颌无牙颌患者术前拍CBCT,得到上颌骨多层次影像,通过测量分析确定种植修复方式,结合简易种植导板完成种植手术,定期随访。结果8例患者共植入39枚种植体,其中6例为种植覆盖义齿修复,共植入24枚种植体;2例为种植固定义齿修复,共植入15枚种植体。均无术中及术后并发症发生。12个月后CBCT检查未见明显骨吸收,种植体存活率100％。结论通过术中简易种植导板定位结合CBCT影像,手术安全可靠,种植体植入的位置较理想,为顺利完成上部修复创造有利条件。     

Brnemark种植义齿修复上颌全牙列缺失的临床评价

目的 :评价Branemark种植义齿修复上颌全牙列缺失3年后的临床效果。方法 :采用Branemark种植系统的常规操作方法 ,在I期手术 ,116枚Branemark种植体植入上颌全牙列缺失的16例患者,6个月后 ,进行II期手术 ,再经1周后 ,用固定可卸式修复体修复。结果 :Branemark种植体修复后3年 ,上颌累积成功率为91.1% ,修复体的稳定率为100%。结论 :Branemark种植义齿修复上颌全牙列缺失具有良好的临床效果。     

Clinical experiences of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw: a 5-year follow-up study

Background: Titanium frameworks have been used in the endentulous implant patient for the last 10 years. However, knowledge of titanium frameworks for the partially dentate patient is limited. Purpose: To report the 5-year clinical performance of implant-supported prostheses with laser-welded titanium frameworks in the partially edentulous jaw. Materials and Methods: A consecutive group of 383 partially edentulous patients were, on a routine basis, provided with fixed partial prostheses supported by Brånemark implants in the mandible or maxilla. Besides conventional frameworks in cast gold alloy, 58 patients were provided with titanium frameworks with three different veneering techniques, and clinical and radiographic 5-year data were collected for this group. Results: The overall cumulative survival rate was 95.6% for titanium-framework prostheses and 93.6% for implants. Average bone loss during the follow-up period was 0.4 mm. The most common complications were minor veneering fractures. Loose and fractured implant screw components were fewer than 2%. An observation was that patients on medications for cardiovascular problems may lose more implants than others (p <.05). Conclusions: The clinical performance of prostheses with implant-supported laser-welded titanium frameworks was similar to that reported for conventional cast frames in partially edentulous jaws. Low-fusing porcelain veneers also showed clinical performance comparable to that reported for conventional porcelain-fused-to-metal techniques.     

上颌后牙区无牙位点在锥形束CT中的解剖学表现

目的 基于锥形束CT（CBCT）分析上颌后牙区无牙位点的相关骨解剖特点。方法 本项研究共选取了上颌后牙区至少有一个缺牙的100名患者的CBCT图像资料,共217个无牙位点。测量无牙位点的剩余牙槽嵴高度、剩余牙槽嵴宽度和角度A,并分析上颌窦底的形态特点。结果 平均剩余牙槽嵴高度为9.53 mm,其中小于10 mm者占62.67%（136/217）。平均剩余牙槽嵴宽度为9.30 mm,大于6 mm占91.71%（199/217）。磨牙区剩余牙槽嵴高度小于前磨牙区,剩余牙槽嵴宽度呈相反趋势。上颌窦底形态以倾斜型（64.52%）为主。角度A小于30°、30°~60°和大于60°者分别占10.14%、42.40%和47.47%。结论 上颌后牙区缺牙位点进行种植手术前,多数需行上颌窦底提升手术增加骨量,建议根据CBCT检查结果评价上颌窦解剖结构从而制定合理的种植方案。     

Computed tomographic assessment of maxillary sinus wall thickness in edentulous patients

Posterior maxillary region is considered to be the most challenging area for dental implant placement. Lateral window opening is the gold standard procedure for maxillary sinus augmentation in this area. The purpose of this study is to evaluate lateral wall thickness of the maxillary sinus for sinus augmentation using computed tomography (CT) in edentulous patients. Computed tomography images of 302 patients were analysed. Using the maxillary sinus floor as the reference point in edentulous regions, lateral wall thickness was measured on CT scans. After drawing a tangent line at the lowest point of the sinus floor, another perpendicular line to the tangent line was drawn at the same point of the sinus floor. Thickness of the lateral wall of the maxillary sinus was measured using 10DR implant software at 3 (R1), 10 (R2) and 15 mm (R3) from the sinus floor. The mean thickness of the lateral wall of the maxillary sinus from the first premolar to second molar was 1·69 ± 0·71, 1·50 ± 0·72, 1·77 ± 0·78 and 1·89 ± 0·85 mm, respectively. The thickness differed significantly at the R2 and R3 points. Women had thinner lateral walls at the R1 and R2 points at the premolars than did men. At the R2 and R3 points at the second premolar, the mean thickness of smokers was larger than that of non-smokers. There were no significant differences on age or reasons for tooth loss. The changes in the thickness of the lateral wall at different reference points were observed, and CT examinations may help make lateral window without membrane perforation.     

Use of biofunctional prosthetic system following partial maxillary resection: a clinical report

This clinical report describes the prosthodontic rehabilitation of an edentulous patient with a maxillary defect using the biofunctional prosthetic system. The Biofunctional Prosthetic System brand denture includes a comprehensive technique for impressions, record taking, tooth placement, fabrication and processing. The advantage of this technique is to provide patients with optimal form, function, and aesthetics in complete dentures. This system is based on a team effort and systematic approach to removable prosthetic treatment.