12例重度慢性牙周炎患者全颌种植义齿修复的临床观察

目的探讨对经牙周治疗的重度慢性牙周炎患者拔除剩余牙齿后同期植入种植体并采用全颌种植义齿修复的可行性。方法对12例重度慢性牙周炎患者行牙周治疗，控制病情后，拔除剩余牙齿并同期植入种植体，5～6个月后行全颌种植义齿修复。根据临床、X线检查和患者主诉评价修复效果。结果共计108枚种植体植入20个牙弓，其中37枚种植体即刻植入拔牙窝内。种植体平均承载3年，所有种植体均无松动。2枚种植体发生种植体周围炎，有进行性骨吸收，其中1枚为即刻植入拔牙窝内的种植体。除2枚有进行性骨吸收的种植体外，其余种植体周围的骨吸收高度平均为（1．33±0．10）mm。108枚种植体的存留率为98．1％，37枚即刻种植体的存留率为97．3％。结论对重度慢性牙周炎患者行牙周治疗后拔除剩余牙齿并同期植入种植体，采用全颌种植义齿修复，可减少牙槽骨的吸收、缩短种植修复疗程，在定期的口腔卫生维护下获得理想的修复效果。     

非潜入式植入法对平台转换连接种植体颈部牙槽骨吸收的影响

目的：评价非潜入式植入法对平台转换连接种植体颈部牙槽骨吸收有无影响。方法：23例共33颗后牙缺失患者按要求植入ankylos种植体,取出覆盖螺丝并上愈合基台。植入当天和二期修复时拍牙片并进行前后对比。结果：1枚种植体植入一周时出现异常予以拔除,其余种植体均能形成良好的骨结合。经牙片对比,植入当天与二期修复时种植体颈部牙槽骨无明显变化。结论：非潜入式植入法对平台转换连接种植体颈部牙槽骨吸收无明显影响。     

种植体联合牙半切术单冠修复下颌磨牙的疗效观察

目的探讨应用种植体联合牙半切术单冠修复下颌磨牙的临床疗效。方法选择12例患牙,健康牙根完善根管治疗,微创拔除病变牙根。半切术后8～10周植入种植体,种植体植入后3～4个月进行种植二期手术,安装穿牙龈愈合基台。牙龈愈合4～6周后开始进行全冠修复,并随访2～4年。结果 11例种植体联合牙半切术单冠修复下颌磨牙均获成功,种植体稳固,种植体周骨组织未见明显吸收,修复体形态美观,功能恢复良好,患者满意度高。1例因病变的远中牙根与牙槽骨发生骨粘连,术中不得不使用骨凿损伤了近中牙根而一并拔除。结论种植体联合牙半切术单冠修复下颌磨牙是一种有效的修复方法。     

富血小板血浆修复种植体周围骨缺损的实验研究

目的探讨富血小板血浆(platelet-rich plasma,PRP)修复种植体周围骨缺损的能力。方法Beagle犬4只,拔除单侧下颌1、2、4前磨牙作为实验牙位。3个月后植入种植体,其周围制备骨缺损并植入相应骨移植材料:实验组植入PRP/磷酸三钙(tricalcium phosphate,TCP);对照组植入TCP。8、16周分别处死动物2只,进行组织学、扫描电镜观察,观察新骨形成和种植体-新骨界面情况,能谱分析种植体-新骨界面Ca含量。结果8周及16周通过肉眼及组织学观察,实验组修复效果优于对照组,种植体-新骨界面Ca含量均高于对照组,差异有显著性(P<0.05)。结论PRP/TCP作为修复种植体周围骨缺损的骨移植材料具有可行性。     

41例ITI种植体即刻种植的临床疗效与体会

目的：探讨ITI种植体前牙区即刻种植应用,评价其临床效果及患者满意度调查。方法：对41例患者,78枚ITI种植体在前牙区微创拔除残冠残根后即刻植入,并根据骨缺损度同期植入Bio-Oss骨粉,及Bio-Gide生物膜后,进行一般情况、复诊情况、临床疗效等进行回顾性分析。结果：种植体植入到修复平均时间为18周（8周-30周）,种植体支持的上部结构修复包括单冠修复、连冠修复;其中1枚脱落时间于6周后,脱落位置为上颌前牙区,患者为糖尿病Ⅱ期。结论：即刻种植患者的满意度高,但必须严格掌握适应症。     

Zimmer种植体在上前牙即刻种植与修复中的临床应用

目的探讨Zimmer种植体在微创拔除上颌前牙即刻种植与修复中临床效果。 方法20例患者共20颗无法保留的上颌前牙,Benex微创拔牙器械拔牙后,Zimmer种植体即刻植入,其中2例患者唇侧骨板内侧植入天博人工骨粉并覆盖海奥可吸收膜,临时冠塑型及修复,3~6个月后行永久修复。术后随访观察2年,通过临床和影像学检查评估修复体的临床效果。 结果20例患者的20颗患牙经过2年随访,成功20例（100%）。 结论上颌前牙区采用微创拔牙器械拔除患牙,即刻植入Zimmer种植体及制作临时修复体,短期临床效果良好。     

Cem-Ostetic修复牙种植体颊侧骨缺损的初步实验观察

目的:探讨Cem-Ostetic(骨速刚)修复牙种植体颊侧骨缺损的可行性.方法:拔除3只犬双侧下颌第二、三、四前磨牙,每侧即刻植入3颗种植体,并在种植体颊侧骨壁制造3 mm×3 mm×2 mm缺损.暴露种植体,由近中向远中依次植入Bio-Oss骨粉、磷酸钙骨水泥、Cem-Ostetic骨浆.种植术后4、8、12周各处死...     

种植体支持套筒冠固位全口覆盖义齿即刻负重3例

对3例全口无牙颌或重度慢性牙周炎牙列缺损患者术前制作全口义齿或即刻全口义齿,拔除全口余留牙,在下颌植入4颗Ankylos种植体,上颌植入6颗种植体,将SynCone套筒基台接入种植体,再套入预成圆锥形外冠,完成临时义齿修复。3～12个月后将临时义齿更换为铸造支架覆盖义齿。随访12～24个月,除1例种植体在植入后1个月松动拔除而重新植入种植体外,其余种植体均未出现明显的牙槽骨吸收。     

牙周病患者拔牙后即刻植入骨粉一例报道

目的:报道一例牙周病患者拔牙后即刻植入骨粉的成骨情况及种植修复后效果.方法:患者男性,71岁,下颌余留牙为43.43牙槽骨吸收2/3,Ⅱ度松动,拟拔除43后,刮净肉芽组织,即刻行骨粉植入,择期与33,43位置植入种植体,行覆盖义齿修复.结果:四月后,临床检查34部位牙槽窝愈合情况良好,有部分骨粉未吸收,X线示43牙槽窝底,中1/3骨质密度高,五月后43,33种植体植入,修复后效果良好.讨论:该病例患牙拔除后即刻植入骨粉虽未完全成骨,但对于种植体骨结合和修复后效果未有明显影响.结论:牙周病患者拔牙后若缺骨严重可考虑即刻行骨粉植入,以缩短种植修复时间.     

牙周炎患者即刻种植修复的临床观察

目的 评价重度牙周炎患者拔牙后种植治疗并行即刻修复的临床效果.方法 选择在中山大学光华口腔医学院·附属口腔医院种植科就诊的需行义齿修复的重度牙周炎患者12例.术前行完善的牙周治疗,术中拔除余留牙,彻底清创,植入种植体并于手术当日完成树脂临时修复,6个月后行永久修复.术后l、6、12、24个月复诊,评价种植体和修复体存留率及软硬组织状态.结果 植入种植体84枚,上颌50枚、下颌34枚,其中32枚为即刻植入新鲜拔牙窝.3例(4枚)种植体失败,种植体两年存留率为95％,其中上颌92％( 46/50),下颌为100％ (34/34);修复成功率为100％.所有的种植失败均发生在手术后6个月内.即刻种植体植入拔牙窝和种植体植入正常牙槽骨两组在植入扭矩及牙槽骨吸收水平方面差异无统计学意义.结论 本组牙周炎患者行完善牙周治疗后全口种植即刻修复取得满意的修复效果.     

An evaluation of the Periotest system. Part I: Examiner reliability and repeatability of readings. Dental Implant Clinical Group (Planning Committee).

The clinical success of endosseous dental implants is related to the extent of osseointegration. Many of the presently used methods of evaluating osseointegration are highly subjective. The Periotest is claimed to offer a more objective means to assess osseointegration and supporting bone stability of implants by means of microcomputer-controlled percussion. Investigators involved in a clinical study on dental implants being conducted by the Dental Implant Clinical Research Group participated in a two-part in vitro evaluation of the Periotest system. The first part, with which this article is concerned, involved each of 35 investigators taking three readings for each of 16 models designed to simulate an implant in place in the oral cavity and to cover most of the effective measuring range of the instrument. The Periotest system generally demonstrated a high degree of reliability and repeatability, with higher variability associated with specific model samples. Further evaluation of the Periotest as a research instrument will be conducted within the clinical environment of the Dental Implant Clinical Research Group study.     

Screw versus cemented implant supported restorations

Implant supported restorations can be attached to implants with screws or can be cemented to abutments which are secured to implants with screws. Screw retained implant restorations are the authors' preferred method of securing restorations to implants. This article will be written from this perspective and the advantages and disadvantages of each method of retention will be discussed under the following headings: Aesthetics, Retrievability, Retention, Implant placement, Passivity, Provisionals, Occlusion, Immediate loading, Impression procedures, Long term treatment planning.     

Prevalence and Predictive Factors for Peri‐Implant Disease and Implant Failure: A Cross‐Sectional Analysis

Background: Long‐term studies worldwide indicate that peri‐implant inflammation is a frequent finding and that the prevalence of peri‐implantitis correlates with loading time. Implant loss, although less frequent, has serious oral health and economic consequences. An understanding of predictive factors for peri‐implant disease and implant loss would help providers and patients make informed decisions. Methods: A cross‐sectional study was performed on 96 patients with 225 implants that were placed between 1998 and 2003. Implant placement data were collected from patient records, and patients presented for a clinical and radiographic follow‐up examination. Implant status and periodontal status were determined, the data were analyzed to determine the prevalence of peri‐implant disease or implant loss, and a predictive model was tested. Results: The mean follow‐up time for the patients was 10.9 years. The implant survival rate was 91.6%. Peri‐implant mucositis was found in 33% of the implants and 48% of the patients, and peri‐implantitis occurred in 16% of the implants and 26% of the patients. Individuals with peri‐implantitis were twice as likely to report a problem with an implant as individuals with healthy implants. Peri‐implantitis is associated with younger ages and diabetes at the time of placement and with periodontal status at the time of follow‐up. Implant loss is associated with diabetes, immediate placement, and larger‐diameter implants. Conclusions: One in four patients and one in six implants have peri‐implantitis after 11 years. The data suggest that periodontal and diabetes status of the patient may be useful for predicting implant outcomes.     

下颌后牙区短种植体联冠修复短期临床效果评价

目的 评估应用短种植体联冠修复下颌后牙牙列缺损的短期临床疗效。方法 选择2008年1月至2013年1月在中国医科大学附属口腔医院种植中心植入2枚种植体并用联冠修复下颌后牙牙列缺损的患者65例,共植入130枚种植体。其中,31例患者植入62枚短种植体（长度≤ 8.5 mm）作为短种植体组,34例患者植入68枚标准种植体（长度≥ 11.5 mm）作为对照组。记录并统计分析病例在手术当天及复诊时的相关临床资料,包括种植体累积成功率、生物机械并发症、边缘骨吸收、临床冠根比等。结果 两组各有2枚种植体失败;两组种植体累积成功率、并发症及边缘骨吸收比较差异无统计学意义（P > 0.05）;短种植体组临床冠根比显著大于对照组（P < 0.01）。结论 在严格控制适应证的情况下,对于骨量不足的患者应用短种植体修复下颌后牙牙列缺损能够取得理想的临床效果,同时可以降低手术风险,并减轻患者经济负担。     

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??Abstract??Objective To evaluate the short-term clinical effect of splinted short implants in the partly edentulous mandible of posterior regions. Methods Totally 65 patients??130 implants??who received short implants or standard implants to restore dentition defect in mandible of posterior regions during the period between January 2008 and January 2013 at the Implant Center of Hospital of Stomatology??China Medical University were selected??including 31 patients with 62 short implants??length ≤ 8.5 mm??as the short implant group and 34 patients with 68 standard implants??length ≥ 11.5 mm??as control group. Relevant clinical data was recorded and analyzed??such as cumulative success rate??biomechanical complications??marginal bone loss and Crown/Implant ratio. Results Two implants failed in both short implant group and control group. No significant differences in cumulative success rate??biomechanical complications and marginal bone loss were found between the two groups??P > 0.05??. The clinical Crown/Implant ratio in short implant group was significantly greater than that of the control group??P < 0.01??. Conclusion In the case of strict control of indications??the application of short implants to restore edentulous mandible of posterior regions for those who had bone defect can achieve more satisfactory clinical results??and additionally reduce the operation risk and the economic burden of patients.     

Prosthodontic procedures for implant reconstruction. 1. Diagnostic procedures

The University of Sydney Dental School and more recently the Implant Centre have been treating patients with the Brånemark Osseointegration Implant System since 1981. Success depends on close cooperation between surgeon and prosthodontist. This paper describes specific prosthodontic treatment planning procedures based on a general knowledge of prosthodontics, and detailed methods for determining the position, length and alignments of the implants for a specific case by the use of radiographic and surgical templates.     

Osseointegrated implants in irradiated bone: a case-controlled study using adjunctive hyperbaric oxygen therapy.

PURPOSE: The current investigation was undertaken to study whether osseointegration of implants in irradiated tissues is subject to a higher failure rate than in nonirradiated tissues. It further aimed to study whether hyperbaric oxygen treatment (HBO) can be used to reduce implant failure. PATIENTS AND METHODS: Seventy-eight cancer patients who were rehabilitated using osseointegrated implants between 1981 and 1997 were investigated. Three groups of patients were compared: irradiated (A), nonirradiated (B), and irradiated and HBO-treated (C). In addition, 10 irradiated patients who had lost most of their implants received new ones after HBO treatment. These were compared as a case-control group. RESULTS: Implant failures were highest in group A (53.7%). Implant failure was 13.5% in group B and 8.1% in group C. The difference between group A and the other two groups was statistically significant (P = .001 to .0023, Mantell's test). HBO significantly improved implant survival in the case-control group from 34 of 43 implants lost to 5 of 42 lost (P = .0078). CONCLUSIONS: Implant insertion in irradiated bone is associated with a higher failure rate. Adjuvant HBO treatment can reduce the failures.     

Is the osseointegration of immediately and delayed loaded implants the same?—comparison of the implant stability during a 3‐month healing period in a prospective study

Objectives: The objectives of the present study were (1) to compare the stability of delayed loaded (DL) and immediately loaded (IL) ITI SLA implants during the first 3 months of the healing period using resonance frequency analysis (RFA) and (2) to determine the factors that affect implant stability during the healing period.
Materials and methods: To compare implant stability, RFA was performed on two groups of patients (12 patients received 25 IL implants and 47 patients received 79 DL implants) with a total 104 ITI SLA implants. Implant stability was measured directly by RFA at implant placement and consecutively once a week for 12 weeks. Statistical analyses were carried out to study implant stability differences between IL and DL groups.
Results: One of the 25 implants in the IL group failed, and no implant was lost in the DL group. Implant stability between the IL and DL groups showed a statistically significant difference ( P <0.05). The mean implant stability quotient of all measured implants from implant insertion to 12 weeks was 72.88 ± 5.39 for the DL and 75.86 ± 3.60 for the IL types. The lowest stability was at 4 weeks for DL implants (mean: 71.58 ± 5.11) and 2 weeks for IL implants (mean: 71.33 ± 2.97). In both groups, bone types I and II showed higher implant stability than bone type III ( P <0.05).
Conclusions: The findings of this study indicate that differences in osseointegration between IL and DL implants may be predicted according to differential implant stability.     

Relationship of implant stability and bone density derived from computerized tomography images

Background and Purpose

Implant stability is one of the most important factors influencing osseointegration. Using stereolithographical guides for maximizing precision, this study aimed at investigating the relationship between implant stability and bone density derived from computerized tomography analysis.

Materials and Methods

One hundred ninety‐five implants were placed in 48 patients using digitally designed stereolithographical surgical guides. Ninety‐five implants were placed using a mucosa supported guide and 100 implants were placed using a bone supported guide. Implant stability was measured by means of resonance frequency analysis (RFA) and damping capacity assessment (Periotest, PTV). Bone density (Hounsfield units) was measured at different regions of interest (ROI) and cortex thickness was measured around each implant.

Results

Implant stability correlated significantly with the different ROI. The best correlation for RFA was obtained for the spongious bone ROI (r = .64) and PTV best correlated with the coronal cortex density (r = ?.41). Shorter implants (9 mm) had a significantly lower primary stability than longer implants (11, 13, 15 mm). Primary stability was also significantly higher in 4 mm diameter implants than in 3.5 mm diameter implants. A formula for the prediction of primary stability based on the different variables investigated was developed.

Conclusions

Bone density and cortex thickness have a significant influence on implant primary stability. Longer and wider implants reached higher primary stability than shorter and narrower implants. These correlations lose their significance after osseointegration has taken place. Implant stability can be predicted based on an preoperative analysis of bone characteristics.     

Xive Implant System的临床应用评价

目的:评价XiveImplantSystem的临床效果。方法:应用XiveImplantSystem对失牙区进行即刻或延期种植,部分采用埋入或二次手术方式,部分采用一次手术直接安装愈合基台,对62例患者植入100枚种植体,金属烤瓷冠及8例后牙区因颌龈距过低而采用铸造冠修复。临床随访观察三年六个月。结果:种植体成功率100%,种植体周牙槽骨吸收<0.2mm/年,种植体周围炎2枚,固定螺丝松动2枚。结论:XiveImplantSystem适用于牙列缺损及缺失的延期或即刻修复。