微型种植体支抗和XIVE种植体在牙列缺损修复中的临床应用

目的：探讨用微型种植体作为正畸支抗压低伸长磨牙,同时用XIVE种植体修复对（牙合）缺失牙的可行性.方法：选择7例下颌第一磨牙缺失,对颌牙伸长＞2.5mm种植修复的患者.在对颌伸长的第一磨牙的近中腭侧和远中颊侧各植入1枚微型种植体.用橡皮链挂在颊、腭侧的种植体上,以压低伸长的对颌牙齿,定期更换并进行临床检查.同时缺牙区植入XIVE种植体,常规种植治疗.结果：7例患者中,1枚微型种植钉松动脱落,余6例患者伸长牙平均压低3mm,平均压低时间为5个月,经种植修复后均获得满意的临床效果.结论：针对下颌第一磨牙缺失对颌牙伸长较多的病例,微型种植体支抗和种植体的联合应用,能达到良好的修复效果.     

种植支抗压低对(牙合)伸长牙同期种植修复缺失后牙的临床研究

目的研究种植支抗压低对伸长牙同期种植修复缺失后牙的临床效果。方法 8例后牙缺失伴对牙伸长的成年患者,利用支抗种植钉作为骨支抗,对16颗对伸长牙进行正畸压低矫治,矫治结束前8～12周植入种植体,矫治结束时即刻进行上部结构修复。随访1年,观察临床效果。结果 8例患者16颗伸长对牙压低矫治成功,平均压低疗程为7个月,缺失牙种植义齿修复后咀嚼功能正常;1年后随访,压低后的天然牙与种植义齿咬合稳定,X线片显示矫治压低的对牙和种植义齿均未出现明显的骨吸收。结论种植支抗压低对伸长牙同期种植修复缺失后牙,缩短了疗程,有利于早期建立稳定的咬合关系,是一种可行的临床治疗选择。     

微种植支抗压低成年人上颌伸长磨牙的CBCT分析

目的探讨通过微种植体支抗植入,结合正畸压力,压低成年人上颌伸长磨牙,为对颌缺失牙种植修复提供足够的颌间距离。方法选择11名成年患者15颗上颌伸长磨牙,对颌缺失牙颌间距离明显缩短,影响缺失牙种植修复。在上颌伸长磨牙颊、腭侧各植入一枚自攻型钛合金微种植钉作为支抗,即刻负载,用橡皮链进行牵引加力,压低磨牙,每4周加力。当伸长磨牙压低并已创造足够的颌间距离后停止加力,进行下颌缺失牙修复。治疗前后拍摄CBCT,测量比较上颌伸长磨牙在治疗前后压低量。结果 15颗上颌伸长磨牙均获得有效压低,平均压低2.43 mm,平均压低时间5.8个月。上颌伸长磨牙未出现明显松动。结论应用微种植支抗可有效压低成年人上颌伸长磨牙。     

种植体支抗压低过长磨牙的临床效果分析

目的探讨使用种植体支抗压低过长上颌磨牙的临床效果。方法使用微螺钉种植体支抗配合部分或全口矫治器压低13例患者的过长上颌磨牙（共23颗），其中第一磨牙15颗、第二磨牙7颗、第三磨牙1颗。在头颅侧位片上测量磨牙近、远中边缘嵴至腭平面的垂直距离，配对t检验比较治疗前后的差异。结果压低过长磨牙的矫治疗程为5～18个月，平均10．4个月。头影测量结果显示磨牙压低0．45～7．00mm，平均（2．86±1．80）mm，治疗前后磨牙近中和远中边缘嵴至腭平面垂直距离的差异均有统计学意义（P〈0．001）。X线片显示牙槽骨高度无改变，根尖无明显吸收。结论以微螺钉种植体作为支抗压低过长上颌磨牙，是一种有效的治疗方法。     

种植义齿联合正畸治疗修复颌龈距离过小牙列缺损

目的:探讨种植义齿与正畸联合修复颌龈距离过小的末端游离牙列缺损病例的临床效果。方法:选择2010-01—2012-04就诊的5例因磨牙伸长,对后牙没有足够修复间隙的患者,下颌3例,上颌2例。均在过长磨牙的颊腭侧植入微种植体支抗钉,应用橡皮链直接将支抗钉与磨牙带环上牵引钩牵引施加力压入;同时在对缺牙位点植入Straumann种植体,待颌间间隙打开完全后进行义齿上部结构修复,随访观察治疗效果。结果:经过3～7个月,5例患者伸长的7颗磨牙均被有效压低,对牙获得了足够的修复间隙,运用Straumann种植体修复上端结构后获得满意的治疗效果,修复完成后1、3、6个月复诊,咬合关系良好,患者表示满意。结论:运用微种植体支抗压低伸长磨牙,再植入种植体修复游离端缺失磨牙,可取得较好的治疗效果。     

微型种植体支抗在压低前牙和磨牙中的应用

目的:评价微型种植体作为垂直向支抗压低前牙和磨牙的有效性.方法:选取9例由于前牙过长,唇齿关系不协调露龈笑的病例及5例由于对颌牙缺失导致磨牙伸长,义齿修复困难的病例,采用微型种植体支抗压低前牙或磨牙.比较压低治疗前后的X线头影测量片,测量上下颌中切牙切缘和磨牙边缘嵴相对于腭平面、下颌平面的压低量.结果:压低前牙的9例患者,治疗后前牙覆(牙合)达到正常,切缘平均压低4.2 mm,露龈笑明显改善.5例压低磨牙病例,4例实现了磨牙的绝对压低,平均压低4.1 mm,缺牙区成功进行义齿修复.结论:微型种植体支抗可以实现理想的垂直方向的支抗控制.     

应用微型种植体作支抗压低磨牙

目的：探讨微型种植体作为正畸支抗在压低磨牙中的应用。方法：选择5例需要压低磨牙的患者（包括3例开殆患者和两例因对殆牙缺失而致磨牙伸长的修复前正畸患者），使用微型种植体作支抗压低磨牙，治疗前后拍摄头颅侧位定位片，测量比较磨牙在矫治前后的压低量。结果：矫治结束后开殆患者前牙达到正常的覆殆覆盖，修复前正畸患者矫治至缺牙区能进行常规修复。磨牙平均压低3．1mm。结论：应用种植体作支抗能有效地压低磨牙，为某些错合畸形的矫治提供了新思路。     

微种植体支抗压低伸长磨牙的临床研究

目的：探讨使用微种植体支抗压低伸长磨牙的临床效果及相关因素。方法：选取20例24颗磨牙伸长病例使用微种植体支抗进行压低,共植入微种植体47枚,分别植于颊腭（舌）侧牙槽中隔,1个月后负载加力,记录微种植体支抗压低磨牙使用的方法、效果、所需时间及牙根吸收情况,并进行评价。结果：所有伸长磨牙均有效压低,平均压低（3．45±1．05）mm,疗程3．5～9个月,平均5．6个月,每个月平均压低0．65mm;压低过程中牙根均有不同程度的吸收,但下颌磨牙较上颌磨牙牙根吸收明显。结论：使用微种植体支抗压低伸长磨牙疗效可靠,能顺利完成义齿修复。     

利用种植体支抗压低修复前过长的后牙

目的 研究并介绍使用种植体支抗压低后牙的方法和疗效.方法 使用微螺钉种植体和微钛板种植体作为骨性支抗对20名成年患者的39颗过长的后牙进行正畸压低.结果 多数患者矫治成功,后牙明显压低.平均疗程为8.5个月.结论 利用种植体支抗压低过长的后牙是一种有效的矫治手段.     

种植支抗压低上颌磨牙与下颌种植修复

目的:探讨片段弓技术联合部种植支抗压低上颌磨牙,为下颌牙缺失的种植修复提供足够的合间距离.方法:1)适应证:下颌后牙缺失伴上颌磨牙伸长而致的合间距离变小,使下颌种植义齿修复困难的成年患者.2)利用片段弓技术结合种植体支抗将上颌磨牙压低,获得上颌整齐的后牙区牙列及足够的种植修复空间.3)下颌缺牙区植入种植体,种植义齿修复.结果:17例下颌后牙缺失伴上颌磨牙伸长的病例,经片段弓联合种植支抗技术治疗后进行种植义齿修复,均达到理想的临床效果.讨论:下颌后牙长期缺失常常影响引起上颌磨牙伸长,导致下颌缺牙区的种植修复的间隙不够.利用片段弓技术联合种植支抗,将上颌伸长的磨牙压低,可以使缺牙区获得足够的种植空间,从而避免将伸长磨牙磨短或者杀髓,最终获得更好的功能及稳定的种植修复.结论:对下颌后牙区牙齿缺失伴上颌磨牙伸长病例,利用片段弓技术联合种植支抗来压低上颌磨牙,能获得更好的种植效果.     

运用微型种植体支抗矫治埋伏阻生牙

目的 初步分析运用种植支抗牵引埋伏牙的临床效果,探讨正畸治疗中选择种植支抗牵引埋伏牙的适应证及该项治疗的特点.方法 对6例埋伏牙患者的8颗埋伏牙运用种植支抗进行牵引治疗,牵引后对牙齿的松动度、牙髓活力等各项临床指标进行检查,并摄术前术后曲面断层片对牵引效果进行观察.结果 6例患者经3～5个月的牵引后埋伏牙萌出,牙髓活力正常,未发现牙根吸收.与以往的方法相比,运用种植支抗牵引埋伏牙支抗充足,患者不适感降低.结论 运用种植支抗牵引埋伏牙为埋伏牙牵引治疗提供了一种方法选择.     

Palatal implant anchorage reinforcement of posterior teeth: A prospective study

A new orthodontic implant anchor system (Orthosystem) has been developed. This 1-piece device made from titanium consists of a screw-type endosseous section (lengths of 4 and 6 mm), a cylindrical transmucosal neck, and an abutment. Clamp caps with slots provide for attachment of square orthodontic wires (transpalatal bars) to the implant. The aim of the present prospective study was to evaluate the anchorage capacity of palatally inserted Orthosystem implants for anchorage reinforcement of posterior teeth. The sample consisted of 9 dental Class II patients (age 15 to 35 years) whose treatment plan included extraction of the maxillary first premolars. Each of the patients received 1 implant inserted into the center of the anterior palate. After a mean unloaded implant healing period of 3 months, transpalatal bars were inserted to connect the posterior teeth to the implant. Retraction of the canines and incisors was accomplished without the use of compliance-dependent headgear or Class II elastics. The degree of anchorage loss as well as the amount of canine and incisor retraction were evaluated by measurements of the casts and lateral cephalograms. The mean anchorage loss was 0.7 mm on the right side and 1.1 mm on the left (P <.05). The right and left canines were retracted 6.6 and 6.4 mm, respectively, and the mean overjet reduction was 6.2 mm. Because clinical assessment and postremoval histologic assessment both revealed stability of the short implant, the small anchorage loss was most likely from the deformation of the transpalatal bars by the orthodontic forces. Nevertheless, the treatment goal was achieved in all patients without the use of compliance-dependent auxiliaries. The clinical experience during and after implant insertion, active orthodontic treatment, retrieval of the implant, and subsequent wound healing are described.     

使用改型腭杆辅助压低过长上后牙的临床研究

目的评价使用改型腭杆辅助压低过长上后牙的临床效果。方法5名成年患者,因无法使用种植体支抗而使用改型腭杆辅助压低5颗过长的上后牙。在矫治前、后采取研究模型,进行三维测量,明确过长后牙的压低量和支抗后牙的移动量。通过曲断体层片观察上后牙压低后其牙根吸收情况。结果5名患者均完成上后牙压低,平均疗程为6个月。模型测量表明：过长后牙的压低量为（2．29±0．44）mm。采用配对样本t检验表明过长牙的压低量有显著的统计学意义（P〈0．001）;支抗后牙有的伸长,有的被压低,移动量范围是-0．24mm～0．71mm（负值为伸长量,正值为压低量）,支抗牙的移动量没有显著的统计学意义（P〉0．05）。X片显示被压低的上后牙和支抗牙没有出现明显的牙根吸收。结论对于不适合植入支抗钉压低过长后牙的患者使用改型腭杆辅助压低是一种有效的正畸矫治方法。     

应用微螺钉种植体支抗压低伸长磨牙辅助修复治疗

目的 探讨微螺钉种植体支抗在压低伸长磨牙中的临床应用.方法 因修复缺失磨牙而需压低对颌伸长磨牙的病例10例,共10颗拟压低的伸长磨牙,植入自攻式不锈钢微螺钉后即刻加力,对伸长的磨牙进行压低.结果 10颗伸长的磨牙均被成功压低,压低时间为3～8个月,平均(5.37±1.65)个月;压低高度1.5～3.5 mm,平均(2.57±0.62) mm.压低后的磨牙牙轴正常,未出现舌尖伸长现象.结论 微螺钉种植体支抗能够有效地压低伸长磨牙,可为缺失磨牙修复创造所需的(牙合)龈空间.     

Clinical management in extraction cases using palatal implant for anchorage

Abstract

This case report presents a Class I extraction treatment in an adult patient with bimaxillary crowding using a palatal implant for anchorage control. The implant (pure titanium 6 mm SLA) is inserted in the middle of the palate, after a careful radiological assessment on a lateral cephalogram. At the end of the healing period (13 weeks), an anchorage device, such as a squared trans-palatal bar connecting the maxillary molars to the palatal implant, is projected and placed in order to obtain the posterior anchorage control. The orthodontic treatment was performed according to the bidimensional technique.     

Forced orthodontic extrusion to restore extensively damaged anterior and premolar teeth as abutments for single-crown restorations: Up to 5-year results from a pilot clinical study

Statement of problemClinical data on orthodontic extrusion to restore teeth deemed unrestorable because of their defect size are scarce. It remains unclear for which defects forced orthodontic extrusion and tooth retention is preferred to extraction.PurposeThe purpose of this pilot clinical study was to investigate the survival, frequency, and type of complications of extensively damaged teeth requiring single-crown restorations after forced orthodontic extrusion.Material and methodsParticipants were recruited from consecutive patients in need of restorative treatment of extensively damaged teeth at a university clinic. The teeth were orthodontically extruded to reestablish the biologic width and to ensure a 2-mm ferrule preparation before restoration. The primary endpoint was restoration success and survival. At recall, survival was defined as the tooth being in situ and success as a symptom-free tooth with an intact, caries-free restoration and with physiological pocket probing depths, no signs of intrusion, ankylosis, root resorption, or periapical radiolucency. Recalls were performed every 6 months; the outcome was assessed by radiographic and clinical evaluation after up to 5 years of clinical service. Quantitative parameters were described with mean values and standard deviations.ResultsThirty-four participants were assessed for eligibility and enrolled (mean ±standard deviation age: 53.4 ±18.9 years). Four participants were premature dropouts. Data were analyzed for 35 teeth in 30 participants. The amount of extrusion varied between 2 and 6 mm (mean ±standard deviation 3.4 ±0.9 mm). The mean duration of extrusion was 18.9 ±12.6 days and the mean duration of retention was 126.94 ±88.1 days. The mean ±standard deviation crown-to-root ratio after treatment was 0.8 ±0.1 (range: 0.5 to 1.0). Three participants exhibited orthodontic relapse before restoration. Teeth were successfully restored after repeated extrusion. After a mean observation period of 3.3 years (range: 1 to 5.2 years), 29 of 31 teeth were still in situ. Two teeth were fractured, and 4 participants were not available for recall. Thus, the survival rate was 94%. No resorption or periapical translucencies were observed radiographically. Clinical examinations revealed physiological probing depths and absence of ankyloses. One tooth presented with marginal bone loss. The most frequent type of complication was orthodontic relapse at recall (n=3). A total of 84% of teeth were considered a success.ConclusionsForced orthodontic extrusion allowed for the restoration of anterior and premolar teeth deemed as nonrestorable because of their defect size. Tooth retention of extensively damaged teeth and their use as abutments for single-crown restorations can be recommended.     

缺牙区伴埋伏牙的种植修复策略

埋伏牙是牙齿萌出期已过而仍存在于颌骨内未能萌出的牙齿。埋伏牙的存在会影响美观及功能,导致邻牙牙根吸收、颌骨囊肿等病变的发生。除此之外,受植区埋伏牙的存在还可能影响种植体的植入。在临床治疗中,埋伏牙的治疗策略通常是拔除或正畸牵引。近年来,保留受植区埋伏牙通过种植修复缺失牙受到医生的广泛关注。本文就埋伏牙的诊断、流行病学以及通过正畸及种植等对其治疗的方法等进行综述,为临床处理该类患者提供参考。     

Interdisciplinary treatment planning for orthodontic‐prosthetic implant anchorage in a partially edentulous patient

Successful orthodontic treatment is characterized by optimal anchorage control. Teeth or groups of teeth are united to counteract biomechanical reactive forces during orthodontic treatment. These classic anchorage control mechanisms are less efficient or even non-existent in partially edentulous patients who are missing multiple posterior teeth. However, osseointegrated oral implants ad modum Br-vemark can provide optimal anchorage control for orthodontic tooth alignment and rehabilitation of occlusion through prosthetic implant restorations. Careful multidisciplinary planning based on complex diagnostic wax setup casts to determine exact implant location and orientation in line with future orthodontic tooth displacements and prosthetic implant crown restorations is the most important step in the overall treatment planning.     

Mass retraction movement of the anterior upper teeth using orthodontic mini-implants as anchorage

Background

Several studies have demonstrated the application of mini-implants in the orthodontic treatment as anchorage during the retraction movement of the anterior teeth.

Purpose

This study was designed to evaluate the mass retraction movement of the anterior upper teeth using orthodontic mini-implants as anchorage.

Materials and methods

Nine patients with class I malocclusion and Angle's class II, needing extractions of the upper first premolars, were enrolled in this case series. The retraction was performed using sliding mechanics and orthodontic anchorage on mini-implants. Measures were taken by initial and final cephalometric X-rays of the retraction movement to evaluate whether the mini-implants remained stationary and displacements of the incisors and the upper first premolars.

Results

Out of 18 mini-implants, 8 mesialized (0.45?mm, average) and 3 extruded (0.14?mm, average). The upper incisors were retracted on the average of 4.21?mm, extruded 0.33?mm, and tipped 10.3°. There were no statistical significant modifications in the placement of the posterior teeth.

Conclusions

Although there was a very small displacement of the mini-implants, they still provided an adequate anchorage for the retraction of the anterior teeth, and there was no loss in the anchorage of the posterior teeth.     

护理指导对外伤松动牙在树脂纤维弹性夹板固定过程中口腔卫生情况的影响

目的 观察口腔护理指导在树脂纤维弹性夹板固定外伤松动牙过程中对口腔卫生情况的影响。方法 收集51例因外伤导致牙松动的病例(349颗牙齿),行树脂纤维夹板固定处理后,随机分为2组：对照组(25例,152颗牙齿)行常规医嘱;试验组(26例,197颗牙齿)予以常规医嘱+口腔卫生护理指导。患者于术后第2 w进行复查,观察树脂纤维夹板范围内的口腔卫生情况,包括牙唇侧表面软垢形成程度,牙周探诊深度及牙周探诊出血(Bleeding on probing,BOP) 阳性率。结果 试验组的牙齿表面白色软垢形成程度明显低于对照组(P<0.05);试验组的龈沟深度为(2.68±0.36) mm,对照组为(3.23±0.45) mm,差异无统计学意义;试验组的BOP阳性率为31.98%,低于对照组的BOP阳性率77.68% (P< 0.05)。结论 口腔护理指导在外伤松动牙树脂纤维弹性夹板固定过程中十分必要,可明显改善患者口腔卫生环境,有助于预防牙龈炎症的发生。