前牙区即刻种植的美学效果观察

目的：探讨前牙区即刻种植永久修复后的牙龈美学效果。方法：22例前牙缺失病例,行不翻瓣拔牙同期植入28颗种植体,上前牙24颗采用非埋入式种植术式,下前牙4颗采用埋入式种植术式,种植体愈合3-4个月进行永久修复。随访时间为12-30个月（平均18个月）。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12个月后的牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果：28颗种植体留存率100%。Miller分类,18颗种植体牙龈边缘无退缩;8颗种植体牙龈边缘Ⅰ类退缩;2颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论：前牙区即刻种植,延期修复是一项较成熟的手术方法,但须严格掌握适应症,才能获得良好的修复效果。     

上颌前牙美学区连续多颗牙缺失即刻种植的临床研究

目的分析不同牙种植系统上颌美学区即刻种植对种植体周围骨组织吸收的影响,并探讨改良微创"H"形切口在上颌美学区多颗相邻牙即刻种植修复的应用技巧及美学影响因素。方法选取2011年1月—2015年1月在我院口腔科接受牙体种植修复的患者58例,所有患者均在牙槽嵴顶作微创"H"切口,种植体采用潜入式手术。根据患者种植的牙体系统,将患者分为3组:3I组、DIO组、Replace组。随访12个月,观察患者种植体周围骨吸收量、探诊深度及术后龈沟出血指数。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12月后牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果 3组患者的周围骨组织骨吸收量在植入术后6个月均呈稳定的趋势,不同的种植体增长的幅度不同,差异无统计学意义(P>0.05),DIO组患者第3个月的骨吸收量显著高于Replace组和3I组,其差异具有统计学意义(P<0.05)。术后不同时期,3组患者的龈沟出血指数与天然牙相比,6个月时,DIO组患者的龈沟出血指数虽然高于天然牙,差异无统计学意义(P>0.05);9、12个月时,3组患者的龈沟出血指数与天然牙差异无统计学意义(P>0.05);术后6个月,3组患者的探诊深度呈稳定的趋势,各个时期3组患者的探诊深度略高于天然牙,差异无统计学意义(P>0.05)。159颗种植体存留率100%,Miller分类,136颗种植体牙龈边缘无退缩;18颗种植体牙龈边缘I类退缩;5颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论不同牙种植体系统对美学区多颗相邻牙即刻种植的种植体周围骨组织及软组织均具有较理想的稳定性及美学效果。改良微创"H"形切口为相邻多颗牙即刻种植的应用技巧提供了临床依据,值得临床推广。     

Ankylos种植系统在前牙区的临床应用及效果评价

目的:探讨Ankylos种植系统修复部分前牙缺失患者的短期临床效果和优点.方法:应用Ankylos种植系统对19例部分前牙缺失患者进行即刻或延期种植,部分采用一次手术直接安装愈合基台,部分直接安装基台并进行即刻修复,共植入30颗种植体.均采用金属烤瓷冠修复.通过临床检查及X线检查,评估种植体周骨高度丧失情况及牙龈乳头充填情况.结果:观察12-18个月,除一颗即刻修复的种植体植入1个月失败后,其余29颗种植体均稳固无松动,种植修复临床效果满意.修复完成1年后边缘骨吸收为0.16(-0.10-0.57)mm;按Jemt牙间乳头分类,本组47个位点中达I度7个位点,Ⅱ度29个位点,Ⅲ度11个位点.结论:Ankylos种植系统应用于前牙区其操作简单可靠,短期临床效果满意,并可减少种植体边缘骨吸收,促进种植修复的美学效果.     

微创拔牙即刻种植的牙龈美学效果观察

目的探讨微创拔牙即刻种植技术的临床特点及修复后的牙龈美学效果。方法21例上前牙单个缺失病例，行不翻瓣微创拔牙同期23颗种植体即刻植入，并且同期安装愈合基台直接暴露于口腔，即非埋入式种植术式，种植体愈合6个月后进行永久修复。种植永久修复后观察时间平均27．6个月（13～51个月）。根据Jemt牙龈乳头指数（papilla index score，PIS）观察种植体永久修复12个月后的近远中牙龈乳头状况，根据Flirhauser的改良红色美学指数观察种植体永久修复1年后与相邻天然牙唇侧龈缘位置的协调性；唇侧软组织与相邻天然牙唇侧牙龈色泽协调性。结果23颗种植体均获得良好的骨结合；种植修复体近远中PIS均为Ⅱ级以上。种植修复体与相邻天然牙唇侧牙龈缘水平位置协调性一致的15颗，8颗不协调；唇侧软组织色泽与相邻天然牙协调一致的18个牙位，5个牙位有轻度差异。结论微创拔牙即刻种植术是一项要求较高的技术，多因素影响软组织美学效果，严格掌控适应证，才能获得理想修复效果。     

牙龈诱导在Ankylos系统中的应用观察

目的：探讨临时冠诱导牙龈成形在Ankylos系统中的应用效果。方法：应用Ankylos种植系统对13名前牙缺失患者进行种植,共植入20颗种植体,部分直接安装基台并进行即刻临时冠修复,部分两月后临时修复,期间对临时冠形态不断调整,3-6个月后永久修复,12个月后复查,通过临床检查来评估牙龈健康状况及牙龈乳头保存情况。结果：12个月后,所有种植体均无松动,牙龈健康,按Jemt牙间乳头分类,28个观察位点中,1级4个,2级18个,3级6个。结论：在前牙区Ankylos种植系统的修复中,利用临时冠诱导牙龈成形是简单可靠的,有助于提高种植修复的美学效果,但长期效果还有待于进一步的观察。     

牙龈诱导在平台转换连接种植体中的应用观察

目的：探讨临时冠诱导牙龈成形在平台转换连接种植体中的应用效果。方法：应用Ankylos种植系统和Osst em种植系统GS系列对15名前牙缺失患者进行种植,共植入20颗种植体,部分直接安装基台并进行即刻临时冠修复,部分两月后临时修复,期间对临时冠形态不断调整,3-6个月后永久修复,12个月后复查,通过临床检查来评估牙龈健康状况及牙龈乳头保存情况。结果：12个月后,所有种植体均无松动,牙龈健康,按Jemt牙间乳头分类,35个观察位点中,1级6个,2级23个,3级6个。结论：在前牙区平台转换连接种植体的修复中,利用临时冠诱导牙龈成形是简单可靠的,有助于提高种植修复的美学效果,但长期效果还有待于进一步的观察。     

单个前牙种植体即刻种植和即刻修复的牙龈美学效果评价

目的:评价种植体即刻种植即刻修复的牙龈美学效果及患者对美观的满意度.方法:观察28例患者28枚ITI种植体在单个前牙种植体即刻种植即刻临时冠修复,对种植义齿周围的牙龈美观状况及相应的软组织健康状况进行观察,并对患者满意度进行调查,托槽弓丝固定3个月,6个月后行永久烤瓷冠修复.结果:12个月时所有种植体都发生了骨结合现象,种植义齿周围的软组织外形正常,牙问乳头外形大小与菌斑附着,龈炎并不相关.患者对即刻种植修复的美学效果均非常满意.结论:在严格掌握适应证的前提下,单个前牙即刻种植修复比延期修复可获得更佳的软组织外形,尤其是牙间乳头外形大小达到更理想的美学效果.     

Straumann种植体在上颌前牙区即刻种植修复中的应用

目的 评估Straumann种植体即刻种植修复上颌前牙区的近期临床效果。方法 临床选择28例上前牙残根患者,在拔牙后即刻植入Straumann种植体40枚。其中11例15个牙位行不翻瓣种植,17例25个牙位采取翻瓣GBR技术即刻种植。3～9个月后行永久性修复。随访3～36月,临床观察种植体、基台和牙冠的稳固性,牙龈组织、龈乳头情况及牙冠美观状况。结果 所有种植体均发生骨结合,无松动现象,未见种植体周围炎表现,即刻种植存活率为100%。不翻瓣种植病例的唇侧龈缘无明显退缩,牙龈乳头无明显丧失;翻瓣植骨的病例唇侧牙龈缘少许退缩,牙龈乳头轻度丧失。修复体外形美观,周围牙龈形态正常,功能良好,患者满意。结论 在严格掌握适应证和注意术中术后各种细节的情况下,应用Straumann种植体即刻种植修复上颌前牙区可获得理想的美学修复效果。     

上颌前牙即刻种植即刻修复的临床应用研究

目的:评估上颌前牙区即刻种植即刻修复的临床应用效果,特别是美学效果,并探讨其临床应用技巧及美学影响因素。方法:选择16例共18颗无法保存的上前牙,微创拔除后即刻植入Xi ve或Repl ace种植体共18枚,均于48小时内完成临时固定修复,4～6个月后完成最终修复。种植永久修复后追踪观察12～36个月,观察种植体周围软硬组织情况,统计种植义齿存留率、牙龈乳头充盈指数以及修复体与相邻天然牙唇侧牙龈的协调性、患者主观满意度。结果:在观察期内18枚种植体均获得了良好的骨结合,种植体无松动,种植体周围未见病理性骨吸收,存留率为100%;18枚种植修复体周围共34个牙龈乳头充盈指数均为2到3度,其中24个(70.6%)为3度;15枚种植修复体唇侧龈缘位置与相邻天然牙协调无差异,3枚轻度差异;16枚种植修复体与相邻天然牙牙龈颜色质地协调无差异,2枚轻度差异。患者主观满意度VAS值平均达91.5。结论:在严格掌握适应证的前提下,应用正确的手术技巧对无法保存的上前牙进行微创拔除后即刻种植即刻修复能获得理想的临床效果,特别是美学效果。     

微创拔牙即刻种植的临床观察

目的:探讨微创拔牙即刻种植技术的临床可行性。方法:25例上前牙单个缺失病例,行不翻瓣微创拔牙后即刻植入28枚种植体,同期安装愈合基台直接暴露于口腔中,即非埋入式种植术,六个月后行永久修复。结果:28枚种植体均获得良好的骨性结合。其中21颗牙位种植修复体与邻近天然牙唇侧牙龈位置及牙龈色泽协调一致,7颗牙位不协调,有轻度差异。结论:微创拔牙即刻种植是一项要求较高的技术,须严格掌握适应征,严格操作规程,才能达到理想的远期修复效果。     

骨劈开技术在上颌前牙区种植术中的应用

目的：评价骨劈开术在上颌前牙区种植术中的临床应用效果。方法：42例患者,缺失上前牙1-4颗,牙槽嵴可利用骨高度〉10mm,宽度3-5mm。采用骨劈开术形成唇侧骨瓣,在腭侧骨板与唇侧骨瓣之间植入直径3.5mmAnkyl os种植体83枚,劈开部位应用GBR技术,6个月后行二期手术和固定修复。结果：二期手术时所有种植体稳固,1例（2枚种植体）唇侧骨板部分吸收,产生2.0mm种植体颈部唇侧暴露。其余种植体被骨质完全包绕,牙槽嵴宽度增加2.8-4.1 mm,平均增宽3.5mm。83枚种植体完成固定修复,经过2年的追踪观察,无一种植体松动或脱落。结论：上颌牙槽嵴骨宽度为3-5mm时,采用骨劈开术能有效增加骨量,获得满意的临床疗效。     

Survival of dental implants in irradiated head and neck cancer patients: a retrospective analysis

Purpose: To study the long‐term survival of dental implants placed in irradiated bone in subjects who received radiation for head and neck cancer. Materials and Method: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 through July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. Results: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987 to July 2008. The estimated survival at 1, 5, and 10 years was 98.9%, 89.9%, and 72.3%, respectively. Implants placed in the maxilla were more likely to fail than implants placed in the mandible (p = .002).There was also a tendency for implants placed in the posterior region to fail compared with those placed in the anterior region (p = .051). Conclusion: Dental implants placed in irradiated bone have a greater risk for failure. Survival is significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).     

Maxillary Overdentures Supported by Anteriorly or Posteriorly Placed Implants Opposed by a Natural Dentition in the Mandible: A 1‐Year Prospective Case Series Study

Background: For maxillary overdenture therapy, treatment guidelines are missing. There is a need for longitudinal studies. Purpose: The purpose of this 1‐year prospective case series study was to assess the treatment outcome of maxillary overdentures supported by six dental implants opposed by natural antagonistic teeth in the mandible. Materials and Methods: Fifty patients were treated with a maxillary overdenture supported by six dental implants, either placed in the anterior region (n = 25 patients) or in the posterior region (n = 25 patients). Items of evaluation were the following: survival of implants, condition of hard and soft peri‐implant tissues, and patients' satisfaction. Results: One‐year implant survival rate was 98% in the anterior group and 99.3% in the posterior group. Mean radiographic bone loss in the anterior and posterior groups after 1 year of loading was 0.22 and 0.50 mm, respectively. Mean scores for plaque, calculus, gingiva, bleeding, and pocket probing depth were low, and patients' satisfaction was high, with no differences between the groups. Conclusion: Six dental implants placed in either the anterior region or the posterior region of the edentulous maxilla, connected with a bar, and opposed by antagonistic teeth in the mandible supply a proper base for the support of an overdenture.     

即刻种植即刻修复的临床疗效观察

目的：观察前牙区拔牙后即刻种植即刻修复的临床效果。方法：对4例前牙种植病例，在拔牙后即刻植入6枚Friait-2或Xive种植体，同时接入Pro—Tect基台行复合树脂临时冠／桥修复，根据骨质情况，3—6个月后，行永久性修复。结果：追踪12～27个月，全部种植体成功。结论：严格掌握好适应证，拔牙后即刻种植即刻修复，临床效果良好。     

Healing at Implants Placed in an Alveolar Ridge with a Sloped Configuration: An Experimental Study in Dogs

Purpose: To study healing around implants placed in an alveolar ridge with a sloped lingual‐buccal configuration. Materials and Methods: Six Labrador dogs were used. Buccal bone defects were prepared in the mandible after extraction of premolars. Three months later, two test implants with a sloped marginal design and two control implants were placed in the chronic defect area with a sloped lingual‐buccal configuration of each premolar region. The test implants were placed in such a way that the buccal margin of the implant coincided with the buccal bone crest. The lingual margin of the control implants was placed to a similar depth as the lingual margin of the test implants. Abutments were connected to the implants in the right mandibular premolar region and flaps were sutured around the neck of the abutments. In the left side of the mandible, cover screws were placed and the flaps were sutured to cover the implants. Biopsies were obtained 4 months later and prepared for histological examination. Results: It was demonstrated that healing around implants placed in an alveolar ridge with a sloped lingual‐buccal configuration resulted in the preservation of a vertical discrepancy between the lingual and buccal marginal bone levels around implants with either a regular cylindrical outline or a modified marginal portion that matched the slope of the alveolar ridge. Conclusion: As the marginal buccal portion of the control implants with a regular design had no bone support, it is suggested that implants with a modified marginal portion may be considered in recipient sites with a sloped lingual‐buccal configuration.     

Preservation of esthetics with implant dentistry: a clinical report

Background: The replacement of single teeth with implants in the anterior maxilla poses a significant challenge to the clinician because of its esthetic implications. Purpose: The purpose of this article is to report a protocol in which single teeth are replaced by implants and temporarily restored without load, immediately after extraction. Materials and Methods: Between June 2001 and July 2002, 16 cases were followed up in which this protocol was used. Briefly, the teeth are extracted with a Periotome (Friadent, Mannheim, Germany), using a napless technique, the sockets are evaluated and débrided, an osteotomy is performed following the direction of the socket, and a tapered implant is placed using the alveolar crest as the landmark. A temporary abutment is immediately custom made, and a temporary crown is placed without loading. The 16 cases are summarized, and 4 of them are presented to illustrate this approach. Results: All four cases have provided excellent esthetic results maintaining an ideal implant‐to‐supporting‐tissue relationship. Furthermore, the overall time needed to restore the cases was considerably reduced when compared with time needed for the conventional approach. Conclusion: The four cases presented support the use of the described protocol in the placement of single implants in areas of the maxillary anterior region where esthetics is a high priority.     

Placement of Brånemark implants in the maxillary tuber region: anatomical considerations, surgical technique and long-term results

Background: Fixture placement in the tuber area is one way to overcome the problem of insufficient bone volume for routine implant surgery in the posterior maxilla due to severe resorption of jawbone and an extensive enlargement of the maxillary sinus. However, little is known about the long‐term results. Purpose: The aim of this study was to retrospectively evaluate the survival rate and marginal bone conditions at fixtures placed in the tuber region of the maxilla. Material and methods: Twenty‐one patients previously treated with at least one implant in the tuber region of the maxilla were included in this retrospective analysis. A total of 23 standard Brånemark System fixtures with a turned surface had been surgically placed in the tuber regions and 71 additional implants in adjacent areas to support fixed dental bridges. All implants were allowed to heal for 6–8 months before abutment connection and following prosthetic treatment. The patients were radiographed after 1–12 years for evaluation of marginal bone levels. In addition, the relation between the apex of the fixture in the tuberosity area and the posterior border of the maxilla was measured. Results: Twenty of the 21 patients representing 22 tuber and 64 additional implants were radiographically evaluated. No implants in the tuber areas were lost during the follow‐up whereas two fixtures in the anterior region had to be removed, one before loading and the other after 4 years of loading not interfering with the prosthesis stability. The mean marginal bone level at tuber implants was situated on average 1.6 mm (SD 1.1, n=22) from the abutment‐fixture junction, whilst the other implants showed an average bone level of 1.9 mm (SD 0.8, n=64). The results were similar when comparing partially and totally edentulous patients. Conclusion: The present retrospective study shows good clinical outcome with standard Brånemark fixtures placed in the tuber region of the posterior maxilla using a two‐stage procedure. In appropriate cases where bone of adequate volume and density is available, our data indicate that the technique can be used as an alternative to more extensive surgery and especially to the sinus lift procedure. However, prospective comparative studies are needed in order to evaluate the efficacy of the described technique for this purpose.     

Maxillary implant‐supported overdentures opposed by (partial) natural dentitions: a 5‐year prospective case series study

The aim of this study was to assess the 5‐year treatment outcome of maxillary implant‐retained overdentures opposed by natural antagonistic teeth. Fifty consecutive patients received maxillary overdentures supported by six dental implants. Implants were placed in the anterior region, if enough bone was present (n = 25 patients) Implant were placed in the posterior region if implant placement in the anterior region was not possible (n = 25 patients). Variables assessed included survival of implants, condition of hard and soft peri‐implant tissues and patients' satisfaction. The five‐year implant survival rate was 97·0% and 99·3%, and mean radiographic bone loss was 0·23 and 0·69 mm in the anterior and posterior group, respectively. Median scores for plaque, calculus, gingiva, bleeding and mean scores for pocket probing depth were low and stayed low. Patients' satisfaction after treatment was high in both groups. Within the limits of this 5‐year study, it is concluded that six dental implants (placed in the anterior or posterior region) connected with a bar and opposed to natural antagonistic teeth result in acceptable results for clinical parameters and good outcomes for marginal bone level changes and patient satisfaction.     

Outcome analysis of immediately placed, immediately restored implants in the esthetic area: the clinical relevance of different interimplant distances

BACKGROUND: The purpose of this study was to compare and evaluate bone and soft tissue levels between immediately placed, immediately restored implants positioned in the esthetic anterior region with different interimplant distances (IID). METHODS: Forty-nine patients requiring multiple implant restorations in the anterior regions received 152 implants, which were restored immediately. Periapical radiographs and digital images of 99 interimplant sites were taken at the regular follow-up examinations at 0, 6, 12, and 24 months after surgery. They were digitally recorded and analyzed. The presence of the interproximal papilla was assessed and compared to the distances between the bone crest and the contact point between the natural teeth and the restoration crowns. RESULTS: Implants with an IID <2 mm seemed to lose less bone laterally. When the IID was <2 mm, vertical crestal bone loss was significantly greater than in the group with IID >4 mm. The percentage of the interproximal papilla presence decreased when the distance between the bone crest and the contact point between the two restoration crowns was >6 mm and when two implants were placed at a distance > or =4 mm. CONCLUSIONS: To guarantee a better esthetic result in immediately placed, immediately restored implants, the contact point between the two prosthetic crowns should be placed at 3 to 4 mm, and never >6 mm, from the bone peak. Two adjacent implants should be placed at a distance >2 and <4 mm.     

Computer-guided flapless placement and immediate loading of four conical screw-type implants in the edentulous mandible

AIM: The aim of this prospective study was to evaluate the outcome of computer-guided flapless placement and immediate loading of four conical screw-type implants in the interforaminal region. PATIENTS AND METHODS: From May to August 2003, 25 consecutive patients (m : f=16 : 9) with edentulous mandibles were included in the study. After transmucosal drilling with computer-assisted navigation, four implants were placed in the interforaminal region. The lower dentures were converted and implants immediately loaded. RESULTS: One-hundred implants were successfully placed. In two patients, all implants had to be submerged because of insufficient primary stability of one of the implants; another patient declined to receive immediate loading of implants after surgery and was lost to follow-up. During follow-up of the remaining 22 patients with 88 immediately loaded implants, loosening of four implants (4.5%) was seen in three patients. In these cases, immediate loading was terminated and all implants submerged; subsequently, two implants were lost in one patient, while the other two implants re-osseointegrated. The cumulative survival and success rates of immediately loaded implants were 97.7% after 2 years. Prosthetic success was 100%. CONCLUSION: Transmucosal computer-assisted placement and immediate loading of mandibular implants is a high-end approach to edentulism that provides excellent results while being minimally invasive.