种植修复后冠松动与扰关系的初步临床观察

目的:修复后冠松动患者咬合接触的特征,探讨后干扰或早接触等咬合异常因素与种植修复体冠松动的关系。方法:选取8例种植粘接修复后冠松动患者,应用T-ScanⅢ咬合分析仪进行正中、前伸及侧方咬合检查,观察干扰和早接触情况,结合咬合纸,指导调,磨除侧方咬合的干扰点。在种植义齿与自然牙的混合牙列,建立种植义齿比自然义齿延迟负载设计模式。结果:8例种植粘接修复后冠松动患者中均存在侧向干扰,早接触等问题,结合咬合纸,指导调,磨除干扰点。分离时间明显较治疗前缩短,早接触出现率较粗治疗前降低。结论:后干扰或早接触等咬合异常因素,易导致种植修复体冠松动,应合理设计种植修复体的力分布,使力沿种植体长轴传导,最大程度减少种植体承受的侧向力和应力,降低种植体负荷。戴冠后应用T-ScanⅢ系统并结合咬合纸,建立种植义齿比自然义齿延迟负载设计模式,缩短侧方研磨时间,能提高种植义齿成功率。     

种植修复下颌磨牙游离缺失满意度的纵向研究分析

目的:纵向比较下颌磨牙游离缺失患者在未修复、活动义齿修复及种植义齿修复后的主观评价。方法:对40例戴用过活动义齿,现已完成种植义齿修复的下颌磨牙游离缺失患者,采取种植修复前自测问卷和种植修复后自测问卷形式,由患者本人填写。结果:种植义齿在咀嚼、语言、舒适性、固位等方面的满意度得分更高。结论:种植义齿是修复下颌磨牙游离缺失的最满意选择,活动义齿和未修复状态的满意度无显著意义。     

种植义齿修复患者主观满意度调查分析及临床效果评价

目的:研究种植义齿修复患者主观满意度的影响因素,及对种植义齿修复的临床效果进行客观评价.了解缺牙患者对口腔种植义齿的认知及接受程度.方法:设计种植义齿修复情况问卷调查表,随机选择45名种植义齿修复后1-2年的患者和45名未选择种植叉齿修复的牙列缺损患者进行问卷调查.检查医生记录并评价患者的种植义齿临床指标.使用SPSS 11.0统计软件对患者的基本情况,各项效果满意度及客观临床指标进行相关性分析.结果:45名未选择种植义齿修复的患者中,91.11%的患者了解种植义齿这一修复方式,但是,对种植义齿治疗所担忧的问题依次为种植体和/或种植义齿使用寿命、术后并发症、治疗费用、咀嚼功能、术后疼痛、修复体美观、愈合期缺牙和治疗时间长.45名种植叉齿修复后的患者中,100%对治疗效果满意.其中:37.78%感觉很满意,13.33%感觉满意,48.89%较满意.68.89%的患者感觉价格较贵.不同年龄,性别,牙位和种植系统对种植牙的总体满意度无显著影响(P>0.05).缺牙患者是否做过义齿修复、对旧义齿的满意程度、关于种植义齿知识的来源及费用对种植义齿的心理接受程度有显著影响.结论:使用种植义齿修复牙列缺损和缺失可以获得良好的临床效果.虽然患者担心种植义齿的使用寿命、并发症和较高的费用等问题,但仍对种植义齿良好的美观、发音及咀嚼等功能感觉满意.     

后牙种植修复体咀嚼效能的初步比较研究

目的:将后牙常规义齿与种植义齿的修复效果进行定量比较。方法:选择单侧后牙缺失4颗以下,无其他口腔疾病者无口腔修复史者90例,牙位等同,分为活动组,固定组,种植组各30例。正常牙列对照组30例。用改良吸光度法测量并比较单侧后牙缺失患者行活动义齿,固定义齿及种植义齿修复前后的咀嚼效能。结果:活动修复后咀嚼效能与正常牙列人群咀嚼效能之间有显著性差别(P<0.05);固定修复后,种植修复后与正常牙列咀嚼效能无显著差别(P>0.05)。结论:活动义齿、固定义齿、种植义齿修复均能有效提高后牙缺失患者的咀嚼效能,但活动义齿效果最差。固定义齿和种植义齿修复均能使后牙缺失患者的咀嚼效能提高至与正牙列人群相似。     

通过种植修复进行全口咬合重建:病例报道

目的:对一列上颌无牙颌患者采用Nobel guide种植修复,下颌牙列缺损采用常规种植固定桥修复.评价和探讨种植修复在全口咬合重建中的应用.方法:患者女性,59岁.上颌无牙颌,全口义齿修复.下颌两侧后牙牙列缺损,固定义齿修复.自诉上颌义齿固位不佳,不能咀嚼,下颌固定义齿松动.拔除下颌松动基牙,取上下颌模型,上诊断合架,制作义齿的诊断蜡型.取得上颌骨的CT数据,制作Nobel Guide模板及即刻临时固定种植义齿.术中利用Nobel Guide模板在上颌植入6颗种植体,并带入预成的临时即刻义齿.下颌按常规在左右后牙区各植入2颗种植体.三个月后,上颌制作个性化纯钛固定种植义齿支架+高强度树脂修复.下颌制作氧化锆全瓷修复(Procera系统).结果:获得了理想的上下颌咬合关系及正常的咬舍曲线.患者的咀嚼效率和美观均得到了很大的改善和提高.结论:利用种植修复进行全口咬合修复是可行的.通过制定缜密的治疗方案是可以达到很好的效果.     

三维有限元法对下颌种植覆盖义齿应力分布的分析

目的：分析种植义齿不同连接方式、即刻载荷式种植义齿、设置缓冲间隙对下颌种植覆盖总义齿应力分布的影响。方法：应用三维有限元法模拟正中开闭口运动中下颌种植覆盖总义齿的受力情况,分析种植义齿不同连接方法、即刻载荷式种植义齿、冲击载荷下缓冲间隙的设置对义齿应力分布的影响。结果：缓冲间隙的设置可以降低种植体内部、种植体软硬组织界面和义齿基托内应力的峰值,最易引起种植体侧方界面骨吸收的压应力峰值降低了约52%。螺丝固定的种植全口固定义齿有助于远期修复效果,即刻载荷式种植义齿初期稳定性尚待研究。结论：螺丝固定的种植全口固定义齿对设置缓冲间隙有利于保护种植体界面软硬组织的健康,防止义齿基托折裂,提高种植义齿的远期成功率。即刻载荷式种植义齿对种植义齿的远期成功率有一定的影响。     

种植义齿即刻修复的临床研究

目的 依据即刻修复种植理论，对种植固定义齿进行即刻修复以恢复美观和功能。方法 对单个牙缺失患者植入Replace螺旋型种植体后即刻修复，定期进行临床及X线片观察。结果 20枚种植义齿随访6～36个月，种植体无松动，X线片显示骨一种植体结合良好，种植体颈周骨吸收小于1．0mm。结论 单牙即刻修复近期临床观察效果满意。     

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牙周炎导致的牙列缺失常伴随严重的牙槽骨吸收,甚至出现上下颌骨体的吸收。松动牙的拔除时机和标准,软硬组织量不足,不同区段骨吸收量不均一,咬合关系异常或不稳定,永久修复前的缺牙期,种植义齿的固位方式、被动就位、咬合设计,防止修复后的种植体周围骨吸收,维持口腔自洁作用及降低患者远期维护成本等问题均是全颌固定种植义齿修复设计时需要考虑的关键因素。本文总结分析四川大学华西口腔医学院种植中心分段式全颌固定种植义齿修复病例,探讨修复设计、种植手术、早期过渡义齿修复和永久修复过程中遇到的问题及思考。     

后牙区种植义齿修复完成一年后并发症的临床分析

目的:总结分析后牙区种植义齿修复完成一年后并发症的发生,为提高临床种植义齿长期修复成功率提供参考。方法:统计分析山东大学口腔医院种植中心自2001年至今完成永久修复一年后出现并发症的后牙区种植体共68颗。结果:出现的并发症有:种植体松动脱落7颗,发生率10.3%;慢性种植体周围炎18颗,发生率26.5%;冠、基台、固位螺丝等部件松动19颗,发生率28.0%;种植体、基台、中央螺丝折断7颗,发生率10.3%;食物嵌塞22颗,发生率32.3%。结论:后牙区种植义齿修复完成后一年出现的并发症主要是食物嵌塞、慢性种植体周围炎、上部修复结构松动。这主要与不同种植系统的选择、种植外科操作、上部修复结构的设计制作及患者的使用维护情况有关。采用规范的外科操作、制作精良的上部修复体,以及注重种植修复体的长期随访维护,就会尽可能地避免种植修复并发症的发生,有效地提高种植义齿修复的长期成功率。     

无牙颌患者种植义齿修复

目的:无牙颌患者采用种植义齿修复可有效的增强义齿的固位,提高义齿的修复效果。方法:从1999年至2007年,对22例无牙颌患者,年龄45-82岁,行种植义齿修复,其中,有2例采用种植固定义齿修复,7例采用杆-卡式种植覆盖义齿修复,11例采用球-帽式种植覆盖义齿修复,1例采用双套筒冠种植覆盖义齿修复,1例采用磁性固位种植覆盖义齿修复。患者种植体植入2-9颗,共植入种植体97枚,种植体采用Frialit-2,Fri-alit-xive系统,观察时间108个月,采用临床检查、X线观察和患者主观评价等来评价种植体与骨组织结合状态,评价其义齿的修复效果。结果:观察期内发现1枚种植体脱(球-帽式固位种植体),1枚种植体未作修复,仍埋入在粘膜下的颌骨内。种植义齿修复后固位稳定作用良好,患者咀嚼有力,对义齿修复效果满意。结论:无牙颌患者种植义齿修复效果良好,患者满意度高。     

A Prosthesis Retention System for Full‐Arch,Fixed, Implant‐Supported Prosthesis

Full‐arch, fixed, implant‐supported prostheses can be designed to be cement‐ or screw‐retained. Both retention mechanisms have a few inherent disadvantages. A fixed attachment system has been introduced to circumvent the disadvantages of both screw and cement retention. This system eliminates the screw access holes and the use of cement. The number of intraoral procedures required is also reduced. The purpose of this article is to report a case using the Locator F‐Tx Attachment System to facilitate fabrication of an esthetic, clinician‐retrievable, full‐arch implant‐supported fixed dental prosthesis.     

Fabrication of an Implant‐Supported Fixed Interim Prosthesis Using a Duplicate Denture: An Alternative Technique

The fabrication of an implant‐supported fixed complete denture prosthesis involves multiple clinical and laboratory steps. One of the main steps is to provide the patient with an interim fixed prosthesis to evaluate the patient's esthetic and functional needs as well as to enhance the patient's psychology before proceeding to the definitive prosthesis. Different techniques for fabricating interim prostheses have been described in the literature. This report describes an alternative technique that uses a duplicate denture made of self‐curing acrylic resin to fabricate an implant‐supported fixed interim prosthesis. The interim prosthesis was later used as a blueprint for the definitive implant‐supported hybrid prosthesis.     

当代牙种植体设计进步与临床意义

牙种植体本身的研发设计进展深刻的影响了临床技术的进步,也深刻的影响了临床治疗效果,甚至给临床治疗理念或流程带来里程碑式的变革。当代牙种植体的设计与临床进步主要表现为：1）种植体根方设计影响了即刻种植的初期稳定性,即刻种植时植入超出牙槽窝上方约3~5 mm的种植体部分的外形结构决定了该种植体的初期稳定性,其外形结构主要体现在种植体根方轮廓设计、螺纹设计及自攻性方面。2）种植体的外形结构设计影响了即刻修复的可能性,即刻修复的基础在尚无骨结合时种植体通过其机械设计可以获得大于35 Ncm的初期稳定性。 微锥度种植体外形,密集型深螺纹,含有良好的自攻刃设计均有利于机械锚定,即初期稳定性,这是即刻修复的物理学基础与机械可能性。3）种植体颈部设计影响美学效果,为了避免拔牙窝唇颊侧骨板吸收显露种植体颈部的金属暗影,均应避免使用颈部膨大设计的种植体,而应采用小直径种植体以利于美学修复美学区域进行种植修复,最好具有平台转移的设计,以获得良好的美学效果。4）种植体与基台的连接设计是骨内种植体设计的关键环节,功能上除了连接种植体与修复体,抗旋转外还需要抵抗或传导各个方向的咀嚼力,连接方式的稳定性会直接影响种植体颈部骨组织的长期稳定性,锥度连接和管套管连接方式都是有良好记录的种植体连接方式。5）平台转移设计影响到种植体颈部骨组织的稳定性,国际上大量临床研究结果及笔者所在科室应用均认为,具有平台转移设计的种植体有利于保存种植体颈部骨组织,无论是在单牙修复还是在多牙或无牙颌种植修复中都表现出良好的种植体颈部骨组织稳定性。6）数字化技术为种植临床技术提供了更为精确,更为高效的高科技方式。应用数字化印模技术结合计算机辅助设计/计算机辅助制作软件及专用设备进行修复体的设计、制作将成为未来种植修复的发展趋势。种植体及其配件的持续研发为临床数字化技术提供了可能性,新一代椅旁数字化系统口内扫描前无需喷粉,免除了即刻种植后伤口由喷粉致感染的潜在风险,解决了即刻种植术后即刻扫描的技术难题。7）种植体基台的特殊设计以满足临床新技术创新发展的需求,推进了临床流程的显著变革。All-on-four即刻修复技术和Weldone口内焊接即刻修复技术的问世都是新型特殊修复基台研发突破进而推动了临床新技术的创新。     

Fabrication of a Fixed Retrievable Implant‐supported Prosthesis Based on Electroforming: A Technical Report

This article describes a method of fabricating a fixed retrievable implant‐retained prosthesis based on electroforming. This method combines the advantages of both the cement‐ and screw‐retained prostheses, including passive fit, ease of fabrication, and retrievability. The absence of visible occlusal screw‐canals adds to its increased esthetic appeal.     

Complication rates for various retention types in anterior implant-supported prostheses: A retrospective clinical study

Statement of problemImplant-supported prostheses have typically been retained by cement or screws, each of which has advantages and disadvantages. Two new types of prosthesis with complementary advantages and disadvantages have been proposed: the screw- and cement-retained prosthesis, which combines cement and screw retention, and the antiloosening inner-post screw (ALIPS) type, which uses lateral screws. Both esthetic and functional factors should be considered for anterior prostheses; however, clinical studies of the complication rates of these designs are lacking.PurposeThe purpose of this retrospective clinical study was to evaluate the complications of dental implant-supported restorations with various prosthetic types in the anterior region and to analyze other factors that affect complications.Material and methodsThis study included 51 patients who had 83 implants placed in the anterior region by a single clinician between August 2009 and December 2016. Surgical and prosthetic features were recorded, and implant complications were analyzed.ResultsThere were 45 (55.4%) cement-retained implants, 5 (6.0%) screw- and cement-retained prosthesis implants, and 32 (38.6%) ALIPS-retained implants. Peri-implant mucositis was observed most frequently in the ALIPS type (21.9%), but the biological complications did not differ significantly with the prosthetic type. The most common mechanical complication was loss of retention in the cement type of prosthesis (30.4%) and screw loosening in the ALIPS type (43.8%). Implant complications varied with position (maxilla or mandible) and implantation timing (period from tooth extraction to implant placement).ConclusionsThe complications of implants placed in the anterior region were affected by different factors but did not differ significantly with the type of the retention.     

Use of distraction osteogenesis for repositioning of an osseointegrated implant: a case report

This report presents a clinical case in which distraction osteogenesis was used for the vertical repositioning of an implant already osseointegrated in the maxillary right central incisor area. An adhesive prosthesis was cemented over the neighboring teeth to accomplish this procedure. The prosthesis was made with a temporary cylinder directly over the implant to guide its repositioning. After incision and osteotomy, the area that contained the implant was fixed with an implant mount screw. After initial gingival healing (7 days), activation of the distraction was begun. The screw was activated with a full turn thrice a day, for a total of 1.0 mm per day for 7 consecutive days. Thereafter, the bone was allowed to heal for 3 months. Distraction osteogenesis led to a better implant-crown relationship, even after the osseointegration of the implant, thus improving the esthetic results.     

Use of Implant‐Supported Custom Milled Impression Copings to Capture Soft‐Tissue Contours and Incisal Guidance

A technique is presented where a custom milled impression coping is used to replicate the clinically established anterior incisal guidance to the definitive prosthesis when multiple implants are restored in the esthetic zone. A conventional impression is initially made, then the stone cast is scanned, and a digitally designed custom screw‐retained, implant‐supported interim prosthesis is milled from a polymethylmethacrylate (PMMA) billet. This is aimed to digitally design the pontic areas, contour the gingival soft tissue, and establish an anterior incisal guidance. A custom milled impression coping (CMIC) is then fabricated. The CMIC has contours similar to the contours of the interim prosthesis and is fabricated from a PMMA billet. Titanium inserts are placed in the interim prosthesis and the CMIC. The CMIC is inserted intraorally and used for the final impression by using a custom tray and by following the open tray impression protocol. With the proposed technique, the exact contours of the digitally designed and clinically verified interim prosthesis are used to fabricate the definitive restoration.     

Replacement of Missing Anterior Tooth Using Screw Retained Implant Prosthesis in the Esthetic Zone: A Case Report with 3 Years of Follow Up

As more and more dental practitioners are focusing on implant-supported fixed restorations, some clinicians favor the use of cement retained restorations while others consider screw-retained prosthesis to be the best choice. As both types of prostheses have certain advantages and disadvantages, clinicians should be aware of the limitations of each type. Screw-retained implant restorations have an advantage of predictable retention, retrievability and lack of potentially retained sub-gingival cement. However, a few disadvantages exist such as precise placement of the implant for optimal and esthetic location of the screw access hole and obtaining passive fit. On the other hand, cement retained restorations eliminates unaesthetic screw access holes; have passive fit of castings; reduce stress to splinted implants because of minor misfit of the framework; reduced complexity of lab procedures; enhanced esthetics; reduced cost factors and non disrupted morphology of the occlusal table. This case report presents the replacement of missing left central incisor using screw-retained implant prosthesis due to palatal trajectory of the implant placement and inadequate abutment height for retention of cement retained prosthesis.     

Cantilever fixed prostheses utilizing dental implants: a 10-year retrospective analysis.

OBJECTIVE: The dental literature has been unclear about long-term success of fixed cantilever prostheses supported by dental implants. The disappointing results reported when cantilever fixed partial dentures (FPDs) are supported with natural teeth are not directly applicable to implant cantilever FPDs. This article reports on 10 years of implant-retained fixed prostheses primarily in the maxillary arch using the ITI dental implant system. METHOD AND MATERIALS: Sixty cantilever prostheses using 115 ITI dental implants on 36 patients were placed and monitored over a 10-year period. RESULTS: No implant fractures, abutment fractures, porcelain fractures, prosthesis fractures, soft tissue recession, or radiographic bone loss were recorded. All 60 cantilevered prostheses remain in satisfactory function. CONCLUSION: Positive, long-term results, using implant-retained cantilever FPDs can be achieved by: (1) using a rough surface implant of 4.1 mm or greater; (2) using an implant/abutment design that reduces stacked moving parts and reduces the implant-to-crowns ratio; and (3) using a cementable prosthesis design that eliminates the need for occlusal screw retention.     

Transition from Failing Dentition to Full‐Arch Fixed Implant‐Supported Prosthesis with a Staged Approach Using Removable Partial Dentures: A Case Series

The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full‐arch fixed implant‐supported prosthesis may be inserted. Eight patients, who had undergone maxillary full‐arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow‐up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.