局部带蒂黏膜瓣附着龈重建术的临床应用

目的 探讨一种能增加种植体周围附着龈宽度的手术方法.方法 选择2014年4月至2016年8月北京劲松口腔方庄医院种植中心、北京口腔医院特诊特需科门诊需行种植修复病人10例,牙缺失时间均在8年以上,种植位点附着龈宽度仅为0.8~1.5mm,行局部带蒂附着龈重建术,术后6周行种植手术,常规负荷.分别观察附着龈重建术前,种植术前,修复前,修复后缺牙区附着龈宽度变化情况.结果 所有患者在局部带蒂附着龈重建术后均获得了5~6mm的附着龈宽度.随访观察4~32个月,未见明显附着龈退缩.结论 局部带蒂附着龈重建术创伤小,术后恢复快,效果稳定,是临床增加种植体周围附着龈宽度的有效方法.     

显微牙周外科技术在种植体周附着龈增宽术中的应用

目的 探讨显微牙周外科技术在种植体附着龈增宽术中的临床应用效果。方法 对20例种植体周附着龈不足或缺失的患者,采用显微牙周外科技术增宽种植体周的附着龈。术后观察游离龈瓣的存活状态,并记录术前、术后即刻、术后1年时附着龈的宽度,计算术后1年附着龈的收缩率。结果 20例患者的游离龈瓣均存活,术后1年附着龈宽度为（3.05±0.44）mm,与术前相比增加了（2.56±0.31）mm,与术后即刻相比减小了（2.13±0.28）mm,附着龈收缩率为41.22%±5.04%。结论 显微牙周外科技术应用于附着龈增宽术可获得较高的成功率,能较好地提高种植体周附着龈的质量。     

附着龈重建在口腔种植修复中的临床分析

目的:探讨并分析附着龈重建在口腔种植修复中临床应用价值。方法:研究对象为2017年10月-2019年10月在我院就诊的72例口腔种植修复患者作为本实验的研究对象,按着随机的原则将72例口腔种植修复患者分为两组(即对照组以及实验组),每组总共有36例患者,其中对照组采用常规牙龈缝合;实验组采用附着龈重建,之后对两组患者的临床疗效进行对比分析。结果:实验组患者临床治疗总有效率(97.12%)明显优于对照组患者(52.78%);两组患者在术前,其平均宽度经统计学分析,未见统计学意义(P>0.05),实验组术后1、6个月平均宽度与对照相比,经统计学分析,其差异具有统计学意义(P<0.05);实验组患者BI(0.71±0.54)、PLI(0.61±0.10)、PD(1.69±0.38)明显优于对照组患者BI(0.86±0.48)、PLI(0.78±0.22)、PD(2.91±0.44);实验组患者生理功能以及心理功能评分明显优于对照组评分。结论:AG重建应用于口腔种植修复中,可明显提高临床修复疗效,改善患者的生活质量,具有较高的临床应用价值,值得临床推广及应用。     

锥形锁柱种植体应用于牙周病患者后牙即刻种植的临床回顾性研究

目的: 比较锥形锁柱种植体在慢性中重度牙周炎患者行后牙区即刻种植和延期种植2种种植方式的短期临床疗效。方法: 收集2015年1月~2015年12月接受种植修复的26例慢性中重度牙周炎患者,共植入种植体52枚,其中即刻种植组(A组)28枚,延期种植组(B组)24枚,术后3~6个月完成冠修复,修复后追踪观察时间(14.4±2.3)月,观察种植体存留情况、修复后种植体周围骨吸收量和调查患者满意度。结果: 即刻种植组1枚植体因感染取出,延期种植组失败0枚,存留率分别为96.4%和100%;修复后1年实验组和对照组的种植体近中边缘骨吸收分别为(0.027±0.340) mm和(0.024±0.292) mm,远中边缘骨吸收分别为(0.011±0.252) mm和(-0.002±0.360) mm;2组患者总体满意度较高,上述差异均无统计学意义(P>0.05),观察期内存留的种植体正常行使功能,种植体周围软组织健康状况良好。结论: 慢性中重度牙周炎患者经过完善的牙周系统治疗后,在牙周状况良好的条件下,应用锥形锁柱种植体进行后牙区即刻种植,与延期种植在短期内临床效果相当。     

数字化导板在前牙美学区种植修复应用的精确度研究

目的 研究数字化导板应用于前牙美学区种植修复的精确度。方法 选择50例需接受上前牙种植修复的患者为研究对象,随机分为2组,每组25例,分别实施常规种植修复（对照组,45枚种植体）和数字化导板辅助种植修复（试验组,51枚种植体）,术后测量2组植入体术前虚拟设计位置与实际植入位置的颈部距离、根尖部距离、深度和角度偏差。在全瓷冠修复完成后1周（基线）、6个月和1年,观察2组患者术后种植体的临床修复疗效,采用红白美学评分[包括红美学分数（PES）和白美学分数（WES）]评价软组织及牙冠修复的美学效果。结果 50例患者的96颗种植体术后均取得了良好的骨结合。试验组种植体植入位置的各项偏差均小于对照组（P<0.05）;修复完成后1周、6个月和1年,试验组的PES及WES均高于对照组（P<0.05）。结论 数字化导板辅助种植修复技术可以提高种植体三维位置的准确性和前牙美学区的修复效果。     

过渡性治疗义齿在疑难全口义齿修复前的临床应用初探

目的 探讨治疗义齿在疑难全口义齿修复前的临床应用价值。方法 选择36例疑难全口病例修复困难或失败的患者,针对修复困难或失败的原因,应用治疗义齿改善不利于义齿修复的多种因素,通过治疗义齿复制,完成最终义齿修复。采用颌位关系指数、固位力及稳定性评分、口腔健康影响程度-EDENT量表评价治疗过程的有效性。结果 36例患者中,33例患者获得有效治疗,顺利完成最终义齿修复,且修复效果良好。结论 治疗义齿是一种行之有效的治疗方法,能纠正咬合和黏膜面问题并作为口颌系统神经及肌肉康复训练的工具,有助于最终义齿修复,值得临床推广和应用。     

臭氧治疗颞下颌关节炎的临床研究

目的:观察颞下颌关节腔注射臭氧治疗颞下颌关节炎的临床疗效。方法:选取2014年6月~2015年6月于我院就诊并被确诊为颞下颌关节炎的患者60例,按照随机原则将所有入选患者分为治疗组30例,对照组30例。治疗组采取颞下颌关节腔注射臭氧治疗,对照组采取颞下颌关节腔注射曲安奈德治疗,治疗之后进行疗效的对比。结果:进行治疗后,治疗组各时点VAS评分及最大张口度与对照组无明显差别。两组情况比较差异无统计学意义。结论:颞下颌关节腔注射臭氧疗效显著,与颞下颌关节腔注射曲安奈德疗效无明显区别,而且并发症少、安全性高。     

脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘

目的 评价脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘的效果。方法 选择上颌骨囊肿摘除术或上颌磨牙拔除术后口腔与上颌窦相通的9例口腔上颌窦瘘患者（缺损大于5 mm×5 mm）,采用脱细胞真皮基质复合小牛脱细胞骨进行同期植入修复缺损。结果 9例患者术后切口均一期愈合,随访6个月,口腔上颌窦相通处黏膜均未见瘘道及分泌物,无鼻塞、流脓涕等上颌窦炎症相关症状,临床检查鼓气试验及CT检查均证实创口愈合。结论 应用脱细胞真皮基质及小牛脱细胞骨修复口腔上颌窦瘘,是一种有效的治疗方法。     

自体颏外板在眶底骨折缺损重建中的应用

目的 探讨自体颏外板修复眶底骨折缺损的效果。方法 对11例眶底骨折缺损患者,采用自体下颌骨颏外板进行眶底重建修复,术后随访6~12月。结果 11例患者术后伤口均一期愈合,眶底结构恢复,无视力下降和眼球运动受限,移植物均无感染排出或吸收,供区无并发症发生。结论 自体颏外板是眶底骨缺损较为理想的一种修复材料。     

封闭负压引流技术治疗口腔颌面间隙感染的临床应用

目的 评价封闭负压引流（VSD）技术持续负压引流并生理盐水持续冲洗治疗口腔颌面间隙感染的疗效。方法 对116例颌面间隙感染病例进行回顾性分析,收集患者临床资料,比较常规手术切开引流（传统治疗组,58例）和手术切开VSD（VSD组,58例）这2种治疗方法的治疗效果。结果 VSD组患者的住院时间、白细胞计数、瘢痕长度、换药次数、疼痛程度均低于传统治疗组,张口改善度优于传统治疗组（P<0.05）。结论 封闭负压引流技术是治疗口腔颌面间隙感染的更为有效的一种方法。     

上颌前牙种植的附着龈重建的临床研究

目的:寻找上颌前牙种植的附着龈重建的方法。方法:选择30例上颌前牙种植二期术患者随机分实验与对照组,实验组上颌前牙种植区正中偏腭侧作切口,剥离粘膜瓣,保留骨膜,上愈合基台,附着龈底部缝于骨膜;修整龈瓣颈缘,并与邻牙相协调;上部结构(基台)精细研磨,重建无缝隙冠龈连接,精度贵金属烤瓷修复。对照组上颌前牙种植区正中切口,剥离粘骨膜瓣,上愈合基台,常规牙龈缝合;基台研磨贵金属烤瓷修复。分别于种植修复后3、6、12月测量上颌前牙种植周附着龈宽度。和评价龈缘外形。结果:实验组附着龈宽度增加值明显高于对照组(p<0.01),龈缘外形明显优于对照组(p<0.01)。结论:上颌前牙种植的附着龈重建方法简单,可行。     

血管化骨移植修复颌骨严重缺损并种植义齿修复

目的:颌骨外伤、肿瘤或其他疾病常导致上下颌骨严重缺损,此时如何重建口腔颌面部的形态和功能一直是口腔修复的难点和挑战。本研究旨在观察血管化骨移植修复颌骨缺损并种植义齿修复的临床效果。方法:对12例颌骨严重缺损患者行血管化髂骨肌瓣或血管化腓骨肌皮瓣修复骨缺损,对牙列缺损患者采用手术导板指导移植骨块的定位,7例患者在导板指导下行同期牙种植体植入术。5例患者在术后4～6月行延期牙种植体植入术。3～4月后行种植义齿修复,其中种植覆盖义齿4例,种植固定义齿8例。结果:所有病例的血管化自体骨移植均获成功。种植义齿修复后经3～24月的临床观察,X片显示种植体与移植骨间未见透射影,2例发生种植体周围软组织增生,患者对形态和功能恢复感到满意。结论:血管化骨移植并种植义齿修复用于颌骨严重缺损的功能重建可获得良好的临床效果,其远期疗效有待进一步观察。     

牙龈退缩根面覆盖治疗1例

目的 牙龈退缩常常导致根面敏感、菌斑控制不良和牙龈美学等问题,影响患者的口腔健康和颜面美观。本病例采用根面覆盖术治疗牙龈退缩,以改善患者牙齿敏感问题。诊治经过：手术采用冠向复位瓣联合结缔组织移植瓣双层技术治疗退缩类型（recession type,RT）为1类的牙龈退缩。结果 术后2周,受区龈缘略水肿;术后12个月复诊,龈缘位置趋于稳定,根面覆盖率达100%,角化龈宽度及临床附着水平增加。患者无牙齿敏感、系带牵拉和瘢痕形成等不适症状,牙龈美学效果良好。结论 冠向复位瓣联合结缔组织移植瓣双层技术治疗RT 1类牙龈退缩效果良好,不仅能够获得完全根面覆盖、牙龈美学效果良好,而且增加了术区角化牙龈的宽度和临床附着水平。     

61例牙龈瘤的临床特点及疗效分析

目的:分析牙龈瘤的临床特点、分型以及改良式牙龈瘤切除术的疗效。方法:收集61例牙龈瘤患者的临床资料,分析临床特点,以改良牙龈瘤切除术治疗,观察术后疗效。结果:61例牙龈瘤患者,平均年龄为33.2岁,20~29岁年龄段女性多发,好发于前牙区唇侧;其中,49.2%为纤维型,29.5%为肉芽肿型,21.3%为血管型;术后1、3、6个月定期复查,60例均取得了良好疗效。结论:术前常规牙周基础治疗控制口腔卫生,以松弛切口转瓣方式增加瘤区角化龈,有助于牙龈瘤切除后牙龈形态的恢复和长期疗效的维持。     

两种材质改良高嵌体/冠修复中重度后牙缺损的疗效研究

目的:比较两种不同材质的牙色改良高嵌体/冠修复中重度后牙缺损的临床疗效。方法:对46名患者51颗中重度缺损后牙分别采用CAD/CAM氧化锆全瓷改良高嵌体(冠)(A组)及钴铬烤瓷改良高嵌体/冠(B组)修复,在修复后12、24个月分别进行回访观察,比较其修复效果。结果:B组有1例在24个月回访时发现边缘瓷层崩瓷,边缘密合度增加,修复体未见损坏、松动,患牙未见继发龋及折裂,7颗修复体与患牙或邻牙颜色轻度不匹配。A组有3颗修复体与患牙或邻牙颜色轻度不匹配,其余未见异常。结论:两种不同材质的牙色改良高嵌体/冠用于中重度后牙缺损的修复效果均较理想,兼顾了修复体的强度与美观, 在选好适应症的情况下,简化了疗程,且临床疗效较好,但由于本研究观察期较短,远期效果有待进一步观察。     

Benefits of an implant platform modification technique to reduce crestal bone resorption

PURPOSE: The alveolar bone resorption that occurs around a 2-piece implant following abutment attachment is a well-documented observation. Several investigators propose that crestal bone loss is a response to the invasion of the biologic width by secondary bacterial colonization and micromovements at the implant-abutment interface. This study proposes the creation of a difference between the diameter of the implant platform and diameter of the abutment (implant platform modification), shifting the implant-abutment interface medially to minimize invasion of the biologic width. MATERIAL AND METHODS: We present a series of 30 control cases and 30 study cases using the platform-modification technique. Interproximal bone resorption on the medial and distal of each implant was assessed using digital radiography at 1, 4, and 6 months after abutment attachment. RESULTS: The mean value of bone resorption observed in the mesial measurement for the control group was 2.53 mm, whereas for those patients included in the study group, it was 0.76 mm. The mean value of bone resorption observed in the distal measurement for patients in the control group was 2.56 mm, whereas for those included in the study group, it was 0.77 mm. CONCLUSIONS: All patients in the study group had a significant reduction of bone loss in comparison to the control group (P < 0.0005).     

Exfoliative Cytology and Titanium Dental Implants: A Pilot Study

Background: Oral exfoliative cytology is a diagnostic method that involves the study of cells exfoliated from the oral mucosa. Ions/particles released from metallic implants can remain in the peri‐implant milieu. The aim of the present study is to assess the presence of metal particles in cells exfoliated from peri‐implant oral mucosa around titanium dental implants. Methods: The study comprised 30 patients carrying titanium dental implants, who had neither a metallic prosthesis nor metal restorations in neighboring teeth. Individuals undergoing orthodontic therapy and those who had oral piercing were also excluded from the study. The study sample included patients with and without peri‐implantitis. Cytologic samples of the peri‐implant area were collected. Samples of the marginal gingiva on the contralateral side of the implant were taken from the same individuals to serve as control. Cytologic analysis was performed using light microscopy. Titanium concentration was determined using inductively coupled plasma‐mass spectrophotometry. Results: Metal‐like particles were observed inside and outside epithelial cells and macrophages in cytologic smears of peri‐implant mucosa of both patients with and without peri‐implantitis. No particles were found in the control cytologic samples. The concentration of titanium was higher in the peri‐implantitis group compared with the group without peri‐implantitis; no traces of titanium were observed in controls. Conclusions: Regardless of an inflammatory response, ions/particles are released from the surface of the implant into the biologic milieu. Exfoliative cytology is a simple technique that may be used to detect metal particles in cells exfoliated from the peri‐implant mucosa.     

Clinical evaluation of implants in patients with maxillofacial defects

AIM: To show the efficacy of reconstruction and rehabilitation of large acquired maxillofacial defects due to tumor resections and firearm injuries. METHODS: The study group comprised of 16 patients (10 men and 6 women) who were operated on because of their maxillofacial defects under local and general anesthesia between June 2007 and June 2011. Prosthetic treatment with the aid of dental implants was performed for all of the patients. Eight patients received an implant supported fixed prosthesis; six patients received implant supported overdentures and two patients received both. Patients were followed up postoperatively for 1 to 4 years. Implant success and survival rates were recorded. Panoramic radiographs were taken preoperatively, immediately after surgery, immediately after loading and at every recall session. Peri-implant and prosthetic complications were recorded. Subjects were asked to grade their oral health satisfaction after treatment according to 100 mm visual analog scale (VAS) and the oral health related quality of life of the patients was measured with the short-form Oral Health Impact Profile. RESULTS: Five implants (3 in the mandible, 2 in the maxilla) in five patients were lost, while the other 53 survived, which brings an overall survival rate of 91.37% on the implant basis, but 68.75% on patient basis. All the failed implants were lost before abutment connection and were therefore regarded as early failures. For all failed implants, new implants were placed after a 2 mo period and the planning was maintained. The mean marginal bone loss (MBL) was 1.4 mm on the mesial side and 1.6 mm on the distal side of the implants. Five of the implants showed MBL > 2 mm (mean MBL = 2.3 mm) but less than 1/2 of the implant bodies and therefore were regarded as not successful but surviving implants. The VAS General Comfort mean score was 85.07, the VAS Speech mean score was 75.25 and the VAS Esthetics mean score was 82.74. No patient reported low scores (score lower than 50) of satisfaction in any of the evaluated factors. The mean of OHIP-14 scores was 5.5. CONCLUSION: Although further follow up and larger case numbers will give more information about the success of dental implants as a treatment modality in maxillofacial defects patients, the actual results are encouraging and can be recommended for similar cases.