慢性牙周炎患者后牙区种植修复后5年临床疗效分析

目的　观察并分析慢性牙周炎患者后牙区种植修复后5年的临床疗效。方法　选取2012—2013年于中国医科大学附属口腔医院种植中心行后牙区种植修复的患者120例,共计患牙232颗,其中慢性牙周炎患者67例为牙周炎组,种植修复患牙112颗;牙周健康患者53例为对照组,种植修复患牙120颗。上部结构修复5年后,比较两组种植体的牙周情况及边缘骨吸收情况。在牙周炎组中,比较种植体与相邻天然牙及吸烟与非吸烟患者的边缘骨吸收情况。结果　上部结构修复5年后,牙周炎组和对照组种植体成功率均为100%。牙周炎组种植体牙周探诊深度、牙龈指数及牙菌斑指数均较对照组高,但差异均无统计学意义（P > 0.05）。牙周炎组和对照组种植体边缘骨吸收量分别为（0.89 ± 0.68）mm和（0.56 ± 0.35）mm,差异有统计学意义（t = 3.338,P < 0.05）;牙周炎组种植体种植体边缘骨吸收量明显大于相邻天然牙边缘骨吸收量［（0.45 ± 0.32）mm］,差异有统计学意义（t = 4.172,P < 0.05）;牙周炎组吸烟患者的种植体边缘骨吸收量［（1.23 ± 0.75）mm］大于非吸烟患者［（0.62 ± 0.48）mm］,差异有统计学意义（t = 5.763,P < 0.05）。结论　与牙周健康患者相比,慢性牙周炎患者后牙区种植修复后5年的种植体成功率和牙周情况无差异,但边缘骨吸收量明显增加,且吸烟可增加慢性牙周炎患者种植体边缘骨吸收量。     

慢性牙周炎对平台转移种植体边缘骨吸收的影响

目的探讨平台转移种植体在慢性牙周炎与牙周健康患者边缘骨吸收差异。方法选择2013年1月至2016年1月间后牙区接受Ankylos系统种植修复牙周炎患者和牙周健康患者各20例,共植入56颗种植体,随访36～50个月,收集复诊临床检查及影像学检查结果,测量两组的种植体与天然邻牙边缘骨吸收量,评估两组种植体功能负载3年以上颈部年均骨吸收量的变化及差异。应用SPSS 13.0软件包对数据进行统计学分析。结果所有病例平均随访时间为(39.2±6.1)个月,无种植体脱落。牙周炎患者种植体年均骨吸收与天然邻牙相比,差异有统计学意义(P<0.001)。牙周健康患者种植体年均骨吸收与天然邻牙相比,差异无统计学意义(P=0.849)。而两组的种植体年均骨吸收差异无统计学意义(P=0.612)。结论慢性牙周炎患者平台转移种植体周围骨组织稳定,可获得与牙周健康患者相同的理想修复效果。     

Ankylos小直径种植体修复后牙区牙列缺损的效果评价

目的评价Ankylos小直径种植体修复后牙医牙列缺损的临床效果,探讨小直径种植体应用于后牙区的适应证及注意事项、、方法选择后牙区牙列缺损需行种植修复而无法植入标准直径种植体的患耆24例．植入商径3．5mm Ankylos种植体兵35枚,3～4个月后行金属烤瓷冠单冠或联冠修复,修复完成后1、3、6个月复诊,之后每半年复诊1次。复诊时检测种植体周围边缘骨水平、软组织健康状况及各种机械并发症。结果随访时间为完成修复后6～30个月。随访期内所有种植体行使功能良好,种植体周围边缘骨水平为－0．6mm至＋0．3mm,软组织健康状况良好,未发现机械并发症。结论应用Ankylos小直径种植体修复后牙Ⅸ牙列缺损可获得良好的短期临床效果;窄牙槽嵴、缺牙区近远中修复间隙不足和邻牙牙根间距离近是小直径种植体的主委适应证.     

牙周炎患者种植义齿修复5年回顾性研究

目的比较牙周炎与牙周健康患者牙列缺损行种植修复后的疗效差异。方法采用回顾性分析的研究方法。牙列缺损患者44例,共植入种植体80颗,慢性牙周炎患者病情稳定后植入种植体40颗（牙周炎组）,牙周健康者植入种植体40颗（牙周健康组）,计算2组修复后5年种植体的存留率,测量种植体周骨吸收量,对2组的种植体存留率比较采用卡方检验,对2组种植体周骨吸收量的比较采用配对t检验。结果牙周炎组及牙周健康组种植体5年存留率分别为95.0%、97.5%,差异无统计学意义（χ2=0.346,P〉0.05）。牙周炎组及牙周健康组种植体周骨吸收量分别为（2.34±0.72）mm、（1.76±0.68）mm,差异有统计学意义（t=3.7,P〈0.05）。结论牙周炎患者种植修复边缘骨吸收显著增加,为种植修复的危险因素之一。     

重度慢性牙周炎患者上颌磨牙区拔牙后即刻种植与位点保存术后延期种植短期疗效观察

目的:观察慢性重度牙周炎患者行系统性牙周治疗后上颌磨牙区拔牙后即刻种植和位点保存术后延期种植两种种植方式的短期临床疗效。方法:38例慢性重度牙周炎患者导致上颌后牙区牙齿保留无望,经过系统性牙周治疗及复查提示牙周状况良好后行种植治疗,共植入修复体49枚,其中即刻种植组23枚,位点保存术后延期种植组26枚,种植术后3~6个月行修复治疗。观察种植体留存情况及修复后种植体周围组织状况。结果:种植体脱落情况:即刻种植组2枚,延期种植组1枚,存留率分别为91.30%和96.15%。两组种植体种植修复后即刻及6月后复查的PD、BI、BOP(+)相比,差异均无统计学意义(P＞0.05);观察期内种植成功的种植体功能良好,种植体周围软组织健康状况良好。结论:慢性重度牙周炎患者经过完善的牙周系统治疗,在牙周状况良好的条件下,上颌后牙区拔牙后即刻种植和位点保存术后延期种植短期内临床效果相当。     

改良树脂夹板在种植体开窗式印模技术中的应用研究

目的:介绍一种改良的种植体开窗式印模转移杆的树脂夹板,并评估其临床应用效果。方法:选择牙列缺损患者18例共44枚种植体,制取印模前于体外制作改良的个性化丙烯酸树脂夹板,返回口内连接固定开窗式印模转移杆,制取印模并制作18件修复体。安装修复体时检测边缘适合性,修复完成后第1、3、6和12个月复诊,以后每12个月复诊一次。复诊时检测种植体周围边缘骨吸收量、软组织健康状况及各种机械并发症。结果:18件修复体边缘适合性均良好,随诊时间12-36个月,平均22个月,第一年平均骨吸收量为0.82mm,随诊期内所有种植体周围软组织健康状况良好,未发现机械并发症。结论:本研究中改良树脂夹板应用于种植体开窗式印模技术精确性高,修复体临床效果良好。     

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。     

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。     

慢性局限型牙周炎患者牙种植修复的早期临床观察

目的:观察慢性局限型牙周炎患者行牙种植修复的早期临床疗效.方法:对21例局部牙缺失、病情在一般控制情况以上的临床诊断慢性局限型牙周炎患者,共植入57颗种植体.二期修复负载后随访1年.结果:有3例4颗种植体骨整合失败、拔除,53颗种植体骨整合良好,早期成功率为92.98%;负载1年X线片测量分析种植体周围边缘骨吸收为(0.77±0.32)mm.结论:在慢性局限型牙周炎病情得到良好控制的情况下,行牙种植修复短期效果良好,长期效果有待继续跟踪观察.     

牙周炎患者种植治疗的临床策略

牙周疾病是导致我国成人牙齿丧失的首要原因,缺失牙的患者往往伴有牙周疾病。如果牙周炎患者在种植前未控制牙周感染,余牙尤其是种植区邻牙牙周袋内的致病菌会迅速定植在种植体上,可导致种植体周围组织的感染,影响骨结合,或发生种植体周围炎,继而导致种植失败。另外,目前尚无证据表明天然牙被种植体取代后,宿主对微生物感染的反应会发生改变,因此牙周炎易感患者如感染控制不当,其种植体和天然牙发生骨丧失的危险性是相似的。种植治疗前要进行全面的牙周检查和危险因素评估以制定合理的牙周和种植治疗计划。如患者伴有牙周炎症,在种植手术前须先行牙周治疗,控制牙周感染,消除牙周炎症。余留牙的探诊深度(PD)≤5mm,牙龈探诊后出血(BOP)<25%,方能开始种植阶段的治疗。牙周炎患者的种植区多存在软、硬组织缺陷,在植入种植体的同期也需进行一些牙周手术治疗,从而有利于种植修复治疗或获得好的美学效果。教会患者进行口腔卫生维护的方法,如刷牙、使用牙线或牙间隙刷等,特别要注意保持种植基台周围的清洁。告知患者要定期复查(修复后早期2-3个月复查一次,以后适当延长间隔期每年至少2次)。医师在复查时发现问题及时处理,并进行专业牙周维护和种植体周的清洁维护。     

重度牙周炎患者种植总义齿修复的临床观察

目的:探讨重度牙周炎患者拔除余留牙后行种植总义齿修复的临床疗效。材料和方法:重度牙周炎患者18位,拔除单颌所有余留牙后即刻或4～6周后植入种植体,采用即刻负重或延期负重的修复方式,并于术后3～8月后完成最终种植总义齿的修复。对所有患者进行临床及X线检查评价修复效果。结果:18位患者共植入144颗种植体,共完成24个种植总义齿的修复,其中上颌14例,下颌10例,12例采用了即刻负重的方式,12例3～8个月后延期负重。最终9例行固定总义齿修复,15例行覆盖义齿修复。永久修复完成后随访10～36个月,平均13个月。观察期内共2颗种植体丧失。修复完成后6个月时与植入时相比,种植体周边缘骨吸收0.56mm。采用覆盖义齿或固定义齿,种植体边缘骨吸收无明显差异。讨论:对于临床预后不佳的重度牙周炎患者,早期拔除余留牙后采用种植总义齿的修复方式,可早日恢复患者的咀嚼功能。严格的适应症选择,合理的治疗设计及正确的手术实施是保证成功率的关键。结论:对重度牙周炎患者采用种植总义齿的修复方式可获得满意的临床效果。     

Oral conditions and aptitude to receive implants in patients with removable partial denture: a cross-sectional study. Part II. Aptitude

summary The aim of this study was to evaluate the possibility of replacing removable partial denture (RPD) with fixed partial dentures on osseointegrated implants in a selective group of patients with partially edentulous lower jaws. Forty patients were evaluated to receive implants. Twenty-three patients showed a precarious oral hygiene, five patients refused the treatment (being satisfied with their RPD), six refused for economic reasons, three patients refused for fear and scepticism, one for long duration of therapy, and one was not treated because of a very marked atrophy of the alveolar crest. Finally, one patient was treated with implants. For these reasons, at the present time implants are not an appropriate treatment for introduction into large-scale public health programmes and RPD must still be considered a valid therapeutic procedure.     

悬臂梁式种植固定义齿的回顾性研究

目的:评价悬臂梁式种植固定义齿的长期临床效果。方法 :采用回顾性研究方法 ,收集2005-01—2011-06,在我科室采用悬臂梁式种植固定义齿修复58例患者(60个修复体,共103枚种植体)的临床及影像学资料。记录种植体的失败个数、修复体失败个数、边缘骨吸收情况、机械及生物并发症情况。结果:随访期内无种植体失败,有3个修复体失败。种植体7年累计存留率100%,修复体7年累计存留率为92.3%。随访期内并未见严重的边缘骨吸收,近悬臂端种植体周边缘骨吸收为(0.08±0.12)mm,远悬臂端种植体周边缘骨吸收为(0.09±0.14)mm。8个修复体(13%)、14枚种植体(14%)发生生物学并发症,11个修复体(18.3%)出现机械并发症。结论:本研究初步证实悬臂梁式种植固定义齿的修复方式临床效果是可靠的,可作为临床种植设计的一个可选方案。因较高的机械并发症,在选择螺丝固位方式时需加以注意。     

Immediate loaded fixed complete dentures supported by implants in patients with a history of periodontitis: A retrospective cohort study of 2 to 7 years

Statement of problemThe outcome of implant-supported fixed complete dentures in edentulous patients with a history of periodontitis is unclear.PurposeThe purpose of this retrospective clinical study was to assess the clinical outcomes of immediate loaded fixed complete dentures in individuals with a history of periodontitis and to analyze risk factors related to implant failure.Material and methodsA total of 642 implants (146 prostheses) in 119 patients were included. The follow-up period ranged from 2 to 7 years. Implant survival rates, marginal bone loss, mechanical complications, biologic complications, and patient satisfaction were evaluated. The Pearson chi-square test, independent samples t test, and multivariate generalized estimating equation were performed for statistical analysis (α=.05).ResultsEleven implants in 9 patients failed, leading to overall survival rates of 98.3% at the implant level and 92.4% at the patient level. The mean ±standard deviation marginal bone loss was 0.62 ±0.86 mm, and marginal bone loss did not differ significantly between axial and tilted implants (P>.05). Mechanical complications were detected in 55 (37.7%) definitive prostheses; biologic complications were detected in 318 (49.5%) implants. Smokers had a significantly lower survival rate than nonsmokers (odds ratio: 6.880, P=.013). Bruxers had a significantly higher incidence of mechanical complications than nonbruxers (P<.001).ConclusionsThe immediate loaded fixed complete denture supported by implants is a suitable treatment option for edentulous patients with a history of periodontitis, with high survival implant rates. Smoking is a risk factor for implant failure. Bruxism may increase the incidence of mechanical complications with implant-supported fixed complete dentures, and the overall biologic complication incidence is comparatively high.     

慢性牙周炎患者种植修复的临床观察

目的:探讨种植义齿修复慢性牙周炎患者牙列缺损的手术技巧及局部预防用药的疗效,并分析相关影响因素。方法:16例因慢性牙周炎致牙列缺损病例植入种植体89枚。5～6个月后行二期修复。根据临床检查、X线片和患者主诉评价修复效果。结果:所有病例均已完成修复,平均随访24个月。均无种植体松动脱落,患者咀嚼功能正常。结论:采取微创种植手术及派丽奥创口缓释用药措施,慢性牙周炎缺牙病例行种植义齿修复可以获得满意的早期临床疗效。     

Ten Years Later. Results from a Prospective Single‐Centre Clinical Study on 121 Oxidized (TiUnite™) Brånemark Implants in 46 Patients

Background: Concerns have been raised that use of surface‐modified implants may result in peri‐implant infection and marked marginal bone loss over time. Purpose: The aim of this prospective study was to evaluate the survival rate, marginal bone, and soft tissue conditions at surface‐modified titanium dental implants after 10 years of function. Material and Methods: Forty‐six totally and partially edentulous patients were provided with 121 Brånemark oxidized implants (TiUnite?, Nobel Biocare AB, Gothenburg, Sweden). Twenty‐four (20%) implants were immediate loaded and 97 (80%) were placed using a two‐stage procedure. A total of 22 single, 23 partial, and 7 total restorations were delivered. Clinical and radiographic checkups were carried out after 3, 6, 12 months, and thereafter annually up to 10 years. At these occasions, oral hygiene was evaluated and peri‐implant mucosa examined by probing. If needed, patients were enrolled in an individual program for hygiene controls and professional cleaning. Marginal bone loss was evaluated in intraoral radiographs taken at baseline and after 1, 5, and 10 years of function. Results: One (0.8%) implant failed after 8 years giving a Survival Rate (SR) of 99.2% after 10 years. A total of 11 sites (9.2%) showed bleeding on probing (BP) at the 10th annual checkup. The mean marginal bone loss was 0.7 ± 1.35 mm based on 106 readable pairs of radiographs from baseline and from the 10th annual examination. Twelve (11.3%) implants showed more than 2 mm bone loss, and five (4.7%) showed more than 3 mm of bone loss after 10 years. For the latter, all patients were smokers and had poor or acceptable oral hygiene. All five implants with >3 mm bone loss showed BP and two (1.9%) showed suppuration from the pocket. For the remaining seven implants with more than 2 mm bone loss, no correlation to smoking, oral hygiene, bleeding, or pus could be seen. Time/marginal bone level plots of the 12 implants with more than 2 mm bone loss after 10 years, showed minor changes from the first annual checkup except for the two infected implants. Conclusions: It is concluded that good long‐term clinical outcomes can be obtained with oxidized titanium dental implants. Only 1.9% of examined implants showed significant marginal bone loss together with bleeding and suppuration after 10 years of function.     

One‐Year Outcome of Implants Strategically Placed in the Retrocanine Bone Triangle

Background: Implant treatment in the partially edentulous maxilla is often challenging because of minimum bone volumes in distal direction. Purpose: The aim of this study was to evaluate, after 1 year of loading, the outcome of three‐unit fixed partial dentures supported by two implants in the retrocanine triangle. Materials and Methods: Twenty patients with atrophic posterior maxillae participated in the study. A total of 40 implants were placed in residual bone anterior to the sinus wall and posterior to the canine. Implant angulations and lengths were chosen to match as much as possible boundaries of the available bone. After a 6‐month healing period, three‐unit, screw‐retained, fixed partial dentures were delivered. The patients were clinically and radiographically reexamined after 1 year of loading. Results: All the implants survived at the end of the follow‐up. No differences in bone level changes resulted between axial and tilted implants. No biological or mechanical complications were recorded. Conclusions: Within the limitations of this short‐term study on relatively few patients, a positive outcome was seen for three‐unit fixed partial dentures supported by two implants. Retrocanine placement of implants with carefully planned lengths and angulations might be an alternative to grafting procedures for restoration of atrophic posterior maxillae.     

Implant-Supported Fixed Prostheses for the Rehabilitation of Periodontally Compromised Dentitions: A 3-Year Prospective Clinical Study

Background: The application of a strict hygiene maintenance care protocol following rehabilitation of periodontally compromised dentitions by means of tooth‐supported fixed partial dentures has demonstrated excellent long‐term treatment outcome. Purpose: A clinical and radiographic study was performed to document and evaluate the short‐ and medium‐term result of occlusal rehabilitation by means of implant‐supported fixed prostheses (ISFPs) in patients treated for advanced peri‐odontal disease. Materials and Methods: Forty‐three consecutive patients were included. All patients were referred because of advanced periodontal disease. Before the implant therapy was initiated, periodontal treatment was performed and the outcome evaluated during at least a 6‐month period. An individual maintenance care program was designed for each patient. All 125 implants were placed using a two‐stage surgical approach. Following installation of the ISFPs, all patients underwent a baseline examination including evaluation of oral hygiene, periodontal or peri‐implant conditions, and radiographs. These examinations were repeated annually during the 3‐year observation period. Results: No single implant was lost during the 3‐year follow‐up period. The percentages of plaque‐harboring surfaces and bleeding units on probing were found to be low (< 10%), and no soft‐tissue complications were recorded. The mean marginal bone resorption during the observation period amounted to 0.21 mm. In a few patients, apposition of marginal bone was observed. Bone loss amounting to 0.5 mm or less was found around 81% of the implants (101/125 implants). The amount of bone loss around the remaining 24 implants (19%) varied between 0.5 and 2.0 mm. Conclusions: The present clinical trial demonstrates that, at least during a 3‐year period, the ISFP is an acceptable and predictable treatment option for rehabilitation in patients who have lost their teeth because of periodontal disease. This observation seems to be valid in edentulous and partially dentate jaws. A prerequisite to reach such a favorable treatment outcome is possibly the combination of the strict maintenance care program and the careful design of the ISFPs.     

种植体与天然牙联合固定修复的远期疗效评价

目的:评价种植体与天然牙联合固定修复的远期疗效。方法:共为73例患者完成种植体与天然牙联合支持固定义齿修复,植入CDIC种植体113颗,制作联合支持固定桥75件,并进行临床随访观察达5～10年。结果:共有4颗种植体脱落,2例联合支持固定桥在完成修复负荷5年、7年因天然基牙牙根折断拆除,其余联合支持固定桥使用良好,骨吸收率0.5～1.0mm之间,成功率为92%。结论:种植体与天然牙联合固定义齿在临床上是一种相对简便、经济、有效的修复方式。