3D打印截骨导板辅助赝复体术中修复BrownⅡ类缺损的精准度评价

目的 设计制作3D打印截骨导板用于赝复体术中修复BrownⅡ类缺损,评价其临床应用的精准度.方法 8例因肿瘤致BrownⅡ类缺损患者纳入研究,术前设计制作3D打印截骨导板及赝复体,术中在截骨导板引导下完成手术,即刻戴入赝复体修复缺损,将术前虚拟计划与术后CBCT融合,对整体及局部区域行偏差分析评价手术精准度.应用SPS...     

肿瘤术后颌骨缺损的功能重建

目的：肿瘤术后造成的颌面缺损使患者丧失咀嚼、语言等功能，并导致颜面畸形。采用植骨种植功能颌面建，以提高患者的生存质量。方法：本组64例肿瘤术后颌骨缺损（上颌10例，下颌54例）所用3种方法：（1）下颌骨部分或全部缺损，采用血管化或非血管化骨移植延期（同期）牙种植，完成种植义齿修复；（2）一侧上颌骨缺损，健侧缺牙或无牙，采用健侧牙种植完成赝复修复；（3）双侧上颌骨缺损，采用颧骨种植，通过磁附着固位完成义颌赝复修复。结果：64例所用3种方法均达到恢复外形与功能理想的效果。观察时间最长12年，最短5年，其中6枚种植体未实现骨结合。上颌缺损修复的种植体存留率为97．5％；下颌骨缺损血管化植骨种植为97．1％；非血管化植骨种植为97．7％。结论：上颌骨缺损采用种植赝复修复可行，若颧骨较薄，应先植骨；植骨－种植是下颌骨功能重建理想的方法。血管化植骨种植适用于植骨床血运差的患者；非血管化植骨种植方法简单，易于推广。因缩短了移植骨的离体时间，骨细胞仍有活性，与血管化骨移植效果一致。证实了自体骨植骨块兼有骨形成、骨诱导及骨传导作用。     

Adult benign granular cell tumor of the maxilla

A granular cell tumor occurred in the right anterior maxilla of a 22-yr-old black man. It involved the right labial maxillary submucosa and the underlying bone. It also invaded the maxillary sinus and the nasal cavity on the same side. The ultrastructural features of the lesion confirmed the biopsy diagnosis of benign granular cell tumor. The treatment involved partial maxillectomy, split thickness skin graft and immediate dental prosthesis.     

髂骨复合组织瓣游离移植修复一侧上颌骨缺损

目的　应用游离髂骨复合组织瓣 (FIOMF)即时修复一侧上颌骨切除后缺损。方法　 1FIOMF的制备 ,根据缺损创面的大小 ,切取相应大小的骨肌瓣 ,注意保护血管蒂 ;2上颌骨切除按常规方法进行 ,但由于血管蒂偏短 ,故切口选择下颌下缘为好 ,将下唇中线拉开暴露上颌骨 ;3受区血管主要用颌外动脉和面前静脉或颈外静脉 ,如蒂长不够 ,可用静脉移植来解决 ;4FIOMF切取后即行修剪、固定、吻合血管 ;5腭部创面封闭可用对侧腭粘骨膜瓣 ,如缺损过大过中线 ,可用 FIOMF带皮肤封闭。早期观察指标 :1颧面部形态基本恢复 ;2无口鼻腔漏 ;3语音清晰 ;4托牙修复效果好。结果　共修复 6例 ,经 3～ 36月的随访 ,5例达到上述的观察指标 ,1例手术后因骨块坏死而失败。结论　由于 FIOMF修复一侧上颌骨缺损具有重建颧面部外形丰满 ,提供有力骨支撑 ,托牙修复效果好 ,可以进行种植体修复等优点 ,所以初步认为 :FIOMF是一侧上颌骨缺损修复的理想材料。     

Magnet-retained facial prosthesis combined with an implant-supported edentulous maxillary obturator: a case report

The prosthetic rehabilitation of maxillofacial defects is especially challenging when the patient is edentulous. Although dental implants are used to enhance the retention and stability of both facial and maxillary prostheses, combining facial and maxillary prostheses is extremely difficult. This article describes the prosthetic treatment of an edentulous patient with a large maxillary and facial defect. After placing dental implants in the remaining maxilla, a maxillary obturator prosthesis supported by a milled bar attachment was fabricated. The facial prosthesis was retained by a magnetic attachment to the maxillary obturator prosthesis. As the obturator prosthesis was supported securely by this sturdy attachment, the facial prosthesis was stable during mastication and facial movement. The patient reported improvement in prosthesis retention and stability. Both the masticatory and the speech functions of the patient improved.     

颧种植体在上颌骨缺损重建中的应用探讨

目的：评价颧种植体结合血管化骨瓣修复上颌骨缺损的效果。方法：对4例上颌骨切除术后缺损患者,利用三维CT数据,借助CAD／CAM系统制作1：1大小的解剖模型,术前测量相关参数并制作精确种植模板。术中采用血管化骨肌皮瓣和骨结合牙种植体修复上颌骨缺损,利用上颌骨和颧骨的测量数据．结合定位模板共植入6枚颧种植体和7枚牙种植体,颧种植体结合血管化骨瓣重建上颌骨的形态和功能。结果：利用血管化骨瓣重建4例患者的上颌牙弓形态,使面中1／3得以恢复：在术前设计和术中植入6枚颧种植体和7枚常规种植体时．应用解剖学模型和外科模板,使种植体精确定位。结论：上颌骨术后缺损,可采用颧种植体重建颧上颌支柱,恢复面中1／3的形态：使用血管化骨瓣结合颧种植体,提高了上颌骨缺损修复的效果;颧上颌支柱的恢复,使he的稳定得到了保证．从而有利于美观和功能的恢复。     

Maxillary reconstruction using a bipedicled osteocutaneous scapula flap

When managing extensive maxillary defects it is difficult to provide a stable biomechanical frame for prostheses, and obturators are difficult to use. This study reviews cases involving angular branch artery pedicled scapular bone flaps (SBF) combined with or without latissimus dorsi musculocutaneous flap (LDMF). Between 2004 and 2007, four wide maxillary defects were repaired using the angular vascularized branch of the scapular bone. Tumor resection with immediate reconstruction using combined LDMF and angular artery pedicled SBF was used in 3 cases and angular artery pedicled SBF alone in 1 case. Follow up was 6 months to 2 years. Satisfactory results were obtained for facial contour, appearance, speech, deglutition and breathing. No donor site complications or restricted shoulder movements were detected. The only complication was a minor infection of one flap. This procedure is useful, functionally and aesthetically, for reconstruction of wide extensive maxillary defects as bone supplied by the angular branch has a wider arc of rotation in relation to skin flaps and has a longer pedicle length from the axillary artery, long enough to reach the maxilla. This procedure also benefits from the flexibility of the soft tissue pedicle, such as the latissimus dorsi, serratus anterior and fasciocutaneous flaps.     

An Alternative Prosthetic Approach for Rehabilitation of Two Edentulous Maxillectomy Patients: Clinical Report

Obturator prosthesis is a common treatment method for maxillectomy patients for maintaining their oronasal separation and resuming their social lives. After tumor resection, the remaining anatomical structures have a significant effect on prosthesis retention. The present study describes the rehabilitation of two maxillectomy patients after cancer surgery using a prosthesis consisting of a denture and a special retentive obturator that is positioned in the anatomical undercuts of the nasal cavity. These patients have undergone total and subtotal maxillectomy surgery after the diagnosis of squamous cell carcinoma. The systemic and local health status of the total maxillectomy patient was not suitable for zygomatic implant surgery. Only one osseointegrated dental implant was placed into the left maxillary tuberosity area in the subtotal maxillectomy patient. In addition, the quality, vertical height, and horizontal width of the remaining bone structures in the maxilla limited the use of osseointegrated dental implants. Mechanical prosthesis retention was provided using a multiunit retentive mechanism composed of an orthodontic forsus fatigue resistant device (OFFRD), two Herbst appliances, and an acrylic piece associated with healthy keratinized mucosa. The OFFRD could easily apply a consistent force and push the acrylic pieces toward the retentive undercut under the control of the two Herbst appliances. Two OFFRD units in different directions were designed for the total maxillectomy patient, while only one OFFRD unit was placed on the opposite side of the osseointegrated implant in the subtotal maxillectomy patient. A sufficient retention was obtained for both patients. The patients were satisfied, and no major complications were observed in periodic controls.     

Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: case series of five patients

PURPOSE: The purpose of this case report is to demonstrate the benefits and applicability of appropriate maxillofacial prosthetic rehabilitation following surgical resection of ameloblastoma of the maxilla in Kenya. MATERIALS AND METHODS: Five patients presenting with ameloblastoma of the maxilla over 3 years were studied with respect to histologic type, site of tumor, resultant surgical defect, and form of definitive obturator prosthesis. Impressions were taken using irreversible hydrocolloid and poured with dental stone. Immediate surgical obturators were fabricated from casts using clear autopolymerizing acrylic resin. One patient had bilateral partial maxillectomy, whereas the rest had unilateral partial maxillectomy. Immediate surgical obturators were fitted intraoperatively and held in place using Adams clasps on the remaining natural dentition for all patients, except the one who had undergone bilateral partial maxillectomy, whose surgical obturator was held loosely using circumzygomatic wires. After 6 to 8 weeks, surgical obturators and packing were withdrawn, and new impressions were taken to fabricate definitive obturators. Patients were reviewed every 2 weeks for 3 months, then once every 3 months per year for 3 years, and thereafter once per year. RESULTS: The immediate surgical obturators facilitated retention of the surgical packing, promoting healing with minimal postsurgical infection and scar contracture formation. This ensured the restoration of acceptable esthetics and maintenance of oral function at a reasonable level during the initial postoperative period. Definitive obturators restored esthetics, oral function, and ability to handle secretions to a satisfactory level. CONCLUSION: Satisfactory functional and esthetic results are achievable in patients with extensive acquired maxillary defects by means of obturator prostheses fabricated using readily available materials.     

应用钛网支架重建上颌骨肿瘤切除术后缺损畸形

目的 观察与评价采用钛网支架重建上颌骨肿瘤切除术后缺损畸形修复的效果。方法 搜集我科上颌骨肿瘤患者25例，其中良性肿瘤12例，恶性肿瘤13例；行上颌骨次全切除术15例，全上颌骨切除术10例。全部病例术中即刻行钛网修复，其中10例眶底板全切患者行上颌骨眶面及前壁结构钛网支架塑形重建，其余15例均行钛网支架上颌骨前壁缺损重建。结果 除2例失败外，23例均Ⅰ期愈合，术后2-4周复查肉芽组织覆盖口内钛网面（纤维内窥镜检查），2-3月口内创面完全愈合，10例术后3-4月行中空式膺复体修复，修复后随访，钛网支架无1例松脱及其它并发症，患者外形美观，语音和咀嚼功能恢复良好，结论 采用钛网支架重建上颌骨肿瘤术后缺损畸形能获得满意的上颌骨术后外形；术后利于观察和对复发患者进行早期处理；同期支撑眶底板缺损区，防止术后复视；联合中空式膺复体修复，可恢复患者的语音和咀嚼功能；术式简单适用，效果满意，风险小，适于基层推广。     

上颌骨缺损的分类与临床特点

上颌骨是一对形态复杂的骨骼，对语音、吞咽和咀嚼功能有重要作用。由于这一多功能区的复杂三维解剖特点，上颌骨缺损后要修复达到术前状态极具挑战性，同时也难以形成普遍接受的分类系统。硬腭缺损小于50%的低位上颌缺损通常可采用赝复体成功修复，较广泛的上颌骨缺损则需复合组织瓣移植和（或）牙种植体支持的赝复体修复。文章就几种常用的上颌骨缺损分类系统及治疗选择做一介绍。     

改良种植环形支架嵌磁性固位体修复全上颌骨缺失9例报道

目的：为解决传统全上颌缺损赝复体体积大、质量重、固位不良等缺点,设计并验证一种改良种植环形支架嵌磁性固位体对全上颌骨缺失患者赝复修复的临床效果.方法：对9例因肿瘤致全上颌骨切除患者,两侧颧骨植入种植体,以种植体为基本支撑方式,在种植体上端制作改良设计的新型金属环行支架,以前垂直杆摩擦力和后扁平环形杆磁固位体的磁力2种固位形式行上颌赝复修复.结果：经1～3a临床追踪观察,结果显示,改良后的种植体-磁性附着体支架固位稳定,效果更加可靠,义齿体积及重量明显减轻,患者自感舒适满意;较传统支架设计形式,平均义齿固位力增加5N,咬合力增加10N.结论：应用改良后的种植环形支架嵌磁性固位体对全上颌骨缺失行赝复修复,较以往修复方式在固位、稳定、舒适程度及患者自身满意程度上均有明显改善,临床应用前景广阔.     

Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla

PURPOSE: In many edentulous maxillae, posterior alveolar atrophy calls for bone grafting. Patient treatment acceptance is increased by eliminating grafting using tilted implants, especially the zygomatic implant in combination with immediate function. The purpose of this study was to evaluate a protocol for immediate function (within 2 hours) of 2 zygomatic and 4 standard implants (Nobel Biocare) supporting a fixed prosthesis in the completely edentulous maxilla. MATERIALS AND METHODS: This clinical study included 14 patients with 83 immediately loaded implants (28 bilateral zygomatic and 55 premaxillary implants) supporting a complete maxillary denture converted to a fixed provisional prosthesis immediately following the surgical procedure. After 6 months of use, a new fixed metal-supported prosthesis was fabricated. RESULTS: Fourteen patients treated with immediate loading of zygomatic implants were followed for at least 12 months. All patients reported minimization of postoperative pain and security during speech, animation, and mastication. No failures occurred during the follow-up period. Discussion: The patients in the study could have been candidates for sinus grafting. With the present concept these patients benefited from a less invasive procedure (1 surgical procedure and no grafting) and immediate rehabilitation (prosthesis attached directly after surgery). CONCLUSION: The high survival rate, increase in patients' immediate functional ability, and reduction of morbidity following the surgical procedure render this procedure a viable treatment option for the completely edentulous maxilla.     

Long-term marginal periimplant bone loss in edentulous patients

PURPOSE: The aim of this study was to examine the long-term periimplant bone loss in patients treated with implant-supported fixed prostheses in both jaws. MATERIALS AND METHODS: The participants comprised 44 edentulous patients who have been followed for a 15-year period after treatment with a fixed implant-supported prosthesis in the mandible. Thirteen of them also received an implant-supported fixed prosthesis in the maxilla, on average 4.5 years after the mandibular treatment. The periimplant bone level was measured on intraoral radiographs. RESULTS: The long-term results of the implant treatment were successful, and only 1% (3/273) of the implants were lost in the mandible and 7% (5/75) in the maxilla. All but one of the failures occurred before the connection of the prostheses. The mean marginal bone loss around the implants was small (less than 1 mm for a 10-year period after implant placement), and was of similar magnitude in both jaws. However, the individual variation was relatively great. There was no significant difference in marginal bone loss between those who had a maxillary complete denture during the entire observation period and those who had received a fixed implant-supported maxillary prosthesis. Smokers lost more periimplant bone than did the nonsmokers; the difference was significant in the mandible but small and nonsignificant in the maxilla. CONCLUSION: The long-term periimplant bone loss was small and of similar magnitude in the mandible and the maxilla in subjects who had received implant-supported fixed prostheses in both jaws. The prosthetic status in the maxilla, i.e., complete denture or fixed implant-supported prosthesis, had no significant influence on the mandibular periimplant bone loss.     

钛网填以松质骨修复上颌骨的临床探讨

目的 体验和探讨在预制钛网支架内填塞自体髂骨松质骨,并以颞肌瓣进行覆盖,修复上颌骨缺损的治疗方法、效果以及其临床意义。方法 6例上颌骨缺损患者,术前预制钛网支架。术中采用钛钉固定在缺损处,网架内填塞自体髂骨松质骨,颞肌瓣包绕钛网支架修复上颌骨缺损。结果 6例患者植入的松质骨及覆盖的颞肌瓣全部存活。术后6个月X片显示:松质骨生长良好。结论 上颌骨不同类型的缺损均可应用此方法进行功能性修复,此方法与其它游离骨复合瓣比较而言,安全系数高,对患者的创伤小,充分体现个性化特点。     

Definitive CAD/CAM-guided prosthesis for immediate loading of bone-grafted maxilla: a case report

Background The reconstruction of a functional occlusion in the presence of severe residual ridge resorption remains a significant challenge for maxillofacial surgeons and prosthodontists. Removable appliances are unsuccessful in severely resorbed cases and the advanced degree of bone loss precludes conventional implant‐retained prostehesis. In recent years, bone graft reconstruction of the maxilla and the mandible has been advocated to reverse the debilitating effects of alveolar ridge resorption. Purpose The surgical objective was the reconstruction of the osseous platform of the jaws, thereby allowing implant‐retained definitive prosthetic rehabilitation utilizing the Teeth‐in‐an‐Hour^TM concept within 4 months. Materials and Methods A completely edentulous patient received bone grafts from the posterior iliac crest to augment both the maxillary and mandibular alveolar ridges. The manmandible was augmented using Marx’s “soft issue matrix expansion procedure” and was restored in the conventional manor using an impression and a milled framework. The maxilla underwent “inlay/onlay” bone graft augmentation of the right and left maxilla at the same time as the mandiblular procedure. Implant placement was at 4 months post‐bone graft reconstruction. Immediate loading of implants into a bone graft using Nobel Biocare’s Teeth‐in‐an‐Hour^TM protocol prelaunch was implemented. This included CT‐based implant planning, simultaneous CAD/CAM fabrication of a surgical guide, a CNC‐milled framework, flapless surgical placement of the implants, and immediate placement of a pre‐fabricated definitive prosthesis. This approach reduced the time necessary for an edentulous patient to transform from severely atrophic alveolar support to implant‐retained maxillary and mandibular prosthetic restorations. Immediate loading with an implant retained definitive prosthesis using a bone graft‐reconstructed osseous platform was also performed. Conclusion The Teeth‐in‐an‐Hour^TM concept was utilized to restore bone grafted augmentation of the maxilla with immediate loading of a definitive prosthesis within 4 months. The remarkable accuracy of the software, minimally invasive and short surgery and treatment time, uneventful quick recovery with minimal discomfort is a benefit not only to the patient, also to the treating team.     

The prosthodontic rehabilitation of malpositioned implants in a patient with basal cell carcinoma: a clinical report

This clinical report describes the prosthodontic rehabilitation of a patient with a partially edentulous maxilla and compromised mandibular anatomy caused by resection of bone due to basal cell carcinoma. Placement of a fibula bone graft was followed by placement of 2 implants. The implants were malpositioned in the anteroposterior plane due to the altered form of the alveolar bone. Prosthodontic treatment included a maxillary removable partial denture and a mandibular partial overdenture supported by implants and remaining teeth.     

上颌窦癌术后颌骨缺损即时修复

目的:研究上颌窦癌手术后即刻修复使患者面容恢复和早期功能重建。方法:在颌骨切除前首先了解病人病情及手术范围。常规取印模,根据制备好的模型,参考X线片在模型上画出手术切除范围。用石膏刻刀削去手术区的石膏及石膏牙齿,使其形成一定的缺陷空腔。一侧颌骨切除,制作修复体首先要选择2-3个正常牙齿作固位,可制做成铸造钴铬合金卡环,也可弯制不锈钢卡环。双侧颌骨全切,修复体过大可制成空腔,高度过高可制成义颌和义齿两部分。结果:上颌窦癌术后即刻修复26例,其中上颌骨全切12例,半侧及部分颌骨切除的14例,共26例。不但早期恢复了患者的咀嚼功能,也给患者心理上减轻一定的负担,获得满意效果。结论:上颌窦癌术后即刻修复,是行之有效的治疗方法。     

Comparison of malignant tumors and sinusitis of maxilla on CT images: Sites of bone destruction

We used CT to examine the bone destruction sites of the entire bone wall of the maxillary sinus in cases of malignant tumors of the maxilla and in maxillary sinusitis cases to investigate the differences between the destructive findings of the bone of both patient groups. The study subjects consisted of 13 patients with malignant tumors of the maxilla and 45 patients with maxillary sinusitis. Destruction of the bone wall was seen in 100% of the patients with malignant tumor of maxilla patients and in 57.8% with the maxillary sinusitis, hence showing a significantly higher incidence in malignant tumors of the maxilla. Neither group of patients exhibited disease-specific characteristics of their bone destruction. The incidence of posterolateral bone destruction in patients with malignant tumor of the maxilla patients was 61.5%, while it was significanty lower at 23.1% in the maxillary sinusitis patients. The number of bone walls affected was 2 or more walls in 84.5% of the malignant tumor patients of the maxilla patients and in 42.3% of the maxillary sinusitis patients.     

A maxillary lip prosthesis retained by an obturator with attachments: A clinical report

This article describes the prosthetic rehabilitation of small maxillary lip and maxilla defects with a lip prosthesis attached to an obturator. The definitive obturator prosthesis was designed with 3 plastic ball attachments on the labial surface that provided adequate retention for the lip prosthesis. The thin margin of the lip prosthesis ensured that it adapted well to functional movements.