腭侧入路牙槽突裂植骨术的初步应用与评价

目的 改进牙槽突裂植骨术的技术方法,并对腭侧入路牙槽突裂植骨术的即刻效果进行初步评价。方法 选取20名非综合征性单侧牙槽突裂患者为研究对象,其中不完全性牙槽突裂患者8名,完全性牙槽突裂患者12名。 对20例患者实施腭侧入路牙槽突裂植骨术,在术前和术后分别拍摄锥形束CT（CBCT）片,使用Image-Pro Plus 5.1软 件测量相关数据并进行统计学分析。结果 20名患者中总体植入骨量比率为88%,唇侧植入骨量比率为93%,腭侧植入骨量比率为84%。结论 腭侧入路牙槽突裂植骨术弥补了既往腭侧植入骨量不足的缺点,裂隙内鼻腔瓣三角瓣的切口设计兼顾了鼻底裂隙和唇侧裂隙的关闭,避免大范围的松弛切口以及颊侧黏膜推进瓣的应用。     

腭侧结缔组织瓣与脱细胞真皮基质移植扩增种植体唇侧组织的效果比较

目的:比较腭黏膜下结缔组织瓣和异体脱细胞真皮基质(ADM)移植丰满种植区唇侧软组织的效果。方法:22例上前牙区单牙缺失患者,伴缺牙区唇侧牙槽外形凹陷。其中12例行牙种植术同期腭黏膜下结缔组织瓣移植术,10例行牙种植术同期种植区唇侧骨膜下ADM膜覆盖。分别于种植术前,术后2周、3个月、6个月、12个月通过石膏模型分析2组种植区牙槽嵴水平宽度的变化。采用SAS6.12软件包对2组实验数据进行t检验,以确定不同时期2组结果是否有显著性差异。结果:随访期内,2组种植体存留率为100%,种植术后2周及术后3、6、12个月腭黏膜下结缔组织瓣移植组及ADM移植组的牙槽嵴宽度较种植术前均有显著差异(P<0.05);术后各时间段2组牙槽嵴水平宽度扩增量无显著性差异(P>0.05)。结论:腭侧黏膜下结缔组织瓣移植、ADM膜骨膜下移植均能明显改善种植区唇侧丰满度,且扩增水平相近。     

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。     

三维CT定位在上颌阻生尖牙拔除中的应用

目的：应用CT对拔除上颌埋伏阻生尖牙进行准确定位，以减少拔除时的盲目性，避免对邻牙及周围组织的损伤。方法：对30例临床上拔除较为困难的埋伏阻生尖牙，拍摄x线全景片和定位片进行分析，并对其中22例较难判断的病例加摄三维CT进行定位，判断埋伏阻生尖牙是否位于唇侧或腭侧，或穿行于唇、腭侧间。结果：30例尖牙埋伏阻生病例，仅8例通过全景片加定位片能较准确地判断其位于唇侧或腭侧，其余22例因移动不明显而难以判断，在通过加摄三维CT后才能准确判断尖牙阻生的位置及与邻牙间的位置关系。结论：三维CT定位准确性高，可避免全景片和定位片因重叠及平面效果而造成的判断错误，减少手术进路的盲目性，缩短手术时间，避免手术中对周围骨组织和邻牙的损伤。     

罕见多生牙伴21埋伏1例

患者男 ,2 3岁 ,因上颌前牙畸形 17年来诊。检查 :2 1部位可见 5个多生牙 ,环抱成蒜头状 ,中间有洞可探及齿槽骨 ,无叩痛 ,无松动 ,牙龈粘膜正常 ,唇侧及腭侧无隆起。Ｘ线片示 :5个多生牙根部又有另 1个多生牙和 2 1恒牙影像。处理 :局麻下在唇侧前庭沟作梯形切口 ,翻起粘骨膜瓣 ,凿掉部分唇侧骨板 ,暴露齿槽骨内 2 1牙冠及另一个多生牙 ,顺利挺出所有牙齿 ,1号丝线间断缝合切口。术后口服阿莫西林胶囊 0 .5ｇ,甲硝唑 0 .4ｇ ,ｔｉｄ ,连服 7ｄ ,拆线。切口Ⅰ期愈合。罕见多生牙伴21埋伏1例@吴子忠$解放军第88医院!山东泰安271000 @林先…     

上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。     

上颌正中埋伏多生牙95例的临床分析及治疗体会

目的:总结儿童上颌正中埋伏多生牙的临床特点,探索拔除方法。方法:对2008—2010年间收治的95例儿童上颌正中埋伏多生牙病例的特点及治疗进行分析。结果:95例患者共120颗埋伏多生牙,均位于上颌两中切牙之间。年龄7~14岁,男女比例为3.75∶1。其腭侧发病率为89.2%,远高于唇侧。所有患儿均于局麻下顺利拔除埋伏多生牙。结论:埋伏多生牙的拔除,术前的准确定位、术前和术中对患儿的心理诱导、良好的局部麻醉效果、合理的手术切口设计及轻柔精准的操作技巧为必备因素。     

上颌尖牙埋伏阻生移植术的临床观察

上颌尖牙埋伏阻生临床较多见 ,笔者自 1992年以来将这种牙拔除后移植到正常位置 ,取得了较好的效果 ,现报告如下 :1　临床资料本组共 18例 ,男 8例 ,女 10例 ,年龄 17～ 2 4岁 ,牙根均已形成。其中 13埋伏阻生 6例 ,2 3埋伏阻生 12例。有乳尖牙滞留者 14例 ,无乳尖牙滞留者 4例。2　治疗方法局麻下在龈唇沟或腭粘膜作切口 ,剥离粘膜瓣 ,去骨 ,拔除埋伏牙。将埋伏牙用盐水纱布包裹待用。测量第一前磨牙与侧切牙的距离 ,如距离较窄 ,片切少许移植牙的近远中面。制备牙槽窝 :如有乳尖牙存在 ,拔除后用圆凿 ,扩大牙槽窝并向上加深 ;如无乳尖牙 ,…     

上颌埋伏牙伴多畸形牙17颗1例

多生牙、埋伏牙为口腔科常见病 ,我们收治的 1例 3埋伏伴 17颗小畸形牙临床罕见 ,现报告如下。1　病例报告患者男 ,13岁。因右上颌肿块两周余就诊 ,患者 2周前无意中发现右上颌有一肿块 ,无明显疼痛及其他不适 ,在当地卫生院就诊后转入我院。检查 3缺失 ,32牙龈及牙槽骨向颊侧膨隆畸形 ,局部无充血及破溃 ,触之硬 ,触痛 (- ) ,行口腔全景片检查示 :3埋伏 ,扭转。其牙槽嵴旁及根方可见散在分布的密度增高区 ,各区间有清晰的阴影。诊断 :3埋伏牙伴多畸形牙。处理 :局麻下采用梯形切口 ,掀开颊侧骨膜瓣 ,取出 3牙槽嵴处牙样增生物 ,拔除 32 ,见…     

一种切开粘膜植入羟基磷灰石增高齿槽嵴的方法

已经证实羟磷灰石是一种有高度组织相容性的亲骨性材料。作者从1978年以来曾用数种方法作牙槽峭增高200余例,虽有较好效果,但有些缺点仍难以克服,于是设计了本术式。方法:在离牙槽嵴顶部约3cm,从一侧磨牙后区至另一侧磨牙后区的唇颊粘膜上作一弧形切口。用小弯剪仔细在粘膜下分离,直达牙槽嵴顶,以形成一全厚粘膜瓣。骨膜瓣的形成是沿牙槽嵴项全长作直达骨面的切开。在牙槽后部之骨膜瓣向外侧翻开可到外斜线,而牙槽前部的翻瓣则依病人下颌牙槽嵴吸收的程度有所不同。在严重骨萎缩病例(Ⅲ、Ⅳ度骨吸收),骨膜瓣同粘膜瓣一样均     

A labially positioned mesiodens: case report

This case report describes a labially positioned maxillary midline mesiodens in an 8-year-old male. The clinical and radiographic appearance and therapeutic considerations are presented. The purpose of this article is to alert the clinician to the importance of radiographic localization prior to surgical intervention, because in some instances a labial surgical approach is preferred over the traditional palatal technique. In this case a labial surgical approach was utilized which allowed for greater conservation of alveolar bone and improved access during removal of the mesiodens.     

Augmentation of the atrophic edentulous maxilla with hydroxylapatite

A technique for augmentation of the severely atrophic edentulous maxilla is presented. This technique combines the mobilization of the available soft tissue of the labial vestibule with a subperiosteal reflection and "filleting" of the redundant crestal soft tissue to create ample space to accommodate the insertion of the desired amount of hydroxylapatite. The surgical development of a distinct labial periosteal flap by both a subperiosteal and supraperiosteal dissection allows a two-layered lapped closure of the mucosal and periosteal flaps. Fourteen patients were treated with this technique and have been observed for period of 8 to 40 months. Arch form was dramatically improved in all cases. Observation of panoramic radiographs disclosed an average initial increase in ridge height of 11.8 mm in the midline and 7.6 mm in the first premolar regions. During the first 6 months, consolidation of the ridge occurred, but the diminution in ridge height never exceeded 15%.     

A technique for the replacement of multiple missing anterior teeth in the presence of a mutilated alveolar ridge

The intent of this paper is to demonstrate a clinical technique for the replacement of multiple missing anterior teeth in the presence of a mutilated ridge. It also reviews basic rules governing the replacement of multiple adjacent missing teeth. The two cases presented clearly demonstrate that multiple adjacent missing teeth can be esthetically restored and still preserve that which remains; teeth, periodontium and soft tissues. The long-term success or failure of prosthodontic restorations relies heavily upon careful consideration of esthetic and foundational requirements. A technique has been described which incorporates the benefits of both fixed and removable dentures to restore multiple missing teeth in the presence of a mutilated alveolar ridge. The first patient was treated approximately twenty years ago. The anterior teeth and alveolar ridge were lost due to an automobile accident. The entire labial alveolar ridge was lost to the base of the nasal spine, thereby making a simple six-unit anterior fixed partial denture a complex and difficult problem. The second patient was recently treated. This patient's alveolar ridge and buccal plate were destroyed by a horse's hoof, again making a restoration procedure a difficult one.     

Reconstructive periodontal therapy with simultaneous ridge augmentation. A clinical and histological case series report

Treatment of intrabony periodontal defects with a combination of a natural bone mineral (NBM) and guided tissue regeneration (GTR) has been shown to promote periodontal regeneration in intrabony defects. In certain clinical situations, the teeth presenting intrabony defects are located at close vicinity of the resorbed alveolar ridge. In these particular cases, it is of clinical interest to simultaneously reconstruct both the intrabony periodontal defect and the resorbed alveolar ridge, thus allowing insertion of endosseous dental implants. The aim of the present study was to present the clinical and histological results obtained with a new surgical technique designed to simultaneously reconstruct the intrabony defect and the adjacently located resorbed alveolar ridge. Eight patients with chronic advanced periodontitis displaying intrabony defects located in the close vicinity of resorbed alveolar ridges were consecutively enrolled in the study. After local anesthesia, mucoperiosteal flaps were raised, the granulation tissue removed, and the roots meticulously scaled and planed. A subepithelial connective tissue graft was harvested from the palate and sutured to the oral flap. The intrabony defect and the adjacent alveolar ridge were filled with a NBM and subsequently covered with a bioresorbable collagen membrane (GTR). At 11-20 months (mean, 13.9+/-3.9 months) after surgery, implants were placed, core biopsies retrieved, and histologically evaluated. Mean pocket depth reduction measured 3.8+/-1.7 mm and mean clinical attachment level gain 4.3+/-2.2 mm, respectively. Reentry revealed in all cases a complete fill of the intrabony component and a mean additional vertical hard tissue gain of 1.8+/-1.8 mm. The histologic evaluation indicated that most NBM particles were surrounded by bone. Mean new bone and mean graft area measured 17.8+/-2.8% and 32.1+/-8.3%, respectively. Within their limits, the present findings indicate that the described surgical approach may be successfully used in certain clinical cases to simultaneously treat intrabony defects and to reconstruct the resorbed alveolar ridge.     

Quantitative analysis of blood flow changes measured by radioactive microsphere technique after segmental anterior maxillary osteotomy in dogs]

The radioactive microsphere technique was used to study quantitatively the blood flow changes after segmental anterior maxillary osteotomy in dog. The results of experiment indicated that the blood flow of gingiva and alveolar bone in segmental side has not significantly changed compared with that of the control side after anterior maxillary osteotomy with intact labial and palatal soft tissue flaps. The blood flow of alveolar bone in segmental side was significantly lower than that of the control side (P < 0.01) when only the labial flap was kept intact, the blood flow of labial and palatal alveolar bone in segmental side was 55.5% and 60.28% lower than that of the control tissue respectively.     

牙槽骨劈开术同期牙种植的临床应用

目的　评价牙槽骨劈开技术在口腔种植中应用的临床效果。方法　对116例缺牙区牙槽嵴高度大于12 mm,颊舌向厚度在3~5 mm之间的牙列缺损患者,行牙槽嵴劈开同期植入种植体治疗。共植入ITI种植体147枚,Replace种植体52枚。根据骨劈开术后间隙及唇颊侧骨壁厚度等不同情况选择植入或不植入自体骨、人工骨粉等修复手段。术后6月种植修复,定期随诊。结果　种植区软组织愈合好,无红肿,颊舌向牙槽骨较种植前明显增宽。术后除1颗种植体失败取出外,其余种植体稳固,种植修复体能正常使用。复诊时X线检查骨吸收≤1 mm。结论　骨劈开术使牙槽骨宽度在3~5 mm的病例有了一期种植的可能,是一种简单有效的增宽牙槽骨的方法。     

Assessment of marginal bone loss using full thickness versus partial thickness flaps for alveolar ridge splitting and immediate implant placement in the anterior maxilla

The aim of this study was to evaluate the effectiveness of maintaining the periosteal attachment of the facial and palatal cortical plates on crestal bone loss that occurs at the margin of dental implants placed immediately in split anterior maxillary alveolar ridges. This was a prospective randomized comparative clinical trial. The study population included 22 patients with edentulous anterior maxillary alveolar ridges who presented for treatment during the period March 2012 to September 2013. The selected patients were divided randomly into two equal groups. All patients underwent a maxillary ridge splitting technique; a total of 43 implants were placed immediately. A full thickness mucoperiosteal flap was performed in the control group patients, while a split thickness mucosal flap was done in the study group patients. Assessments included measurements of the linear changes in the marginal bone surrounding the implants immediately postoperative and after 6 months. Measurements were taken from cross-sectional and longitudinal cone beam computed tomography images using special software. The partial thickness flap used in the study group decreased the percentage of bone loss by 9.5% for the labial bone plate, 7.9% for the palatal bone plate, and 3.5% for the mesiodistal bone plate.     

种植义齿冠修复后失败病例的临床报告

目的:分析影响种植义齿修复成功率的原因。方法:收集临床上的10例种植修复前各项检查无异常,但恢复上部机构后发生种植体炎症或冠折裂等问题的病例,对其原因进行综合分析。结果:2例患者原因为咬合过紧,且后牙未及时修复导致种植体周围炎;3例患者未能成功控制牙周问题;1例患者夜磨牙;其余原因无法确定。结论:种植治疗前的咬合判断及治疗后的维护对种植成功率至关重要。     

腭侧旋转结缔组织瓣在上前牙种植修复中的临床研究

目的:探讨腭侧旋转结缔组织瓣在上颌前牙种植修复中的临床意义。方法:26例上颌前牙种植二期修复时,唇侧软组织有轻度缺损或凹陷,在牙槽嵴顶种植体位置作“H形”切口,形成颊侧带蒂粘骨膜瓣尖端带有腭侧的结缔组织瓣。将腭侧结缔组织旋转折叠,插入颊侧龈瓣内侧。愈合基台挤压龈乳头瓣诱导种植体周围龈乳头成形。2~4周后上部冠修复。6月后测量腭侧旋转结缔组织瓣移植前后唇侧牙龈丰满度等变化。结果:所有种植体均稳固,唇侧龈缘基本对称,手术前后唇侧软组织丰满度差为(1.10±0.45) mm,外形有明显改善,龈乳头顶到牙冠邻面接触点的距离为(2.05±0.76) mm。结论:腭侧旋转结缔组织瓣手术方法简单、易行,针对唇侧软组织缺损较少的部位可以较好地改善上颌前牙美学区种植义齿的软组织凹陷问题。     

Superficial-layer split-thickness flap for maximal flap release and coronal positioning: a surgical technique

The aim of this report is to describe the superficial-layer split-thickness flap, which provides maximal flap release and mobilization for coronal positioning. The traditional split-thickness flap technique dissects following the contour of the buccal alveolar plate, leaving a periosteal layer on the osseous surface, while the muscular layer remains with the flap. This limits flap mobilization and can lead to flap retraction during healing because of muscle pull from lip and cheek movement. The superficial-layer split-thickness flap technique dissects following the contour of the external surface of the flap, toward the lip or cheek, and separates the epithelium and connective tissue from the underlying muscular and periosteal layers, which remain attached to bone. The advantages of this technique are: (1) the extreme flap release that allows complete, passive flap coverage for virtually all root coverage, ridge preservation, and ridge augmentation procedures; and (2) the absence of muscle pull during healing, which prevents flap retraction and promotes more rapid union of flap margins. Four cases are presented to demonstrate the flap technique and healing advantages.