前牙美观区即刻种植修复的临床应用

目的:探讨前牙美观区即刻种植与即刻修复的临床效果.方法:24例患者的31个牙位在拔牙同时植入种植体,5个牙位在拔牙后一周植入种植体,全部病例都作了种植后一周内的即刻修复,追踪观察6～28个月.结果:全部种植体稳固无松动,种植体周围无炎症,X线片未见明显骨吸收.结论:在适当选择病例的情况下,即刻种植与即刻修复可成功应用于前牙美观区.     

运用膜引导技术即刻种植38例的临床观察

目的探讨牙拔除术后结合膜引导技术即刻植入种植体修复牙缺失的可行性。方法对26例38颗牙拔除术后患者，即刻植入种植体使用医用钛膜完全封闭骨缺损区。6个月～1年行冠修复，根据临床X线检查和患者主诉评价修复效果。结果38例即刻种植体12周后骨缺损修复形成，冠修复后承载了3年无松动。5年随访，除1例有进行性骨吸收外，其余种植体周围骨吸收高度平均1．27mm。结论运用膜引导技术进行即刻种植，可获得良好的骨修复，缩短种植修复疗程，很好地承担修复体传导的牙[牙合]力，与延期种植无明显差异。     

浓缩生长因子在上颌窦内提升术同期牙种植中的应用

目的:观察上颌窦内提升术中植入浓缩生长因子(ConcentrateGrowthFactor,CGF)同期植入种植体其骨整合情况及临床效果。方法:选择上颌后牙缺牙区剩余牙槽骨高度为5.2～8.7mm(平均5.8mm)的46例患者,共计58颗种植体,按照随机数字表将其分为两组。实验组(CGF组):23例(31颗),在上颌窦内提升后植入CGF,同期植入种植体;对照组(Biooss组):23例(27颗),上颌窦内提升后植入骨材料Bio-oss骨粉,同期植入种植体,术后6个月行种植义齿修复。种植术后即刻和术后6个月随访。观察上颌窦底提升高度以及种植体顶部骨整合情况和影像学变化。结果:仅有1例缺牙区牙槽嵴顶黏膜有窦道,X线片显示种植体颈部出现骨吸收,去除植体,6个月后重新补种并完成种植义齿修复。1例鼻涕中带血丝,3d后症状消失。两组患者其余种植体愈合良好,均能够行使咀嚼功能,影像学检查种植体顶部新骨形成,且密度均匀,种植体周围骨整合好。结论:上颌窦内提升术植入CGF与植入骨材料可以取得同样的骨增量效果,同时避免因颗粒状骨材料导致上颌窦黏膜穿孔的发生,并能减少种植修复的费用,有一定的临床推广价值。     

即刻种植即刻修复义齿的临床应用效果观察

目的：探讨即刻种植与即刻修复义齿的临床运用原则,初步评价其临床疗效。方法：我院口腔门诊2006年7月-2008年7月就诊的9例患者,男7例,女2例;年龄19～55岁。拔牙后立即植入种植体,共12枚种植体,并于1～30d内行即刻临时修复,术后3～4个月行永久修复。结果：12枚种植体骨结合良好,随访3～12个月,种植体存留率为100％,患者对修复效果均满意。结论：即刻种植即刻修复义齿可以缩短患者缺牙时间,减少创伤,取得良好的美学效果。     

口腔种植修复牙列缺损的疗效和美学观察

目的:探讨ITI Straumann等常用口腔牙种植系统治疗牙列缺损的疗效和美学效果.方法:23例牙列缺损患者植入ITIStraumann等常用牙种植体41件,2～6个月后行上部结构修复,观察术后1～3年种植体骨结合状况、周围软组织与修复体情况、牙龈美学效果和患者的满意度.结果:23例牙列缺损患者41件种植体,术后随访1～3年,种植成功率100%,种植体无松动,牙龈无充血,种植体骨结合良好,周围无X线透视区,外形美观,患者满意.结论:口腔种植义齿修复牙列缺损疗效好,外形美观,是一种较好的修复方法.     

浓缩生长因子(CGF)在即刻种植修复应用中的牙龈美学研究

目的:研究浓缩生长因子(CGF)在即刻种植修复牙龈愈合中的临床效果。方法:20例即刻种植修复患者分为两组,实验组在种植体-骨间隙内添加CGF与Bio-oss骨粉混合物,比例为1:1,对照组种植体-骨间隙内单独添加Bio-oss骨粉,从术后牙龈愈合情况,牙间乳头指数及牙龈缘高度3个方面评价CGF对牙龈组织愈合的影响。结果:术后10天内,实验组牙龈组织愈合明显好于对照组;术后6个月时所有病例为3度牙间乳头;实验组牙龈退缩为(0.35±0.15)mm,对照组牙龈退缩为(0.42±0.37)mm,两者间没有统计学意义(P>0.05)。结论:浓缩生长因子(CGF)具有促进牙龈组织愈合的作用。     

前牙美学区即刻种植即刻非功能修复的临床观察

目的:探讨前牙美学区即刻种植即刻非功能修复的临床特点及修复后的美学效果。方法:25例患者34枚Xi ve种植体前牙区即刻种植即刻临时冠修复,对种植体成功率及周围牙龈附着状况进行观察,6个月后永久冠修复。结果:1枚种植体在愈合期内脱落,其余种植体在修复后12个月时均有骨结合,临床效果良好。结论:前牙美学区即刻种植即刻非功能修复时多因素可影响种植体的成功率及软组织美学效果,严格掌控适应证,才能获得理想的美学效果。     

即刻种植与早期种植对前牙种植体周边软组织美学效果比较分析

目的:探讨即刻种植与早期种植的临床效果及对前牙种植体周边软组织的美学效果比较。方法:选取2015年3月-2018年6月笔者医院收治的上颌前部单牙缺失患者72例,根据随机数字表法分为即刻种植组和早期种植组,两组均36例。比较两组患者修复后1个月、3个月、6个月及12个月的红色美学指数(pinkethetic score,PES)评分、种植体边缘骨吸收水平。比较两组修复后12个月的种植成功率和满意度。结果:修复后1个月、3个月、6个月及12个月,即刻种植组的PES评分均显著高于早期种植组(P0.05);修复后1个月、3个月、12个月即刻种植组的骨吸收水平与早期种植组相比均无明显差异(P0.05),但修复后6个月,即刻种植组的骨吸收水平明显低于早期种植组(P0.05);即刻种植组的种植成功率与早期种植组无明显差异;即刻种植组的修复后满意度为97.22%,显著高于早期种植组的80.56%,有统计学意义(P0.05)。结论:与早期种植相比,即刻种植可明显提高前牙种植体周边软组织的美学价值,种植成功率及安全性较好,且在降低种植后早期骨吸收水平中可能起作用,在修复后期两种种植方式的骨吸收水平未显示出显著差异。     

保留末端基牙在无牙颌精确种植中的应用

目的:探讨保留末端基牙制作牙-黏膜支持式导板在无牙颌精确种植中的应用,并与无牙颌黏膜支持式导板的精准性进行比较。方法:选择临床上无牙颌种植患者18例共98颗种植体,分成两组。牙-黏膜组利用末端基牙制作牙-黏膜支持式数字化种植导板进行无牙颌种植体植入;黏膜组没有可利用的末端基牙,常规制作数字化黏膜支持式导板植入种植体。记录种植留存率及患者满意度。比较两组种植体植入前后位置差异测量值。所有患者术后随访6～20个月。结果:种植体的总存留率为98.97%,患者满意度较高。牙-黏膜组种植体植入颈部距离、尖端距离、植入深度、植入角度偏差均显著小于黏膜组(P0.05)。结论:选择可以保留的末端基牙制作牙-黏膜支持式导板可以提高无牙颌种植的精准性及临床操作便利性,易于实现即刻修复,术者及患者的满意度比较高。这种治疗方案值得在全口种植即刻修复中推广。     

美学区单颗牙即刻种植与延期种植修复效果的临床对比研究

目的:比较美学区单颗牙即刻种植与延期种植的临床修复效果。方法:按照随机数字法将2018年1月-2018年12月在笔者医院行美学区单颗牙种植的120例患者分为即刻种植组与延期种植组,每组60例,种植后所有患者均随访12个月。比较两组的种植成功率,种植后即刻、6个月、12个月的红色美学评分(PES)、种植体边缘骨吸收量及种植体颈部牙槽骨垂直吸收量。结果:两组的种植成功率均为100%。两组在种植后即刻、6个月、12个月的PES评分比较,差异均无统计学意义(P0.05)。即刻种植组在种植后6个月[(0.29±0.11)mm vs (0.45±0.17)mm]、12个月[(0.29±0.11)mm vs (0.45±0.17)mm]的种植体边缘骨吸收量均明显少于延期种植组(P0.05)。即刻种植组在种植后6个月[(0.51±0.24)mm vs (0.86±0.33)mm]、12个月[(0.84±0.35)mmvs(1.32±0.40)mm]的种植体颈部牙槽骨垂直吸收量均明显少于延期种植组(P0.05)。结论:两种种植方法用于美学区单颗牙修复均能获得较高的种植成功率及较好的美学效果,但是即刻种植能够降低骨量的吸收。     

Parastomal hernia repair with acellular dermal matrix.

PURPOSE: Treatment of parastomal hernia is often complicated by a high recurrence rate and likelihood of wound contamination. We reported an initial series of parastomal hernia repairs performed with acellular dermal matrix. METHODS: We reviewed a series of 11 patients who had parastomal hernia repairs with acellular dermal matrix and recorded the type of ostomy, previous repair, associated intestinal pathology, type of repair performed, perioperative complications, and rate of recurrence. RESULTS: Between 2004 and 2006, 11 patients underwent parastomal hernia repair with acellular dermal matrix by the senior author. Nine of 11 patients had associated Crohn's disease or ulcerative colitis and 3 had recurrent parastomal hernias that had failed initial repair. Mean follow-up was 8.7 months (range: 1-21 months). Two patients developed wound infections that did not require implant removal and healed with local wound care. Three patients developed recurrent hernias. CONCLUSIONS: Parastomal hernia with acellular dermal matrix results in recurrence rates comparable to those reported in the literature for synthetic mesh repair. It offers the advantages of avoiding stoma relocation and of not requiring implant removal in cases of wound infection.     

异种脱细胞真皮基质修复口腔颊部肿瘤切除后组织缺损的临床观察

目的:探讨异种脱细胞真皮在口腔颊部肿瘤切除后组织缺损修复中的应用方法、效果及长期观察的评价。方法:收集2006年4月～2009年5月口腔颊部肿瘤切除后组织缺损应用异种脱细胞真皮基质修复膜进行修复的19例患者资料。术后进行追踪随访和功能评价。结果:术后随访6～24个月,平均15个月。19例患者的组织缺损修复均获得成功,术后7～10天均未见修复膜脱落,愈合良好,植入异种生物膜部位逐渐为自体膜组织长入。长期观察,活化后的修复膜在软组织部位受植床存在一定的收缩。结论:生物膜修复组织缺损的机理与传统的植皮方法不同,是生物支架功能,异种脱细胞真皮基质适合口腔颊部肿瘤切除后浅、中层组织缺损的修复。     

异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤

目的探讨应用异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤创面的临床应用效果。方法1997年1月—2004年1月,应用异种(猪)脱细胞真皮基质一次包扎治疗50%~95%总体表面积(TBSA)、深Ⅱ度烧伤的患者67例[异种(猪)脱细胞真皮基质治疗组];同期保痂治疗的50%~95%TBSA、深Ⅱ度的患者10例(保痂治疗组),观察创面愈合时间和愈合质量及其并发症发生情况。治愈患者经过3个月~2年的随诊,观察瘢痕增生情况。结果异种(猪)脱细胞真皮基质治疗组深Ⅱ度创面中途基本不需换药,创面愈合时间缩短,平均(12.2±2.6)d,而保痂治疗组愈合时间为(27.4±3.5)d,差异具有统计学意义(P<0.05);同时,异种(猪)脱细胞真皮基质治疗组瘢痕增生情况较保痂治疗组明显减轻或者无瘢痕增生。结论一次性覆盖异种(猪)脱细胞真皮基质可有效地治疗深Ⅱ度烧伤创面,能加快创面愈合,减轻瘢痕增生,从而降低烧伤感染和炎症反应综合征的发生。     

Immediate single-stage breast reconstruction using implants and human acellular dermal tissue matrix with adjustment of the lower pole of the breast to reduce unwanted lift

Breast reconstruction using implants remains an aesthetic challenge toward achieving symmetry and natural appearance. Closing the areolar defect results in a vertically elevated breast mound. The use of human acellular dermal tissue matrix has been reported to provide coverage and durability over breast implants while allowing for improved shape of the reconstructed breast. This study reports the operative technique used in a series of breast reconstructions using saline implants and human acellular dermal tissue matrix in an immediate one-stage procedure. Complications and appearance were evaluated for all reconstructions. Indications for inframammary fold reconstruction and lower pole breast enhancement using chest skin advancement were discussed. Twenty-three patients were included in the study; 11 had unilateral reconstruction and 12 had bilateral reconstruction for 35 total reconstructions. All patients had immediate reconstruction following skin-sparing mastectomy. Nine patients had inframammary fold reconstruction and 11 patients had a lower chest advancement flap with fold reconstruction. The mean follow-up was 9.5 months with a range of 1 to 24 months. Complications occurred in 3 patients. Human acellular dermal tissue matrix can successfully be used in conjunction with breast implants to achieve an aesthetically pleasing breast reconstruction in one stage at the time of skin-sparing mastectomy. The use of a tissue expander and its associated risks and costs are eliminated. The complication rate is low. In addition, either inframammary fold reconstruction or lower chest advancement and fold reconstruction to augment lower pole skin coverage can improve symmetry with the opposite breast.     

脱细胞真皮基质在整形美容外科中的应用

目的 为改善皮肤移植的形态和功能，提高大面积烧伤缺乏自体供皮来源患者的美容整形治疗效果。方法 应用自制脱细胞真皮基质(ADM)，植入松解或切除瘢痕后的创面，5～10d后再行自体刃厚皮移植，术后观察ADM和创面愈合、瘢痕增生及功能恢复情况。3例再次手术患者留取复合移植组织进行组织学检测。结果 15例23次复合皮移植：14例22次成活率为100％，1例1次成活率为80％，植皮区平整光滑，瘢痕增生不明显，组织学检测提示复合皮血管化明显，胶原排列整齐，表皮-真皮连接结构重建充分，未见排异反应。结论 ADM与自体刃厚皮复合移植能改善创面愈合的质量，是较理想的整形美容修复材料。     

Control of hypertrophic scar from inception by using xenogenic (porcine) acellular dermal matrix (ADM) to cover deep second degree burn

OBJECTIVE: We have spent 7 years to investigate the method of applying porcine acellular dermal matrix (ADM) on deep partial thickness burn wound until the wound heals without dressing change. Known as "Feng's pig skin method" by our hospital, the method appears to encourage rapid re-epithilization with minimum scarring. METHOD: The deep partial thickness burn wound was rinsed cleanly under anesthesia when the patient admitted. ADM was applied on the wound after the detached epidermis was thoroughly removed, wrapped and fixed by sterile gauze and bandages. The dressing was removed within two weeks and the wound completely healed. The outcome of the treatment was analyzed by using the modified Vancouver Burn Scar Assessment Scale. RESULT: All the wounds healed with one dressing within 2 weeks, and the time of wound re-epithelialization shortened to 7-12 days. Scar hyperplasia did not occur, or it was greatly ameliorated compared with traditional treatment after a followed-up period of 3 months to 2 years. The Scar Index was significant lower than that of the traditional exposure method. CONCLUSION: Using ADM to cover deep second degree burn can preserve maximally residual dermal tissue and epithelium, help accelerate the regeneration of epithelial and stem cells, thus shorten the healing time, remodel the skin structure, and consequently has the effect of controlling hypertrophic scar at inception.     

Development of a tissue-engineered human oral mucosa equivalent based on an acellular allogeneic dermal matrix: A preliminary report of clinical application to burn wounds

Tissue-engineered skin equivalents composed of epidermal and dermal components have been widely investigated for coverage of full-thickness skin defects. We developed a tissue-engineered oral mucosa equivalent based on an acellular allogeneic dermal matrix and investigated its characteristics. We also tried and assessed its preliminary clinical application. Human oral mucosal keratinocytes were separated from a piece of oral mucosa and cultured in a chemically-defined medium. The keratinocytes were seeded on to the acellular allogeneic dermal matrix and cultured. Histologically, the mucosa equivalent had a well-stratified epithelial layer. Immunohistochemical study showed that it was similar to normal oral mucosa. We applied this equivalent in one case with an extensive burn wound. The equivalent was transplanted three weeks after the harvest of the patient's oral mucosa and about 30% of the graft finally survived. We conclude that this new oral mucosa equivalent could become a therapeutic option for the treatment of extensive burns.     

应用异种脱细胞真皮的眼睑原位重建术的实验研究

目的探讨应用异种(猪)脱细胞真皮施行兔眼睑原位重建术后的组织相容性,比较异种(猪)脱细胞与异体巩膜替代睑板后的组织转归。方法采用兔眼睑缺损动物模型,随机分别给予异种(猪)脱细胞真皮、兔异体巩膜施行眼睑原位重建术。活体观察动物术后和移植物情况,于术后1、2、4、6、8和12周,取带植片的眼睑,光镜下观察替代材料和自体睑板交界处的组织病理学改变,包括炎症反应、纤维血管化情况和融合情况;取4、8和12周标本做透射电镜观察上述组织的超微结构改变。结果光镜和电镜下二者反应类似,差异无统计学意义。组织学检查显示异种脱细胞真皮引起的免疫和炎症反应轻微。结论异种(猪)脱细胞真皮在植入兔眼睑后有较好的组织相容性,并可引导新生胶原的生长,起到替代睑板的作用。     

Development of a tissue-engineered human oral mucosa equivalent based on an acellular allogeneic dermal matrix: a preliminary report of clinical application to burn wounds.

Tissue-engineered skin equivalents composed of epidermal and dermal components have been widely investigated for coverage of full-thickness skin defects. We developed a tissue-engineered oral mucosa equivalent based on an acellular allogeneic dermal matrix and investigated its characteristics. We also tried and assessed its preliminary clinical application. Human oral mucosal keratinocytes were separated from a piece of oral mucosa and cultured in a chemically-defined medium. The keratinocytes were seeded on to the acellular allogeneic dermal matrix and cultured. Histologically, the mucosa equivalent had a well-stratified epithelial layer. Immunohistochemical study showed that it was similar to normal oral mucosa. We applied this equivalent in one case with an extensive burn wound. The equivalent was transplanted three weeks after the harvest of the patient's oral mucosa and about 30% of the graft finally survived. We conclude that this new oral mucosa equivalent could become a therapeutic option for the treatment of extensive burns.     

异种脱细胞真皮与异体巩膜作为HA义眼台包裹材料的实验研究

目的 观察异种脱细胞真皮（acellular xenogenic dermal matrix,X-ADM）和异体巩膜作为羟基磷灰石（hydroxy apatite,HA）义眼台包裹材料,用于实验兔眼的临床表现及病理组织学变化观察.方法 24只纯种新西兰兔,行一只眼的眼球摘除术后,随机平均分为实验组和对照组.于肌锥内分别置入由异种脱细胞真皮及异体巩膜包裹的HA义眼台.术后观察眼部表现,于1、2、4、6、8和12周,连同异种脱细胞真皮或异体巩膜取出义眼台,光镜下观察包裹材料与义眼台的组织病理学改变,包括炎症反应及血管化情况.取4、8和12周标本做透射电镜观察上述组织的超微结构改变.结果 与异体巩膜组相比,异种脱细胞真皮组在同期的成纤维细胞及新生血管的生长更活跃,而且长入较早,新生胶原形成丰富,几乎没有炎症细胞的浸润以及发生排斥反应.结论 异种脱细胞真皮血管化快,免疫原性低,是一种良好的巩膜替代物.