血管化腓骨游离移植重建下颌骨缺损及同期种植体植入

目的：介绍血管化腓骨游离移植即刻重建下颌骨缺损并同期植入牙种植体的方法。方法：对2例下颌骨造釉细胞瘤骨缺损行血管化腓骨游离移植重建，于术中同期植入Frialit-2台阶柱状牙种植体，术后进行临床和影像学追踪观察。结果：2例患者面部外形恢复满意，咬合关系正常，X线与CT检查骨愈合良好，骨重建形态与种植体位置满意．结论：血管化腓骨游离移植与同期牙种植体植入重建下颌骨缺损可有效地恢复面部外形和口腔生理功能。     

非血管化髂骨移植同期种植重建下颌骨节段缺损的临床研究

目的：研究非血管化髂骨移植同期种植重建下颌骨节段缺损的方法及临床效果。方法：选取下颌骨节段缺损的病人，通过非血管化髂骨移植建立下颌骨连续性，同期植入牙种植体。结果：移植的骨块成活，植入的种植体可以实现骨结合并完成种植义齿修复，行使功能。结论：此方法可以实现下颌骨的功能重建。     

下颌骨缺损自体骨移植术后种植修复

目的：下颌骨缺损自体骨移植术后采用种植义齿修复。方法：6例髂骨移植患者，3例直接植入种植体；2例经颌骨骨块上置法植骨后植入种植体；1例经牵引成骨术增高牙槽突后植入种植体。2例腓骨移植患者，分别经腓骨上置法移植和牵引成骨术增高牙槽突后植入种植体。结果：8例患者最终都植入种植体，其中3例已完成上部义齿修复。结论：下颌骨缺损自体骨移植术后，常有牙槽突骨量不足，需行牙槽突Ⅱ期重建。上置法植骨和牵引成骨术能成功地重建牙槽突缺损骨量。     

带血管髂骨瓣移植同期种植体植入整复节段性下颌骨缺损

目的：利用血管化髂骨移植同期种植体植入早期整复节段性下颌骨缺损。方法：对5例下颌骨肿瘤患者于肿瘤切除后采用血管化的游离髂骨移植同期植入骨内种植体，术后6个月行Ⅱ期手术、义齿修复。结果：移植骨存活，植入的13枚种植体均与移植骨形成骨结合。义齿修复后随访6～48个月，种植体无松动、脱落．种植体颈部未见明显的骨质吸收。患者外形、咀嚼功能恢复满意。结论：采用该方法可早期整复节段性下颌骨缺损，运用时需注意种植体植入位置准确。     

骨移植种植体一期植入的研究进展

因肿瘤或外伤造成下颌骨缺损，其外形及功能的一期整复问题一直困扰着人们。近来，用髂骨移植种植体一期植入修复下颌骨缺损，重建面部外形，恢复咀嚼功能等，国内外做了零星报道。但对牙种植体植入移植骨后能否与移植骨发生骨结合、结合时间、影响结合的因素以及移植骨能否改建形成牙力轨道等都未见报道。本文就血管化骨移植及游离骨移植愈合的组织学差异，以及两类骨移植种植体一期植入的现状、优缺点和应用前景做一综述。     

自体髂骨游离移植加同期种植修复牙槽缺损初步观察

目的：利用自体髂骨游离移植同期种植修复牙槽缺损。方法：13例牙槽嵴萎缩患者行自体髂骨游离移植同期植入29枚种植体。结果：移植骨存活，植入的29枚种植体与移植骨结合良好，义齿修复一年后种植体无松动、脱落。结论：采用该方法可早期修复牙槽缺损，但仍需进一步观察长期效果。     

在移植骨上延期种植的实验研究

目的论证冷冻自体下颌骨复合髂骨移植后延期种植的可行性。方法16只成年雄性杂种狗，制备下颌骨双侧骨缺损，左侧行冷冻自体下颌骨骨块的原位再植并结合髂骨松质骨移植，即复合移植组（composite transplantation group，CTG），右侧缺损行自体髂骨块移植即髂骨移植组（iliac transplantation group，ITG），术后3个月分别在两类骨块上植入IMZ TPS种植体，种植体植入后3、6、9、12周分别处死4只动物取材，采用数字化X线片对种植体与颌骨结合界面进行灰度定量分析，组织学观察种植体．骨结合情况。结果各期种植体周围均未见吸收性骨质密度减低影像。骨一种植体界面灰度定量分析显示，种植体植入两类移植骨3、6和9周时，其界面骨质密度改变差别明显，复合移植组明显优于髂骨移植组；种植体植入12周时，两组界面骨质已无明显差别，两类移植骨均与种植体有良好的骨结合，其骨愈合方式基本相同。结论冷冻自体下颌骨复合移植修复下颌骨缺损并延期植入牙种植体后，二者可形成良好的骨结合。     

即刻植骨同期种植体植入修复下颌骨缺损

目的：探讨下颌骨缺损即刻植骨同期种植的可行性。方法：对6例下颌骨部分切除的患者，行下颌骨缺损即刻植骨同期种植术。其中2例行血管化腓骨双层折叠移植，另4例为非血管化髂骨移植。同期植入种植体共19颗。结果：6例术后均一期愈合，X线显示种植体周围骨结合正常。结论：下颌骨缺损血管化和非血管化骨移植同期种植术是可行的，但由于同期种植的复杂性，要求在适应症的选择及手术操作上应更加严格。     

应用腓骨肌瓣180°折叠即刻种植牙植入修复下颌骨缺损

目的 :切除下颌骨肿瘤,同期应用血管化腓骨肌瓣180折叠即刻种植牙植入骨中修复下颌骨缺损 ,探讨腓骨肌瓣折叠及即刻种植牙植入的手术特点。方法 :对1例下颌骨造釉细胞瘤的病人行肿瘤及下颌骨切除的同时将腓骨肌瓣180折叠并移植至缺损部即刻植入种植牙一枚。结果 :六个月后曲面断层片显示种植体骨整合愈合情况良好。结论 :腓骨肌瓣180折叠即刻种植体植入可以一次手术达到恢复有牙患者下颌骨应有高度和连续性及咀嚼功能的目的     

即刻植骨同期种植体植入修复下颌骨缺损

目的 :探讨下颌骨缺损即刻植骨同期种植的可行性。方法 :对 6例下颌骨部分切除的患者 ,行下颌骨缺损即刻植骨同期种植术。其中 2例行血管化腓骨双层折叠移植 ,另 4例为非血管化髂骨移植。同期植入种植体共 19颗。结果 :6例术后均一期愈合 ,X线显示种植体周围骨结合正常。结论 :下颌骨缺损血管化和非血管化骨移植同期种植术是可行的 ,但由于同期种植的复杂性 ,要求在适应症的选择及手术操作上应更加严格     

“夹心植骨”预防骨劈开术后唇颊侧骨壁吸收的临床研

研究背景：当牙槽嵴尤其是上颌前牙区牙槽嵴宽度不足时,采用骨劈开同期种植体植术能获得可靠地临床效果。然而许多研究和作者本人的临床观察均发现,采用该手术后常见种植体唇侧骨壁部分吸收,致种植体唇侧上、中部多个螺纹暴露于骨面,其表面仅有软组织覆盖,当患者的附着龈较薄时甚至会透出种植体的颜色,这种状况无疑将对种植义齿的长期美观效果和寿命产生严重的不利影响。研究目的：评价＂夹心植骨＂法防止骨劈开后唇颊侧骨壁吸收的临床效果。方法：36例上颌前牙缺失区牙槽嵴宽度2～4mm,有足够骨高度患者,采用骨劈开术同期植入种植体,共植入植体40枚,其中16枚种植体唇侧骨瓣较稳固,可与种植体紧密相贴,直接采用颗粒骨移植材料（天博骨粉或Bio-Oss）和胶原膜覆盖（海奥修复膜或Bioguide膜）,作为对照组。将24枚种植体唇侧骨瓣撑开,在种植体唇侧面与骨瓣之间形成1mm左右的间隙,间隙内填入颗粒骨移植材料（天博骨粉或Bio-Oss）,使种植体唇侧骨质总厚度大于1mm,覆盖胶原膜（海奥修复膜或Bioguide膜）,无张缝合创口。6个月后行Ⅱ期手术,翻瓣检查种植体唇侧骨质状况和骨壁厚度。结果：对照组16枚种植体唇侧骨壁均有不同程度吸收,种植体上部有3～5个螺纹暴露于骨面;24颗采用夹心植骨的种植体唇侧均有坚实的骨质,未见骨吸收和螺纹暴露,种植体唇侧骨壁厚度均大于1mm。结论：骨劈开术中在唇颊侧骨瓣和种植体表面之间夹心植入颗粒状骨移植材料,能有效地防止唇侧骨壁吸收,保证种植体唇侧有足够厚度完整的骨质覆盖。     

下颌前部连续多颗牙缺失区夹层植骨和种植修复的临床研究

目的:评价下颌前部连续多颗牙缺失伴重度骨缺损,以夹层骨移植,同期进行常规种植的临床效果。方法:2002-05—2004-03北京协和医院口腔种植中心的8例患者,下颌前牙区37颗缺牙位点,行夹层骨移植,同期植入24枚种植体;平均4个月愈合期后再次植入12枚种植体;再经过3~6个月后完成最终修复。结果:术后平均垂直向高度提升7.6 mm,牙槽嵴顶厚度增加6 mm;骨块无坏死;所有种植体实现骨结合。随访5.3~7.1年,非种植区骨块牙槽嵴顶冠根向骨吸收<0.16 mm,种植体周围碟形骨吸收<0.25 mm。结论:夹层骨移植是修复下颌前牙区重度骨缺损的有效方法,并可同期种植,减少了手术次数,缩短了治疗时间。     

Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla: A two-stage technique

This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (Brånemark^®) were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.     

邻近自体碎骨移植在种植牙中的应用

目的 探讨种植体周骨缺损采用邻近自体碎骨同期移植的治疗效果。方法 对58颗种植体周有骨缺损者采用邻近自体碎骨同期移植充填缺损。其中35颗种植体周移植碎骨用钛膜固定。结果 2颗种植体周植骨明显吸收,种植体松动失败,其余均获得成功,临床随访1～5年种植牙功能和形态良好,未见明显骨吸收。结论 对种植体测方、根方、颈部等局部骨缺损,用自体邻近碎骨同期移植解决种植床骨量不足,简单实用效果好。     

Evaluation of bone healing in patients with bone grafts and endosseous implants using single photon emission tomography (SPECT)

The aim of the present study was to evaluate the healing of onlay grafts to edentulous jaws in conjunction with osseointegrated implants using single photon emission computed tomography (SPECT). In all, 24 patients were examined who had received 26 full arch onlay grafts for augmentation of extremely atrophic edentulous jaws with secondary placement of implants 21.4 weeks after grafting. 99mTechnetium-MDP scintigrams were performed immediately after grafting. before implant placement, after implant placement and before abutment connection. Tracer accumulation was assessed semiquantitatively by calculating ratios of count densities between the up‐take over the calvarium and over the grafted jaws based on 16 regions of interest in the reconstructed tomograms corresponding to 16 possible areas of implant placement. There was a significant decrease in tracer uptake during graft healing, which was followed by a significant increase after implant placement and a subsequent decrease during implant healing. In 3 patients, infection and partial necrosis of the grafted bone occurred. In these cases, tracer uptake in areas of subsequent graft infection immediately after grafting was significantly lower compared to patients with uneventful healing as a sign of inferior graft revascularization. In 3 patients, 14 implants failed due to mobility at the time of abutment connection or loss of osseointegration within the first weeks thereafter. Significantly lower levels of tracer up‐take immediately after grafting and during graft healing were found in these areas, representing a lack of bone turnover due to decreased revascularization. These areas also showed a lower increase in tracer accumulation after implant placement due to the inferior graft quality, followed by a significant increase of periimplant bone turnover at the time of abutment connection representing inflammatory periimplant bone reaction.     

A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants

Background: Maxillary sinus floor augmentation is a procedure that is indicated in cases when the volume of the posterior maxillary bone is inadequate. The goal of this treatment is to obtain sufficient amount of bone tissue in order to gain osseointegration of endosseous implants. Purpose: The purpose of this study was to conduct a clinical and histological analysis of calcium sulfate (CaS) as bone graft substitute in sinus floor augmentation. Material and Methods: Ten patients with edentulous maxillas were included in this study. They had moderate to severe atrophy of the posterior maxilla. Surgiplaster (Classimplant®, Rome, Italy) was used as graft material in the maxillary sinus and was covered by BioGide® (Geistlish Pharmaceutical, Wolhusen, Switzerland). After 4 months of graft healing, 40 dental implants were placed and a biopsy for histomorphometry was taken at these occasions. The specimens were viewed by light microscope, and the extent of bone regeneration and remaining graft material was evaluated. Radiographs were taken at the time of sinus augmentation and after 4 months of graft healing. Results: At the time of abutment surgery, one implant was considered as a failure and was consequently removed, giving a survival rate of 97.5% after 1 year of loading. Radiographs showed a mean of 26.5% shrinkage of the augmented area. A significant resorption of CaS was noted with a mean value of 8.8% of remaining graft material after 4 months of healing. The biopsies also revealed new bone formation with a mean value of 21.2% of the total biopsy area. Histology showed signs of an acellular substitution of CaS with bone‐like tissue. Conclusion: The results of this study show that new bone regeneration occurs in the maxillary sinus after augmentation with CaS. This enabled successful placement, integration, and loading of dental implants in the posterior maxilla, as only 1 of 40 implants was lost during 1 year of follow‐up.     

Bone augmentation at titanium implants using autologous bone grafts and a bioresorbable barrier. An experimental study in the rabbit tibia.

The aim of the present investigation was to compare the effect of using autologous bone particles covered with a bioresorbable matrix barrier with the use of bone particles alone on bone augmentation at titanium implants installed in the rabbit tibia. Two Brånemark System® implants, one in each tibia, were inserted in each of 9 rabbits in such a way that 5 threads were not covered with bone. Autologous bone particles were harvested from the skull and placed over the exposed implant surfaces on each tibia. The bone graft on one tibia was covered with a Guidor® Matrix Barrier, while the bone graft on the other tibia served as a control. After a healing period of 12 weeks, the animals were sacrificed and specimens taken for histomorphometrical analyses. The analyses showed that a significantly larger volume of augmented bone tissue had formed at the test sites. There were, however, no differences in the amount of mineralized bone. In fact, the difference in tissue volume was due to an increased amount of bone marrow at the test sites. The degree of mineralized bone to implant contact as well as the degree of mineralized bone within the threads at the test implants were similar to that at the controls. In conclusion, it was found that the coverage of particulate autologous bone grafts with a bioresorbable barrier resulted in a larger volume of augmented bone than the use of bone grafts not covered with a barrier.     

Effects of a mechanical barrier on the integration of cortical onlay bone grafts placed simultaneously with endosseous implant

Background: Previous experimental studies on onlay bone graft integration have shown either advantages or disadvantages to the use of mechanical barriers. This indicates that the role played by the biologic properties of transplanted bone and membrane in graft revascularization and bone remodeling has not yet been established. The outcomes regarding osseointegration of titanium dental implants applied in such a condition are still contradictory. Purpose: The rabbit's radius model that is grafted onto the mandibular lower border and covered by membrane can reproduce a challenging experimental situation to preliminarily study the factors involved in osseointegration under deprived blood vessels source. Materials and Methods: Fourteen New Zealand White rabbits had a 2.5‐cm segment of the right radius osteoectomized and fixed onto the right mandibular lower border using titanium screws. Two screw‐shaped titanium implants (2.5 mm wide 2.5 mm long) were installed 7 mm apart in the mid length of the grafted bone. In experimental sites, the graft with the implants and graft‐host bone junction were covered by expanded polytetrafluoroethylene (e‐PTFE) membrane; control sites were left uncovered. Eight animals from the experimental group and six animals from the control group were sacrificed at 6 and 24 weeks after surgery. Ground sections obtained from en bloc tissues containing graft, implants, and recipient bone were subjected to histologic evaluation and histomorphometric analysis (area occupied by the graft and bone‐to‐implant contact). Results: The graft showed significantly more resorption after 24 weeks than at 6 weeks (p .05) irrespective of the treatment (with or without membrane), although the amount of new bone was greater at 24 weeks in sites where a membrane was covering the graft. Compared with 6 weeks postoperatively, the bone‐to‐implant contact was considerably improved at 24 weeks (p .05), and the membrane seemed beneficial for implant osseointegration when compared with unprotected sites (p .05). As a result of graft resorption, the amount of soft tissue was considerably expanded in sites beneath membrane, accompanied by a sustained process of trabecular bone deposition close to the barrier. Conclusions: Cortical onlay grafts covered by membrane demonstrated delayed remodeling, probably as a consequence of a hindered process of graft revascularization. Grafts covered by membrane might rely on previous host bone resorption both to become revascularized and to remodel. The findings that the membrane‐protected grafts were most resorbed at 24 weeks might be attributable to better implant osseointegration, because the fixtures were exposed to greater mechanical stimulation in these sites.