杆-卡结构种植覆盖义齿修复

本文对5例无牙颌患者，6副种植体支持的杆-卡结构种植覆盖义齿作2年的追踪观察资料作了总结。种植体为覆盖义齿提供了满意的支持。固位和稳定作用，增进了咀嚼功能的发挥。未见种植体松动和牙槽骨严重吸收。正确拟订治疗计划，术后戴用过渡性修复体，杆卡符合一定力学要求，正确处理义齿关系等均促成种植体的高成功率（100％）。修复后的定期检查，维护修复体、种植体及杆的清洁，对确保修复的成功具有重要意义。杆卡结构种植覆盖义齿修复牙槽嵴严重吸收的无牙颌是可行的。     

Implants in the zygomatic bone for maxillary prosthetic rehabilitation: a systematic review

The purpose of this systematic review was to evaluate clinical studies on the follow-up survival of implants inserted in the zygomatic bone for maxillary rehabilitation. A comprehensive search of studies published from 2000 to July 2012 and listed in the PubMed/MEDLINE, Embase, and Cochrane Library databases was performed in accordance with the PRISMA statement. Relevant studies were selected according to predetermined inclusion and exclusion criteria. The initial database search yielded 751 titles. After filtering, 313 abstracts were selected, culminating in 42 full text articles. Application of eligibility criteria led to the elimination of 17 articles. Hence 25 full-text articles were considered clinically relevant and were included. Calculations of the interval survival rates and cumulative survival rates of implants could be carried out on the data extracted from the final list of included studies for the different time intervals. These studies reported the insertion of a total of 1541 zygomatic implants and 33 implant failures. Failure generally occurred during the first year interval and was related to clinical complications, such as recurrent acute and chronic sinusitis. After a 36-month follow-up, the survival rate was 97.86%. Additional studies with longer follow-up periods, including the number of zygomatic implants inserted and details of the variations in the surgical techniques used and the impact of the maxillary morphology are still required.     

Short Implants: A Descriptive Study of 273 Implants

Purpose: The study aims to assess the performance of short implants in a series of patients with severe alveolar resorption. Materials and Methods: A review is made of 273 implants measuring 10 mm or less, placed by conventional surgery or using osteotomes, and with a postloading follow‐up of between 18 months and 12 years (mean 81 months). Results: A total of 20 failures were recorded (7.33%), with a global implant survival of 92.67%. The survival rate for 10 mm implants was 92.82%, versus 92.5% in the case of those measuring less than 10 mm. Overall, the failure rate was lowest for the treated surface implants (2.56% vs 4.76%). On considering the implants measuring under 10 mm, the failure rates were similar in both groups (3.77%). Conclusions: Short implants are a good treatment alternative for patients with severe alveolar resorption of both jaws.     

Intra‐ and Extraoral Prostheses Retained by Zygoma Implants Following Resection of the Upper Lip and Nose

Upper lip cancers are infrequent lesions, being aggressive unless diagnosed and treated early. After the surgical resection, maxillofacial defects require special care in rehabilitation. This article describes the maxillofacial rehabilitation of an edentulous patient diagnosed with upper lip squamous cell carcinoma. The treatment consisted of a large amount of upper lip and nose tissue resection, followed by chemoradiotherapy. After the first surgical healing, zygoma implants were inserted in a two‐step procedure. The maxillary and nasal prostheses were installed and fixed by a titanium framework. After 6 years follow‐up, no recurrences were observed, and the patient did not develop metastases. Tissues around implants were in good health, and the prostheses remained well‐fitted. The use of implant‐retained prostheses improved the quality of life, and the patient was extremely satisfied with the final result. The implant‐retained prostheses are well accepted by the patient, improving comfort and safety during function while recovering her esthetic apperance.     

弧线式牵张成骨修复犬部分上颌骨的实验研究

目的:探讨应用内置弧线式骨牵张器实现颧骨弧线式牵张成骨修复部分上颌骨的可行性。方法:以犬建 立实验动物模型,制造上颌骨、颧骨节段性缺损,模拟上颌骨缺失,以内置弧线式骨牵张器牵张颧骨修复部分上颌 骨,共牵引约12mm,固定期X线观察。结果:2只犬实验内容均按计划完成,X线影像示,牵引结束时,骨移动盘实 现显著的改向、内旋,与远端颧骨呈弧线连接,固定期2周时,牵张间隙内早期骨结构形成,随后,骨密度进行性加 强,8周时,新生骨骨质密度接近正常,与双侧正常骨质连续,弧线完整平滑,弧线式牵张成骨修复基本完成;器械始 终处于正常状态。结论:颧骨弧线式牵张成骨术和本文报告的内置弧线式骨牵张器具有临床应用可能性。     

Solutions for Severely Angulated Implants in the Mandibular Overdenture: A Clinical Report

Results of randomized clinical trials have confirmed that implant overdentures provide patients with better outcomes than do conventional complete dentures. Several designs have been introduced for the mandibular implant-retained removable prosthesis. The most commonly used prosthesis design for the mandibular overdenture is two implants in the canine areas with a stud attachment mechanism (i.e., ball attachments). This design is the least expensive, and therefore can service more patients and is now considered to be the "Standard of Care" for the mandibular edentulous patient. Proper treatment planning and execution lead to favorable implant placement and a successful prosthetic restoration and ultimately patient satisfaction; however, implant malposition may occur, which can lead to an unsuccessful prosthesis. This clinical report describes an implant overdenture design used for severely angled implants. Prosthodontic techniques that enabled this patient to have a successful outcome included the use of cast-to attachments and abutments along with a sectional matrix used to locate these components within the bulk of the prosthesis. For this patient the prosthodontic compromises were preferred over another surgical procedure with the additional time, discomfort, increased cost, and possible surgical morbidity. It is important that the patient understand the compromises and potential problems when implant placement is not ideal, especially the potential for implant overload and failure.     

Extrasinus Zygomatic Implants: Three Year Experience from a New Surgical Approach for Patients with Pronounced Buccal Concavities in the Edentulous Maxilla

Background: The surgical protocol for zygomatic fixtures prescribes an intrasinus approach ideally maintaining the sinus membrane intact and the implant body inside the sinus while gaining access to the zygomatic bone. In the presence of a pronounced buccal concavity, the implant head has to be placed far from the alveolar crest in a palatal direction, which results in a bulky bridge construction. Purpose: The aim of this study was to report on the preliminary experiences with zygomatic implants placed with an extrasinus approach in order to have the implant head emerging at or near the top of the alveolar crest. Materials and Methods: Twenty consecutive patients with pronounced buccal concavities in the edentulous posterior maxilla were treated with 104 regular and 36 zygomatic implants as support of fixed dental bridges. Sixteen patients were treated bilaterally and four patients were treated unilaterally. The zygomatic implants were inserted by using an extrasinus surgical approach with the implant body passing from the alveolar crest through the buccal concavity into the zygomatic bone. This enabled placement of the implant head at or close to the alveolar crest. The patients were followed from 36 to 48 months after occlusal loading with a mean follow‐up of 41 months. The relation of the zygomatic implants to the crest was measured and compared with a control group of 20 patients treated with conventional placement of zygomatic implants. Results: No implants were lost during the study period. No pain, discomfort, or complications related to the extrasinus path of the zygomatic implants were recorded after the initial healing period and up to the 36th‐month checkup. The zygomatic implants emerged, on average, 3.8 mm (SD 2.6) palatal to the top of the crest compared with 11.2 mm (SD 5.3) to the conventional technique. Conclusion: The present 3‐year clinical study shows that an extrasinus approach can be utilized when placing zygomatic implants in patients with pronounced buccal concavities in the posterior maxilla. Moreover, the technique results in an emergence of the zygomatic fixture close to the top of the crest, which is beneficial from a cleaning and patient‐comfort point of view.     

无牙颌患者种植义齿修复

目的:无牙颌患者采用种植义齿修复可有效的增强义齿的固位,提高义齿的修复效果。方法:从1999年至2007年,对22例无牙颌患者,年龄45-82岁,行种植义齿修复,其中,有2例采用种植固定义齿修复,7例采用杆-卡式种植覆盖义齿修复,11例采用球-帽式种植覆盖义齿修复,1例采用双套筒冠种植覆盖义齿修复,1例采用磁性固位种植覆盖义齿修复。患者种植体植入2-9颗,共植入种植体97枚,种植体采用Frialit-2,Fri-alit-xive系统,观察时间108个月,采用临床检查、X线观察和患者主观评价等来评价种植体与骨组织结合状态,评价其义齿的修复效果。结果:观察期内发现1枚种植体脱(球-帽式固位种植体),1枚种植体未作修复,仍埋入在粘膜下的颌骨内。种植义齿修复后固位稳定作用良好,患者咀嚼有力,对义齿修复效果满意。结论:无牙颌患者种植义齿修复效果良好,患者满意度高。     

Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study

Objectives: The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes of immediately loaded full‐arch fixed prostheses supported by a combination of axially and non‐axially positioned implants in a large cohort of patients with completely edentulous jaws, up to 5 years of function. Materials and methods: One hundred and seventy‐three edentulous patients (80 males and 93 females) were enrolled according to specific selection criteria. Each patient received a full‐arch fixed prosthesis supported by two distal tilted implants and two anterior axially placed implants. The provisional functional acrylic prosthesis was delivered the same day as surgery in all cases. All cases were finalized 4–6 months later. The patients were scheduled for follow‐up at 6 and 12 months of function, and annually up to 5 years. At each follow‐up plaque and bleeding score was assessed and radiographic evaluation of marginal bone level was performed. Results: The overall follow‐up range was 4–59 months. A total of 154 immediately loaded prostheses (61 in the maxilla and 93 in the mandible) were in function for at least 1 year and were considered for the analysis. Four axially placed implants failed in the maxilla and one tilted implant in the mandible, all within 6 months of loading. No further implant failure occurred to date. Implant survival at 1 year was 98.36% and 99.73% for the maxilla and the mandible, respectively. Marginal bone loss at 1 year averaged 0.9±0.7 mm in the maxilla (204 implants) and 1.2±0.9 mm in the mandible (292 implants). No difference was found in marginal bone loss between axial and tilted implants. Plaque and bleeding scores progressively improved from 6 to 12 months. Fracture of the acrylic prosthesis occurred in 14% of total cases. Conclusions: The present preliminary results from a relatively large sample size suggest that the present technique can be considered a viable treatment option for the immediate rehabilitation of both mandible and maxilla. To cite this article:
Agliardi E, Panigatti S, Clericò M, Villa C, Malò P. Immediate rehabilitation of the edentulous jaws with full fixed prostheses supported by four implants: interim results of a single cohort prospective study.
Clin. Oral Impl. Res. 21 , 2010; 459–465.
doi: 10.1111/j.1600‐0501.2009.01852.x