上颌窦底骨切开提升术及同期牙种植体植入

目的：介绍经牙槽嵴顶进路行上颌窦底骨切开提升术,并同期植入牙种植体的方法与疗效。方法：对31例上颌后牙牙槽骨剩余高度5～10mm（平均高度7.1mm）的牙缺失者行上颌窦底骨切开提升术,同期植入牙种植体。术前摄X片测定牙槽骨高度,提升高度1～2mm者,仅植入种植体,提升高度超过3mm者,窦底放置Bio-Oss人工骨。结果：共植入40枚牙种植体,窦底提升1～2mm5枚,超过3mm者35枚,窦底平均提升3.70mm。分别植入Frialit-2种植体10枚,Xive种植体8枚,ITI种植体22枚。术后无术区感染和上颌窦炎症。X线片示种植体处窦底骨板呈半球状隆起,半年后见种植体与骨结合满意。结论：⑴经牙槽嵴顶行上颌窦底骨切开提升,可同期植入牙种植体,手术操作简便,创伤小。⑵牙槽骨剩余高度5～10mm为窦底骨切开提升术的适应症。⑶窦底提升2mm以内者无需植入骨替代材料,术后4月可行义齿修复;提升3～6mm时需放置植入物,义齿修复应延迟在术后6～8月进行。     

上颌窦内提升植骨同期植入Endopore种植体临床评价

目的 评价上颌窦内提升植骨同期植入Endopore种植体临床效果。方法 20例上颌后牙缺失，因牙槽骨高度不足，采用上颌窦内提升植骨，同期植入Endopore种植体28枚。术后6-9个月行种植义齿修复。结果 28枚种植体植入后伤口一期愈合，无上颌窦炎发生，义齿修复后行使咀嚼功能6-36个月，种植体稳定。X线检查植骨改建成新骨并与种植体形成紧密结合。结论 对牙槽骨高度不足的上颌后牙缺失，经上颌窦内提升植骨同期植入Endopore种植体，近期成功率高，方法简便。     

经牙槽嵴顶上颌窦底提升同期植入短种植体的回顾性研究

目的研究上颌后牙区不同窦嵴距时，采用经牙槽嵴顶上颌窦底提升植骨并同期植入短种植体术后，种植体周围骨高度随时间的变化情况。方法对37例患者进行经牙槽嵴顶上颌窦底提升植骨并同期植入共74枚Bicon短种植体，其中剩余牙槽骨高度（RBH）<4 mm组43个位点，RBH≥4 mm组31个位点。随访5年后，通过临床检查和X线片测量分析不同窦嵴距时，种植体周围骨高度随时间的变化情况。结果74个种植位点术后窦底提升高度（6.64±1.32）mm，修复负载5年后上颌窦内获得骨高度为（3.35±1.29）mm；RBH<4 mm组和RBH≥4 mm组之间的种植体颈部骨吸收量的差异无统计学意义，而上颌窦内获得骨高度及种植体顶部骨高度的差异有统计学意义。结论上颌后牙区RBH<4 mm时，采用经牙槽嵴顶上颌窦底提升同期植入Bicon短种植体的术式可获得较高的种植体存留率及上颌窦内骨增加量，同时并不会增加牙槽嵴顶骨吸收量。     

羟基磷灰石牙槽嵴加高与骨融合式种植体同期植入的有限元 …

以骨膜一种植体固定羟基磷灰石髁粒加高的牙槽嵴，并同期植入骨融合式种植体为实验组，以单独植入的骨融全式种植体为对照组建立有限元分析模型，分别在两种骨融合式种植体的顶端，沿其长轴生趣加载４０ｋｇ的力。     

前牙骨缺损环状骨移植同期植入种植体近期疗效观察

目的探讨临床应用环状骨移植同期植入种植体修复前牙区骨缺损的效果。方法 7例前牙区严重骨吸收患者,在颏部或者上颌骨取环状骨,将种植体旋入环状骨,再将种植体连同环状骨一起同期植入已制备好的种植窝内。植入共12颗种植体。种植术后半年行上部结构修复。完成修复后随访3～12个月。结果 6例10颗种植体成功完成上部结构修复。1例失败,该患者1颗种植体环状骨少量暴露,磨除少量环状骨后愈合良好,另1颗种植体因环状骨暴露,去除环状骨后螺纹暴露过多而被取出后重新植入种植体。结论应用环状骨作为前牙区骨增量手段,效果肯定,可同期植入种植体。     

羟基磷灰石牙槽嵴加高与骨融合式种植体同期植入的扫描电镜…

利用羟基磷灰石（ＨＡ）颗粒与骨形成蛋白（ＢＭＰ）形成的复合材料加高牙槽嵴，并以骨膜下种植体固定ＨＡ颗粒，保持加高牙槽嵴的高度和形态，同期植入骨融合式种植株，结果显示，４个月时ＨＡ颗粒与骨膜下种植体完全被致密的骨组织包绕，ＨＡ颗粒与骨融合式种植体界面为一层均质的骨化带，获得ＨＡ颗粒，骨膜下种植体和骨融合式种植体三者通过骨组织连接而形成的一个与牙槽骨架紧密结合的整体结构。表明这种修昨方法具有良好的运用     

上颌窦外提升同期种植体植入后近期效果观察

目的探讨上颌窦外提升同期植入种植体的方法及效果。方法16例患者21侧上颌窦通过外提升同期植入种植体共28枚。结果上颌窦底平均增加骨高度11.8mm,16例均已完成修复,随访3～18个月,平均随访10个月,无种植体松动脱落,咀嚼功能正常。结论上颌窦外提升同期植入种植体,疗效肯定,可明显缩短治疗周期,减少手术创伤。     

羟基磷灰石牙槽嵴加高与骨融合式种植体同期植入的有限元分析

以骨膜下种植体固定羟基磷灰石颗粒加高的牙槽嵴，并同期植入骨融合式种植体为实验组，以单独植入的骨融合式种值体为对照组建立有限元分析模型，分别在两组骨融合式种植体的顶端，沿其长轴垂直加载４０ｋｇ的力。结果显示：实验组骨融合式种植体周围牙槽嵴顶部的压在力较对照组增加了３６．３０５４Ｎ／ｍｍ２，约３０．３５％，而牙槽嵴顶部与骨融合式种植体界面的切应力较对照组减少了７０．４０５８Ｎ／ｍｍ２，约１９．４６％。表明这种同期植入的修复方法有助于减少骨融合式种植体边缘骨的吸收，提高种植体的成功率。     

严重骨量不足的上颌窦底提升同期种植体植入

牙种植患者上颌或下颌牙槽嵴足够的骨量是施行牙种植修复的前提,但上颌牙缺失后常出现上颌窦腔的扩大气化,导致牙槽嵴高度不足。这常需要进行上颌窦底提升手术以恢复植牙所需的骨高度。常规的治疗方案中,在牙槽嵴剩余骨量小于3mm时,需先进行骨增量手术,待新骨生成后,再作二期种植体植入手术。这种治疗方案由于需两次手术,增加病员的负担及复诊次数,需要较长的治疗疗程。     

羟基磷灰石牙槽嵴加高与骨融合式种植体同期植入的扫描电镜观察

利用羟基磷灰石（ＨＡ）颗粒与骨形成蛋白（ＢＭＰ）形成的复合材料加高牙槽嵴，并以骨膜下种植体固定ＨＡ颗粒，保持加高牙槽嵴的高度和形态，同期植入骨融合式种植体。结果显示：４个月时ＨＡ颗粒与骨膜下种植体完全被致密的骨组织包绕，ＨＡ颗粒与骨融合式种植体界面为一层均质的骨化带，获得了ＨＡ颗粒、骨膜下种植体和骨融合式种植体三者通过骨组织连接而形成的一个与牙槽骨紧密结合的整体结构。表明这种修复方法具有良好的运用前景。     

自体原位取骨植骨上颌窦提升同期种植体植入术的临床研究

目的:通过原位取骨、植骨、同期植入CDIC种植体,以解决上颌后牙区因上颌窦过大或牙槽嵴严重萎缩导致骨量不足的问题。方法:采用空心环柱形切骨锯在所需种植区域取骨,将圆柱状骨块取出后研磨成颗粒。在使用骨膨胀器对上颌窦底提升后,将骨颗粒和CDIC种植体一起置入预备好的种植窝。结果:对3例患者实施手术,共植入种植体6枚,术后全部为一期愈合,无并发症,种植修复效果理想。结论:采用自体原位取骨上颌窦提升术同期植入CDIC种植体,可以通过微创操作有效地解决上颌后牙区骨量不足的问题。和传统的上颌窦侧方开窗、提升、植骨相比,它不但降低了手术操作的复杂程度,同时也使患者的痛苦减小到最低。     

基于CT影像的牙种植模板相关的颌骨解剖学研究

目的:通过观测成人颌骨形态结构及其周围骨突的情况,为临床口腔种植手术导板的设计、制作,模板导向孔的安置、深度和方向以及种植角度提供参考数据。方法:对临床上31例上颌骨及44例下颌骨的CT断层图像,应用3D-DOCTOR软件对其各个牙位上相应的牙槽嵴与对应牙的夹角进行观测与测量,并用统计分析软件SPSS13.0加以分析。结果:上颌骨牙长轴与牙槽突的唇腭侧偏移关系有71.92%在偏唇与偏腭20°以内,下颌骨牙长轴与牙槽突的唇腭侧偏移关系有98.68%在偏唇与偏舌20°以内。结论:颌骨牙长轴与牙槽嵴的相对偏斜度可为种植位点的选择和种植导向模板的制作提供理论依据。     

Stereoscopic Technique for Conversion of Radiographic Guide into Implant Surgical Guide

Purpose: The aim of this study was to develop and evaluate a new stereoscopic technique for conversion of radiographic guide into surgical guide for dental implant placement. Materials and Methods: Ten partially dentate patients requiring 18 implants for tooth replacement were recruited. Radiographic guides were modified with the addition of index rods for double computed tomography scanning. Implant positions were planned with implant planning software, and the stereoscopic angulations were measured. The radiographic guides were converted into surgical guides using either a generic bench drill (Group A, n = 9) or a milling machine (Group B, n = 9). Stereolithographic surgical guides were also made for three patients (Group S, n = 5). Differences between the planned and actual angulations were tested by pair‐sample t‐test. Difference of mean angle deviation among groups was tested by Brown–Forsythe test. Differences were considered significant if p < .05. Results: Eighteen implant sites were successfully treated with the converted surgical guides. The mean angle deviation of Group A (1.3 ± 0.6°) was significantly greater than Group S (0.4 ± 0.6°), while no differences were found between Group B (0.9 ± 0.3°) and Group S. The linear error was greatest in Group A with 1.5 mm at the head and 1.8 mm at the apex of the implant. Conclusions: The use of this new stereoscopic technique appears to be an acceptable alternative method for converting radiographic guide into surgical guide.     

微创取骨进行自体骨移植在牙种植中的临床应用

目的:探讨牙种植中骨缺损区微创取骨进行自体骨移植的效果。方法:选择15例18颗牙槽骨缺损牙种植病例,在牙槽骨缺损区周围局部取骨,空心取骨锯颌骨取骨及常规髂骨手术取骨后植骨,或同时行钛膜引导,同期或6月后延期行种植体植入,4~6个月后行烤瓷冠修复。结果:所有病例均取得良好成骨及修复效果。结论:空心取骨锯取骨和缺骨区周围局部取骨损伤小;有钛膜引导病例成骨量较大,骨吸收少;取髂骨手术取骨量大,但损伤较大,不应作为常规植骨方法。     

种植技术在自体牙移植的临床应用研究

目的:探讨牙种植技术在自体牙移植中的应用方法,评价其临床效果。方法:选择磨牙、前磨牙缺失17例及磨牙残根残冠行微创拔除19例,应用Frialit-2种植工具完成移植窝制备,拔除自体第三磨牙并植入移植窝,同期植入自体骨,托槽弓丝固定4周,固定期间进行移植牙根管治疗。结果:1例术后3月移植牙松动被拔除,35例(97.2%)术后随访1～7年,移植牙稳固,咀嚼功能正常,x线示移植牙与牙槽骨紧密贴合,牙根无吸收。结论:应用种植技术实施自体牙移植具有去骨精确,骨损伤小,成功率高的优点,临床效果肯定。     

上颌垂直骨劈开法同期种植体植入的临床评估

目的：评估上颌垂直骨劈开法同期植入种植体的临床效果。方法：收集不同时段不同年龄患者40位,使用牙槽骨劈开手术同期种植体植入。6月后,制作固定义齿,并定期随访。结果：使用上颌垂直骨劈开法同期植入种植体共122枚,其中有11枚种植体于观察期间失败,结果显示,Frialit-2与Frialit-synchro存活率87.5%,Fri-alit-XiVE（TPS）与Frialit-XiVE S cellplus存活率96.0%。结论：利用垂直骨劈开法使上颌牙槽嵴扩张,行种植体同期植入,与常规有足量骨量种植相比,存活率相近。     

Bacterial Persistence in Dentoalveolar Bone Following Extraction: A Microbiological Study and Implications for Dental Implant Treatment

Background: The microbiological status of apparently healed alveolar bone implant sites is unknown. Implant success may be compromised by site‐specific persistence of bacterial biofilm co‐aggregations contaminating healed alveolar bone. Purpose: The purpose of the present study was to investigate whether extraradicular infection can persist in apparently healed alveolar bone and to develop a surgical debridement strategy that favors implant osseointegration. Materials and Methods: The study was conducted on 32 private practice patients. Seventy‐seven microbiological samples were taken from 16 pre‐implant extraction sockets, 56 healed post‐extraction osteotomies at fixture placement, and five failed fixtures. Two of the healed osteotomy samples were healed retreatment sites. Tissue fluid and bone samples were analyzed by either anaerobic/aerobic culturing or DNA molecular techniques. All patients were treated ad modum Brånemark, with a two‐stage sterile surgical procedure. A search of the medical and dental literature revealed no evidence‐based or best practice recommendations for the use of debridement in implant therapy. Thus, we developed a new technique for the debridement of alveolar bone found to be contaminated by persistent biofilm or planktonic bacteria. Results: The results of the microbiological analysis of 77 bone and effusion samples from 47 implant sites of the 32 patients showed that overall, 32% (n = 25) had bacteria present in the sample. In 16 pre‐implant extraction sockets, 69% of samples were positive for the presence of bacteria (n = 11). Of 56 osteotomies with a minimum 3‐month healing at fixture placement, 21% revealed a positive culture (n = 12). Two‐stage failed fixtures had 100% positive cultures (n = 5) and it was evident from radiographs that all of these failed fixtures had the apical ends close to the former tooth root end. Based on these findings, we have developed a microbiologically based surgical debridement strategy to successfully re‐treat early infective failures and to place successful two‐stage fixtures. Conclusion: Bacteria can persist as a contaminant in apparently healed alveolar bone following extraction of teeth with apical or radicular pathosis. A new technique for surgical debridement to reduce and limit this bacterial contamination has been described.     

一段式叶状钛牙种植体骨内种植的临床研究

作者自1992年开始开展了一段式叶状钛牙种植体骨内种植的临床研究工作，至今随访已超过三年的为138例患者，205颗种植体，拔除16颗，其中因种植体折断而拔除的4颗，其成功率为92．2％。本文对其手术方法、成功因素、一段式种植体的优点等进行了分析和讨论。作者认为一段式叶状钛牙种植体是一种值得推广的种植体。