应用The Wand口腔无痛局麻仪行上牙槽前、中神经注射麻醉的评价

目的 采用The Wand口腔无痛局部麻醉仪进行上牙槽前、中神经注射麻醉，评价其优缺点。方法 将患者随机分为2组，试验组使用无痛局麻仪，进行上牙槽前、中神经注射；对照组采用传统的唇颊侧浸润和腭侧浸润注射方法。注射后由患者评定注射疼痛10点视觉模拟标尺表（VAS）值，医生评定麻醉效果，记录麻醉作用时间。结果 试验组的麻醉效果与对照组无显著性差异（P＞0.05），但麻醉作用时间较对照组持久（P＜0.01），而注射疼痛VAS值试验组明显低于对照组（P＜0.01）。结论 用The Wand进行上牙槽前、中神经注射，与传统的注射方法麻醉效果相当，而前者无明显注射痛。     

牙槽嵴增高术38例治疗体会

临床资料一、一般资料作者于1989年共收集38例病例，应用羟磷灰石陶瓷的成品增高牙槽嵴，其中男性5例、女性3例，年龄在60～80岁之间。二、手术方法1、常规消毒、麻醉受骨区。2、受骨区的切口设计要保证粘骨膜瓣对受骨区的良好覆盖，一般采用与牙槽嵴顶呈垂直角度的切口，注意勿损伤颏神经，因在下颌高度萎缩，病例，颏神经常常在牙槽嵴顶，应掀起一全厚粘骨膜瓣，分离出颏神经，使其位置降低。3、用剥离器剥离粘骨膜瓣，直至骨面，后端应止于磨牙后垫区，口内的粘骨膜瓣形成后，领侧游离范围应广泛，使其松驰，下颌舌骨肌在其附丽处切断，…     

应用外科方法建立幼犬牙槽裂模型的研究

目的:通过外科手术建立与临床牙槽裂相似的动物模型，为牙槽裂的治疗研究提供实验材料。方法：8周龄杂种犬6只。制备牙槽裂模型：设计唇腭侧2个矩形粘骨膜瓣，切除自第一乳侧切牙远中至乳尖牙近中约7mm的牙槽骨段，两个粘骨膜包裹覆盖切骨创面。通过临床观察、连续X线、头颅干骨测量和组织学检查评价实验结果。结果：所有动物形成规则的牙槽裂，观察期间无自发骨性愈合。各标本裂隙宽度与手术切除宽度基本一致，缺隙两侧的牙齿萌出正常。骨缺损缘表面光滑，有皮质骨形成。X线摄片发现，裂隙边缘密度逐渐增高，类似骨皮质影像，未见新骨向裂隙区生长迹象。组织学发现，牙槽裂缘组织由外向内依次为粘膜鳞状上皮、粘膜下纤维组织、薄层纤维骨膜和骨组织。结论：本实验形成牙槽裂模型与临床情况接近，方法可靠，稳定性和重复性好。     

骨膜下滑润麻醉牙髓切除（断）术临床观察

目的 探索上下颌牙牙髓切除（断）术麻醉效果更好，更理想的麻醉方法。方法 对3767例上下颌牙骨膜下浸润麻醉作牙髓切除（断）术。其中乳牙、上颌牙、下切牙，与相同数量同名牙在骨膜上浸润麻醉切髓作比较，下尖牙及双尖牙与相同数量同名牙在下牙槽神经阻滞麻醉切髓作比较；下磨牙与相同数量同名牙在下牙槽神经阻滞麻醉切髓作比较。结果 乳牙、上颌牙、下颌前牙及双尖牙骨膜下浸润麻醉切髓时基本无痛、总有效率明显高于对照组（P＜0．01）。下磨牙骨膜下浸润麻醉总有效率低于神经阻滞麻醉。结论 乳牙、上颌牙、下前牙及双尖牙采用骨膜下浸润麻醉、下磨牙采用下牙槽神经阻滞麻醉作切髓术麻醉效果较理想。     

仅用阿替卡因颊侧浸润麻醉拔除上颌第三磨牙的临床对照研究

目的：评价上颌第三磨牙拔除术中阿替卡因颊侧浸润注射对腭侧软组织的麻醉作用,讨论常规腭侧浸润麻醉注射是否必须。方法：28例拔除双侧上颌第三磨牙患者,每位患者作为其自身对照。对照侧利用盐酸阿替卡因行颊侧浸润麻醉及腭侧浸润麻醉,实验侧仅行颊侧浸润麻醉。注射3min后常规方法拔除患牙。利用100mm直观模拟标度尺（VAS）及问卷调查获得患者拔牙时的痛觉数据。结果：实验侧和对照侧的疼痛感觉（VAS值）没有显著性差异（P〉0．05）,拔牙过程中的疼痛均可接受。结论：仅用阿替卡因颊侧浸润麻醉可顺利拔除上颌第三磨牙,无需常规腭侧浸润麻醉,从而避免腭侧注射的疼痛不适。     

普罗卡因阻滞麻醉鼻腭神经合并暂时性听力下降一例

患者,女,30岁,因上前牙唇侧前突错位影响美观,要求拔除。检查:2|2唇侧移位,冠近中向倾斜并前突,上、下唇闭合时齿外露,31|13不松其间有3毫米间隙,余无异常,诊断2|2错位牙,治疗经过:用2％普鲁卡因2毫升作2|2唇侧根尖部浸润麻醉,后作门齿孔鼻腭神经阻滞麻醉,当注射针进     

阿替卡因麻醉下拔除上颌恒磨牙不施行腭侧注射麻醉的可行性

目的探讨拔除上颌恒磨牙时单用阿替卡因进行颊侧注射不施行腭侧注射的可行性。方法选择2007年5-7月在四川省人民医院口腔科就诊的104例需拔除上颌恒磨牙的患者为研究对象,38例患者为双侧上颌均有恒磨牙需要拔除,选择其中一侧作为试验牙,另一侧作为对照牙;两侧磨牙分2次拔除,间隔时间为7 d。66例患者为单侧上颌恒磨牙拔除,将需拔除牙作为试验牙,以前的拔牙经历作为对照。试验组由颊侧前庭沟注射点注入1.7 mL盐酸阿替卡因,对照组除颊侧注射外,在腭侧同时注射2%盐酸利多卡因0.25 mL。麻醉5 min后拔除患牙。由患者填写视觉模拟量表,对疼痛打分。结果试验组上颌恒磨牙麻醉成功率为96.2%,对照组上颌恒磨牙麻醉成功率为97.1%,二者之间的差异无统计学意义（P>0.05）。结论在上颌恒磨牙的拔除中,阿替卡因颊侧注射麻醉后能达到较好的麻醉效果,可以不进行腭侧麻醉。     

个别正常成人上前牙美学区唇、腭侧骨板厚度测量分析

目的:测量分析国人个别正常成人上前牙美学区唇、腭侧骨板厚度,为口腔种植手术,尤其是即刻种植的术前分析、方案制定提供数据支持,并为构建数据库奠定基础。方法:应用KaVo 3D eXam CBCT机对符合纳入标准的60例受试者进行锥形束CT(CBCT)扫描,所得Dicom格式三维重建数据导入InVivo 5软件,测量垂直于牙体长轴L3、L6、L9、L12水平处相应唇、腭侧骨板厚度,所得数据应用SPSS 18.0软件包进行95%参考值范围、频率、配对样本t检验、独立样本t检验、方差分析及多重比较。结果 :在各牙位各参考线水平,唇侧骨板厚度均较腭侧薄(P<0.05),唇侧骨板较多出现小于1 mm及骨板缺如的情况(40.6%~93.1%),腭侧骨板厚度普遍大于2 mm(L6及以上水平:60%~100%);左右同名牙、同牙位唇腭侧、性别、年龄段、同参考线不同牙位、同牙位不同参考线间骨板厚度存在差异。结论:上前牙区种植时常存在骨量不足情况,以侧切牙处尤为明显;唇侧骨板厚度较腭侧更薄,且常存在凹陷。种植手术时应在CBCT指导下,适当偏腭侧植入,必要时应用自体骨移植以及骨替代材料、骨劈开、骨增量技术,保证唇侧骨壁的完整性及足够的骨板厚度。     

牙周膜麻醉法312例应用报告

牙周膜麻醉法３１２例应用报告内蒙古赤峰市敖汉旗医院口腔科李仁适应症：主要用于松动牙，残根及多生牙拔除的麻醉；亦可用于其它浸润麻醉或阻滞麻醉的辅助麻醉。注射方法：病人取正坐位。消毒后，在要拔除的病牙的唇（颊）侧及舌（腭）侧，用２ｍｌ齿科注射器和５号注射...     

孪生兄弟同患多生牙1例

二患儿男, 8岁。系孪生兄弟,二人因上前牙区正中有多生牙而要求拔牙。口腔检查: 11、12、21、22、31、32、41、42已萌出,牙冠形态正常。均于 11与 21的腭侧有一多生牙,牙冠呈锥形。诊断为 11、21腭侧多生牙。盐酸利多卡因局麻下拔除。拔除后见多生牙牙根较短。两患儿为孪生兄弟。来自父母的遗传基因相同,在相同部位发生了形态相同的多生牙。孪生兄弟同患多生牙1例@李焕玉$澄江县人民医院!云南澄江652500 @李建芳$澄江县人民医院!云南澄江652500 @李正伟$澄江县人民医院!云南澄江652500…     

Assessment of the effectiveness of peripheral administration of fentanyl with lidocaine in inflamed dentoalveolar tissues

Peripheral action of opioids for pain control, for which local inflammation has been shown to be crucial, is being increasingly used in clinical practice. The aim of this study was to evaluate the hypothesis that addition of fentanyl to lidocaine, when injected into inflamed dentoalveolar tissues, can improve the quality of analgesia during surgery. Seventy-one patients reporting with pain and tenderness in the maxillary tooth were assigned into the experimental (LAF) or control (LA) group in a prospective, randomized double-blind trial. The LAF group (n = 36) was injected submucosally with a mixture of 40 microg of fentanyl (0.8 ml) and 2% lidocaine hydrochloride with 1:200000 adrenaline (2 ml). In the LA group (n = 35) 0.9% of saline (0.8 ml) was added instead of fentanyl. The pain scores were recorded before injecting, 5 min after injection, and immediately after surgery using a visual analogue scale. The mean pain scores were not significantly different at all time intervals. Twelve patients in the LAF group (2.75+/-0.72 ml) and ten patients in the LA (2.90+/-0.70 ml) group required additional local anaesthetic to achieve pain control. In conclusion, there was no improvement in quality of intraoperative analgesia on addition of fentanyl to lidocaine in inflamed dentoalveolar tissues.     

Effects of anesthetics containing epinephrine on catecholamine levels during periodontal surgery

Nine stable cardiovascular disease patients were evaluated in a double-blind cross-over trial during periodontal surgery using 2% lidocaine with epinephrine 1:100,000 or lidocaine alone. In the lidocaine with epinephrine group, epinephrine levels increased from 198 +/- 54 pg/ml to 592 +/- 166 pg/ml at 2 minutes post-injection. In the lidocaine alone group, epinephrine levels increased from a baseline of 115 +/- 34 pg/ml to 150 +/- 34 pg/ml at 2 minutes post-injection. Despite these elevations in epinephrine, no significant changes in heart rate or mean arterial pressure were noted. Plain lidocaine provided unsatisfactory levels of hemostasis and/or anesthesia during periodontal surgery. This study documents acute elevations in plasma epinephrine levels following local dental anesthesia for periodontal surgery. These elevations in plasma epinephrine failed to produce a significant cardiovascular response in a group of stable cardiovascular disease patients. This suggests that the cardiac effects of local anesthetics containing epinephrine are small and that they can be safely used in stable cardiovascular disease patients.     

Age differences in adult dentoalveolar heights

A previous study of age differences in facial morphology in a dentate sample representing young, middle, and old age (Tallgren and Solow, 1987) indicated an increase in lower anterior face height during adulthood. The aim of the present study was to examine in detail the accompanying age differences in dentoalveolar heights. The material consisted of lateral head films of 191 dentate Finnish women divided into the age groups 20-29, 30-49, and 50-81 years. The present study comprised 26 variables calculated from digitized reference points. The maxillary and mandibular anterior dentoalveolar heights were significantly larger in the middle and old age groups than in the young group, and the mean differences were of the same magnitude for the maxilla and the mandible. Analysis of the dentoalveolar components showed that in the mandible the extra-alveolar height of the incisors was significantly larger in the two older age groups than in the young group, while no significant differences were found in the maxilla. The mean differences in anterior mandibular ridge height between the older age groups and the young group were smaller than in the maxilla. No significant differences in dentoalveolar morphology were observed between the middle and the old age groups.     

Comparison of the Effectiveness of Lidocaine in Permanent Maxillary Teeth Removal Performed with Single Buccal Infiltration Versus Routine Buccal and Palatal Injection

Purpose

For many dental patients, palatal injection proves to be a very traumatic experience. Diverse methods have been suggested to reduce the discomfort of palatal injection. Nevertheless, the reliability of these methods is not obviously evident and they are not found to be universally effective. The desirable method to evade pain during palatal injection is just not to have one. Hence, the present study aims at investigating if lidocaine hydrochloride could provide palatal anesthesia in maxilla when only a buccal infiltration anesthesia is done for teeth extraction.

Patients and Methods

One hundred and fifty patients requiring extraction of maxillary teeth were included in the study. Patients were randomly allotted to two groups, study and control. Patients in study group received a single buccal infiltration of 1.5 mL of lidocaine with epinephrine for extraction of maxillary teeth. Patients in control group received 1.5 mL of buccal and 0.3 mL of palatal infiltration of lidocaine with epinephrine for the extraction. After achieving adequate palatal anesthesia the tooth was extracted with consistent technique. Pain level experienced by the patients during injection procedure and during tooth extraction was rated in an 11-point pain rating scale. Time taken to achieve palatal anesthesia following a single buccal infiltration of anesthetic solution was evaluated by regular pin-prick evaluation of palatal tissues.

Results

The overall success rate of palatal anesthesia achieved with a single buccal infiltration is 81.3 %. The success rate reduced as we proceed from anterior to posterior maxilla. Time taken to achieve successful palatal anesthesia by single buccal infiltration is 7–9 min.

Conclusion

The extraction of permanent maxillary anterior teeth and premolars is possible by depositing local anesthesia to the buccal vestibule of the tooth without palatal supplementation. However, the extraction of permanent maxillary posterior teeth with similar technique would result in fewer success rates suggesting its avoidance.     

安氏Ⅱ1类错(牙合)不同骨面型的牙颌垂直向形态特征分析

目的：探讨安氏Ⅱ^1类错[牙合]不同骨面型牙颌垂直向形态特征。方法：选取恒牙初期的正常[牙合]Ⅱ^1类错[牙合]均角型、高角型、低角型的X线头颅侧位片各30张,男女各半,进行X线头影测量分析,通过多组间单因素方差分析及两两比较,明确Ⅱ^1类错[牙合]3种骨面型和正常[牙合]的牙颌垂直向形态变化。结果：（1）所有Ⅱ^1类错[牙合]总体上颌复合体的前部相对于后部垂直向发育过度。均角组上颌复合体整体相对发育过度,颅底-下颌支复合体发育不足：高角组上颌复合体前部发育过度,后部和颅底-下颌支复合体发育不足;均角组和高角组下颌有后下旋转的趋势。低角组颅底-下颌支复合体的垂直生长相对于上颌复合体的后部发育过度,上颌复合体前部发育正常。下颌有前上旋转的趋势。Ⅱ^1类错[牙合]L6的垂直高度降低,U6远中倾斜。高角组、均角组U6垂直高度未增加,功能[牙合]平面（FOP）前下倾斜．高角组U6及功能[牙合]平面倾斜的程度最大;低角组U6垂直高度降低,远中倾斜程度最小,功能[牙合]平面未见异常。结论：Ⅱ^1类错[牙合]不同骨面型牙颌形态表现出不同的垂直向特征,治疗时垂直向控制应采取不同的措施。     

The compensatory mechanism in high-angle malocclusions: a comparison of subjects in the mixed and permanent dentition

Dentoskeletal morphology was assessed in 191 untreated and unselected children with a hyperdivergent (high-angle) mandibular plane (ML/NSL > or =40 degrees) by analyzing lateral roentgenographic cephalograms. The subjects were divided into mixed dentition and permanent dentition groups, and further divided into subgroups based on the amount of overbite (OB) as a measure of dentoalveolar compensation of jaw base hyperdivergency: OB < 0 mm (openbite) = insufficient/no compensation; OB 0 to 4 mm (normal overbite) = acceptable compensation; OB > 4 mm (deepbite) = overcompensation. Openbite was observed in 20% of the children, normal overbite in 50%, and deepbite in 30%. Skeletally, the deepbite mixed dentition group was characterized by a relatively posterior inclination of the maxilla, while the deepbite permanent dentition group had a relatively anterior inclination of the mandible. Dentoalveolar compensation was accomplished by relative increases in maxillary and mandibular anterior dentoalveolar heights in the mixed dentition group and by relative decreases in maxillary and mandibular posterior dentoalveolar heights in the permanent dentition. Positive overbite was found in the majority (80%) of children with high-angle morphology. Thus, mandibular hyperdivergency is frequently compensated for. Skeletal characteristics and dentoalveolar compensatory mechanisms differ with dental maturity and seem to be influenced by mouth breathing and other oral habits.     

笑气吸入与靶控输注异丙酚镇静在小儿埋伏多生牙拔除术中应用的比较

目的对笑气吸入和靶控输注异丙酚两种镇静方法在小儿埋伏多生牙拔除术中应用进行比较。方法选择择期接受上前牙区埋伏多生牙拔除手术的患儿60例,年龄6岁~14岁,ASA分级Ⅰ级。随机分为两组：P组（异丙酚组,n=30）和N组（对照组,n=30）。异丙酚组：滴定法靶控输注异丙酚,初始血浆浓度0.8g/ml,每5分钟增加浓度0.2g/ml。至OAA/S评分4分时,2利多卡因与1：200000肾上腺素混合液局麻后进行手术。笑气组：滴定法吸入笑气,至OAA/S评分4分时,2利多卡因与1：200000肾上腺素混合液局麻后进行手术。采用Houpt行为治疗效果评分两组患儿术中配合情况,并记录两组患者入室平静后（T0）、输注异丙酚或吸入笑气起效时（T1）、局麻时（T2）、手术开始（T3）、术中（T4）、手术结束时（T5）以及出室时（T6）的心率、血压、血氧饱和度和呼吸频率和NI指数,并记录相关反应情况。结果Houpt3~4分者P组5人,N组4人;Houpt5~6分者P组25人,N组26人。差异均无统计学意义（P〉0.05）。T1~5时心率、收缩压、舒张压及NI指数P组明显低于N组（P〈0.05）;血氧饱和度及呼吸频率两组无明显差异,均在正常范围内。不良反应P组低于N组。结论在小儿埋伏多生牙拔除手术中应用靶控输注异丙酚镇静略优于笑气吸入镇静。     

地佐辛联合利多卡因在下牙槽神经阻滞麻醉中应用效果评价

目的　评价地佐辛联合利多卡因在下牙槽神经阻滞麻醉中应用的安全性和有效性。方法　选取2019年5—8月于中国医科大学附属口腔医院口腔颌面外科行下牙槽神经阻滞麻醉患者40例，随机均分为2组。研究组麻醉药物选用2%利多卡因4 mL+地佐辛0.2 mL（1 mg），对照组麻醉药物选用2%利多卡因4 mL+生理盐水0.2 mL。记录麻醉起效时间、麻醉持续时间、术中镇痛效果及麻醉相关并发症。结果　研究组麻醉起效时间为（150.90 ± 24.92）s，对照组麻醉起效时间为（228.60 ± 28.47）s，其差异具有统计学意义（P < 0.05）；研究组麻醉持续时间（3.49 ± 0.43）h，对照组麻醉持续时间（2.39 ± 0.31）h，其差异具有统计学意义（P < 0.05）；两组术中镇痛效果的比较，差异无统计学意义（P > 0.05），且均有1例出现一过性头晕症状。结论　地佐辛联合利多卡因应用于下牙槽神经阻滞麻醉效果良好，能够有效缩短利多卡因起效时间，延长持续时间，并不会导致恶心、呕吐、嗜睡等不良反应的发生。     

Skeletal and dental effects of a mini maxillary protraction appliance

The aim of this study was to evaluate the skeletal and dentoalveolar changes achieved by a modified protractor in growing skeletal and dental Class III patients and to compare these changes with normal growth in a Class I untreated control group. The study group consisted of 25 patients (11 girls, 14 boys; mean age 11.74 +/- 1.81 years). The control group was composed of 20 patients (15 girls, five boys; mean age 11.89 +/- 1.08 years). The Class III patients were treated with a bonded acrylic cap splint type expander and a modified maxillary protractor until a positive overjet was achieved. The mean observation period was 0.65 years. Changes in study and control groups and differences between the groups were analyzed statistically. The results showed that protraction appliance produced a significant positive improvement in maxillo-mandibular relations. The forward movement of the maxilla was significant in treated Class III patients, but a slight difference was present between the two groups regarding maxillary rotation. The effective length of the maxilla was significantly increased in the Class III patients. The mandible was positioned backward, and posterior rotation of the mandible was significant in the treatment group. There was a significant increase in lower anterior facial height of treated Class III patients. The dentoalveolar measurements showed that the maxillary incisors proclined and the mandibular incisors significantly retroclined in the Class III group. A modified maxillary protractor treatment is effective for correcting skeletal Class III malocclusion.     

2种浓度利多卡因对下颌智牙拔除麻醉效果的影响

目的：探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法：采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100 000肾上腺素（低浓度组）或3 mL 2%利多卡因1∶100 000肾上腺素（高浓度组）行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平（疼痛评估量表,NRS）、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0 软件包对数据进行统计学分析。结果：21例患者（平均年龄24岁）完成试验,其中62%为女性。低浓度组的疼痛水平（1.09,95% CI,0.77~1.41）显著低于高浓度组（1.66,95%CI,1.33-1.99）（P=0.010）。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间（52~63 s）显著快于高浓度组（259~335 s）（P=0.000）。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异（P=0.751）。在疼痛NRS值为1~3的患者中,低浓度组,9例（100%）均在分牙时疼痛（下牙槽神经麻醉深度浅）;高浓度组3例（43%）分牙时疼痛,4例(57%)翻瓣时疼痛（颊神经麻醉深度浅）（P=0.019）。高浓度组麻醉持续时间比低浓度组平均长61 min（52~69 min）（P=0.000）。结论：用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。