种植修复后冠松动与扰关系的初步临床观察

目的:修复后冠松动患者咬合接触的特征,探讨后干扰或早接触等咬合异常因素与种植修复体冠松动的关系。方法:选取8例种植粘接修复后冠松动患者,应用T-ScanⅢ咬合分析仪进行正中、前伸及侧方咬合检查,观察干扰和早接触情况,结合咬合纸,指导调,磨除侧方咬合的干扰点。在种植义齿与自然牙的混合牙列,建立种植义齿比自然义齿延迟负载设计模式。结果:8例种植粘接修复后冠松动患者中均存在侧向干扰,早接触等问题,结合咬合纸,指导调,磨除干扰点。分离时间明显较治疗前缩短,早接触出现率较粗治疗前降低。结论:后干扰或早接触等咬合异常因素,易导致种植修复体冠松动,应合理设计种植修复体的力分布,使力沿种植体长轴传导,最大程度减少种植体承受的侧向力和应力,降低种植体负荷。戴冠后应用T-ScanⅢ系统并结合咬合纸,建立种植义齿比自然义齿延迟负载设计模式,缩短侧方研磨时间,能提高种植义齿成功率。     

无牙颌种植义齿修复咬合接触设计的研究进展

种植义齿咬合接触的设计是无牙颌患者种植修复的重要考量因素之一。适宜的咬合力在保证患者咀嚼能力的同时，避免种植体受到过大负荷，而不良咬合力则会影响种植修复的预后。无牙颌患者种植义齿的正中咬合接触设计应当尽量保证咬合力平行于种植体长轴，减少悬臂梁和不良支点的存在，保持后牙接触的均匀稳定，首选尖牙保护作为种植体保护性咬合。     

种植支抗压低对(牙合)伸长牙同期种植修复缺失后牙的临床研究

目的研究种植支抗压低对伸长牙同期种植修复缺失后牙的临床效果。方法 8例后牙缺失伴对牙伸长的成年患者,利用支抗种植钉作为骨支抗,对16颗对伸长牙进行正畸压低矫治,矫治结束前8～12周植入种植体,矫治结束时即刻进行上部结构修复。随访1年,观察临床效果。结果 8例患者16颗伸长对牙压低矫治成功,平均压低疗程为7个月,缺失牙种植义齿修复后咀嚼功能正常;1年后随访,压低后的天然牙与种植义齿咬合稳定,X线片显示矫治压低的对牙和种植义齿均未出现明显的骨吸收。结论种植支抗压低对伸长牙同期种植修复缺失后牙,缩短了疗程,有利于早期建立稳定的咬合关系,是一种可行的临床治疗选择。     

种植义齿失败原因的探讨

目的:对种植义齿失败病例进行了分析。方法：193年7月至2001年6月共完成种植义齿422例，植入种植体482颗，其中有48颗种植体失败脱落。结果：种植失败的主要原因是修复前种植体与骨组织之间未发生骨性结合、种植体周围炎、机械性折断和种植体旋转分别为6、28、8、6颗，失败率为9．96％。结论：种植体材料、结构、设计和类型，外科植入技术，修复设计原则及修复技术，咬合力的控制和口腔清洁卫生的保持是影响种植成败的主要因素，种植体周围炎和种植体机械性折断是种植失败的主要原因。     

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目的探讨正畸与种植体联合治疗下前牙先天缺失伴错畸形的临床效果。方法对2003—2007年在中国医科大学口腔医学院正畸科就诊的15例下切牙缺失伴错畸形的患者行正畸治疗,开辟种植义齿修复间隙,然后行种植义齿修复缺失牙。结果经联合治疗后15例患者均获得正常的覆、覆盖关系和美观效果。共植入25枚种植体,随访时间12～24个月,均稳定无松动。结论正畸与种植体联合应用治疗伴有下切牙先天缺失的错畸形,能够获得满意的治疗效果。     

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口腔种植修复技术的出现,为口腔修复提供了新的临床途径。种植修复中的咬合问题不仅对恢复美观及功能有着重要影响,还关乎种植的成败。在种植修复前需考虑天然牙与种植体存在的差异,并根据缺失牙范围、设定的修复体类型等对种植修复进行有针对性的咬合设计。本文旨在对种植义齿修复相关学问题进行探讨。     

上颌前部种植义齿失败的临床回顾性研究

目的:分析上颌前部种植义齿失败原因,为提高临床种植义齿修复技术水平提供理论依据.方法:回顾分析10年来烟台市口腔医院种植修复失败病例,分析其原因.结果:上颌前部种植修复失败原因以术后感染最为常见,其他原因如修复设计不合理导致侧向力过大、种植体周围炎等也比较常见.结论:种植修复外科中严格无菌操作观念是降低术后感染的有效方法.合理设计种植修复计划可有效提高种植修复的成功率.     

人工种植牙的义齿修复及临床效果初探

作者对51例不同牙列缺损的患者,种植了77颗不同材料、不同类型的人工种植牙根,术后在不同的时期,采用不同方法完成义齿修复。本文结合典型病例,通过修复前后菌斑指数测量、龈沟液流量测量、修复后(牙合)力测量,以及不同程期X线片对比及其它临床检查结果对人工种植牙的材料选择,种植义齿的制作工艺要求及种植义齿的临床效果作初步的分析。结果说明,无论是钛合金种植体或是羟基磷灰石钛合金复合种植体均为成功的种植材料。修复后的种植义齿(牙合)力最高可达54kg,最低超过10kg,均能适合日常生活所需要(牙合)力,经过两年的临床应用,种植体无松动,周围无炎症,无骨吸收,具有良好的修复效果。     

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。     

种植义齿的咬合恢复

种植体修复已经被越来越多地应用于临床,成为传统修复方式的重要补充.种植修复的关键,在于种植体和支持骨整合成功.由于这种种植体-骨整合和天然牙-牙槽骨的结合方式截然不同,两者对于(牙合)力反应不同.所以,种植义齿上部结构的咬合设计,与传统义齿应有所不同.但是,尽管对于天然牙和传统义齿的(牙合)重建,已有大量研究资料,而对于种植义齿的咬合尚少有研究.种植义齿的咬合设计,多依据传统义齿的经验和原则.本文通过对种植义齿咬合重建研究的综述,试图归纳出系统的种植义齿咬合恢复的原则.     

Issues and considerations in dental implant occlusion: what do we know, and what do we need to find out?

Implant dentistry continues to struggle with what are the appropriate occlusal concept(s) for implant-supported restorations. The biological and mechanical consequences of the loading environment leads to establishing and maintaining an implant interface in a wide variety of bone quality and quantity, implant and prosthesis designs. To the restorative dentist, the role of occlusion is more focused on extending the service life of the restoration and the connecting abutment(s) than protecting the osseous integration of the implant(s). This study reviews the relevant issues regarding implant occlusion along with implant and prosthesis design in order to provide optimal patient care.     

锥体束CT辅助种植义齿导航系统

目的:研发种植义齿导航系统。方法:通过制作缺失牙位模板义齿初步确定植体的定点和方向。再通过CBCT精确测量,利用模板定位仪精确定位,使植体在颌骨内达到理想定位。结果:统计测量70枚术后种植体,经CBCT冠切、矢切检验,达到理想定位标准者占98.6%。讨论:1、种植体在缺隙的定点和在颌骨内的定位应该符合牙合力传导的规律。植体在颌骨内的方向应与相应义齿牙合力传导方向一致。一般情况下,牙合力传导方向与该自然牙的牙体长轴方向一致。2、在部分病例中,植体在颌骨内的定位受到局部骨质条件的限制。植体的理想定位标准是:依据缺失牙位修复体的功能需求,充分利用缺失牙位局部骨质条件,结合种植体的系统、系列特点,依此确定植体的直径、长度以及植体在颌骨内的方向。3、本导航系统首先以自然牙的牙体长轴方向作为参照制作模板义齿,再以锥体束CT摄影技术进行检验,最后再用模板定位仪进行矫正,确保植体在颌骨内达到理想定位。结论:CBCT辅助种植义齿导航系统操作简便,费用低廉,效果良好,可以推广应用。     

Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale

Due to lack of the periodontal ligament, osseointegrated implants, unlike natural teeth, react biomechanically in a different fashion to occlusal force. It is therefore believed that dental implants may be more prone to occlusal overloading, which is often regarded as one of the potential causes for peri-implant bone loss and failure of the implant/implant prosthesis. Overloading factors that may negatively influence on implant longevity include large cantilevers, parafunctions, improper occlusal designs, and premature contacts. Hence, it is important to control implant occlusion within physiologic limit and thus provide optimal implant load to ensure a long-term implant success. The purposes of this paper are to discuss the importance of implant occlusion for implant longevity and to provide clinical guidelines of optimal implant occlusion and possible solutions managing complications related to implant occlusion. It must be emphasized that currently there is no evidence-based, implant-specific concept of occlusion. Future studies in this area are needed to clarify the relationship between occlusion and implant success.     

Occlusal contacts of the natural teeth

The areas of contact between the mandibular and maxillary teeth are critical in helping control the occlusion. They affect the amount and direction of force against the teeth and the periodontium. In addition, they determine how efficiently the forces are expended. The significant aspects of the occlusal contacts of the posterior teeth are: the mandibular position and excursion at the time of their occurrence and their location, size, distribution, and, possibly, number.If the occlusal forces produce unfavorable occlusal contacts and if the periodontal structures are susceptible, trauma from occlusion will occur. This can result in advanced bone loss and excessive mobility of the teeth.The occlusion is most favorable when the contacts are small and arranged symmetrically and when the forces are directed in a vertical direction, along the long axis of the tooth.     

后牙种植单冠修复后局部咬合变化的四年前瞻性临床研究

目的:定量分析后牙种植单冠修复后4年患者口内局部 力分布与咬合时间的变化规律,为种植修复体的咬合设计、调整和长期维护提供参考。 方法:前瞻性收集2012年12月至2013年12月于北京大学口腔医学院·口腔医院修复科行后牙种植单冠修复的患者,分别于修复后2周和3、6个月以及1、2、3、4年复查,采用...     

Occlusal principles and clinical applications for endosseous implants

Endosseous implant dentistry has become a predictable clinical modality. The role of the restorative dentist is to minimize overload to the crestal bone by utilizing implant occlusal principles. The prosthetic stages of treatment should follow a disciplined sequence. This article reviews occlusal principles and clinical applications for long-term success of endosseous implants.     

Occlusal contacts of edentulous patients with mandibular hybrid dentures opposing maxillary complete dentures.

The purpose of this study was to evaluate differences between the occlusal contacts of edentulous patients with mandibular implant-supported hybrid dentures opposing maxillary complete dentures and those of patients with conventional maxillary and mandibular complete dentures. Six parameters related to occlusion were measured in the 2 groups (n = 40 for each group) using pressure-sensitive film. The mean values generated by each test group for each parameter were compared using a t test. Pearson's correlation coefficients between occlusal force, age, and time in function were examined. Occlusal force and area in the implant denture wearers were larger than those in the conventional denture wearers. No significant difference was seen in occlusal force balance between the left and right sides. The center of occlusal load in the implant denture wearers was more anterior. The maxillary denture may become more unstable in implant denture wearers. It is suggested that the stability and retention of a maxillary denture be checked and the occlusion be adjusted more frequently in the hybrid denture wearer than in the conventional denture wearer.     

Influence of off-axis loading of an anterior maxillary implant: a 3-dimensional finite element analysis

PURPOSE: To evaluate the influence of the stress/strain distribution in bone around an anterior maxillary implant using 2 types of bone and under 3 different loads. MATERIALS AND METHODS: A premaxillary finite element model featuring an implant and its superstructure was created. Six different testing conditions incorporating 2 types of cancellous bone (high density and low density) under 3 different loading angles (0, 30, and 60 degrees) relative to the long axis of the implant were applied in order to investigate resultant stress/strain distribution. RESULTS: The maximum equivalent stress/strain increased linearly with the increase of loading angle. For each 30-degree increase in loading angle, the maximum equivalent stress in cortical bone increased, on average, 3 to 4 times compared with that of the applied axial load. In addition to loading angle, bone quality also influenced resultant stress distribution. For the low-density bone model, a substantial strain in the cancellous bone was found not only near the implant neck but also at the implant apex. CONCLUSION: To achieve a favorable prognosis under off-axis loading of an anterior maxillary implant, careful case selection for appropriate bone quality and precise occlusal adjustment should be attempted to optimally direct occlusal force toward the long axis of the implant.     

第一磨牙缺失不同修复方法的咬合接触特征研究

目的 针对单个第一磨牙缺失的病例,研究种植及可摘局部义齿（RPD）种不同修复方法所恢复的牙列咬合接触特征。方法 选择15名单个第一磨牙缺失的患者作为实验组,15名正常牙列人群作为对照组,其中,实验组每位患者同时进行种植及RPD修复,应用TeeTester咬合分析仪,测试对照组和实验组在未修复、RPD修复及种植义齿修复后3种状态下分别做正中咬合及咀嚼运动,分析其咬合接触特征(总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间,OT/DT比值),并进行统计学分析。结果 患者做正中咬合时,在总咬合力、总接触面积、不平衡指数方面,患者未修复时分别为（48.76±12.82）kg,（317.59±58.47）mm2,（24.78±7.40）,行RPD修复时分别为（54.36±10.59）kg,（355.81±77.43）mm2,（18.29±8.42）,行种植修复时分别为（61.94±12.36）kg,（398.17±83.86）mm2,（17.80±6.69）;患者咀嚼运动时在总咬合力、总接触面积、不平衡指数、单次咀嚼循环时间及T0/Td方面,患者行种植修复时分别为（52.14±16.53）kg,（348.08±81.76）mm2,（15.69±9.16）,（0.4072±0.10）s,（1.718±0.26）。统计学分析表明,RPD、种植义齿修复和对照组的部分咬合接触特征结果无显著性差异,但与未修复前结果有显著性差异。单次咀嚼循环时间及T0/Td在各组间均无显著性差异。结论 在恢复咬合力及咬合接触面积方面,种植义齿优于RPD,较接近天然牙列,并明显优于不修复。正中咬合时全牙列的总咬合力及总接触面积明显大于咀嚼运动时,但不平衡指数无明显统计学差异。     

A positive correlation between occlusal trauma and peri-implant bone loss: literature support

The relationship between occlusal overload and peri-implant bone loss remains a controversial topic in implant dentistry. A causal relationship between the incidence of marginal bone loss next to an implant and occlusal overload implies a treatment plan and occlusal scheme would benefit from a force management approach. A MEDLINE-assisted and hand search of peer-reviewed English literature and relative textbooks were used for a selective review of articles addressing biomechanical stress and bone loss in cellular biomechanics, engineering principles, mechanical properties of bone, animal studies, clinical reports, bone physiology, and implant design biomechanics. These papers demonstrate occlusal overload on implants may increase the incidence of marginal bone loss.