牙种植修复中的咬合重建、数字化技术、无牙颌种植修复方法——“争鸣与共识”种植论坛(第二季)学术共识

随着牙种植技术的发展与进步,以修复为导向的牙种植治疗已经成为广泛共识,新技术的应用也为精准治疗提供了可行性。然而,在一些难点问题上,仍然存在争议和困惑,特别是咬合重建问题、数字化技术的应用以及无牙颌的种植修复设计。本文就"争鸣与共识"种植论坛(第二季)的讨论结果,针对上述三大疑难问题达成共识,以期更好促进口腔种植技术的临床规范化应用。     

唑来膦酸系统治疗对骨质疏松时人工骨植骨愈合及种植体骨结合的影响

目的：研究唑来膦酸系统治疗对骨质疏松时人工骨植骨愈合及其内种植体骨结合的影响。方法：30只雌性SD大鼠随机分成3组：假手术组（A）、骨质疏松组（B）和唑来膦酸治疗组（C）。A组接受假手术,B、C组行双侧卵巢切除术。术后12周在大鼠右侧胫骨近中干骺端植入羟基磷灰石涂层种植体,并于种植体旁制备骨缺损,行Bio-oss骨粉同期植入术;C组给予唑来磷酸钠0.2mg/kg/3周肌注,A、B组注射生理盐水。种植术后第4周、12周分2批处死动物,标本制作不脱钙切片检测。结果：种植术后4周时,B组皮质骨厚度（TCB）、种植体骨结合率（IBCR）、新生骨量（NBV）、Bio-oss骨粉包被率（ERBP）均显著低于A组和C组（P〈0.01）;而C组除TCB外,其它参数则均显著高于A组（P〈0.01）。12周时,B组各项参数均显著低于A组和C组（P〈0.01）,C组除TCB略低于A组外（P〈0.05）,其它参数与A组相似（P〉0.05）。结论：实验性骨质疏松可延迟人工骨植骨愈合,降低种植体骨结合率;唑来膦酸系统应用则可拮抗骨质疏松的负面影响,促进植骨愈合,使种植体骨结合率增加。     

Efficacy of GentleWave System and Passive Ultrasonic Irrigation with Minimally Invasive and Conventional Instrumentation Technique against Enterococcus faecalis Lipoteichoic Acid in Infected Root Canals

IntroductionThis study evaluated the effectiveness of the GentleWave System (GWS; Sonendo, Laguna Hills, CA) and passive ultrasonic irrigation (PUI) in removing Enterococcus faecalis lipoteichoic acid (LTA) from infected root canals with a minimally invasive technique (MIT) and the conventional instrumentation technique (CIT).MethodsSixty extracted human maxillary first premolars were included. All teeth were dentin pretreated and inoculated with LTA prepared from E. faecalis. First, 12 teeth were cryogenically ground to investigate the viability of recovering intraradicular E. faecalis LTA. Afterward, 48 teeth were randomly divided into the following groups: GWS + MIT, GWS + CIT, PUI + MIT, and GWS + CIT (all n = 12). Teeth were instrumented with a Vortex Blue (Dentsply Sirona, Ballaigues, Switzerland) rotary file size 15/.04 for MIT and 35/.04 for CIT. Samples were collected before and after a root canal procedure with sterile/apyrogenic paper points and after cryogenically ground for intraradicular LTA analysis. LTA was quantified with an LTA enzyme-linked immunosorbent assay kit.ResultsE. faecalis LTA was recovered from 100% of the samples (48/48) before the root canal procedure. GWS + MIT and GWS + CIT were the most effective protocols against E. faecalis LTA, with no difference between them (P > .05). PUI + CIT was more effective than PUI + MIT (P < .05) but less effective than GWS + MIT and GWS + CIT (P < .05). The GWS groups showed more root canals with undetected E. faecalis LTA after treatment than all groups tested.ConclusionsGWS + MIT and GWS + CIT were the most effective protocols against E. faecalis LTA in infected root canals.     

Dental disease before radiotherapy in patients with head and neck cancer: Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients

Background

No evidence-based guidelines exist for preventive dental care before radiation therapy (RT) in patients with head and neck cancer (HNC). An ongoing multicenter, prospective cohort study, Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad), is addressing this knowledge gap. The authors evaluated the level of dental disease before RT in the OraRad cohort, factors associated with dental disease, and dental treatment recommendations made before RT.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each.

Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+?rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day?+?brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography.

Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p?p?Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.