后牙种植修复体咀嚼效能的初步比较研究

目的:将后牙常规义齿与种植义齿的修复效果进行定量比较。方法:选择单侧后牙缺失4颗以下,无其他口腔疾病者无口腔修复史者90例,牙位等同,分为活动组,固定组,种植组各30例。正常牙列对照组30例。用改良吸光度法测量并比较单侧后牙缺失患者行活动义齿,固定义齿及种植义齿修复前后的咀嚼效能。结果:活动修复后咀嚼效能与正常牙列人群咀嚼效能之间有显著性差别(P<0.05);固定修复后,种植修复后与正常牙列咀嚼效能无显著差别(P>0.05)。结论:活动义齿、固定义齿、种植义齿修复均能有效提高后牙缺失患者的咀嚼效能,但活动义齿效果最差。固定义齿和种植义齿修复均能使后牙缺失患者的咀嚼效能提高至与正牙列人群相似。     

固定义齿与正畸联合治疗伴错畸形的牙列缺损

临床上常见伴发错畸形的牙列缺损病例,用常规的修复方法,虽然能够修复缺失牙余留的间隙,但很难达到美观、功能、稳定兼顾的效果。作者对12例伴发错畸形的牙列缺损患者,采用正畸与固定修复联合治疗的方法,先正畸矫治错畸形,调整咬合关系,调整余留牙与缺失牙在牙弓中的位置,以获得固定修复的适应症,然后对牙列缺损进行固定修复,取得了良好的治疗效果。资料与方法1.研究对象选择常规就诊的12例伴错畸形的牙列缺损的成年患者。适应症:无牙周病或轻度牙周病变可控制的患者,出现下列情况之一时,即为适应证图2正畸修复后1。①牙列不齐、中…     

牙列缺损伴重度(牙合)面磨损(牙合)重建修复的临床研究

目的 通过对不同类型牙列缺损并伴重度(牙合)面磨损的患者进行修复治疗,探讨(牙合)重建的有关问题.方法 选取牙列缺损并伴重度(牙合)面磨损患者69例,制取修复前研究模型,根据不同的缺损类型进行(牙合)垫式可摘局部义齿、固定义齿或固定-可摘义齿联合修复,随访3个月～4年,观察修复治疗效果.结果 患者的咀嚼功能明显改善,有颞下颌关节症状者,症状得到了缓解,无颞下颌关节症状者在咬合升高后未出现新的颞下颌关节症状.结论 对于牙列缺损伴重度(牙合)面磨损患者,(牙合)垫式可摘义齿及固定义齿修复均是(牙合)重建修复的有效方法.     

牙列重度磨损咬合重建修复治疗方法的探讨

目的 探讨牙列重度磨耗患者行固定义齿咬合重建修复的可行性.方法 结合1例牙列重度磨耗患者,咬合垫佩戴3个月后,制作过渡性修复体,口内观察1年,然后行上下颌固定义齿最终修复,经过这一序列诊疗过程完成咬合重建.结果 患者使用最终修复体2年,美观满意,咀嚼效率良好,无咀嚼系统肌肉及颞下颌关节不适症状.结论 牙列重度磨耗的固定义齿咬合重建修复是一个复杂的序列治疗过程,治疗效果是满意的.     

Kennedy Ⅰ、Ⅱ类牙列缺损2种固定修复方法的效果比较

目的:探讨Kennedy Ⅰ、Ⅱ类牙列缺损采用种植体单独支持或与天然牙联合支持式烤瓷冠桥固定修复的可行性及临床效果,并与传统单端固定义齿进行比较.方法:60例Kennedy Ⅰ、Ⅱ类牙列缺损患者,随机分为A、B 2组,A组采用种植体单独支持或与天然牙(包括经治残冠、残根桩核修复)联合支持式烤瓷固定冠桥修复.B组采用天然牙单独支持式烤瓷单端固定冠桥修复.采用SPSS17.0软件包对结果进行X2检验.结果:经5年随访,A组30例,成功30例;B组30例,成功26例,失败4例.2组成功率有显著差异(P<0.05).结论:KennedyⅠ、Ⅱ类牙列缺损采用种植体单独支持或与天然牙联合支持式烤瓷冠桥固定修复,疗效肯定.     

修复治疗中松动牙的保留

牙周病患者伴有缺失牙时,固定后用作基牙的松动牙和对松动牙列患者进行的各种固定形式是不同的。本文介绍了松动牙作基牙修复前的处置方法和各种修复设计,提出了修复后应注意的问题。这种通过固定和可摘修复方式来达到松动牙的动态固定,是牙周病患者用松动牙作基牙时固定松牙和修复缺失牙相结合的形式。     

固定义齿与正畸联合治疗伴错(牙合)畸形的牙列缺损

临床上常见伴发错[牙合]畸形的牙列缺损病例，用常规的修复方法，虽然能够修复缺失牙余留的间隙，但很难达到美观、功能、稳定兼顾的效果。作者对12例伴发错[牙合]畸形的牙列缺损患者，采用正畸与固定修复联合治疗的方法，先正畸矫治错[牙合]畸形，调整咬合关系，调整余留牙与缺失牙在牙弓中的位置，以获得固定修复的适应症，然后对牙列缺损进行固定修复，取得了良好的治疗效果。     

圆锥型套筒冠义齿修复重度牙周病伴牙列缺损的咀嚼效能分析

目的 :探讨圆锥型套筒冠义齿修复重度牙周病伴牙列缺损患者咀嚼效能的变化规律。方法 :采用吸光度法对 10例牙列缺损患者修复前、修复后 1个月、3个月、6个月分别进行咀嚼效能的定量分析。结果 :重度牙周病伴牙列缺损患者咀嚼效能随义齿使用时间的延长逐渐提高 ,修复后 6个月的咀嚼效能接近正常牙列者的咀嚼效能。结论 :圆锥型套筒冠义齿具有可摘义齿和固定义齿的优点 ,又具有牙周夹板固定的作用 ;并能提高患者口腔的咀嚼效能 ,是修复重度牙周病伴牙列缺损较理想的修复体。     

上海市老年人义齿修复状况抽样调查及影响因素分析

目的:评估上海市老年人的义齿修复情况及其影响因素,为政府有关部门制定相关政策提供依据.方法:采厍多阶段分层等容量随机抽样方法,调查上海市788名6574岁老年人的口腔及义齿修复情况,对其中325人的社会经济信息和生活健康信息进行问卷调查.应用Logistic回归模型分析影响缺牙老人是否进行义齿修复的相关因素.结果:该样本组缺牙患者义齿修复率仅为61.37%,牙列缺损患者义齿修复率显著低于牙列缺失患者(P<0.01).固定义齿、活动义齿、固定+活动义齿、全口义齿和非正规固定桥分别为21.94%、41.58%、5.87%、20.92%和9.69%.郊区老人全口义齿、固定义齿及非正规固定桥的比例显著高于城区(P<0.01).Logistic回归分析显示,缺牙位置、性别和缺牙数量是影响缺牙老人是否进行义齿修复的主要因素.结论:上海老年人缺牙患者义齿修复率普遍较低,提示政府有关部门应采取积极措施,强化居民口腔保健意识,提高老年患者义齿修复的及时性和有效性.     

老年人牙列重度磨耗的固定义齿咬合重建修复

目的：探讨老年人牙列重度磨耗的固定义齿咬合重建修复的可行性，总结临床经验。方法：回顾性研究7例老年人牙列重度磨耗的固定义齿咬合重建患者临床资料，分析临床表现、诊疗特点，总结诊疗过程中注意事项。由一个典型病例介绍诊疗过程。结果：老年人牙列重度磨耗临床表现、并发症多样，[牙合]垫式活动义齿暂时性修复3个月后，单颌或双颌固定义齿咬合重建，修复12个整牙列，随访2～4年，患者满意度高，未出现再度磨耗，颞下颌关节稳定。结论：老年人牙列重度磨耗的固定义齿咬合重建修复可行，诊疗过程较长，中短期疗效肯定。     

Full-arch restoration of the jaw with fixed ceramo-metal prosthesis: late implant placement

BACKGROUND: The completely edentulous patient has few treatment options in conventional dentistry. When implants are considered, treatment plans range from a 2-implant overdenture to a completely implant-supported prosthesis. Fixed prosthesis is often the preferred selection of the edentulous patient. This study assesses the 5-year cumulative survival rate of implants placed to support full-arch fixed restoration. METHODS: During 1990 to 1995, 171 implants were placed in 22 completely edentulous jaws of 20 patients. All patients were discharged wearing immediate dentures. The implants were analyzed as to the number of implants per jaw, implant location, length, and diameter. RESULTS: The 5-year cumulative survival rate was 89.9%. The mean number of implants per jaw was 7.7 for the maxilla and 8 for the mandible. In the maxilla, the preferred implant locations were the canines, centrals, laterals, and first premolars; in the mandible, they were the canines, laterals, and first molars. The mean implant length was 14.2 mm for the mandible and 13.2 mm for the maxilla. The mean implant diameter was 3.6 mm for the maxilla and 3.8 for the mandible. CONCLUSIONS: The results of the present study indicate that fixed full-arch ceramo-metal restorations can be a predictable implant treatment modality for the edentulous patient.     

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口腔种植40余年前从下无牙颌的种植修复起步,迄今已获得令人满意的临床效果。经过几十年的发展,无牙颌种植修复的理念、方式、材料均发生了很大变化。包括无牙颌种植即刻修复的尝试和临床应用、无牙颌上部结构的发展变化、计算机技术在无牙颌种植修复中的应用等。本文旨在对无牙颌种植修复上部结构的变迁和技术进步进行述评,以期对无牙颌种植修复的临床工作有一定的启示。     

Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study

PURPOSE: The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants. MATERIALS AND METHODS: At 4 study centers, 342 Osseotite NT implants were consecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae). The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titanium framework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The final prosthesis was delivered after 3 months of healing. RESULTS: Three implants failed during the first year and another 2 within 18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to 40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%. Marginal bone loss around upright and tilted implants was similar. Patients were satisfied of their esthetics, phonetics, and function. CONCLUSION: The preliminary results of this study suggest that immediate rehabilitation of the edentulous maxilla and mandible by a hybrid prosthesis supported by 6 or 4 implants, respectively, may represent a viable treatment alternative with respect to more demanding surgical procedures. The clinical results indicate that immediately loaded tilted implants may achieve the same outcome as upright implants in both jaws.     

Immediate occlusal loading of Osseotite implants in the lower edentulous jaw. A multicenter prospective study

OBJECTIVE: This paper reports the results of a prospective multicenter clinical study on immediately fully occlusally loaded full-arch screw-retained prostheses with distal extensions (hybrid prostheses) supported by Osseotite implants inserted in edentulous lower jaws. METHOD AND MATERIAL: Sixty-two patients were enrolled in four clinical centers. Three hundred and twenty-five Osseotite implants were inserted and occlusally loaded according to an immediate loading protocol. The temporary prosthesis was delivered 4 h from surgery. The final prosthesis was delivered after 6 months. Marginal bone loss was monitored from periapical radiographs using a computerized technique. RESULTS: Two implants failed to integrate within 2 months of occlusal loading. A cumulative implant success rate of 99.4% was achieved for a period of 12-60 months postplacement (mean 28.6+/-14.1 (SD) months). Crestal bone loss around the immediately loaded implants was similar to that reported for standard delayed loading protocols. CONCLUSION: The results of this study suggest that the rehabilitation of the edentulous mandible by an immediate occlusally loaded hybrid prosthesis supported by five to six Osseotite implants represents a viable alternative treatment to classic delayed loading protocols.     

金沉积技术在种植固定修复中的临床应用效果观察

目的:探讨金沉积技术在种植固定修复中的临床应用效果。方法:7例牙列缺失与牙列缺损的患者(男性3例,女性4例,年龄22-58岁),共9个修复体,其中单冠6个,无牙颌固定桥3个,植入种植体34个。观察方法为临床检查及x线检查。修复后平均追踪27个月(14-37个月)。结果:所有病例在修复后至最后一次复查未见种植体脱落。所有修复体无折断、松动或破损,修复效果良好,患者满意。一例行金沉积烤瓷单冠修复患者的一个烤瓷单冠在紧固横向螺钉时发生瓷面裂纹,经再次烧结后固定。结论:本研究结果提示金沉积技术用于制作种植体支持的修复体具有良好的生物相容性,美学效果好,同时还可以通过金沉积冠作为固位体解决种植修复体多个固位体之间的被动就位问题,近期临床效果满意。     

A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up

BackgroundImmediate-function implants have become an accepted alternative for fixed restoration protocols in edentulous mandibles on the basis of documented high success rates. The All-on-4 concept (Nobel Biocare, Göteborg, Sweden), a surgical and prosthetic protocol for immediate function involving the use of four implants to support a fixed prosthesis in patients with completely edentulous mandibles, represents one of these protocols. The authors conducted a study to document long-term follow-up of the All-on-4 concept.MethodsThis longitudinal study included 245 patients with a total of 980 immediate-function implants (four per patient), all placed in the anterior region, to support fixed full-arch mandibular prostheses. The inclusion criterion was having an edentulous mandible, or a mandible with hopeless teeth, in need of fixed implant restorations.ResultsA total of 21 implants failed in 13 patients, giving cumulative patient-related and implant-related success rates of 94.8 percent and 98.1 percent, respectively, at five years, and 93.8 percent and 94.8 percent, respectively, with up to 10 years of follow-up. The prostheses’ survival rate was 99.2 percent with up to 10 years of follow up.ConclusionsThe results support the conclusion that use of the All-on-4 immediate-function implant concept in completely edentulous mandibles is viable in the long term.Clinical ImplicationsHigh prosthesis survival rates can be achieved by the use of four implants to support a full-arch fixed prosthesis in the mandible.     

All-on-Four临床应用及研究进展

为寻求简便有效的无牙颌修复方法,Maló等人于2003年提出All-on-Four种植即刻修复概念,通过植入4颗种植体支持整个无牙颌修复重建,并于术后行即刻修复.All-on-Four种植即刻修复具有避免额外植骨手术、避开重要解剖结构及缩短缺牙时间等优势,近年在临床上得到广泛应用.随着外科引导技术及生物力学研究的发展,All-on-Four种植即刻修复获得了理想临床效果,已成为无牙颌患者种植固定修复的一种可行且可靠方案.笔者就All-on-Four概念发展、生物力学研究、外科和修复要点以及临床应用效果作一阐述.     

Immediate loading with fixed full-arch prostheses in the maxilla: Review of the literature

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full-arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extraction implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic procedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the conclusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures. Key words:Immediate loading, full-arch, dental implants, loading protocols.     

Immediate loading of implants in the edentulous maxilla

The overall aim of this thesis was to investigate different therapeutic strategies in treatment of the edentulous maxilla with dental implants and their importance for treatment outcome. The introduction of one-stage surgery, in place of two-stage surgery, was a paradigm shift in the area of implant treatment since submerged implant healing underneath the mucosa was considered a prerequisite for healing in the original concept. The advantages of a one-stage method are that a second surgery is unnecessary, costs are lower, and patients complain less about the surgical procedures. The development of implant treatment, regardless of whether it is performed in the mandible or the maxilla, strives to shorten the period from implant placement to implant loading. For the edentulous patient--due to esthetic, economical, or psychological reasons--shortening this time and thus avoiding a long period of wearing a transitional removable prosthesis is advantageous. Use of conventional one-stage surgery makes possible and is a prerequisite for immediate loading of implants. Successful treatment outcome has been demonstrated for immediate loading of implants in the mandible, but documentation of the method in the maxilla is still sparse. Two prospective clinical studies compared (i) one- and two-stage surgery and (ii) immediate and conventional loading in patients consecutively treated in the edentulous maxilla with implant-supported fixed prostheses. The first study found that the cumulative survival rate (CSR) after one-stage surgery performed according to a conventional protocol was consistent with two-stage protocol CSRs reported in previous studies. The second study evaluated an immediate loading protocol that provided patients with interim fixed prostheses within 24 hours after implant placement. A comparison of the studies found no significant difference in CSRs. But it was found that when a conventional protocol was used, transitional removable prostheses could traumatize the bone-implant interface during healing by adverse loading on the implants, which pierced the mucosa. Moreover, splinting the implants immediately after surgery with an interim fixed prosthesis might protect them from adverse loading. In a finite element analysis comparing uncoupled and splinted implants--imitations of the clinical situations in the two studies--splinted implants drastically reduced stresses in the bone tissue surrounding the implant, which might facilitate bone healing. Two factors considered important for a successful treatment outcome, especially when loading implants immediately, are (i) jawbone quality and (ii) primary implant stability at placement. In implant literature, bone quality is generally equivalent to bone density. Results of the third clinical study in this thesis indicate that use of computed tomography with calculations of bone mineral density can be a useful tool in bone tissue evaluation before implant placement. After 1 year of loading, changes in marginal bone level, compared to baseline, did not differ between implants that were stable and implants that were not stable at placement. The results of this thesis do not strengthen earlier recommendations that immediate and early loading is a treatment alternative that can be considered only in jaws with good bone quality. In conclusion, immediate loading with interim fixed prostheses in the edentulous maxilla is a viable treatment alternative. Splinting of implants seems to be important in immediate loading, especially when bone density is low.     

临时种植体即刻负载在半颌即刻种植中的应用

目的：评价临时种植体即刻负载在半颌即刻种植中的应用效果。方法：20例半颌即刻种植患者行136枚即刻种植体植入,采用95枚临时种植体即刻负载恢复患者牙列。3-6月后行固定修复。结果：即刻负载临时种植体和即刻种植体成功率达100%。结论：临时种植体即刻负载半颌即刻种植是很好的临床方法。