即刻负重在上颌前牙区牙种植修复中的应用

目的：探讨即刻负重存上颌前牙区种植义齿修复中的临床应用。方法：13例前牙缺失患者植入15枚Frialit-2阶梯螺旋状种植体,手术当日即以聚丙烯酸树脂冠完成修复,消除正中、前伸和侧方[牙合]早接触点并以[牙合]夹板固定,术后6个月完成全瓷冠修复体。结果：植入上颌前牙区的15枚种植体直径分别为4．5mm（8枚）、5．5mm（7枚）,长度为13mm（12枚）和15mm（3枚）,种植体植入时的转矩介于32Ncm和45Ncm。植入后6个月和12个月时种植体周围牙槽骨的吸收程度平均分别为0．35mm和0．55mm。植入后12个月未见种植体松动脱落,所有种植体均稳定地行使功能,除1例外,患者均获得满意的美观修复效果。结论：上颌前牙区种植体即刻负重修复可缩短种植修复疗程,及时恢复患者美观、发音、咀嚼等功能,有临床应用前景。     

上颌前牙即刻种植6例分析

目的分析探讨上颌前牙即刻种植手术的临床特点和疗效。方法回顾性分析2006年在我院接受上颌前牙即刻种植的患者6例,共种植14颗,追访术后6-60个月上颌前牙新种植体情况,分析比较临床特点和疗效。结果种植体的存留率达到100%;平均骨吸收量0.86mm,最大骨吸收量为1.35mm,最小骨吸收量为0.32mm;种植体的周探诊深度平均为2.5mm,最小值为1.9mm,最大值为3.2mm。结论上颌前牙即刻种植是一种比较有效可行的修复方式,值得临床推广。但本研究的样本量很小,随访时间比较短,上颌前牙即刻种植还需要进一步临床观察及研究。     

即刻种植技术在上颌前牙区的临床应用

目的：探讨即刻种植技术在上颌前牙区的临床应用,并对近期效果进行评价。方法：10例患者,13颗种植体,拔除患牙清创后同时植人BEGO种植体。所有永久修复均在术后6个月进行,定期复诊。观察种植修复体负重1年后的成功率,测量种植体周骨组织水平改变情况。结果：有1例1颗种植体于2周内因松动而拔除,其余病例临床效果良好。种植体累积留存率为91．67％,平均种植体周骨组织吸收为（0．80-0．44）mm,牙龈乳头指数达到Ⅲ级。结论：即刻种植在掌握适应证、处理好技术要点的情况下,可以取得良好的临床效果。     

前牙区人工即刻种植64例临床观察

目的：探讨口腔前牙区人工即刻种植的应用原则,初步评价其临床效果。方法：采Frialit-2种植系统植入前牙缺失区,共79枚,对其进行定期的临床和放射学检查。结果：79颗即刻种植前牙种植体,2枚种植体丢失,1枚弃用。结论：人工即刻种植的临床方法可行,近期临床效果满意,修复美学效果佳,值得推广。     

Frialit-2种植体拔牙后即刻种植的临床研究

目的探讨Frialit-2种植体在即刻种植中的应用及体会。方法对12例患者即刻种植15颗种植体，种植体周围间隙植入自体骨与骨粉的混合物并覆盖超薄钛膜，4-6月后义齿修复。结果全部种植体与骨结合良好，修复后龈缘外形较好，部分已行使功能8个月，复查X线片可见骨种植体结合，未见明显骨吸收。结论根型种植体可达到较好的初期稳定性及减少植骨量，为达到较好的美学效果，前牙区轻度骨量不足仍有必要植骨，多根牙的即刻种植应慎重。     

下颌牙列缺失种植即刻修复的临床评价

【目的】对下颌牙列缺失种植即刻螺丝固位修复进行临床观察研究。【方法】选择中山大学附属口腔医院种植科2001年1月至2006年5月期间。选择下颌无牙颌、下颌余留牙无法保留的患者共21例（男10例，女11例），平均年龄是51．1岁（范围为26，65岁）。每例植入4～8枚Nobelbiocare种植体，术后当天或第7天种植体支持式热凝树脂固定桥修复，12周～36周后金瓷同定桥修复。【结果】21例149枚种植体中，121枚种植体即刻修复，l枚种植体失败，即刻修复种植体3～67个月的累积成功率为99．2％。【结论】种植体初期稳定性达到35～45N·cm，下颌牙列缺失种植即刻修复可获得满意的中短期效果。     

36例前牙即刻种植即刻修复的临床观察

目的:探讨前牙即刻种植即刻修复的临床效果。方法:36例因外伤而致前牙根折、无骨缺损患者,总计41颗行即刻种植,均于术后2周左右在种植体上部完成临时冠,3个月后烤瓷冠永久修复。结果:36例种植体修复后,观察至少6个月,稳定性良好,未发生种植体脱落,牙龈形态、色泽正常,X-线片显示骨组织无异常吸收。结论:只要掌握好适应证和选择好特殊设计的种植系统,对前牙缺失患者进行即刻种植即刻修复,可以达到满意效果。     

ANKYLOS种植系统用于上前牙外伤后即刻种植的临床观察

目的评估ANKYLOS种植系统修复上颌前牙区外伤牙拔除后即刻种植的临床效果。方法临床选用21例上前牙外伤患者,在拔牙后即刻植入ANKYLOS种植体共36枚,3～6个月后永久修复,随访3～36个月,对其行临床及X线观察。结果植入的36枚种植体无松动脱落,均形成良好的骨结合,即刻种植成功率100％。结论ANKYLOS种植系统用于上前牙外伤后即刻种植效果良好。     

即刻种植和延期种植对上前牙美学修复效果影响

目的 比较上前牙美学区即刻种植和延期种植的临床效果,包括种植修复成功率、种植体周围软组织恢复情况和美学效果.方法 收集65例上领单颗前牙种植修复病例,按照随机原则分为两组,研究组行即刻种植后延期修复(30例),对照组行延期种植后延期修复(35例).两组在种植体愈合后3个月后行氧化锆全瓷冠修复.测量修复完成当天、修复12...     

兔上颌前牙即刻种植动物模型的构建及其骨结合观察

目的：构建新西兰兔上颌前牙即刻种植的实验动物模型,观察不同时间点的种植体骨结合特征。方法：准备16只新西兰兔,随机分为2周、4周、8周、12周组,每组4只。拔除兔的上颌前牙,在其新鲜拔牙窝内即刻植入纯钛实验种植体。术后分别在2周、4周、8周、12周采集含种植体的上颌骨标本,再通过大体观察、Micro?CT扫描、组织切片染色研究即刻种植后不同时间点的种植体骨结合特征。结果：①大体观察：各组实验兔的术后状态正常,食欲无明显异常,创口愈合良好,种植体均未松动脱落。②Micro?CT分析：随着种植体植入后愈合时间的延长,种植体螺纹处的骨质密度和厚度不断增加。③ 组织学检测：随着种植体植入后时间的延长,硬组织切片染色测算所得的种植体?骨接触率（bone?implant contact ratio,BIC）稳步增长,而脱钙颌骨切片染色显示种植体周围的骨质结构呈散在?岛状?条索状?板层状骨演化,提示骨结合形成良好。2周和4周组中存在大量的破骨细胞和炎症细胞,8周和12周组中则几乎未见这类细胞,但存在更多的红细胞和黄骨髓。结论：兔上颌前牙拔除后即刻植入种植体可构建即刻种植动物模型,为即刻种植后骨结合过程的观察以及钛种植体的动物体内研究提供新的选择和途径。     

Evaluation of success rates of immediate and delayed implants after tooth extraction

Objective To evaluate the success rates of immediate and delayed placement of implants with respect to the causes of tooth extraction and implant positions.Methods A total of 310 dental implants (immediate implants : delayed implants =76 :234) were inserted into 80 patients. The types, sizes and positions of the implants and the causes of tooth extraction were recorded. We then investigated the relationship of implant loss with the causes of tooth extraction and placement methods.Results A higher failure rate was found for the implants in the posterior region of the maxilla, and when periodontitis was cited as a reason for tooth extraction. The overall success rates were 93.4% and 95.7% in the immediate and delayed implant placement groups, respectively, after a 2-year follow-up. No obvious relationship of success rate was observed with the implant placement method,cause of tooth extaction, and implants‘ position.Conclusion The immediate placement of implants into fresh extraction sockets could offer advantages over the delayed implant placement. It seems to be a safe and predictable method forpatients.     

功能状态下即刻颌骨内植入种植体的实验研究

目的 探讨功能负荷状态下即刻颌骨内植入种植体的骨整合。方法 选择３种不同种植体采用即刻拔牙后植入５只犬的下颌两个前磨牙及第一磨牙的牙槽窝内,分别于术后２、４、８、１２、２４周取同标本,作Ｘ线、光镜、扫描电镜观察。结果 ３个月时所有种植体均已达到完善骨整合,成骨量和骨小梁排列方向与Ｈｅ力负荷方向一致。结论 功能负荷即刻植入种植体有利于缩短疗程,节省费用,提高种植成功率。     

前牙即刻种植和常规种植修复2年后软、硬组织稳定性比较

目的：比较前牙区即刻种植和常规种植两组病例在修复2年后其软、硬组织稳定性的差异。方法：选择2010 年10月至2011 年12月来北京大学口腔医院第二门诊部就诊的拟在前牙区1～2颗不相邻的牙位进行种植治疗的健康患者38名,共植入43颗种植体。在行种植上部修复前均采用种植体支持的临时冠进行牙龈形态的诱导,直至永久修复完成。在修复即刻及2年后测量近远中牙龈乳头、唇侧龈缘水平高度以及种植体近远中侧骨水平的变化。结果：前牙即刻种植组完成16例,植入种植体17颗;常规种植组完成22例,植入种植体26颗。两组病例在永久修复前种植体稳定性系数值（implant stability quotient,ISQ）差异无统计学意义（P>0.05）。即刻种植组和常规种植组在修复2年后近中龈乳头高度平均增高分别为（0.15±0.42）mm和（0.06±0.65）mm,远中龈乳头高度平均增高分别为（0.06±0.50）mm和（0.02±0.57）mm;唇侧龈缘水平平均丧失分别为（0.15±0.23）mm和（0.15±0.46）mm;种植体骨吸收量在近中侧分别为（0.67±0.35）mm和（0.69±0.49）mm,远中侧分别为（0.73±0.31）mm和（0.75±0.48）mm;两组间差异均无统计学意义（P>0.05）。结论：两组病例在修复后2年内都显示出良好的效果,其软、硬组织均很稳定,提示这两种方法都可以获得可靠的修复效果。在严格掌握适应征的前提下,前牙区的即刻种植与常规种植在修复后的近期效果相当,但即刻种植在缩短疗程方面显然要优于常规种植。     

不同加载时机对种植体稳定性的影响

目的 探讨不同加载时机对种植体稳定性的影响.方法 将40颗种植体植入2只实验犬的双侧上、下颌骨,每只20颗.分为五组,对照组负载力值为0g,其他四组于即刻、术后2周、4周、6周加载力值200 g.测量种植体的位移情况,观察并分析种植体-骨组织界面的组织形态学变化情况.结果 40枚种植体有1枚出现Ⅰ °松动,其余39枚稳固无松动.随着加载时间的延长,种植体的平均位移逐渐缩短.不同加载时机各组的骨沉积率与对照组差异无统计学意义,不同加载时机各组的骨结合率差异无统计学意义.结论 不同加载时机会对种植体的位移距离产生一定的影响,对骨沉积率和骨结合率无明显影响,对种植体的稳定性无明显影响.     

Clinical evaluation of Xive implants 3-year after placement

Objective: The main purpose of this retrospective study is to evaluate clinical outcomes of Xive implants 3-year after insertion. Methods: 219 Xive implants were placed in 139 patients and their clinical effects were evaluated using the Albrektsson Standard. Results:The 3- year survival rate of the Xive implants is 97.26%(213/219). Eleven cases of immediate implants and 15 cases of implant insertion after maxillary sinus lifting all succeeded. The failure ratio is 6/219(2.74%) with failures resulting from excess bone loss in the implant region, peri-implant mucosal inflammation or continuous pain caused by some unknown reasons. Conclusion: Xive implants are clinically effective for the restoration of missing teeth. Immediate implant and implant following maxillary sinus lifting were also successful.     

口腔正畸微种植体的实验研究

目的：研究微种植体在即刻的正畸力影响下的支抗能力和组织学特征。方法：16枚钛合金微种植体，放置于狗上下颌颊侧根间区，愈合在开放的环境下，立即承担约200g左右的持续的水平力。9wk后，测量相互受力的微种植体的稳定性，种植体周边袋及组织学检查。结果：绝大部分种植体稳定性良好，能承担即刻的矫治力。有1枚微种植体松动，周围X线阴影等种植失败症状。上下颌骨种植体均有轻度的移位现象，上颌种植体移位多于下颌种楚体。突出，倾斜可见于上下颌前面的微种植体。组织学分析显示成功的种植体与骨组织形成良好的骨性结合，中间没有纤维结缔组织干扰。松动的种植体被植入到牙根中，周围有炎性细胞，纤维结缔组织，无骨组织可见。结论：微种植体是一种非常可靠的正畸支抗源，与骨组织有良好的生物相容性，并可即刻施力。     

微种植体支抗即刻和早期加载的电镜观察

目的研究不同加载时间及加载力值对微钛螺纹钉种植体-骨结合界面的影响。方法选取5只Beagle犬建立实验动物模型,分别在左、右两侧上颌牙槽骨内植入微钛螺纹钉种植体各9枚。采用恒定力值为100 g及300 g的镍钛螺旋拉簧,分别在即刻、第2、4、8周对两侧种植体加载,对照组不加力。于第20周处死动物,取含微钛螺纹钉及其周围2 mm组织块,采用扫描电镜观察骨结合的状态。结果分别对不同加载力值及加载时间各组的扫描电镜图片进行对比观察,各组种植体-骨结合界面在形态学上均无显著性差异,均表现为：种植体与周围骨质结合良好,表面有大量骨质覆盖。种植体与其周围骨质间存在微小间隙,间隙均小于0.85 mm。结论微钛螺纹钉种植体即刻加载300 g以内的水平力不影响支抗种植体的稳定性。     

A comparative analysis of periimplant bone levels of immediate and conventionally loaded implants

Background

With the trend of shortening the treatment time and reducing patient discomfort/inconveniences immediate loading of implants has emerged as an alternative approach for replacing missing natural teeth. The aim of this study is to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol in partially edentulous mandible.

Methods

Twenty patients were selected from out patients department who needed the replacement of one of the missing mandibular first molar. They were divided into two groups. In Group A patients implants were loaded with immediate implant loading protocol, whereas in Group B they were loaded with conventional loading protocol. Periimplant bone loss and soft tissue health were measured and compared using OPG and IOPA radiographs 06 and 12 months after implant placement.

Results

One implant failed in immediate loading group (Group A), whereas all implants survived in conventional loading group (Group B). The average periimplant bone loss after 6 months and 1 year for Group A were 0.69 mm and 1.09 mm respectively, whereas it was 0.74 mm and 1.13 mm respectively for Group B. The difference in the bone loss between Group A and B was not statistically significant.

Conclusion

Immediate implant loading protocol has a highly acceptable clinical success rate in partially edentulous lower jaw although implant survival rate is slightly inferior to conventional loading protocol.     

A comparative analysis of periimplant bone levels of immediate and conventionally loaded implants

Background

With the trend of shortening the treatment time and reducing patient discomfort/inconveniences immediate loading of implants has emerged as an alternative approach for replacing missing natural teeth. The aim of this study is to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol in partially edentulous mandible.

Methods

Twenty patients were selected from out patients department who needed the replacement of one of the missing mandibular first molar. They were divided into two groups. In Group A patients implants were loaded with immediate implant loading protocol, whereas in Group B they were loaded with conventional loading protocol. Periimplant bone loss and soft tissue health were measured and compared using OPG and IOPA radiographs 06 and 12 months after implant placement.

Results

One implant failed in immediate loading group (Group A), whereas all implants survived in conventional loading group (Group B). The average periimplant bone loss after 6 months and 1 year for Group A were 0.69 mm and 1.09 mm respectively, whereas it was 0.74 mm and 1.13 mm respectively for Group B. The difference in the bone loss between Group A and B was not statistically significant.

Conclusion

Immediate implant loading protocol has a highly acceptable clinical success rate in partially edentulous lower jaw although implant survival rate is slightly inferior to conventional loading protocol.