可摘局部义齿结合复合树脂贴面对老年牙列缺损患者进行咬合重建修复的临床研究

目的观察应用可摘局部义齿进行咬合重建并结合复合树脂贴面恢复老年患者牙列缺损的临床效果,并探讨其临床操作特点及适应证。方法选择2002年3月-2003年5月肯氏1类牙列缺损的门诊患者16例,采用可摘局部义齿（RPD）修复并恢复垂直距离,进行咬合重建修复,在此基础上采用光固化复合树脂进行前牙区贴面修复,以恢复前牙区美观、高度并重建切导,部分病例同时应用复合树脂进行了松牙固定。于修复完成后3个月、2年、4年进行随访,树脂修复采用USPHS标准进行评价,RPD则通过问卷调查结合临床检查进行评价。结果临床观察4年,复合树脂修复效果可靠,易于修理调改,调简单方便,并能最大限度保存牙体组织;修复体经济、美观,4年树脂贴面的保存率为85.7%,基本能够满足临床的美观及功能要求;与可摘局部义齿配合使用,克服了后者外观欠佳的缺点。结论应用复合树脂结合可摘局部义齿进行咬合重建具有创伤小、经济、美观、有利于牙体组织保存的优点,易被老年牙列缺损患者所接受,值得进行进一步临床研究。     

悬锁卡环义齿的临床应用效果观察

目的观察悬锁卡环局部可摘义齿的临床应用效果。方法对2004年1月～2011年6月为14例双侧后牙缺失患者制作的悬锁卡环义齿进行随访观察1～7年,评价其临床效果。结果义齿有效修复13件,占总数的92.9%;无效修复1件,占总数的7.1%。结论悬锁卡环义齿对双侧后牙缺失有良好的修复效果,可以较好地改善咀嚼功能。     

隐形义齿修复前牙缺失的疗效观察

观察隐形义齿用于前牙缺失的修复效果。对 116例用于隐形义齿修复前牙缺失的患者进行两年以上随访 ,观察其临床效果。 116例患者中计 10件义齿因各种原因返工 8件 ,失败 2件 ,各占 6.8%和 1.7%。用隐形义齿修复前牙缺失 ,美观效果好 ,主观感觉舒适 ,疗效优于常规活动义齿。1　资料与方法1.1　病例选择　前牙缺失修复但又不愿意磨牙 ,不愿意暴露金属 ,咬合关系正常 ,缺隙大小合适 ,基牙周组织健康 ,牙齿松动在Ⅱ°以内。本文共 116例 ,男 66例 ,女 5 0例 ,平均年龄 41岁。1.2　材料和设备　采用美国独资长沙噢伦高科技有限公司经销的弹性塑料…     

用铸造支架式设计制作局部义齿修复治疗老年牙缺损

目的 总结针对老年复杂牙列缺损,采用铸造支架可摘局部义齿的设计制作经验和体会,为临床局部义齿的修复治疗作借鉴.方法 对1998年以来门诊病案中老年复杂牙列缺损542例的义齿修复治疗病例,按照缺牙类型、部位施行铸造支架式设计进行分析总结.结果 542例的义齿修复治疗病例,按照缺牙类型、部位,采用铸造义齿支架个别设计修复义齿,分别设计了后牙低间隙缺牙铸造金属围墙强化义齿,牙齿重度磨耗设计金属(牙合)垫、金属塑料混合垫义齿,牙周病伴随缺牙设计铸造牙列式夹板义齿,食物嵌塞设计防嵌器.其中36例进行两年随访,31例义齿使用正常,4例卡环折断,经重新设计修复体铸造支架获得满意效果,患者戴用义齿情况良好,能很快适应,复诊率低,义齿的强度也有不同程度的提高.采用义齿个别设计铸造支架式可摘局部义齿修复各类缺牙,可较好地解决牙列重度磨耗、食物嵌塞、牙周疾患等问题.结论 针对老年牙列缺损伴有垂直距离过低、重度磨耗、食物嵌塞以及牙周病患者,采用铸造围墙式义齿、(牙合)垫式义齿、防嵌器和铸造牙列式夹板义齿可以取得良好的临床效果.     

可摘局部义齿修复后电话随访对复诊率的影响

目的：探讨电话随访对可摘局部义齿患者复诊率及满意度的影响。方法选取可摘局部义齿修复患者100例,随机分为观察组和对照组,每组50例。两组修复后均进行常规健康宣教,观察组加施电话随访,3个月后复诊并统计复诊率,采用VAS量表由患者对义齿满意度进行评价,评价方面主要包括佩戴后的义齿满意度、舒适度、美观性、咀嚼能力、发音情况及护理服务满意度。结果观察组复诊率24.0%,显著低于对照组50.0%（P<0.05）;观察组患者佩戴义齿的满意度、舒适度及对护理工作的满意度显著高于对照组（P<0.05）,而在美观性、咀嚼能力及发音情况等项目的对比中,观察组患者情况得到一定改善,但结果无统计学差异。结论电话随访能够降低可摘局部义齿患者复诊率,提高患者满意度。     

3精密附着体修复多个磨牙游离端缺失60例

游离端可摘局部义齿常使患者感到不舒适，且戴牙数年后基牙松动拔除需更换新义齿。随着生活水平的提高，患者越来越不满足于用可摘局部义齿来恢复功能，而是期望在美观和舒适程度上能达到更高要求。近些年来，应用精密附着体修复游离端缺失牙，可在很大程度上满足患者的美观要求及咀嚼功能。笔者于2009-01至2012-01应用精密附着体治疗磨牙游离端缺失患者60例，效果良好。     

胶托可摘局部义齿折裂原因分析及预防措施探讨

在牙列缺损患者的修复治疗中，可摘局部义齿在目前仍然是主要方法之一。胶托可摘局部义齿因价格便宜、制作简单快捷仍在基层广泛应用，但患者戴用后发生折裂的现象时有发生。我们收集2000年1月2006年12月发生折裂后来我科修理的胶托可摘局部义齿共257件，对其折裂原因进行初步分析，并探讨预防措施。现结果如下。     

隐形义齿失败原因观察

我院开展隐形义齿三年，做了456例，隐形义齿基托材料有弹性且透亮，色泽和牙龈相近，不需要金属卡环，美观舒适，制作简单，是口腔修复一种新技术，已广泛应用，但制作中有注压不全，人工牙、颌支托义齿变形等问题。主要是注压不全。     

应用铸造牙合垫局部义齿治疗老年缺失牙与伴发症的修复探讨

目的：探讨应用铸造牙牙合垫局部义齿对老年缺失牙伴重度磨耗的修复。方法：对1994-01~2008-08期间老年重度磨耗伴缺失牙患者,采用铸造牙牙合垫铸造支架局部义齿修复65例。结果：铸造牙牙合垫局部义齿对老年人重度磨耗和牙本质过敏起到治疗意义,对松动牙的固定,对基牙的保护以及垂直距离的控制均起到较好效果。结论：铸造牙牙合垫局部义齿对老年缺失牙患者是一种良好可行的修复方法。     

利用原有义齿修补缺牙187例

可摘局部义齿是恢复美观和咀嚼功能常用的修复体。随着使用义齿患者的年龄、全身健康状况的改变,义齿基牙或余牙缺失,或无法保留者并不少见,往往需要重新制作义齿。我们利用原有义齿修补缺牙获得满意效果,现报道如下。1 临床资料 1990年 1月～2001年 3月,因可摘局部义齿个别基牙或余牙缺失和无法保留而就诊者187例,男132例,女55例,年龄26～78岁。其中40岁以下13例,41～50岁58例,51岁以上116例。义齿个别基牙或余牙缺失134例,基牙或余牙因牙周病、龋     

前牙重度磨耗伴游离端牙列缺损固定-活动联合修复的临床应用

目的评价采用固定-活动联合修复前牙重度磨耗伴游离端牙列缺损重建咬合关系的临床效果。方法对28例前牙重度磨耗伴游离端牙列缺损的患者,前牙进行完善根管治疗,后牙先以活动可摘局部义齿重建后牙咬合关系和牙合间距离,经过不断调整、观察2～3个月后,采用前牙桩核烤瓷连冠修复,后牙根据最后确定的垂直高度采用附着体义齿修复。结果 28例前牙重度磨耗伴游离端牙列缺损经过咬合重建序列治疗,采用固定-活动联合修复后,患者面下1/3高度均得到恢复,面部丰满美观,关节无疼痛和弹响,前牙烤瓷冠牢固、美观,游离端附着体义齿固位良好,咀嚼效能高,无卡环,义齿美观舒适,恢复了垂直距离,确定了咬合关系。结论固定-活动联合修复是治疗前牙重度磨耗伴游离牙列缺损患者的一种有效可行的修复方法。     

Arthroscopic repair of type II superior labral anterior posterior lesions with and without acromioplasty: a clinical analysis of 50 patients

BACKGROUND: The treatment of type II superior labral anterior posterior (SLAP) lesions remains controversial. Many surgeons are reluctant to combine a SLAP repair with an acromioplasty for fear of postoperative shoulder stiffness and a poor clinical outcome. HYPOTHESIS: A SLAP repair and an acromioplasty done concomitantly may yield acceptable outcomes. Study Design: Case series; Level of evidence, 4. METHODS: We compared the clinical results of 50 patients who had either an isolated type II SLAP repair (SLAP group, 34 patients) or a combined type II SLAP repair and acromioplasty (combined group, 16 patients). Patients were excluded for full-thickness rotator cuff tears or instability. All patients were evaluated with the L'Insalata Functional Shoulder Rating Questionnaire, with the American Shoulder and Elbow Surgeons (ASES) questionnaire, and by subjective evaluation. RESULTS: At an average of 3.4 years postoperatively, the L'Insalata and ASES scores were similar for the 2 groups: 87.1 and 85.8 for the SLAP group and 85.1 and 86.5 for the combined group, respectively (P > .05). Subjectively, only 65% of the patients in the SLAP group reported a "good" or "excellent" satisfaction with the surgery, compared with an 81% "good" or "excellent" satisfaction rating among the patients in the combined group. Seven patients (21%) in the SLAP group had postoperative clinical impingement, compared with no patients (0%) in the combined group (P < .03). CONCLUSIONS: According to our data, these 2 procedures done concomitantly may yield acceptable outcomes. Our findings indicated that a combined type II SLAP repair and acromioplasty had no negative effect clinically and, furthermore, appeared to prevent residual clinical impingement.     

Effect of recasting on the elastic modulus of metal-ceramic systems from nickel-chromium and cobalt-chromium alloys

BACKGROUND/AIM: Elastic modulus of metal-ceramic systems determines their flexural strenght and prevents damages on ceramics during mastication. Recycling of basic alloys is often a clinical practice, despite the possible effects on the quality of the future metal-ceramic dentures. This research was done to establish recasting effects of nickel-chromium and cobalt-chromium alloys on the elastic modulus of metal-ceramic systems in making fixed partial dentures. METHODS: The research was performed as an experimental study. Six metal-ceramic samples of nickel-chromium alloy (Wiron 99) and cobalt-chromium alloy (Wirobond C) were made. Alloy residues were recycled through twelve casting generations with the addition of 50% of new alloy on the occasion of every recasting. Three- point bending test was used to determine elastic modulus, recommended by the standard ISO 9693:1999. Fracture load for damaging ceramic layer was recorded on the universal testing machine (Zwick, type 1464), with the speed of 0,05 mm/min. RESULTS: The results of this research revealed significant differences between elasticity modules of metal-ceramic samples in every examined recycle generation. Recasting had negative effect on the elastic modulus of the examined alloys. This research showed the slight linear reduction of elastic modulus up to the 6th generation of recycling. After the 6th recycling there was a sudden fall of elastic modulus. CONCLUSION: Recasting of nickel-chromium and cobalt-chromium alloys is not recommended because of the reduced elastic modulus of these alloys. Instead of reusing previously recasted alloys, the alloy residues should be returned to the manufacturer.     

Evaluation of cermet fillings in abutment teeth in removable partial prostheses

The aim of the study was to describe the clinical process of setting the purpose filling on abutment teeth, after finishing the removable partial dentures. The aim was also to investigate the use of cermet glass-ionomer cement for the purpose filling in the abutment teeth for removable partial dentures, as well as to investigate the surface of the purpose filling. For the clinical evaluation of purpose filling slightly modified criteria according to Ryg's were used in 20 patients with different type of edentulousness. Changes occurring on the surface of purpose filling have been experimentally established by the method of scanning electron microscopy on the half-grown third molars in seven patients. It could be concluded that cement glass-ionomer was not the appropriate material for the purpose fillings in abutment teeth for removable partial dentures.     

吻合血管皮瓣移植修复前臂和手部复杂性软组织缺损

目的探讨吻合血管皮瓣移植修复前臂和手部复杂软组织缺损的临床效果。方法对17例前臂和手部复杂软组织缺损采用股前外侧皮瓣、胸脐皮瓣、小腿内侧与股前外侧皮瓣的串联皮瓣游离移植修复创面。创面面积11 cm×8 cm～26 cm×9 cm,皮瓣切取面积13 cm×9 cm～27 cm×10 cm。结果移植皮瓣全部成活;8例皮瓣臃肿,需再次手术整形;4例骨缺损在皮瓣成活后半年施行自体髂骨植骨钢板内固定,骨折愈合,前臂的旋转功能和手部功能恢复满意;3例肌腱缺损者术后3～5个月用健侧掌长肌腱或手屈指浅肌腱移植修复,手部功能获得部分恢复;2例尺、桡动脉严重损伤,合并重度皮肤肌肉组织缺损者手部功能获得部分恢复,其余患者前臂旋转功能和手部功能恢复满意。结论吻合血管皮瓣移植能有效地修复前臂和手部复杂软组织缺损,控制创面感染,有助于骨折愈合和手部功能的恢复。     

Time course of bone metabolism at the residual ridge beneath dentures observed using 18F-fluoride positron emission computerized-tomography/computed tomography (PET/CT)

Objective

Excessive pressure due to wearing mal-adapting dentures is well known to cause residual bone resorption beneath the denture. X-rays have been commonly utilized to evaluate the changes in the bone beneath the denture. However, X-ray images merely detect bone density and relatively large changes in the bone shape and structure, whereas nuclear medicine imaging can detect functional changes, which occur prior to structural changes. This article aimed to describe the time course of the bone metabolism at the residual ridge beneath the denture following denture use by ¹⁸F-fluoride positron emission computerized-tomography (PET)/computed tomography (CT) scanning.

Methods

Three subjects, who had a free-end edentulous mandible, were treated with a denture replacing the edentulous region of the dental arch. The metabolic changes in the residual bone beneath the denture were assessed by ¹⁸F-fluoride PET/CT imaging. ¹⁸F-fluoride PET/CT scanning was performed at baseline, and 4?C6 and 13?weeks after denture use. A volume of interest (VOI) was placed on their mandibles at the edentulous region beneath the denture on the PET/CT image. CT value and mean standardized uptake value (SUV) of the VOI were calculated. The difference in the time variation between the CT value and SUV was analyzed.

Results

The adaptation of the denture base to the residual ridge was successful, and there was no trouble such as pain at the residual ridge beneath the denture. The SUVs of each VOI significantly increased at 4?C6?weeks after denture use and then decreased at 13?weeks in all three subjects (P?<?0.05; two-way ANOVA, Dunnett test). On the other hand, the CT images showed no obvious changes in the bone shape or structure beneath the dentures, and the CT values of each VOI remained static after denture use in all three subjects.

Conclusions

This study indicates that in the present first-time removable partial denture (RPD) users, wearing of a well-adapted RPD initially increased bone metabolism beneath the denture and then decreased it at around 13?weeks after RPD use without any bone structural changes detectable by clinical X-rays. These metabolic changes are a mechanobiological reaction to the pressure induced by RPD use.     

A prospective, randomized clinical investigation of the treatment of first-time ankle sprains

BACKGROUND: Acute ankle ligament sprains are treated with the use of controlled mobilization with protection provided by external support (eg, functional treatment); however, there is little information regarding the best type of external support to use. HYPOTHESIS: There is no difference between elastic wrapping, bracing, bracing combined with elastic wrapping, and casting for treatment of acute, first-time ankle ligament sprains in terms of the time a patient requires to return to normal function. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Patients suffering their first ligament injury were stratified by the severity of the sprain (grades I, II, or III) and then randomized to undergo functional treatment with different types of external supports. The patients completed daily logs until they returned to normal function and were followed up at 6 months. RESULTS: Treatment of grade I sprains with the Air-Stirrup brace combined with an elastic wrap returned subjects to normal walking and stair climbing in half the time required for those treated with the Air-Stirrup brace alone and in half the time required for those treated with an elastic wrap alone. Treatment of grade II sprains with the Air-Stirrup brace combined with the elastic wrap allowed patients to return to normal walking and stair climbing in the shortest time interval. Treatment of grade III sprains with the Air-Stirrup brace or a walking cast for 10 days followed by bracing returned subjects to normal walking and stair climbing in the same time intervals. The 6-month follow-up of each sprain severity group revealed no difference between the treatments for frequency of reinjury, ankle motion, and function. CONCLUSION: Treatment of first-time grade I and II ankle ligament sprains with the Air-Stirrup brace combined with an elastic wrap provides earlier return to preinjury function compared to use of the Air-Stirrup brace alone, an elastic wrap alone, or a walking cast for 10 days.     

单个后牙缺失伴远端基牙倾斜的树脂黏结固定桥修复研究

目的 观察树脂黏结固定桥(RBFPD)修复下颌单个后牙缺失合并桥基牙倾斜患者的临床效果,并总结其适应证和设计特点.方法 选择2002-2003年在解放军总医院口腔科就诊的典型下颌单个后牙缺失、远端基牙近中倾斜的患者18例,所有患者基牙倾斜度不超过50°,基牙无明显松动,牙周无异常.根据基牙倾斜和模型观测结果,设计(牙合)支托和固位体的位置和形态,义齿选择普通钛合金烤瓷或钻铬合金烤瓷修复,并在修复体完成后进行5年随访.随访时进行临床检查、X线片检查并询问患者主观感受.结果 远端倾斜基牙平均倾斜33°.随访5年后,2例修复病例修复体脱落,其余义齿功能良好,牙周无明显炎症.基牙以及桥体下方牙龈无明显红肿,X线片示基牙牙周间隙无异常,患者对于修复体的外观及使用情况满意.5年期间修复体的成功率为88.9%.结论 对于伴有基牙倾斜的单个后牙缺失,采用树脂黏结固定桥进行修复的效果可靠,并具有磨牙少、基牙无需进行根管治疗等优点.     

Arthroscopic meniscus repair

From February 1982 through July 1987, the author studied 87 patients who had a total of 116 meniscus tears, 96 of which were repaired. Seventy patients (79 meniscus repairs) had postoperative followup ranging from 12 months to 5 1/2 years (mean, 39 months). The patients' ages ranged from 14 to 51 years with a mean age of 22. The time from injury to surgery ranged from 1 week to 6 years. Twenty-five percent of the injuries were considered acute, i.e., less than 6 weeks after the injury, and 75% of the injuries were considered chronic. Nineteen patients (27%) had isolated meniscus injuries. All meniscus repairs were done arthroscopically, using an inside-outside technique. Ligament stabilizing procedures were done on all patients who had ACL deficient knees. Forty-seven patients (67%) had postoperative documentation including either an arthroscopic examination or an arthrogram done an average of 5 to 6 months after surgery. There was one case of peroneal nerve palsy from which the patient made a complete recovery in 6 months. There was one case of infection/thrombophlebitis. One patient had paresthesia and numbness along the medial aspect of the left leg corresponding to a saphenous nerve injury. The aim of this investigation was two-fold, consisting of determining if an arthroscopic technique could be used successfully to repair acute as well as chronic vertical tears involving the meniscus, and also, evaluating the relationship between ACL stability and meniscus healing. The overall success rate of retained menisci following repair was 91%. The time from injury to repair did not affect meniscus healing. Associated stabilization of ACL deficiencies is imperative in patients undergoing meniscus repair.