GBR技术在颌骨囊肿手术中的临床应用观察

目的:观察膜引导骨再生技术(guide bone regeneration,GBR)在颌骨囊肿术后对颌骨缺损修复的临床疗效。方法:小型颌骨囊肿50例,囊肿大小为1.5 cm×1.5 cm~3.0 cm×3.0 cm,均采用颌骨囊肿摘除术治疗。术中将颌骨囊肿完整摘除,确认未与鼻底及上颌窦穿通后,将人工骨粉与自体静脉血混合充填入颌骨囊肿骨缺损区,再以生物膜覆盖,常规缝合切口。结果:术后2周拆线,除5例外切口均愈合良好;术后6个月复查全景片,充填材料复合体密度与颌骨密度趋于一致;术后1年,充填材料与周围颌骨生长完全融合,不能分辨,原囊肿区可见正常的骨小梁网纹结构。结论:GBR技术对修复小型颌骨囊肿术后的局部骨质缺损安全有效。     

羟基磷灰石颗粒复合物充填颌骨囊腔的疗效观察

目的:评价羟基磷灰石颗粒复合纤维蛋白封闭剂修复颌骨囊肿术后遗留的较大骨缺损的临床疗效。方法:33例牙源性颌骨囊肿患者,采用羟基磷灰石颗粒与纤维蛋白封闭剂以11∶体积比复合,充填术后骨腔,颌骨缺损范围为2.5cm×3.0cm～3.5cm×5.5cm。结果:术后创口均Ⅰ期愈合,无1例发生术后感染或排异反应。术后6月X线曲面断层片显示缺损区密度与宿主骨密度趋于一致。随访1年以上,无1例术后复发。结论:纤维蛋白封闭剂具有封闭组织缺损、止血、促进组织愈合和生物粘合等功能,与羟基磷灰石颗粒复合,能有效地整复较大的颌骨缺损。     

羟基磷灰石生物陶瓷联合口腔修复膜在颌骨囊肿手术中应用

目的探讨羟基磷灰石生物陶瓷联合口腔修复膜在颌骨囊肿手术中的临床应用及效果。方法选择2012年1月至2015年1月收治的颌骨囊肿患者93例,将囊肿摘除后使用羟基磷灰石生物陶瓷填塞骨缺损,再覆盖口腔修复膜,根据临床及X线片资料评价骨缺损区的骨再生及改建情况。结果 90例患者术口Ⅰ期愈合,1例切口拆线后裂开,2例患者感觉术区存在肿胀或疼痛不适。术后1、3、6、12个月复查X线片提示缺损区骨质增生及改建良好。结论羟基磷灰石生物陶瓷联合口腔修复膜用于颌骨囊肿造成的骨缺损操作简单,临床疗效可靠。     

CGF 联合骨代用品及口腔修复膜在颌骨囊肿手术中的应用

目的：观察浓缩生长因子（ CGF）联合羟基磷灰石生物陶瓷及口腔修复膜在颌骨囊肿手术中促进骨组织愈合的临床效果。方法：45例颌骨囊肿患者行囊肿刮除术,采用浓缩生长因子及羟基磷灰石生物陶瓷混合物填充骨腔,CGF膜及口腔修复膜双层覆盖在骨缺损区表面。术后随访3～12个月,通过临床和影像学检查评估治疗效果。结果：45例患者术后伤口均为Ⅰ期愈合。直径＜2 cm的骨缺损在术后3个月羟基磷灰石生物陶瓷与周围骨组织界限消失,可见正常网纹结构的骨小梁。直径＞2 cm的骨缺损,术后9个月羟基磷灰石生物陶瓷与周围骨组织界限模糊;术后12个月界限消失,充填材料与新生骨及周围骨组织生长良好。结论：CGF联合羟基磷灰石生物陶瓷充填颌骨囊肿骨缺损区同时覆盖口腔修复膜的引导骨再生技术可有效促进骨愈合,修复骨缺损。     

羟基磷灰石修复颌骨缺损的临床应用

目的　临床观察羟基磷灰石植入治疗颌骨缺损疗效。方法　对临床 11例术后颌骨缺损范围 2 .5～ 5 .5cm病例 ,采用块状羟基磷灰石修复颌骨缺损。结果　 11例切口均一期甲级愈合 ,无 1例出现术后感染和排异反应。结论　块状羟基磷灰石修复颌骨缺损 ,使病人短期内恢复功能和面部形态 ,减少了感染机会     

根尖囊肿摘除术中应用羟基磷灰石的疗效观察

目的观察羟基磷灰石生物陶瓷填塞根尖囊肿术中骨腔的效果。方法4箩例根尖囊肿病灶牙及囊肿累及邻牙行热牙胶尖垂直加压充填完成根管治疗后，按随机原则分为2组，试验组25例根尖囊肿摘除术中应用羟基磷灰石生物陶瓷骨粉填塞骨缺损；对照组23例采用传统的囊肿骨腔血凝块机化愈合方法。观察两组疗效，比较术后感染、血肿及成骨情况。结果术后随诊6个月-2年，试验组25例患者术后均无感染，血肿发生；6个月后术区骨密度明显增高，骨化程度良好。对照组6个月后出现2例失败病例,21例术区骨化程度低于试验组。结论根尖囊肿应用羟基磷灰石生物陶瓷填塞骨缺损可有效引导骨再生，减少术后并发症，值得临床推广应用。     

自体骨柱用于前牙美学区早期种植临床效果研究

目的 研究自体骨柱用于前牙美学区早期种植的临床效果。方法 选取2018年1月至2020年1月于大连市口腔医院种植科就诊的单侧上颌前牙缺失伴水平骨量不足,需行引导骨再生术(guided bone regeneration,GBR)的单颗牙种植修复治疗患者55例。将患者分为对照组(14例)、自体骨柱组(24例)及自体骨屑组(17例),在早期种植同期分别采用Bio-Oss^?骨粉、自体骨柱结合Bio-Oss^?骨粉、自体骨屑结合Bio-Oss^?骨粉行GBR。记录3组患者种植体存留率及并发症;分别于GBR当天及GBR后第15个月测量种植体颈部肩台至唇侧骨壁的宽度、种植体表面1/2处至唇侧骨壁宽度、种植体唇侧颈部(肩台)边缘至唇侧牙槽骨顶点(唇侧骨壁冠方最高点)的高度,并计算唇侧骨壁吸收量;测量3组患者GBR后当天骨增量体积及GBR后第15个月骨吸收量体积;于GBR后第15个月测量植骨区域近远中邻牙的牙髓活力;于永久修复后当天(骨愈合后第6个月)及GBR后第15个月评估3组患者粉白美学指数。结果 3组患者种植体均正常行使功能,存留率为...     

高强度硅橡胶人工下颌骨临床应用观察

下颌骨缺损，以往大多用自体骨作为最佳材料移植修复，但要在正常部位作第二切口取骨，患者往往难以接受。因此临床上先后采用有机玻璃、不锈钢、钛合金、羟基磷灰石、生物陶瓷、异体骨等材料替代植入。近年来，我们采用高强度硅橡胶人工下颌骨，为１６例患者进行了下颌骨...     

羟基磷灰石生物陶瓷在上颌埋伏尖牙拔除术中的应用

目的研究羟基磷灰石生物陶瓷填塞埋伏尖牙拔除术后骨腔应用效果。方法将38例无法通过正畸治疗开窗导萌至正常位置的上颌埋伏尖牙患者分为2组。试验组19例20颗埋伏尖牙,微创拔除后应用生物陶瓷骨粉填塞拔牙术后骨缺损,并对其中5例行同期牙种植术。对照组19例23颗埋伏尖牙,常规拔除。分别于拔牙术后1周及术后1、3、6个月复查,比较两组患者术后感染、血肿的发生率及成骨情况。结果试验组19例患者术后均未发生感染、血肿,术后6个月术区骨密度明显增高,骨化程度良好;对照组19例患者术后未发生感染,有3例出现血肿,术区骨化程度低于试验组。结论应用羟基磷灰石生物陶瓷填塞埋伏尖牙拔除术后骨腔可有效预防牙槽嵴吸收,与骨组织结合良好并可同期牙种植修复缺牙,减少术后并发症,具有临床可行性。     

羟基磷灰石颗粒充填颌骨囊肿术后骨缺损31例观察

颌骨囊肿是口腔颌面外科常见病之一。常规手术方法治疗大中型颌骨囊肿后 ,不但遗留颌骨缺损 ,还需多次换药 ,疗程长 ,患者痛苦较大。作者自 1990年开始 ,以羟基磷灰石颗粒充填大中型颌骨囊肿术后骨缺损 31例 ,效果良好。1　材料与方法1.1　材料来源　北京口腔医院与航空工业部北京 6 2 1所研制的高纯度羟基磷灰石颗粒 ,呈乳白色 ,无臭无味。1.2　方法　术前 3ｄ给以多贝尔氏液嗽口 ,每日 4次。如为根尖囊肿 ,患者给以根管治疗 (稍超充 )。常规消毒麻醉、切口、刮除囊肿 (及所含牙齿 ) ,生理盐水冲洗术腔后 ,取适量羟基灰石颗粒 ,用生理盐水…     

开窗减压术联合囊肿塞治疗颌骨囊性病变的临床分析

目的　　评价开窗减压术联合囊肿塞在颌骨囊性病变治疗中的临床效果。方法　对在我院口腔颌面外科诊断为颌骨囊性病变的61例患者切除部分组织行病理检查明确诊断,并采用开窗减压术联合囊肿塞治疗,开窗口大小1.0 cm × 1.5 cm～1.5 cm × 1.5 cm。术后儿童每2个月、成人每3个月复查一次,并拍摄曲面断层片,随访1～3年,观察骨再生修复情况和预后。结果　所有病例术后引流较好,未见出血、感染、永久性下颌神经损伤及复发等并发症,临床及口腔曲面断层片检查可见囊性病变范围逐渐缩小,骨再生情况良好,在儿童病例中囊性病变甚至完全消失。结论　开窗减压术联合囊肿塞治疗可促进颌骨囊性病变体积明显缩小甚至消失,可最大限度地保护及恢复颌骨的形态和功能,是治疗颌骨囊性病变的有效方式。     

前牙区即刻种植同期行唇侧GBR的临床观察

目的：评价前牙区即刻种植同期行唇侧GBR的临床效果。方法：15例患者共26颗种植体,外伤牙,残根残冠微创拔出并即刻植入种植体,并根据骨缺损情况同期植入骨粉及生物膜。种植体愈合时间较各类型种植体常规愈合时间延期1个月,后行上部修复。修复后平均追踪12个月,进行定期的临床及X线片检查。结果：种植体唇侧牙龈形态良好,牙周探诊深度均在2-3mm。X线片示种植体与周围骨组织结合良好,颈部边缘骨吸收小于1.5mm。结论：前牙区即刻种植并且同期行唇侧GBR的临床方法可行,近期临床效果良好,美学效果佳,值得推广。     

Study on regeneration of mandibular bone with bioabsorbable organic/inorganic composite membrane

Guided bone regeneration (GBR) has attracted much attention as a means to treat bone defects and congenital malformation. However, presently available materials are not ideal and further improvements are necessary. Hence we have been developing a novel bioabsorbable composite material beta-TCP/CPLA for the GBR technique. The polymeric matrix is a copolymer of poly-L-lactide acid and fatty polyester (CPLA) that is biodegradable by hydrolysis, and the ceramic filler is beta-tricalcium phosphate (beta-TCP) that is bioabsorbable and has good osteoconductivity. The materials were evaluated by in vivo and in vitro experiments. Furthermore, animal experiments with mandibular bones defects in dogs were carried out. Good bone regeneration was observed in the case of the treatment with beta-TCP/CPLA membrane whereas almost no bone regenerated in the cases without the membrane. beta-TCP/CPLA membranes were suggested to have promising properties for bone defect treatment.     

Rare giant epidermal cyst in the infratemporal fossa and middle cranial fossa

A 50-year-old man presented with a rare giant crossing cranium-temporal combined epidermal cyst. Physical examination found left facial numbness and temple severely numbness with light pressure. Horizontalis craniocerebral computed tomography demonstrated a mass lesion of 3.0 × 2.0 cm in the middle cranial fossa area; sagittal craniocerebral magnetic resonance scanning demonstrated a mass consisting of 2 leaves (the upper one, 4.0 × 3.0 cm; the lower one, 2.0 × 1.5 cm). Computed tomography angiography showed that the blood supply of the lesion came from superficial temporal artery and middle cranial fossa artery. The clinical diagnosis was neurilemmoma. Surgery revealed a pearly cyst consisting of 2 leaves (connected by a narrowed bridge located at the articular fossa of temporal bone) was 6 × 3 × 3 cm. Histologic examination disclosed disintegrated keratinizing epithelium layer, keratinizing epithelium layer, and stratified squamous epithelium layer from inner to outer and found no hair follicles or sebaceous gland with the diagnosis of epidermoid cyst. Surgery was successfully performed, and the patient was discharged home with severer left facial numbness relatively and left jaw slight opening. The present case suggests that epidermoid cysts can be seen in any location, even giant crossing cranium-temporal combined lesion, and the blood supply should be considered as a factor judging its pathogenesis.     

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze‐dried demineralized bone matrix

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration(GBR) and implantation of xenogeneic freeze‐dried demineralized bone matrix (xDBM). A total of 16 titanium plasma‐sprayed (TPS) and 16 hydroxyapatite‐coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR+xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR+xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR+xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR+xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.     

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze-dried demineralized bone matrix.

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration (GBR) and implantation of xenogeneic freeze-dried demineralized bone matrix (xDBM). A total of 16 titanium plasma-sprayed (TPS) and 16 hydroxyapatite-coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR + xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR + xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR + xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR + xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.     

Biological effects of drug-loaded biodegradable membranes for guided bone regeneration

The biological effects of drug-loaded biodegradable novel membrane for guided bone regeneration (GBR) was evaluated. The membranes were polyglycolic acid mesh coated with poly-L-lactic acid containing flurbiprofen, tetracycline or PDGF-BB. Porous structure was generated in the membranes by using a phase inversion method. The membrane was less toxic, nicely biodegradable and biocompatible for 8 wk after implantation in the dorsal skin of the rat. The drugs released from the membranes were shown to be effective for new bone formation. Tetracycline, flurbiprofen or PDGF-BB loaded membrane was markedly effective for osteoid tissue and new bone formation in the bony defect prepared in rat calvaria to compare with that by unloaded membrane. These results suggested that drug-loaded biodegradable barrier membrane might be a potential tool for GBR in periodontal therapy.     

牛骨粉(Bio-Oss)/人工生物膜(海奥)联合治疗下颌骨缺损骨腔的临床观察

目的　　探讨下颌骨囊肿术中使用牛骨粉(Bio-Oss)/人工生物膜(海奥)联合治疗疗效。方法　选取下颌骨囊肿患者12例病例,囊肿摘除后,分成2组,1组骨粉填塞,并用生物膜覆盖,另1组不作处理。根据临床及影像学资料分析评估囊肿术后骨缺损处的骨质再生和改建情况。结果　骨粉/生物膜联合治疗组术后患者骨缺损区成骨较好。结论　下颌骨囊肿术后骨缺损使用骨粉/生物膜联合治疗,效果确切、可靠。     

Results of fibrin clot application for acceleration of regeneration of the damaged mandible in experiment

The processes of regeneration of the damaged rat bottom jaw bone after application of enriched thrombocytes a fibrin clot were studied by morphological and radiovisiographic methods. At a natural course of regeneration the artificial aperture of bone was filled with blood and there the blood clot was formed. After 1 week the separate bone islets of a young tissue occurred in bone defect. In 2-3 weeks the aperture in a bottom jaw bone was completely closed by a young bone tissue. After operation with filling of bone bottom jaw defect by fibrin clot there was no formation of a blood clot. Already after 1 week the bone tissue defect was filled by the merged islets of again generated bone. By second week after fibrin use the further formation of bone tissue in defect and formation of a bone callosity was noted.