颧种植体技术的临床应用与评价

各种原因所致的上颌骨后牙区严重萎缩患者,是临床上非常棘手的种植病例。尽管有许多方法试图克服这一困难,如上颌窦开窗植骨、大块自体骨移植、骨牵引术等,但治疗周期均较长,有相关并发症的产生和远期效果的不确定性等不足。颧种植体是指植入颧骨内的种植体,主要用在上颌骨后牙区严重萎缩患者。其主要优点是避免大量植骨手术、治疗周期缩短,3个月内就能恢复咀嚼功能。     

种植支抗后牵引猴上颌骨颌面形态变化的实验研究

目的 研究种植支抗后牵引猴上颌骨颌面形态的变化。方法 选用生长发育期雄性恒河猴3只,随机分为2组,对照组1只,实验组2只。于双侧颧骨植入钛板,通过镍钛拉簧牵拉上颌骨种植体,向后牵引上颌骨。牵引力值每侧2.94 N, 时间3个月。对比研究治疗前后面像、牙牙合模型和X线头影测量数值。结果 实验期间,种植体稳定;实验组前牙覆盖及上牙弓长度均显著减小,上牙弓宽度增加;实验组SNA、ANB减小,A点均后移2 mm;实验组和对照组的上颌平面角都增加,上颌骨轻度顺时针旋转。结论 口内种植支抗后牵引上颌骨能抑制上颌向前生长,为治疗生长发育期上颌前突错牙合畸形新方法提供实验依据。     

Immediate placement and implant loading for expedited patient care: a patient report

This patient report concerns etiologic factors leading to a failed natural dentition, masticatory function, and poor dental esthetics in a 30-year-old woman. The surgical and restorative treatment provided for the patient was designed to address her dental phobia, location of residence, and debilitated oral condition. While the following case report details an example of the clinical success that can be achieved through advances in dental implant treatment, the most satisfying event was not necessarily the procedure itself, but the profound change that the generosity of the osseointegration community has made on the life of a needy individual. Through the active leadership of the Osseointegration Foundation Charitable Grant Program, the patient, whose complex treatment is described here, was able to take advantage of treatment that otherwise would not have been available to her. This complex treatment was enabled by the Osseointegration Foundation and other caring donors.     

恒河猴颧骨种植支抗后牵引上颌骨矫形作用的组织学研究

目的：采用颧骨种植支抗后牵引上颌骨,观察在牵引力作用下上颌骨和颧骨周围相关骨缝的组织学变化。方法：生长发育期恒河猴4只,3只用于研究(1只牵引1.5个月、2只牵引3个月),1只作为对照;HE染色和活体骨标记染色,观察上颌骨周围的颧颌缝、横腭缝、翼腭缝、额颌缝以及颧骨后部的颧额缝、颧颞缝、蝶颧缝的组织学变化。结果：上颌骨周围4条骨缝发生明显的以吸收为主的组织学反应。由于骨缝的位置和走向不同,横腭缝、额颌缝表现为骨突顶部吸收为特征的楔形交错性反应;翼腭缝表现为骨突一侧骨表面沉积、另一侧表面骨吸收的位相性反应;颧颌缝兼有2种反应。颧骨后部骨缝呈现牵张状态,观察到骨沉积增加,破骨活动较弱,同样表现出3种不同的骨缝反应。结论：颧骨种植支抗后牵引使上颌骨和颧骨周围骨缝发生了有别于生理性生长改建的明显变化,但未发现破坏性改变。上颌骨周围骨缝组织学反应以吸收为主,不同骨缝组织学反应有所差异,上颌骨因此向后移动并伴有一定的旋转。颧骨后部骨缝发生了与传统口外弓作用不同的牵张成骨反应。     

Computer-guided implant placement in a patient with severe atrophy

Computer software associated with imaging techniques facilitates diagnosis, planning, and management in cases of severe maxillary atrophy, by reducing the incidence of complications and improving the postoperative course and functional outcome. This article reports on a case of a 66-year-old woman with maxillary atrophy. Computer software was used to plan and position 6 maxillary and 4 mandibular implants, taking maximum advantage of the remaining bone. Bicorticalization was sought by angulation and implant fixation in the buttresses, while rehabilitation was carried out by means of a fixed screw-retained upper prosthesis and a lower overdenture. No implants were lost after 36 months of follow-up. This technique optimized precise implant placement as planned without the need for more complex reconstruction techniques.     

Rescue implant concept: the expanded use of the zygoma implant in the graftless solutions

The use of "anteriorly or posteriorly" tilted implants in a graftless approach for immediate loading the edentulous maxillae has been well documented in the literature. This treatment concept allows for rehabilitation of the edentulous maxillae with a fixed prosthesis. The purpose of this article is to describe criteria for the use of the zygomatic implant, including the expanded use of the zygoma implant in cases where failure of one of the anterior or posterior tilted implants has occurred in the All-on-Four treatment concept. Zygomatic implant placement becomes a "rescue procedure", which allows for continuity of care without resorting to a removable denture.     

Rescue implant concept: the expanded use of the zygoma implant in the graftless solutions

The use of "anteriorly or posteriorly" tilted implants in a graftless approach for immediate loading the edentulous maxillae has been well documented in the literature. This treatment concept allows for rehabilitation of the edentulous maxillae with a fixed prosthesis. The purpose of this article is to describe criteria for the use of the zygomatic implant, including the expanded use of the zygoma implant in cases where failure of one of the anterior or posterior tilted implants has occurred in the All-on-Four treatment concept. Zygomatic implant placement becomes a "rescue procedure", which allows for continuity of care without resorting to a removable denture.     

Rehabilitation of atrophic posterior maxilla with zygomatic implants: review

The objective of this study was to review the published literature to evaluate treatment success with zygomatic implants in patients with atrophic posterior maxilla. Studies from 1987 to 2010 were reviewed. In each study, the following were assessed: indications for treatment, number of patients, number of implants, length and diameter of the implants, surgical technique, prosthetic rehabilitation, success rate, complications, and patient satisfaction. Sixteen studies were included, with a total of 941 zygomatic implants placed in 486 patients. The follow-up periods ranged from 12 to 120 months. Three different surgical techniques were used to place zygomatic implants: intrasinus implants with the classic sinus window technique, the sinus slot technique, and extrasinus zygomatic implants. The most common restoration used was fixed prosthesis, with either delayed loading after 3-6 months (89%-100% success) or immediate loading (96.37%-100% success). The weighted average success rate was 97.05%, and the most frequent complication was maxillary sinusitis. The general level of patient satisfaction was high. Zygomatic implants have a high success rate and constitute a suitable alternative to treat severe posterior maxillary atrophy.     

Oral rehabilitation of a patient with bruxism and cluster implant failures in the edentulous maxilla: a clinical report

For most patients with failed dental implants, the placement of new implants is the only option that allows for retreatment with a fixed dental prosthesis. This clinical report describes the rehabilitation of a patient with a history of bruxism and cluster implant failures in the edentulous maxilla 10 years after the insertion of a milled bar overdenture. Seven failed implants were removed and simultaneous bone grafting was performed. After an 8-month healing period, 8 dental implants with new surfaces were placed. These supported a metal ceramic fixed complete denture with a metal occlusal surface. The prosthesis was retained with 3 sections of milled bars and 3 set screws. This clinical report describes the details of the treatment with an emphasis on prosthetics.     

Immediate dental implant placement in calvarial bone grafts to rehabilitate the severely resorbed edentulous maxilla: A prospective pilot study

Purpose

The aim of this study was to describe the surgical technique of immediate dental implant placement in calvarial grafts for augmentation of the severely resorbed maxilla and to assess the treatment results.

Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report.

OBJECTIVE: This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. METHOD: Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. RESULTS: Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. CONCLUSION: The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.     

Clinical application of zygomatic implants for rehabilitation of the severely resorbed maxilla: a clinical report

PURPOSE: A zygomatic implant can be an effective device for rehabilitation of the severely resorbed maxilla. If zygomatic implants are used, onlay bone grafting or sinus augmentation would likely not be necessary. Where an anterior onlay bone graft is required, extension of the graft in the posterior region could be reduced. The results of the application of zygomatic implants in 9 patients and clinical evaluation of this therapy are reported. MATERIALS AND METHODS: Nine patients received a total of 15 zygomatic implants. Six to 8 months elapsed for healing before second-stage surgery was performed. Six months after prosthetic treatment, patients' opinions were solicited by means of a questionnaire. RESULTS: No implant was removed at the time of abutment connection surgery or during the follow-up period. In many cases, the zygomatic implant platform was located palatal to the alveolar ridge. However, no patients complained of any continuing speech impediment following superstructure fabrication. Computed tomograms taken before implant placement and 6 months after implant placement showed no sign of sinusitis in any patient. DISCUSSION: The zygomatic implant allows shorter treatment time and hospitalization. However, there can be some problems in the application of zygomatic implants. CONCLUSION: It is necessary to investigate long-term clinical prognosis.     

Immediately loaded fixed maxillary implant treatment for a patient with advanced periodontal disease: a clinical report

Patients with a failing maxillary dentition typically require an extended treatment sequence that involves extractions, interim prosthesis wear, grafting and subsequent implant placement, and restoration with an implant-supported fixed or bar-retained prosthesis. Established maxillary implant protocols can take up to 15 or more months to complete. The purpose of this report is to describe a treatment sequence using zygomatic implants in a patient with advanced periodontal disease. A fixed prosthesis was fabricated without grafting, resulting in a shortened treatment time.