不同种属的脱细胞真皮基质做屏障膜的近期临床评价

目的：观察在牙种植术中分别采用异体、异种脱细胞真皮基质（AcellularDermalMatrix,ADM）做屏障膜完成引导骨再生（Guided Bone Regeneration,GBR）术后,手术位点的软硬组织愈合过程的临床差异,评价两种不同的ADM临床应用的价值。方法：32例因上颌单个前牙缺失要求行种植修复的患者,种植体植入术中发现种植体颈部骨缺损,按患者就诊时间先后分为两组,前12例作为对照组,采用异体ADM做为屏障膜,后20例作为实验组,采用异种ADM做为屏障膜,两组患者均于种植术同期以GBR技术修复种植体颈部骨缺损。术后1周,2周,1个月,6个月复诊时,观察记录①两组伤口愈合的情况;②附着龈宽度变化;③术后即刻与术后6个月全景片上种植体颈部骨缺损修复情况。结果：1）实验组和对照组伤口均一期愈合。2）附着龈宽度同组内术后较术前减少,有统计学差异;组间无论术前术后均无统计学差异。3）X线检查术后即刻与术后6个月比较,种植体颈部平均有明显骨吸收,组间没有统计学差异。结论：在观察期内两种不同种属的ADM具有相近的临床效果,临床用做屏障膜完成GBR术是安全的,但需要针对膜的不同性状采用不同的技术手段。     

下颌前部垂直牵张成骨在种植义齿中的临床应用

目的应用牵张成骨技术治疗下颌前部牙槽骨垂直高度不足,并进行种植义齿治疗下前牙缺失。方法应用国产骨牵张器对3例外伤后多个前牙缺失伴有严重骨缺损、骨高度不足的患者进行下颌前部垂直牵张成骨,牵引增高下颌骨至理想的高度并固定2个月后,去除骨牵张器,同期植入牙种植体,术后3个月完成种植修复。结果3例患者骨牵张手术伤口愈合良好,牵引顺利,平均牵引增高下颌骨8.2 mm。X线检查牵引骨块生长良好,无明显骨吸收。二期手术时未见明显感染,固定骨和牵引骨之间的间隙内充满了新生骨,牵引骨块稳固。共植入骨内种植体14颗,3个月后完成种植二期手术和种植修复。1年后复查,种植体稳固,咬合功能良好,外形满意。结论牵张成骨技术是治疗下颌骨前部严重骨缺损牙槽骨高度明显不足一项非常有效的方法,可以为牙种植术提供足够的骨量。在此基础上及时进行下颌前牙区种植义齿修复临床疗效满意。     

前牙区骨缺损伴缺牙患者植骨同期行牙种植即刻负重的临床应用

目的:探讨前牙区骨缺损伴缺牙患者植骨并行同期牙种植即刻负重的临床效果.方法:对河北医科大学口腔医院口腔种植中心就诊的14例17-41岁前牙区骨缺损伴缺牙患者(其中1例牙槽突隐裂),采用Bio-oss人工骨粉植入加Bio-Gide骨引导膜修复前牙区骨缺损并同期行人工牙种植体植入术,共植入HBIC纯钛人工牙种植体14颗,术后立即行聚丙烯酸树脂冠临时修复,即刻负重,修复后追踪观察3-46个月.以临床检查和影像学检查评价修复治疗效果.结果:观察3-46个月,14例患者种植体均未见松动,种植体周围软组织健康;局部牙槽骨丰满,所植骨粉无感染和排出,植骨后鼻底及上唇塌陷畸形明显改善.根尖片显示种植体周围骨质无明显吸收.结论:对于较大年龄前牙区骨缺损伴缺牙患者进行植骨修复时可尝试行同期牙种植术、术后即刻负重.     

牵引成骨修复牙槽骨缺损的临床研究

目的评估牵引成骨术修复外伤或肿瘤切除术后牙槽骨缺损的临床效果。方法6例外伤或颌骨切除术后骨缺损患者,采用垂直牵引成骨术修复垂直向骨量,牵引成骨3～5个月后植入种植体。结果牙槽骨高度得到有效恢复,种植体与颌骨形成骨愈合。结论牵引成骨术是修复颌骨垂直骨缺损的一种有效方法。     

引导骨再生膜技术在上颌前牙缺失伴重度骨缺损中的应用

目的：评价引导骨再生技术（GBR）在上颌前牙缺失伴重度骨缺损的种植修复效果。方法：选择30例上颌前牙缺失伴重度骨缺损患者,植入Xive种植体62枚,在骨缺损区植入Bio-Oss骨粉,Bio-Gide膜覆盖,重建牙槽骨的高度和宽度;8-10个月后二期手术,术后6周种植修复。结果：62枚种植的Xive种植体,观察最长48个月,最短12个月,种植体存留率100%。结论：骨再生引导膜技术（GBR）在上颌前牙缺失伴重度骨缺损中的临床应用效果稳定,有效。     

异种脱细胞真皮基质联合珊瑚羟基磷灰石在GBR术中的应用

目的：评价异种脱细胞真皮基质联合珊瑚羟基磷灰石在引导骨组织再生术中的应用效果。方法：17例共27颗牙缺失患者作为研究对象,其中10颗上前牙牙槽骨宽度约4mm的延期种植先行骨挤压术植入种植体再行GBR术,其余12颗延期即刻种植上前牙及5颗环状骨缺损后牙常规植入种植体后行GBR术。6-8m后观察成骨效果。结果：除一例患者右上侧切牙植体颈部唇侧暴露约1.5mm左右,其余患者植体均被新生骨包绕,成骨效果显著。结论：异种脱细胞真皮基质联合珊瑚羟基磷灰石在牙种植术中引导骨组织再生效果良好。     

Bio-Gide生物膜引导再生骨中种植体短期成功率的临床回顾

目的：评估141例通过Bio-Gide生物膜引导的再生骨中种植和负重的259枚种植体的成功率方法：选择种植术区存在骨缺损，可通过GBR技术修复骨缺损的患者141例其中123例202枚种植体周存在水平向骨吸收，种植体通过GBR可同期植入；18例57枚种植体周骨缺损量较大，存在垂直向多壁骨缺损，需先通过GBR技术引导新骨生成，6—8个月后再植入种植体。生物膜均采用可吸收性的Bio—Gide膜，骨移植物为自体骨与Bio—OSS骨粉的混合物术后1、3、6月进行X光检查及临床检查。二期手术时，对新生骨组织量进行评估：种植修复体完成后，分别于戴牙后6、12、24月定期复诊，检查种植体周围骨组织的吸收及种植体周围软组织情况：结果：二期手术时，141例253枚种植体均已与骨组织形成理想的骨结合，6枚种植体周围形成纤维愈合而失败，后经重新种植，所有种植体均顺利完成种植义齿修复。修复后随访6—24个月，种植体均能成功地恢复咬he功能。结论：Bio—Gide生物膜引导再生骨中种植体成功率为96．9％，与正常骨组织中种植修复的成功率不存在明显差异。     

异种烧结骨修复颌骨缺损的临床观察

本文报告了应用异种烧结骨修复颌骨缺损25例,采用手术前后X线及免疫学、r骨显像等观察,进行了较系统的临床研究.经6～12个月追踪观察,结果表明:创口愈合正常,未见免疫排斥反应.术后3周左右植骨成活,2～3个月有新骨形成、与空白对照组比较,烧结骨有明显加快骨缺损部位成骨作用,新生骨出现早,成骨速度快.证实烧结骨具有良好的组织相容性和骨传导能力,具有较高的临床实用性,是一种较理想的骨移植材料.     

微创取骨进行自体骨移植在牙种植中的临床应用

目的:探讨牙种植中骨缺损区微创取骨进行自体骨移植的效果。方法:选择15例18颗牙槽骨缺损牙种植病例,在牙槽骨缺损区周围局部取骨,空心取骨锯颌骨取骨及常规髂骨手术取骨后植骨,或同时行钛膜引导,同期或6月后延期行种植体植入,4~6个月后行烤瓷冠修复。结果:所有病例均取得良好成骨及修复效果。结论:空心取骨锯取骨和缺骨区周围局部取骨损伤小;有钛膜引导病例成骨量较大,骨吸收少;取髂骨手术取骨量大,但损伤较大,不应作为常规植骨方法。     

Cem-OsteticTM修复颌骨囊肿术后骨缺损的临床观察

目的 探讨Cem-OsteticTM人工骨浆修复颌骨囊肿术后骨缺损的可行性.方法 12名上颌骨或下颌骨根尖囊肿、鼻腭囊肿和含牙囊肿的患者,在囊肿刮除后置入Cem-OsteticTM人工骨浆,术后观察6至12个月,观察手术术区创口生长情况,行X线检查观察各个时期骨缺损区的成骨情况.结果 10名患者术后术区均愈合良好,术区植骨未见不良反应,术后3个月后植入的人工骨大部分吸收并被新骨取代,术后6个月术区骨缺损均可见成骨,大部分缺损已修复.2名患者术后2周出现术区渗出,植入骨粉大部分渗出,行局部冲洗换药后创口逐渐愈合.结论 Cem-OsteticTM人工骨浆可以充填囊肿摘除后遗留的空腔,并在3至4个月内逐渐吸收且促进新骨形成,是一种良好的新型骨修复材料,但对颌骨大型骨腔缺损(大于5cm)应谨慎使用.     

Spontaneous bone healing of the large bone defects in the mandible

Spontaneous healing of large bone defects in the mandibles of 33 patients was studied. Standard postoperative clinical and radiographic examinations were performed immediately after surgery and after 2, 6 and 12 months. They were analysed using a novel relative bone densitometry method and indexes of relative bone healing were established. Spontaneous bone regeneration occurred in all patients clinically, and the computer analysis of radiographs showed that the mean final bone density in the bone defects was 88% of the bone density of the surrounding healthy bone. In the cases of smaller defects (the greatest diameter on panoramic radiographs was 20-30 mm) the final bone density was 97%, while the larger defects finally healed with 84% of the bone density of the surrounding bone. Increased patient age had a negative influence on healing and the shape of the bone defects was more important for healing than their volume. Spontaneous bone healing occurred even in large bone defects in the mandible, therefore this simple treatment with low economic and biological costs should be the treatment of choice, taking into account the patient's age, surgical principles and time of rehabilitation.     

Aneurysmal bone cyst of the sphenoid bone

Aneurysmal bone cyst (ABC) is an uncommon benign lesion that rarely presents in the craniofacial region. Aneurysmal bone cysts represent nearly 1.4% of all bone tumors, and among those, only 3% are located in the cranium. In this study, we report on an ABC located in the sphenoid bone with superior nasal cavity and ethmoid extension. The presenting symptom of our patient was headache, followed by diplopia, loss of visual accuracy, and abduction restriction. We successfully resected the lesion by a combined subcranial-midfacial degloving approach without any complications or recurrence.     

Aneurysmal bone cyst of the zygomatic bone

Aneurysmal bone cysts are a rare finding in the facial bones and jaws. Only one previous case of this entity affecting the malar bone could be found in the literature. Ultrasound and isotope scan features of this entity are described.     

Correlation in the densities of augmented and existing bone in guided bone augmentation

Objectives: Our previous work used a rabbit experimental model to investigate the effectiveness of guided bone augmentation (GBA). Although a density similar to that of existing bone is required for successful bone augmentation, few studies have compared the densities of augmented and existing bone. The purpose of the present study was to investigate the correlation in the densities of existing and augmented bone following GBA in rabbit calvaria. Material and methods: The calvaria of 18 adult male Japanese white rabbits were exposed. A circular groove and nine small holes were drilled into the cortical surface of each left parietal bone. A customized, standardized, hemispherical titanium cap was press‐fitted into each groove. Six animals were sacrificed after each healing period of 1, 3, and 6 months and histomorphometric analyses were conducted. Results: Significant increases were observed in the area of augmented bone between 1 and 6 months (62.7±21.6% vs. 93.4±3.9%). In contrast, no significant differences among healing periods were observed in the density of augmented or existing bone. Regression analysis demonstrated a significant positive correlation between the densities of augmented and existing bone; the strength of this correlation increased with the length of healing (R²=0.97). Conclusions: These results suggest that the area of augmented bone increases significantly with the length of healing, filling the occlusive space after 6 months, and that the density of augmented bone depends on that of the existing bone, such that augmented bone has a density about half that of the existing bone. To cite this article:
Yamada Y, Sato S, Yagi H, Ujiie H, Ezawa S, Ito K. Correlation in the densities of augmented and existing bone in guided bone augmentation. Clin. Oral Impl. Res. 23 , 2012; 837–845
doi: 10.1111/j.1600‐0501.2011.02204.x     

GBR技术应用于上前牙种植骨缺损的临床研究

目的：评估引导骨再生技术（GBR）在上前牙不同类型骨缺损种植修复中的效果。方法：对35例上前牙牙槽骨缺损种植的患者采用GBR技术进行骨增量,其中29例种植体周围骨缺损患者仅采用GBR技术,在植体植入骨床后,同期植入Bio～oss人工骨粉,表面盖Bio～gide可吸收性胶原膜;6例牙槽骨缺损患者采用移植自体块状骨联合Bio～oss人工骨粉,盖Bio～gide可吸收性胶原膜,5～6个月后行Ⅱ期种植体植入术。结果：所有患者在植体植入术后6～12个月临床观察种植体与骨结合良好,软组织形态与周围组织一致,行冠或桥修复,修复后12个月随诊复查无种植体失败。结论：引导骨再生技术皆能有效地对上前牙不同类型骨缺损进行骨增量,符合美学种植要求。     

复合型人工骨预制体在颌面骨缺损修复中的应用

目的探讨计算机辅助设计与制造（CAD／CAM）技术制作的复合型人工骨预制体在个性化颌面骨缺损修复中的临床应用价值。方法对6例颌面骨缺损的患者利用复合人工骨进行骨缺损修复,术前对颌面骨缺损部位进行螺旋cT扫描并三维重建,应用计算机辅助设计软件、计算机辅助制造快速成型机、复合人工骨材料及一系列的工序处理后制成三维颌面模型及个性化的颌面骨预制体．术中在模型指导下将颌面骨预制体精确定位与固定。其中3例并明显皮肤软组织缺损患者．则予同期或二期行皮肤软组织缺损的修复。结果全部颌面预制体术中能准确快速的就位及固定．无预制体断裂等发生,转移修复皮肤软组织缺损的皮瓣血运良好．除1例经口内切口患者术后部分伤口裂开予二期清创缝合后伤口愈合外,余伤口愈合良好。随访6个月至4年,无预制体移位、排斥等并发症发生,双侧颌面外形基本对称,外形满意。结论应用CAD／CAM制成的个性化复合材料颌面骨预制体能达到颌面骨缺损的精确重建．有效地解决植入体塑形困难．简化了手术程序及缩短手术时间．且并发症少,效果良好,值得临床推广应用。     

Proportion of deproteinized bovine bone and autogenous bone affects bone formation in the treatment of calvarial defects in rabbits

This study assessed new bone formation generated using three different proportions of autogenous bone (AB) and deproteinized bovine bone (DBB). Thirty bicortical skull defects were prepared in 15 rabbits, divided into 3 groups: Group 1, critical size defect (CSD) versus AB as controls; Group 2, DBB versus a composite of AB and DBB using a proportion of 1:1; and Group 3, a composite of AB and DBB using a proportion of 1:2 versus a proportion of 1:4. After 8 weeks, radiographic evaluation was assessed using densitometry and new bone formation by histomorphometry. The mean optical density of the CSD (0.108 ± 0.238) and AB (0.352 ± 0.161) groups differed significantly from the DBB group (1.044 ± 0.093) and the groups using a proportion of 1:1 (0.905 ± 0.078), 1:2 (0.865 ± 0.294) and 1:4 (0.867 ± 0.304). Histomorphometry revealed a higher percentage of new bone in the AB group (30.223 ± 16.722) than in the groups using proportions of 1:2 (22.639 ± 5.659), 1:1 (20.929 ± 6.169), 1:4 (9.621 ± 2.400), DBB (14.441 ± 2.742) and CSD (10.645 ± 8.868), respectively. The 1:2 group had significantly higher bone content than the 1:4 group. The proportions of 1:1 and 1:2 resulted in greater bone formation than the proportion of 1:4, DBB and CSD.     

Influence of decortication of the donor bone on guided bone augmentation. An experimental study in the rabbit skull bone

The aim of the present study was to evaluate if early access to the endosteal bone compartment by removal of the outer cortical bone plate will enhance bone augmentation in a secluded space. Two titanium cylinders were placed on the skull of each of 8 rabbits. Each cylinder was placed into a circular slit, secured to the skull bone via two mini-screws and supplied with a titanium lid. On the test side, the outer plate of the cortical bone, demarcated by the slit, was removed. The subsequent bleeding resulted in blood fill of the cylinders to various degrees. On the control side, the corfical bone plate was left intact and no bleeding was observed at the time of the placement of the titanium lids. After 3 months, the animals were sacrificed to obtain histology and histomorphometry. No differences in the total amount of augmented bone tissue, in relation to the total experimental area (75.5% +/- 10.9% at the test sites and 71.2% +/- 13.5% at the control sites) or of the augmented mineralized bone tissue in relation to the total amount of augmented bone tissue, was revealed (17.8% +/- 3.0% and 16.0% +/- 4.9% respectively). There was no difference in the morphological appearance of the augmented bone between test and control sites and there were no obvious similarities in the appearance between the newly formed bone tissue and the donor bone. The augmented bone consisted of slender bone trabeculae, distributed in abundant marrow spaces. A conspicuous finding was that the bone trabeculae tended to climb along the inner walls of the titanium cylinder. It is concluded that decortication of the calvarial bone in the rabbit does not result in more bone formation beyond the skeletal envelope after a healing period of 3 months compared to no removal of the cortical bone plate inside a secluded experimental area.