口腔种植愈合基台重复使用的相关研究进展

种植体颈部良好的软组织附着和封闭,对于种植体周围感染的预防和控制至关重要,是保证种植修复远期成功率的重要条件。然而,临床上愈合基台多为清洗消毒后重复使用,其表面可能有污染物残留以及不同程度的改变,增加种植体周围感染的风险。文章就愈合基台重复使用的现状及原因、表面特性及周围软组织附着、重复使用的潜在危害、预防处理方案等做一综述。     

不同洁治器械对钛种植体基台表面的影响

目的 探讨不同洁治器械在种植体临床应用的可能性。方法 用扫描电镜和干涉显微镜观察比较了使用碳纤维、塑料或不锈钢洁治器处理后钛种植体基台表面的变化。结果 不锈钢洁治器在基台表面形成明显的划痕,而碳纤维和塑料洁治器则对基台表面无明显影响;金属器械处理后的基台表面粗糙度明显大于非金属器械处理面及未处理的对照区（Ｐ〈０．０１）,而碳纤维和塑料洁治器处理面的粗糙度与对照区无明显差异。结论 碳纤维洁治器头可能     

种植体-基台连接界面对螺丝松动的影响

种植修复是目前牙缺失的理想治疗方法,具有很高的成功率,但目前存在的一些术后并发症仍困扰着临床医生.基台螺丝松动是最常见的机械并发症之一,种植体植入位置、上部修复体形态、基台-种植体连接设计、口腔副功能等均可能引起基台螺丝松动.其中种植体-基台连接界面是种植体系统中的薄弱环节,不同的基台连接设计、螺丝材料的选择等都可能会对螺丝松动产生影响.因此本文主要从种植体-基台连接界面对螺丝松动产生影响的因素进行综述.     

种植体-基台连接面的研究进展

种植体-基台连接面的几何形状有20余种,该界面的精密连接与稳定性,是确保种植体在植入后能否长期有效行使功能的关键因素之一。本文就该连接面的种类及结构特点进行综述。     

两种漱口水对钛种植体基台的影响

目的：观察含氟漱口水和洗必泰含漱剂对钛种植体基台的腐蚀性及其抑菌效果。方法：将钛种植体基台置于0.2％氟化钠漱口水及洗必泰含漱剂中,观察两种漱口水对钛种植体基台的腐蚀性。模拟口腔环境,观察洗必泰含漱剂对钛种植体基台的抑菌效果。结果：含氟漱口水对钛种植体基台具有腐蚀性,洗必泰含漱剂对钛种植体基台无腐蚀性且有较强的抑菌效果。结论：对种植牙病例,洗必泰含漱剂是一种安全有效的含漱剂。     

磁性附着体代替预成磁性种植基台的临床研究

目的探讨在种植体上利用Magfit磁性附着体活动修复的方法和效果。方法为10例患者种植18颗ITI种植体,在其上铸造Magfit磁性附着体后活动修复,对义齿的固位、咀嚼和使用情况进行2年的随访观察。结果种植体上使用磁性会着体的设计,降低了一期种植体植入的难度,大幅度降低上部修复费用。18颗种植体及磁性附着体均正常使用,义齿的固位力、稳定性、咀嚼功能良好。结论种植体上使用铸造Magfit磁性附着体可为牙槽骨严重吸收或常规义齿修复困难的患者提供一种良好的修复方法。     

种植体-基台连接设计对基台与基台螺丝受力影响的三维有限元分析

目的: 研究锥形固位、平台转移种植体的不同连接设计对基台及基台螺丝受力情况的影响。方法: 建立平台转移量分别为0.2、0.4、0.6、0.8、1.0 mm并对应基台锥度分别为6°、8°、10°的种植体模型,分析各组模型受不同载荷时,基台及基台螺丝von-Mises应力及应变情况。结果: 随着平台转移量增大,基台与基台螺丝峰值von-Mises应力及应变增大,且平台转移量≥0.8 mm的模型在水平向力作用下,其峰值von-Mises应力高于690 MPa。水平向加力时,应力与应变随平台转移量增大的幅度最大,斜向加力时次之,垂直向加力时最小。81.67%的模型基台应力集中于基台颈部;所有模型基台螺丝应力均集中于基台螺丝头部与体部转折处。结论: 平台转移量增大使基台与基台螺丝在咬合过程中受力增大。为了减少种植修复后机械并发症的发生,建议在一定范围内选用平台转移量小的种植体。当平台转移量≥0.8 mm时,基台与基台螺丝最大应力超过纯钛的屈服强度,临床上应慎用该设计。     

种植体-基台连接形式对种植体周围骨组织应力分布的影响

目的分析种植体-基台连接形式对种植体周围骨组织应力分布的影响，从生物力学角度探讨平台转换连接形式防止或减少种植体周围骨吸收的可能机制。方法利用COSMOSM2．85软件包建立种植体支持的下颌第一磨牙三维有限元模型，种植体-基台的连接形式分别采用平齐对接（模型A）和平台转换（模型B）。采用垂直和斜向两种形式加载，载荷均为200N，比较两种模型种植体周围骨组织的应力分布情况以及种植体-骨界面颊舌侧相同位置的von Mises应力大小。结果不同加载条件下两种模型种植体周围骨组织应力集中在种植体颈部颊舌侧骨皮质内，斜向加载时最大von Mises应力值高于垂直加载时。模型A和模型B骨组织内最大von Mises应力值在垂直加载时，分别为11．61MPa和7．15MPa，斜向加载时分别为22．07MPa和11．87MPa。距离种植体-基台连接处越远，von Mises应力值越小，骨皮质到骨松质交界处的应力变化最明显。与模型A相比，模型B种植体-骨界面相同节点的最大von Mises应力值较小。结论与平齐对接形式相比，平台转换设计可改善种植体周围骨组织的应力分布，降低种植体颈部骨组织所受的应力。     

种植体周软组织封闭建立的难点与改善方案

稳定的软组织封闭对于防止微生物入侵,维持种植体的长期稳定性至关重要.种植体周软组织封闭由上皮附着与结缔组织附着两部分构成,与天然牙相比附着较弱,易被外界干扰因素破坏,增加种植体周围疾病的发生率.因此,促进种植体周软组织封闭形成并保持稳定对于维持种植体长期成功尤为重要.本文将分析种植体软组织封闭难以建立并维持稳定的原因,...     

种植体与基台连接的微观形态学观察

目的: 对种植体与原厂基台及第三方基台连接组件形态学上的微观特征进行观察,探讨形态差异与潜在并发症之间可能的关系。方法: 3种基台(1个原厂装,2个来自第三方) 在规定扭矩下装配到Straumann RN种植体上,种植体基台连接单元经过一系列包埋等程序后切割形成剖面,对剖面进行打磨,对完成的试件进行扫描电镜观察。采用图像测量软件（Image J）对获得的图片进行校准测量,比较三者之间在接触长度及接触性质之间的差异,尤其是3个重要部位即肩部、内连接及螺纹处的差异。结果: 3个连接单元的所有被研究的接触面之间均存在一定的尺寸差异。3个单元中,种植体外肩部的紧密接触相似,但第三方基台内部连接的啮合,特别是抗旋转单元严重欠缺,其中1个第三方基台的螺丝啮合不良。结论: 与原装基台对比,第三方基台呈现出关键性的形态差异,横断面的几何学差异导致总体接触面积有很大不同。无论从质量上,还是数量上这种差异对修复体的长期稳定性均有可能产生严重影响。     

A modified implant healing abutment to optimize soft tissue contours: a case report

The soft tissue profile created around a conventional healing abutment may be inadequate to accommodate an anatomically shaped abutment that is larger than a standard machined abutment. This causes difficulties in its insertion and subsequent impression-making and provisional restoration fabrication. This article presents a simple technique to overcome these problems.     

Critical soft tissue parameters of the zygomatic implant

AIM: Zygomatic implants have been introduced for the rehabilitation of patients with severe bone defects of the maxilla. The soft tissue aspects of the palatal emergence situation have not been described yet. The aim of this study was to evaluate the incidence and clinical impact of possible periimplant alterations of zygomatic implants. MATERIALS AND METHODS: From 1998 to 2001 all patients with zygomatic implants were included into this study (24 patients, 37 zygomatic implants). One implant was lost in the loading phase giving a survival rate of 97%. Fourteen patients with 20 zygomatic implants fulfilled the inclusion criteria and were all available for the recall examination. Thirteen zygomatic implants were inserted in cases of severe maxillary atrophy, seven in cases of tumour-resection of the maxilla. Clinical examination and microbial analysis using a DNA probe was performed. The implants had a mean time in situ of 598 days (min: 326, max: 914). RESULTS: Colonisation with periodontal pathogens was found at four of the 20 implants. A positive microbiologic result of the periimplant pocket and the maximum pocket probing depth were not statistically related. Nine of the 20 implants showed bleeding on probing, four of these had positive microbiologic results. At sites without bleeding on probing only negative microbiologic samples were found (p=0.026). The mean palatal and mesial probing depth was 1 mm deeper than at the vestibular and distal aspect. Thus at nine out of the 20 implants both, bleeding on probing and pocket probing depth >/=5 mm indicated soft tissue problems resulting in a success rate of only 55%. The patient's history (tumor versus atrophy) or smoking habits seemed not to have influence the situation. CONCLUSION: These soft tissue problems should be taken into account if zygomatic implants are considered as an alternative therapy option in the maxilla.     

Effects of modified abutment characteristics on peri‐implant soft tissue health: A systematic review and meta‐analysis

Objectives

The purpose of this systematic review was to evaluate the impact of the abutment characteristics on peri‐implant tissue health and to identify the most suitable material and surface characteristics.

Methods

A protocol was developed aimed to answer the following focused question: “Which is the effect of the modification of the abutment design in regard to the maintenance of the peri‐implant soft tissue health?” Further subanalysis aimed to investigate the impact of the abutment material, macroscopic design, surface topography and surface manipulation. Randomised controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading were considered as inclusion criteria. Meta‐analyses were performed whenever possible.

Results

Nineteen final publications from thirteen investigations were included. The results from the meta‐analysis indicated that zirconia abutments (Zi) experienced less increase in BOP values over time [n = 3; WMD = ?26.96; 95% CI (?45.00; ?8.92); p = .003] and less plaque accumulation [n = 1; MD = ?20.00; 95% CI (?41.47; 1.47); p = .068] when compared with titanium abutments (Ti). Bone loss was influenced by the method of abutment decontamination [n = 1; MD = ?0.44; 95% CI (?0.65; ?0.23); p < .001]. The rest of the studied outcomes did not show statistically significant differences.

Conclusions

The macroscopic design, the surface topography and the manipulation of the implant abutment did not have a significant influence on peri‐implant inflammation. In contrast, the abutment material demonstrated increased BOP values over time for Ti when compared to Zi abutments.

     

种植体掺离子表面改性技术及其促进骨结合的研究进展

种植牙因其在解决牙列缺损方面巨大的优势,已成为许多缺牙患者首选的治疗方式。在临床应用中,如何促进种植体与骨组织界面的骨结合是种植治疗成功的关键,因此种植体表面改性一直是研究的热点。骨组织中含有钙、磷、锌、镁、锶等大量微量元素,这些微量元素对于骨组织的生长发育必不可少。因此可以通过将微量元素掺入种植体表面来促进种植体骨结合。本文着重介绍了种植体表面改性的相关技术以及微量元素促进骨结合的具体机制。     

钛种植体表面粗糙度对细菌黏附的影响

目的：研究钛种植体的不同表面粗糙度对变形链球菌及血链球菌黏附的影响.方法：用光电3-D表面测量系统测定两种纯钛片机械切割表面和大颗粒喷砂酸蚀表面的表面粗糙度.将钛片与变形链球菌和血链球菌共同培养,培养时间分别为4h,1d和5d.通过菌落形成单位（CFU）计数法及结晶紫染色法,比较不同时间点两种细菌在两种粗糙度钛片上的黏附量.结果：机械切割表面和大颗粒喷砂酸蚀表面钛片的表面粗糙度Ra值分别为1.25 μm和4.25 μm.CFU计数显示,在不同的培养时间点,两组钛片上的变形链球菌及血链球菌活菌黏附数量相近,差异无统计学意义（P＞0.05）.结晶紫染色显示,在不同的培养时间点,大颗粒喷砂酸蚀组钛片上血链球菌的细菌黏附总量均多于机械切割组钛片,差异有统计学意义（P ＜0.05）.在培养早期（4h）,大颗粒喷砂酸蚀组钛片上变形链球菌的细菌黏附总量大于机械切割组钛片;但在培养后期（1 d,5 d）两组钛片上变形链球菌的细菌黏附总量相近,差异无统计学意义（P＞0.05）.结论：钛片不同表面粗糙度对变形链球菌和血链球菌的活菌黏附数量无影响,但粗糙表面上黏附的细菌及基质总量大于中度粗糙表面.对于变形链球菌而言,粗糙度对细菌及基质黏附总量的影响随着生物膜的成熟而消失.     

2种不同种植体植入对种植体周围软组织的影响

目的: 研究2种种植体对种植体周围软组织的影响。方法: 选择2020年12月—2021年2月普陀区眼病牙病防治所收治的单颗后牙缺失且需行种植修复的患者40例,其中植入骨水平种植体10例,软组织水平种植体30例。在完成种植冠修复当天、3个月、6个月及12个月时比较2组种植体的探诊深度,检测种植体龈沟液中天冬氨酸转氨酶（AST）和碱性磷酸酶（ALP）水平。采用SPSS 17.0软件包对数据进行统计学分析。结果: 修复完成当天、3个月、6个月及12个月,软组织水平种植体的探诊深度和ALP水平均显著低于骨水平种植体（P<0.05）。其中修复完成当天,软组织水平种植体的AST显著低于骨水平种植体（P<0.05）。随着时间增加,骨水平种植体龈沟液中的AST迅速降低,最后与软组织水平种植体接近（P>0.05）。结论: 尽管骨水平种植体和软组织水平种植体均具有良好的临床使用效果,但软组织水平种植体周围的软组织表现出更好的稳定性。     

The influence of abutment surface roughness on plaque accumulation and peri‐implant mucositis

Bacterial adhesion to intra-oral, hard surfaces is firmly influenced by the surface roughness of these structures. Previous studies showed a remarkable higher subgingival bacterial load on rough surfaces when compared to smooth sites. More recently, the additional effect of a further smoothening of intra-oral hard surfaces on clinical and microbiological parameters was examined in a short-term experiment. The results indicated that a reduction in surface roughness below R_a=0.2 μm, the so-called “threshold R_a”, had no further effect on the quantitative/qualitative microbiological adhesion or colonisation, neither supra- nor subgingivally. This study aims to examine the long-term effects of smoothening immoral hard transgingival surfaces. In 6 patients expecting an overdenture in the lower jaw, supported by endosseus titanium implants, 2 different abutments (transmucosal part of the implant): a standard machined titanium (R_a=0.2 μm) and one highly polished and made of a ceramic material (R_a=0.06 μm) were randomly installed. After 3 months of intra-oral exposure, supra- and subgingival plaque samples from both abutments were compared with each other by means of differential phase-contrast microscopy (DPCM). Clinical periodontal parameters (probing depth, gingival recession, bleeding upon probing and Periotest-value) were recorded around each abutment. After 12 months. the supra- and subgingival samples were additionally cultured in aerobic, CO,-enriched and anaerobic conditions. The same clinical parameters as at the 3-month interval were recorded after 12 months. At 3 months, spirochetes and motile organisms were only detected subgingivally around the titanium abutments. After 12 months, however, both abutment-types harboured equal proportions of spirochetes and motile organisms, both supra- and sub-gingivally. The microbial culturing (month 12) failed to detect large interabutment differences. The differences in number of colony forming units (aerobic and anaerobic) were within one division of a logarithmic scale. The aerobic culture data showed a higher proportion of Gram-negative organisms in the subgingival flora of the rougher abutments. From the group of potentially “pathogenic” bacteria, only Prevotellu inter-media and Fusobacterium nucleatum were detected after anaerobic culturing and again the inter-abutment differences were negligible. Clinically, the smoothest abutment showed a slightly higher increase in probing depth between months 3 and 12, and more bleeding on probing. The present results confirm the findings of our previous short-term study, indicating that a further reduction of the surface roughness, below a certain “threshold R_a”(0.2 μm), has no major impact on the supra- and subgingival microbial composition.