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目的    研究孕期及产后妇女饭后咀嚼木糖醇口香糖的防龋效果。方法    随机选取2007年5月在石家庄市第一医院体检的孕期或产后妇女［龋、失、补牙面数（DMFS）≥8］96名。经龋齿基线检查后，随机分为木糖醇组、氟化泡沫组、对照组3组。2年后复查龋患情况。结果    木糖醇组、氟化泡沫组、对照组3组新增龋面均分别为1.28、1.32、2.35，木糖醇组、氟化泡沫组与对照组比较，新增龋面均差异具有统计学意义（P < 0.01）。木糖醇组、氟化泡沫组与对照组比较，新增龋面均降低率分别为43.11%、41.33%。结论    在良好的口腔保健条件下，木糖醇口香糖与氟化泡沫有同等的防龋效果。     

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目的评价自攻型微种植体作为强支抗移动上颌磨牙向远中的有效性。方法选取2005年9月至2006年3月在大连大学附属中山医院口腔科就诊的35例安氏Ⅱ类错畸形患者,在上颌磨牙区腭中缝植入微型种植体共35枚。2周后用NiTi拉簧连接种植体与横腭杆,加载1.96N拉力,推磨牙向远中。对磨牙移动前后的X线头影测量数据和模型测量数据进行统计分析。结果在矢状向,磨牙远中平均移动3.32mm,倾斜10.22°;第一双尖牙远中移动4.23mm,第二双尖牙远中移动3.86mm,上切牙远中移动2.47mm,唇倾减少1.76°,差异均具统计学意义。在垂直向,第一双尖牙压低1.71mm,具有统计学意义;上切牙伸长0.36mm,第二双尖牙伸长0.72mm,磨牙相对腭平面伸长0.41mm,均无统计学意义。结论自攻型微种植体在推上颌磨牙远移过程中,发挥了绝对强支抗作用,有效地远中移动了上颌磨牙。     

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??Objective    To evaluate the aesthetic outcome of early single-tooth implant in the anterior maxilla. Methods      Thirty patients with single-tooth lost were treated with early implant surgery. The outcome was assessed after the final restoration was completed 2 days??3 months??12 months and 24 months later. The bone resorption??pink esthetic score??PES????modification sulcus bleeding index??MBI????probing depth??PD??and patient satisfaction were observed to evaluate the aesthetic effect and survival rate. Results    The implant survival rate was 100%. Bone resorption were??0.61 ± 0.16??mm. Significant improvement of PES was found between baseline and 2-year assessment. The MBI score was??0.98 ± 0.68??mm on average. The PD score was??2.16 ± 0.27??mm on average. The score between MBI and PD showed no significant difference at every testing time. The extreme satisfaction was 86.6%. Conclusion    Single-tooth lost in esthetic zone may-be performed early implant which can acquire a satisfactory aesthetic  effect.     

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??Objective    To explore the clinical effect of contralateral facial artery pedicle nasolabial island flap in reconstructing tongue defect after resection of tongue carcinoma. Methods    Totally 6 cases who underwent radical surgery for tongue carcinoma with opposit nasolabial groove flap for repairing defect immediately were summarized and analyzed. The vitality of flaps was observed and the patients were followed up postoperatively. Results    All flaps survived without severe complications and there was no tumor recurrence until now. Shape and motion range of reconstructed tongue were satisfactory. Function of speech and swallow were nearly normal. Conclusion    Efficacy of tongue defect reconstruction with opposit nasolabial groove flap after radical resection is effective and accordant with tumor free concept?? and it is worthy of promotion.     

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目的探讨维生素B12注射治疗在颞下颌关节紊乱病中的临床应用。方法对2006—2007年首都医科大学附属北京口腔医院颌面外科和北京丰台医院口腔科收治的145例颞下颌关节紊乱病患者,采用维生素B12注射治疗,观察其疗效。结果注射治疗后患者能立刻缓解症状,疼痛患者治疗有效率为92.8%,表现为关节绞锁和张口困难的治疗有效率为90.3%。随访观察1年复发率为10.3%。结论维生素B12关节区注射治疗能有效缓解关节区疼痛和张口受限,短期疗效稳定。     

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目的    探讨全面部骨折各种手术复位径路的可行性及优缺点。方法    对2002—2009年在宿州市立医院口腔颌面外科救治的资料完整的69例全面部骨折手术病例复位手术径路进行回顾性分析。结果    69例患者中,有47例采用了头皮冠状切口+小切口,22例单纯采取局部小切口。术后随访平均6个月,患者在功能上皆取得了良好的治疗效果,并发症表现各有不同。结论    冠状切口+小切口和单纯局部小切口在不同适应证中均可获得满意的治疗效果,应进一步研究如何减少冠状切口的并发症和如何应用微创切口对全面部骨折进行良好复位。     

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目的探讨口腔功能性矫治器治疗青春期下颌后缩伴阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的远期疗效。方法选择2003年4月至2005年10月焦作市第二人民医院收治的下颌发育后缩合并OSAHS的患儿19例,戴用口腔功能性矫治器进行治疗,分别在治疗前、治疗结束时、治疗后5年拍摄X线头颅侧位片和进行多导睡眠监测,比较睡眠呼吸暂停低通气指数（AHI）、夜间最低血氧饱和度（SaO2）和X线头影测量指标的变化。结果治疗后患儿均诉鼾声减小或消失,未见睡眠中憋气,日间困倦缓解或消失。治疗结束时SNA角无明显改善,SNB角明显增大,LL—H线距明显减小,且SNA角与SNB角相差较大的OSAHS患儿治疗效果更好;治疗结束后追踪随访5年发现,SNA角、SNB角、LL—H线距、夜间最低SaO2及AHI均无明显改变。结论口腔功能性矫治器治疗青春期下颌后缩伴OSAHS远期疗效稳定,具有无创伤、安全、痛苦小、效果稳定的优点。     

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口腔细菌产碱代谢与牙菌斑酸碱平衡、细菌微生态平衡以及龋病的发生、发展密切相关。口腔细菌产碱代谢研究主要集中在尿素代谢、精氨酸代谢、精胺代谢和苹果酸代谢的调控机制及其与龋活跃程度的关系方面,是近年来龋病防治的研究热点。本文着重针对口腔细菌产碱代谢的临床研究做一综述。     

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??Objective    To study the anatomic features of medial sural artery perforator flap and provide anatomic evidence for its clinical application. Methods    Totally 10 lower limbs preserved in formaldehyde from cadavers of adults were used to observe the anatomy of medial and lateral sural artery. Between April of 2010 and April of 2011?? 14 clinical cases were reconstructed by using medial sural artery perforator flap??perforator data were collected. Results    In all 10 specimens the mean number??median  of total perforators was 2.5??ranging 1 to 6??. All perforators were in an area between 5.0 cm and 19.0 cm from the popliteal crease and between 1.0 cm and 6.0 cm from the midline of the gastrocnemius muscles. In clinical study?? the mean number??median of total perforators was 2.0??ranging 0 to 4??. All perforators were in an area between 5.0 cm and 19.0 cm from the popliteal crease and between 0 cm and 5.8 cm from the midline of the gastrocnemius muscles. Most perforators entered the medial gastrocnemius muscle at a relative distance of one-fifth to one-third of the lower leg length measured from the popliteal crease. Conclusion    The medial sural artery perforator flap provides a constant anatomy with a long pedicle. It is a good alternative for oral and maxillofacial reconstruction of defects.     

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??Objective    To evaluate the sealing effect of a dentin adhesive in Class??restorations. Methods    Standardized mixed Class??cavities??2 mm × 2 mm × 2 mm??were prepared in 120 extracted premolars that were randomly assigned to 4 groups??n=30 for each group??. Three adhesive systems??All Bond Universal??total-etch and self-etch????Prime & Bond NT??and G bond and resin composite??were applied to each group following manufactures′ instructions. The teeth were immersed in 50 % ammoniacal silver nitrate and depth of penetration was evaluated under a microscope??and data were statistically analyzed by SPSS 20.0 software. Results    Microleakage was observed in all groups. All Bond Universal??total-etch??scores were lower than the other two groups??P??0.05??. There was no difference between total-etch and self-etch when All Bond Universal was used??P??0.05??. Higher microleakage scores were observed along the gingival margin than along the occlusal margin in all groups??P??0.05??. Conclusion    New universal adhesive ??All Bond Universal?? is a convenient and efficient adhesive. Total-etch and self-etch have no influence on marginal microleakage the long-term effect need further study.     

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颞下颌关节强直是口腔颌面部一类严重的疾病,其临床分型主要依据颞下颌关节骨性融合情况及其周围附属结构受累情况而定。临床针对颞下颌关节强直的治疗主要以手术为主,术后加以功能训练。外科手术治疗颞下颌关节强直的主要途径可以概括为以下三方面：解除关节强直的解剖因素;恢复或重建关节基本结构;对继发畸形的治疗。目前针对以上三方面的多种治疗手段各有利弊,本文将对近年来常用的手术治疗方法予以分类介绍。     

创伤性颞下颌关节强直

颞下颌关节（TMJ）强直是一种严重影响下颌运动的疾病,创伤是其常见的病因,但创伤如何引起TMJ强直的发生,目前尚未完全阐明,本文就创伤性颞下颌关节强直危险因素、发病机制假说进行综述。     

Sliding reconstruction of the condyle using posterior border of mandibular ramus in patients with temporomandibular joint ankylosis

The traditional approach for ankylosis is gap arthroplasty or interpositional arthroplasty followed by reconstruction of the condyle using, for example, costochondral grafts. As these are non-pedicled grafts, there is eventual resorption with subsequent decrease in height of the ramus, facial asymmetry and deviated mouth opening. The authors have applied the method of total and partial sliding vertical osteotomy on the posterior border of the mandibular ramus for reconstruction of the mandible condyle as a pedicled graft for the correction of temporomandibular joint (TMJ) ankylosis. From 2004 to 2008, 18 patients who were diagnosed with TMJ ankylosis underwent operations for resection of the ankylosed condyle. Two methods were performed depending on the level of osteotomy on the posterior part of the mandibular ramus. All patients were followed-up for an average of 36 months (range 24-48 months). All patients showed apparent improved joint function with no cases of re-ankylosis. The results showed that sliding vertical osteotomy on the posterior border of the mandibular ramus seems to be an alternative and promising method for condylar reconstruction in patients with TMJ bony ankylosis.     

Navigation-guided gap arthroplasty in the treatment of temporomandibular joint ankylosis

Gap arthroplasty, used in the treatment of temporomandibular joint (TMJ) ankylosis, is challenging, requiring resecting of massive abnormal bone formation at the skull base with complex and distorted anatomy. This study evaluated the application of image-guided navigation to gap arthroplasty. Four gap arthroplasties were performed on patients with unilateral TMJ ankylosis under computer-assisted navigation guidance. After preoperative planning and 3-dimensional simulation, the normal anatomic structures of the TMJ were created by superimposing and comparing the unaffected and affected sides. The amount and range of ankylotic bone to be resected was determined and displayed. Registration achieved an accurate match between the intra-operative anatomy and the CT virtual images. Anatomic structures and the position of surgical instruments were shown real time on the screen. In all cases the accuracy of the system measured by the computer did not exceed 1 mm. No complications occurred and the mean minimal thickness of the skull base between middle cranial fossa and reconstructed glenoid fossa was 1.97 mm. Using image-guided navigation resulted in safe surgical excision of the bony ankylosis from the skull base. Navigation-guided resection of the ankylotic bone in the TMJ gap arthroplasty was a valuable and safe technique in this potentially complicated procedure.     

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外伤是颞下颌关节强直最主要的病因,但髁突骨折与外伤性关节强直的关系一直存在争议。有研究表明,髁突囊内骨折可引起关节软骨损伤、关节盘移位或破损、关节积血,继发关节纤维化以及骨化,最终导致关节强直。本文从临床和实验角度探讨了髁突骨折与颞下颌关节强直的关系。     

Clinical investigation of early post-traumatic temporomandibular joint ankylosis and the role of repositioning discs in treatment

This study investigated the development of temporomandibular joint (TMJ) ankylosis after condylar fracture and the functional results of surgery that included repositioning of the articular discs. In a total of 18 patients, there were 13 cases of fibrous ankylosis (type I) and 11 of partial bony ankylosis (type II). CT scans for both groups and MRI scans for type I patients were analysed. Intraoperative inspection of the damaged disc, the sites of adhesion or bony fusion, and remaining intra-articular movement was recorded. After release arthroplasty and repositioning of discs, follow-up was for 1 to 3.5 years (mean 2.2 years). Post-traumatic TMJ ankylosis was highly associated with sagittal and comminuted condylar fractures. Type I ankylosis usually formed in the 4th to 5th month post-trauma with mean interincisal opening distance of 18.3+/-5.5mm. Progression from type I to II ankylosis occurred 1 year post-trauma and caused a reduction of 5mm in the range of mouth opening. The disc was displaced for each of the involved joints, and intra-articular adhesions or ossification initiated at the site where there was no intervening disc present. After surgical repositioning of the disc, stable joint function and mouth opening from 30 to 45 mm were obtained in all patients but one (recurrence due to dislocation). Sagittal and comminuted condylar fractures predispose the TMJ to ankylosis, and the displacement of the articular disc plays a critical role. Early surgical intervention to reposition the disc was successful for early trauma-induced TMJ ankylosis.     

The interpositional dermis-fat graft in the management of temporomandibular joint ankylosis

The aim of this retrospective clinical study is to present the clinical experience of using dermis-fat interpositional grafts in the surgical management of temporomandibular joint (TMJ) ankylosis in adult patients. Eleven adult patients who presented with ankylosis of the TMJ were identified and included in the study. All patients underwent a TMJ gap arthroplasty which involved the removal of a segment of bone and fibrous tissue between the glenoid fossa and neck of the mandibular condyle. The resultant gap was filled with an autogenous dermis-fat graft procured from the patient's groin. All patients were followed up for a minimum of 2 years. Five of the 11 patients were found to have osseous ankylosis while 6 patients had fibro-osseous ankylosis. Two patients had bilateral TMJ ankylosis that were also treated with costochondral grafts which were overlaid with dermis-fat graft. The average interincisal opening was 15.6 mm on presentation which improved to an average of 35.7 mm following surgery. Patients were followed up from 2 to 6 years post-operatively (mean 41.5 months) with only 1 re-ankylosis identified out of the 13 joints treated. This study found that the use of the autogenous dermis-fat interpositional graft is an effective procedure for the prevention of re-ankylosis up to 6 years following the surgical release of TMJ ankylosis.     

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颞下颌关节强直（temporomandibular joint ankylosis．TMJA）是口腔颌面部常见的疾病,可导致患者开口受限、咀嚼困难等,严重影响患者的身心健康。临床上,TMJA多由创伤引起。因此,创伤性TMJA的发生机制以及如何在临床上预防其发生一直是众所关注的热点和难点。     

小儿颞颌关节强直手术的麻醉处理

目的 探讨小儿颞下颌关节强直手术的麻醉方法及并发症的防治。方法 31例病人全部经鼻腔盲探插管。结果 麻醉插管成功30例，气管切开1例，全麻诱导与插管期间发生低氧6例，鼻出血2例，导管插入后出现呛咳5例。结论 充分的鼻腔准备和完善的咽喉表面麻醉是经鼻腔插管成功的关健。患者年龄越小麻醉的风险越大，并发症越多。