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目的 评述近十年来关于即刻种植后种植体周围牙槽嵴垂直向和水平向的早期改建的相关文献,为即刻种植提供可靠的临床指导.方法 使用MeSH主题词在PubMed上搜索2000-01-0l至2011-12-30的电子英文文献,对相关的前瞻性研究和回顾性研究进行分析.结果 符合纳入标准的文献共10篇,其中9篇为前瞻性研究,1篇为回顾性研究.即刻种植无法阻止牙槽嵴的生理性改建,虽然不能减少牙槽嵴水平向吸收,但有可能减少牙槽嵴垂直向吸收.结论 在选择即刻种植的治疗方案时需要考虑到新鲜拔牙窝颊侧骨壁的厚度以及种植体植入应偏舌(腭)侧及牙槽嵴根方的位置,即刻种植后牙槽嵴垂直向吸收减少有利于软组织美学的形成.     

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即刻种植技术能够有效地保持剩余牙槽嵴的高度和宽度,临床已得到广泛应用.磨牙由于其自身的解剖特点,应用即刻种植技术时常在种植体与骨组织间存在一定间隙,从而影响种植体的初期稳定性及其有效骨结合.本文对磨牙即刻种植过程中,如何处理种植体-骨间隙问题进行了讨论.     

珊瑚骨粉、口腔修复膜应用于即刻种植的临床研究

目的:选择合适的适应征进行微创拔牙后行即刻种植术,观察人工珊瑚颗粒、海奥生物膜行GBR技术,应用于前牙区即刻种植成骨效果.方法:25例前牙冠根折伴骨吸收患者进行即刻种植手术.微创拔除残根,牙槽窝嵴周少量骨缺损或伴唇侧骨壁洞穿,常规预备后植入种植体,种植体与牙槽窝骨壁间隙内、骨缺损处植入人工珊瑚颗粒(天博骨粉),盖海奥口腔修复膜,种植体均为潜入式愈合,二期手术后常规修复.观察二期手术及修复后6月或1年植骨区外形及牙龈状况.结果:二期手术时牙槽嵴成骨明显,包绕种植体颈周,二期手术修复后6月或1年牙槽外形均较植骨前丰满,牙龈质地、色泽良好.结论:珊瑚骨粉颗粒联合海奥生物膜应用于即刻种植修复少量骨缺损,成骨效果可靠.     

种植相关的牙槽嵴保存技术

充足的牙槽骨宽高度和骨质量是种植体植入的前提条件。但拔牙后局部牙槽骨的改建和吸收极易造成骨量和骨质减少,影响种植体植入。牙槽嵴保存技术有利于拔牙后牙槽骨的愈合,减少骨吸收,为后期种植修复创造条件。本文将对近年来牙槽嵴保存的方法、疗效及后期种植体植入效果做一综述。     

拔牙位点保存

目的：探讨拔牙位点保存在种植体植入之前保存拔牙后的牙槽嵴和软组织、预防拔牙后的牙槽嵴吸收,并改善骨和软组织质量的效果。方法：29例前牙和前磨牙单颗牙位点,拔牙后即刻向拔牙窝内植入去蛋白牛骨基质,游离移植腭粘膜瓣覆盖并初期创口关闭。6个月之后植入种植体,4个月之后修复。测量骨的颊舌向厚度和高度变化,以及龈乳头的高度变化。结果：牙槽窝粘膜及骨愈合良好,成功完成最终种植修复。结论：位点保存技术可以成功实现拔牙窝骨愈合,减少因拔牙造成的骨缺损,有利于提高种植的成功率,降低GBR的必要性。     

自体牙来源骨移植材料在口腔种植中应用的短期临床观察

目的:观察使用椅旁拔除的自体牙,即刻制备为骨移植材料,用于牙槽嵴骨增量的短期临床效果。方法:拔除患者因龋坏或牙周病无法保留的废弃牙、阻生牙,在椅旁即刻制备为粉状或块状骨移植材料,用于重建缺损牙槽嵴,同期或延期植入种植体。二期手术及种植修复完成后对治疗的预后,影像学检查和种植体存留率进行评估。结果:临床观察显示所有病例骨增量区创口愈合良好,无骨增量相关并发症的发生,全景片及CBCT显示种植体骨结合良好,所有种植体在功能性负载后3～6个月的观察期内无一例失败,种植修复取得了较好的临床效果,存留率100%。结论:椅旁即刻制备的自体牙骨移植材料,成骨效果良好,可用于牙槽嵴骨缺损的重建,有望成为继自体骨和人工骨移植材料之后,又一种新型骨替代材料。     

ITI种植体即刻负重与延期负重行永久修复前牙槽嵴骨吸收变化的比较研究

目的:比较ITI种植体即刻负重与延期负重行永久修复前牙槽嵴的吸收变化.方法:选择上前牙区植入时最大扭矩大于35的种植体20颗.随机分为两组:即刻负重组10颗,种植体植入后连接临时基台并行临时冠修复;延期负重组10颗,种植体植入放置愈合螺丝延期修复.在两组种植体植入时及1周,2周,4周,8周,16周后,进行X线检查,测量牙槽嵴骨吸收量并时结果进行统计学分析(ANOVA).结果:种植体无一失败.牙槽嵴的吸收随时间逐渐增加,即刻负重组和延期负重组之间无统计学差异.讨论:对即刻负重的长期效果应对两组种植体行永久修复后继续观察牙槽嵴的吸收变化.结论:ITI种植体行即刻负重与延期负重于永久修复前牙槽嵴骨吸收量不存在显著性差异.     

不翻瓣植入牙种植体手术方式的优点与局限性

在种植义齿修复高成功率和远期良好的预后得到充分证实后,如何降低种植体植入外科的手术创伤也逐渐成为一个被关注的热点.与经典的翻开粘骨膜瓣植入种植体的手术模式相比,采用不翻瓣的植入种植体是较为微创的手术模式.不翻瓣手术或是采用环形刀在牙槽嵴粘骨膜上开孔,或是用骨钻直接穿过牙槽嵴粘骨膜.从我中心多年的临床病例观察所见,采用不翻瓣的手术方式,术后局部组织反应明显减轻,患者主观感受较好.不翻瓣的种植体植入方法的优点是:微创利于消除患者对种植义齿修复手术的恐惧感;减少术中出血;缩短手术操作时间;减少感染风险;利于即刻修复;还有人认为不翻瓣,可减少牙槽嵴骨吸收.在采用骨膨胀操作技术时,牙槽嵴骨组织受到挤压后缺血,与骨面没有剥离的粘骨膜对血供也起着保障作用.在美学区不翻瓣的手术避免了切口瘢痕,有利于软组织的美学效果.然而采用不翻瓣的方式对种植手术操作也会带来某些不利的影响:因未暴露骨面,术者在非直视的条件下对牙槽嵴骨形态的判断可能产生偏差,导致制备种植窝洞的位置偏移,出现骨壁侧穿或骨壁缺损.种植体植入不仅要求准确的点位,而且种植体就位后颊舌侧也应有一定厚度骨壁包绕,根据牙槽骨嵴顶的形态变化,种植体就位的深度也是不同的,当其牙槽骨嵴顶颊舌向宽度不足时,牙槽骨嵴顶最高点并非是确定就位的深度的依据.不翻开粘骨膜瓣,就不容易根据牙槽骨嵴顶的形态以精确控制就位的深度.在牙槽骨嵴顶的形态不规则情况下,预备的骨孔口出现斜面,操作过程中较低的一侧的骨壁容易被进一步破坏.不翻瓣也限制了植骨,组织诱导再生等骨增量手术的实施.采用骨钻直接穿透牙槽嵴粘骨膜的操作,对冷却水的灌注也有不利的影响.因此不翻瓣手术增加了外科操作的不确定因素和风险,     

CBCT研究即刻种植愈合期牙槽骨的改变

目的:利用锥形束CT探讨即刻种植后牙槽骨嵴的改变。方法:本研究选择14例上牙即刻种植患者,共植入Ankylos种植体16枚,患者种植手术完成时(T1)和二期手术时(T2)均拍摄锥形束CT(CBCT),测量所有种植体唇颊侧,腭侧,近中,远中四个方向牙槽嵴顶端高度与种植体下端之间的垂直距离。并使用SPSS11.0软件进行配对t检验分析T1-T2期间种植体各方向牙槽骨的吸收变化。结果:T1-T2期间所有种植体唇颊侧,腭侧,近中,远中四个方面牙槽嵴顶端骨高度均发生了明显变化。但吸收情况不尽相同。结论:即刻种植愈合期各方向牙槽骨嵴均发生了明显的骨吸收,唇颊侧骨吸收较其它方向更加明显。     

牙种植术中植骨材料的研究进展

种植区骨量是影响种植体成功率的重要因素,在骨量不足或拔牙术后即刻种植的情况下采取骨移植的方法可以增加骨量,增加牙槽嵴的高度和丰满度,提高种植成功率.本文主要阐述植骨材料在牙种植术中的应用及研究进展.     

牙髓干细胞修复即刻种植周围骨缺损

目的：建立兔下颌骨前牙区即刻种植种植体周围骨缺损的动物实验模型,并观察牙髓干细胞在种植体周围骨缺损中骨再生能力。方法：将实验兔分为2组,分别拔除兔双侧下颌前牙,并在拔牙窝颊侧建立2 mm ×3 mm大小骨缺损区,即刻植入种植体。对照组植入Bio-oss骨粉,实验组植入Bio-oss骨粉与牙髓干细胞（ Dental Pulp Stem Cells,DPSCs）,通过扫描电镜和HE染色观察评价植入后4周种植体-骨结合状况。结果：扫描电镜观察见实验组种植体周围骨缺损处可见编织骨及骨小梁形成,种植体与牙槽窝间隙基本消失且与龈方间隙减小,周围松质骨密度增高。实验组HE染色切片见种植体周围骨缺损处牙槽骨部分胞质呈空泡状,成骨细胞与破骨细胞分布于骨小梁上,骨小梁致密且排列规则。结论：建立的兔下颌骨前牙区即刻种植的种植体周围骨缺损动物实验模型,可为即刻种植方向的相关研究提供重要参考。     

环状植骨术同期牙种植临床效果的短期观察

目的 观察环状植骨术后的临床效果并总结其手术操作要点。方法 15例牙槽骨量严重不足的患者接受环状植骨术并同期植入种植体,术后 5个月后行上部修复。分别于术前和术后 4个月拍摄锥形束 CT,测量牙槽骨增加的高度和唇舌侧骨吸收量。冠修复后 4~6个月对其牙龈附着水平、牙间乳头分级和牙周探诊深度（PD）进行测量分析,统计骨环的成活率及种植体的存留率,同时观察术后并发症并了解患者的满意度。结果 术后 4个月复查,骨环成活率为 94.4%,种植体的存留率为 100%;增加的垂直骨量为（6.06±1.06） mm,骨吸收量为（1.33±0.84） mm;种植体颈部中心唇舌向的骨宽度为（6.94±0.73） mm。冠修复后 4~6个月随访时,增加的垂直骨量为（5.62±1.03） mm,骨吸收量为（1.51±1.02） mm,种植体颈部中心唇舌向的骨宽度为（6.77±0.72） mm。种植牙和邻牙的PD无明显差异（ P>0.05）。术后无明显的并发症,修复效果好,患者满意度高。结论 环状植骨术同期植入种植体,手术操作相对容易,疗程缩短,近期效果可靠,远期效果有待进一步观察。     

Do dental implants preserve and maintain alveolar bone?

Dental implants have been touted as capable of playing an active role in the maintenance of alveolar bone height, despite the lack of a sound biological basis to support this proposition. This paper reviews the biology of bone loss, the literature concerning alveolar bone remodeling in both the postextraction period and long term, and discusses the literature regarding the influence dental implant placement has on this process. Based on current evidence, implants do not have an active role in the preservation and maintenance of alveolar bone height. Following extraction of a tooth, no external influence has been identified that will prevent loss of bundle bone or alveolar bone remodeling. Additionally, the magnitude of change is patient, site, and time dependant. Further supporting evidence is required before it can be concluded that dental implants are capable of influencing alveolar bone remodeling.     

拔牙后牙槽嵴位点保存在口腔种植学中的应用

拔牙后牙槽嵴的高度、宽度以及周围软组织的保存对于缺牙部位进行种植修复有着非常重要的意义。牙齿拔除后,拔牙窝内新生骨一般无法达到原牙槽嵴的水平,唇颊侧骨板受到的损害尤其严重,造成种植体植入时骨量不足。牙槽嵴位点保存的目的是在拔牙后能有效地保存剩余牙槽嵴的高度、宽度以及相应软组织量,为随后的种植手术和修复提供足够的骨量和美学基础。本文对牙槽嵴位点保存技术及相关的移植材料在骨内种植体领域的研究进展作一综述。     

上颌窦底内提升微创种植体植入17例临床疗效观察

目的:探讨上颌窦底内提升同期不翻瓣微创种植体植入术的临床疗效。方法:2006-09—2010-05期间,17例上颌后牙缺失患者,种植区剩余垂直骨高度(residual bone high,RBH)为5.5～9.0 mm,进行上颌窦底内提升同期不翻瓣微创种植体植入术植入后3～6个月行种植体永久修复。术后1周及1、3、6、12个月复诊,之后每6个月复诊1次,检查种植体稳定性、种植体周牙龈组织健康状况,拍摄X线片观察种植体周骨高度。结果:追踪观察6～40个月,均未见种植体松动或上颌窦炎发生,种植体周龈组织健康;X线片检查种植体骨结合良好种植体周围骨高度稳定。患者对修复效果满意。结论:上颌窦底内提升同期不翻瓣微创种植体植入近期临床效果满意,长期效果尚需进一步观察。     

Sinusfloor elevation and grafting with autogenous iliac crest bone.

Insufficient bone height in the posterior area of the maxilla, due to expansion of the maxillary sinus and atrophic reduction of the alveolar process of the maxilla, represents a contra-indication for insertion of dental implants. This anatomic problem can, in many cases, be solved by augmentation of the floor of the maxillary sinus. This surgical technique was introduced by Tatum. The so-called top hinge door method creates a new floor of the maxillary sinus at a more cranial level. Underneath this new floor the existing space is filled with a bone graft. Implantation in the alveolar process with increased bone height allows insertion of dental implants. This sinus grafting technique was used in the present study. In total, 62 sinusfloor elevations were performed with cancellous iliac bone grafts in 42 patients. In those 62 augmented sinuses, 161 ITI screw type implants were inserted. The follow-up was 1-6 years after implantation. In 2 cases infections occurred. One implant needed an extended integration time. No implants were lost. The ITI solid screw implant appears to be a suitable implant following sinusfloor elevation operations, due to its rough surface, its shape and the size of the thread. The sinusfloor elevation procedure with autogenous cancellous bone graft appears to be a valuable and reliable pre-implantological procedure, provided a proper pre-operative investigation and careful surgery are performed. This procedure allows dental implant placement with a high success rate.     

Alveolar Bone Regeneration around Immediate Implants Using an Injectable nHAC/CSH Loaded with Autogenic Blood‐Acquired Mesenchymal Progenitor Cells: An Experimental Study in the Dog Mandible

Background: Lack of osseointegration between a dental implant and the walls of the alveolar bone is a common problem in immediate implantation. Injectable tissue‐engineered bone (ITB) may be an effective and minimally invasive solution to the problem. In this study, an injectable bone cement, nHAC/CSH, which consists of nano‐hydroxyapatite/collagen (nHAC) and calcium sulfate hemihydrate (CaSO₄.½H₂O; CSH) was investigated as a tissue‐engineered scaffold material with blood‐acquired mesenchymal progenitor cells (BMPC) as seeding cells. Purpose: The aim of the study was to assess the new bone formation around immediate dental implants using nHAC/CSH loaded with dog blood‐acquired mesenchymal progenitor cells (dBMPC) in a canine model. Materials and Methods: dBMPC were first isolated from peripheral blood of healthy adult dogs. Alizarin red and oil red O staining were then used to evaluate the potential of dBMPC to differentiate into bi‐lineage mesenchymal tissues in vitro. Four healthy mongrel dogs were used in this study. The alveolar bone defects around immediate implants of dogs were created. Each defect was randomly assigned to one of the following three groups: (1) the ITB group (dBMPC + nHAC/CSH); (2) injectable bone cement nHAC/CSH; or (3) no materials (controls). Methylene blue staining was used to examine the bone formation after 3 months. Results: Studies in vitro revealed that dBMPC could be induced to osteoblasts and adipocytes. The ITB group (dBMPC + nHAC/CSH) showed significantly more bone‐implant contact and bone density than either nHAC/CSH or control groups in the areas with peri‐implant defects 3 months after implantation. Conclusion: The results indicate that the ITB composed of nHAC/CSH and dBMPC may represent a useful strategy for the clinical reconstruction of bone defects around immediate implantation. However, further investigation is needed involving the use of human BMPC as well as possible use of stem cells.     

Localized ridge maintenance using bone membrane

The immediate placement of a dental implant into a fresh extraction socket has been limited in many instances by the quantity of bone that remains after the extraction. This article presents two clinical cases that demonstrate successful regeneration of alveolar ridges in which there was extensive loss of the buccal plate of bone. This lack of alveolar process impeded the immediate placement of dental implants into fresh extraction sockets. The surgical technique performed in these cases was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane. The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissues. Bone formation took place for the placement of endosseous dental implants 8 months after the procedures were initiated. These human clinical cases confirm positive results of previous animal findings.     

Reconstruction of Severely Atrophied Alveolar Ridges with Calvarial Onlay Bone Grafts and Dental Implants

Objective: Severely atrophied alveolar ridges are most commonly reconstructed with free autologous bone grafts from the iliac crest. The use of these grafts, however, is frequently associated with bone resorption as possible late complication after implant surgery and prosthetic loading. Other donor sites, especially intraoral donor sites, show limited availability. The aim of this present study was to evaluate the clinical and radiographical outcome of alveolar ridge reconstruction with bone from the calvarium and subsequent implant rehabilitation. Patients and Methods: Reconstruction was performed by using calvarial split grafts in case of severe and complex alveolar ridge defects induced by trauma or bone atrophy. Fifteen patients were treated at 19 different intraoral recipient sites (15 sites in the maxilla, four in the mandible). Autologous block grafts were used for combined vertical and horizontal grafting. After a 3‐month healing period, patients received dental implants. A total of 99 dental implants (OsseoSpeed?, Astra Tech AB, Mölndal, Sweden) were inserted and left to heal in a submerged position for 3 months before the prosthetic implant‐based rehabilitation was performed. Results: No donor site complications occurred during or after surgery. At the intraoral recipient sites two infections occurred, leading to partial loss of the grafts. Implant placement, however, was possible in all cases. Two of 99 implants were lost in two patients prior to prosthetic loading. Patients were followed up clinically and radiographically for an average observation period of 28 months. Implant survival rate and success rates were 97.85 and 95.7%, respectively, and a minimal marginal bone loss was documented. Discussion: The low morbidity at the donor sites and the good marginal bone stability in the reconstructed regions indicate that calvarial bone grafts represent a viable treatment alternative to grafts from the iliac crest.