�������ܻ������ƶԱ���Ӣ������ҩ��������������Ч����

目的评价单纯牙周基础治疗对苯妥英钠(PHT)所致药物性牙龈增生的治疗效果。方法选择佛山市禅城区向阳医院·禅城区口腔医院2011年1月至2013年6月因服用PHT导致牙龈增生的患者16例,在不停药亦不换药的情况下行牙周基础治疗,并于治疗前及治疗后1、3、6个月进行牙龈增生指数(GHI)、菌斑指数(PLI)、龈沟出血指数(SBI)、探诊深度(PD)等临床指标检查。结果单纯牙周基础治疗后1、3、6个月的GHI、PLI、SBI、PD各项临床指标逐步改善,牙龈炎症逐步减轻,牙龈增生状况持续好转;与治疗前基线相比,差异均有统计学意义(均P<0.05)。结论单纯牙周基础治疗对PHT所致药物性牙龈增生有效。     

���Ϣ���1���ಡ��������΢��ֲ��֧����Ӧ��11������

目的探讨应用微种植体支抗治疗安氏Ⅱ类1分类错畸形临床疗效及治疗方法临床要点。方法对2005—2008年在山东省济宁口腔医院就诊的安氏Ⅱ类1分类上颌前突或伴轻微下颌后缩的正畸患者11例,采用MBT(滑动)直丝弓矫治技术,进行减数双尖牙矫治。黏结矫治器之前在上颌双侧第二双尖牙和第一磨牙之间的颊侧分别植入微种植体,在治疗早期应用自攻型微种植体进行尖牙向远中牵引,并在更换至稳定弓丝后利用微种植体整体内收前牙,牵引力值为1.5～2.0N,平均治疗时间为19个月,治疗结束观察1年。于治疗前后拍摄头颅侧位片,进行头影测量分析。结果11例患者除1例种植体松动脱落,其余患者第一磨牙在前后向和垂直向均未发生显著性移动,患者的颜面侧貌得到明显改善,取得较为满意的治疗效果。与治疗前相比,治疗后SNA、ANB、FHtoU1、IMPA角明显减小,差异均具有统计学意义;SNB角略有增大,FMA略有减小,但差异无统计学意义。结论微种植体支抗能够有效治疗安氏Ⅱ类1分类患者,并达到磨牙强支抗的效果。     

������λ��������ֲ�ٴ�Ч������

目的探讨外伤脱位牙即刻再植的临床疗效及其影响因素。方法选择1993年10月至2005年10月于江西省萍乡市人民医院和广东工业大学医院口腔科就诊的外伤脱位牙患者46例60颗牙进行即刻再植,术后随访观察5年。结果再植牙术后5年成功率为75%,累计有11例15颗再植牙失败,失败原因主要为术后牙根吸收大于根长1/3(占60%)、继发感染(占26.7%)、固定不牢靠(占13.3%)。离体时间<30 min再植牙的牙髓成活率和牙周膜愈合率均高于离体时间>30 min的再植牙,差异有统计学意义(P<0.01)。结论即刻再植外伤脱位牙经适当的临床治疗仍可保留多年,再植成功的关键是严格选择适应证、正确选择离体牙储存介质、尽快植入缩短牙离体时间、尽可能保存牙周膜活性、牢靠的固定结合功能运动和及时有效防治感染。     

ǰ��������������ճ��1������

?? Chemokine stromal cell-derived factor-1??SDF-1??has characteristics of cell migration and is expected to be used in the field of oral tissue repair and regeneration. When the damage occurs in the body's tissues and organs??impaired cells secret and express SDF-1 and recruit bone marrow-derived stem cells or progenitor cells to the injured site??so as to promote the repair of damaged tissue by providing the new blood vessels and cells. This paper summarizes the effect of SDF-1 in oral tissue repair and the direction of future researches of the SDF-1.     

����������1������

牙根内吸收是指根管内发生的进行性病理性吸收，无明显的临床症状，多在X线检查时偶然发现．一般表现为膨出于根管的圆形或卵圆形透射影．有时是根管影像的整体性增宽，严重的牙根内吸收可导致牙齿丧失。     

ȫ�������ʷ�����ȫ������ؽ����Ҳ�1������

釉质发育不全（amelogenesis imperfecta,AI）是一组影响釉质发育的遗传性疾病,由于釉质形成时造釉器的某些功能障碍,导致釉质在厚度、结构和组织上的改变。临床可分为3型：釉质发育不良型（hypoplastic AI,HPAI）,釉质矿化不良型（hypocalcified AI,HCAI）和釉质未成熟型（hypomaturation AI,HMAI）。AI以牙色改变和釉质缺损为主要表现,严重者可伴有颞下颌关节紊乱病（temporomandibular joint disorders,TMD）等。笔者在临床中遇到1例全口乳牙、恒牙严重AI伴TMD病例,现报道如下。     

���Ը�����ȫ�ڸ�������ٴ�Ч������

目的评价磁性附着体在全口覆盖义齿中的临床应用效果。方法对2012年11月至2013年11月于沈阳市和平区牙病防治所就诊的17例牙列缺损患者,以Magfit Ex400/Ex600磁性附着体为固位装置行全口覆盖义齿修复。共制作了22件全口覆盖义齿,使用了52枚磁性附着体。随访6~18个月,对义齿的固位效果进行评价,并对应用磁性附着体后义齿出现的问题进行观察。结果 17例患者的22件全口覆盖义齿,固位效果满意16件、良好4件、改善2件。随访中2例患者出现了龈缘炎、1例患者磁体从义齿中脱落、1例患者义齿树脂托出现裂纹,均经适当处理后义齿继续使用。结论磁性附着体能有效改善全口覆盖义齿的临床修复效果,为患者更好提供舒适性、咀嚼功能等主观感受,有利于牙周组织健康。     

��֢�����������ȫ������1������

尿毒症患者病情复杂,常合并严重的贫血、低蛋白血症、高血压、水电解质紊乱、凝血功能障碍、组织水肿、重要器官功能异常等症状,这就给需要手术治疗的患者的全身麻醉(简称"全麻")带来了挑战[1]。严重尿毒症全麻病例少见,现将我院近期收治的1例报道如下。1病例资料患者女,27岁。于2012-01-31以"口内上腭1     

ǰ��������������ѧ�޸��ٴ�Ч������

??Objective    To evaluate the clinical aesthetic efficacy of ultra-thin veneers for anterior teeth. Methods    Totally 126 anterior teeth of 54 patients were chosen and restored in Department of Prosthodontics??Nanjing Stomatological Hospital between February 2012 and February 2013. Ultra-thin ceramic veneers were made from IPS e.max Press HT ??high translucency?? lithium disilicate glass ceramic ingots??and cemented with light-cured resin cement. Patients were interviewed and examined at 1 month??6 months??1 year??2 years??3 years??4 years and 5 years respectively. The clinical evaluation of ultra-thin ceramic veneers was carried out with reference to the criteria of USPHS from the aspects of secondary caries??marginal suitability??appearance??color match and integrity. Results    Totally 126 anterior teeth were restored with ultra-thin ceramic veneers made of IPS e.max Press. After 1 month??2 veneers ??1.6%?? were B class in color match??and the other indicators were A class. At 6 months??1year and 2 years after restoration??all veneers achieved A class in each evaluation indicator. After 3 years??gap was detected at the margin of 2 veneers ??1.6%????which were B class in marginal suitability. After 4 years??2 veneers ??1.6%?? were C class in integrity with 1mm incisal fracture. At 5 years after restoration??1 veneer ??0.8%?? was C class in integrity with disto-incisal fracture; slight discoloration was observed in 5 veneers ??4.0%????which were B class in color match??and one veneer was lost in follow-up. All the veneers were clinically effective with no sensitivity symptoms??no secondary caries or gingivitis. Conclusion    Ultra-thin ceramic veneers have the advantages of excellent translucency??natural appearance and acceptable marginal suitability??and have been an ideal choice for anterior aesthetic restoration.     

��ϸ���Դ���1������

浆细胞性唇炎（plasma cell cheilitis，PCC）是一种少见的良性非特异性炎症反应性疾病。现将我科诊治的1例报告如下：     

����������ؽ�ǿֱ���������ƽ�չ

外伤性颞下颌关节强直的手术方法主要有裂隙式关节成形术、插入式关节成形术及关节重建术。如何选择正确的手术方法和理想的插入材料,是手术成功的关键。术后有效的早期开口训练也是改善开口度的重要手段。本文就这些方面的新进展做一综述。     

The sequential treatment of temporomandibular joint ankylosis with secondary deformities by distraction osteogenesis and arthroplasty or TMJ reconstruction

The purpose of this study was to evaluate the sequential treatment of patients with temporomandibular joint (TMJ) ankylosis and secondary deformities by distraction osteogenesis and subsequent arthroplasty or TMJ reconstruction. This study included 40 patients treated at a stomatological hospital in China; they ranged in age from 9 to 53 years (mean age 24.5 years). Ten of these patients were diagnosed with unilateral TMJ ankylosis and 30 with bilateral TMJ ankylosis. Twenty-seven patients also presented obstructive sleep apnoea–hypopnoea syndrome (OSAHS). All patients underwent distraction osteogenesis as the initial surgery, followed by arthroplasty or TMJ reconstruction. Some patients underwent orthognathic surgery to improve occlusion and face shape along with or after arthroplasty or TMJ reconstruction. The therapeutic effects were evaluated in terms of the improvements in maximum inter-incisal opening (MIO), appearance, and respiratory function. After the completion of treatment, all patients showed improvements in MIO and appearance, and the symptom of snoring disappeared. The airway space was significantly increased. Patient follow-up ranged from 6 to 85 months (mean 28.3 months), and four patients experienced relapse. This study suggests that treating TMJ ankylosis with secondary deformities by distraction osteogenesis as the initial surgery and arthroplasty or TMJ reconstruction as the second-stage treatment may achieve favourable outcomes, especially for patients with OSAHS; however, some patients may require orthognathic surgery.     

The use of virtual planning and navigation in the treatment of temporomandibular joint ankylosis

Temporomandibular joint ankylosis is not common in our community but can occur as a result of severe facial trauma or significant connective tissue disorders such as rheumatoid arthritis, osteoarthritis and psoriatic arthritis, and unfortunately as a result of iatrogenic causes. Ankylosis surgery is aimed at gap arthroplasty and mobilization of the joints. However, the removal of the bony ankylosis and the production of a gap between the ramus of the mandible and the base of the skull is often difficult because of the size of the ankylosis and the anatomy on the inner aspect of the mandible. As a result of this, the author has found that surgical navigation has been useful with the removal of the ankylosis, both on the medial side of the mandible and the cranial base. Once the ankylosis has been freed and the mandible mobilized, the gap arthroplasty needs to be maintained or the release of the ankylosis will fail and the joints will re‐ankylose. It is important to maintain the space produced by the arthroplasty but this is difficult when autogenous materials such as temporalis muscle, dermis fat and other like materials are used. The gap ultimately closes under the influence of the masseter and medial pterygoid muscles and the ankylosis may return. This case report presents three representative patients in whom ankylosis has been released and the gap reconstructed with a total alloplastic joint replacement. All patients have had their ankylosis removed with the aid of a navigation system and all patients have been reconstructed with bilateral Biomet prosthesis. One patient has had their implant selected using virtual planning and the production of templates to help with placement of the stock implant.     

Condyle-preserved arthroplasty versus costochondral grafting in paediatric temporomandibular joint ankylosis: a retrospective investigation

We aimed to evaluate results of condyle-preserved arthroplasty and costochondral grafting in growing children with temporomandibular joint ankylosis through medium-term follow-up and three-dimensional metric analysis. We assessed 11 patients (14 sides) with type II ankylosis (group A) and 11 patients (13 sides) with type III/IV (group B) from January 2012 to December 2015. Group A patients received condyle-preserved arthroplasty and group B patients received costochondral grafting. Postoperative computed tomography was used to measure condylar height, condylar width, mandibular ramus height and mandibular body length. Changes in maximum mouth opening were evaluated >1 year postoperatively.Postoperative follow-up showed similar average maximum mouth opening and one case of recurrence in each group. Computed tomography measurements showed that condylar width and mandibular ramus height increased in both groups A and B (P < 0.05). Moreover, in group A, condylar angulation of medially displaced malformation decreased by 13.2° (P < 0.05), and mandibular body length increased by 5.7 mm (P < 0.05). Thus, both condyle-preserved arthroplasty and costochondral grafting were effective surgical methods for treatment of temporomandibular joint ankylosis. Moreover, compared with group B, group A patients manifested more remarkable mandibular growth, at least in the anteroposterior direction of the mandibular body.     

计算机辅助外科技术在颞下颌关节疾病治疗中的应用

计算机辅助外科技术已经在口腔颌面外科诸领域（如创伤重建、正颌外科、头颈部肿瘤的切除与重建等）得到广泛应用。其在颞下颌关节疾病治疗中的应用近年来也有很大的发展,例如在颞下颌关节强直骨球的截除、髁突骨折的固定及髁突良恶性肿瘤的切除等方面。本文就此部分内容做一综述。     

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。     

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.     

Gap arthroplasty of temporomandibular joint ankylosis by transoral access: a case series

This article describes a technique of gap arthroplasty in temporomandibular joint (TMJ) ankylosis performed by transoral access. The treatment of TMJ ankylosis by creating an adequate gap is of paramount importance in preventing any future recurrence and this can be achieved only when good access is gained to this complex anatomical joint. Five patients with TMJ ankylosis (eight TMJ) were treated by gap arthroplasty using an intraoral approach. The average mouth opening before surgery was 8.6 mm and the average mouth opening achieved postsurgery was 37.9 mm. The average follow-up time was 13 months and none of the patients had any recurrence or significant complications during or after surgery. Our technique relies on the use of a stable landmark to trace the superior-most extent of the ankylotic mass thereby facilitating the removal of the entire mass including the medial extent. We found that even though transoral access is technically challenging and took an average time of 84 min, it has many advantages over conventional extraoral approaches in terms of facial scars and facial nerve injury. The authors also emphasize the importance of good postoperative physiotherapy and presurgical patient counselling to prevent future recurrences.     

��������������ؽ�ǿֱ19���ٴ��о�

目的观察采用下颌升支垂直截骨上推术治疗真性颞颌关节强直的疗效。方法对2004年12月至2008年5月山西医科大学第一临床医院口腔颌面外科收治的19例真性颞颌关节强直患者采用下颌升支垂直截骨上推术治疗,并按期随诊,监测指标,观察其疗效。结果所有患者张口度均接近或达到正常,无关节疼痛及弹响症状,随访期内无一例复发。结论根据国内外文献及术后观察,下颌升支垂直截骨上推术是治疗真性颞颌关节强直的一种可选择的、有效的方法。     

����ؽ�ǿֱ����̷��������εĽ���

颞下颌关节强直继发畸形临床表现复杂多样,是口腔颌面整复外科领域内颇具挑战的一类疾病。近年来,运用多种矫治方法来恢复关节功能,改善容貌缺陷,矫正咬合紊乱以期获得形态与功能俱佳的治疗效果是诊治此类严重畸形的终极目标。目前,临床上综合运用关节成形术、正颌外科与正畸联合、牵张成骨、轮廓整形外科、骨或骨替代材料移植等技术来矫治此类继发畸形,获得了较为满意的治疗效果。