一种国产牙种植体5年临床效果评价

目的:评价一种国产牙种植体临床应用效果。方法:按纳入标准收集32例种植修复单颗牙缺失的患者,共植入38枚种植体,随访5年,通过临床检查及X线影像学检查,参照Albrektsson种植体成功标准,评价该牙种植体临床应用效果。结果:种植修复后,随访5年,32例患者无不适主诉,38枚种植体无松动、脱落、断裂,周围黏膜无急慢性炎症;种植体与骨组织结合良好,种植修复5年时,种植体颈部边缘骨平均吸收高度为0.63 mm (SD:0.30; range:0.33～0.93),5年成功率达100%。结论:该牙种植体具有良好的骨结合力和较少的颈部边缘骨吸收。     

增强钛种植体表面亲水性能研究进展

骨内种植体修复缺失牙已成为具有大量证据支持的治疗方法。种植技术的理论基础是骨结合,即种植体表面与周围活骨的直接连接,种植体材料表面特性则是影响种植体骨结合生物学过程的重要影响因素 。近年来,研究者们通过各种方法修饰种植体的表面特性,如改变表面形态、结构、化学性能和亲水性等,以促进骨结合的速度。目前,通过提高钛种植体表面的亲水性能从而促进骨结合已成为研究热点之一。本文就提高钛种植体表面性能,尤其是亲水性能的研究现状进行综述。     

糖尿病缺牙修复研究现状与临床

目的:如何提高糖尿病缺牙患者种植体的成功率,特别是远期成功率一直是最近几年国内外学者研究的热点。基于此问题,本次讲课内容将结合文献和我们课题组的研究结果与同行交流,便于大家更好地去认识这一种植临床问题,并提高糖尿病缺牙患者种植的成功率。方法:从国内外研究现状、发展动态及种植修复临床要点来总结分析。结果:目前的研究认为,糖尿病会导致种植体周围骨组织形成减少,种植体植入后骨结合形成不完全,愈合时间长,新生骨不成熟,缺乏有机物,与无糖尿病新生骨差别较大;即使能在局部形成部分骨结合,但却无法进行功能性修复,远期成功率明显降低;虽然局部进行胰岛素干预可以提高种植体周围骨形成,但是种植体骨结合率尚没有得到明显的改善。需要重视并采用更多的方法来研究。讨论:种植义齿修复已经成为最理想口腔缺牙和颌骨缺损的修复方式,但是在临床工作中许多系统疾病均能影响种植体骨结合的发生,极大地限制了种植体技术的推广应用,特别是糖尿病(Diabetes Mellitus,DM),其种植体骨结合失败率显著高于普通人群。同时,需要种植牙的糖尿病患者牙槽骨往往伴有水平或垂直骨缺损,常规植骨材料效果不理想,植骨后再种植愈合效果差。而脂肪干细胞的应用则获得了积极结果。结论:提高糖尿病缺牙患者种植体骨结合成功率是亟待研究解决的口腔种植临床课题。     

牙种植体即刻种植骨愈合过程的组织学观察

目的：了解即刻种植体的骨愈合过程，验证即刻种植的可行性。方法：在１２只犬下颌前磨牙新鲜拔牙创内立即植入纯钛牙种植体，通过组织学光镜和扫描电镜观察术后２、４、６、８、１２周种植体周围骨缺损修复过程和种植体骨结合形成情况。结果：骨缺损区内血块首先机化，而后沿牙槽窝骨壁向中心方向逐渐骨化形成新骨。小于１ｍｍ骨缺损１２周内可完全修复，种植体骨结合形成；１ｍｍ以上骨缺损则不能完全修复。结论：即刻种植体周围骨缺损的修复和骨结合形成类似于拔牙创的愈合，大于１ｍｍ的骨缺损应争取植骨。     

即刻种植修复的临床研究

目的评价种植术后即刻修复的临床效果。方法单颗牙缺失,牙槽嵴高度及宽度足够的患者12例,植入种植体,要求种植体植入扭力大于40Ncm,即刻取模,术后3d戴入临时冠,3～6个月后改为烤瓷冠永久修复,定期进行临床及X线片观察,观察种植体的动度、种植体周骨结合情况及边缘骨吸收量。结果12颗种植体均已完成金属烤瓷冠修复,经15～26个月的追踪观察,种植体无一松动或脱落,X线显示种植体骨结合良好,种植体植入后1年种植体周骨高度丧失(0.75±0.22)mm。结论若缺失区骨质情况良好,单牙种植即刻修复可获得满意的近期临床效果。     

上颌窦提升植骨同期牙种植的临床疗效

目的 研究上颌窦提升术后同期植入种植体的临床效果.方法 对15例38颗垂直骨量不足的上颌后牙行上颌窦提升植骨同期牙种植,种植体上部结构修复完成后6～36个月定期复查.结果 观察期内,除1颗种植体由于(牙合)力负荷过大松动脱落外,其余种植体与周围组织均形成良好的骨性结合,能行使较好的咀嚼功能.结论 掌握上颌窦提升植骨同期牙种植的适应证和手术技巧,灵活选择种植系统,短期效果良好,长期效果有待追踪.     

SLA表面种植体修复牙列缺损8年疗效观察

目的:评价SLA表面种植体固定修复牙列缺损的8年临床应用效果.方法:对130例在烟台市口腔医院种植科要求种植修复牙列缺损的患者,植入SLA表面处理种植体191颗,定期临床及放射学检查,记录种植体存留率、成功率、种植体周围软、硬组织状况及上部结构的稳定性.采用SPSS 17.0软件包对数据进行统计学分析.结果:24例患者的31颗种植体失访,1颗种植体在术后5个月时因松动取出,4颗种植体出现种植体周围炎,种植体失访率、存留率、成功率分别为18.46％、99.38％和96.88％.种植成功的155颗种植体,8年内未出现明显的生物学并发症,种植体边缘骨吸收平均为(1.34±0.52)mm.8年内共25颗种植体出现螺丝松动、冠脱落、崩瓷、种植体折断等机械性并发症,修复体成功率为83.87％.结论:SLA表面种植体不仅能够达到较好的骨结合,而且种植体周围软组织及上部结构能够长期保持健康稳定的状态,临床应用效果较好.     

应用共振频率评估种植体稳定性的临床研究

目的：应用共振频率分析评估牙种植体初期稳定性和预测牙种植俸骨结合．为上颌窭提升植骨同期植入种植体和种植体早期暴露的临床应用提供客观依据方法：36个病人共植入87颗牙种植体，分为3组，A组种植体早期暴露组；B组上颌宴提升植骨同期种植组；C组常规种植组即对照组在种植体植入即刻、二期暴露或修复负重前测定种植体稳定性，每一颗种植体前后测定2次测定使用的仪器是共振频率分析仪Osstell，其数值单位是ISQ.结果：三组种植体初期稳定性数值范围是5492—80．20ISQ A组初期稳定性值最高，和其他两组之间的差异存在显著性.R组和C组之间差异没有统计学意义骨结合形成后稳定性范围在57．94—79．38ISq三组种植体的后期稳定性之间差异没有统计学意义.A组和B组初期稳定性和骨结合形成后的稳定性数值前后没有差异，C组前后稳定性差异有统计学意义.结论：共振频率分析牙种植体初期稳定性和预测骨结合是一种可靠而有效的方法，同时也提示种植体早期丞露和上颌宴提升植骨同期种植术对具有适应症的病例是可行的.     

骨质疏松状态下不同种植体表面涂层改性技术对种植体骨结合的影响

钛及钛合金种植体广泛应用于牙列缺损和缺失的修复。骨质疏松患者由于种植体骨结合不良和初期稳定性不佳，存在较高的失败风险。因此，探究骨质疏松状态下如何促进种植体骨结合具有重要的临床意义。近年来关于骨质疏松状态下不同种植体表面涂层改性的研究主要可分为无机材料、生物分子、金属材料、中药类涂层以及具有治疗效果的药物涂层五大类。各类涂层改性的作用机制和生物学效果不尽相同，本文将对骨质疏松状态下不同种植体表面涂层改性技术对种植体骨结合的影响进行分析综述。     

天然牙-种植体联合修复上前牙区多牙缺失探讨

目的评价天然牙-种植体联合固定修复上前牙区多牙缺失的临床效果。方法上前牙区多牙缺失牙槽骨骨量不足或基牙分布不均、要求种植固定修复的17例患者,行骨劈开引导骨组织再生术,同期植入Strau-mann种植体共41颗,术后6～9个月采用天然牙与种植体联合支持的固定义齿修复。随访3～24个月,行X线和临床检查。结果术后上前牙区牙槽嵴唇舌向宽度平均增加2.3mm,1例患者的1颗种植体松动,其余16例患者的40颗种植体形成良好的骨整合,X线检查见天然牙及种植体周围垂直向骨吸收每年不超过0.2mm。结论严格筛选适应证,应用骨劈开引导骨再生术同期植入种植体,延期行天然牙-种植体联合固定修复上前牙缺失短期效果评价较为满意。     

The role of Vitamin D as an adjunct for bone regeneration: A systematic review of literature

Background and objectivesIn spite of bone’s healing capacity, critical-size bone defect regeneration and peri-implant osseointegration are challenging. Tissue engineering provides better outcomes, but requires expensive adjuncts like stem cells, growth factors and bone morphogenic proteins. Vitamin D (Vit.D) regulates calcium and phosphorus metabolism, and helps maintain bone health. Vit.D supplements in deficient patients, accentuates bone healing and regeneration. Therefore the aim of this systematic review was to evaluate the role of adjunctive Vit.D on bone defect regeneration.MethodsComprehensive database search of indexed literature, published between January 1990 and June 2022, was carried out. English language articles fulfilling inclusion criteria (clinical/in vivo studies evaluating bone regeneration including osseointegration and in vitro studies assessing osteogenic differentiation, with adjunct Vit.D) were identified and screened.ResultsDatabase search identified 384 titles. After sequential title, abstract and full-text screening, 23 studies (in vitro – 9/in vivo – 14) were selected for review. Vit.D as an adjunct with stem cells and osteoblasts resulted in enhanced osteogenic differentiation and upregulation of genes coding for bone matrix proteins and alkaline phosphatase. When used in vivo, Vit.D resulted in early and increased new bone formation and mineralization within osseous defects, and better bone implant contact and osseointegration, around implants. Adjunct Vit.D in animals with induced systemic illnesses resulted in bone defect regeneration and osseointegration comparable to healthy animals. While systemic and local administration of Vit.D resulted in enhanced bone defect healing, outcomes were superior with systemic route.ConclusionsBased on this review, adjunct Vit.D enhances bone defect regeneration and osseointegration. In vitro application of Vit.D to stem cells and osteoblasts enhances osteogenic differentiation. Vit.D is a potentially non-invasive and inexpensive adjunct for clinical bone regeneration and osseointegration. Long term clinical trials are recommended to establish protocols relating to type, dosage, frequency, duration and route of administration.     

Osseointegration: An Update

Osseointegration, defined as a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant, is critical for implant stability, and is considered a prerequisite for implant loading and long-term clinical success of end osseous dental implants. The implant–tissue interface is an extremely dynamic region of interaction. This complex interaction involves not only biomaterial and biocompatibility issues but also alteration of mechanical environment. The processes of osseointegration involve an initial interlocking between alveolar bone and the implant body, and later, biological fixation through continuous bone apposition and remodeling toward the implant. The process itself is quite complex and there are many factors that influence the formation and maintenance of bone at the implant surface. The aim of this present review is to analysis the current understanding of clinical assessments and factors that determine the success & failure of osseointegrated dental implants.     

骨免疫微环境在种植体骨结合中的作用

种植体骨结合是多细胞多因子参与的动态过程,种植体-骨结合界面的成骨、破骨反应一直是口腔种植学领域的重要关注点。随着骨免疫学的发展,研究发现骨的免疫微环境在骨结合的建立和长期维持中发挥了重要作用。一系列免疫细胞通过趋化因子、细胞因子调控种植体周骨组织的修复,良好的免疫微环境可以促进组织的愈合和再生,达到更理想的骨结合效果。如何通过骨免疫调节种植体骨结合治疗种植体周炎,在口腔种植学的研究中逐渐受到关注。该文就种植体骨结合形成中的免疫应答过程作一综述。目前研究巨噬细胞的文献较多,而对其他免疫应答细胞的阐述较少,免疫细胞与种植体之间的应答反应机制仍有很多问题尚待阐明。     

Mineralization at the interface of implants

Osseointegration of implants is crucial for the long-term success of oral implants. Mineralization of the bone's extracellular matrix as the ultimate step of a mature bone formation is closely related to implant osseointegration. Osteogenesis at oral implants is a complex process, driven by cellular and acellular phenomena. The biological process of the maintenance and emergence of minerals in the vicinity of oral implants is influenced to a great extent by biophysical parameters. Implant-related structural and functional factors, as well as patient-specific factors, govern the features of osteogenesis. To understand the influence of these factors in peri-implant bone mineralization, it is important to consider the basic biological processes. Biological and crystallographic investigations have to be applied to evaluate mineralization at implant surfaces at the different hierarchical levels of analysis. This review gives insight into the complex theme of mineral formation around implants. Special focus is given to new developments in implant design and loading protocols aimed at accelerating osseointegration of dental implants.     

Surface treatments of titanium dental implants for rapid osseointegration.

The osseointegration rate of titanium dental implants is related to their composition and surface roughness. Rough-surfaced implants favor both bone anchoring and biomechanical stability. Osteoconductive calcium phosphate coatings promote bone healing and apposition, leading to the rapid biological fixation of implants. The different methods used for increasing surface roughness or applying osteoconductive coatings to titanium dental implants are reviewed. Surface treatments, such as titanium plasma-spraying, grit-blasting, acid-etching, anodization or calcium phosphate coatings, and their corresponding surface morphologies and properties are described. Most of these surfaces are commercially available and have proven clinical efficacy (>95% over 5 years). The precise role of surface chemistry and topography on the early events in dental implant osseointegration remain poorly understood. In addition, comparative clinical studies with different implant surfaces are rarely performed. The future of dental implantology should aim to develop surfaces with controlled and standardized topography or chemistry. This approach will be the only way to understand the interactions between proteins, cells and tissues, and implant surfaces. The local release of bone stimulating or resorptive drugs in the peri-implant region may also respond to difficult clinical situations with poor bone quality and quantity. These therapeutic strategies should ultimately enhance the osseointegration process of dental implants for their immediate loading and long-term success.     

Needs and current research directions of biological regenerative medicine in prosthodontic practice--to attain reliable and sophisticated dental implant therapy

Appropriate dental implants are known to improve the quality of life in totally and partially edentulous patients, as well as to prevent future tooth loss, and so prosthetic treatment modalities have drastically changed recently with reconstruction therapy. However, dental implant therapy did not win the confidence of the dental community in the early developmental stage, until osseointegration between titanium and surrounding bone tissue was discovered and the modality utilizing osseointegration became reliable and produced durable treatment outcomes for long-term function. On the other hand, the biological mechanism of osseointegration has not been clarified yet and the time required for osseointegration is still long, e.g. three to four months. As well, when the implant is applied in the upper posterior region, the acquisition of osseointegration and the long-term survival of the implant are still not clinically adequate. Therefore, to reduce the time required for osseointegration and to regenerate enough alveolar bone mass in the target implantation site, the oral implant modality must be made more useful and potent as one of the treatment options for partial and total edentulism. With this background, we have studied biological strategies for reducing the time required for osseointegration and for regenerating enough alveolar bone mass, e.g., investigation of the specific genes for osseointegration between titanium and bone, nano-level surface modification of the titanium, biodegradable apatite foam for alveolar bone regeneration, application of bone formation-related growth factors with biological scaffold, and autologous cell transplantation of bone marrow derived mesenchymal stem cells. In this article, we review the current status of regenerative medicine being applied in prosthodontics and discuss our future research direction.     

Laminin coatings on implant surfaces promote osseointegration: Fact or fiction?

To our knowledge from indexed literature, the role of laminins in the expression of osteogenic biomarkers and osseointegration enhancement has not been systematically reviewed. The aim of the present systematic review was to assess the role of laminin coatings on implant surfaces in promoting osseointegration. To address the focused question, “Do laminin coatings on implant surfaces influence osseointegration?”, indexed databases were searched from 1965 up to and including November 2015 using various combination of the following keywords: “Bone to implant contact”; “implant”; “laminins”; and “osseointegration”. Letters to the Editor, case-reports/case-series, historic reviews, and commentaries were excluded. The pattern of the present systematic review was customized to primarily summarize the pertinent data. Nine studies were included. Six studies were prospective and were performed in animals and 5 studies were in vitro. Results from 8 studies showed that laminin coatings enhanced new bone formation around implants and/or bone-to-implant contact. One study showed that laminin coated implants surfaces did not improve osseointegration. On experimental grounds, laminin coatings seem to enhance osteogenic biomarkers expression and/or osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the role of laminin coatings in promoting osseointegration around dental implants.     

口腔干细胞成骨分化过程中非编码RNA作用的研究进展

应用口腔种植技术能够有效修复牙列缺损和牙列缺失。与传统修复方法相比,种植体更加美观、固位力强、咀嚼效率高、异物感小,并且可延缓牙槽骨的吸收。参与种植修复过程的口腔特有的干细胞具有快速增殖、迁移、成骨分化及矿化能力,其中成骨分化能力是影响种植体骨结合稳定程度的一个关键因素,直接影响口腔修复进程。非编码RNA（non-coding RNA,ncRNA）是一类不具备编码功能的RNA,其可在转录及转录后水平调控多种细胞的成骨分化。目前报道较多的ncRNA主要有微小RNA（microRNA,miRNA）、长链非编码RNA（long non-coding RNA,lncRNA）和环状RNA（circular RNA,circRNA）。文章对成骨分化过程中ncRNA作用的研究进展进行综述。     

Implant Osseointegration in Circumferential Bone Defects Treated with Latex‐Derived Proteins or Autogenous Bone in Dog's Mandible

Background: In sites with diminished bone volume, the osseointegration of dental implants can be compromised. Innovative biomaterials have been developed to aid successful osseointegration outcomes. Purpose: The aim of this study was to evaluate the osteogenic potential of angiogenic latex proteins for improved bone formation and osseointegration of dental implants. Materials and Methods: Ten dogs were submitted to bilateral circumferential defects (5.0 × 6.3 mm) in the mandible. Dental implant (3.3 × 10.0 mm, TiUnite MK3?, Nobel Biocare AB, Göteborg, Sweden) was installed in the center of the defects. The gap was filled either with coagulum (Cg), autogenous bone graft (BG), or latex angiogenic proteins pool (LPP). Five animals were sacrificed after 4 weeks and 12 weeks, respectively. Implant stability was evaluated using resonance frequency analysis (Osstell Mentor?, Osstell AB, Göteborg, Sweden), and bone formation was analyzed by histological and histometric analysis. Results: LPP showed bone regeneration similar to BG and Cg at 4 weeks and 12 weeks, respectively (p ≥ .05). Bone formation, osseointegration, and implant stability improved significantly from 4 to 12 weeks (p ≤ .05). Conclusion: Based on methodological limitations of this study, Cg alone delivers higher bone formation in the defect as compared with BG at 12 weeks; compared with Cg and BG, the treatment with LPP exhibits no advantage in terms of osteogenic potential in this experimental model, although overall osseointegration was not affected by the treatments employed in this study.