颞下间隙感染致髁状突破坏的病例报告

颌面部间隙感染目前仍然是口腔颌面外科的常见多发病。随着抗生素的普遍使用,口腔颌面间隙感染发病率呈上升趋势。由于颌面部特殊的解剖结构,颌面间隙感染的并发症较多且危险。预防颌面感染并发症成为治疗颌面间隙感染的治疗的关键。颌面间隙感染并发髁状突破坏在国内外鲜有报道,本文将报道1例颞下间隙感染并发髁状突破坏的病例,并对国内外文献进行回顾。     

髁突、颞骨多发性巨细胞修复性肉芽肿1例报道

巨细胞修复性肉芽肿（giantcellreparativegranuloma,GCRG）是一种少见的非肿瘤性病变,具有局部侵袭性,容易误诊为骨巨细胞瘤。巨细胞修复性肉芽肿又称巨细胞肉芽肿,多发性更为少见。笔者近收治1例左髁突及颞骨多发性巨细胞修复性肉芽肿,报道如下：病例报告患者女性,48岁,2001年4月20日收入院。因左颞部反复疼痛不适1年余,外院曾诊断为“神经痛”,经营养神经药物治疗,疗效不佳,无外伤史。临床检查：左颞部关节区稍膨隆,可及一2.5cm×2cm大小肿块,界不清,触痛。关节动度可,张口度3.5cm。CT示左髁突及相邻颞骨呈多囊状改变,…     

Simplified Technique for Incorporating a Metal Mesh into Record Bases for Mandibular Implant Overdentures

Mandibular implant‐retained overdentures have become the standard of care for patients with mandibular complete edentulism. As part of the treatment, the mandibular implant‐retained overdenture may require a metal mesh framework to be incorporated to strengthen the denture and avoid fracture of the prosthesis. Integrating the metal mesh framework as part of the acrylic record base and wax occlusion rim before the jaw relation procedure will avoid the distortion of the record base and will minimize the chances of processing errors. A simplified method to incorporate the mesh into the record base and occlusion rim is presented in this technique article.     

Influence of Metal Guide Sleeves on the Accuracy and Precision of Dental Implant Placement Using Guided Implant Surgery: An In Vitro Study

Purpose

Metal sleeves are commonly used in implant guides for guided surgery. Cost and sleeve specification limit the applications. This in vitro study examined the differences in the implant position deviations produced by a digitally designed surgical guide with no metal sleeve in comparison to a conventional one with a metal sleeve.

Materials and Methods

The experiment was conducted in two steps for each step: n = 20 casts total, 10 casts each group; Step 1 to examine one guide from each group with ten implant placements in a dental cast, and Step 2 to examine one guide to one cast. Implant placement was performed using a guided surgical protocol. Postoperative cone-beam computed tomography images were made and were superimposed onto the treatment-planning images. The implant horizontal and angulation deviations from the planned position were measured and analyzed using t-test and F-test (p = 0.05).

Results

For Step 1 and 2, respectively, implant deviations for the surgical guide with sleeve were –0.3 ±0.17 mm and 0.15 ±0.23 mm mesially, 0.60 ±1.69 mm, and –1.50 ±0.99 mm buccolingual at the apex, 0.20 ±0.47 mm and –0.60 ±0.27 mm buccolingual at the cervical, and 2.73° ±4.80° and –1.49° ±2.91° in the buccolingual angulation. For Step 1 and 2, respectively, the implant deviations for the surgical guide without sleeve were –0.17 ±0.14 mm and –0.06 ±0.07 mm mesially, 0.35 ±1.04 mm and –1.619 ±1.03 mm buccolingual at the apex, 0.10 ±0.27 mm and –0.62 ±0.27 mm buccolingual at the cervical, and 1.73° ±3.66° and –1.64° ±2.26° in the buccolingual angulation. No statistically significant differences were found in any group except for mesial deviation of the Step 2 group (F-test, p < 0.001).

Conclusions

A digitally designed surgical guide with no metal sleeve demonstrates similar accuracy but higher precision compared to a surgical guide with a metal sleeve. Metal sleeves may not be required for guided surgery.     

Prospective Clinical Trial Evaluating a New Implant System for Implant Survival,Implant Stability and Radiographic Bone Changes

Background: There are a few prospective studies reporting on new implant systems. When a new implant is brought to market, prospective trials should be carried out to determine the predictability of that system. Purpose: This prospective study evaluates implant survival, Resonance Frequency Analysis (RFA), and crestal bone level changes for a new implant system (Neoss System, Bimodal surface, Neoss Ltd, Harrogate, UK). Materials and Methods: Seventy‐six patients, 38 females (age ranging from 23 to 57 years) and 38 males (ranging in age from 17 to 85 years) received 100 Neoss implants. Patients were consecutively enrolled in the study if they were missing one or more teeth in either arch, or a single tooth was scheduled for removal and immediate implant replacement. Evaluated implants were 4, 4.5, or 5 mm wide and were 7, 9, 11, 13, or 15 mm long. A one‐stage approach was followed. At first stage and prior to healing abutment placement RFA measurements were taken. Measurements were retaken at second stage. Fifty‐one implants were placed for restoration of single missing teeth and 49 were for short span implant bridges. Results: The cumulative survival rate at 1‐ to 2‐year interval was 93%. Average initial RFA measurement for all implants was 72.06, while the average final score was 72.58. These changes were not statistically significant. Changes in RFA scores for maxillary implants were insignificant. Forty‐two paired mandibular RFA measurements were evaluated. Initial and final mean mandibular RAF measurements were 73.65 (SD 9.203) and 77.186 (SD 6.177), respectively. These changes were statistically significant (p = .02). Sixty‐four paired radiographs were available for evaluation. Between examinations, there was an average –0.6 mm of bone loss, which was statistically significant (p = .03). On average, 4.0‐mm‐wide implants lost 0.1 mm of bone when compared with 5‐mm‐wide implants. These differences were insignificant (p = .86). Bone loss was adjusted for implant length, and tooth position and there were small, but clinically insignificant changes. Five‐millimeter‐wide implants lose 0.2 mm more than 4.0‐mm‐wide implants (p = .7). Maxillary incisors lose the least amount of bone 0.152 (p = .33). Conclusions: The implants tested in this study had initially high RAF readings, indicating good primary stability. RFA readings for implants placed in the mandible improved from baseline and the changes were statistically significant. Marginal bone levels revealed clinically insignificant bone loss from implant installation to second stage. Loss of seven implants with initially high RFA readings is surprising.     

髁状突游离再植治疗颞下颌关节髁突颈部骨折的临床研究

目的:探讨髁状突游离再植重建颞下颌关节治疗髁突颈部骨折的方法与疗效.方法:15例17侧髁突颈部骨折患者行髁状突游离再植鈦板复位固定的治疗,术后定期复查患者颞下颌关节功能和X线片检查.结果:患者术区伤口均一期愈合,追踪1～5年颞下颌关节无疼痛、弹响及明显功能障碍,2例面神经颞支有影响,1例轻度错牙合畸形. 结论:本法操作简单易行、复位准确、固定可靠,并发症少,适用于移位的髁突颈部骨折.     

Complications in treatment of a mandibular defect with a Silastic implant.

Failure of a previously published Silastic implant technique in the treatment of facial asymmetry has been reported. It is a clinician's obligation to report failures as well as successes in the treatment of the oral surgical patient so that other practitioners are not misguided.     

Joint Distraction and Condyle Advancement with a Modified Functional Distraction Appliance

When the disk of the temporomandibular joint is displaced anteriorly, a functional distraction appliance (FDA) is often helpful to gently distract the joint, allowing it to return to its normal physiology. This article describes the construction of a modified FDA and discusses its use in treatment procedures that bring about condylar advancement, thus helping the disk return to its normal position.     

Aneurysmal Bone Cyst, a Lesion of the Mandibular Condyle

Benign and malignant tumors of the temporomandibular joint are rare. An aneurysmal bone cyst (ABC) of the condyle is even more unusual and usually presents as a slowly enlarging firm swelling which occasionally may be associated with pain and tenderness. Surgical curettage or excision is the treatment of choice, in an attempt to reduce the potential problem of recurrence; we undertook surgical resection of the affected bone. Immediate mandibular reconstruction using autologous bone was deferred though it is generally recommended in such type of cases.