激光在牙种植术中的应用

随着激光技术在口腔科学领域中的广泛应用,一些牙科激光在种植义齿中的作用越来越受到人们重视。本文就常用牙科激光在种植体表面清洁、种植体周围软组织处理中的作用以及激光热效应对种植体周围骨组织的影响作一综述。     

激光在牙种植术中的应用

随着激光技术在口腔科学领域中的广泛应用，一些牙科激光在种植义齿中的作用越来越受到人们重视。本文就常用牙科激光在种植体表面清洁、种植体周围软组织处理中的作用以及激光热效应对种植体周围骨组织的影响作一综述。     

Mx-grafter在即刻牙种植术中的临床应用

目的 :评价在即刻牙种植术中用Mx grafter采取上颌结节处自体骨移植的应用方法和效果。方法 :2 1例 (2 5枚 )拔牙后即刻种植 ,采用Mx grafter由上颌结节处取自体骨 ,植入螺纹根状种植体与拔牙窝之间的间隙内或缺损处。骨的缺损情况在 1期手术和 2期手术时分别测量进行比较。结果 :3～ 4月后 ,2期手术显示自体骨改建形成了新骨 ,与种植体形成紧密的骨性结合 ,间隙或缺损被新骨修复。所有病例皆完成修复及行使功能。结论 :采用Mx grafter取自体骨植骨 ,满足了拔牙后即刻种植、植骨的需要。方法简单 ,值得临床推广。     

骨膨胀技术在牙种植术中的运用

1　材料与方法1.1　病历资料　本科行种植牙患者 30名 ,其中男 18名 ,女12名 ,年龄 16～ 5 2岁 ,平均年龄 30 .4岁。 48个牙位 ,46颗已完成金属基底烤瓷冠修复 ,负荷 1～ 3年。1.2　种植体及骨膨胀工具　华西医科大学、卫生部口腔种植科技中心提供ＣＤＩＣ柱状种植体 ,长度分别为 10ｍｍ、12ｍｍ、13ｍｍ ;直径分别为 4.5ｍｍ、5 .0ｍｍ ;骨膨胀工具使用似锥状种植体的锥攻 ,直径为 3.6～ 3.8ｍｍ。1.3　手术方法　局部浸润麻醉下 ,按术前的定点标志用环形刀切开牙槽嵴粘膜 ,先用先锋钻钻穿骨皮质 ,然后用裂钻按牙体长轴方向缓慢钻入牙槽骨 …     

锥束CT在牙种植术中的应用

目的：初步评价CBCT在口腔种植中应用的价值。方法：应用普兰梅卡锥束CT,对134例患者颌骨拟手术部位进行CBCT扫描,获得三维图像,。结果：CBCT正确指导了100例202个区域的牙种植术,为种植体直径、长度、植入轴向及手术方法的选择提供了准确的依据,并成功完成了种植及辅助手术。结论：CBCT在口腔种植术前检查、诊断,治疗计划的制定中均起关键作用,增加种植体植入的准确性,降低手术风险和并发症的发生率,极大的提高了种植的成功率。     

牙槽骨劈开术在上前牙种植术中的应用

牙槽骨劈开术在上前牙种植术中的应用广东省口腔医院种植科（５１０２６０）张开宜李静在行上颌前牙种植术时，常因牙槽骨唇舌向的厚度不足而给手术带来困难，其原因多由拔牙时损伤太大或拔牙时间太长，牙槽骨吸收较多之故。术前测量牙槽骨厚度约为４ｍｍ左右，拟将最小直...     

笑气吸入在牙种植术中的镇静效果观察

目的评价笑气吸入加局部麻醉用于牙种植术的临床镇静效果。方法行牙种植术的患者100例,分成2组,试验组30例使用笑气加局部麻醉,对照组70例单独使用局部麻醉。牙种植术中测量患者的心率、呼吸频率及血氧饱和度。牙种植术后,调查2组患者对牙种植术的感受,并进行Ram say镇静评分。结果 2组患者的心率（t=5.468）、呼吸频率（t=5.724）差异有统计学意义（P〈0.05）,血氧饱和度（t=1.214）差异无统计学差异（P〉0.05）。Ram say镇静评分差异有统计学意义（Z=6.144,P〈0.001）。结论笑气吸入有利于患者缓解牙种植术中的紧张情绪,在牙种植术中取得满意的临床效果。     

超声骨刀在上颌窦底提升牙种植术中的应用

在上颌磨牙区牙槽骨高度不足的情况下,种植牙修复上颌后牙,常常需要提升上颌窦底黏膜。相比于传统的提升器械,超声骨刀在上颌窦底提升技术上,显示出明显的优势。超声骨刀刀头特有的切割方式可使其在切割过程中不损伤软组织,可调节的超声震动频率和骨切割时超声水流的冲击作用,也可显著降低上颌窦黏膜穿孔的发生率。本文就超声骨刀的工作原理、及在上颌窦底提升技术中的临床应用等作一介绍。     

CDIC牙种植术（二）

１与人工牙种植术有关的辅助手术在人工牙种植术前后 ,有时根据患者的局部解剖条件和种植义齿设计制作要求 ,需要辅助进行失牙区唇 (颊 )侧植骨、前庭沟加深、系带修整、上颌窦升高、下牙槽神经解剖等手术 ,简介如下。１．１失牙区唇 (颊 )侧植骨术本手术主要对象为牙槽骨的高度适合作牙种植术 ,但唇 (颊 )侧骨质有较多缺失 ,牙槽骨厚度不足的病例。手术主要目的是恢复失牙区牙槽骨唇(颊 )侧的丰满度 ,增加牙槽骨的强度 ,同时 ,亦为骨内的种植体提供支持。有时 ,采用骨膨胀术亦可将种植体按要求植入 ,但因唇 (颊 )侧牙槽骨厚度不足 ,丰满度…     

CDIC~R牙种植术(一)

对于每一位牙缺失患者来说,口腔医师所面临的根本问题归根到底是:为患者重建一个正常的咬合关系。而种植义齿修复技术为达到这一目的提供了简便而又可靠的保障。高质量的口腔种植义齿修复技术包括:医患之间的沟通,详细的病史采集,全面的检查以及制定一个完整、合理的口腔种植义齿修复治疗方案。在获得患者的同意后,医师将按照治疗方案分阶段逐步实施,完成口腔种植义齿的修复。ＣＤＩＣ种植体系列包括锥状、叶状和柱状螺纹等三大类型种植体,可适用于多种牙缺失的修复。本文主要介绍口腔种植义齿修复技术中的外科学部分的有关内容。１人工牙种…     

Management of patients with trigeminal nerve injuries after mandibular implant placement

BACKGROUND: Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves. All dentists who place mandibular implants should be aware of the appropriate early management of these injuries, as well as the appropriate time to refer patients with these injuries to a microneurosurgeon. OVERVIEW: The lingual nerve is less likely to undergo spontaneous regeneration than is the inferior alveolar nerve, which is protected within the inferior alveolar canal. Since the inferior alveolar canal can be seen on most panoramic radiographs and on all high-quality computed tomographic scans, it is easier to avoid damage to the inferior nerve than to the lingual nerve, which is not visualized on radiographs and whose relationship to the posterior portion of the mandible varies from person to person. RESULTS: The authors reviewed one study that showed that lingual nerve repair helped 90 percent of patients. A second study found that patients who underwent lingual nerve repair reported a mean score of 7 on a scale from 0 to 10 in regard to the postoperative return of nerve function. Several other studies reported favorable patient responses to inferior alveolar nerve repair. CONCLUSIONS AND CLINICAL IMPLICATIONS: These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur. Failure to refer patients with trigeminal nerve injury before distal nerve degeneration develops prevents minimization of the injury through microneurosurgical repair.     

Nerve injury following implant placement: prevention, diagnosis and treatment modalities

Nerve injury is a well-known complication following oral and maxillofacial surgery. Direct trauma, inflammation and infection are postoperative neural disturbances main causes. The most inflicted nerves associated with endosseous implant placement are those innervating the mandible: the inferior alveolar nerve, the mental nerve and the lingual nerve. Evaluation of the nerve injury characteristics and severity as early as possible has always imposed a great challenge for clinicians. We demonstrate a reliable yet simple way of dealing with this kind of problem in conjunction with comparing preoperative and postoperative sensation of the chin, the tongue and the lower lip. On the other hand, it is considerably important to take preventive measures for such injuries by using appropriate radiographic images. If a nerve damage has occurred, best prognosis is to be expected by early and appropriate treatment. It is imperative to treat such injuries in four months following the injury, otherwise a permanent nerve damage may occur. Further investigation of nerve damage risks following implant placement should be performed in order to enable patient to decide whether having implants dependent rehabilitation or choosing an alternative.     

Bone defect formation during implant placement following alveolar distraction

PURPOSE: This retrospective study was designed to evaluate the volume of hard tissue generated at the time of implant placement in distracted alveolar bone. MATERIALS AND METHODS: All patients who underwent distraction osteogenesis between 2000 and 2003 were included. The preoperative bone height, amount of distraction performed, and presence or absence of complications affecting implant placement were recorded. The augmentation achieved was correlated with insufficient bone formation using the Spearman correlation and the Fisher exact test. RESULTS: The study included 43 implants placed in 17 cases of alveolar distraction. Of the 34 implants placed in bone augmented by 4.5 to 6.5 mm, bone defects were observed with 12. All 9 implants placed in ridges augmented by 7 to 10.5 mm demonstrated a bone defect. The "defect" and "no-defect" implant groups differed significantly with respect to preoperative bone height and amount of distraction performed (P < .001 for both). Significantly more defects were formed in bone augmented by > 25% compared to bone augmented by < 25% (P < .001). CONCLUSIONS: When considering distraction osteogenesis, augmentation of up to 25% of the initial bone height seems more predictable and less likely to be associated with complications at the time of implant placement. In distractions greater than 25% of the original height, additional treatment should be considered.     

Flapless dental implant placement

Flapless dental implant placement is possible in selected patients but limited to those sites with adequate or augmentable attached gingiva and available bone volume and density. Inadequate attached gingiva, available bone, and bone density may be augmented by pre-, intra-, or postoperative procedures. Bone ridge contour can be approximated by using a described fast set polyvinyl siloxane site evaluation technique. Assuming adequate length and height, a bone width of 5 mm is usually acceptable for standard diameter implants (3.5-4.2 mm). However, implant placement in sites with parabolic shaped ridges may need to be placed deeper to avoid vertical bone loss and implant thread exposure. Inadequate bone volume, less than 5 mm of bone width, may be developed by ridge expansion (split ridge) techniques. With ridge expansion, complications may arise such as malposition and labyrinthine concussion. Malposition may be corrected intraoperatively or grafted for a later implant placement. Labyrinthine concussion is usually of short duration but may be treated with head maneuvers. Sites with 2 mm or less width of available bone may not be treated flaplessly and may be more appropriately treated with extracortical augmentation grafting.     

Using a fixed provisional prosthesis during post-extraction healing and implant placement

Most dental patients insist on the use of provisional prostheses throughout healing and osseointegration when replacing extracted teeth with implants in esthetically sensitive areas. Removable appliances of some kind are normally used for this purpose, but patients often consider them to be too cumbersome. This can lead to decreased case acceptance and compliance with the use of the provisional restoration, which can compromise the final result of treatment. Custom fixed solutions to this problem exist, but they tend to be more complicated, less practical, and more expensive than other options now available. The Monodont bridge, a new system of prefabricated components for the creation of provisional fixed partial dentures, can be more esthetic, more retentive, more functional, more cost-effective, and more universally applicable than any other available techniques. This can raise patient tolerance of provisional prostheses and thus increase case acceptance, while fostering a more predictable esthetic result with regard to soft tissue contours and emergence profile.