羟基磷灰石+医用胶原膜在颌骨囊肿骨腔中的应用

羟基磷灰石(hydroxyapatite,HA)是一种新型骨代用品,具有良好的生物相容性,能引导骨组织再生,已被广泛应用于临床,对口腔颌面部硬组织缺损的修复,如颌骨囊肿术后骨腔填塞取得了很好的疗效。我科自1995年以来,对27例颌骨囊肿骨腔充填HA,经5年临床随访观察,效果满意,现报告如下。     

下颌第三磨牙易位髁状突颈部并感染误诊1例报告

目的:观察下颌第三磨牙易位髁状突颈部的临床表现,分析误诊误治原因.手术评价临床治疗效果.方法:手术拔除髁状突颈部埋伏齿,骨腔内填塞羟基磷灰石(HA),表面覆盖医用胶原膜(GTR).结果:术后X线片显示:HA材料充盈骨腔周界骨白线清晰;1年后复查,X线片显示:HA与周围骨组织生长良好,新生骨与周围宿主骨密度影相似,无分界...     

应用袋形术联合囊肿塞治疗大型颌骨囊肿临床疗效分析

目的:评价袋形术治疗颌骨囊肿的临床应用。方法:收集2007—2016间来我院就诊,并采用袋形术治疗的大型颌骨囊肿患者39例,术后随访1～3年,对术后治疗效果进行评价、分析。结果:35例患者术后3～6个月X线片示骨腔缩小,骨密质增强;30例患者术后12个月骨腔逐渐消失;9例患者术后1年骨腔缩小,行囊肿刮治术,术后3～6个月伤口愈合良好,囊腔消失。结论:袋形术是一种简单、有效的治疗大型颌骨囊肿的方法,手术创伤小,减少了对重要结构的损伤,最大限度地保存牙齿,维持颌面部外形和功能。     

重组合异种骨应用于颌骨囊肿术后骨腔修复42例临床观察

目的探讨颌骨囊肿术后骨腔的修复方法。方法将重组合异种骨应用于42例颌骨囊肿术后骨腔的修复,术后观察临床效果和X线的变化。结果重组合异种骨与正常骨组织生长良好,未出现骨排斥症状,术区颌骨形态良好。结论重组合异种骨具有良好的骨诱导和骨引导能力,是修复颌骨囊肿术后骨腔较理想的植骨材料。     

羟基磷灰石微粒填塞有感染颌骨囊肿骨腔的临床观察

对于较大的颌骨囊肿,特别是有明显感染的颌骨囊肿骨腔,临床上常感处理困难。如果仅采取严密缝合术,由于骨腔较大容易继发感染;如果采用开放填塞术,术后需多次换药,疗程很长。国内闵文宪等用羟基磷灰石微粒填塞无明显感染的颌骨囊肿骨腔,收到良好效果。在此基础上,我们对有明显感染的较大颌骨囊肿骨腔也用羟基磷灰     

保存受累牙的大型颌骨囊肿摘除术65例临床观察

目的 研究对于大型颌骨囊肿行囊肿摘除术并保存受累牙治疗的临床效果。方法 对65例大型颌骨囊肿患者的256颗相关受累牙术前行根管治疗术,手术彻底摘除或刮除颌骨病变组织后,将暴露于骨腔中的根尖磨除2~3 mm,保存受累牙,囊腔以碘仿纱条填塞。术后定期更换碘仿纱条至遗留骨腔平复或成碟形。随访2~8年,检查经治牙的松动、咬合、牙根吸收以及骨质修复、囊肿有无复发等情况。结果 65例患者复发3例。受累牙297颗,256颗行保存治疗,218颗成功,均能行使正常咀嚼功能。结论 保存治疗受累牙、囊肿摘除、碘仿纱条填塞治疗大型颌骨囊肿,在根治囊肿的同时绝大多数受累牙均可以得到保存。     

引导骨再生膜技术对较大根尖囊肿术后骨腔修复的临床研究

目的　探讨Bio-oss骨粉复合胶原膜在较大根尖囊肿术后骨腔修复中的临床效果。方法　将63例根尖囊肿的患者随机分成实验组和对照组。第1组21例行根尖囊肿摘除后给予Bio-oss骨粉复合胶原膜填塞;第2组21例仅在术后骨腔外放置胶原膜;选择21例术后囊腔内不放置充填物作为对照组。进行第3、6、12个月的临床观察,分析2组X线下成骨变化。结果　术后第3、6、12个月骨缺损区骨密度改变中骨粉复合胶原膜组均显著优于对照组（P<0.05）,且以植骨复合胶原膜组骨密度增高明显,有较多的新骨小梁修复,实验组患牙未见瘘管形成,患牙保存较好。结论　Bio-oss复合胶原膜具有良好的生物相容性、骨传导和骨诱导作用,有利于骨组织长入及囊肿术后骨腔的修复,是一种理想的颌骨骨缺损的组织再生修复材料。     

羟磷灰石颗粒填塞颌骨囊肿骨腔的临床应用

<正> 羟磷灰石材料,已被成功地应用于口腔颌面部硬组织缺损的修复,如牙周骨缺损、牙槽脊修复和形态保持,以及颌骨囊肿刮治术后的骨腔填塞修复。我院1988年以来,对良性囊肿的上下颌骨术后骨腔进行羟磷灰石颗粒材料填塞结果报告如下:临床资料本院所用羟磷灰石颗粒人工骨材料均由上海第二医科大学生物材料研究室提供。该颗粒直径0.5～1.0mm,其理化性质均经该院实验证实良好,致密度96.9%,动物实验该材料具有良好的生物相容性,骨     

羟基磷灰石人工骨在颌骨腔性骨缺损整复中的应用：附26例临…

作者自１９８７年１２月１９９４年４月，采用国内新合成的生物陶瓷种植材料－羟基磷灰石微粒人工骨，填塞颌骨骨腔２６例，其中根类囊肿刮治术后遗留骨腔２０例，含牙囊肿术后遗留骨腔２例，牙瘤摘除术后遗留骨腔１例，获得较好的疗效，２５例成功，１例失败，并分析了失败原因。临床观察证明，羟基磷灰石人工骨填塞颌骨手术后骨腔，补充了骨量损失，消除死腔，促进骨组织生长修复，减少术后出血和感染的机会，有利于较大骨腔的修复     

羟基磷灰石人工骨在颌骨腔性骨缺损整复中的应用（附26例临床观察）

作者自１９８７年１２月～１９９４年４月，采用国内新合成的生物陶瓷种植材料─—羟基磷灰石微粒人工骨，填塞颌骨骨腔２６例，其中根尖囊肿刮治术后遗留骨腔２０例，含牙囊肿术后遗留骨腔２例，牙瘤摘除术后遗留骨腔１例，获得较好的疗效，２５例成功，１例失败，并分析了失败原因。临床观察证明，羟基磷灰石人工骨填塞颌骨手术后骨腔，补充了骨量损失，消除死腔，促进骨组织生长修复，减少术后出血和感染的机会，有利于较大骨腔的修复和患区松动牙的保存牢固，木后无并发症及不良反应，具有临床实用价值。     

β-TCP植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果分析

目的:分析β-磷酸三钙人工骨(β-TCP)植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果。方法:选取2018年7月~2019年9月我院颌骨囊肿患者116例,采用随机数字表法将其分为对照组和观察组,每组各58例。对照组经囊肿摘除术刮治后对创面采用口腔修复膜覆盖治疗,观察组经囊肿摘除术刮治后放置β-TCP充填骨缺损并采用口腔修复膜覆盖治疗。比较两组患者的临床疗效、骨缺损区电子计算机断层扫描(computed tomography,CT)值以及丧失功能牙术后恢复情况。结果:术后,观察组总有效率明显高于对照组(P<0.05);术后3个月时,两组患牙缺损区CT值均明显高于术前(P<0.05);术后6个月时,两组患牙缺损区CT值均明显高于术后3个月及术前(P<0.05),患牙恢复情况均明显优于术后3个月(P<0.05),术后12个月时,两组患牙缺损区CT值均明显高于术前、术后3个月及术后6个月(P<0.05),患牙恢复情况均明显优于术后3个月及6个月(P<0.05),且术后3个月、6个月及12个月时,观察组骨缺损区CT值明显高于对照组(P<0.05),患牙恢复情况明显优于对照组(P<0.05)。结论:在手术刮治后采用β-TCP填充联合口腔修复膜覆盖治疗颌骨囊肿患者可有效促进成骨及患牙恢复,具有较好疗效。     

Bio-Oss在颌骨囊肿术后缺损中的应用

目的：评估应用天然骨无机材料Bio—Oss治疗上、下颌骨缺损的疗效。方法：选择16例无其他系统性疾病的颌骨缺损患者，在缺损区植入Bio—Oss，并于术后1个月、3个月、6个月回访，通过临床检查及X线检查对移植效果进行评估。结果：所有病例均最终愈合。术后6个月缺损区完全修复，缺损区与周围骨组织无显著差别。结论：Bio—Oss天然骨无机材料具有良好的生物相容性，可以有效引导骨组织再生。     

引导组织再生术与联合应用植骨术治疗牙周骨内缺损的临床研究

比较引导组织再生术（GTR）与联合骨移植术治疗牙周骨内缺损的临床疗效。方法 选取45例牙周炎重度垂直骨吸收的患牙,随机平均分为翻瓣术组、单纯GTR组及联合植骨组。分别在术前和术后1年记录牙周袋深度、附着丧失、牙龈退缩并进行比较。结果 术前、后自身比较,3组的各项检查指标均有显著性改变(P<0．05);与翻瓣组相比,单纯GTR组及联合植骨组牙周袋深度及附着丧失减少更显著,具有统计学差异(P<0．05),而龈退缩量无统计学差异。单纯GTR组与联合植骨组相比各项临床指标均无统计学差异。结论 与单纯翻瓣术相比,引导组织再生术与联合应用植骨术治疗垂直型牙周骨内缺损均可获得更好的临床效果,GTR联合植骨术稍优于单纯GTR术。     

自体富血小板血浆在颌骨囊肿术后骨腔修复中的应用

目的:探讨富血小板血浆应用于颌骨囊肿术后骨腔修复的临床效果。方法:将24例颌骨囊肿患者随机分成实验组和对照组。实验组:12例颌骨囊肿摘除后用自体富血小板血浆+可溶止血纱布充填;对照组:术后骨腔放置可溶止血纱布。观察术后6个月X线的变化。结果:术后6个月骨缺损区骨密度实验组优于对照组。结论:富血小板血浆的局部应用有利于颌骨囊肿术后骨腔修复。     

胶原膜与羟基磷灰石治疗牙周骨缺损的临床观察

目的评价羟基磷灰石联合胶原膜牙周引导再生术（HA＋GTR）与传统牙周翻瓣术植羟基磷灰石（HA）治疗牙周骨缺损的疗效。方法选择127颗经牙周基础治疗的牙周骨缺损的患牙，随机分二组HA＋GTR（n=67），HA（n=60），术后定期随访，以临床及X线检查评定疗效。结果两组术后牙周袋深度（PD）、根分叉水平探入深度（HPD）、附着丧失（AL）、牙龈指数（GI）均有明显减少，且有显著性差异（P〈0．05），HA＋GTR组的PD、HPD、AL值小于HA组，有显著性差异（P〈0．05），两组骨缺损处牙槽骨修复均明显。结论HA＋GTR治疗牙周骨缺损疗效显著。     

Implant placement in bone formed beyond the skeletal envelope by means of guided tissue regeneration: an experimental study in the rat

OBJECTIVES: The aim of the present study was to evaluate whether the placement of implants in bone formed by means of guided tissue regeneration (GTR) beyond the skeletal envelope may influence bone volume and/or structure. MATERIAL AND METHODS: Rigid, hemispherical, Teflon capsules were placed with their open part facing the lateral surface of the ramus in both sides of the mandible in 18 rats. After 1 year, the capsules were removed by a re-entry operation, and a custom-made titanium implant was placed in the augmented ramus in only one side of the jaw. Six animals were sacrificed shortly after implant surgery, another six after 3 months, and the last six after 6 months. Histological specimens of the augmented sites including the implants were prepared, and the volumes of (1) the newly formed bone (mineralized bone and marrow) (2) the soft connective tissue, and (3) the implant, in the space originally created by the capsule were estimated by a point-counting technique. Additionally the height of the augmented bone was measured. RESULTS: One year after capsule placement, the major portion of the space originally created by the capsules was filled with newly formed bone. In the test specimens, implant placement seemed to result in a denser arrangement of the augmented bone, but this event did not influence its long-term stability. Although some resorption occurred after 3 and 6 months, the vast portion of the generated bone remained stable over time in both tests and controls, and there were no differences between tests and controls at any observation periods. CONCLUSION: It is concluded that large amounts of bone can be formed beyond the skeletal envelope by means of GTR, and that this bone remains stable on a long-term basis both with and without the placement of titanium implants.     

开窗减压术联合囊肿塞治疗颌骨囊性病变的临床分析

目的　　评价开窗减压术联合囊肿塞在颌骨囊性病变治疗中的临床效果。方法　对在我院口腔颌面外科诊断为颌骨囊性病变的61例患者切除部分组织行病理检查明确诊断,并采用开窗减压术联合囊肿塞治疗,开窗口大小1.0 cm × 1.5 cm～1.5 cm × 1.5 cm。术后儿童每2个月、成人每3个月复查一次,并拍摄曲面断层片,随访1～3年,观察骨再生修复情况和预后。结果　所有病例术后引流较好,未见出血、感染、永久性下颌神经损伤及复发等并发症,临床及口腔曲面断层片检查可见囊性病变范围逐渐缩小,骨再生情况良好,在儿童病例中囊性病变甚至完全消失。结论　开窗减压术联合囊肿塞治疗可促进颌骨囊性病变体积明显缩小甚至消失,可最大限度地保护及恢复颌骨的形态和功能,是治疗颌骨囊性病变的有效方式。     

CGF 联合骨代用品及口腔修复膜在颌骨囊肿手术中的应用

目的：观察浓缩生长因子（ CGF）联合羟基磷灰石生物陶瓷及口腔修复膜在颌骨囊肿手术中促进骨组织愈合的临床效果。方法：45例颌骨囊肿患者行囊肿刮除术,采用浓缩生长因子及羟基磷灰石生物陶瓷混合物填充骨腔,CGF膜及口腔修复膜双层覆盖在骨缺损区表面。术后随访3～12个月,通过临床和影像学检查评估治疗效果。结果：45例患者术后伤口均为Ⅰ期愈合。直径＜2 cm的骨缺损在术后3个月羟基磷灰石生物陶瓷与周围骨组织界限消失,可见正常网纹结构的骨小梁。直径＞2 cm的骨缺损,术后9个月羟基磷灰石生物陶瓷与周围骨组织界限模糊;术后12个月界限消失,充填材料与新生骨及周围骨组织生长良好。结论：CGF联合羟基磷灰石生物陶瓷充填颌骨囊肿骨缺损区同时覆盖口腔修复膜的引导骨再生技术可有效促进骨愈合,修复骨缺损。     

开窗减压联合生物材料填充治疗颌骨大型囊性病变的研究

目的:评价开窗减压术联合生物材料硫酸钙填充治疗颌骨大型囊性病变的临床疗效。方法:选取颌骨大型囊性病变患者70例,随机均分为观察组和对照组,观察组行I期开窗减压保守治疗,待囊肿明显缩小后行Ⅱ期小囊肿刮除术并硫酸钙生物材料充填术;对照组行传统颌骨囊肿刮除术,同时予以硫酸钙生物材料充填术。观察并比较两组患者手术时间、术中出血量、术后疼痛及感染、囊腔体积缩小程度、骨质增生厚度及骨密度值、术后复发率及神经性并发症发生情况。结果:两组患者手术时间、术中出血量、术后疼痛及感染发生率相比差异具有统计学意义(P＜0.05);术后6月各指标较术后3月均明显改善,观察组术后3、6月囊腔缩小值、术后骨质增生厚度、术后骨质密度值均优于对照组,差异具有统计学意义(P＜0.05);术后均随访12~24月,对照组1例复发,观察组无复发,差异无统计学意义。结论:采用开窗减压术治疗颌骨大型囊性病变手术创伤小,可保护囊肿周围血管神经等重要结构;在囊肿刮出后采用医用硫酸钙充填缺损骨腔,防止软组织嵌入,加快了成骨速度,降低术后复发。     

Long-term stability of jaw bone tuberosities formed by "guided tissue regeneration"

The aim of the present study was to evaluate whether bone tuberosities produced by GTR on the lateral surface of the mandibular ramus in rats are stable on a long-term basis. Thirty male 6-month-old albino rats of the Wistar strain were used in the study. Tissue flaps were elevated on the lateral aspect of the mandibular ramus. The periosteum was preserved (P+) on one side of the jaw while the bone was denuded (P-) on the other. A rigid, non-porous oval-shaped teflon capsule was placed on both sides with its opening facing the ramus. Six months following surgery, 10 rats were sacrificed and prepared for histology while the remaining 20 rats were subjected to a second operation during which the capsules were removed. Standardized radiographs, taken immediately before and after removal of the capsule and after 3, 6, 9 and 12 months, were subjected to planimetric measurements and subtraction radiography. Ten animals were sacrificed and prepared for histological analysis after 6 months following removal of the capsules and the remaining 10 animals after 12 months. Histology revealed that at 6 months after the placement of the capsules, 17 were completely filled with new bone. The remaining 3 capsules which were displaced exhibited only partial bone fill. The radiographic analysis revealed that after 6 months 98.6 +/- 7.6% (mean +/- SD) in average of the cross-sectional area created by the capsules was filled with new bone. Within 3 months after removal of the capsules a slight resorption of the new bone had occurred, thereby reducing the area of the bone tuberosities by 4 to 8%. No further resorption of the bone tuberosities took place from 3 to 12 months. These observations indicating that new bone produced by GTR is stable on a long-term basis, may question the general belief that non-functional bone will resorb over time.