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种植修复目前已经成为牙列缺损后常见的修复方法,发生于颌骨的囊肿通常会导致大量骨质破坏,尤其是上颌前牙区为囊肿多发部位,临床中摘除囊肿并拔除患牙后通常会造成大面积骨缺损,最终使种植修复面临很大困难。目前,多种骨增量手术可有效解决这一问题。自体骨是移植材料的金标准,但术后自体骨不可预知的吸收常影响临床效果。本文就1例上颌前牙囊肿摘除术后的病例,取下颌骨外斜线自体骨块Onlay植骨联合     

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。     

Cem-OsteticTM修复颌骨囊肿术后骨缺损的临床观察

目的 探讨Cem-OsteticTM人工骨浆修复颌骨囊肿术后骨缺损的可行性.方法 12名上颌骨或下颌骨根尖囊肿、鼻腭囊肿和含牙囊肿的患者,在囊肿刮除后置入Cem-OsteticTM人工骨浆,术后观察6至12个月,观察手术术区创口生长情况,行X线检查观察各个时期骨缺损区的成骨情况.结果 10名患者术后术区均愈合良好,术区植骨未见不良反应,术后3个月后植入的人工骨大部分吸收并被新骨取代,术后6个月术区骨缺损均可见成骨,大部分缺损已修复.2名患者术后2周出现术区渗出,植入骨粉大部分渗出,行局部冲洗换药后创口逐渐愈合.结论 Cem-OsteticTM人工骨浆可以充填囊肿摘除后遗留的空腔,并在3至4个月内逐渐吸收且促进新骨形成,是一种良好的新型骨修复材料,但对颌骨大型骨腔缺损(大于5cm)应谨慎使用.     

GBR技术在颌骨囊肿手术中的临床应用观察

目的:观察膜引导骨再生技术(guide bone regeneration,GBR)在颌骨囊肿术后对颌骨缺损修复的临床疗效。方法:小型颌骨囊肿50例,囊肿大小为1.5 cm×1.5 cm~3.0 cm×3.0 cm,均采用颌骨囊肿摘除术治疗。术中将颌骨囊肿完整摘除,确认未与鼻底及上颌窦穿通后,将人工骨粉与自体静脉血混合充填入颌骨囊肿骨缺损区,再以生物膜覆盖,常规缝合切口。结果:术后2周拆线,除5例外切口均愈合良好;术后6个月复查全景片,充填材料复合体密度与颌骨密度趋于一致;术后1年,充填材料与周围颌骨生长完全融合,不能分辨,原囊肿区可见正常的骨小梁网纹结构。结论:GBR技术对修复小型颌骨囊肿术后的局部骨质缺损安全有效。     

天然骨无机材料修复颌骨缺损的临床研究

目的:观察天然多孔骨无机材料修复颌骨囊肿术后缺损的临床效果及适用范围。方法:对33例颌骨囊肿 术后缺损(体积≤4.2cm3)的病例随机分成二组,分别用天然多孔骨无机材料充填和血块充填植入颌骨缺损区。术 后随访1个月、3个月、6个月分别X线片动态比较其密度变化。结果:天然骨无机材料充填组1个月后骨密度增 高,3个月后趋近正常骨密度,颌骨缺损区修复速度明显比血块充填组快。结论:天然多孔骨无机材料在骨缺损区 植入时有引导骨再生的作用,对缺损区促进早期形成有功能性的、成熟的骨组织作用,是一种较为理想的修复骨缺 损的材料,适用范围一般为缺损区体积≤4.2cm3。     

自体骨膜移植治疗颌骨囊肿的临床观察

目的:通过自体骨膜移植探讨颌骨囊肿术后创腔的修复效果。方法:对56例颌骨囊肿术后创腔行自体邮票状游离骨膜移植,术后1、3、12月随访,并行X线检查。结果:骨膜移植后3个月骨缺损处全部被新生骨充填,骨密度明显增高,部分新生骨质结构与正常趋于一致,12个月后受区恢复正常骨结构。结论:骨膜移植是修复颌骨囊肿术后创腔的一种较好方法,为临床提供了新的治疗手段。     

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。     

重组合异种骨修复颌骨缺损临床观察

本文采用重组合异种骨修复颌骨缺损,经临床３１例颌骨囊肿和颌骨肿瘤应用,表明该材料具有良好的骨诱导和骨引导能力,并具有一定的抵抗感染能力．术后未出现植骨区无限制增生而保持良好的颌骨形态．未出现骨排斥症状,是一种较理想的植骨材料     

羟基磷灰石生物陶瓷联合口腔修复膜在颌骨囊肿手术中应用

目的探讨羟基磷灰石生物陶瓷联合口腔修复膜在颌骨囊肿手术中的临床应用及效果。方法选择2012年1月至2015年1月收治的颌骨囊肿患者93例,将囊肿摘除后使用羟基磷灰石生物陶瓷填塞骨缺损,再覆盖口腔修复膜,根据临床及X线片资料评价骨缺损区的骨再生及改建情况。结果 90例患者术口Ⅰ期愈合,1例切口拆线后裂开,2例患者感觉术区存在肿胀或疼痛不适。术后1、3、6、12个月复查X线片提示缺损区骨质增生及改建良好。结论羟基磷灰石生物陶瓷联合口腔修复膜用于颌骨囊肿造成的骨缺损操作简单,临床疗效可靠。     

硫酸钙修复颌骨囊肿术后感染原因分析及处理措施

目的分析医用硫酸钙骨粒修复颌骨囊肿缺损术后感染的可能原因,并提出预防及处理措施。方法对36例牙源性颌骨囊肿采用刮治术加医用硫酸钙骨粒植入治疗。患者术前均行颌骨曲面体层片（orthopantomography,OPT）或颌骨CT平扫加三维重建,明确囊肿位置和大小。采用颌骨囊肿刮治术加医用硫酸钙植入术进行治疗,术后观察并发症及成骨情况。结果36例牙源性颌骨囊肿患者中,8例术后1周至1个月出现感染症状,主要表现为骨腔肿胀,疼痛,局部皮温升高,其中有2例伴有全身低热,给予抗感染处理,持续根管开放引流等措施后逐渐愈合。术后复诊成骨情况满意,但与术后未感染的骨腔相比,成骨时间延长。结论医用硫酸钙植入颌骨囊肿术后应延长引流时间,加强抗感染处理,可有效减少感染的发生率。     

上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响

目的研究牙槽嵴顶入路上颌窦底提升术后,上颌窦内黏膜囊肿的变化和囊肿区种植体周围的成骨情况,探讨上颌窦黏膜囊肿对牙槽嵴顶入路上颌窦底提升术的影响。 方法选取12例上颌后牙缺失骨量不足并患有上颌窦黏膜囊肿的患者,在不摘除窦腔内黏膜囊肿的情况下,经牙槽嵴顶入路提升上颌窦底同期植入种植体14枚。术前测量上颌窦底高度,术后当日测量种植体穿入窦底长度,术后1年测量穿入窦腔内的种植体周围成骨高度,观察黏膜囊肿对种植体周围成骨的影响。采用配对样本t检验对比术前-术后当日及术前-术后6个月黏膜囊肿投影面积变化,评估手术创伤与黏膜囊肿的相互的影响。 结果通过牙槽嵴顶入路上颌窦底提升术植入的种植体在含有上颌窦黏膜囊肿的上颌后牙区种植体周围成骨良好,术后6个月时全部14枚种植体形成良好骨结合。术前上颌窦底高度为（5.5 ± 1.4）mm,术中种植体穿入上颌窦长度为（2.9 ± 1.3）mm,上颌窦底厚度平均增加了（1.8 ± 1.0）mm。根据测量结果计算黏膜囊肿投影面积,术前（201.2 ± 184.0）mm²,术后当日（133.6 ± 187.6）mm²,术后6个月（134.5 ± 107.1）mm²。术前-术后6个月的成对差分均值及标准差[（66.6 ± 142.8）mm²]明显增大,说明术后6个月时黏膜囊肿的体积呈现出多样化的表现。术前-术后当日的黏膜囊肿投影面积相比显著减小,差异有统计学意义（t= 2.685,P= 0.021）,术前-术后6个月的黏膜囊肿投影面积差异无统计学意义（t= 1.617,P= 0.134）。手术短期内会对上颌窦内黏膜囊肿造成一定的创伤,但未对上颌窦黏膜囊肿产生激惹、恶化等不良影响。 结论上颌窦内黏膜囊肿的存在不影响牙槽嵴顶入路上颌窦底提升术的实施与种植体周围成骨。     

Postoperative tomographic assessment of veneer bone grafting with implant placement in the maxillary anterior region

Various ridge augmentation and sinus lift procedures were performed in severely resorbed alveolar crests of a maxilla to provide some volume for implant treatment. It was reported that the outcome of maxillary sinus lift procedures was evaluated with conventional tomography or computerized tomography, and that grafted bone around implants markedly progressed in resorption, particularly at the implant apex. However, veneer bone grafting with implant placement has not been evaluated after treatment with imaging techniques. Therefore, the purpose of this study was to assess veneer bone grafting after maxillary anterior implant treatment. Seven patients with a mean age of 24 years, with implants placed in the maxillary anterior region with or without autogenous veneer bone grafting were postoperatively examined using conventional tomography. On tomograms, the ratio of bone-to-implant contact and the area of bone were measured in labial bones with bone grafts, and they were compared with the values without bone grafts. In cases with bone grafting, the average ratio of bone-to-implant contact was 63.6%, whereas 81.8% was formed in cases without bone grafting. The average area of bone was 12.9 mm and 23.4 mm in patients with and without bone grafting, respectively. No significant difference was found between the implants with and without bone grafts. Resorbed labial bone was observed in the maxillary anterior region with and without veneer bone grafting.     

Alveolar zygomatic buttress: A new donor site for limited preimplant augmentation procedures.

PURPOSE: Augmentation of anterior maxillary alveolar bone defects before placement of endosseous implants still poses a clinical challenge. Previous traumatic loss of upper anterior teeth is often concomitant with significant bone loss. The aim of augmentation is to reconstitute as far as possible the original hard tissue contour. This is a prerequisite for later optimal positioning of the dental implants in accordance with prosthodontic and functional principles. MATERIALS AND METHODS: This article describes a new method for the reconstruction of small anterior maxillary alveolar bone defects using donor bone from the zygomatic buttress region. RESULTS: This region provides harvested bone with a natural convex shape, which is ideally suited for the anterior alveolar process region. Later fibrous tissue transplantation to provide more anterior projection to the anterior dental area is also avoided. CONCLUSION: Bone harvesting was done with the piezoelectric device, which avoids trauma to the mucosal membrane of the maxillary sinus.     

伴上颌窦囊肿或慢性上颌窦炎的上颌窦底外提升术效果评价

目的探讨伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗上颌窦底提升术同期牙种植的治疗效果。 方法从2014年3月至2018年3月期间在广州市海珠区口腔医院种植修复科以及口腔外科诊治的行经外侧壁开窗的上颌窦底提升术同期牙种植的患者共53例种植体，根据文献报道的纳入标准，分为三组，可进行上颌窦底提升术的伴上颌窦囊肿者为囊肿组共17例，可进行上颌窦底提升术的伴有慢性上颌窦炎者为炎症组共15例，上颌窦内无明显炎症或囊肿者为正常对照组共21例。术前记录上颌窦黏膜厚度，上颌窦底剩余牙槽骨高度（RBH），术中记录有无上颌窦黏膜撕裂、破裂。术后7 d记录术后并发症情况，定期随访，在修复后12个月记录分析上颌窦内成骨高度（SBG）、种植体尖端成骨高度（ABH）、种植体边缘骨吸收（MBL）、上颌窦囊肿变化或上颌窦黏膜增厚情况。使用SPSS 20.0进行数据统计分析。术后急性感染比较使用卡方检验中Fisher精确检验，三组间的上颌窦黏膜厚度、上颌窦内成骨、边缘骨吸收等指标使用单因素方差分析进行差异比较，术前、术后囊肿直径和上颌窦黏膜厚度对比使用配对t检验。 结果三组病例术中均未出现上颌窦黏膜撕裂。囊肿组2例、炎症组3例、对照组1例出现术后急性上颌窦炎，三组间急性炎症例数差异无统计学意义（χ² = 2.049，P = 0.352）。三组病例均无术后上颌窦积血、积液等情况。修复后12个月，囊肿组SBG为（8.09 ± 1.20）mm，炎症组SBG为（7.17 ± 1.18）mm，对照组SBG为（7.36 ± 1.41）mm，组间比较差异无统计学意义（F = 2.409，P = 0.100）；囊肿组ABH为（1.94 ± 1.34）mm，炎症组ABH为（1.40 ± 1.12）mm，对照组ABH为（2.10 ± 1.30）mm，组间差异无统计学意义（F = 1.382，P = 0.261）；囊肿组MBL为（0.53 ± 0.70）mm，炎症组MBL为（0.47 ± 0.92）mm，对照组MBL为（0.48 ± 0.67）mm，组间差异无统计学意义（F = 0.118，P = 0.889）。囊肿组术后囊肿直径[（2.35 ± 3.51）mm]较术前的囊肿直径[（8.41 ± 3.04）mm]有所缩小，差异有统计学意义（t = 5.216，P<0.001）。炎症组术后黏膜厚度[（6.27 ± 2.15）mm]较术前厚度[（5.27 ± 1.58）mm]有所增加，差异有统计学意义（t = -2.562，P = 0.023）。 结论伴上颌窦囊肿或慢性上颌窦炎的经外侧壁开窗的上颌窦底提升术同期牙种植可以取得较好的临床效果。     

正畸拔牙矫治前后上颌牙槽骨改建的初步研究

目的 通过正畸拔牙治疗前后上颌骨三维重建和配准研究,确定上颌前牙区牙槽骨在正畸治疗前后的改建情况.方法 选择15例拔牙治疗病例治疗前后CBCT为研究样本,用mimics10.0进行三维重建,采用上颌骨双颧部重叠法用rapidform 2006软件对治疗前后上颌骨进行配准并进行全局偏差检测,从而研究上颌前牙区牙槽骨改建情况.结果 上颌牙槽骨大部分区域配准偏差在0-0.50mm,极少部分可见橘色或红色区域配准偏差达1.5-2.0mm;腭侧牙槽骨则大部分为蓝色,其中穿插少部分浅绿色配准偏差约0.6mm之内.配准全局偏差结果显示15名患者治疗前后上颌骨配准平均距离在0.50mm之内.结论 生长发育结束的患者正畸拔牙治疗前后上颌牙槽骨改建大多在0.50mm之内,唇侧牙槽骨改建较多,腭侧改建相对较少.     

上颌前牙埋伏阻生的X线分析

目的　总结上颌前牙埋伏阻生的X线影像特点。方法　收集 2 92例患者上颌前牙埋伏阻生的X线片 ,观察埋伏阻生牙的牙位、位置高低、牙冠方向及周围组织情况。结果　 2 92例 387枚阻生牙 ,其中 2 92枚颌骨内埋伏 ;6 7枚牙根弯曲 ;5 6枚埋伏阻生牙异位或错位。埋伏阻生的相关情况主要有 :冠部有致密骨壁线包绕 2 11枚 ;萌出间隙不足 94枚 ;受多生牙阻挡 5 2枚。埋伏方向 :平行 15 9枚 ;倒置 32枚 ;斜位 14 0枚和水平 4 7枚。结论　埋伏阻生牙的冠周有骨壁线包绕 ,又不能正常萌出应视为含牙囊肿或囊样变。判断埋伏牙阻生方向应从六面的三维视角进行定位。?     

上颌中切牙长轴与牙槽骨方向夹角的锥形束CT测量分析

目的:利用锥形束CT(cone-beam CT,CBCT)测量、分析上颌中切牙长轴与牙槽骨方向夹角角度,为前牙种植美学修复的手术指导和风险评估提供参考.方法:随机选取374例成年患者,按照年龄分成青年、中年、老年3组,拍摄CBCT,通过Kavo eXam Vision软件测量上颌中切牙长轴与牙槽骨方向之间的夹角角度.使用SPSS16.0软件包对数据进行t检验.结果:青年组上颌中切牙长轴与牙槽嵴方向夹角角度为13.81°±4.37°,中年组为15.19°±5.23°,老年组为18.51°±6.62°,各组内男、女比较无显著差异(P＞0.05),各组组间比较有显著差异(P＜0.05),且随着年龄增大,其夹角角度逐渐增大.结论:患者性别对上颌中切牙长轴与牙槽骨方向夹角角度影响不大;患者年龄和上颌中切牙长轴与牙槽骨方向夹角角度有一定关系.对于上颌前牙种植患者,要达到美观修复,术前需要充分了解上颌中切牙长轴与牙槽骨方向夹角角度,尤其是老年患者.     

Anatomic Site Evaluation of Edentulous Maxillae for Dental Implant Placement

Purpose This study evaluated 17 edentulous cadavers for bone quantity and quality of the alveolar process of the maxilla for the purpose of dental implant placement. Materials and Methods The maxillary arch was divided into four anatomically defined regions for measurements of bone quantity. Bone quality was assessed histologically and described by trabecular bone patterns and tissue composition. Results Average bone height with a minimum thickness of 4 mm was as follows: region 1, 12.1 ± 4.9 mm; region 2, 14.1 ± 7.2 mm; region 3, 6.1 ± 2.8 mm; and region 4, 8.5 ± 2.2 mm. Histological evaluation showed increased trabeculation and thicker cortex in the maxillary anterior area, regions 1 and 2. Region 3, the floor of the maxillary sinus area, had the least amount of bone; however, the quality of bone was superior to that of region 4, the maxillary tuberosity area. Trabecular distance or marrow spaces ranged from 40 μm to 2 mm with larger spaces associated with the posterior maxilla. Conclusions Maxillary tuberosity is the least desirable site for the placement of implants in the maxilla. The area corresponding to the first and second molars had the least bone thickness. All measures of bone preservation need to be considered, especially in this area.     

Microcystic lateral parodontal cyst. Report of a case

The lateral periodontal cyst (LPC) is an odontogenetic lesion of the maxillary bone representing about 0.8% of maxillary cystic lesions. It starts in the lateral periodontal area of a vital erupted tooth. Clinical symptoms are generally absent. Its diagnosis usually can be made on the basis of an occasional radiographic examination which shows an osteolytic monoloculate lesion with defined outlines. The botryoid cyst is a variation of LPC and is radiographically different and more aggressive than the common LPC. A clinical case of LPC which allows to make histopathological and clinical considerations on these cystic lesions is described.     

Postoperative maxillary cyst following sinus bone graft: report of a case

Sinus bone grafting with autogenous bone is routinely performed to allow placement of endosseous dental implants. Although numerous maxillary sinuses have been successfully grafted, some complications of this procedure have been reported. These include maxillary sinusitis, resorption, infection and possible failure of grafts, loss of implants after 1-stage surgery, and oroantral fistulae. Only one case of postoperative maxillary cyst developing in the graft has been reported in the literature. Here, the authors report a similar case that necessitated grafting of the cyst with autologous iliac bone.