单钉近嵴顶固定颏部骨块移植术在上前牙骨增量种植中的应用

目的：评价单钉近嵴顶固定颏部骨块移植术在上前牙区骨增量种植中的临床应用和疗效。方法：2013年1—6月收集上前牙区牙槽嵴严重吸收患者5 例,年龄19~24岁,平均21.6岁,其中单牙缺失3例,多牙缺失2例。取患者颏部块状骨,采用单钉近嵴顶固定法行自体骨块移植,术后定期随访。种植体植入术前拍摄锥形束CT（cone beam computed tomography,CBCT）,观察移植骨愈合情况,并测量牙槽嵴宽度和钛钉距牙槽嵴顶距离。参考CBCT检查结果,常规完成种植体植入术,待种植体骨结合形成后完成种植修复。结果：5 例自体骨块移植术全部成功,无1 例出现相关并发症。术后上前牙区骨量充足,固定钛钉顶端接近牙槽嵴顶。结论：采用单钉近嵴顶固定法行颏部自体骨块移植能有效改善上前牙区的骨量严重不足,临床疗效良好。     

下颌骨半柱状骨块重建牙种植患者萎缩牙槽嵴的临床疗效

目的：评价以下颌骨外斜线半柱状骨块重建前牙单牙缺失种植修复患者明显萎缩牙槽嵴技术的临床疗效。方法：用环形钻或柱形钻将前牙单牙缺失骨缺损区的受骨床预备成半凹柱状,使用环形钻从患者的下颌骨外斜线和升支取与半凹柱直径等同、长度等同或略长的半柱状骨块,将获取的骨块与受骨床嵌贴后用钛钉固定,愈合3~6个月后植入种植体,观察牙槽嵴水平向和垂直向骨量增加情况;再过2~4个月以冠修复种植体,观察1年后种植体的周围组织健康状况和邻面嵴顶骨吸收状况。结果：14例患者15个部位的牙槽嵴水平向骨量术中平均增加（3.8±0.8） mm（x±s）,5例患者5个部位的牙槽嵴垂直向骨量术中平均增加(3.0±1.2) mm（x±s）;平均愈合(4.5±1.7)个月（x±s）后,水平向和垂直向的骨吸收率分别为8%和7%。取骨区未出现神经损伤麻木感、伤口感染等并发症。15个部位均完成了牙种植修复,观察1年无种植体脱落,探诊深度均≤4 mm,邻面嵴顶骨吸收(0.7±0.35) mm（x±s）。结论：这项技术具有操作简便安全、骨愈合快、取骨区神经损伤反应轻等优点,是重建上前牙单牙缺失牙槽嵴缺损的较好方法。     

Perfect与Replace种植体延期负重颈部骨应力比较

目的：研究延期负重时Perfect种植体与Replace种植体颈部骨质应力分布情况。方：借助医用CT电子扫描技术、图像传输与转换技术以及三维有限元软件模拟建立上颌骨前牙区的三维有限元模型,分别模拟植入Perfect种植体及对照组的Replace种植体,比较分析两种种植体在即刻负重时牙槽嵴顶皮质骨的应力分布情况。结果：延期负重时,Perfect种植体在牙槽嵴顶部的等效应力和压应力略小于Replace种植体在牙槽嵴顶部的等效应力和压应力,拉应力则略大于Replace种植体在牙槽嵴顶部的拉应力。结论：延期负重条件下,Perfect种植体在牙槽嵴皮质骨的应力分布与Replace种植体相似,仅从生物力学方面考虑,Perfect种植体不会加快种植体颈部牙槽嵴的吸收速度。     

上颌窦提升在上颌后牙区萎缩牙槽嵴牙种植术中的应用

目的：探讨上颌窦提升术对上颌后牙区萎缩牙槽嵴患者种植义齿修复的临床应用价值。方法：56例患者植入196枚种植体，患者平均年龄60．6岁。将自体松质骨(Spongiosa)与Bio-OSS混合进行上颌窦提升术，根据情况一期或二期植入种植体。种植体植入后至少6个月，选用适当的上部修复体进行义齿修复。结果：上颌窦提升术后或／和种植体植入术后，创口愈合良好，未见种植体松动或脱落，供骨区和种植术区均未见并发症。术后12个月PTVs最小为-5，X线检查种植体周垂直骨吸收均不超过1mm。种植体全部稳定地行使功能。结论：应用上颌窦提升术对上颌后牙区萎缩牙槽嵴患者进行种植义齿修复有广阔的应用前景。     

引导骨再生膜技术在修复部分牙槽嵴缺损的临床应用

目的 :探讨使用引导骨再生膜技术重建牙槽嵴的临床效果。方法 :对 2 5例部分牙槽嵴萎缩或缺损者采用手术在牙槽嵴区植入骨粉 ,加盖双层可吸收胶原膜引导骨再生修复牙槽嵴。结果 :于 3、6个月分别行X线片检查 ,手术区可见骨质生长 ,牙槽嵴形态恢复良好。结论 :使用引导骨再生膜技术能修复重建牙槽嵴 ,为牙种植体的植入及义齿的修复提供了良好的基础     

牙周病患牙拔除即刻种植即刻修复10例临床体会

目的:探讨牙周病患牙拔除后即刻种植及前牙区即刻种植即刻临时冠修复的优点和临床操作要点。方法:选取符合种植修复条件,愿意接受即刻种植的患者10例30颗牙齿。牙槽嵴横行切口加唇颊侧梯形延长,无创拔牙,彻底清创拔牙创周围炎性肉芽组织,常规植入种植体,骨缺损区如超过1mm充填自体骨,必要时骨缺损区植入Bio~oss人工骨粉及海澳胶原膜固定,严密缝合创口。结果:30颗种植体行即刻临时冠修复。3~4月后行2期修复,2周后行上部修复。全部稳定无松动,种植体颈部软组织无炎性表现,X线片未见种植体周围有骨质吸收。结论:即刻种植减少了种植修复的周期,缩短疗程。有利于保持牙槽嵴形态,延缓牙槽嵴吸收。同时恢复了患者外观及部分功能。牙周病患者拔牙即刻种植即刻临时冠修复具有临床可行性,可以推广。     

单枚种植体牵引增高兔下牙槽嵴的组织学研究

目的　观察单枚种植体牵引增高兔下牙槽嵴的组织学变化。方法　兔随机分实验组、实验对照组和空白对照组。实验组及实验对照组在建立兔下颌缺牙颌模型基础上将种植体植入成年兔下牙槽嵴内。实验组术后 1w开始旋转种植体持续牵引下牙槽嵴 ,每天牵引 1 0mm ,1d牵引 2次 ,5d后完成牵引 ;实验对照组术后 1w直接牵引升高 5 0mm。空白对照组 2只 ,不做任何处理。预期时间处死动物进行光镜及扫描电镜观察。结果　扫描电镜显示 ,固定 2w ,新生的骨小梁与牵引方向平行 ;第 4周小梁逐渐融合 ,交织呈网状。光镜观察 ,固定 4w ,实验组骨小梁相连成片。结论　单枚种植体持续牵引下牙槽嵴牵引间隙成骨方式以膜化骨为主。     

松软牙槽嵴患者的全口义齿修复

目的：比较中性区排牙与牙槽嵴顶排牙两种排牙方法，哪种更加适合于松软牙槽嵴患者的全口义齿修复。方法：选择松软牙槽嵴患者28例，分别采用中性区排牙和牙槽嵴顶排牙两种排牙方法进行全口义齿修复。修复前询问患者义齿使用习惯，检查口腔及旧义齿情况，进行必要的修复前手术，择期重新修复。在修复后0．5a、1a、2a后复查，根据病历记录检查患者口腔和义齿情况是否有改变。结果：义齿修复后的2a中，采用牙槽嵴顶排牙法进行全口义齿修复的松软牙槽嵴患者，牙槽嵴的松软范围没有明显扩大，义齿使用效果良好，较中性区排牙法更加适合。结论：松软牙槽嵴患者的全口义齿修复，应采用二次印模法制取准确的印模，更重要的是采用牙槽嵴顶排牙法排列前牙，使前牙在正中牙争时不接触，在侧方验和前伸牙争时也无接触，尽量避免前牙区的牙槽嵴承受过大的咬合压力导致的牙槽骨吸收，以及牙槽嵴松软范围的扩大。     

牙槽嵴劈开术对牙槽骨水平宽度不足种植牙患者的效果观察

目的 探讨牙槽骨水平宽度不足的种植牙患者应用牙槽嵴骨劈开术的临床疗效.方法 收集要求种植固定修复的上颌牙列缺失患者48例,所选患者有充足的牙槽嵴高度（＞ 10 mm）,但牙槽嵴骨宽度仅3～4 mm,牙槽骨骨量不足且基牙分布不均,采用牙槽嵴骨劈开术形成唇颊侧骨瓣,在腭侧骨板与唇颊侧骨瓣之间共植入75枚种植体.术后6个月种植修复,定期随诊.结果 种植区软组织愈合好,种植体骨结合良好,牙槽嵴宽度增加达4～5mm,平均增宽4.4 mm,2枚种植体术后6个月失败,失败率为2.67％,剩余种植体均稳固性好,完成烤瓷修复后美学效果好,追踪24个月以上,无种植体失败.结论 牙槽嵴骨劈开术保证了牙槽骨厚度不足患者的种植修复难题,效果显著.     

Anthogyr球帽附着体种植覆盖义齿在无牙颌患者中的应用

目的：探索牙槽嵴严重萎缩无牙颌患者的修复方法,评价球帽附着体种植覆盖义齿的临床应用效果。方法：按照Antho-gyr种植系统常规操作方法,在10例牙槽嵴严重萎缩的无牙颌患者口中植入种植体,每例2～4枚,6个月后,行二期手术,两周后行球帽附着体种植覆盖义齿修复,随访2年。结果：除1例患者1枚种植体修复前感染松动拔除外,其余种植体愈合良好;义齿固位、稳定良好,咀嚼功能良好,义齿外观满意;1例患者修复1年后更换了一个球帽橡皮圈。结论：球帽附着体种植覆盖义齿修复牙槽嵴严重萎缩的无牙颌临床效果满意,是此类患者有效的修复方式。     

antagomir-30d转染BMSCs联合CPC支架材料的异位成骨作用

目的：构建antagomir-30d/种子细胞骨髓间充质干细胞（BMSCs）/磷酸钙骨水泥（CPC）复合物,并将该复合物植入裸鼠皮下,研究antagomir-30d促进体内骨形成的作用。方法：将转染有150 nmol/L antagomir-30d、NC的BMSCs以及未经转染的空白BMSCs转移到CPC支架进行孵育,后植入到BALB/c-nu裸鼠皮下,以此研究裸鼠异位成骨。术后2、4、8周分别取出植入体。2周时,取出植入体,提取RNA进行RT-PCR检测,分析成骨基因碱性磷酸酶（ALP）、骨钙素（OC）以及Runt相关转录因子2(RUNX2)mRNA表达情况。此外,4周和8周的植入体分别进行苦味酸品红组织学染色和组织形态学分析新骨形成的情况。结果：植入2周RT-PCR结果显示,各成骨基因mRNA水平的表达量中转染有antagomir-30d组最高,并显著高于另外2组（P<0.05）。组织学染色结果表明,植入后4周,antagomir-30d组有少量新骨形成,而另外2组则少有新骨形成。组织形态学分析显示,新骨面积百分比antagomir-30d组为1.28%±0.19%。植入后8...     

Clinical outcome of dental implants placed in fibula-free flaps for orofacial reconstruction

Background Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors. Methods We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed. Results In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants respectively. The main reasons for failure of the dental proliferation. The fibula flap presents many advantages for implant-supported prosthetic rehabilitation difficult. placed into the fibula bone grafts were 95% and 87%, replants were infection, tumor recurrence and soft tissue implant placement, but its limited height sometimes makes Conclusions Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.     

OSSTEM（奥齿泰）系统短种植体在后牙区骨高度不足病例中修复的临床效果

目的探索短种植体在后牙区骨髙度不足病例中修复的临床应用。方法选取本院56例患者,均为上、下颌后牙区高度不足的病例（4.5～7.5mm）,分别植人OSSTEM短种植体（长度6～7mm）,其中下颌植人54枚种植体,上颌共植入40枚种植体。其中上颌后牙区牙槽骨髙度不足的患者行上颌窦内提升术同期植入种植体。3～6个月后完成永久修复。结果经12个月的临床观察,有54例92枚OSSTEM短种植体临床检査种植体稳定,X线检査,种植体骨结合良好。有2例患者上颌2枚种植体二期手术时松动脱落,种植成功率为97.87%。结论在后牙区骨髙度不足的病例,通过植入OSSTEM系统短种体,扩大了种植适应证,治疗成功率较髙,值得临床推荐。     

OSSEOINTEGRATED TITANIUM PLASMA COATED IMPLANTS IN RECONSTRUCTION OF EDENTULOUS MANDIBLE

Fifteen patients underwent surgical insertion of titanium plasma sprayed screws in the mandible ridge over the symphysis region. In 3 patients, along with the screws in the symphysis region, hollow basket implant type ‘H’, one each in the mandible first/second molar region were inserted. Implants were fixed only in those patients who had retention and stability problems of mandibular artificial denture. Indication, technique and biocompatibility of titanium implants and tissue supported over denture have been discussed.KEYWORDS: Mandibular artificial denture, Plasma coated titanium implants, Stability     

不同直径支抗种植体对关闭上颌拔牙间隙影响的比较研究

目的 比较不同直径的种植体在关闭上颌拔牙间隙时对种植体周围骨组织以及支抗磨牙的影响。方法 利用有限元分析软件建立两个含不同直径种植体的模型,比较载荷条件下种植体骨界面的应力分布、种植体的位 移、上颌第一恒磨牙的运动趋势及其周围骨组织的应力分布改变。结果 支抗种植体直径的增大有利于种植体周 围骨组织应力的分布,减少骨吸收发生的概率。直径较大的种植体在体现支抗效果时优于直径较小的种植体。直 径不同的种植体对支抗牙周围骨组织应力改变的影响无差异。不同直径的支抗种植体在加强磨牙支抗时体现出来 的支抗效能等同。结论 种植体直径的改变对支抗种植体周围骨组织的应力分布以及种植体受力后的位移均有影 响。支抗种植体的直径对支抗牙周围骨组织的应力分布及其位移变化没有影响。     

The impact on bone tissues of immediate implant-supported mandibular overdentures with cusped and cuspless teeth

Objectives:

To examine the effects on bone tissues of immediate implant-supported mandibular overdentures with cusped or cuspless teeth.

Methods:

A randomized controlled trial was conducted at the Dental Clinic, Faculty of Dentistry, Al-Azhar University, Assiut Branch, Egypt, over a 12-month period from September 2013 to September 2014. Twenty patients were treated with immediate implant-supported overdentures: one group received overdentures with cusped teeth, and the other group received overdentures with cuspless teeth. The rate of implant success was assessed clinically and radiographically at 3, 6, 9, and 12 months. The data were collected by a questionnaire, an observation checklist, and radiography. The data were then analyzed using computerized methods.

Results:

Overdentures with cusped teeth showed a significant improvement in the clinical criteria, including the absence of clinical implant mobility, pain, and bone resorption, while the clinical criteria for the absence of peri-implant radiolucency were insignificantly different between the 2 groups (p>0.05). There were no significant differences in the clinical evaluations for bone levels at the time of insertion or 3 months after insertions, while significant differences were found at 6, 9, and 12 months after insertion.

Conclusion:

Overdentures with cusped teeth supported by immediate implants were found superior regarding many clinical criteria than those cuspless counterparts.As the life span increases, significant damage occurs to the teeth. Treating edentulous patients can be a demanding challenge.1 Implants in mandibular retained overdentures could be an effective method for the treatment of these patients;2 the success of maxillary implant overdentures was 86.6%, and the success of mandibular implant overdentures was 95.8%.3 Implant-supported overdentures have been preferred over complete dentures due to their simplicity and improved patient quality of life.1-4 The roots have been used beneath overdentures in cases with almost hopeless mandibular dentition. The overdenture design was found to be highly effective in the mandible and has been popularly accepted,5 allowing the root-to-crown ratio to increase, and the prognosis of the remaining teeth to improve. It also seems that the presence of the vertical periodontal ligament preserves the alveolar ridge morphology.6,7 Mainly, 3 impressions have been widely utilized to treat the edentulous jaw, including fixed prostheses supported with implants, removable overdentures supported with implants, and implant overdentures supported with soft tissue.8 The immediate implants are located at diseased and non-diseased sites.9 Immediately after extraction, placing the implant at a site with endodontic infection has resulted in a good substitution for complete dentures.10 Today, the problem is facilitated by the use of implants. The utilization of 4 implants is now common and popularly acceptable. In one case study of a treatment concept using Biohorizons™ Tapered Internal Implants, it was found that the use of the 4-implant concept had many advantages and good success.11 Cusped teeth have advantages, such as their effectiveness, the balance of occlusion, the definitive point of relationship between the upper and lower posterior teeth, and their acceptability and compatibility. Cuspless teeth have some advantages, such as resistance to non-masticatory mobility and the absence of harm to supporting tissue. The use of natural teeth with cusps leads to instability of the dentures, which could not be overcome.12 There has been a lack of evidence for the effectiveness of immediate implant-supported mandibular overdentures. The use of 2-implant mandibular overdentures for edentulous patients is affordable and cost-effective. The overdenture design was found to be highly effective in the mandible and has been popularly accepted. This study aimed to examine the impact on the surrounding bone tissue of immediate implant-supported mandibular overdentures with cusped or cuspless teeth.     

后牙区单牙种植修复5年后的临床修复疗效观察

目的: 分析后牙区单牙种植修复患者在行使功能5年后的临床修复疗效。方法: 选取2005年10月至2010年5月在北京大学口腔医院第二门诊部接受种植治疗并且负重已达到5年的后牙区种植治疗患者,回顾患者的临床资料、X线片、种植体近远中边缘骨高度的变化以及修复体的情况(包括修复体完整性、松动情况、螺丝孔封闭材料存留状况、修复体固位螺丝及修复基台的松动或折断情况)来评估临床疗效。结果: 215例患者,平均年龄48.6岁(27~71岁),共植入软组织水平种植体321枚(其中上颌126枚、下颌195枚)。9枚种植体在回访期间出现松动、脱落,累计存留率达97.2%。存留的312枚种植体中,上颌120枚、下颌192枚,其中直径为3.3、4.1和4.8 mm的种植体分别为5枚(1.6%)、115枚(36.9%)和192枚(61.5%),长度为8、10和12 mm的种植体分别为21枚(6.7%)、206枚(66.0%)和85枚(27.2%)。上部修复体固位方式中,粘接固位为277枚(88.8%),螺丝固位为35枚(11.2%)。负载5年后种植体近远中牙槽骨高度平均吸收分别为(0.73±0.25) mm和(0.78±0.26) mm,近远中骨吸收程度与植入区骨质类型、种植体规格、修复基台角度、固位方式、临床冠-种植体长度比、性别、年龄等因素均未显示有相关性(P>0.05)。修复后主要的机械并发症有:修复体固位螺丝松动(8.6%)或折断(2.9%)、修复体上螺丝孔封闭材料脱落(11.4%)、修复体崩瓷(13.8%)及修复体脱粘(14.1%),其中仅修复体脱粘的发生率与修复时使用的基台角度(0°/15°)和修复体的临床高度这两个因素相关(P<0.05)。结论: 软组织水平种植体在单颗后牙缺失的修复病例中负重5年后,种植体周围的骨水平基本稳定,全面完善的种植诊疗计划、规范严谨的临床操作以及定期的复查可能是减少修复后并发症的有效方法。     

兔下颌前牙即刻种植后种植体周围炎动物模型的构建

目的：构建兔下颌前牙即刻种植后种植体周围炎动物模型。方法：选取12只健康雄性新西兰大白兔,麻醉后拔除兔下颌左侧前牙,在拔牙窝中即刻植入锥柱状纯钛种植体。待种植体植入8周后,随机选择3只实验兔处死,采用Micro-CT观察种植体骨结合状况。剩余实验兔随机分为3组：空白组不加刺激,对照组种植体周围注射磷酸盐缓冲溶液,实验组注射细菌内毒素溶液。加刺激2周后处死实验动物,取含种植体的下颌骨标本,采用Micro-CT观测骨量;取种植体周围牙龈标本,采用HE染色,观察牙龈组织病理学改变。结果：即刻种植8周后,种植体骨结合良好,牙龈健康。加刺激2周后,空白组和对照组牙龈健康呈粉红色,质地坚韧,种植体骨结合良好,种植体顶部骨组织无明显吸收,牙龈组织中见散在炎症细胞;实验组牙龈红肿,质地软,种植体顶部牙槽骨明显吸收,骨密度和骨体积分数显著降低,牙龈组织中见大量炎症细胞弥散性浸润。结论：种植体周围局部注射细菌内毒素可快速构建兔种植体周围炎原位动物模型。     

术区锥形束CT颌骨密度与种植体植入扭矩的相关性研究

目的 探讨锥形束CT颌骨密度与种植体植入扭矩的关系。方法 随机选择拟行种植修复的63例牙列缺损患者作为研究对象,经锥形束CT扫描Kavo eXam Vision软件测量获得各种植体术区颌骨密度的HU值,按照Biomet 3i根形种植体的要求,植入83颗种植体并记录植入扭矩,根据散点图的相关数据求出线性回归方程,分析颌骨密度与植入扭矩的相关性。结果 锥形束CT测量结果显示：上颌前部和后部的颌骨密度分别为（415.44±147.14）HU和（336.00±148.04）HU,下颌前部和后部的颌骨密度分别为（815.09±88.08）HU 和（537.08±167.28）HU。上颌前部和后部的植入扭矩分别为（43.08±10.52）Ncm 和（36.90±11.68）Ncm,下颌前部和后部的的植入扭矩分别为（50.00±0.00）Ncm和（44.05±11.17）Ncm。相关性分析结果显示锥形束CT扫描所得颌骨密度与种植体植入扭矩高度相关（r=0.536, P〈0.01）。结论 根据锥形束CT扫描测得的术区颌骨密度可对种植体植入扭矩进行初步评估,有助于手术方案的制定。     

Comparison of crestal bone loss along two implant crest module designs

Background: Crestal bone loss along the dental implant surface deranges its prognosis and is known to occur with implants having 02 mm smooth crest module/collar design. Implants with rough coated crest module/collar design are said to reduce crestal bone loss. Comparison of crestal bone loss with both crest module/collar designs of implants needs to be done.