Alveolar Bone Grafting in Cleft Patients from Bone Defect to Dental Implants

Cleft lip and palate is the most common congenital deformity affecting craniofacial structures. Orofacial clefts have great impact on the quality of life which includes aesthetics, function, psychological impact, dental development and facial growth. Incomplete fusion of facial prominences during the fourth to tenth week of gestation is the main cause. Cleft gaps are closed with alveolar bone grafts in surgical procedure called osteoplasty. Autogenic bone is taken from the iliac crest as the gold standard. The time of grafting can be divided into two stages: primary and secondary. The alveolar defect is usually reconstructured between 7 and 11 years and is often related to the development of the maxillary canine root. After successful osteoplasty, cleft defect is closed but there is still a lack of tooth. The space closure with orthodontic treatment has 50-75% success. If the orthodontic treatment is not possible, in order to replace the missing tooth there are three possibilities: adhesive bridgework, tooth transplantation and implants. Dental implant has the role of holding dental prosthesis, prevents pronounced bone atrophy and loads the augmentation material in the cleft area. Despite the fact that autologous bone from iliac crest is the gold standard, it is not a perfect source for reconstruction of the alveolar cleft. Bone morphogenic protein (BMP) is appropriate as an alternative graft material. The purpose of this review is to explain morphology of cleft defects, historical perspective, surgical techniques and possibilities of implant and prosthodontic rehabilitation.Key words: Cleft Lip, Cleft Palate, Alveolar bone grafting, Bone Morphogenic Proteins, Dental implants, Dental prosthesis, Orthodontic Space Closure     

下颌骨取骨onlay植骨改善种植骨量不足的临床研究

目的:评价应用下颌骨取骨onlay植骨改善种植术前重度萎缩牙槽嵴的手术方法及疗效。方法:18例患者接受了下颌骨来源的onlay植骨术,手术同期或术后4～6个月共植入22颗种植体,并于术后4～6个月暴露种植体,最终完成烤瓷冠修复。结果:植骨术后无并发症发生,2例骨吸收较明显,其余均顺利植入种植体,二期手术时骨吸收平均20%。所有病例均最终完成种植修复,观察6～28个月,无种植体脱落。结论:下颌骨取骨onlay植骨修复重度萎缩的牙槽嵴操作简便,效果可靠。     

AAA骨粉和骨内种植体复合立即种植的临床疗效观察

人工种植牙技术近几年来在我国发展很快，国内学者多认为立即植入法保存率较低，所以目前绝大多数医师多采取延期植入手术方法。为了探索立即种植的可行性，本文作者自1991年开始，在共计完成的206枚种植体植入手术中，分别采用延期植入，AAA骨粉复合立即植入和单纯立即种植等三种不同的方法进行比较，结果表明，在102例采用AAA骨粉和种植体复合立即植入的病例中成功100例，成功率达98.1%，经统计学比较与延期植入效果无明显差别，而与单纯立即植入差别有高度显著性。本文提出AAA骨粉有利于种植体周围的骨质生长，可使立即植入成功率大大提高，同时提出手术操作要点。立即种植具有减少创伤次数，缩短病人失牙时间，尽早恢复咀嚼功能，减少牙槽骨进行性吸收，保存牙槽骨量等不可比拟的优点，是一种很有发展前景，有价值，易于推广的种植方法。     

牙-骨联合支持式CAD/CAM种植手术模板的临床应用

目的:口腔种植体植入位置的正确性与精确性以及方向与深度问题的把握,一直为临床口腔种植外科领域关注的问题.本研究在基于CT影像颌骨三维解剖结构分析的基础上,研究适合国人的计算机辅助设计与制作(CAD/CAM)的口腔种植外科手术模板系统,旨在探讨个体化设计的牙-骨联合支持式CAD/CAM种植手术模板的临床应用效果.材料与方法:应用Philips Brilliance 64层螺旋CT机、CHEU-DENTAL Biostar?空气压模机、SPS600B激光快速原型机并借助Advantage-Dentascan AW4.0软件、ez-DICOM程序、PRO/E及在Visual C++6.0程序设计语言编程下的CISPlan牙种植软件,先后完成研究包括:①基于螺旋CT受植颌骨三维结构分析;②CAD/CAM牙种植外科手术定位导向模板的设计;③12例末端游离缺失患者种植的,临床应用及评价.结果:该辅助软件系统均能满足涉及三维重建、图像分割、图像显示、图像融合等方面的图像处理功能与医学图像的三维可视化,系统可以直接读取DICOM格式、JPG格式和BMP格式的图像数据,实现颌骨CT数据多平面重建与浏览包括轴位、侧断层、全景及受植颌骨三维结构图像的任意剖面的显示.在仿生下颌骨上应用RP技术制作的3、5、10mm三种不同高度的种植外科导向模板进行13mm长度种植体模拟种植的结果提示,5mm以上厚度模板能将植入位点误差控制在1mm以内,角度误差在3度以内.该研究成果为临床研究提供了可靠的实验依据,并为种植外科医生术中准确与精确植入牙种植体提供了安全保障.12例末端游离缺失患者种植外科临床应用效果显示:牙-骨联合支持式CAD/CAM光敏树脂手术模板能满足手术便利、准确、精确与安全的需要.讨论:经临床种植病人初步应用,牙-骨联合支持式CAD/CAM种植手术模板具有如下优点:①将骨支持与牙支持方式结合起来,研制出以模板的骨支持为基础并辅以激光扫描获得的高?     

Radiographic Evaluation of Crestal Bone Loss Around Dental Implants in Maxilla and Mandible: One Year Prospective Clinical Study

Purpose

The aim of the study was to analyze the amount of maxillary and mandibular crestal bone loss around Bredent Sky Blue type of implants of different dimensions one year after implantation.

Materials and Methods

36 implants of diameter 3.5 x 10 mm were inserted in the maxilla and 12 in the mandible. 52 implants of diameter 4.0 x 8 mm were inserted in the maxilla, and 61 in the mandible (two-stage implant surgery).

Results

No statistically significant differences were found between the right and left side of the maxilla and between the right and left side of the mandible at the implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).

Conclusion

Statistically significant differences were found between anterior maxilla, posterior maxilla and anterior mandible and posterior mandible at implant sites regarding distal and mesial bone losses as shown by analysis of variance (ANOVA).Key words: Alveolar Bone Loss, Bone Resorption, Dental Implants, Maxilla, Mandible     

骨内牙种植体六年临床观察

目的：评价牙种植体的临床效果。方法：对192例281枚种植体进行了6年的临床观察,采用的种植体为叶状、螺旋状和羟基磷灰石涂层（Ti-HAc）种植体。结果：牙种植体6年临床观察的成功率为89.68%,种植体周围炎和机械性折断是种植体失败的主要原因。     

3种类型牙种植体的临床应用

目的比较3种牙种植体的临床疗效。方法常规植入3种不同材料、形状的牙种植体共384颗,依照我国种植义齿成功标准,比较3种种植体的成功率。结果经1～5a的临床观察,3种种植体的成功率均在97%以上。结论常规植入种植体的成功主要与适应证的选择、病例设计、手术修复操作及患者自身维护有关,3种种植体的成功率无明显差异。