吸烟患者牙种植疗效的临床研究

目的探讨吸烟对种植义齿临床疗效的影响。方法后牙缺失拟行种植修复的患者81例,分为吸烟组和非吸烟组,共植入124颗种植体,于负载后1年随访,检测种植体存留率、边缘骨吸收量、改良菌斑指数（modified plaque index,mPLI）和改良出血指数（modified sulcus bleeding index,mSBI）等临床指标。结果吸烟组有4颗种植体脱落,存留率为92%,非吸烟组种植体存留率为100%,2组差异有统计学意义（χ2=6.090,P=0.028）。吸烟组种植体周围边缘骨吸收量平均为（1.04±0.18）mm,mPLI和mSBI平均水平P50均为1。非吸烟组种植体周围边缘骨吸收量平均为（0.74±0.11）mm,mPLI和mSBI平均水平P50均为0。2组的边缘骨吸收量、mPLI、mSBI差异均有统计学意义（P〈0.05）。结论吸烟是导致种植义齿失败的一个危险因素,吸烟患者种植修复的预后较非吸烟者差。为提高种植义齿的成功率,吸烟患者应尽早戒烟,并保持口腔清洁卫生。     

上颌前牙区单个即刻种植义齿的美学效果评估

目的：对比上颌前牙区即刻种植和延期种植义齿修复的美学效果。方法：采取病例对照研究,选取27例上颌单个前牙种植病例,根据即刻种植与延期种植随机分为2组,采用粉红美学指标（PES）分别测量种植义齿修复完成时,以及种植义齿行使功能1年后的软组织变化情况,评估其美学效果。结果：27例种植体全部成功,两组的PES得分在不同时间点均无显著性差异,超过7％的病例美学失败,7％的病例可以被认为是完美的结果,其余病例表现出可以接受的美学效果。结论：即刻种植修复对种植义齿的存活率没有显著影响,且即刻种植和延期种植义齿修复对美学效果的影响也没有明显差异。     

后牙种植修复体咀嚼效能的初步比较研究

目的:将后牙常规义齿与种植义齿的修复效果进行定量比较。方法:选择单侧后牙缺失4颗以下,无其他口腔疾病者无口腔修复史者90例,牙位等同,分为活动组,固定组,种植组各30例。正常牙列对照组30例。用改良吸光度法测量并比较单侧后牙缺失患者行活动义齿,固定义齿及种植义齿修复前后的咀嚼效能。结果:活动修复后咀嚼效能与正常牙列人群咀嚼效能之间有显著性差别(P<0.05);固定修复后,种植修复后与正常牙列咀嚼效能无显著差别(P>0.05)。结论:活动义齿、固定义齿、种植义齿修复均能有效提高后牙缺失患者的咀嚼效能,但活动义齿效果最差。固定义齿和种植义齿修复均能使后牙缺失患者的咀嚼效能提高至与正牙列人群相似。     

单侧游离缺失不同修复方法的咬合力学分析

目的分析单侧游离缺失不同修复方法咬合力分布情况与特点及与天然牙列咬合力分布的差异。方法采用T—Sean咬合分析仪进行体内咬合力分布及咬合时间的测定。实验组为单侧游离缺失患者,按照修复方法不同分为种植组（种植固定义齿修复患者,15名）和支架组（铸造支架活动义齿修复患者,13名）。对照组为正常牙列（15名）。比较种植组、支架组与正常组咬合力分布的差异。结果从出现牙尖交错位到最大咬合力的时间：正常组、种植组和支架组的均值分别为：0．39s、0．42s和0．62s,三组间差异无统计学意义。正常组与种植组、支架组左右向位移均无显著性差异;正常组与支架组有显著性差异。正常组、种植组和支架组3组之间前后向位移均有显著性差异。结论种植义齿和活动义齿修复区域均出现咬合力偏低趋势,但种植义齿达到牙弓的左右向咬合平衡,与对侧天然磨牙咬合力较接近,较接近天然牙列的咬合力分布。而活动义齿在牙弓的左右向和前后向都未能达到天然牙列的咬合力平衡。     

口腔肿瘤治疗后上颌种植义齿失败的分析

目的:分析口腔肿瘤治疗和重建术后患者上颌种植修复失败的影响因素.方法:27例病人,共植入131枚上颌种植体,25例患者佩戴了上颌种植义齿,12例接受了术前或术后的放射治疗,采用Kaplan-meier的方法评价种植体和修复体的生存率,Log-rank检验比较放疗和未放疗患者的种植体和修复体生存率,对所观察种植体的边缘骨吸收,种植体周围袋深度,菌斑指数,种植体周围出血指数以及吸烟与否等资料进行了统计学分析.结果:接受放疗和未接受放疗的患者之间,其种植体和修复体的5年累计生存率差异均有显著性(P＜0.01);种植体周围袋深度,菌斑指数,种植体周围出血指数以及吸烟与种植义齿失败之间无显著差异.结论:放疗是影响上颌种植修复失败的主要因素,其它因素尚需进一步探索.     

种植义齿在单个磨牙缺失修复中的临床应用研究

目的:评价种植义齿修复单个磨牙缺失的临床应用效果。方法:对20例单个磨牙缺失的患者进行种植义齿修复,在完成修复后1个月、3个月、6个月复诊,以后每年复诊1次,对种植体稳固性、种植体周围组织进行随访评价。结果:在完成修复后的12—24个月内,种植体均无松动,3例基台螺丝松动导致牙冠松动,患者均无主诉持续性及不能缓解的不适症状。结论:修复设计是种植治疗中的主导因素。种植义齿修复单个磨牙缺失可以成为首选的修复方法。     

上颌前部种植义齿失败的临床回顾性研究

目的:分析上颌前部种植义齿失败原因,为提高临床种植义齿修复技术水平提供理论依据.方法:回顾分析10年来烟台市口腔医院种植修复失败病例,分析其原因.结果:上颌前部种植修复失败原因以术后感染最为常见,其他原因如修复设计不合理导致侧向力过大、种植体周围炎等也比较常见.结论:种植修复外科中严格无菌操作观念是降低术后感染的有效方法.合理设计种植修复计划可有效提高种植修复的成功率.     

338枚即刻种植义齿的临床疗效观察

目的:探讨即刻种植义齿修复牙缺失外科植入和修复方法;初期:(≥6月)和远期(≥36个月)疗效;评价其相关影响因素.方法:291例拔牙患者在拔除牙根后立即在牙槽窝内植入种植体338枚(HBIC,CDIC,CAMLOG,ITI,DIO,OSSTEM,XIVE),3-6月后延期修复,观察6-60个月.结果:338枚种植体随访300枚,6-60个月存留率95.67%.结论:即刻种植义齿修复具有自身优点和适应症,长期效果与延期种植效果无显著性差异,是可行、简便的种植叉齿修复方式之一.     

上下颌游离缺失Brnemark种植义齿早期临床效果的比较研究

目的:比较上下颌游离缺失Branemark种植义齿修复早期临床效果。方法 :5例上颌 (17颗 )和7例下颌(22颗 )游离缺失Branemark种植体植入金合金烤瓷桥修复行使功能18个月后 ,比较上下颌游离缺失Branemark种植体支持固定桥义齿的稳固情况、种植体周牙龈指数和种植体周骨吸收量。结果 :上下颌游离缺失Branemark种植体支持固定桥义齿种植体周骨吸收量无显著性差异 (P>0.05) ;两者种植体周牙龈均处于正常状态 ;上下颌游离缺失种植义齿均未见种植体松动或脱落 ,基台和全冠的稳固性均良好。结论 :上下颌游离缺失Branemark种植体支持种植固定桥义齿修复效果良好     

种植修复下颌磨牙游离缺失满意度的纵向研究分析

目的:纵向比较下颌磨牙游离缺失患者在未修复、活动义齿修复及种植义齿修复后的主观评价。方法:对40例戴用过活动义齿,现已完成种植义齿修复的下颌磨牙游离缺失患者,采取种植修复前自测问卷和种植修复后自测问卷形式,由患者本人填写。结果:种植义齿在咀嚼、语言、舒适性、固位等方面的满意度得分更高。结论:种植义齿是修复下颌磨牙游离缺失的最满意选择,活动义齿和未修复状态的满意度无显著意义。     

Comparison of Peri‐Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non‐Smokers: 5‐Year Follow‐Up Results

Background: The aim of this study is to compare peri‐implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non‐smokers. Methods: Thirty‐one patients with IL implants (16 smokers and 15 non‐smokers) and 30 patients with DL implants (17 smokers and 13 non‐smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri‐implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05). Results: All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non‐smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non‐smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non‐smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants. Conclusions: Tobacco smoking enhances peri‐implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri‐implant hard and soft tissue status in healthy smokers and non‐smokers.     

Private practice results of screw-type tapered implants: survival and evaluation of risk factors

PURPOSE: The aims of this study were to examine the long-term survival and the prosthetic treatment outcome of screw-type, tapered implants placed in a private practice setting and to explore potential risk factors of implant failures. MATERIALS AND METHODS: In this retrospective analysis of patients treated with endosseous screw-type tapered implants, data relative to implant placement and failure, implant length, location, prosthetic treatment, medical history, smoking habits, and oral health behavior were gathered by chart review and questionnaire. An oral examination was also conducted. Cumulative survival rates were estimated through Kaplan-Meier methods. Comparisons between subgroups of patients were made using the log-rank statistical test. The association between several factors and implant failures was analyzed using Cox regression analyses (random and dependent models). Differences were considered significant when P < .05. RESULTS: The survival rate of 663 implants placed in 159 patients (65 men, 94 women; 80.7% of 197 eligible patients) was 91.8% after 120 months. Mandibular implants had a higher survival rate than maxillary implants (96% versus 89%, P = .011). The failure rates for implants were 15.0% among current smokers, 9.6% among former smokers, and 3.6% among nonsmokers. The differences between nonsmokers, former smokers, and current smokers were significant (nonsmokers versus former smokers: P = .036, nonsmokers versus current smokers: P < .001, former smokers versus current smokers: P = .003). Only number of years of smoking was significantly associated with an increased risk of implant failures (P = .036 using dependent estimation; P = .004 using independent estimation). The HR increased to 6.6 for patients who had smoked for 45 years. Loosening of prosthetic components were rare (n=12). No fractures of screws or implants were found. DISCUSSION: Higher failure rates for former smokers and a dose-response effect between duration of smoking and implant failure rates suggested that permanent tissue damage from smoking may occur in addition to immediate local and systemic effects. The frequency of prosthetic complications was comparable to other studies. CONCLUSIONS: Screw-type tapered implants placed in a private dental office demonstrated a cumulative survival rate of 91.8%. The relative risk of implant failure increased with the duration of smoking.     

Smoking and complications of endosseous dental implants

BACKGROUND: The purpose of this study was to compare the incidence of the complications and survival rate related to dental implants among smokers and non-smokers, and to evaluate the influence of smoking by analyzing data of 959 implants placed in 261 patients during the years 1995 to 1998. METHODS: Patients were divided into 3 groups: non-smokers, mild smokers (up to 10 cigarettes per day) and heavy smokers (more than 10 cigarettes per day); smokers were divided into 2 subgroups according to duration of smoking (less or more than 10 years). Complications included minor (spontaneous implant exposure), major (spontaneous implant exposure requiring surgical intervention), and implant failure. The influence of smoking was analyzed for the type of implant cover screw and immediate versus late implantation. RESULTS: The overall failure rate was 2% for non-smokers and 4% for all smokers. Minor and major complications were found in higher percentages (46%) in the smoking groups than in the non-smoking group (31%). A significantly higher incidence of complications was found among smokers who received dental implants with high cover screws (63%) compared to those who received dental implants with flat cover screws (27%). CONCLUSIONS: This study establishes a relationship between implant complications and smoking, implant type (external or internal hex), and time of implantation as significant factors. A higher incidence of complications was found in the smoking group, especially in implants that had a high cover screw. Most complications will not lead to failures. Immediate implants failed less frequently than non-immediate implants. Limiting or reducing smoking habits will decrease complications of endosseous dental implants.     

Effects of smoking on implant success in grafted maxillary sinuses.

STATEMENT OF THE PROBLEM: Cigarette smoking has been identified as a significant risk factor for dental implant treatment. PURPOSE: This retrospective study evaluated the effect of smoking and the amount of cigarette consumption on the success rates of the implants placed in grafted maxillary sinuses. MATERIAL AND METHODS: Sixty patients (16 smokers and 44 nonsmokers) were evaluated for the effects of smoking on osseointegrated implants placed in 84 grafted maxillary sinuses that contained a total of 228 endosseous root-form implants. Seventy implants were placed in 26 maxillary sinuses in smokers, whereas 158 implants were placed in 58 sinuses in nonsmokers. The number of implant failures and the amount of cigarette consumption were recorded. RESULTS: Of the 228 implants, 205 (89.9%) remained in function, after a mean follow-up period of 41.6 months (2 to 60 months). There was a significantly higher cumulative implant success rate in nonsmokers (82.7%) than in smokers (65.3%) (P =.027). Overall cumulative implant success rate was 76%. There was no correlation between implant failures and the amount of cigarette consumption (P >.99). CONCLUSION: Within the limitations of this study, cigarette smoking appeared to be detrimental to the success of osseointegrated implants in grafted maxillary sinuses regardless of the amount of cigarette consumption.     

The effect of smoking on achieving osseointegration of surface-modified implants: a clinical report

PURPOSE: The present study evaluated the effect of smoking on achieving initial osseointegration when surface-modified dental implants were used. MATERIALS AND METHODS: During an 18-month period in a private practice setting 1,183 implants were placed in 461 patients. The group of smokers consisted of patients who smoked a half pack or more of cigarettes per day. RESULTS: The overall success rate for smokers and non-smokers in achieving osseointegration was 98.1%. Ninety-seven percent of the implants placed in smokers osseointegrated successfully, and 98.4% of implants placed in non-smokers osseointegrated successfully (P < .05). DISCUSSION: The surface of an implant may be a critical determinant for achieving osseointegration in patients who smoke. CONCLUSION: It appears from this short-term retrospective study that smoking does not play a significant role in achieving the osseointegration of surface-modified dental implants.     

一段式锥状种植体用于前牙即刻加载种植修复的远期疗效评价

目的：对前牙区牙槽嵴较狭窄病例采用微创技术和锥状种植体进行前牙区即刻加载修复并评价其远期临床疗效。方法：收集1998～2000年临床病例21例,应用非翻瓣式一期法环切术,将一段式锥状种植体植入前牙缺失区,57枚种植体分为即刻加载修复组（治疗组）27枚和常规延期修复组（对照组）30枚,术后观察指标为：GI、种植体周围炎、植体稳定性,拍摄X线片了解牙槽嵴吸收情况,随访10～12年,评价其远期临床效果。结果：治疗组和对照组的临床成功率分别为96.3﹪和96.7﹪,统计学无显著性差异。结论：小直径一段式种植体较适合国人前牙区牙槽嵴解剖结构,不易引起骨壁侧穿,初期稳定性好;非翻瓣式环切手术入路,可保留龈乳头的完整性,使患者免除二次手术痛苦。     

Long-term changes in soft tissue height on the facial surface of dental implants

The success of osseous healing around dental implants has allowed for an increased emphasis on soft tissue healing and esthetic results. However, there is limited information profiling the long-term healing of the soft tissues following prosthesis placement. The purpose of this study was to assess the long-term changes in the position of the facial soft tissue margins following restoration of a one-stage implant system. One hundred and six one-stage ITI implants were evaluated in 39 patients. Implants were placed in maxillary and mandibular anterior regions. Clinical assessment of the soft tissues on the midfacial aspect of the implants was performed over a 2-year period, at 3 and 6 month intervals, following placement of the final restoration. A total of 63 implants were placed as multiple units in the mandible, 23 as single units in the maxilla, and 20 as multiple units in the maxilla. There were no implant failures over this time period. Overall, on the facial aspect of 61% of the 106 implants there was 1 mm or more of soft tissue recession, whereas 19% of the implants showed 1 mm or more of gain in soft tissue height. There was a significantly (P < 0.01) greater number of implants showing a gain in soft tissue levels in the mandibular implants compared with the maxillary implants. Of the 39 patients assessed, 24 showed a loss and five showed a gain of 1 mm or more of the soft tissue levels around the implants. Overall, there was a significant decrease in the mean levels of tissue height of 0.6 mm within the first 6 months, with relatively little change afterward. However, in evaluating only patients showing a loss in tissue height around one or more implants, the mean loss in tissue height was 1.6 mm after 24 months. These results suggest that the potential for significant changes in soft tissue levels after completion of restorative therapy need to be considered for implant therapy in esthetic areas.     

异体脱细胞真皮基质修复犬即刻种植软组织创口的实验研究

目的：评价异体脱细胞真皮基质（ADM）修复犬即刻种植软组织创面的效果。方法：选取成年杂种犬6只,全麻后拔除双侧下颌第四前磨牙,立即植入12枚BLB种植体。应用ADM修复即刻种植后软组织缺损创面。术后3个月行二期手术,2周后行烤瓷冠修复并功能负荷1个月。术后观察种植体骨结合、ADM修复创面的愈合情况,并制作种植体-牙槽骨-牙龈切磨片进行组织学观察。结果：术后所有创面完全封闭愈合,种植体周围软组织解剖形态无明显改变;种植体颈部软组织形成了类似天然牙结合上皮的形态。结论：ADM取材广泛,具有良好的即刻种植创面封闭作用,且能增加软组织量,修复美学效果好;种植体周围软组织能形成类似天然牙的结合上皮。     

不翻瓣种植的临床观察及手术探讨

目的：观察不翻瓣种植技术的临床应用效果并探讨其临床操作技巧.方法：45例患者分为60岁以上老年组（A组）和60岁以下非老年组（B组）.术前行CBCT检查,制作手术导板.所有植体采用不翻瓣种植技术植入,术后2-6个月进行永久修复.于修复后6个月和12个月复查,行X线检查和临床牙周检查.结果：A组14例患者植入17枚植体,植入扭矩均≥25 N.cm,平均种植操作时间为12.1 min,修复后1年的平均骨丧失量为0.69±0.40mm、平均探诊深度2.01±0.87ram.B组31例患者植入33枚种植体,3枚植体的植入扭矩＜25N.cm,采用埋入式愈合,平均种植操作时间为11.8 min,修复后1年的平均骨丧失量为0.64±0.29mm.牙周平均探诊深度为2.13±0.90mm.两组病例随访12-24个月,植体存留率100％.两组间骨丧失量及牙周探诊深度无统计学差异.结论：在严格掌握手术适应症,充分术前计划和精湛手术技巧的前提下,不翻瓣种植手术具有过程简单,时间短,术后反应轻等优势,尤其适合于老年患者,短期内可达到与翻瓣手术相同的存留率.