临床平台转移技术在上颌后牙区种植中的应用

目的:评价临床平台转移技术在上颌后牙区种植的效果.方法:选择60例上颌后牙种植患者随机分实验与对照组,共植入141枚种植体,植体肩部与牙槽嵴平齐.实验组30例选用小于植体直径的愈合基台(0.7mm)与种植体相连,重建种植区的结合上皮.上部结构(基台)精细研磨,重建无缝隙冠龈连接,精度贵金属烤瓷修复.对照组选用与植体直径相同的愈合基台与种植体相连,常规修复.分别于种植修复后3、6、12月测量上颌后牙种植体周围边缘骨高度和评价软组织情况.结果:实验组种植体周围边缘骨高度变化明显小于对照组(P＜0.01),两组软组织情况变化不明显(p＞0.05).结论:临床平台转移技术可保持种植体周围边缘骨高度,其远期效果可期.     

Bicon短种植体在上颌后牙区骨量不足病例中的临床应用

目的：评估Bicon短种植体在上颌后牙区骨高度不足病例种植修复的临床效果。方法：选择上颌后牙区骨高度1．7—8ram的病例62例,共植入Bicon短种植体252枚,其中植入长度6ram的种植体192枚,长度8mm的种植体60枚。其中上颌窦区牙槽骨高度不足的患者行经牙槽嵴上颌窦底提升术同期植入种植体,部分植体使用上颌窦基台固位。3—6个月后完成永久修复。结果：62例252枚Bicon短种植体均获得了良好的骨结合,9—26个月的随访观察及X光片和牙科CT检查,临床效果良好,种植体周围骨组织稳定。结论：Bicon短种植体在上颌后牙区骨量不足病例种植修复中临床效果肯定。     

临床平台转移设计用于下颌后牙种植修复的五年效果观察

目的:通过下颌后牙区种植修复的五年随访观察,评价临床平台转移设计临床应用的效果.方法:选择下颌后牙区种植一期术后患者90例,随机分实验组对照组;实验组使用较常规小一号的愈合基台和修复基台,临床平台转移与重建种植体周围龈袖口,62例.对照组使用常规愈合基台和修复基台,转移与重建种植体周围龈袖口28例.术后当天和功能负重后1、3、5年后分别拍摄X线根尖片,测量种植体周围边缘骨高度丧失量并评价软组织情况.结果:实验组边缘骨丧失量明显低于对照组(P＜0.01);实验组的软组织的稳定性也明显优于对照组(P＜0.01).结论:临床平台转移设计可以明显地减少种植体周围颈部边缘骨的吸收和保持周围软组织稳定,对种植修复的长期成功率具有重要的意义.     

CBCT对上颌后牙区骨高度不足种植治疗的临床应用

目的:对于长期缺牙或者患有骨质疏松的患者,易致颌骨骨量不足。上颌后牙区,由于特殊解剖结构因素,其种植外科手术常临床工作中的难点。而颌骨曲面断层片由于拍摄角度、放大倍率的因素,常会发生误读与误判颌骨情况。本研究旨在利用锥形束状CT对颌骨结构进行三维重建,对术区进行准确定位,分析可利用的骨量,确定手术方案。方法:针对拟行上颌后牙区种植修复且伴骨高度不足的患者,在术前利用CBCT影像诊断系统对其口腔上下颌骨进行扫描并MPR多平面重建,测量并分析术区颌骨高度及宽度,颌骨的骨质密度情况。结果:CBCT图像清晰直观,测量精准,可在术前就能预判颌骨情况,选择短种植体还是上颌窦提升术,内提升还是外提升。讨论与结论:CBCT宜作为上颌后牙区伴骨高度不足种植治疗的常规术前检查,对手术方案的选择有极大帮助。     

不同冠根比短种植体在上颌后牙区种植修复的短期临床研究

目的观察不同冠根比短种植体在上颌骨高度不足后牙区种植修复的临床效果。方法选取剩余牙槽骨高度为4～5 mm的后牙缺失病例,共计12例患者植入17颗短种植体。随访1年半,检测指标包括种植体存留率、边缘骨水平变化、临床检查(改良菌斑指数、改良出血指数、探诊深度)。对数据进行统计学分析。结果短种植体存留率为100%,总体边缘骨吸收为(0.45±0.07)mm,临床检查平均改良菌斑指数为(1.12±0.32),出血指数为(1.11±0.32),探诊深度为(1.57±0.37)mm。平均冠根比C/IR=1.92±0.30,按1.02.0进行分组,不同冠根比组边缘骨吸收与探诊深度无明显差异,P=0.47;冠根比与改良菌斑指数和出血指数具有相关性,P<0.05。结论在骨高度不足的上颌后牙区,冠根比对种植体早期边缘骨吸收无明显的影响,但对软组织健康可能有影响,应定期复查和维护口腔卫生,以提高种植体的长期稳定性。     

上颌后牙区即刻种植及同期上颌窦提升的临床应用

目的:探讨上颌后牙区即刻种植及同期上颌窦内提升的临床效果. 方法:选择上颌后牙区即刻种植病例57例,其中上颌后牙区上颌窦底骨高度为(3.2±0.6)mm,微创拔除患牙后,行单纯上颌窦内提升同期牙种植术,植入德国XIve种植体21枚,德国Ankylos种植体45枚,种植体与拔牙窝骨壁之间的间隙植入自体骨或人工骨代用品,缝合固定胶原塞以关闭拔牙窝. 种植手术后至少5~6个月完成永久修复,随访6~24个月. 结果:临床随访期内种植体存留率100%,57例患者上颌窦底提升高度3~5 mm. 66枚种植体成功负载,种植体稳定,骨结合状况良好. 57例患者均达到良好的临床和放射学上的骨结合并成功负载. 结论:上颌后牙区即刻种植及上颌窦内提升术不仅能有效治疗上颌窦底牙槽骨高度不足的上颌后牙区,而且缩短治疗过程,简化手术操作,获得较为理想的临床效果.     

倾斜种植体在上颌后牙区骨量不足患者中的应用

目的:探讨倾斜种植体作为一种避免上颌窦植骨的方法,应用于上颌骨后牙区骨量不足患者种植修复的可靠性。方法:2005年1月—2007年12月间,21例患者共27个固定桥修复上颌后牙缺失,分别使用ITI和Br覽nemark 2种种植系统共植入78颗种植体,其中34颗种植体采用倾斜植入,44颗轴向植入。所有患者均为上颌后牙区骨量不足无法直接接受常规种植体植入。种植体植入后常规愈合3个月,除1颗种植体失败外,其余种植体均功能性负载支持固定义齿修复,修复方式为黏结固位和螺丝固位。每例患者均于负载后12、24和36个月接受临床和放射学随访检查。采用SPSS11.0软件包对数据进行统计学处理。结果:上颌有1颗轴向种植体在术后2个月时失败,倾斜种植体无失败。随访时间为36个月。上颌轴向种植体的累积存活率为97.72%,倾斜种植体的累积存活率为100%,修复成功率为100%。随访期间,种植体周围软组织保持稳定,平均探诊深度和附着水平无明显变化。结论:倾斜种植体作为一种上颌骨后牙区骨量不足患者的治疗方法是可靠的,能有效避免植骨手术,并节约治疗时间。     

人工骨折在上颌后牙种植术中的应用

人工骨折在上颌后牙种植术中的应用广东省口腔医院口腔种值科（５１０２６０）张开宜，黄云飞制作上颌后牙种植义齿时，常因上颌窦位置太低而为种植术带来困难。为此可采用上颌窦底植骨术或牙槽骨加高术来解决牙槽骨高度不足。但手术较复杂，疗程也较长。作者在上颌窦底制...     

上颌后牙区牙种植术研究进展

上颌后牙区牙槽嵴顶的过度吸收、上颌窦的过度气腔化常导致骨量不足,加之骨质疏松等不利因素,使上颌后牙区牙种植术的临床应用受到很大限制。各国学者们纷纷围绕上颌后牙区骨量不足及骨质疏松的问题展开全面的研究,取得了积极的进展,本文主要就上颌窦底提升植骨术的改进和完善、种植体几何形状及尺寸的优化设计以及种植方式的创新发展及临床应用进行综述。     

短种植体在上颌后牙区的应用与风险

上颌后牙区种植常面临可用骨高度不足的问题,使用短种植体可以避免骨增量手术,得到良好的临床效果,但也有一些因素会给短种植体的成功应用带来风险.本文介绍了短种植体的定义与发展,对短种植体应用于上颌后牙区的风险因素进行探讨,并对种植体与修复方式的选择提出建议.     

消极吻合技术在下颌前牙种植修复中的应用

目的：探讨种植修复消极吻合的重要性。方法：32例下颌前牙缺失骨量不足患者种植85颗种植体,取模,制作金属基底冠桥,分开其连接处,试戴就位,分开处在口内以成型塑料连接,重新二次印模,激光焊接,再试基底冠桥,检查其颈部密合性和翘动情况,制作烤瓷牙,粘固固位种植修复体,定期牙周维护。分别于种植修复后3、6、12月临床检查修复体稳定性与牙龈情况,X线检查种植体-骨界面与牙槽嵴情况。结果：种植修复成功31例,失败1例。结论：消极吻合是保证口腔种植修复成功的要素之一。     

平行切削仪在下颌种植修复中的应用

目的：探讨平行切削仪在下颌种植修复中取得共同就位道的方法与效果。方法：选择60例下颌后牙多个联冠种植修复患者,植入186枚种植体,精确取模,选择合适上部结构,安装模型于平行切削仪,反复多次测量与确定共同就位道,选用锥度磨头精细研磨上部结构,表面高度抛光,成型塑料与专用蜡制备冠蜡型,贵金属底冠铸造,精度贵金属烤瓷冠修复。应用临床与X线检查方法分别于试戴金属底冠与烤瓷修复体时检查种植修复体边缘密合度与翘动情况。结果：60例中55例种植修复体边缘密合度良好,无翘动,有效率91.7%;3例密合度不足,但无翘动,占5%;2例密合度严重不足,翘动,占3.3%。结论：平行切削仪切削技术可有效取得种植修复体共同就位道,可达到消极吻合。     

平台转换在种植义齿修复中的临床评价

目的：评价平台转换技术在牙列缺损种植修复中的临床效果。方法：38例牙列缺损种植患者随机分为实验组与对照组,共植入51枚直径为4.5 mm XIVE种植体。实验组：19例27枚种植体选用愈合基台直径为3.8 mm平台转换连接式,重建种植区的结合上皮,3.8 mm修复基台,高含金量贵金属烤瓷冠修复。对照组：19例24枚种植体选用愈合基台、修复基台直径与种植体直径相同的平齐对接连接式,高含金量贵金属烤瓷冠修复。分别于种植体负载前及负载后3、6、12月时行X线检查,测量种植体颈部边缘骨吸收量及软组织健康状况并进行评价。结果：平台转换种植体颈部骨吸收量明显小于对连接种植体（P﹤0.01）,两者软组织健康状况差异不明显（P﹥0.05）。结论：与平齐式对接相比,功能负载1年内,临床平台转换设计可保留种植体颈部边缘骨高度。     

引导骨再生膜技术在上颌前牙缺失伴重度骨缺损中的应用

目的：评价引导骨再生技术（GBR）在上颌前牙缺失伴重度骨缺损的种植修复效果。方法：选择30例上颌前牙缺失伴重度骨缺损患者,植入Xive种植体62枚,在骨缺损区植入Bio-Oss骨粉,Bio-Gide膜覆盖,重建牙槽骨的高度和宽度;8-10个月后二期手术,术后6周种植修复。结果：62枚种植的Xive种植体,观察最长48个月,最短12个月,种植体存留率100%。结论：骨再生引导膜技术（GBR）在上颌前牙缺失伴重度骨缺损中的临床应用效果稳定,有效。     

Submerged and transmucosal healing yield the same clinical outcomes with two-piece implants in the anterior maxilla and mandible: interim 1-year results of a randomized, controlled clinical trial

Objectives: To test whether or not transmucosal healing at two‐piece implants is as successful as submerged placement regarding crestal bone levels and patient satisfaction. Material and methods: Adults requiring implants in the anterior maxilla or mandible in regions 21–25, 11–15, 31–35 or 41–45 (WHO) were recruited for this randomized, controlled multi‐center clinical trial of a 5‐year duration. Randomization was performed at implantation allowing for either submerged or transmucosal healing. Final reconstructions were seated 6 months after implantation. Radiographic interproximal crestal bone levels and peri‐implant soft tissue parameters were measured at implant placement (IP) (baseline), 6 and 12 months. Patient satisfaction was assessed by a questionnaire. A two‐sided t‐test (80% power, significance level α=0.05) was performed on bone‐level changes at 6 and 12 months. Results: One hundred and twenty‐seven subjects were included in the 12‐month analysis (submerged [S]: 52.5%, transmucosal [TM]: 47.2%). From IP to 6 months, the change in the crestal bone level was ?0.32 mm (P<0.001) for the S group and ?0.29 mm (P<0.001) for the TM group. From IP to 12 months, bone‐level changes were statistically significant in both groups (S ?0.47 mm, P<0.001; TM ?0.48 mm, P<0.001). The mean differences of change in the bone levels between the two groups were not statistically significant at either time point, indicating the equivalence of both procedures. For both groups, very good results were obtained for soft tissue parameters and for patient satisfaction. Conclusions: Transmucosal healing of two‐piece implants is as successful as the submerged healing mode with respect to tissue integration and patient satisfaction within the first 12 months after IP. To cite this article:
Hämmerle CHF, Jung RE, Sanz M, Chen S, Martin WC, Jackowski J, Ivanoff CJ, Cordaro L, Ganeles J, Weingart D, Wiltfang J, Gahlert M. Submerged and transmucosal healing yield the same clinical outcomes with two‐piece implants in the anterior maxilla and mandible: interim 1‐year results of a randomized, controlled clinical trial.
Clin. Oral Impl. Res 23 , 2012; 211–219.
doi: 10.1111/j.1600‐0501.2011.02210.x     

Progressive recovery of osseoperception as a function of the combination of implant-supported prostheses

The extraction of teeth involves the elimination of extremely sensitive periodontal mechanoreceptors, which play an important role in oral sensory perception. Objectives: The aim of this study was to evaluate the recovery of interocclusal sensory perception for micro‐thickness in individuals with different types of implant‐supported prostheses. Materials and Methods: Wearers of complete dentures (CDs) comprised the negative control group (group A, n=17). The experimental group consisted of wearers of prostheses supported by osseointegrated implants (Group B, n=29), which was subsequently divided into 4 subgroups: B₁ (n=5) – implant supported overdentures (ISO) occluding with CD; B₂ (n=6) – implant‐supported fixed prostheses (ISFP) occluding with CD; B3 (n=8) – wearers of maxillary and mandibular ISFP, and B₄ (n=10) – ISFP occluding with natural dentition (ND). Individuals with ND represented the positive control group (Group C, n=24). Aluminum foils measuring 10 μm, 24 μm, 30 μm, 50 μm, 80 μm, and 104 μm thickness were placed within the premolar area, adding up to 120 tests for each individual. Results: The mean tactile thresholds of groups A, B₁, B₂, B₃, B₄, and C were 92 μm, 27 μm, 27 μm, 14 μm, 10 μm, and 10 μm, respectively. [Correction added after publication online 18 April 2008: in the preceding sentence 92 μm, 27 μm, 14 μm, 10 μm and 10 μm, was corrected to 92 μm, 27 μm, 27 μm, 14 μm, 10 μm and 10 μm.] The Kruskal‐Wallis test revealed significant difference among groups (P<0.05). The Dunn test revealed that group A was statistically different from groups C, B₃, and B₄, and that B₁ and B₂ were statistically different from group C. Conclusion: Progressive recovery of osseoperception as a function of the combination of implant‐supported prostheses could be observed. Moreover, ISO and/or ISFP combinations may similarly maximize the recovery of osseoperception.     

Early complete failures of fixed implant-supported prostheses in the edentulous maxilla: a 3-year analysis of 17 consecutive cluster failure patients

Background Clusters of implant failures in the edentulous maxilla seem to occur in some patients. To create groups for analysis with higher numbers of these patients implies large original groups for inclusion. Purpose The aim of this study was to retrospectively describe and compare a group of “cluster failure patients” with randomly selected patients treated in the edentulous maxilla. Materials and Methods From a group of 1,267 consecutively treated patients in one clinic, all patients presenting failing fixed implant‐supported prostheses within the first 3 years of follow‐up were included. All patients were treated with turned titanium implants using two‐stage surgery. A control group of equal number of patients were created for comparison. Data on patients were retrospectively retrieved from their records, and compared. Results Seventeen patients (1.3%) met the inclusion criteria in the entire group. The bone resorption index revealed less bone quantity in the study group (p < .05) during implant placement, but there was no difference regarding primary implant stability at first‐stage surgery. The distribution of short and long implants showed relatively higher number of short implants in the study group (p < .05), and more patients had a presurgical discussion on the risk of implant failure prior to treatment in this group (p < .05). Only 5 out of 102 implants (4.9%) were lost before prosthesis placement as compared to 38 and 25 lost implants during the following two years in the study group. Smoking habits and signs of bone loss related to periodontitis in the lower dentition were more frequent in the study group, but did not reach a significant level (p > .05). Conclusion The results indicate that bone quantity, reflected in fixture length, has a significant impact on increased implant failure risk. Other factors of interest as predictors for implant failures could be smoking habits and also possibly signs of periodontitis in the opposing dentition.