应用新型愈合帽固定钛网在下颌后牙区垂直骨增量的临床研究

目的:评价一种新型愈合帽将钛网用于下颌后牙区垂直骨缺损区种植修复的临床效果.方法:纳入存在垂直向骨缺损的下颌后牙缺失病例20例,共27颗种植位点,同期植骨,使用一种新型愈合帽固定于种植体顶端完成种植,术后随访2年,CBCT观察种植体颊舌侧骨增量高度.结果:术后半年颊侧骨增量平均(2.82±0.64)mm,舌侧(2.29...     

牵张成骨和引导骨再生术在垂直骨增量上的比较研究

随着种植外科的进展,大量垂直向和水平向骨增量技术得到了发展。许多种植患者存在垂直向骨量不足的问题,需要增加垂直向骨量;但垂直向骨增量相对于水平向骨增量难度比较大,预见性较差,往往易致较多的并发症;因此,垂直向骨增量技术受到了越来越多的关注。引导骨再生技术和牵张成骨术是2类较常用的垂直向骨增量技术,在临床上已得到一定的应用,本文对其在垂直向骨增量上的研究进展作一综述。     

脱矿人牙骨基质粒径大小对垂直骨增量效果的影响

目的:探究不同粒径大小的脱矿人牙骨基质材料对兔颅骨垂直骨增量效果的影响.方法:选择6只新西兰大白兔,每只兔颅骨制备3个9 mm环形裂隙并在其上方固定钛容器,容器内随机植入以下3组:A组脱矿人牙骨基质(0.25～0.5 mm);B组脱矿人牙骨基质(0.5～1 mm);C组空白对照组.植入后12周进行锥形束计算机断层摄影(Cone beam computed tomography,CBCT)检查和组织学观察分析.结果:CBCT结果显示A,B,C三组有明显新骨生成,新骨自基底骨垂直向上生长,脱矿人牙骨基质与兔颅骨结合稳定,垂直骨高度维持良好.组织学观察显示脱矿人牙骨基质和骨组织界面出现不同程度血管化及新生骨.A,B两组新骨形成率无显著差异(P>0.05).结论:粒径大小对于垂直骨增量的效果没有显著性影响,不同粒径大小的脱矿人牙骨基质在垂直骨增量手术中均显示出良好的骨传导性及骨诱导性.     

改良自攻性纯钛帽植入兔颅骨的动物模型研究

目的对传统的纯钛帽改良后植入兔颅骨,建立新的种植体表面处理研究的动物模型。方法运用数控机床对纯钛板进行机械加工,压制中空半球形钛帽,底部添加自攻性螺纹,顶部添加两个环形小孔。48个纯钛帽植入12只新西兰兔颅骨。选取观察时间点为2周、4周,6周。通过大体标本和牙科微型CT观察纯钛帽植入的稳定性,制作带金属不脱钙硬组织切片,观察纯钛帽植入兔颅骨的动物实验模型骨组织效应。结果手术过程中植入共48个纯钛帽,其中2个松动,松动率为4.17%;植入2、4、6周取材时,48个标本无松动,脱落。牙科微型CT结果显示,纯钛帽能够稳定在兔颅骨上。带金属不脱钙硬组织切片显示,新旧骨组织形成明显界限,周围骨组织长入纯钛帽底部的螺纹,嵌合良好。结论改良自攻性纯钛帽制作加工相对传统的钛帽工艺简单,稳定性良好,减少辅助固定装置,减少手术创伤,简化操作步骤,提高实验效率,可以用于研究种植体表面处理方式的动物模型。     

应用骨胶原结合帐篷技术行上颌后牙连续缺失垂直骨增量一例

垂直骨增量是口腔种植骨增量手术中最大的挑战之一。当骨缺损较大时,往往需要开辟第二术区进行块状自体骨移植,或应用钛网或钛增强支架联合使用颗粒状自体骨及骨替代材料,并发症发生率较高,手术创伤较大。本病例患者上颌后牙区连续多牙重度垂直骨缺损,使用骨胶原（Bio-OssCollagen）结合钛钉及可吸收胶原膜进行垂直骨增量,于骨增量后6个月获得了平均6.57mm的骨高度增加,满足了种植体植入需要,种植体周围骨组织在修复后随访过程中较为稳定。此术式骨增量效果可预期、操作简便、创伤较小,或可为临床垂直骨增量的术式选择提供参考。     

增材制造个性化骨增量钛网的工程实现

目的 阐述个性化骨增量钛网的增材制造研发和生产工艺流程,确保质量可靠且一致性的钛网成品进入临床手术.方法 采用有限元分析的方法优化个性化骨增量钛网的设计,使用医用纯钛金属材料增材制造个性化骨增量钛网及随炉试样,对试样做理化性能测试来评估个性化骨增量钛网的性能.结果 在水平、垂直和45° 方向增材制造试样的屈服强度平均值...     

侧壁开窗上颌窦底提升术后垂直向骨增量的观察研究

目的通过观察侧壁开窗上颌窦底提升术后垂直向骨增量的变化情况,研究其相关的影响因素。方法收集上颌后牙区牙列缺损行侧壁开窗上颌窦底提升术分期种植患者资料,对纳入病例的术前剩余牙槽骨高度(residual bone height,RBH)、术后当日垂直向骨高度、术后6个月垂直向骨高度及垂直向骨增量的变化情况进行观察。结果术后6个月较术后当日垂直向骨高度有显著性降低,降低量为0.56±0.25mm;上颌窦底黏膜厚度的术后6个月较术后当日垂直向骨增量的变化量无明显差异;在不同剩余牙槽骨高度情况下,术后6个月较术后当日垂直向骨增量的变化量有统计学差异,RBH大于5mm的患者相对RBH小于5mm的患者垂直向骨增量的降低值显著增加;上颌窦宽度与术后6个月较术后当日垂直向骨增量的降低值呈正相关。结论侧壁开窗上颌窦底提升术后6个月较术后当日存在垂直向骨增量的降低现象;剩余牙槽骨高度大于5mm时垂直向骨增量的降低值显著增加;上颌窦宽度与垂直向骨增量的降低值呈正相关。     

预成型钛网及浓缩生长因子在骨增量中的应用1例

天然牙缺失往往容易造成牙槽嵴骨吸收.下前牙区由于骨质较为致密,当发生复杂骨缺损时,仅采用传统的骨增量技术难以恢复骨缺损区形态,植骨效果难以保证.本文报告下前牙缺牙位点植入种植体同期联合应用预成型钛网及浓缩生长因子( concentrated growth factors,CGF)进行牙槽嵴骨增量手术患者1例,通过观察植...     

下前牙骨皮质切开术联合骨增量手术对唇侧骨增量的疗效评价

目的 评价下前牙骨皮质切开术联合骨增量手术对唇侧牙槽骨增量的效果.方法 回顾下前牙行骨皮质切开术联合骨增量手术患者术前、术后3个月和术后1年的锥形束CT(cone-beam computed tomography,CBCT),测量牙根长度、釉牙骨质界(cemento-enamel junction,CEJ)到牙槽嵴顶的距离以及距离CEJ 7 mm和9 mm处唇侧牙槽骨厚度,比较三个时间点各项指标的差异.结果 该手术对牙根长度无显著影响(P>0.05);与术前相比,术后3个月和术后1年牙槽嵴顶到CEJ的距离显著减少(P<0.05);术后1年牙槽嵴顶到CEJ的距离较术后3个月明显增加(P<0.05);总体与术前相比,术后3个月和术后1年距离CEJ 7 mm和9 mm处唇侧牙槽骨的厚度均显著增加(P<0.05).结论 骨皮质切开术联合骨增量手术对下前牙唇侧牙槽骨厚度的增加具有显著效果,对于下前牙正畸治疗有重要的临床意义.     

纯钛杯在引导骨再生动物实验中的应用研究

目的:探讨纯钛杯的制备方法以及在引导骨再生动物实验中的作用与优点。方法:制备钛杯,按分组装入不同骨代用品后定植于兔颅顶骨,术后2、4、6周取样,组织学切片观察。结果:钛杯提供了一个良好的引导骨再生屏障及环境,在显微镜下骨粉与新生骨有良好的分界,可以清晰观察到新生骨高度及密度,并可作量化对照分析。结论:钛杯的应用使引导骨再生动物实验更具可靠性、可比性,操作更为简便,可广泛应用于骨代用品动物实验研究并起到重要作用。     

Vertical Bone Augmentation Using Different Osteoconductive Scaffolds Combined with Barrier Domes in the Rat Calvarium

Purpose: To compare the regenerative potential for vertical bone augmentation of various osteoconductive scaffolds when used in conjunction with barrier domes. Materials and Methods: Following exposure and perforation of the calvarium, a gold occlusive dome was filled with the tested scaffold and anchored by fixation screws. Flaps were repositioned and secured. The four treatment groups, three to five rats each, were as follows: Bio‐Oss collagen (BOC), β‐tricalcium phosphate (TCP), collagen sponge (COL), and empty domes (C). Rats were sacrificed 8 weeks later, and specimens were prepared for histological and histomorphometric analysis. Vertical bone height and total tissue height were measured. Results: The newly regenerated bone appeared mature, highly vascularized, and with no signs of inflammation. Vertical bone height in the TCP group (mean 2.04 ± 0.2 mm) was greater than all other groups (0.76 ± 0.02, 1.52 ± 0.18, and 1.77 ± 0.61 mm for the BOC, C, and COL, respectively) but significantly only for the BOC group (p = .0145). Total tissue height was significantly higher (p < .0001) in both BOC and TCP groups (4.48 ± 0.23 and 5.5 ± 0.24 mm, respectively) compared with COL (3.22 ± 0.11 mm) and C (2.39 ± 0.3 mm) groups. Conclusion: TCP in conjunction with barrier dome resulted in greater vertical bone augmentation in the calvarium of rats.     

Beagle犬下颌重度牙槽嵴萎缩动物模型的建立

目的 建立一种与临床相符的下颌重度牙槽嵴萎缩的动物模型.方法 以Beagle犬为实验动物,拔除其双侧下颌第四前磨牙和第一磨牙,在距下颌第三前磨牙及下颌第二磨牙釉牙骨质界8 mm处的牙槽嵴上水平磨一凹线,咬骨钳去除该线上方的牙槽骨,用骨凿将去骨区域修平,形成25 mm×8 mm大小的箱状缺损洞形,置入无菌硅胶假体,严密缝合后,待其自然愈合.术后8周行锥形束CT检查.结果 骨改建8周后术区牙槽嵴顶呈圆弧形,嵴顶最低点至下牙槽神经管的距离平均2.5 mm.结论 本研究成功构建了Beagle犬下颌重度牙槽嵴萎缩动物模型,为进行垂直骨增量相关实验奠定了实验基础.     

Effects of Recombinant Human Bone Morphogenetic Protein‐2 on Vertical Bone Augmentation in a Canine Model

Background: Vertical bone augmentation (VBA) remains unpredictable and challenging for most clinicians. This study aims to compare hard tissue outcomes of VBA, with and without recombinant human bone morphogenetic protein (rhBMP)‐2, under space‐making titanium mesh in a canine model. Methods: Eleven male beagle dogs were used in the study. Experimental ridge defects were created to form atrophic ridges. VBA was performed via guided bone regeneration using titanium mesh and allografts. In experimental hemimandibles, rhBMP‐2/absorbable collagen sponge was well mixed with allografts prior to procedures, whereas a control buffer was applied within controls. Dogs were euthanized after a 4‐month healing period. Clinical and radiographic examinations were performed to assess ridge dimensional changes. In addition, specimens were used for microcomputed tomography (micro‐CT) assessment and histologic analysis. Results: Membrane exposure was found on five of 11 (45.5%) rhBMP‐2–treated sites, whereas it was found on nine of 11 (81.8%) non–rhBMP‐2–treated sites. Within 4 months of healing, rhBMP‐2–treated sites showed better radiographic bone density, greater defect fill, and significantly more bone gain in ridge height (P <0.05) than controls. Experimental hemimandibles exhibited lower rates of membrane exposure and a noteworthy, ectopic bone formation above the mesh in 72% of sites. Results from micro‐CT also suggested a trend of less vertical bone gain and bone mineral density in controls (P >0.05). Under light microscope, predominant lamellar patterns were found in the specimen obtained from rhBMP‐2 sites. Conclusion: With inherent limitations of the canine model and the concern of such a demanding surgical technique, current findings suggest that the presence of rhBMP‐2 in a composite graft allows an increase of vertical gain, with formation of ectopic bone over the titanium mesh in comparison with non–rhBMP‐2 sites.     

Beagle犬后牙完全性纵折粘结再植的实验研究

目的：探讨建立Beagle犬后牙完全性纵折口外粘结再植模型方法。方法：选取32颗Beagle犬前磨牙,劈裂牙冠后完整拔出,体外完成根管治疗,Super Bond C＆B粘结剂粘结两纵折片,植入牙槽窝,Ribbond弹力纤维固定实验牙。通过大体检查和X线放射检查观察实验牙8周。结果：劈冠后拔牙口外粘结再植成功率为71.9%。结论：Beagle犬前磨牙可作为建立后牙完全性纵折口外粘结再植的动物模型。