全牙列缺失口腔种植的即刻修复

为保证种植体初期稳定性,形成良好的骨整合,通常需在种植体植入后3～6个月再延期修复近年来,越来越多的文献报道了全牙列缺失即刻修复的病例,且取得了良好的临床效果。但是,对全牙列缺失的即刻修复尚存一些争议。本文在回顾近年文献的同时结合本课题组的研究结果,对上下颌牙列缺失即刻修复进行评估,并提出相关论点。     

部分牙缺失种植即刻功能负荷的临床探讨

目的:对部分牙缺失种植即刻功能负荷进行临床探讨。方法:将NobelBiocare种植体植入颌骨内,种植体植入扭力必须达到35Ncm以上。选择永久基台接在种植体上,用一定的扭力拧紧基台,基台水平印模,按常规制作和即刻戴上临时塑料修复体。6周后再印模,制作和戴上烤瓷修复体。结果:36例65枚种植体中,下颌22例41枚种植体,上颌14例24枚种植体,修复后成功率为98.5%。结论:部分牙缺失种植即刻功能负荷初步临床结果是满意的,其长期效果有待进一步的观察。     

下颌前部连续多颗牙缺失区夹层植骨和种植修复的临床研究

目的:评价下颌前部连续多颗牙缺失伴重度骨缺损,以夹层骨移植,同期进行常规种植的临床效果。方法:2002-05—2004-03北京协和医院口腔种植中心的8例患者,下颌前牙区37颗缺牙位点,行夹层骨移植,同期植入24枚种植体;平均4个月愈合期后再次植入12枚种植体;再经过3~6个月后完成最终修复。结果:术后平均垂直向高度提升7.6 mm,牙槽嵴顶厚度增加6 mm;骨块无坏死;所有种植体实现骨结合。随访5.3~7.1年,非种植区骨块牙槽嵴顶冠根向骨吸收<0.16 mm,种植体周围碟形骨吸收<0.25 mm。结论:夹层骨移植是修复下颌前牙区重度骨缺损的有效方法,并可同期种植,减少了手术次数,缩短了治疗时间。     

无牙颌下颌后牙区颌骨的三维重建及测量研究

目的了解无牙颌下颌后牙区颌骨及下颌管走行的解剖特点,为该区进行牙种植术设计时提供解剖参考,避免损伤下齿槽神经。方法对24例下颌无牙颌的下颌骨进行螺旋CT三维重建,从颏孔区开始,每隔5mm截取侧横断面,用mimics8.1软件测量管嵴距、下颌管外缘到颊舌骨板的距离、牙槽嵴宽度等,对所得数据进行统计学分析。结果无牙颌下颌管到颊侧骨板的距离从颏孔区至颏孔后20mm逐渐增大,到舌侧骨板的距离逐渐减小;牙槽嵴宽度由前向后逐渐增宽,由下向上逐渐减小。结论无牙颌下颌后牙区牙种植术中,种植体根方略侧向颊侧骨板可避免损伤下牙槽神经血管。     

牙种植修复中的咬合重建、数字化技术、无牙颌种植修复方法——“争鸣与共识”种植论坛(第二季)学术共识

随着牙种植技术的发展与进步,以修复为导向的牙种植治疗已经成为广泛共识,新技术的应用也为精准治疗提供了可行性。然而,在一些难点问题上,仍然存在争议和困惑,特别是咬合重建问题、数字化技术的应用以及无牙颌的种植修复设计。本文就"争鸣与共识"种植论坛(第二季)的讨论结果,针对上述三大疑难问题达成共识,以期更好促进口腔种植技术的临床规范化应用。     

无牙颌患者种植义齿修复

目的:无牙颌患者采用种植义齿修复可有效的增强义齿的固位,提高义齿的修复效果。方法:从1999年至2007年,对22例无牙颌患者,年龄45-82岁,行种植义齿修复,其中,有2例采用种植固定义齿修复,7例采用杆-卡式种植覆盖义齿修复,11例采用球-帽式种植覆盖义齿修复,1例采用双套筒冠种植覆盖义齿修复,1例采用磁性固位种植覆盖义齿修复。患者种植体植入2-9颗,共植入种植体97枚,种植体采用Frialit-2,Fri-alit-xive系统,观察时间108个月,采用临床检查、X线观察和患者主观评价等来评价种植体与骨组织结合状态,评价其义齿的修复效果。结果:观察期内发现1枚种植体脱(球-帽式固位种植体),1枚种植体未作修复,仍埋入在粘膜下的颌骨内。种植义齿修复后固位稳定作用良好,患者咀嚼有力,对义齿修复效果满意。结论:无牙颌患者种植义齿修复效果良好,患者满意度高。     

无牙颌患者种植修复的研究进展

<正>伴随社会老龄化的日益加重,全口无牙颌患者越来越普遍。范卫华等[1]采用多阶段分层等容量随机抽样的方法,抽取广东省城乡35⁴4岁、6544岁、65⁷4岁常住人口各720人,男女各半,按照《第三次全国口腔健康流行病学调查方案》检查余留牙和无牙颌,结果显示3574岁常住人口各720人,男女各半,按照《第三次全国口腔健康流行病学调查方案》检查余留牙和无牙颌,结果显示35⁴4岁组人均有29.41颗牙,无单颌牙     

Overdentures in the Edentulous Mandible Supported by Implants and Retained by a Dolder Bar: A 5‐Year Prospective Study

Purpose: This prospective study was performed to evaluate the outcomes of XiVE® S plus implants (Dentsply Friadent, Mannheim, Germany) following conventional restoration with bar structures and overdentures in the edentulous mandible. Materials and Methods: A total of 39 patients were treated with four interforaminal implants (n = 156) splinted by a Dolder bar. Overdentures were attached to the bars after 3 months of healing. As primary outcome measures, clinical and radiological parameters were evaluated at the time of implant placement (baseline) and once a year (1, 2, 3, 4, 5 years) after functional loading. Secondary outcome measures included (i) primary stability and surgical complications, as well as (ii) Periotest® (Medizintechnik Gulden, Modautal, Germany) values, implant survival, and prosthetic complications at baseline and follow‐up. Results: A total of 156 implants were placed. The vast majority (n = 149) were tightened to >30 Ncm, while torques in the range of 20–30 Ncm were obtained in the remaining cases (n = 7). Mean crestal bone levels around the implants were 0.41 mm at baseline and 1.04/1.20/1.34/1.45/1.44 mm after 1/2/3/4/5 years respectively. The mean values of the plaque, calculus, bleeding, and mucosal indices remained low throughout this period. The reported follow‐up periods involved one implant loss after 3 months (survival rate: 99.4%) and one implant failure after 4 years (success rate: 98.4%). Prosthetic complications included factures of bars (n = 3) and denture teeth (n = 7). Prosthetic survival was 100%. Conclusions: Dolder bars to restore oral implants in the edentulous mandible appear to offer a high rate of implant survival, good stability of the peri‐implant tissue, and a low rate of prosthetic complications.     

无牙颌的种植义齿支持式固定修复——附1例病例报道

目的:探讨无牙颌固定式种植义齿修复模式和临床应用体会,为无牙颌患者的临床治疗提供一些有意义的参考。方法:报道1例全口无牙颌患者的种植修复诊疗全过程及3年追踪观察的临床疗效。结果:19枚种植体术中及术后均未发生感染及神经损伤等并发症,修复前均达到骨结合;义齿固位效果良好,达到患者对美观和功能的要求,疗效满意。结论:全口无牙颌的种植义齿支持式固定修复可有效恢复咀嚼功能,改善患者容貌,临床效果可靠,是一种值得推广的无牙颌修复方式。     

杆卡式固位种植覆盖义齿在严重吸收上颌骨的临床应用

目的：评价Branemmk杆卡式固位种植覆盖义齿修复严重吸收上颌骨全牙列缺失的临床效果。方法：采用Branemark种植系统的常规操作方法，46枚Brdnemark种植体植入11例严重吸收上颌全牙列缺失的患者，3～6个月后，进行Ⅱ期手术，将愈合基台连接在种植体上修复期在Ⅱ期手术二周后进行，选择永久基台连接在种植体上.采用杆卡附着体（Bar-elip attachment），按常规制作和载上塑料活动修复体。结果：Btanemark杆卡式固住种植覆盖义齿修复严重吸收上颌骨全牙列缺失的近期成功率为100％.结论：Barnnemark杆卡式固位种植覆盖义齿修复严重吸收上颌骨全牙列缺失具有良好的临床效果.     

Biofilms in the Edentulous Oral Cavity

Purpose: The oral cavity presents numerous surfaces for microbial colonization. These surfaces produce biofilms of differing complexities unique to each individual. Several studies have looked at biofilms in dentate patients. There has been limited research regarding biofilms on dentures or soft tissues of edentulous patients. The purpose of the present investigation was to provide meaningful data describing microbial ecological relationships in the oral cavity of edentulous patients and to evaluate the microbiota on hard and soft tissue surfaces and saliva in edentulous patients wearing complete dentures. Materials and Methods: Sixty‐one edentulous subjects with complete maxillary and mandibular dentures were recruited. “Supragingival” biofilm samples were taken from 28 denture teeth for each subject. Biofilm samples were also taken from the dorsal, lateral, and ventral surfaces of the tongue, floor of mouth, buccal mucosa, hard palate, vestibule/lip, “attached gingiva,” and saliva. Samples were individually analyzed for their content of 41 bacterial species using checkerboard DNA–DNA hybridization. Levels and proportions of each species were determined for every sample location. Results: Periodontal pathogens such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were clearly present in the samples from the edentulous subjects. Microbial profiles in samples from the soft tissue surfaces differed among site locations. Samples from the dorsum of the tongue exhibited the highest bacterial counts followed by the “attached gingiva” and the lateral surfaces of the tongue, while the lowest mean counts were found in samples from the buccal mucosa and labial vestibules. Using cluster analysis of the proportions of the test species, three clusters were formed. The first cluster comprised saliva, supragingival plaque, and the lateral and dorsal surfaces of the tongue. The second cluster comprised the other six soft tissue surfaces. Species on the denture palate formed a third cluster. Conclusions: One of the major findings in this study was the detection of periodontal pathogens, A. actinomycetemcomitans and P. gingivalis, in the edentulous subjects, as these species were thought to disappear after removal of all natural teeth. This finding has implications regarding future dental treatment and the general health of individuals. Distinct patterns of microbial colonization were seen on the different soft tissue surfaces. Thus, this investigation provided the first step in defining the organisms that are associated with edentulous patients on both soft (mucosa) and hard surfaces (denture). The study also provided meaningful data that described microbial ecological relationships in the oral cavity of edentulous subjects. The authors believe that this study is the first comprehensive assessment of the microbiota in the complete denture‐wearing subject.     

磁性固位种植覆盖义齿在无牙颌修复中的应用

目的:为解决牙槽骨严重吸收无牙颌患者的修复难题,探讨磁性附着体种植覆盖义齿在临床上的应用效果。方法:本文对12例牙槽骨严重吸收的无牙颌患者均采用2枚CDIC种植体,4-6个月后进行磁性附着体覆盖义齿修复,每半年复诊,观察义齿使用情况,并结合临床检查和X线检查评价效果。结果:12例患者24枚种植体均达到骨结合,12件覆盖义齿固位良好,患者满意度100%,义齿稳定性较好,患者满意度90%。结论:磁性固位种植体覆盖义齿用于牙槽骨严重吸收的无牙颌患者修复治疗,临床效果好,值得推广。     

老年无牙颌患者两种义齿修复后牙槽嵴吸收的8年X-线观察

目的 :8年追踪研究全口义齿和种植覆盖义齿修复患者牙槽嵴吸收变化趋势。方法 :对8例种植覆盖义齿修复患者和10例全口义齿修复患者进行了8年的追踪研究 ,通过对全景片的定位 ,观测修复后0年、1年、3年、5年、8年患者牙槽嵴高度的变化趋势。结果 :两种方式修复在第1年牙槽嵴吸收较快,种植覆盖义齿和全口义齿修复者前后牙区牙槽嵴年吸收速率均有差异 (P<0.05);种植覆盖义齿患者下牙槽嵴总吸收程度明显小于全口义齿患者 ,每年年吸收速率间有统计学意义。结论 :全口义齿和种植覆盖义齿修复均可达到延缓牙槽骨进一步丧失的目的 ,但是后者在功能上更趋近于天然牙受力情况 ,是一种比较适用的老年无牙颌患者的修复方法     

下颌无牙颌种植修复设计体会

目的:探讨下颌无牙颌种植体植入位置、数目与修复设计的关系。方法:采用Frialit-2种植体36枚和Endo-pore种植体6枚对8例下颌无牙颌患者进行了种植修复,其中2例进行了杆卡覆盖义齿修复,2例球帽覆盖义齿修复,4例种植固定义齿修复。结果:二期手术时,42枚种植体均形成了良好的骨性结合。经6~24个月的临床修复观察,种植体负重6个月时骨吸收平均0.5mm±0.02mm,戴义齿12个月后骨吸收平均0.1mm±0.03mm。修复的种植义齿能较好地行使咀嚼功能,收到了满意的临床效果。结论:对于下颌无牙颌的种植患者,合理的治疗计划,对于保障种植义齿的修复效果及维持种植体的长期成功率是重要的。     

全口即刻负重种植固定义齿2例

对2例全口多数牙缺失、残留少量重度牙周炎患牙的患者拔除全口余牙,即刻于上下颌分别植入10颗和8颗Straumann种植体,36颗种植体经共振频率分析,种植体稳定指数（ISQ）值大于60的34颗种植体即刻接入临时基台行复合树脂临时固定桥修复,3个月左右种植体形成骨整合后完成永久性修复。修复后追踪18～26个月,无1颗种植体失败,平均累积骨丧失为0.41 mm。     

无牙颌种植修复的数字化临床诊疗流程

数字化技术在口腔领域的广泛应用解决了传统无牙颌种植修复中的诸多问题。由于缺乏系统化临床诊疗流程,种类繁多的数字化设备及技术尚待整合。本文将传统无牙颌种植修复流程结合新兴数字化技术,并对其特点进行系统阐述,提出无牙颌种植修复的数字化临床诊疗流程,以期指导临床实践。     

慢性牙周炎缺牙患者种植体周围组织状况的研究

目的 探讨慢性牙周炎对种植体周组织健康的影响.方法 慢性牙周炎缺牙进行种植义齿修复的患者14例为试验组,无牙周炎13例患者为对照组,在对照组和慢性牙周炎试验组各植入20枚ITI种植体,修复后6个月,检测改良菌斑指数、改良龈沟出血指数、探诊深度、边缘骨质吸收状况指标,并进行比较.结果 对照组和试验组的各项指标差异无统计学意义.结论 对可控制的慢性牙周炎缺牙患者,应用ITI种植系统可以获得可靠的疗效.     

Tilted Implants for the Rehabilitation of Edentulous Jaws: A Systematic Review

Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function. Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full‐text review of these studies, 10 articles were selected for analysis. Seven were prospective single‐cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty‐five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri‐implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires. Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short‐medium term. However, randomized long‐term trials are needed to determine the efficacy of this surgical approach.