国产微螺钉种植体支抗远中移动牙齿动物实验研究

目的:研究国产微螺钉种植体支抗远中移动牙齿过程中的稳定性,观察种植体-骨界面的组织学特点.方法:4只成年beagle犬,拔除双侧上颌第一前磨牙,将国产微螺钉种植体MAS系统(长7 mm,直径1.4 mm)分别植入双侧上颌后牙根分歧或牙根间牙槽骨,每侧卜颌3枚,植入后即刻以其中1枚种植体为支抗,另2枚为对照,对上颌尖牙施以0.98 N远中牵引力,牵引时间为3个月.共植入24枚种植体,其中8枚加载,另16枚为对照.加力结束后检查种植体松动度和位移变化,同时测量种植体-骨界面骨结合率.结果:8枚加载种植体均保持了稳固,在加载过程中发生了微小位移,平均位移0.74 am;加载结束后发生部分种植体-骨结合,平均骨整合率为43.75%.结论:微螺钉种植体在受到持续负载的情况下达到良好稳固度,可以作为正畸支抗移动牙齿.     

即刻加载不同力值的微螺钉支抗种植体骨界面组织学研究

目的：研究微螺钉支抗种植体在不同力值加载条件下与颌骨的结合形式及种植体稳定性。方法：3只杂种犬的下颌骨分别植入24枚钛合金微螺钉种植体,随机分为4组,分别即刻加力0g、200g、400g、600g,8周后处死动物。标本常规脱钙,HE染色和BMP-2免疫组化染色,利用图象分析方法测定骨界面区BMP-2的平均灰度值,分析种植体与骨组织的结合情况。结果：200g、400g组骨界面出现大量成骨细胞及少量类骨质,600g组种植体近颈部周围被大量纤维组织包绕,有炎性细胞浸润,并出现骨组织缺损。种植体骨界面BMP-2的平均灰度值随加载力值的增加而出现先上升后下降的趋势。结论：即刻加载的微螺钉支抗种植体骨界面的结合方式是非完全骨性结合。0～400g矫治力不影响微螺钉种植体的稳定性;而600g矫形力可导致种植体颈部骨组织缺损,其稳定性受到影响。     

微螺钉支抗考虑的国人正常颌骨皮质厚度CT测量分析

目的通过测量中国成人正常颌骨微螺钉种植体植入的不同位点处皮质骨厚度,为临床植入部位的选择提供参考,以提高正畸支抗的成功率。材料和方法采用螺旋CT对30例18-40岁正常颌中国成人颅颌面进行扫描并重建,测量适合微螺钉种植体植入处的皮质骨厚度,并进行统计分析。结果48个测量项目中,均值从1．73mm至10．67mm不等,最小值仅0．8mm。除前鼻嵴和下颌11牙尖隙外,46个左右对称的测量项目（左右各23个）中,34处左右对应指标相互比较均无差异（P〉0．05）,另有12处测量位点左右配对检验有统计学差异（P〈0．05）。结论本实验提供了微螺钉种植体支抗常见植入位点处皮质骨厚度参考值范围的数据库。下颌前牙根尖间隙,植入微螺钉种植体时应更加小心;上下颌磨牙牙尖隙处,植入相对安全。不同成人的皮质骨厚度差异较大,提示临床工作者最好能先根据病员的CT片测出相应植入位点处皮质骨厚度,再确定微螺钉种植体的植入部位与方向。     

正畸微种植体支抗即刻加载的稳定性研究

目的 本研究通过观察即刻加载的微种植体支抗周围骨界面组织学变化,旨在探索即刻加载是否会影响微种植体支抗的稳定性.方法 本试验选用成年狗1只,16枚正畸用微种植体植入狗的下颌骨后即刻施加1.5 N力,施力9周后狗被处死.骨标本作病理切片后进行组织学观察和测量.结果 微种植体可以承受即刻加载的1.5 N正畸力而无松动.组织学观察显示骨-微种植体界面有骨组织沉积,没有纤维组织生成,即刻加载的正畸力没有影响骨细胞在微种植体表面的沉积.结论 在严格控制植入创伤、加载力量大小的前提下,微种植体的即刻加载是可行的.     

正畸使用微螺钉种植支抗研究进展

目的:报道正畸微螺钉支抗种植体植入后的有关功能和形态学的变化.方法:收集近8年国内外公开发表(截止08年2月)的有关文献.文献内容包括实验性动物(小猪,beagle狗和猴子)研究和临床试验性研究(接受正畸治疗的牙颌畸形患者),使用直径1.1～2.2mm和微种植螺钉和小型钛板作为正畸临时骨性支抗.分析加力前等候时间、加力大小、稳定情况、副作用、骨整合及失败率情况等.结果:微螺钉支抗种植体在功能和结构上均能满足对支抗的要求;种植体未发现有严重的副作用;加载前等候时间从零到12周不等;加力范围从25g到500g.骨与种植体的整合度从10%到58%,支抗螺钉植入后随着时间的推移骨结合量也随之增加,骨结合量的多少与种植体负载与否没有显著性差异,负载种植体压力侧与张力侧的骨结合量没有显著性差异;微螺钉支抗种植体失败率从0%～19%不等.种植体置入位置、手术方法、种植体加力时机以及负载大小等因素均有可能影响成功率.结论:理想的加载前等候时间和加载力值、种植体植入手术和种植体植入的最适宜位置,仍待日后采用标准化程序进行标准化研究.     

不同加载条件下的微螺钉支抗种植体骨界面的组织学观察

目的:研究微螺钉支抗种植体在不同加载力值、加载时机与颌骨的结合程度及种植体的稳定性.方法:在3只杂种犬的上、下颌骨分别植入36枚钛合金微螺钉种植体,根据植入颌骨的部位(左、右侧)分为即刻加力组和延期加力组.植入犬左侧颌骨内的延期加力组种植体暂时不加力,4周后与植入犬右侧颌骨内的即刻加力组同时加力.每侧近中种植体不加力,远中2枚种植体相互加力,上颌骨加载1.96N力,下颌骨加载3.92N力.第13周处死动物.标本常规脱钙,行BMP-2免疫组化染色,利用图像分析方法测定骨界面区BMP-2的平均灰度值,分析种植体与骨组织的结合情况.采用SPSS10.0软件包对数据进行t检验和方差分析.结果:即刻加力组(1.96N力、3.92N力)、延期加力组(1.96N力、3.92N力)与非加力组的种植体骨界面BMP-2平均灰度值均有显著性差异(P<0.05),即刻加力组与延期加力组之间平均灰度值无显著性差异(P>0.05).结论:即刻加载、延期加载正畸矫治力均有助于提高微螺钉支抗种植体与周围骨组织骨性结合的能力.正畸力的加载时机对微螺钉种植体稳定性的影响较小.     

微螺钉种植体支抗的并发症分析

目的 研究自攻型微螺钉正畸支抗的并发症.方法 选择36例应用微螺钉的正畸患者,共植入82枚微螺钉,观察微螺钉种植体支抗并发症的表现,计算微螺钉相关并发症的发生率.结果 70枚微螺钉完成正畸支抗, 10枚松动, 3枚发生周围炎, 1枚植入后出血.结论 微螺钉种植体是正畸的有效支抗,同时应重视并防治其并发症的发生.     

自攻型微螺钉种植体支抗周围骨组织中MMP-9表达变化的研究

目的：通过检测种植体支抗周围骨组织MMP-9含量,从分子水平来探讨种植体支抗周围骨改建情况。方法：选用成年雄性杂种狗4只,随机分为1、2、4、8周组。在每只狗上颌颊侧磨牙区靠近膜龈联合处植入微螺钉,每侧2枚,每组4枚。即刻用镍钛拉簧（1.96N）对拉同侧种植体。在相应的分组时间处死动物,进行免疫组化染色。采用spss17.0软件包进行Χ2检验,检验水准a=0.05。结果：HE染色显示即刻加载自攻型微螺钉种植体支抗颈部周围骨组织改建在即刻加载8周内以纤维改建为主;基质金属蛋白酶9（MMP-9）含量在即刻加力8周内表达有差异,加力2周时表达含量最高。结论：即刻加载微型种植体支抗周围颈部骨组织改建在加力8周内以胶原纤维改建为主;MMP-9与微螺钉种植体支抗骨组织周围骨改建密切相关。     

力值、时间因素对即刻加载微钛钉最大抗力强度影响的实验研究

目的建立动物实验模型,研究力值、时间因素对即刻加载的微钛钉支抗种植体最大负载强度的影响。材料方法本研究包括8只新西兰大白兔,平均分成4组:即刻组、2周、4周、8周加力组。即刻组实验动物上颌骨两侧分别植入2枚微钛钉,右侧的4枚微钛钉用于即刻植入后最大抗力强度的检测。加力组试验动物上颌骨两侧分别植入3枚微钛钉,近中的两枚问相互加力,右侧150克力,左侧50克力,远中的一枚微钛钉不加力。加力组分别在2、4、8周时各处死两只动物,用于微钛钉最大抗力强度的力学检测。结果自攻型微钛钉植入后即刻加载时种植体-骨界面最大负载强度平均为2.1公斤。即刻加载并持续负载的微钛钉最大负载强度随时间明显增长,2—4周有显著性提高。150克和50克负载组之间在不同的时间段最大负载强度均无显著差异。结论微钛钉种植体能够有效的提供正畸支抗,其最大负载强度受加载时间的影响大于力值变化的影响。最大负载强度随时间呈增长趋势,提示种植体骨界面在负载正畸力的条件下也可能形成骨性结合。     

种植微螺钉支抗矫治下颌磨牙缺失患者的上牙前突伴拥挤

目的探讨微螺钉种植体作为支抗用于下颌磨牙缺失患者矫治上牙前突伴拥挤的临床效果。方法选择下颌单侧磨牙缺失、上牙前突伴拥挤的成年错!患者8例（年龄22~38岁）,在每位患者下颌磨牙缺失侧的第二前磨牙远中11~13 mm颊侧牙槽嵴处各种植1枚纯钛微螺钉,并以栓道固位方式在微螺钉的龈上部分附着自制微螺钉牵引帽,利用微螺钉牵引帽依次牵引同侧的下颌前磨牙、尖牙、切牙向远中移位,并利用牵引帽上的牵引钩行颌间Ⅱ类牵引。结果采用种植微螺钉作为支抗的8例患者治疗后均达到较理想的效果,前牙覆盖覆!和后牙尖窝关系均正常。疗程最长者24个月,最短者15个月,平均20.8个月。结论微螺钉种植体支抗可以用于下颌磨牙缺失的上牙前突伴拥挤患者的矫治。     

Sliding mechanics with microscrew implant anchorage

Three cases are illustrated. One was treated with maxillary microscrew implants, another with mandibular microscrew implants, and the third with both maxillary and mandibular microscrew implants. With the maxillary microscrew implants, the maxillary anterior teeth were retracted bodily with a slight intrusion and all the premolar extraction space was closed without loss of anchorage. Furthermore, the maxillary posterior teeth showed distal movement. The mandibular microscrew implants controlled the vertical position of the mandibular posterior teeth and played an important role in improving the facial profile. The efficacy of sliding mechanics with microscrew implant anchorage on the treatment of skeletal Class II malocclusion is also discussed.     

Treatment of open bite with microscrew implant anchorage.

Open bite treatment with microscrew implant anchorage is discussed in relation to vertical control of the posterior dentoalvelar dimension. Maxillary microscrew implants provided anchorage for intruding the posterior teeth and retracting the anterior teeth; mandibular microscrew implants were used to apply intrusion force distal to the mandibular first molars to prevent mesial tipping of the posterior teeth during space closure. Closing the mandibular plane after intruding the maxillary posterior teeth and bodily mesial movement of the mandibular posterior teeth contributed to facial profile improvement. The efficacy and potency of microscrew implants in open bite treatment are discussed.     

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目的探讨正畸与种植体联合治疗下前牙先天缺失伴错畸形的临床效果。方法对2003—2007年在中国医科大学口腔医学院正畸科就诊的15例下切牙缺失伴错畸形的患者行正畸治疗,开辟种植义齿修复间隙,然后行种植义齿修复缺失牙。结果经联合治疗后15例患者均获得正常的覆、覆盖关系和美观效果。共植入25枚种植体,随访时间12～24个月,均稳定无松动。结论正畸与种植体联合应用治疗伴有下切牙先天缺失的错畸形,能够获得满意的治疗效果。     

Group distal movement of teeth using microscrew implant anchorage

The purpose of this study was to quantify the treatment effects of distalization of the maxillary and mandibular molars using microscrew implants. The success rate and clinical considerations in the use of the microscrew implants were also evaluated. Thirteen patients who had undergone distalization of the posterior teeth using forces applied against microscrew implants were selected. Among them, 11 patients had mandibular microscrew implants and four patients had maxillary implants, including two patients who had both maxillary and mandibular ones at the same time. The maxillary first premolar and first molars showed significant distal movement, with no significant distal movement of the anterior teeth. The mandibular first premolar and first and second molars showed significant distal movement, but no significant movement of the mandibular incisor was observed. The microscrew implant success rate was 90% over a mean application period of 12.3 +/- 5.7 months. The results might support the use of the microscrew implants as an anchorage for group distal movement of the teeth.     

自攻型微种植支抗钉在矫治下颌磨牙舌倾中的应用

目的评价自攻型微种植支抗钉治疗下颌磨牙舌倾的有效性。方法 选择8例下颌磨牙舌倾的正畸患者,应用自攻型微种植支抗钉牵引11颗舌倾的下颌磨牙。分别在微种植支抗钉植入前和取出后拍摄曲面断层片和头颅侧位片,并进行头影测皱及模型测绩分析。结果8例患者所植入的自攻型微种植支抗钉在矫治过程中均保持稳定;舌倾的磨牙均得到有效的直立,矫治后下颌磨牙间宽度增加4．5mm,与矫治前相比下颌磨牙宽度变化差异有统计学意义（P〈0．01）;下颌磨牙高度降低1．2mm,有统计学意义（P〈0．05）;而下颌平面角（MP—SN）及面下高与全面高之比（ANS—Me／N—Me）变化差异无统计学意义（P〉0．05）。结论自攻型微种植支抗钉可有效地直立舌倾的下颌磨牙,避免磨牙伸长,磨牙咬合关系良好。     

Use of osseointegrated implants in adult orthodontic treatment: a clinical report

This article describes the complex dental treatment of an adult patient with multiple missing teeth, mild periodontitis, and a malocclusion. Titanium implants were placed in the posterior mandibular edentulous segments and became osseointegrated. The placement of the mandibular implants was originally designed for orthodontic anchorage. The mandibular implants would subsequently be used for implant-retained crowns on completion of orthodontic treatment. After a 4-month healing period, an impression was made of the implant hexes and a master cast was formed. Two-piece temporary healing abutments were placed on the implants and used to retain orthodontic brackets. The orthodontist retracted the mandibular anterior teeth using the posterior implants for anchorage. The abutment screws of the 2-piece temporary healing abutments were tightened to 20 N-cm at the insertion appointment and did not need to be tightened again during the course of orthodontic therapy. Standard orthodontic brackets were cemented to the 2-piece temporary healing abutments. Orthodontic treatment was accomplished uneventfully. Prosthodontic treatment was completed using the osseointegrated implants to replace the missing teeth. The methods described in this clinical report present clinicians with additional choices in the treatment of complex dental disease using osseointegrated dental implants.     

微型自攻钛钉种植体支抗压低切牙的初步应用研究

目的介绍微型自攻钛钉种植体用于正畸支抗的临床经验,评价自攻型微型钛钉种植体作为垂直向支抗压低前牙的有效性.材料方法在26例采用微型自攻钛钉种植体作为支抗手段的临床病例中,选择3名患者(年龄20-25岁),均表现为上颌或下颌前部牙齿槽发育过度,采用微型种植体支抗压低前牙.种植体植入上颌中切牙和侧切牙之间的牙槽间隔或下颌侧切牙和尖牙之间的牙槽间隔,每侧以50克力压低前牙.比较压低治疗前后的X线头颅侧位片,测量前牙切缘的压低量和转矩的改变量.结果所有病例治疗后前牙覆(牙合)达到正常,切缘平均压低4.3毫米,转矩平均增加9.8度.治疗过程中所有微型种植体均保持了稳定,种植体周围软组织健康.结论微型自攻钛钉种植体能够作为稳定的骨性正畸支抗,压低前牙,改善覆(牙合)和龈笑.并且具有操作简单灵活,可即刻加力,不依赖患者合作的优势.     

Five-year results with fixed complete-arch mandibular prostheses supported by 4 implants

This study examined whether it is possible to restore an edentulous mandible with a complete-arch fixed prosthesis retained by only 4 implants without decreasing the survival rate. One hundred nineteen patients received complete-arch mandibular prostheses retained by 4 implants. Most patients were followed for 3 years or more. All patients followed a routine protocol, including annual check-ups and regular radiographic examinations. Twenty-one patients dropped out. Radiographic measurements used the threads of the implants as a basis for comparison. No indication was found that the number of supporting implants could have influenced the observed frequency of technical and surgical complications. Three implants were lost, 2 after 1 year and 1 after 5 years. A statistically significant difference in bone loss between the mesial and distal implants was found. The number of fractured resin teeth in mandibular prostheses was higher when patients had an implant-supported prosthesis in the maxilla. The present study revealed an implant survival rate of 98.6% after 5 years. Therefore, it was concluded that there may not be a need for more than 4 implants to support a fixed mandibular prosthesis, when implants at least 10 mm long can be used.     

下颌牙周病渐进缺牙致无牙颌的种植方案设计

目的：牙周病致牙列缺失的义齿修复是非常困难的,尤其是下颌骨低平条件较差的下颌牙列缺失修复。患者常抱怨义齿的压疼、固位稳定及咀嚼效率差。虽然牙种植体应用较好地解决了上述问题,但在临床中患者由于下颌后牙区骨高度不足且距下颌神经管较近,医疗风险及手术难度加大,使得种植覆盖义齿修复效果不如预期。本文目的是用种植体最佳分布结果指导临床牙周病渐进性拔牙病例设计种植修复方案。方法：通过分析牙周病致无缺牙行种植覆盖义齿修复的临床效果并对下颌无种植覆盖义齿三维有限元分析。结果：牙周病致无缺牙行种植覆盖义齿常规在两侧颏孔区之间种植2-4枚种植体,由于后牙区没有种植体支撑,从义齿修复受力原则及防止磨牙区及种植体周骨质吸收来讲不是最佳方案,最佳应在后牙区种植种植体。结论：牙周病治疗过程中在下颌缺牙的磨牙区植入1-2枚种植体,即便最后下颌自然牙全部缺失,可以常规在两侧颏孔区之间种植2-4枚种植体,结合前期植入的种植体共有6-8枚,可以考虑种植固定或者套桶冠固位进行下颌牙列缺失的种植修复,使种植修复效果达到最佳。     

Growth analysis of a patient with ectodermal dysplasia treated with endosseous implants: a case report.

Congenital absence of multiple teeth and poorly developed alveolar ridges are associated with ectodermal dysplasia. Affected patients often require dental prosthetic treatment during their developmental years. Maxillofacial growth and development in a preadolescent female patient with ectodermal dysplasia following oral rehabilitation with maxillary and mandibular endosseous dental implants is reported. Four maxillary and 4 mandibular implants were successfully integrated and restored at 8 years of age. Growth analysis 12 years later revealed that the implants followed maxillary and mandibular growth displacement. Minor impaction of the maxillary implants was observed, and mandibular implants were affected by the mandibular growth rotation, which led to a change in implant inclination. The treatment outcome is compared to similar previously reported studies and cases.