纳米羟基磷灰石／PRP修复牙槽突裂的实验研究

目的:研究纳米羟基磷灰石/PRP(nano-HA/PRP)修复牙槽突裂的生物性能及富含血小板血浆(PRP)在其中的作用。方法:将40只雄性日本大白兔随机平均分成nano-HA/PRP和nano-HA两组。每只动物的两侧下颌骨均外科形成类似牙槽突裂样缺损。2个月后各组动物分别以上述两种材料充填修复牙槽突裂。于2周、4周、8周、12周和24周处死动物,采用组织学、组织形态学等方法观察样本。结果:组织学检查发现,nano-HA/PRP组在术后2周时成骨活性明显优于对照组,而在两周后骨痂改建期两组间无明显差异。术后第12周,两组材料均基本吸收。术后第24周,nano-HA/PRP组和对照组新骨平均丧失高度分别为修复高度的11.9%和12.4%。结论:nano-HA是牙槽突裂修复的良好生物材料,PRP在骨修复早期对骨愈合有促进作用。     

唇腭裂牙槽突裂同期植骨修复术

先天性牙槽突裂是唇、腭裂常见的伴发畸形,并造成口腔形态和功能异常以及面部整体发育不协调。早期修复牙槽突畸形,恢复上颌骨骨性结构的完整和连续性,有助于恢复口腔正常形态和功能,利于面中、下部骨性支架的生长发育,是唇腭裂序列治疗中极为重要的一环。为此,近3年来作者在行唇、腭裂修复术的同时进行牙槽突一期植骨修复术(简称同期手术),近期效果满意,并对此进行讨论。1材料和方法1.1 临床资料1997年5月～1999年12月在西安交通大学口腔医学院颁面外科唇腭裂治疗科进行唇、腭裂修复术的患者中选择26例行牙槽突裂同期植骨修复术,其中男20例,女6例,年龄6月～16岁,平均5.2岁。26例均合并有牙槽突裂,其     

羟基磷灰石重建牙槽嵴后前牙种植的临床观察

作者自 1995年对前牙牙槽嵴萎缩患者 ,通过种植前羟基磷灰石重建牙槽嵴后再种植 ,效果满意 ,报道如下。　　一、材料和方法1.材料 :选用四川大学生物材料研究所生产的颗粒型致密多晶羟基磷灰石 (ＨＡ )及羟基磷灰石涂层钛种植体(ＨＡＣＩ)。一般齿槽外科器械 ,法国进口种植机及配套钻具。2 .病例选择 :46例 6 3颗前牙 ,其中男 2 6例 ,女 2 0例 ;上前牙 44颗 ,下前牙 19颗。所有病例均常规取模 ,测量牙合龈、近远中及颊舌向距离 ,常规摄牙片 ,并在模型上试排牙 ,了解要取得前牙理想修复效果牙槽嵴应具备的条件。 6 3颗前牙均有中度萎缩 ,参照…     

唇、腭侧联合入路修复牙槽突裂的临床初步研究

目的：探讨唇、腭侧联合入路修复牙槽突裂的临床效果。方法45例先天性牙槽突裂患者接受植骨手术修复,其中21例（年龄9~13岁,平均年龄10.3岁）行唇、腭侧联合入路植骨修复（实验组）,24例（年龄9~14岁,平均年龄11.2岁）行唇侧入路植骨修复（对照组）。术后1~12个月随访,采用临床回顾性研究的方法比较2组术后疼痛、肿胀程度;牙槽突裂植骨成功率评价的临床分级标准一般以Bergland牙槽突裂植骨分级标准进行评价。结果实验组在术后疼痛、肿胀程度均低于对照组;实验组植骨手术成功率81%,对照组植骨手术成功率42%。结论唇、腭侧联合入路植骨修复牙槽突裂手术创伤小、术后不良反应少,临床效果满意。     

颏部取骨牙槽突裂修复术78例报告

目的 探讨颏部取皮质骨于唇腭裂伴齿槽裂整复术中同期植骨的可行性及临床效果。方法 78例唇腭裂伴齿槽突裂患者整复术中，同期自下颌骨颏骨取骨植入牙槽突裂隙。结果 78例术后均一期愈合，容貌有较大改观。结论 该方法成功地恢复了上颌牙槽骨弓的连续性，保证了颌骨的稳定性，有利于上颌牙齿的正常萌出，促进了上颌骨的发育，同时矫正了患侧鼻底及上唇塌陷畸形，为正畸治疗打下基础，是唇腭裂序列治疗必要步骤。     

牙槽突裂骨移植治疗进展

牙槽突裂骨移植是口腔颌面部裂隙畸形重建的重要步骤。初期肋骨移植能使上颌骨连续,消除口鼻腔瘘,不影响面中部发育,有助于防止双侧唇裂上颌骨节段性塌陷。二期髂骨移植成功率高,能稳定地产生小梁骨,恢复上颌骨连续性,提供正畸支持。牙槽突植骨能否产生足够的牙槽骨支持后期的正畸治疗,尚需进一步研究。本文就牙槽突裂骨移植治疗的进展作一综述。     

骨移植术在修复腭裂牙槽突裂畸形中的应用

目的 探讨骨移植术在修复腭裂牙槽突裂中的意义。方法 对16例行植骨术的病例进行初步分析,探讨手术适应症、方法、效果评价、供骨区选择及术前术后处理等问题。结果 术区严密缝合是植骨成功的关键;植骨前后应接受正畸治疗;供骨区选择应根据患者年龄、裂隙大小及需骨量等来决定。结论 骨移植修复牙槽突裂是一种可推广的手术。     

牙体修复性纳米羟基磷灰石复合材料生物相容性评价

目的:初步评价牙体修复性纳米羟基磷灰石复合材料的生物相容性,为其临床应用的安全性提供实验室依据。方法:采用ISO评价标准中的部分体内试验方法,通过不同途径进行动物急性毒性实验、热原实验、过敏实验、口腔黏膜刺激实验、皮肤刺激实验,根据相关标准评价该材料的生物相容性。结果:该新型材料对生物机体无致热性、无致敏性、无刺激性,无明显急性毒性。结论:牙体修复性纳米羟基磷灰石复合材料对机体组织无明显毒害作用,具有良好的生物相容性。     

唇腭裂患者牙槽突裂的修复与效果评价

本文对牙槽突裂修复的历史、修复时间、植骨材料的选择、植骨效果及与正畸治疗的关系进行了综述，对牙槽突裂植骨的评价和正畸治疗的新方法进行分析，对牙槽突裂患者的治疗有一定指导意义。     

组织工程骨修复牙槽突裂的研究进展

牙槽突裂是伴发于唇腭裂的一种常见的先天性发育缺陷性疾病.为消除牙槽突裂患者的口鼻瘘,使裂隙区以及裂隙两侧的牙齿能正常萌出并能获得良好的牙周附着,这类患者常常需要作二期骨移植.传统的取自患者自身新鲜骨的骨移植修复,虽能较好地修复牙槽突裂,但也存在着诸多弊端:受供区取骨量的限制和骨移植后随着患者的生长和植骨区植入骨的吸收,...     

改良Millard''s功能性修复双侧唇裂

目的 探讨双侧唇裂的功能性修复方法。方法 应用改良Millard‘s法通过增加环鼻翼外侧脚切口，使鼻翼外侧脚更易复位，矫正了口轮匝肌的异常附着，一期重建口轮匝肌环，对于前唇过于短小者则借鉴Barsky‘s法延长前唇。应用该方法修复双侧唇裂24例，年龄最小6月，最大12岁。结果 多数患者获得了满意的修复效果，仅1例伤口部分裂开。结论 应用该方法修复双侧唇裂有较高的临床应用价值。     

Comparison of tooth development stage of the maxillary anterior teeth before and after secondary alveolar bone graft: Unilateral cleft lip and alveolus vs unilateral cleft lip and palate

Objective:To compare the effect of secondary alveolar bone graft (SABG) on the tooth development stage of the maxillary central incisor (MXCI) and maxillary canine (MXC) in terms of the severity of unilateral cleft.Materials and Methods:The subjects consisted of 50 boys with unilateral cleft lip and alveolus (UCLA) or unilateral cleft lip, alveolus, and palate (UCLP). The age- and sex-matched subjects were divided into group 1 (UCLA, n = 25; 9.3 ± 0.8 years old) and group 2 (UCLP, n = 25; 9.4 ± 0.6 years old). In panoramic radiographs taken 1 month before (T0) and 1 year after SABG (T1), tooth development stage was evaluated according to the Nolla developmental (ND) stage. A panoramic radiograph taken 3 years after SABG was used as a reference for the final root length of individual tooth.Results:In groups 1 and 2, the ND stage of the MXCI did not exhibit differences between the cleft and non-cleft sides at T0 and T1, respectively. However, although the ND stage of the MXC of group 2 was delayed on the cleft side compared with the non-cleft side at T0 (P < .05), the MXC on the cleft side developed faster than that on the non-cleft side after SABG (P < .01). In terms of tooth development speed, group 2 showed a higher rate of faster developed MXCs on the cleft side compared with the non-cleft side after SABG than group 1 (36.0% vs 8.0%, P < .05).Conclusion:SABG performed at approximately 9 years of age might increase tooth development speed of MXC in patients with UCLP compared with patients with UCLA.     

腭裂术后复裂的原因分析及临床体会

目的：分析腭裂术后复裂的原因,探讨预防复裂的方法。方法：通过105例腭裂术后复裂的临床资料进行回顾性分析,找出导致复裂的原因。结果：腭裂术后复裂的原因是多方面的,有病人自身因素,有手术医师的技术操作,还有术前、术后的护理等因素。充分认识这些因素并加以预防,腭裂术后复裂是可以避免或减少的。结论：腭裂术后复裂的因素是多方面的,只要加以重视,复裂是可以避免或减少的。     

应用Millard法分期修复双侧先天性唇裂

目的：评价Millard法分期修复双侧先天性唇裂的效果。方法：自2005年—2008年尝试用分期手术治疗双侧先天性唇裂12例。以典型Millard法修补一侧裂隙,将双侧唇裂改变成单侧唇裂,4～6个月后再以同样方法修补另一侧裂隙,完成手术治疗。结果：12例患儿均分两期顺利完成手术,伤口一期愈合。由于完全保留了前唇下方唇红组织,术后能形成自然唇珠形态,同时避免了“方块”形人中,从而使修复后的外形更加美观。对于双侧混合性唇裂,分期手术的效果明显优于一次法。结论：分期修复的方法发挥了Millard法的优势,修复效果良好,尤其适合于治疗双侧混合性唇裂。     

倍骼生修复牙槽突裂的初步临床观察

目的：观察人工骨修复材料-倍骼生治疗牙槽突裂的临床效果。方法：牙槽突裂患者39例，年龄6-12岁，随机分成2组，A组25例。用自体髂骨松质骨行牙槽突裂移植修复；B组14例，应用倍骼生修复牙槽突裂。结果：A、B两组牙槽突裂植骨区X线片均示成骨良好，尖牙可在植骨区萌出。经统计学分析，A、B两组牙槽突裂植骨术的临床治疗成功率无显著差别．但不同牙槽突裂类型的临床治疗成功率有显著差别，即完全性牙槽突裂的临床治疗成功率显著低于单纯性牙槽突裂组。结论：新型骨修复生物活性材料倍骼生修复牙槽突裂骨性裂隙区可以成骨，尖牙可在移植区萌出。     

Evaluation of alveolar bone support around incisors in patients with unilateral cleft lip,alveolus, and palate in late mixed dentition using cone beam computed tomography

Objectives:To evaluate alveolar bone support around cleft-adjacent maxillary central incisors (U1) in patients with unilateral cleft lip, alveolus and palate (UCLAP) in the late mixed dentition and to investigate the correlation between the alveolar bone thickness (ABT) and tooth inclination.Materials and Methods:Cone beam computed tomography scans of 45 subjects with UCLAP (29 boys, 16 girls; mean age = 10.74 ± 1.08 years) were assessed. The distance between the cementoenamel junction (CEJ) and alveolar bone crest (AC), and the ABTs at 3 mm, 6 mm, and the apex were measured on the labial, lingual and distal surfaces of U1. The cleft and normal sides were compared using a paired t-test and Pearson''s χ² test. Pearson''s correlation was used to explore the association between the ABT and tooth inclination of cleft-adjacent U1 in the labiolingual and mesiodistal dimensions.Results:The CEJ-AC distances were significantly greater in cleft-adjacent U1 (P < .01), with more bone height reduction observed labially and distally (P < .001). The labial, lingual, and apico-distal ABTs were decreased on the cleft side (P < .01). A positive correlation was found between the apico-labial ABT and the labiolingual inclination (r = 0.568, P < .01).Conclusions:Patients with UCLAP have reduced alveolar bone support around the cleft-adjacent U1, and the apico-labial ABT tends to decrease with increasing lingual tooth inclination; however, the correlation was weak.     

Periodontal attachment loss over 14 years in cleft lip,alveolus and palate (CLAP,CL, CP) subjects not enrolled in a supportive periodontal therapy program

OBJECTIVES: (i) To assess the overall and (ii) cleft-associated rate of periodontal disease (PD) progression in subjects with cleft lip, alveolus and palate (CLAP) and (iii) to compare these rates with those of subjects with cleft lip (CL) and cleft palate (CP). MATERIAL AND METHODS: Twenty-six subjects not enrolled in a supportive periodontal therapy (SPT) program were examined in 1979, 1987 and 1993. PD progression was assessed as increase in pocket probing depth (PPD in mm) and probing attachment loss (PAL in mm). RESULTS: Extensive plaque accumulation and high frequencies of gingival units bleeding on probing were observed at all three examinations. A statistically significant increase in mean PPD of 0.57+/-0.21 mm (SD) in both groups as well as a statistically significant loss of PAL of 1.85+/-0.23 mm (SD) in the CLAP group and of 1.72+/-0.21 mm (SD) in the CL/CP group occurred over the observation period (p<0.05). In subjects with CLAP, statistically significant increases in PPD and loss of PAL were recorded over time at sites adjacent to the cleft as well as at control sites (p<0.05). Over 14 years, however, PPD increased 1.72+/-1.08 mm (SD) at cleft sites versus 0.72+/-1.14 mm (SD) at control sites (p<0.05), and PAL amounted to 3.19+/-1.35 mm (SD) at cleft sites versus 2.41+/-1.52 mm (SD) at control sites (p<0.05). CONCLUSION: Both the CLAP and the CL/CP subjects are at high risk for PD progression if no SPT program is provided. This also suggests that alveolar cleft sites in subjects with high plaque and gingival inflammation scores underwent more periodontal tissue destruction than control sites over a 14-year period.     

机械通气在婴幼儿唇腭裂修复术麻醉中的应用

目的 :评价机械通气在婴幼儿唇、腭裂修复术麻醉中的安全性和有效性。方法 :49例新生儿和婴儿唇、腭裂修复术全身麻醉气管插管后 ,行机械定压模式呼吸通气 3 0min后 ,监测动脉血气值、SpO2 、肛温、PetCO2 、气道压、呼吸频率、心电等参数。结果 :新生儿和婴儿唇、腭裂修复术全身麻醉控制呼吸 ,根据PetCO2 适当调节呼吸参数 ,采用定压呼吸模式 ,能够维持PaO2 、PaCO2 于正常范围。结论 :机械通气能安全有效地应用于新生儿和婴儿唇、腭裂修复术。     

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对于每个患有唇裂的患者及其家属来讲,他们惟一的要求是希望通过唇裂整复手术获得比较完美的局部形态,这也是每个从事该专业人员努力追求的目标。目前在中国,从事唇腭裂专业的同行正面临着来自多方面前所未有