上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。     

骨劈开技术在上颌前牙区种植的临床效果观察

目的 评价上颌前牙区牙槽骨水平宽度不足的种植牙患者应用骨劈开技术增宽牙槽嵴的临床效果。方法 选择19例上前牙缺失患者,有充足的牙槽嵴高度(≥12 mm),但牙槽嵴骨宽度仅3~5 mm,行骨劈开术同期植入种植体治疗。共植入种植体29枚,其中ITI种植体21枚,Replace种植体8枚。根据骨劈开术后间隙及唇侧骨壁厚度等不同情况选择植入或不植入人工骨粉修复手段,术后6个月暴露种植体,完成上部修复,定期随诊。结果 术后无明显并发症发生,修复完成后经过6~24个月追踪观察,种植体行使功能良好,无松动或脱落。结论 当上颌前牙区牙槽嵴宽度为3~5 mm时,通过使用骨劈开术来增加牙槽嵴的宽度,是一种使种植体能够获得同期植入的有效方法。     

CBCT技术研究前牙区骨劈开术种植修复的骨吸收特点

目的:采用CBCT技术分析骨劈开手术后种植体唇侧骨板垂直骨吸收特点及与水平向厚度的关系。方法:选取19例上前牙种植患者,共26个种植牙位,牙槽嵴宽度均在3~5 mm之间,采用骨劈开手术联合引导骨组织再生术(GBR)种植Ankylos种植体,患者种植修复完成时和2年后复诊时均拍摄锥形束CT,观察唇侧骨板吸收特点,并根据统计学分析唇侧垂直骨吸收与牙龈退缩的相关性,及与骨板水平向厚度的相关性。结果:种植体唇侧骨板垂直骨吸收与牙龈的退缩有明显的相关性,与唇侧骨板颈部水平向厚度也有相关性。结论:种植治疗时骨劈开技术能够有效增宽牙槽嵴宽度,种植体颈部唇侧骨板水平向厚度是唇侧骨板垂直骨吸收与牙龈退缩的一个重要影响因素。     

“夹心植骨”预防骨劈开术后唇颊侧骨壁吸收的临床研

研究背景：当牙槽嵴尤其是上颌前牙区牙槽嵴宽度不足时,采用骨劈开同期种植体植术能获得可靠地临床效果。然而许多研究和作者本人的临床观察均发现,采用该手术后常见种植体唇侧骨壁部分吸收,致种植体唇侧上、中部多个螺纹暴露于骨面,其表面仅有软组织覆盖,当患者的附着龈较薄时甚至会透出种植体的颜色,这种状况无疑将对种植义齿的长期美观效果和寿命产生严重的不利影响。研究目的：评价＂夹心植骨＂法防止骨劈开后唇颊侧骨壁吸收的临床效果。方法：36例上颌前牙缺失区牙槽嵴宽度2～4mm,有足够骨高度患者,采用骨劈开术同期植入种植体,共植入植体40枚,其中16枚种植体唇侧骨瓣较稳固,可与种植体紧密相贴,直接采用颗粒骨移植材料（天博骨粉或Bio-Oss）和胶原膜覆盖（海奥修复膜或Bioguide膜）,作为对照组。将24枚种植体唇侧骨瓣撑开,在种植体唇侧面与骨瓣之间形成1mm左右的间隙,间隙内填入颗粒骨移植材料（天博骨粉或Bio-Oss）,使种植体唇侧骨质总厚度大于1mm,覆盖胶原膜（海奥修复膜或Bioguide膜）,无张缝合创口。6个月后行Ⅱ期手术,翻瓣检查种植体唇侧骨质状况和骨壁厚度。结果：对照组16枚种植体唇侧骨壁均有不同程度吸收,种植体上部有3～5个螺纹暴露于骨面;24颗采用夹心植骨的种植体唇侧均有坚实的骨质,未见骨吸收和螺纹暴露,种植体唇侧骨壁厚度均大于1mm。结论：骨劈开术中在唇颊侧骨瓣和种植体表面之间夹心植入颗粒状骨移植材料,能有效地防止唇侧骨壁吸收,保证种植体唇侧有足够厚度完整的骨质覆盖。     

前牙区微创骨劈开同期种植的短期临床疗效观察

目的:评价前牙区行微创骨劈开术并同期植入种植体的临床疗效。方法:前牙缺失患者15名,植入种植体21颗。缺牙区牙槽嵴呈薄刃状,宽度约2～4mm,平均为3.3mm。局部浸润麻醉下行嵴顶小切口,微翻瓣,仅暴露嵴顶部分,先锋钻定位,刃状骨凿将颊舌侧骨板分开并将颊侧骨板向外移位,基底部仍与基底骨相连,形成青枝骨折,相应扩孔钻行种植窝的精确预备并收集自体骨屑,同期植入种植体,两侧的骨沟隙内填入自体骨屑或自体骨与人工骨混合物,严密缝合创口,术后6个月行二期手术。结果:术后CBCT影像未见唇侧骨板折断、游离,患者术后疼痛、肿胀等不良反应轻微,二期手术时可见种植体周围骨成形理想,修复完成后种植体行使功能良好。讨论:微创骨劈开术可以减小创伤,保留骨组织并提高种植体周围骨密度,同期植入种植体缩短了患者就诊疗程,保存牙槽嵴劈开后的骨宽度,该技术应用于前牙区能取得良好的临床效果。结论:微创骨劈开术是解决前牙区水平骨量不足的一种可预测的有效的骨增量方法。     

上颌菲薄牙槽骨劈开同期人工牙种植的初步观察

目的：评价上颌菲薄牙槽骨在行骨劈开同时植入种植体及人工骨后的临床效果。方法：对9例上颌牙缺失、剩余牙槽骨宽度为3-4mm、高度大于12mm的病例，行骨劈开，植入29颗种植体，同时在缺隙处植入Bio—Oss骨粉。结果：术后6-8个月X线片检查种植体骨结合良好。行二期手术，重新暴露术区，发现牙槽嵴植骨区已矿化，27颗种植体牙槽嵴顶骨厚度5-6mm．种植体已形成骨结合。有2颗种植体唇／颊侧部分骨质菲薄如牛皮纸，需采用骨组织引导再生技术。所有病例修复后美学效果好。追踪12个月以上，无种植体失败。结论：牙槽骨劈开同期植入种植体。解决了上颌菲薄牙槽骨患者的种植修复难题，操作简单，效果良好。在严格控制适应证的前提下，可在临床推广应用。     

牙槽骨劈开术同期牙种植的临床应用

目的　评价牙槽骨劈开技术在口腔种植中应用的临床效果。方法　对116例缺牙区牙槽嵴高度大于12 mm,颊舌向厚度在3~5 mm之间的牙列缺损患者,行牙槽嵴劈开同期植入种植体治疗。共植入ITI种植体147枚,Replace种植体52枚。根据骨劈开术后间隙及唇颊侧骨壁厚度等不同情况选择植入或不植入自体骨、人工骨粉等修复手段。术后6月种植修复,定期随诊。结果　种植区软组织愈合好,无红肿,颊舌向牙槽骨较种植前明显增宽。术后除1颗种植体失败取出外,其余种植体稳固,种植修复体能正常使用。复诊时X线检查骨吸收≤1 mm。结论　骨劈开术使牙槽骨宽度在3~5 mm的病例有了一期种植的可能,是一种简单有效的增宽牙槽骨的方法。     

骨劈开、牙槽嵴扩张联合GBR技术同期上颌前牙区种植的临床疗效观察

目的:评价上前牙区牙槽骨水平宽度不足的患者应用骨劈开、牙槽嵴扩张联合GBR技术同期植入种植体的的临床疗效。方法:2011年5月~2013年9月,选取来本院就诊的24例上前牙种植区剩余骨量不足患者,应用超声骨刀行前牙牙槽骨劈开术,骨扩张、同期植入30枚Ankylos种植体,辅以GBR技术。6个月后,平行投照根尖片、CBCT复查,完成修复,随访1年。结果:牙槽嵴唇腭侧术前、术后平均宽度分别为(3.2±0.12)mm和(6.4±0.16)mm,差异有统计意义(t=239.024,P<0.05),牙槽骨宽度在术后基线与半年后结果相比,差异无统计意义(t=1.795,P>0.05)。结论:骨劈开、牙槽嵴扩张联合GBR技术并同期植入种植体短期临床效果较好,远期效果有待于进一步观察。     

骨劈开、骨挤压联合GBR技术同期植入种植体的临床疗效评价

目的:采用CBCT及临床检查的方法评价骨劈开、骨挤压联合GBR技术同期植入种植体的的临床疗效。方法:采用CBCT检查术前牙槽骨的形态和骨量,唇舌向牙槽骨厚度介于2.5-4mm的病例适用这种技术。方法如下:使用1.0mm细钻针作为引导钻沿种植体拟植入方向钻入所需深度,然后使用骨劈开器沿钻孔方向劈开牙槽嵴,使用BICON手用扩孔器械逐级备洞,并挤压劈开的唇侧骨板,收集自体骨骨屑,同时撑开牙槽骨增加宽度,植入种植体。在骨质缺损区暴露的种植体表面和较薄的唇侧骨板表面先铺放获得的自体骨屑,然后再铺放人工骨粉,最后以胶原膜覆盖植骨区。6个月后,CBCT复查,完成修复。随访2年。结果:40例患者接受了这种骨增量技术治疗,共植入56颗种植体,均获得成功,平均增加牙槽骨宽度3.5mm。讨论:牙缺失后常常造成骨量不足,单一技术的运用不能获得良好的骨增量效果。骨劈开、骨挤压联合GBR技术是一种综合性的微创骨增量技术,获得了肯定的临床效果。结论:骨劈开、骨挤压联合GBR技术并同期植入种植体是一种有效的骨增量种植方式。     

上颌即刻种植后牙槽骨改建的CBCT分析

目的:分析即刻种植术后可能影响上颌牙槽嵴改建的因素。方法:共80例接受上颌即刻种植的患者,在上颌前牙及前磨牙区拔牙后即刻植入80枚种植体。检查并记录如下数据:1种植体表面距颊侧牙槽嵴外侧骨板的距离;2种植体颊侧水平骨缺损距离;3种植体颊侧垂直缺损距离。并于术后4个月行二期手术时复查上述数据。依据以下3个原则进行分析:颊侧牙槽骨厚度;缺牙位置;是否因牙周病拔牙。结果:当颊侧骨板较厚时,牙槽嵴吸收量较少。前磨牙区域牙槽嵴吸收量较少。结论:颊侧骨板的厚度及缺牙位置均有可能影响术后牙槽嵴的改建。在行即刻种植术时,临床医师必须密切关注种植体颊侧骨板的厚度,水平缺损的宽度等条件。     

Ridge splitting technique in atrophic anterior maxilla with immediate implants, bone regeneration and immediate temporisation: a case report

Narrow alveolar ridges remain a serious challenge for the successful placement of endosseous implants. This article reports a technique for widening the atrophic ridge by splitting the alveolar bone longitudinally and filling the bone gap with collagenised pig bone, treatment of ridges as thin as 2.5mm at the alveolar crest and simultaneous placement of dental implants. Treatment of a 22-year-old female patient with a severely resorbed anterior maxilla is described. 4mm wide by 13mm long threaded Osseotite implants were immediately placed within the split ridge and surrounded with a mixture of autogenous tuberosity and collagenised pig bone. The advantages of this technique for patients include less surgical trauma and reduced treatment time.     

“三明治”截骨术在前牙区种植修复临床应用

目的:评价“三明治”截骨术用于前牙区种植修复临床效果。方法:使用“三明治”截骨术对6例前牙缺失区垂直骨缺损严重的患者进行骨增量,植骨术后6个月行种植术,3个月后修复。结果:植骨前后对比获得骨高度增加为4.10 mm,3.70~4.40 mm(M,Q25~Q75),差异具有统计学意义(P<0.05)。负载1年后平均骨吸收量0.3 mm。顺利完成9颗种植体植入术并获得较满意的美学修复效果。结论:“三明治”截骨术用于前牙种植修复表现出良好的美学效果,是一种安全可靠的骨增量技术。     

帐篷螺丝技术在上前牙区连续缺失种植修复中的疗效评价

目的:评价帐篷螺丝植骨技术在上前牙区连续多牙缺失水平向骨增量术中的临床应用效果。方法:使用帐篷螺丝技术(screw-tent technique)对9例上前牙连续缺失(21个位点),骨缺损严重的患者进行水平向骨增量,6~9个月后行种植体植入术,植入术后6个月行种植修复,并追踪观察修复后12个月的修复效果。结果:9例患者共植入21枚种植体,无一松动或者脱落,并获得较满意的修复效果。术前牙槽嵴宽度为(2.41±0.49)mm,术后6个月牙槽嵴宽度为(8.27±0.79)mm,对比植骨术前和术后,差异有统计学意义(P<0.05)。修复完成后12个月牙槽嵴宽度为(7.74±0.52),对比种植术后和修复后12个月,差异有统计学意义(P<0.05)。结论:螺丝技术在上前牙连续缺失的水平向骨增量中,可获得较理想的水平向骨增量效果及修复效果。但由于观察时间较短,其远期效果仍需要进一步的观察研究。     

Onlay植骨技术在上颌前牙美学区种植修复中的应用

目的:评估Onlay植骨技术在上颌前牙美学区种植修复中的应用。方法:随机选取82例行种植修复术的患者,根据术前评估,给予患者合理的Onlay植骨技术及牙种植修复手术方案。观察患者植骨期间牙槽嵴骨量变化及美学指标变化情况,记录牙种植体存活率。结果:Onlay植骨术后3个月末牙槽嵴水平向骨量(7.84±0.42)mm、牙槽嵴垂直向骨量(11.65±0.85)mm和术后6个月末牙槽嵴水平向骨量(7.15±0.60)mm、牙槽嵴垂直向骨量(10.86±0.63)mm均显著高于植骨前骨量,P=0.035、0.039、0.035、0.040;牙种植修复术后3个月末PES(7.48±1.36)分、WES(7.56±1.09)分和术后6个月末PES(7.78±1.42)分、WES(7.82±1.51)分均显著高于术前评分水平,P=0.040、0.043、0.038、0.032;Onlay植骨术后,骨组织美观丰满,伤口愈合良好,未出现植骨坏死,种植体存活率高。结论:将Onlay植骨技术应用于上颌前牙美学区种植修复中,可显著改善种植区骨量不足的问题,骨愈合情况良好,种植体存活率高,值得推广使用。     

天然牙-种植体联合修复上前牙区多牙缺失探讨

目的评价天然牙-种植体联合固定修复上前牙区多牙缺失的临床效果。方法上前牙区多牙缺失牙槽骨骨量不足或基牙分布不均、要求种植固定修复的17例患者,行骨劈开引导骨组织再生术,同期植入Strau-mann种植体共41颗,术后6～9个月采用天然牙与种植体联合支持的固定义齿修复。随访3～24个月,行X线和临床检查。结果术后上前牙区牙槽嵴唇舌向宽度平均增加2.3mm,1例患者的1颗种植体松动,其余16例患者的40颗种植体形成良好的骨整合,X线检查见天然牙及种植体周围垂直向骨吸收每年不超过0.2mm。结论严格筛选适应证,应用骨劈开引导骨再生术同期植入种植体,延期行天然牙-种植体联合固定修复上前牙缺失短期效果评价较为满意。     

Preliminary report on a staged ridge splitting technique for implant placement in the mandible: a technical note

PURPOSE: Narrow edentulous alveolar ridges less than 5 mm wide require horizontal augmentation for the placement of screw-type dental implants. A staged approach to ridge splitting in the mandible to decrease the risk of malfracture during osteotomy is presented. MATERIALS AND METHODS: Five consecutive patients with 6 long-span edentulous areas of the mandibular ridge were included in this study. After corticotomy of a rectangular buccal segment and a 40-day healing period, the mandibular ridge was split, leaving the buccal periosteum attached to the lateralized segment. Seventeen dental implants were placed, and the gap between the implants and the bone filled with a mixture of venous blood and a porous algae-derived hydroxyapatite. RESULTS: All buccal segments fractured as planned at the basal corticotomy during ridge splitting. After 6 months, all implants were stable and surrounded by bone; prosthetic loading with fixed partial dentures was successful in all cases. DISCUSSION: In the mandible, greenstick fracture during widening with osteotomes has not been controllable to date because of cortical thickness of the bone; the risk of malfracture during single-stage ridge splitting was high. With this approach, the location of the greenstick fracture is predetermined, and the perfusion for the buccal segment remains intact, although vascularization shifts from internal perfusion from spongy bone after the first intervention to external perfusion from the periosteum after the second intervention. The buccal cortical segment remains a pedicled graft after ridge splitting. CONCLUSION: The preliminary results of this report indicate that staged ridge splitting can be a safe technique which overcomes the problems associated with single-stage ridge expansion/ridge splitting procedures without causing significant delay in treatment.     

Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region.

BACKGROUND: The regeneration of gingival papillae after single-implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single-tooth implants, and 2) whether the surgical technique at uncovering influences the outcome. METHODS: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla-like formation around dental implants. Fifty-two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone. RESULTS: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was > or = 6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively. CONCLUSIONS: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering.