根形骨块onlay移植治疗上颌前牙种植术所需的牙槽骨骨量不足

目的:研究根形骨块移植治疗上颌骨前部骨量不足的效果。方法:通过对7例患者前牙区的26个牙位进行根形植骨术,重建牙槽骨的形态后植入种植体,术后随访时间平均10个月。结果:重建的牙槽骨唇侧丰满,骨面根形逼真,种植体无松动,无脱落,唇侧牙龈无退缩。结论:根形植骨术是治疗上颌多颗前牙缺失伴水平向骨量不足的有效手段。     

牙周炎患者行冲压式上颌窦底提升种植术的临床疗效观察

目的:评价冲压式上颌窦底提升术同期植入种植体修复中、重度慢性牙周炎患者上颌后牙缺失骨量不足的临床疗效.方法:选择中、重度慢性牙周炎伴上颌后牙缺失患者35例,剩余牙槽骨高度平均(5.95±1.19)mm.采用经牙槽突进路上颌窦底提升术不植骨同期植入Straumanns@种植体47颗,分别于3～6个月后行上部修复,随访期为6～30个月,通过影像学及临床PD、PLI、BOP等评价指标,评价种植体修复后的临床疗效.结果:观察期内种植体的留存率为95.74％,45颗种植体成功负载,种植体稳定,骨结合良好.术中2颗种植体发生上颌窦黏膜破裂,穿孔率为4.26％.随访期内,种植体周围组织状况良好,PD平均为(3.22±1.07)mm,平均累积边缘骨丧失为(1.38±0.59)mm.结论:对中、重度慢性牙周炎患者,冲压式上颌窦底提升不植骨同期牙种植术能有效修复上颌后牙区骨高度不足的牙缺失,短期疗效可靠,长期疗效需进一步观察.     

“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。     

“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。     

骨劈开技术在上颌前牙区种植术中的应用

目的：评价骨劈开术在上颌前牙区种植术中的临床应用效果。方法：42例患者,缺失上前牙1-4颗,牙槽嵴可利用骨高度〉10mm,宽度3-5mm。采用骨劈开术形成唇侧骨瓣,在腭侧骨板与唇侧骨瓣之间植入直径3.5mmAnkyl os种植体83枚,劈开部位应用GBR技术,6个月后行二期手术和固定修复。结果：二期手术时所有种植体稳固,1例（2枚种植体）唇侧骨板部分吸收,产生2.0mm种植体颈部唇侧暴露。其余种植体被骨质完全包绕,牙槽嵴宽度增加2.8-4.1 mm,平均增宽3.5mm。83枚种植体完成固定修复,经过2年的追踪观察,无一种植体松动或脱落。结论：上颌牙槽嵴骨宽度为3-5mm时,采用骨劈开术能有效增加骨量,获得满意的临床疗效。     

冲顶式上颌窦提升的临床评价及相关问题探讨

目的:评价经牙槽嵴顶入路行冲顶式上颌窦提升同期植入牙种植体的临床疗效及相关影响因素.方法:25例上颌后牙缺失的患者接受冲顶式上颌窦提升术同期植骨并植入牙种植体,共植入种植体51颗,采用自体骨和人工骨的混合骨粉作为植骨材料,术后随访1-3年.结果:原牙槽嵴高度为4-8.9mm,术后提升上颌窦底高度2～6mm,平均提升高度3.98mm.种植体长度在8-13mm之间,平均11.5mm.有一例术后24 h有轻微鼻腔出血,所有病例均未发生上颌窦穿孔.三颗种植体在二期修复前松动,拔除后有两颗重新植入获得良好的骨整合效果.所有病例均在术后6-18个月行固定义齿修复,在随访期内未发现种植体或上部结构松动.结论:冲顶式上颌窦底提升同期牙种植体植入术较开窗式上颌窦提升创伤小,操作步骤简单,避免了二次手术,节约了患者的时间和费用,可以广泛应用于垂直骨量相对不足的上颌后牙区.     

开窗植骨与闭合冲压上颌窦底提升同期种植的临床研究

目的:研究比较上后牙缺失牙槽嵴高度不足患者,根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底,同期种植牙的治疗效果。方法:43例(55侧)上后牙缺失患者,其中34例(40侧)窦底牙槽嵴骨高6~10 mm者行闭合冲压上颌窦底提升术,其余9例(15侧)骨高2~5 mm者行开窗植骨上颌窦底提升手术,均同期完成一期种植体植入手术。结果:所有患者术后未出现上颌窦炎症,9例行开窗植骨上颌窦底提升手术的患者,无窦膜穿孔,平均提升窦底高度5.8 mm,26颗种植体平均负载30个月,种植体稳定,骨结合状况良好。34例行闭合冲压上颌窦底提升术的患者,平均提升窦底高度4.3 mm,手术操作中有3颗发生可察觉窦膜破孔,发生率为4.1%(3/73),在73颗种植体中,有2颗种植体失败,71颗种植体平均负载23个月,种植体稳定,未见明显骨吸收,成功率97.3%(71/73)。结论:闭合冲压上颌窦底提升术是一种微创、简单、可靠用于上颌后牙上颌窦底牙槽嵴骨高度不足的种植临床技术,临床上应根据上颌窦底牙槽嵴骨高度不同,选用开窗植骨或闭合冲压提升上颌窦底。     

美学区域拔牙窝植骨联合应用PRF的临床观察

目的:通过观察拔牙同期行拔牙窝植入胶原骨联合应用富血小板纤维蛋白并进行种植修复的临床效果,探讨美学区域拔牙植骨的适应证、外科技术及种植时机等。方法:2006年7月至2010年1月,位于美学区域且唇侧骨板缺损或为菲薄型牙周生物类型的42颗患牙于北京大学口腔医院种植中心拔除,同期行拔牙窝植骨并联合应用PRF,术后观察并记录软硬组织愈合情况、种植体类型及术中初期稳定性、采用的植骨术式等。结果:36例患者的42个牙位植骨区均愈合良好,已全部完成种植手术。42枚种植体平均观察时间14.6个月,目前无一例松动脱落,平均直径为3.8±0.4mm,平均长度为13.5±1.7mm。其中14枚种植体种植术中唇侧骨板<1mm,采用GBR技术增厚;其余28枚种植体植入后唇侧骨板厚度>1mm,未行植骨手术(占66.7%)。33枚种植体均已完成修复,临床观察27枚种植修复体龈缘高度及牙间乳头均获得了良好的保存。结论:位于美学区域、唇侧骨板缺损或为菲薄型牙周生物类型的患牙,拔牙同期拔牙窝植入胶原骨,并覆盖PRF关闭拔牙创,可有效的保存牙槽嵴顶的宽度,能为II期早期种植及最终的美学修复创造有利条件,临床操作简便,并可有效的节省患者的植骨费用并缩短治疗周期,临床应用前景广阔。     

上颌前牙种植美学修复46颗的临床评价

目的 评价上颌前牙区种植体的临床应用效果。方法 38例上颌前牙缺失的患者,植入ITI种植体46颗,植入后2～4个月完成上部结构修复。术后随访6～12个月。结果 种植修复后临床效果满意率达95%。但有2例出现颈缘金属外露,1例1年后唇侧牙龈退缩。结论 上前牙缺失在种植外科手术时,需注意种植体植入的三维方向,大多数需采用引导骨再生技术恢复牙槽骨的骨量及丰满度,以达到理想的美学效果。     

前牙区即刻种植的临床研究

目的　评价前牙区即刻种植的临床效果。方法　共对 132例患者前牙区患牙 /种植体拔出后 ,分情况即刻植入BLB、Br&nemark、ITI及Frialit- 2　 4种种植系统共 173颗 ,对其进行定期的临床和放射学检查。结果　 173颗即刻种植前牙种植体 ,其中 83颗行引导骨再生技术 ,经 6个月以上观察 ,失败 4颗 ,1颗弃用。结论　如种植体取得良好的初期稳定性 ,对种植体与拔牙窝间存在大于 1mm的间隙 ,采用引导再生膜技术处理 ,即刻种植可以取得良好的临床效果。     

即刻种植的临床研究

目的 :评价即刻种植的临床效果。方法 :对99例病人在拔出患牙同时 ,分情况即刻植入Xive及Frialit-2两种种植系统共123枚 ,3～9个月后行修复 ,123均已完成修复 ,并对其进行定期的临床和放射学检查。结果 :共123枚即刻种植病例 ,其中67枚行引导骨再生技术 ,修复后经12个月以上观察 ,失败3枚 ,1枚因角度不佳弃用。结论 :配合采用引导骨再生技术处理 ,即刻种植可以取得良好的临床效果。     

牙种植体即刻种植骨愈合过程的组织学观察

目的：了解即刻种植体的骨愈合过程，验证即刻种植的可行性。方法：在１２只犬下颌前磨牙新鲜拔牙创内立即植入纯钛牙种植体，通过组织学光镜和扫描电镜观察术后２、４、６、８、１２周种植体周围骨缺损修复过程和种植体骨结合形成情况。结果：骨缺损区内血块首先机化，而后沿牙槽窝骨壁向中心方向逐渐骨化形成新骨。小于１ｍｍ骨缺损１２周内可完全修复，种植体骨结合形成；１ｍｍ以上骨缺损则不能完全修复。结论：即刻种植体周围骨缺损的修复和骨结合形成类似于拔牙创的愈合，大于１ｍｍ的骨缺损应争取植骨。     

即刻种植的临床探讨

目的：报告拔牙后即刻种植的临床结果并对即刻种植的处理方法进行探讨。方法：拔除患牙，清创拔牙窝后，采用Branemark种植系统的操作方法，在Ⅰ期手术，将Branemark种植体即刻植入患者颌骨，酌情植入自体骨或异体骨，必要时加盖生物膜；4～6个月后，进行Ⅱ期手术，再经1～2周后，用目定修复体修复。结果：138颗即刻种植的Branemark种植体中，上颌76颗，下颌62颗，有4颗种植体失败，观察最长60个月，最短36个月，种植体存留率为96．4％。结论：即刻种植初步临床结果是满意的，其长期效果有待进一步的观察。     

Sinus floor elevation via the maxillary premolar extraction socket with immediate implant placement: a case series

Background: When immediate implant placement is considered for teeth with close proximity to the sinus floor, apical extension of the osteotomy is significantly limited, and often a staged approach is used. Implant placement into fresh extraction sockets and sinus floor manipulation using bone‐added osteotome sinus floor elevation with implant placement are techniques most often used independently or sequentially. Very few reports have described the combined use of immediate implant placement in fresh sockets and the bone‐added osteotome sinus floor elevation technique. Methods: We present five cases in which a maxillary premolar was extracted and an implant placed into the extraction site with simultaneous abfracture of the sinus floor using osteotomes. All teeth were extracted atraumatically, and sockets carefully debrided and checked for integrity of the walls. After ideal osteotomy preparation, particulate bone graft was placed in the osteotomy and appropriately sized osteotomes were used for sinus floor elevation. After sufficient elevation, implant placement was completed and particulate bone was packed in the bone–implant gap when indicated. Results: All implants were restored after a minimum healing period of 6 months. At the time of final restoration, bone was seen surrounding the implants from the apical portion to the most coronal thread. All five implants healed without complications and were in function for periods ranging from 6 to 12 months. Conclusions: Immediate implant placement with simultaneous osteotome sinus floor elevation is an advantageous combination of two successfully used techniques. This combined approach can significantly reduce the treatment time for implant therapy in teeth with close sinus proximity and provide the operator with the ability to place implants of desired length.     

Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants

Purpose: To compare ex vivo bone tissue strains around natural teeth with immediate implants supporting unsplinted and splinted fixed prostheses. Material and methods: Six linear strain gauges were bonded on the labial marginal bone of bilateral maxillary anterior teeth in two fresh‐frozen human cadavers. The natural teeth were loaded in centric occlusion via an occlusal splint with integrated miniature load cells. Strain measurements were performed at a sample rate of 10 kHz and under a maximum load of 100 N, simultaneously monitored from a computer connected to data acquisition system. Upon extraction of the anterior teeth, Ø 4.1 mm and Ø 4.8 mm ITI^® dental implants were placed into sockets of incisors and canines, respectively. Installation torque value (ITV) of each implant was measured by a custom‐made torque wrench and resonance frequency analyses (RFA) were also undertaken. Strain measurements were performed for (1) single‐tooth implant restorations, (2) unilateral splinted anterior implants, and (3) bilateral splinted anterior implants. Finally, an autopolymerizing acrylic resin was injected into the implant sockets for simulation of osseointegration and strain measurements were performed. Results: Microstrains of all groups were statistically comparable (P>0.05), although lower strains were elicited for implants in sockets of incisors in comparison with natural teeth. Microstrains around canine implants were comparable or higher than those induced around natural canines. For all groups, microstrains around canines were higher than those around lateral (P<0.05) and central incisors (P<0.01), which had similar strain levels (P>0.05). The RFA values of implants were comparable. The ITVs of implants in sockets of lateral incisors and canines were similar and were higher than those of implants in central incisor regions. Conclusion: The labial marginal bone having no contact with immediate implants may experience strain gradients within physiologic levels due to deformation of bone under load. Although one prosthetic design does not seem to have clear advantages over another, splinting of implants may be considered as a safety measure for immediately loaded immediate implants, if possible.     

Bio-oss植骨材料在Replace select即刻种植的应用

目的：谈讨Bio—oss植骨材料在Replace select即刻种植的临床应用。方法：拔除患牙，采用Replace select种植系统的操作方法，将Replace select种植体即刻植入拔牙创，植入Bio—oss骨粉，必要时加盖Bio—gide可吸收胶原膜；1～6个月后，进行Ⅱ期手术，1周后，完成固定修复。结果：57枚即刻种植的Replace select种植体中，上颌36枚，下颌21枚，观察最长20个月，最短6个月，种植体存留率为100％。结论：Bio—oss植骨材料在Replace select即刻种植的临床结果是满意的，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。     

Extractions, immediate implant placement and ridge preservation utilizing alloplastic bone graft material. Report of a case

A case report of extractions of periodontally involved teeth with immediate implant placement and ridge preservation using alloplastic material is discussed. The bone graft substitute was for bone maintenance in the extraction sockets and around the dental implants. The case is followed for over one year through the restorative phase.