上颌前牙区单牙种植钛膜引导成骨的美学效果观察

目的上颌前牙单牙种植采取不可吸收性无孔纯钛膜进行引导骨再生,对成骨效果以及修复后软组织美学效果进行观察。方法 2004年6月至2009年12月,在北京大学口腔医学院种植中心,20例上颌前牙单牙缺失种植患者（男12例,女8例,年龄19~56岁,平均34.0岁）。种植体植入后唇侧颈缘出现裂开性骨缺损或唇侧骨板厚度小于等于0.5mm,采用少量自体碎骨和Bio-Oss骨粉充填骨缺损后,以钛膜覆盖植骨区,并用小膜钉固定。愈合5~6个月行Ⅱ期手术,取出钛膜,测量种植体唇侧骨板的厚度。Ⅱ期术后2个月进行种植修复。使用PES（pink esthetic score）评分对种植修复体周围软组织进行评价。结果 20例病例中,没有一例出现伤口的裂开及感染。20颗种植体均获得骨结合。种植体植入时,唇侧骨板的厚度平均0.23mm,种植Ⅱ期手术暴露种植体取出钛膜时,测量唇侧骨板的厚度为1.5mm~3.5mm,平均2.33mm,平均增加2.10 mm。PES平均得分为10.05±1.57。结论在上颌前牙区单牙种植时,采取钛膜引导成骨,解决种植体唇侧颈部骨板裂开性骨缺损及厚度不足效果可靠,牙龈软组织的近期效果良好。     

上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究

目的 探讨唇侧骨板部分缺损的患者行即刻种植和延期种植对术后软硬组织变化情况及美学效果的影响。方法 将40例唇侧骨板呈有利型裂开式骨缺损,且缺损高度不超过4 mm的上颌单颗前牙患者分为即刻种植组（20例）和延期种植组（20例）,两组均在全程导板引导下植入Nobel Active种植体,种植体颈部平台位于唇侧龈缘根方3～4 mm。植入后两组均行即刻修复,并应用Bio-Oss骨粉及Bio-Gide膜同期行引导骨再生术（guided bone regeneration,GBR）。比较两组种植体成功率、种植体唇侧骨板厚度变化、种植体唇侧轮廓厚度变化以及红色美学评分（pink esthetic score,PES）。结果 两组患者的种植体成功率均为100%,随访期间未发生并发症。两组术后唇侧骨板均在种植体颈部观察到最大的骨吸收量,术后12个月即刻种植组的颈部骨吸收量为（1.29±0.71）mm,延期种植组为（1.43±0.19）mm,但两组间在各测量位点骨吸收量差异均无统计学意义。即刻种植组和延期种植组术后6个月及12个月唇侧龈缘最高点以及近远中牙龈乳头高度的变化量差异均无统计学意义;PES评分在...     

应用CBCT对上颌前牙区即刻种植后唇侧骨板变化的评价

目的:应用锥束CT(CBCT)观察上颌前牙区即刻种植后唇侧骨板的变化。方法:30例上前牙即刻种植患者,微创拔牙后植入种植体,植入唇侧骨下1mm,唇侧跳跃间隙在1.0-2mm之间,15例对照组患者跳跃间隙不做处置,15例实验组患者跳跃间隙内放置骨粉。应用CBCT分别测量术后当日及术后3个月、6个月种植体平肩台处唇侧骨壁的厚度,所有数据取平均值。结果:对照组三个时间点唇侧骨板厚度分别为1.82mm、0.83mm、0.75mm;实验组三个时间点唇侧骨板厚度分别为2.25mm、2.13mm、2.06mm。讨论:上颌前牙区种植体唇侧骨板的存在及厚度对美学修复具有决定性的作用,因此对即刻种植后对唇侧骨壁三维变化客观直接的认识具有重要意义,从CBCT图像上可以清晰的看到即刻种植后唇侧骨壁的变化,参考手术前后的骨量变化,根据术前牙槽骨形态设计种植位点具有重要意义。结论:CBCT评价种植体周围的骨量变化是一种客观直接的手段     

钛网联合浓缩生长因子重建上前牙唇侧骨板重度缺损的临床疗效评价

目的:在上颌前牙唇侧骨板重度缺损的重建术中,应用钛网联合浓缩生长因子(concentrate growth factors,CGF)并且同期植入种植体,观察唇侧骨板修复情况以及种植体唇侧颈部新生边缘骨的稳定性.方法:选择20例上颌前牙唇侧骨板重度缺损患者,其中15例为单侧中切牙缺失,5例为双侧中切牙缺失,共25个植入位点.在种植体植入同期进行钛网联合CGF的复合引导骨再生(GBR)技术,埋入式愈合6个月后进行常规二期手术,临时修复3个月后进行永久修复.观察二期手术时骨缺损的修复情况,测量二期手术时、永久修复后3、6、12、18个月种植体唇侧颈部的骨厚度和边缘骨高度.应用SPSS19.0软件包对数据进行非参数多样本检验、Fierdman检验.结果:二期手术时唇侧骨板重建完整,新骨爬行至种植体顶端,唇侧颈部骨厚度平均为(2.69±0.154) mm;修复后3、6、12、18个月,唇侧颈部骨厚度分别为(2.67±0.152) mm、(2.66±0.153) mm、(2.65±0.153) mm和(2.65±0.151) mm,以种植体-基台连接处为基线,唇侧颈部边缘骨高度分别为基线下(0.02±0.048) mm、(0.69±0.085) mm、(0.87±0.019)mm和(0.87±0.013) mm.统计学分析表明,修复后3～12个月,唇侧颈部骨厚度随时间显著减小(P＜0.001),以种植体-基台连接处为基线,唇侧颈部边缘骨高度随时间亦显著降低(P＜0.001);两者在12个月和18个月的差异无显著性(P＞0.05).结论:钛网联合CGF的复合GBR技术能有效重建上前牙唇侧重度骨缺损,颈部新生边缘骨厚度和高度在永久修复1年后趋于稳定,是一种值得临床推广应用的有效和可靠的方法.     

上颌前牙区不同骨条件种植方式的选择

目的:报告四例上颌前牙区不同骨条件下种植方式的选择方法,探讨上颌前牙区骨量对选择种植修复方式的影响.方法:选择四例上颌前牙区不同骨条件的患者.对上颌前牙区骨量无缺损的患者,行即刻拔牙同期植入种植体技术;对上颌前牙区唇侧骨板部分缺损的患者,行即刻拔牙同期植入种植体,并应用GBR技术诱导成骨;对上颌前牙区骨厚度为3mm的患者,行骨劈开后同期植入种植体技术;对上颌前牙区骨厚度约1mm的患者,一期行异体骨骨增量技术,二期植入种植体.结果:四例患者术后种植体愈合良好,修复治疗后对修复效果均满意.讨论:上前牙缺失的患者,缺牙区牙槽嵴往往较窄,常规备孔植入种植体的方法通常比较困难,而且患者对前牙美学区的种植修复效果要求较高,因此,选择合适的种植方式,是影响种植体的骨结合及最终修复效果的关键因素,通过细致的术前设计、术中操作和修复设计,可达到良好的修复效果.     

钛膜在种植即刻修复中引导骨再生的临床效果与体会(附临床病案3例)

目的:评价钛膜在种植即刻修复中治疗种植体周围骨缺损的临床效果,探讨其是否适用于种植即刻修复.方法:3例下颌前牙唇侧骨量不足的牙种植病例,缺损区域植骨覆盖钛膜,并行椅旁即刻修复.术后连续进行临床观察和X线检查.结果:3例均在术后1-2周出现软组织瓣裂开、钛膜暴露,局部冲洗清洁,钛膜保留一月后取出,观察到钛膜覆盖下区域有软组织侵入.讨论:钛膜的固有缺陷以及即刻修复时基台周围缺乏血供的黏膜是造成钛膜高暴露率的原因.结论:鉴于种植即刻修复的特殊性,为避免由于钛膜自身缺陷而造成的膜暴露问题,建议在种植即刻修复中应用更有利于软组织生长的胶原膜作为引导骨再生技术中的屏障膜.     

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。     

美学区即刻种植联合钛网引导组织再生1例

报道1例右侧上颌中切牙根折伴颊侧骨吸收患者,采用即刻种植术式并于植入位点放置骨粉、生物膜及PRF膜引导组织再生,联合钛网维持唇侧的成骨空间。最终恢复了前牙唇侧骨板丰满度,保障种植区硬、软组织的功能及美学效果。     

上颌前牙单牙不翻瓣即刻种植修复的临床研究

目的：旨在探讨上颌美学区域单牙不翻瓣即刻种植修复的技术特点及临床效果。材料与方法：16例上颌前牙单牙进行不翻瓣即刻种植修复。纳入条件：唇侧骨板完整,唇侧牙槽嵴骨面距龈缘3mm左右。微创拔牙,偏腭侧植入种植体,同时种植体植入深度为龈缘下3mm左右。种植体与唇侧骨板之间间隙至少2mm,间隙内植入BioOss颗粒。薄龈生物型、术前龈缘高度偏根方的患者,进行结缔组织移植。术后4-6周采用种植体支持过渡义齿修复,进行牙龈诱导塑形。采用Jemt牙间乳头的分类标准测量种植修复后牙间乳头的高度。采用PES（pinkestheticscore）评分系统评价软组织整体美学效果。PES涉及种植体周围软组织美学的多个因素,包括种植体两侧龈乳头高度、边缘龈水平、软组织轮廓、牙槽突度、软组织质地、软组织颜色7组评分指数,每组由低到高有0、1、2三个记分值,总分最低为0,最高为14。采用CBCT评估唇侧骨板厚度。结果：16位患者16颗种植体平均追踪时间21.8月（12-34月）,至最后一次复查种植体无脱落。根据Jemt牙间乳头评估标准：0度0牙位,Ⅰ度0牙位,Ⅱ度2牙位,Ⅲ度14牙位,Ⅳ度0牙位。PES评分：12分2牙位,13分8牙位,14分6牙位。CBCT显示唇侧骨板厚度得到维持。结论：不翻瓣即刻种植技术可以获得可靠的美学效果,前提是需严格适应证选择,评估局部位点软硬组织解剖条件,采用微创拔牙技术,保证种植体三维方向的准确性,尤其是种植体在唇舌向的位置与轴向,以及种植体植入的深度。并根据位点牙龈情况进行相应的软组织处理,合理选择过渡义齿的方式和戴用时机进行牙龈诱导,并注意修整修复体的唇侧穿龈轮廓为凹形设计,勿使其膨大。     

翻瓣GBR在薄骨壁表型上颌单颗前牙即刻种植即刻修复中的临床效果

目的 探讨唇侧骨壁较薄（<1 mm）的上颌单颗前牙行即刻种植即刻修复时,同期翻瓣行引导骨再生术（guided bone regeneration, GBR）对术后软硬组织变化情况及美学效果的影响。方法 纳入34例唇侧骨壁较薄（<1 mm）的上颌单颗前牙患者,根据即刻种植即刻修复时是否同期行翻瓣GBR分为两组,统计比较两组病例的种植体存留率、种植体唇侧骨厚度及变化量、种植体唇侧软组织高度变化量、红色美学评分（pink esthetic score, PES）以及患者满意度评分。结果 术后12月时两组患者的种植体存留率均为100%,随访期间均未发生种植并发症。术后12月时,翻瓣GBR组唇侧骨壁平均厚度超过2 mm,唇侧骨嵴的平均高度为1.39 mm,而不翻瓣组唇侧骨壁平均厚度不足2 mm,唇侧骨嵴的平均高度为1.03 mm,二者的差异均有统计学意义（P<0.05）。但翻瓣GBR组唇侧骨吸收量在各测量位点均较不翻瓣组更大（P<0.05）。两组间唇侧龈缘位置最高点以及近远中龈乳头高度变化量在术后6月及12月差异均无统计学意义（P>0.05）。翻瓣GBR组与不翻瓣组...     

Variation in periodontal referral in 2 regions in theUK

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.     

云南省五岁儿童乳牙龋病调查分析

目的：了解云南省５岁儿童乳牙龋齿患病情况。方法：随机抽取云南省三个城市三个农村的２１３２名５岁常住儿童,采用第二次全国口腔健康流行病学调查标准调查龋齿患病情况。结果：云南省５岁儿童乳牙患龋率为７５．７５％,龋均为４．４４,充填率仅为６．５７％,仅占构成比的４．３９％。结论：云南省５岁儿童乳牙龋齿患病率高,充填率低。儿童龋病防治应注重两个方面：１．加强对家长和教师的幼儿口腔卫生保健知识及方法的宣传。     

Changes in cyclooxygenase metabolities in experimental periodontitis in Macaca mulatta

The four principal metabolites of cyclooxygenase (CO) were examined during the progression of experimental periodontitis in the rhesus monkey Macaca mulatta. Thirty-two monkeys were divided in four disease-matched groups. Three groups were treated with flurbiprofen, a potent CO inhibitor, at either 0.027, 0.27 or 7.1 mg/kg/day delivered systemically by a subcutaneously-implanted osmotic mini-pump. We have previously described the findings indicating that flurbiprofen treatment significantly retarded clinical attachment loss (ALOSS), redness and radiographic bone loss (BLOSS). This investigation focuses on the changes in CO metabolites which occur during disease progression of ligature-induced periodontitis and on the dose-response relationship of flurbiprofen, as it relates to disease inhibition and the suppression of ARA metabolites within the crevicular fluid (CF). In untreated animals there was a statistically significant 3-fold increase in CF levels of prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) at 3 months, as compared to baseline, which positively correlated with increases in redness, bleeding, ALOSS and BLOSS. CF-PGE2 and TxB2 levels reached a 6-fold peak at 6 months and returned to baseline by 12 months. Flurbiprofen (Fb) prevented the 3-month rise in TxB2, but did not affect the increase in PGE2. At 6 months, Fb administration caused a dose-dependent inhibition of both PGE2 and TxB2. Probit analysis of the dose-response data revealed that the concentration of Fb which caused a 50% inhibition of CF-TxB2 level (the IC50 value for TxB2 synthesis) was approximately two logs lower than the IC50 value for PGE2 synthesis, i.e. TxA2-IC50 = 0.013 vs. PGE2-IC50 = 1.35 mg flurbiprofen/kg/d. The slopes of the PGE2 and TxB2 inhibition curves were identical, consistent with a similar mechanism or singular enzyme for the site of action of Fb inhibition of CO activity. However, the kinetics and sensitivity of Fb inhibition were significantly different for the CO activity responsible for TxB2 and PGE2 synthesis, perhaps due to different compartmentalization of CO within different cell types.     

Mast cells in masseter muscle in experimental bruxism in man

Three human subjects performed tooth grinding for 25 min, and after 20 h biopsies of the right and left masseter muscles were examined for their contents of mast cells. In comparison with specimens from a control group of three subjects, there was an increase of degranulating mast cells in muscles that had performed bruxism.     

Experience in using moradol in osteoplastic operations in oral surgery

Osteoplastic operations on the jaws were carried out in 19 patients aged 14-64 under moradol anesthesia. The mean length of the operation was 3 hours. The authors come to a conclusion that moradol in a dose of 0.3 mg/kg b. w. ensures adequate anesthesia, with a high level of analgesia persisting in the immediate postoperative period.