磨牙区Replace种植体上部结构的临床应用

目的:探讨Replace种植系统上部结构在磨牙区缺失牙修复中的应用.方法:对84例患者用Replace种植系统在磨牙区缺失牙进行种植义齿修复,采用不同的修复设计方案及技工室加工技术.共完成了153颗牙的修复体,对完成修复后的1个月,3个月,6个月进行复诊,以后每年复查一次.对种植体稳定性及种植体周围组织进行随诊观察.结果:在完成修复后的3-12个月内种植体均无松动.1例烤瓷冠崩瓷.1例种植体周围粘膜炎.结论:Replace种植系统上部结构多样化,为临床修复设计提供了更多选择空间,有利于患者的个性化修复.     

BLB种植系统的临床应用及疗效观察

目的评价BLB种植系统的临床效果.方法用BLB种植系统进行延期或即刻种植,采用一期埋入,二期暴露的二次手术方式,对337例患者植入555枚种植体.金属烤瓷冠修复,其中6例患者20枚行全口义齿的球帽及杆卡可摘义齿修复,临床随诊观察一至四年.结果种植成功率95.4%,种植体周围齿槽骨水平吸收＜0.2 mm/年.修复基台松动7枚,烤瓷冠中央螺丝松动38枚,烤瓷冠崩瓷6枚,种植体周围炎24例;球帽式总义齿修复有2例4枚半年后义齿固位力下降,球基台发生磨损;杆卡式总义齿修复效果良好.结论 BLB种植体适合于常见的牙列缺损及牙列缺失的种植修复.     

应力缓压式种植修复体的临床应用研究

目的　研究应力缓压式种植修复体在临床上的应用效果,探讨全瓷冠修复体在种植体冠修复的应用方法。方法　选择临床30例患者的33颗后牙种植体进行种植后行应力缓压式单颗-螺丝固位-全瓷-种植体支持固定义齿修复,并进行随访、分析。结果　经过1年随访,除1例患者因种植体松动导致修复失败外,另29例32颗种植体冠修复效果良好无1例出现瓷裂,崩瓷,螺丝折断,修复体脱落等现象。结论　应力缓压式种植修复体取得了满意的修复效果,具有良好的临床应用前景。     

三种固位方式烤瓷冠修复年轻下颌无髓磨牙残冠的临床效果研究

目的:探讨利用桩核固位的烤瓷冠、利用髓室固位的嵌体烤瓷冠及利用髓室和远中根管固位的嵌体烤瓷冠三种方式修复牙合龈距短的年轻患者下颌磨牙残冠的临床效果。方法:选择解放军第309医院口腔科门诊42例患者,年龄18-24岁,共65颗牙体大面积龋损的下颌磨牙,其中第一磨牙61颗,第二磨牙4颗。经完善根管治疗后,根据修复方式分为三组,分别采用桩核固位的烤瓷冠修复、髓室固位的烤瓷嵌体冠修复及利用髓室和远中根管固位的烤瓷嵌体冠修复。在修复后的6个月、12个月、24个月进行临床追踪观察,根据评价标准做出临床修复效果评价。统计学分析研究结果,评价不同方法的优缺点。结果:经2年的随访,结果显示桩核固位组出现崩瓷3例,修复体边缘不密合2例,继发龋5例和边缘性龈炎2例;髓室和远中根管固位组出现崩瓷1例,修复体边缘不密合2例,继发龋1例和边缘性龈炎2例。而髓室固位组则未出现上述情况。结论:年轻下颌牙合龈距较短的磨牙残冠宜采用髓室固位的嵌体烤瓷冠修复。     

种植多单位修复中螺丝固位与粘接固位联合运用中机械并发症发生情况的回顾性研究

目的:比较多单位螺丝固位种植修复中,采用口内粘接与技师模型上粘接修复体内外冠的螺丝固位修复体在长期使用后机械并发症发生方面的差异.方法:收集后牙区后多单位螺丝固位种植修复体戴牙后3年的患者205例(414颗种植体),其中技师模型上完成金属内冠和氧化锆外冠粘结而后口内螺丝固定99例(198颗植体);采用口内金属内冠螺丝固...     

种植固定义齿两种固位方式的研究进展

近年来,种植义齿得到快速广泛的发展,已经成为牙列缺损和牙列缺失的常规治疗方法之一。选择修复体的固位方式,是进行种植修复至关重要的一步,这也是多年来学者们争论的焦点之一。本文从对种植体周围软硬组织的影响、取戴便利性、修复体的被动就位、美观及患者满意度、修复体对崩瓷的抵抗力、修复体固位力六个方面对螺丝固位与粘接固位两种固位方式的种植义齿进行综述比较,以期为临床治疗提供参考。     

即刻种植修复上前牙的临床美学疗效观察

目的:评价上颌前牙即刻种植即刻修复的临床关学效果.方法:临床选择26例上前牙残根患者,在拔牙后即刻植入 Xive种植体26枚,同时接入基台行复合树脂临时冠/桥修复,6个月后,行永久性修复.种植后嘱患者按期复查,评价应用效果.结果:种植牙修复后咀嚼功能恢复良好,种植体周围软组织健康美观.修复体单冠和修复基台的接缝位于龈下.种植牙给人以从龈下长出来的视觉效果.24名患者对修复体及其临床应用效果和美观效果都评价为满意,1枚种植体发生周围炎,1颗烤瓷冠崩瓷.满意度为92.31%.结论:Xive种植体在上颌前牙缺失即刻种植即刻修复中能够获得满意的临床效果.但要注意种植中软、硬组织和修复体的美学处理.     

种植修复中崩瓷原因的探讨(附1例报告)

目的:探讨种植修复中上部修复体崩瓷的原因。方法:结合本院接诊的一例行种植修复患者上部修复体出现多次崩瓷的具体情况,针对性地搜索相关文献,由此总结归纳分析在种植修复中引起上部修复体崩瓷的原因。结果:导致种植上部修复体崩瓷的原因可能与下列因素有关:不良的口腔习惯、种植体间的跨度过大、种植修复体的固位方式、对颌牙的情况、修复体基台与种植体肩台间未完全就位、种植义齿相互保护的应用情况等。结论:引起种植修复体崩瓷的原因是多方面的,临床操作中应考虑到各方面因素的影响,以选择最佳的种植修复方案,将崩瓷等并发症的发生率降至最低,提高种植修复的成功率。     

Ankylos种植系统多牙固定修复短期临床疗效评价

[摘要] 目的 评价Ankylos种植体用于固定修复多牙缺失的临床应用效果。方法 临床选择21例多牙缺失患者完成An-kylos 68枚种植体进行潜入式种植手术,部分骨量不足的患者,同期使用膜引导骨再生术、上颌窦内提升术或上颌窦外提升术。Ⅱ期手术两周后,按照常规方法完成金钯合金烤瓷冠修复。术后随访,检查修复体与基台的稳定性,种植体周围牙龈组织的健康状况;通过X线检查观察骨组织的吸收情况及基台的密合程度;调查患者对种植义齿咀嚼、美观功能的主观满意度。种植后及义齿修复后的临床观察期为1～2.5年。结果 冠桥修复后,1例患者的1枚种植体在种植修复后1个月时,发生种植体周围炎;1例在修复后1年烤瓷冠崩瓷;其余种植体均稳定,无明显骨吸收,种植体基台界面密合,牙龈组织健康。按种植成功标准,修复成功66枚,成功率97.1%;失败2枚,占2.9%。结论 Ankylos种植体用于多牙缺失的固定修复具有良好的临床效果。     

多单位种植修复中组合运用螺丝固位与粘接固位的临床回顾性研究

目的:比较种植联冠修复中组合使用螺丝与粘接固位修复方式(SCP)与单纯粘接及螺丝固位方式在修复体固位并发症方面的差异.方法:收集后牙区多单位种植修复体戴牙后2年的患者152例,共331颗种植体.其中使用螺丝固位的44例(S组,94颗植体);口内粘结固位56例(C组,121颗植体);螺丝固位与粘接固位联合运用52例(SC...     

An esthetic solution for single-implant restorations - type III porcelain veneer bonded to a screw-retained custom abutment: a clinical report

A new esthetic solution to restore dental implants in combination with limited interdental, facial or labial, or interocclusal space is presented. This article describes the translational application of novel-design porcelain veneers and adhesive restorative principles in the implant realm. A patient is presented who was treated with a single implant-supported restoration replacing a missing mandibular lateral incisor and partially collapsed interdental space. A screw-retained custom metal ceramic abutment was combined with a bonded porcelain restoration. This unique design was motivated by the limited restorative space and subgingival implant shoulder. It was also developed as a solution to the interference of the screw-access channel with the incisal edge, therefore providing the surgeon with more options during implant axis selection. The porcelain-to-porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment.     

Fracture resistance of implant-supported screw- versus cement-retained porcelain fused to metal single crowns: SEM fractographic analysis.

OBJECTIVES: The present in vitro study aimed at evaluating the fracture resistance of both implant-supported screw- and cement-retained porcelain fused to metal (PFM) single crowns. A scanning electron microscope (SEM) evaluation of the mode of failure of the specimens was also performed. METHODS: Forty PFM premolar-shaped identical single crowns were realized. The restorations were divided into two groups: cement-retained (group 1) and screw-retained (group 2) prostheses. Compressive loading tests and SEM fractographic analyses were performed. The data were statistically analysed by means of the Student's t-test, with a confidence interval of 95%. RESULTS: The mean fracture load value was 1657 (+/-725) N in group 1 and 1281 (+/-747) N in group 2; the statistical analysis pointed out no significant differences between the two groups (p=0.115). The mean work at maximum load value was 0.775 (+/-0.619) J in group 1 and 0.605 (+/-0.526) J in group 2; the statistical analysis pointed out no significant differences between the two groups (p=0.355). All the samples were affected by cohesive fractures of the porcelain. Screw-retained crowns showed microcracks at the level of the occlusal access to the screw and extensive fractures in the whole thickness of the ceramics. On the contrary, cement-retained restorations were affected by less wide paramarginal fractures of the porcelain. SIGNIFICANCE: A stronger implant-prosthetic connection was noticed in cemented restorations group than in screw-retained single crowns. Even though negatively influenced by the presence of the occlusal access to the screw, the metal-ceramics bond can be considered predictable in both the implant-prosthetic connection systems analysed.     

三种不同金属基底烤瓷冠的临床效果研究

目的 :比较铸造高金合金基底、铸造TILITE合金基底、铸造镍铬合金基底烤瓷冠的临床应用效果。方法 :分别制作铸造高金合金基底、铸造TILITE合金基底、铸造镍铬合金基底烤瓷冠 ,观察三者戴入时及戴入两年后烤瓷冠的颜色、冠边缘的密合度、颈缘染色及冠的折裂、折断情况。结果 :高金合金基底烤瓷冠的颜色、冠边缘的密合度及颈缘染色均优于TILITE合金、镍铬合金基底烤瓷冠 (P <0 .0 1) ,三者在冠的折裂、折断方面的差异无显著性(P >0 .0 5 )。结论 :TILITE合金底冠烤瓷冠能基本满足临床要求 ,但其长期的临床效果有待于进一步观察。     

Immediate loading of four or six implants in completely edentulous patients

In this retrospective study, 44 patients received screw-retained full-arch acrylic resin provisional prostheses connected on 4 or 6 implants in the mandible or maxilla, respectively. With a mean follow-up of 17.6 months, 3 of 205 implants were lost and replaced successfully. Cosmetic fractures were shown in six patients; one abutment loosening, one abutment fracture, and one implant fracture were also observed. Prosthetic fracture was shown in one patient. Marginal bone loss reached two to five threads on 13 implants (6.4%). The results confirmed that immediate loading of 4 mandibular or 6 maxillary implants with an acrylic resin prosthesis for full-arch rehabilitation is a reliable technique in the short- and midterm.     

种植义齿修复10年临床效果评价

目的:评价种植义齿的中、长期临床效果。方法:1995年6月至2005年6月,为1121例患者植入了1786颗种植体并完成上部结构修复,种植体系统分别为Br nemark系统92颗、ITI系统108颗、Replace系统21颗、Lifecore系统79颗、BLB系统1486颗。其中,单牙螺丝固定修复510例,单牙粘结固定修复413例,固定桥修复175例,种植体支持的覆盖义齿23例。随访9～122个月,观察方法为X线片、临床观察、患者满意度调查。应用寿命表法计算10年累计存留率,应用SAS9.1.3软件对数据进行配对t检验。结果:1102例患者的1760颗种植体完成骨整合。19例患者的26颗种植体松动脱落,10年累计存留率为98.1%。510例烤瓷冠螺丝固定患者中,39例发生螺丝松动,2例折断;413例烤瓷冠粘结患者中,17例崩瓷,5例冠脱落。X线片比较检查种植体周围骨吸收状况,结果无显著性差异。患者对美观、发音满意度和固位、咀嚼能力在种植治疗后明显提高,并具有统计学差异。结论:种植义齿是修复缺失牙的有效方法,本组病例10年累计存留率为98.1%。     

全氧化锆单牙种植体支持带角度螺钉通道基牙修复短期疗效评价

目的:探讨全氧化锆单牙种植体支持带角度螺钉通道基牙的修复效果.方法:前瞻性选择2016年3月—2018年3月接受上颌和下颌后牙区域单牙种植的牙缺失患者76例,均于种植后3个月提供带角度螺钉通道基台;分别于植入物放置即刻(T0)、4周(T1)、1年(T2)和2年(T3)进行随访,测量改良龈沟出血指数(mSBI)、改良菌斑...     

微创种植固定修复在下颌无牙颌患者中的临床应用研究

目的：通过在下颌微创种植8枚种植体，使下颌无牙颌患者获得固定义齿。方法：对下颌无牙颌要求种植固定义齿的患者进行筛选，制定详细的治疗方案。采用不翻瓣的手术方法植入8枚种植体，对患者原义齿缓冲后做过渡使用。术后6个月采用黏固式分段烤瓷桥的设计方式修复完成至少12牙单位修复。结果：本院自2006年至2013年期间采用此方法对下颌无牙颌患者完成种植固定义齿修复18例，追踪期（0.8-7年）内，种植体存留率100%，种植体周围组织稳定，义齿局部崩瓷一例。结论：下颌无牙颌患者8枚种植体支持的固定义齿咀嚼功能恢复理想，患者使用舒适方便，义齿卫生易于维护，患者接受度和满意度高。     

Considerations for fabrication of implant-supported posterior restorations

Implant-supported posterior restorations must be fabricated following established prosthodontic principles. The need for screw-retained abutments and the narrow diameter of root-form implants dictate additional treatment protocols that fall beyond the scope of conventional prosthodontics. Cemented restorations offer simplicity and good control of morphology, but can only be considered if removal or no reservicing of the restoration is anticipated. Screw-retained restorations allow for reservicing or remediation but necessitate centering of the retaining screw within the occlusal anatomy. When the implant is misaligned, axis problems are solved with preangled copings, custom copings, or double frameworks. The diameter of root-form implants is significantly smaller than posterior natural teeth, and the emergence of the restorations must be progressively flared to achieve proper morphology. Limited interocclusal space and implant placement may dictate restoring posterior teeth as premolars, selecting a short abutment or a nonsegmented ("UCLA") abutment, or overlapping the crowns over the soft tissues. The final abutment selection is best assisted with a diagnostic waxing and with provisional restorations anticipating the completed treatment.     

A comparison of the porcelain fracture resistance of screw-retained and cement-retained implant-supported metal-ceramic crowns

STATEMENT OF PROBLEM: The presence of a screw opening on the occlusal surface of implant-supported metal-ceramic crowns may decrease the porcelain fracture resistance and shorten the longevity of the crown. PURPOSE: The purpose of this study was to compare the porcelain fracture resistance between screw-retained and cement-retained implant-supported metal-ceramic crowns and to assess whether narrowing the occlusal table or offsetting the screw-access opening affects fracture resistance. MATERIAL AND METHODS: Forty standardized maxillary premolar metal copings were fabricated with a Pd-Ga alloy (Protocol) on an implant abutment. Copings were divided into 4 groups (n=10): Group 1 (Screw-retained; occlusal surface buccolingual width=5 mm), screw access opening placed in the center of the occlusal surface; Group 2 (Screw-retained; occlusal surface buccolingual width=5 mm), screw access opening positioned 1 mm offset from the center of the occlusal surface toward the buccal cusp; Group 3 (Cement-retained; occlusal surface buccolingual width=5 mm), copings were not altered; and Group 4 (Cement-retained; occlusal surface buccolingual width=4 mm), copings designed to have a reduced occlusal surface width. All castings were finished with aluminum oxide stones and airborne-particle abraded. Two layers of opaque and dentin porcelain were applied, respectively, on all specimens, which were then glazed. The crown specimens were positioned in a custom testing apparatus and vertically loaded on the middle of the occlusal surface with a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. Mean values of load at fracture (Kgf) were calculated in each group and compared with a 1-way analysis of variance and Tukey's Studentized test (alpha=.05). RESULTS: Mean values of loads required to fracture the crowns were as follow: Group 1: 95.01+/-46.6 Kgf; Group 2: 108.61+/-57.9 Kgf; Group 3: 390.94+/-151.3 Kgf; Group 4: 380.04+/-211.8 Kgf. Groups 1 and 2 required a significantly lower force to fracture the crowns compared with Groups 3 and 4 (P=.0001). Comparing Group 1 with 2 (P=.9) and Groups 3 with 4 (P=.6), no significant differences were noted. CONCLUSIONS: Screw-retained implant-supported metal-ceramic crowns demonstrated a significantly lower porcelain fracture resistance than cement-retained crowns. Placing the screw access opening 1 mm offset from the center of the occlusal surface did not result in lower fracture resistance. Cement-retained crowns with 4- or 5-mm buccolingual width of the occlusal surface showed similar porcelain fracture resistance.