Brnemark种植覆盖义齿的临床评价

目的 :评价Branemark种植覆盖义齿修复全牙列缺失3年后的临床效果。方法 :采用Branemark种植系统的常规操作方法 ,在I期手术 ,225颗Branemark种植体植入全牙列缺失的86例患者,下颌的有63例136颗种植体 ,上颌的有23例89颗种植体 ,下颌一般植入2～3颗种植体 ,上颌则需要3～6颗。4～6个月后 ,进行II期手术 ,将愈合基台连接在种植体上。修复期在Ⅱ期手术一周后进行。取下愈合基台 ,选择永久基台接在种植体上。根据具体情况选择杆卡附着体 (Bar-clipattachment)或球形附着体 (Ballattachment) ,按常规制作和戴上塑料活动修复体。结果 :Branemark种植覆盖义齿修复后3年的累积成功率上颌为83.2% ,下颌为99.3%。结论 :Branemark种植覆盖义齿修复全牙列缺失时 ,下颌比上颌具有较好的临床效果     

无牙颌杆卡式种植覆盖义齿的制作及临床效果

目的探讨无牙颌杆卡式种植覆盖义齿技术的临床应用。方法拟行无牙颌种植义齿修复的患者34例,临床进行种植义齿设计、模型制取,技工室制作杆卡式种植覆盖义齿34副。随访1～4年,检查种植体健康及义齿固位情况。结果完成的34副无牙颌杆卡式种植覆盖义齿就位顺利,固位、稳定性良好,患者佩戴舒适、美观,修复效果良好。其中3副义齿戴入3个月左右发生折断,主要原因是初期进行义齿制作时,没有设计起加强作用的金属网,改进后,未再发生义齿折断。有6例患者戴牙6～12个月后,出现个别种植杆的焊点断裂,主要原因是激光焊接强度不足,进行了重新焊接。结论杆卡式种植覆盖义齿是一种较好的种植义齿修复方法,值得推广应用。     

磁性固位种植覆盖义齿在无牙颌修复中的应用

目的:为解决牙槽骨严重吸收无牙颌患者的修复难题,探讨磁性附着体种植覆盖义齿在临床上的应用效果。方法:本文对12例牙槽骨严重吸收的无牙颌患者均采用2枚CDIC种植体,4-6个月后进行磁性附着体覆盖义齿修复,每半年复诊,观察义齿使用情况,并结合临床检查和X线检查评价效果。结果:12例患者24枚种植体均达到骨结合,12件覆盖义齿固位良好,患者满意度100%,义齿稳定性较好,患者满意度90%。结论:磁性固位种植体覆盖义齿用于牙槽骨严重吸收的无牙颌患者修复治疗,临床效果好,值得推广。     

下颌无牙颌种植修复设计体会

目的:探讨下颌无牙颌种植体植入位置、数目与修复设计的关系。方法:采用Frialit-2种植体36枚和Endo-pore种植体6枚对8例下颌无牙颌患者进行了种植修复,其中2例进行了杆卡覆盖义齿修复,2例球帽覆盖义齿修复,4例种植固定义齿修复。结果:二期手术时,42枚种植体均形成了良好的骨性结合。经6~24个月的临床修复观察,种植体负重6个月时骨吸收平均0.5mm±0.02mm,戴义齿12个月后骨吸收平均0.1mm±0.03mm。修复的种植义齿能较好地行使咀嚼功能,收到了满意的临床效果。结论:对于下颌无牙颌的种植患者,合理的治疗计划,对于保障种植义齿的修复效果及维持种植体的长期成功率是重要的。     

无牙颌种植修复设计

牙列缺失后,常存在颌位关系异常,同时口腔黏膜组织萎缩变薄,敏感度增加,义齿难以获得良好的固位及咀嚼功能。种植修复能够降低骨吸收量,增加义齿稳定性,减少戴牙后疼痛,是恢复患者咀嚼功能的有效方法。但患者个体差异导致的咬合力大小,颌间距离,牙槽骨高度、宽度及质量,黏膜厚度等条件均有差异,不同医师提出的治疗方案各异,难以统一。本文拟就无牙颌种植修复常见问题及设计时应考虑的因素作以讨论。     

无牙颌种植覆盖义齿修复设计与并发症

 传统全口义齿有稳定性差、固位不良、咀嚼效率低等缺点，难以被患者接受。与传统全口义齿相比，无牙颌种植覆盖义齿由种植体提供支持或辅助固位，可获得较好的稳固性和患者满意度，得以在临床广泛应用。然而，无牙颌种植覆盖义齿组成结构和修复设计复杂，受患者自身颌骨条件、修复空间和口腔卫生维护能力等因素的影响，在使用过程中易发生并发症。文章就无牙颌种植覆盖义齿修复设计中种植体数量、位置和附着体类型的选择及并发症做一阐述。     

无牙颌种植覆盖义齿修复设计与并发症

传统全口义齿有稳定性差、固位不良、咀嚼效率低等缺点，难以被患者接受。与传统全口义齿相比，无牙颌种植覆盖义齿由种植体提供支持或辅助固位，可获得较好的稳固性和患者满意度，得以在临床广泛应用。然而，无牙颌种植覆盖义齿组成结构和修复设计复杂，受患者自身颌骨条件、修复空间和口腔卫生维护能力等因素的影响，在使用过程中易发生并发症。文章就无牙颌种植覆盖义齿修复设计中种植体数量、位置和附着体类型的选择及并发症做一阐述。     

微型种植体在无牙颌患者覆盖义齿修复中的初步应用

目的探讨微型种植体在无牙颌患者修复中的临床初步应用。方法2002年5至8月，为4例全身健康情况不良伴牙槽骨重度吸收的无牙颌患者植入14枚微型种植体，磁性固位体覆盖义齿修复。术前、术后即刻、术后每年评估种植体周围皮质骨高度及周围牙龈健康状况，检查修复体戴用情况，评估患者满意度。结果14枚种植体至今全部存留，未发生种植体周围炎，X线片检查显示：种植体周围皮质骨高度稳定。除1枚下颌种植体磁性基台折断，余无异常。全部患者对修复体满意。结论利用微型种植体为无牙颌且伴有牙槽骨吸收的患者行覆盖义齿修复是可行的。本组随访3年的临床效果满意，长期效果尚待进一步观察。     

无牙颌患者种植修复的体会

目的：探讨无牙颌种植覆盖义齿、种植固定义齿修复的临床疗效。方法：对34例单颌、全颌无牙颌患进行了种植修复。单颌无牙颌26例中10例进行了杆卡修复,5例球帽修复,2例磁性固位体修复,9例种植固定修复。全颌无牙颌8例中3例种植固定修复,3例杆卡修复,2例球帽修复。结果：经6～60个月的临床观察,256枚种植体中,除3枚种植体形成纤维愈合(1．17％)外,其余253枚种植体均形成了良好的骨性结合(98．83％),种植义齿功能较好,收到了满意的临床效果。结论：对于无牙颁的患,通过精心的设计、精巧的外科手术及合理的种植修复类型的选择,完成的种植修复体能有效地恢复咀嚼功能,并能使种植体长期稳固于口腔内行使功能。     

磁性附着体下颌种植覆盖义齿牙槽骨的三维光弹应力分析

目的：研究磁性附着体下颌种植覆盖义齿在各种咬合状态时下颌牙槽骨的应力分布。方法：选取标准无牙颌模型,在双侧尖牙区植入种植体,连接磁性附着体,翻制下颌环氧树脂模型,制作生物功能性全口义齿,分别在正中、前伸、侧向咬合时加载应力,冻结切片,观测各牙位应力条纹。结果：磁性附着体下颌种植覆盖义齿在正中、侧向、前伸咬合应力加载时种植体周围牙槽骨应力值最大,余留牙槽嵴后牙区所受应力大于前牙区。正中、前伸磨牙区最大应力值出现于颊侧,切牙区最大应力值出现于舌侧。侧向工作侧最大应力值出现于唇颊侧,平衡侧最大应力值出现于舌侧。结论：磁性附着体种植覆盖义齿各向咬合时,应力既分布到种植体,也分布到剩余牙槽嵴,可以明显降低种植体周围骨组织的受力,有利于种植体的健康。     

种植体支持球帽附着体固位下颌覆盖全口义齿的临床应用

目的:评价种植体支持球帽附着体固位的下颌覆盖全口义齿临床应用效果.方法:随机选择15例下颌无牙颌患者,每例植入2枚种植体,共植入30枚,随访观察1-12个月,从患者满意度、临床检查及种植体X线片观察修复效果.结果:种植体支持覆盖全口义齿修复下颌无牙颌,义齿固位和咀嚼功能满意率分别为100％和93.3％,义齿稳固,咀嚼功...     

无牙颌种植固定修复的并发症及风险防控

随着医学技术和社会经济的发展，无牙颌种植即刻固定修复已在临床上广泛应用。这一技术尽管存在着许多优点，然而同样也存在着广泛的机械、生物、美学及外科并发症。文章就无牙颌种植固定修复的并发症及相关因素进行探讨，并提出有效的风险防控措施，为无牙颌患者种植即刻固定修复及最终永久修复的合理设计、安全实施提供参考。     

Removable four implant-supported mandibular overdentures rigidly retained with telescopic crowns or milled bars: a 3-year prospective study

Purpose: The present study evaluated implant survival/success rate, peri‐implant parameters and prosthodontic maintenance efforts for four implant‐supported mandibular overdentures (IOD) rigidly retained on either milled bar or double crowns (telescopic) attachments. Material and methods: In a randomized prospective trial, 51 patients with edentulism received four mandibular interforaminal implants and complete maxillary dentures. For IOD, rigid denture stabilization was chosen randomly selecting 26 patients for milled bars (group I) and 25 patients for double (telescopic) crowns (group II). During a 3‐year follow‐up period, implant survival/success, peri‐implant parameters (marginal bone resorption, pocket depth, plaque‐, bleeding‐, gingival index [BI and GI], calculus) and prosthodontic maintenance efforts were evaluated and compared between both retention modalities used. Results: Forty‐five patients (23 group I, 22 group II) were available for a 3‐year follow‐up (dropout rate: 11.8%) presenting a high implant survival/success rate (100%). Peri‐implant marginal bone resorption, pocket depth as well as BI and GI did not differ for both rigid retention modalities. However, annually higher values for plaque‐ (NS) and calculus index (P<0.035) were noticed for the bar (group I) than for the telescopic crown (group II) attachments. Prevalence of prosthodontic maintenance did not differ between both retention modalities (group I: 0.41/maintenance efforts/year/patients vs. group II; 0.45 maintenance/efforts/year/patients). However, prosthodontic adaption for handling mechanism showed benefits for the bar retention. Conclusion: Rigid anchoring of IOD retained either by bar or telescopic attachments showed high implant success rates and minor prosthodontic maintenance efforts regardless of retention modalities used. Stable denture retention presented healthy peri‐implant structure for implants in bar and telescopic anchoring systems. Drawbacks such as higher plaque/calculus for bar retention and less favorable handling properties (output) for telescopic crown attachment leave the decision on the selection at the discretion of the clinician. To cite this article:
Krennmair G, Sütö D, Seemann R, Piehslinger E. Removable four implant‐supported mandibular overdentures rigidly retained with telescopic crowns or milled bars: a 3‐year prospective study.
Clin. Oral Impl. Res. 23 , 2012 481–488.
doi: 10.1111/j.1600‐0501.2011.02169.x     

无牙颌种植义齿修复方式探讨

种植体在无牙颌修复中的应用可显著改善义齿的修复效果，提高患者的满意度。为促进无牙颌种植修复技术的推广与合理应用，本文基于现有临床报道与基础研究结果，针对下颌无牙颌种植修复和上颌无牙颌种植修复两部分内容，就无牙颌种植修复中种植体数量与位置的选择、种植体上部结构的设计等问题进行探讨，目的在于为临床医生选择修复方案提供引导。     

Relative effectiveness of powered and manual toothbrushes in elderly patients with implant-supported mandibular overdentures

AIM: The aim of this study was to compare the clinical effectiveness of a powered toothbrush (Braun Oral-B Plaque Remover 3-D) and a manual soft toothbrush (Oral-B Squish-grip brush) for the control of supragingival plaque and soft tissue inflammation around implants supporting mandibular overdentures. MATERIAL AND METHODS: The study sample involved 40 edentulous subjects, aged 55-80 years, having 2 unsplinted mandibular implants supporting a complete removable overdenture opposed by a maxillary complete denture. In this single-blinded, randomised, cross-over clinical trial, two 6-week experimental phases were separated by a 2-week wash-out period. 2 weeks prior to each experimental phase (pre-entry visits), implant abutments were polished to remove all plaque and a standardised instruction in the use of the toothbrush was given. Modified plaque and bleeding indices were recorded at the start and end of each experimental period. Mean index scores at each phase were analysed using paired t-test, and the mean number of sites showing a change in plaque or mucositis were compared using the Mann-Whitney U-test. Combined data from 2 different implant systems were considered after controlling for implant type. RESULTS: Only minor changes in plaque and bleeding scores were observed following the two test periods. There were no statistically significant differences between the manual and powered toothbrushes. CONCLUSION: Manual and powered brushes were found to be of comparable efficacy with regard to improvement in peri-implant bleeding and plaque indices.     

部分牙缺失的即刻修复

为保证种植体初期稳定性,形成良好的骨整合,通常认为需在种植体植入后3-6月再延期修复。然而近年来,越来越多文献报道了牙列缺损即刻修复的病例,且取得良好的临床效果。但是,对牙列缺损的即刻修复尚存一些争议。本研究回顾近年文献同时结合本课题组的研究结果对牙列缺损即刻修复进行评估,并提出相关研究进展。     

下颌无牙颌种植后早期负重的临床研究

目的:探讨下颌无牙颌在种植后早期进行杆卡固位覆盖义齿修复的技术要点和临床效果。方法:8例下颌无牙颌患者,在双侧颏孔之间植入4颗种植体,术后即刻印模转移,1周内完成种植体支持的杆卡固位覆盖义齿修复,均于负重后1、3、6、12个月复诊,之后每12个月复诊一次,检查种植体的稳固性、种植体周龈组织状况,并拍摄X线片观察种植体骨吸收和骨结合状况。结果:8例共32颗种植体早期负重,追踪观察12~48个月,平均观察26个月,种植体无松动或脱落;种植体周龈组织健康;种植体周未见X线透射影;种植体周边缘骨吸收0.5~1.2mm,平均0.7mm;患者对修复效果满意。结论:下颌无牙颌患者,在双侧颏孔间植入4颗种植体,如种植体可获得足够的初始稳定性,即刻采用种植体支持的杆卡覆盖义齿修复是可行的,短期临床效果满意。     

Improvement and long-term stability of neuromuscular adaptation in implant-supported overdentures

Objectives: In edentulous patients, implant-supported overdentures can improve chewing efficiency and patient satisfaction, and even a positive impact on bone tissue preservation has been observed. The objective of this long-term study was to investigate whether kinesiographic and electromyographic (EMG) parameters would also benefit from implant placement and whether the status achieved would remain consistent over time.
Material and methods: The functional adaptability of the neuromuscular system in edentulous patients has been recorded in four different states of restoration: (1) insufficient old dentures, (2) new complete dentures, (3) implant-supported overdentures, and (4) implant-supported overdentures 10 years in use. In each state of restoration, the neuromuscular adaptation was assessed during masticatory activity on the basis of myodynamic parameters such as vertical opening, frontal extension and closing velocity. EMG parameters, i.e. Musculus masseter and Musculus temporalis activities were recorded simultaneously.
Results: The results revealed a general increase in the myodynamic and EMG-parameters. All of them clearly approached the values for normal dentate subjects and maintained this level over a period of 10 years. The significant changes between states 2 and 3 indicate that implant stabilization of dentures is accompanied by an immediate increase of the neuromuscular parameters.
Conclusions: In elderly edentulous patients, the treatment with two interforaminal implants provides evidence of neuromuscular adaptation towards values of healthy dentate. Thus, the known benefits of implant placement such as tissue perseverance and improved function are complemented by improved neuromuscular adaptation.     

Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible

Objectives: The purpose of this study was to evaluate the survival rate, success rate and primary complications associated with mandibular fixed implant‐supported rehabilitations with distal cantilevers over 5 years of function. Material and methods: In this prospective multi‐center trial, 45 fully edentulous patients were treated with implant‐supported mandibular hybrid prostheses with distal extension cantilevers. Data were collected at numerous time points, including but not limited to: implant placement, abutment placement, final prosthesis delivery, 3 months and 5 years post‐loading. Biological, implant and prosthetic parameters defining survival and success were evaluated for each implant including: sulcus bleeding ndex (SBI) at four sites per implant, width of facial and lingual keratinized gingiva (mm), peri‐implant mucosal level (mid‐facial from the top of the implant collar, measured in mm), modified plaque index (MPI) at four sites per implant, mobility and peri‐implant radiolucency. Survival was defined as implants or prostheses that did not need to be replaced. Success rate was defined as meeting well‐established criteria that were chosen to indicate healthy peri‐implant mucosa osseointegration, prostheses success and complications. Results: A total of 237 implants in 45 completely edentulous patients were included in the study. In each patient, four to six implants were placed to support hybrid prostheses with distal cantilevers. Cantilevers ranged in length from 6 to 21 mm, with an average length of 15.6 mm. The ages of the patients ranged from 34 to 78 with a mean age of 59.5 years. The survival rate of implants was 100% (237/237) and for prostheses 95.5% (43/45). The overall treatment success rate was calculated as 86.7% (39/45). Of the six patients that have not met the criteria for success, two patients required replacement of the entire prosthesis and four patients presented >four complications events. Conclusion: Fixed implant‐supported rehabilitation with distal cantilever resulted in a reliable treatment modality over the 5‐year observation period. Although biological parameters of MPI, SBI, keratinized tissue and peri‐implant mucosal levels showed statistically significant differences over time, the mean values for each patient remained within the normal limits of oral health. Complications were categorized as biological or technical. The majority of complications were technical complications (54/79) and of these most involved fracture of the acrylic teeth and base (20/54). While the survival rate was 100% for implants and 95.5% for prostheses, the application of strict criteria for treatment success resulted in an overall treatment success rate of 86.7%.