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目的评价前牙区牙槽骨水平宽度不足的患者联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入的临床效果。方法 2004—2009年福州市第一医院口腔科就诊的前牙区牙缺失伴前牙区牙槽骨水平宽度不足的种植患者28例,联合应用骨劈开、骨挤压,填入骨粉,行骨引导再生术后同期植入40颗种植体,术后4～6个月内完成上部修复。术后1年,通过临床检查、全景片等观察效果。结果术前、后牙槽骨平均宽度分别为(3.2±0.89)mm、(6.5±0.75)mm,平均增加了(3.3±0.34)mm。术后牙槽骨宽度与术前相比,差异有统计意义(t=2.47,P<0.05)。术后无明显并发症发生,种植体行使功能良好,仅1例患者的1颗牙种植失败,种植近期成功率达97.5%。结论对前牙区牙槽骨水平宽度不足的患者,联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入,可增加骨量,获得种植体的同期植入,减少患者痛苦,改善种植修复的临床效果。     

口腔种植成骨材料的研究现状及进展

随着口腔种植技术的快速发展，种植修复已逐渐成为牙列缺损和牙列缺失患者的首选治疗方案。种植区牙槽骨骨量充足是种植修复成功的前提条件及关键因素。然而，临床上种植区牙槽骨骨量不足十分常见，影响种植修复体的功能发挥、美学效果及远期疗效。口腔植骨材料配合骨增量手术是目前临床常用重建缺失骨组织，使其骨量满足种植要求的方法之一。口腔植骨材料的自身特性如生物相容性、骨传导、骨诱导及骨生成等性能对植骨成功率具有至关重要的影响。该文从植骨材料的性能、分类及临床运用三个方面重点介绍口腔种植成骨材料的研究现状及最新进展，以期为成骨材料的临床选择及种植修复成功率的提高提供理论指导。     

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由于种植体生物相容性的不断改良和完善,目前的牙种植体均能获得理想的可预期的骨结合,在新拔除患牙的牙槽窝内即刻植入种植体已经成为一种常规的术式拔牙后即刻种植可有利于减少外科手术次数,有利于牙槽嵴骨量的保存,降低治疗费用并减少缺牙时间,更易被患者接受.但由其解剖生理因素决定,牙槽嵴在牙缺失后通常要出现唇侧骨板的吸收萎缩,这常导致种植体唇面暴露,出现美学上的问题.即刻种植的同时,在充分理解和使用引导骨再生原理的基础上配合骨增量材料的应用才能获得理想的修复效果,本文就我们的临床体会结合文献进行了分析讨论.     

两种自体骨粉末修复种植体周围骨缺损的临床研究

目的：评价自体骨夹层法修复种植体周围骨缺损的近期临床效果。方法：48例患者共82颗种植体,植入的种植体唇侧骨壁缺损,其余三个骨壁都存在,随机分为两组：一组为混合法,22例患者39颗种植体,自体骨粉与Bio-Oss骨粉按1：1比例混合修复骨缺损部位。另一组为夹层法,26例患者43颗种植体,局部微量刮取自体骨粉涂于暴露的种植体表面,再覆盖Bio-Oss骨粉,再覆盖生物膜。植入6个月后行上部修复。修复后追踪时间平均24个月。根据临床、X线检查和患者主诉评价修复效果。结果：两组均无种植体脱落,存留率100%,二者差异无统计学意义。其龈袋深度、出血指数、年累计骨吸收量及X线检查均无明显不同。结论：对于骨缺损的病例,采用自体骨夹层法可以应用于临床。近期效果良好,长期效果有待追踪。     

带种植体骨磨片的标准化制作

目的：探讨带种植体骨磨片的标准化制作流程，为进行人工种植体相关研究提供病理实验依据。方法：回顾自1998年以来制作的850张带种植体骨磨片，按照塑料包埋前、包埋、粘结、切片、研磨、染色等几大步骤，对磨片进行评价。以（1）种植体完整，种植体长轴与组织面平行且在同一平面上；（2）组织经脱水处理包埋聚合后组织内无气泡；（3）组织与载物片粘贴紧密无气泡；（4）镜下观察磨片组织内无金属碎屑，种植体无脱落；（5）染色均匀，新生骨组织区分明显等5个方面作为标准化制作流程的评价指标，且5个指标需同时达标才能认为磨片制作成功。结果：对照5项指标对850张磨片进行回访式检查，早期因制作经验以及方法不当等原因，合格率约为50％，后经改进工艺与提高技术水平，2000年后所制作磨片的成功率提高到85％。结论：通过改进方法，规范化操作，选择适宜的染色方法，可以提高种植体骨磨片制作的成功率，扩大带种植体骨组织的研究范围。     

EH型复合人工骨材料动物体内植入研究

ＥＨ型复合人工骨材料在人白鼠及大白兔体内种植，结果表明，该材料具有优良的生物相容性，对肌肉组织不引起反应，与骨组织能构成骨性结合，是一种较理想的骨缺损修复材料。     

Anatomic site evaluation of the zygomatic bone for dental implant placement

Thirty human zygomatic bone specimens (15 females mean age 81.60 +/- 11.38 years, 15 males, mean age 78.47 +/- 6.58 years) were examined by quantitative computed tomography and histomorphometry. The aim of the study was to assess the bone mineral density, the trabecular bone volume and the trabecular bone pattern factor. Moreover, the anterior-posterior and the medio-lateral dimensions and the estimated implant length within the zygomatic bone were determined. For quantitative computed tomography the specimens were scanned together with a bone mimicking anthropomorphic reference phantom. The bone mineral density was calculated for the specimens in the plane of the intended direction of the implant placement. Subsequently, with the sawing and grinding technique, the specimens were prepared in the same plane for histomorphometry. The trabecular bone mineral density was 369.95 +/- 188.80 mg/cm3 for the female and 398.94 +/- 99.11 mg/cm3 for the male specimens (P = 0.23). The male trabecular bone volume showed a value of 27.32 +/- 9.49%, while the female group reached a value of 19.99 +/- 7.60% (P = 0.23). The trabecular bone pattern factor was 1.2 x 10-2 +/- 1.28 mm-1 for the male and 1.02 +/- 0.96 mm-1 for the female specimens (P = 0.045). The study reveals that the zygomatic bone consists of trabecular bone with parameters that are unfavourable for implant placement. However, the success of implants placed in the zygomatic bone is secured by the employment of at least four cortical portions.     

血浆基质在口腔种植水平骨增量中的应用

牙齿缺失伴随着牙槽骨吸收或缺损,导致骨量和软组织量不足。种植治疗除恢复缺失牙的咀嚼功能外,还需恢复牙弓的轮廓和外形,引导骨再生术是骨增量的常用手段。异种颗粒状骨替代材料因其降解时间长、免疫反应低等优点,在临床水平骨增量领域应用广泛,但存在操作不便、成骨活性低等问题。血浆基质能有效提高口腔组织再生效果、减少术后并发症的出现,在口腔组织再生中的应用逐渐增多。本文首先介绍了血浆基质在水平骨增量中的主要应用形式(固态血浆基质膜、血浆基质骨块),并根据临床常用的骨增量决策方案,即是否能够在理想位置植入种植体以及植入后是否存在骨开裂对水平骨缺损进行重新分类,其中Ⅰ类水平骨缺损为缺牙位点骨量可供植入理想尺寸的种植体,且种植体周围无骨开裂,但牙槽骨轮廓比非缺牙区凹陷的情况;Ⅱ类水平骨缺损为缺牙位点骨量根据未来修复体位置确定的种植位点植入理想尺寸种植体后,种植体三侧均有骨,但颊侧骨壁存在骨开裂(骨开裂长度小于种植体长度的50%)的情况;Ⅲ类水平骨缺损为缺牙位点骨量不足以在理想位置植入理想尺寸的种植体,需要先行植骨恢复骨量以利于种植体植入的情况。本文随后对血浆基质在不同水平骨缺损类型中的应用方法进行阐述:...     

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。     

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze-dried demineralized bone matrix.

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration (GBR) and implantation of xenogeneic freeze-dried demineralized bone matrix (xDBM). A total of 16 titanium plasma-sprayed (TPS) and 16 hydroxyapatite-coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR + xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR + xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR + xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR + xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.     

Performance of six bone collectors designed for dental implant surgery

OBJECTIVES: The aim of this study was to perform an in vitro comparison of six bone collectors for harvesting of particulate bone. MATERIAL AND METHODS: Four commercially available bone collectors (Frios, Osseous Coagulum Trap, ACE Autografter, Bone Trap) and two custom-designed models were tested. Three different in vitro tests were performed to determine the harvesting capabilities of the collectors. In test I, a bovine mandible was drilled and the bone collectors were used to collect bone chips. The harvested bone volumes and dry weights were measured after harvesting. In test II, three dental implant sites were prepared in a bovine mandible. The bones from the implant osteotomies were collected, and bone volumes and dry weights were measured. In test III, 1 ml of bone chips was mixed with water, and suctioned through the bone collectors. The volumes of the bone chips retained were measured to determine the efficiency of each collector. RESULTS: The Osseous Coagulum Trap and the custom-made collectors were the most effective instruments in test I. The mean volumes ranged from 0.17 to 0.38 ml. In test II, the difference between the collectors was small and the bone volume ranged from 0.28 to 0.37 ml. In test III, the Bone Trap became blocked before the other collectors, and its bone procurement was therefore limited. CONCLUSION: Comparison of six different bone collectors in this in vitro study showed that all collectors are usable in clinical situations but their effectiveness varies.     

口腔种植体植入后骨吸收水平的临床研究

目的：观察种植体植入后牙槽骨吸收情况,分析不同种植体以及种植体植入不同时间骨吸收速度。方法：收集1998年至2013年潍坊市人民医院牙科种植中心接受ITI、 DIO、奥齿泰以及BLB种植体种植的病例,均对其在植入后即刻、1个月、3个月、6个月、12个月拍摄口腔曲面断层片,测量种植体周围骨吸收水平,并运用SPSS21.0进行统计分析。结果：不同种植体之间的骨吸收速度无统计学差异（P＆gt;0.05）;种植体植入后1个月与3个月之间,3个月与6个月之间,1个月与12个月之间的种植体周围骨吸收速度有非常显著性意义（P＆lt;0.01）结论：不同种植体骨吸收速度无差异,种植体植入1个月,6个月时周围骨吸收速率最大。     

Optimal implant stabilization in low density bone

Initial stability of the implant is one of the fundamental criteria for obtaining osseointegration. An adequate primary anchorage is often difficult to achieve in low density bone (type IV). Various surgical suggestions were advanced in the 1980s which were aimed at achieving optimal osseous integration in poor quality bone. They offered satisfactory short-term results. Recently, as a result of surgical and technological innovations, new therapeutic proposals have shown very interesting results in their initial studies.     

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze‐dried demineralized bone matrix

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration(GBR) and implantation of xenogeneic freeze‐dried demineralized bone matrix (xDBM). A total of 16 titanium plasma‐sprayed (TPS) and 16 hydroxyapatite‐coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR+xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR+xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR+xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR+xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.