非埋入式种植体早期软组织贴合与边缘骨吸收的临床研究

目的:比较非埋入式种植体术后第1个月与术后第2、3两个月边缘骨吸收及1个月时骨吸收与软组织早期贴合的关系.方法:非埋入式ITI系统种植体植入33名患者口内.种植术后及1个月、3个月拍摄曲面断层片.测量术后第1个月及第2、3两个月种植体边缘骨的变化量.10 d时观察种植体周软组织贴合情况.结果:术后第1个月与第2、3两个月的骨吸收具有显著性差异(P< 0. 01);第1个月时骨的吸收量与10 d时种植体周软组织贴合不良呈正相关(r=0.794,P<0. 01).结论:种植体植入后第1个月边缘骨吸收量最多,且种植体周软组织贴合情况对1个月时种植体周边缘骨的吸收量有影响,生物学封闭是影响骨吸收的关键因素.     

闭合式上颌窦内提升的临床研究及评价

目的评价行上颌窦内提升术植骨后同期植入种植体修复上磨牙缺失的临床疗效。方法对2006年以来在我院行上磨牙缺失上颌窦内提升术同期植入牙种植体的28例患者共计54枚种植体进行为期1～4年观察随访。结果术后3枚种植体在二期修复前松动,观察期内种植体存留率为96.11%,3枚种植体再植均获得得良好的骨整合效果。54枚种植体均在术后6～12个月成功负载,功能行使良好。术中未发生上颌窦穿孔。牙槽嵴骨高度平均提升4.18mm。随访期内未发现种植体或上部结构松动。结论上颌窦内提升术创伤较小,操作简单,效果肯定,值得在垂直骨量相对不足的上颌后牙区推广。     

BEGO种植体术后短期效果观察

目的观察评价BEGO种植系统种植术后1、3个月的短期临床效果。方法20例患者共计植入种植体20枚,术后1、3个月定期随访,检查患者口腔卫生情况,通过探诊种植体周龈沟观察种植体周软组织情况,拍摄X线全景片检查种植体周硬组织变化,评价种植体术后短期临床效果。结果术后1、3个月,20例种植体周围牙槽骨吸收平均值分别为0．32mm、0．47mm,各有1例出现牙龈炎,经局部处理后炎症得以控制,未出现种植体脱落。结论采用BEGO种植系统修复的患者,术后软组织炎症出现少,边缘骨吸收在正常范围内,短期稳定性较好。     

利用上颌窦底壁骨嵴和骨突进行种植体植入的方法研究

目的研究并评价将种植体尖端安全准确植入上颌窦底壁骨嵴和骨突内的方法。方法 8例上颌后牙缺失、可用骨高度不足种植义齿修复需要的患者,其中男5例,女3例,年龄46.4±12.8岁,经CT扫描三维重建确定每例患者缺牙间隙上方均伴有上颌窦底壁骨嵴和骨突,并且这些骨嵴和骨突符合基底部宽度大于5mm、近中或远中斜面与上颌窦底壁夹角小于70°的纳入标准。利用快速成型技术制造缺牙区树脂模型,实施模型手术将种植体尖端准确定位在骨嵴和骨突内,制作手术导板,并完成患者口内的种植导航手术。术后即刻CT扫描分析种植体尖端与骨嵴和骨突的关系,观察上颌窦底黏膜是否完整。结果种植体植入位置与模型手术相符,8颗种植体尖端2~5mm部分成功进入上颌窦底壁骨嵴和骨突内,并在骨嵴的近中斜面或远中斜面突破骨皮质,种植体尖端部分一侧位于上颌窦底壁骨嵴内,一侧位于上颌窦腔黏膜下方。种植体初期稳定性好,上颌窦底黏膜完整。结论上颌窦底壁骨嵴和骨突能为上颌后牙缺失骨量不足的患者提供必要的可用骨高度,从而获得足够的种植体稳定性。要将种植体尖端准确安全地植入到骨嵴和骨突内,需要CT扫描三维重建进行骨嵴和骨突的选择及准确定位、模型手术和手术导板制作、导板辅助的种植手术、上颌窦底开孔钻的使用等步骤的严密配合。     

非负荷期牙种植体近远中牙槽骨吸收的数字全景X片观察与分析

目的：评价和分析非负荷期种植体周围牙槽骨的吸收情况。方法：观测、分析、对比32例植入43枚Replace系统种植体在术后3～4个月非负荷期间的数字全景X片上种植体近远中牙槽吸收的情况。结果：43枚Replace种植体植入后3～4个月近远中骨吸收测量结果分别为0．09mm和0．12mm，两者之间无明显差异（P〉0．05）。结论：数字全景X片显示非负荷期种植体周围牙槽骨有吸收并且种植体近远中牙槽吸收无明显差异。     

翼上颌区穿翼种植体入路分析

目的 基于对103例锥体束电子计算机断层扫描(CBCT)影像数据进行分析,观察穿翼种植体合适的植体长度和在三维方向上的最佳植入角度。方法 选取103例上颌后牙区骨萎缩患者,对每位患者的CBCT影像进行个性化解剖测量,随后选择合适长度的种植体模拟植入,分别测量相对于眶耳平面种植体在矢状方向和冠状方向的角度。结果基于此次分析,翼上颌区种植体以选择≥15 mm的种植体为最佳。相对于眶耳平面种植体矢状面的平均植入角度为(61. 57±4. 21)°;冠状面的平均植入角度为(80. 68±2. 89)°。结论 充分利用翼上颌区的骨量,使种植体获得良好的初期稳定性,在行翼上颌区种植手术时,尽量选择植入长度≥15mm的种植体;相对于眶耳平面,种植体在矢状面的植入角度约为61°,冠状面的植入角度约为80°。     

数字曲面体层X片在评价非负荷期种植体周围骨吸收的临床应用

目的:评价数字曲面体层X片在测量非负荷期种植体周围牙槽骨吸收的应用情况。方法:观测、分析对比26例患者50枚Camlog系统种植体临床应用非负荷期间数字化曲面体层X片和X线牙片上种植体周围牙槽骨吸收的情况。结果:50枚Camlog种植体植入后10 d,两种X片骨吸收测量结果分别为0.65 mm、0.81 mm,两者之间无明显差异;第4个月(或6月\下颌)分别为0.12 mm、0.19 mm,两者之间无明显差异。结论:本研究显示数字化曲面体层X片在测量非负荷期种植体周围牙槽骨吸收的应用中有操作简单、重复性好、精确度高、变形可补偿等优点,有实际应用价值,值得推广。     

ITI种植系统用于后牙游离端缺失修复中的疗效评价

目的评价ITI种植体用于后牙游离端缺失修复中的临床疗效。方法后牙游离端缺失采用种植义齿修复的56例共227个种植体。其中即刻种植4例,上颌窦内提升术9例。3～6个月后行上部结构修复。定期随访种植牙的探诊深度、种植体骨结合状况、种植体的骨丧失水平。结果经过1～4年的随访观察,227颗种植体无一松动脱落,均未发生神经损伤和感觉异常。种植体稳定,未见其周围有X线透视区。种植体周围组织健康,种植体龈沟探诊深度为(2.93±0.37)mm;术后1年的骨丧失水平均值为(0.92±0.62)mm,1年后的平均每年骨吸收均<0.2 mm。病人对舒适度、美观性和咀嚼效率评价良好。结论 采用ITI种植系统对后牙游离端缺失进行修复,操作简单,临床效果好。     

即刻种植与拔牙窝愈合初期种植的效果比较

 目的 比较即刻种植与初期种植的种植体存留率与种植后5年边缘骨吸收的情况,为选择种植时机提供参考。方法 选择拔牙后即刻种植和拔牙后两周内行牙种植(初期种植)的患者58例,共计75颗种植体,其中初期种植的27颗植体为A组,即刻种植的48颗植体为B组,分别于术后即刻、1、3、6、12个月,以后每12个月拍摄X线片,随访5年及以上种植体存留情况,测量植体近远中牙槽嵴顶骨吸收的程度。用SPSS21.0统计软件,对寿命表法计算的两组成功率和存留率进行χ²检验,近远中骨吸收值进行两独立样本t检验。结果 A组种植体成功率79.25%,存留率100%;B组种植体在种植后1~9个月内5颗脱落,成功率76.47%,存留率89.47%,在种植体成功率方面,两者差异无统计学意义;在存留率方面,两者差异具有统计学意义。此外,术后即刻、随访5年近中牙槽嵴高度差值比较,A组为(1.16±0.32) mm,B组为(1.39±0.41) mm,P=0.216;远中牙槽嵴高度差值A组为(0.96±0.39) mm,B组为(1.05±0.52) mm,P=0.302;统计学分析显示,在种植术后5年,初期种植与即刻种植在近远中牙槽嵴改变值方面无统计学差异。结论 在拔牙窝愈合的初期(7~14 d)行种植体的植入,是可行的种植手术时机。     

白细胞介素-1对种植体术后早期边缘骨吸收的影响

临床发现,种植体颈部位置对美观及牙龈健康有重要作用.种植后的骨吸收主要发生在种植术后1个月内.早期边缘骨吸收,可导致种植体颈部暴露,严重影响美观,并影响牙龈的自洁及增加菌斑附着,不利于牙龈组织的健康及种植体长期稳定.     

Annual bone loss and success rates of dental implants based on radiographic measurements

Objectives:

Bone loss around dental implants is generally measured by monitoring changes in marginal bone level using radiographs. After the first year of implantation, an implant should have <0.2 mm annual loss of marginal bone level to satisfy the criteria of success. However, the process of measuring marginal bone level on radiographs has a precision of 0.2 mm (or more) owing to variations in exposure geometry, exposure time and observer perception. Therefore, the value of the annual loss may vary considerably, especially when short intervals are considered. This study investigates how the success rate of dental implants depends on the way annual bone loss is calculated.

Methods:

Panoramic radiographs of 82 implant patients with an average follow-up of 10.4 years were analysed. Marginal bone levels near the implants were indicated by one observer. The annual loss of marginal bone level was determined according to four different calculation methods.

Results:

The methods yielded success rates of 9%, 45%, 81% and 89%.

Conclusions:

The success rate of dental implants measured on radiographs greatly depends on the details of the calculation method. Without rigorous standardization, annual bone loss and implant success rate are not well defined.     

Digital subtraction radiography evaluation of longitudinal bone density changes around immediate loading implants: a pilot study

Objective

The aim of this study was to assess longitudinal quantitative changes in bone density around different implant loading protocols and implant surfaces measured by digital subtraction radiography (DSR).

Methods

12 patients received bilateral homologous standard and TiUnite® (Nobel Biocare, Kloten, Switzerland) single-tooth implants under 2 implant—loading protocols: immediate loading (8 patients, 16 implants, 12 maxillary) and conventional loading (4 patients, 8 implants, 4 maxillary). Standardized periapical radiographs were taken immediately after implant placement (baseline image) and at the 3-month, 6-month and 12-month follow ups. Radiographic images were digitized and submitted to digital subtraction using the DSR system® (Electro Medical System, Nyon, Switzerland), resulting in three subtracted images. Quantitative analysis of bone density was performed using Image Tool® software (University of Texas Health Science Centre, San Antonio, TX) to assess pixel value changes in five areas around the implants (crestal, subcrestal, medial third, apical–lateral and apical).

Results

Repeated-measures analysis of variance showed that grey levels were significantly influenced by follow-up time and implant-loading protocol. A linear increase in grey levels was found for immediate loading (IML) implants and a significant decrease in grey levels was observed in the 12-month follow up for conventional loading implants. No effect of implant surface treatment was observed.

Conclusion

In conclusion, IML protocol induced mineral bone gain around single-tooth implants after the first year under function for cases with favourable bone conditions.     

Radionuclide imaging in oral implantations. Personal experience in maxillary sinus elevation

PURPOSE: Presently nuclear medicine techniques are not very popular in oral implantology, but they can play an interesting role in this surgical field too. In particular bone scan with 99mTc-MDP allows to evaluate the function of oral implants and the survival of bone grafts. We report our experience with skull bone scan in maxillary sinus lifting. MATERIAL AND METHODS: We performed a three-year follow-up on 13 patients treated with inlay-one stage uni- or bilateral sinus lifting with a mixture composed of 90% bovine bone powder and of 10% small bone splinters and autogenous fibrin glue. We performed imaging studies and quantitated implant MDP uptake from the mean values at the surgical site to the 5th neck vertebral ratio (M/V index). The M/V index was also statistically compared with the one measured in 13 patients with severe resorption of distal upper dental arches (bone height less than 0.5 cm) and in 63 patients with normal dental status. Scintigraphic data were interpreted in the light of clinical, radiological and histologic findings. RESULTS: All oral implants appeared to be fixed and radiographs showed good positioning and bone adhesion; bone height exceeded 1 cm. Peri implant biopsy material was formed by normal mature bone tissue without bovine bone granules, necrotic areas and inflammatory cells. The highest bone activity (M/V index: 1.54-2.57) was observed 1-4 months after sinus lifting. Then MDP uptake decreases and 18 months after surgery radionuclide uptake in maxillary arches is homogeneous, with M/V values of 0.81-0.88. The average M/V value in the 18 surgical sites was clearly higher than in the resorbed (1.44 vs 0.64; Kruskall-Wallis ANOVA test; Dunn's method; p < 0.05) and normal (1.44 vs 0.73; p < 0.05) maxillary arches. DISCUSSION AND CONCLUSIONS: 99mTc-MDP can show the transformation of newformed into mature bone and then allows in vivo visualization of implant osteointegration. The importance of our work lies in the use of radionuclide imaging to assess both the function of oral implants inserted by a complex surgical technique and the expected bioactive properties of the filling mixture. Nevertheless the strong active autogenous compounds do not permit to detect the real agent of local bone induction. An interesting finding is that implant stability is biologically gained 18 months after intervention and that the uptake index facilitates comparison of sequential scans and confirmation of local bone growth. Therefore high MDP uptake by the implant 2-3 years after surgery can suggest mechanical or septic bone injury which can lead to implant failure if not treated promptly. In conclusion we believe that quantitative bone scan is a valid diagnostic tool in the follow-up of oral implants inserted with sinus lifting, though our experience needs confirmation on larger series and new research is warranted to understand the real mechanisms of assisted bone regeneration.     

数字化及3D打印技术结合非血管化髂骨修复外伤性上颌骨前牙区骨缺损的疗效

目的 探讨数字化及3D打印技术结合非血管化髂骨修复外伤性上颌骨前牙区骨缺损的疗效.方法 采用回顾性病例系列研究分析2013年6月至2018年1月郑州大学第一附属医院收治的8例外伤性上颌骨前牙区严重骨缺损患者临床资料,其中男6例,女2例;年龄18～43岁[(31.9 ±9.0)岁].术前均采用数字化技术对上颌骨进行重建,...     

不翻瓣技术在上颌前牙区种植中的应用效果

 目的 探讨不翻瓣技术在上颌前牙区种植中的应用效果。方法 选取2018年4-10月在武警北京总队医院进行上颌前牙区种植的32例患者,随机分为不翻瓣组(采用不翻瓣技术种植)和翻瓣组(采用翻瓣技术),每组16例。比较两组手术情况和种植手术后的效果;种植后3和6个月进行随访,比较种植体周围牙槽骨骨吸收程度。结果 不翻瓣组的手术时间(18.87±4.34)min,翻瓣组的手术时间为(37.27±5.35)min,两组差异有统计学意义(P<0.05);不翻瓣组的术后肿痛时间和抗生素应用时间分别为(0.85±0.33)d和(1.84±0.75)d,翻瓣组的术后肿痛时间和抗生素应用时间分别为(2.61±0.74)d和(4.22±1.36)d,两组对比差异均有统计学意义(P<0.05)。不翻瓣组种植后3个月和6个月时的种植体周围牙槽骨吸收分别为(0.29±0.05)mm和(0.36±0.07)mm,翻瓣组种植后3个月和6个月分别为(0.55±0.06)mm和(0.65±0.05)mm,两组差异有统计学意义(P<0.05)。结论 口腔种植采用不翻瓣技术,能缩短手术时间和手术后肿痛时间,减少抗生素使用,降低牙槽骨吸收。     

骨劈开术在口腔种植骨增量中的应用

目的探讨种植区骨量不足患者行骨劈开增量,并同期植入种植体的临床效果。方法 18例种植区骨量不足,牙槽嵴高度充足但厚度仅3～5 mm的患者。行骨劈开术并同期植入ITI种植体,直径3.3～4.1 mm,共计24枚,18例均采用固定修复。结果 24枚种植体均形成良好的骨结合,负载12～24个月,无一种植体失败,功能和美学效果满意。结论上颌牙槽嵴骨宽度为3～5 mm时,采用骨劈开术能有效增加骨量并可同期植入种植体,获得满意的临床疗效。