老龄患者的口腔种植治疗

随着材料和技术的进步,现代口腔种植学得到了快速的发展。种植牙已成为恢复缺失牙的首选治疗方式。尽管在健康成人中,种植牙已经取得了很高的成功率,但对于老龄患者,随着身体机能的下降和伴发其他系统性疾病,种植治疗的风险相应地增加。老龄患者在进行种植治疗时应该考虑哪些影响因素以及如何预防可能的风险和并发症,应引起口腔种植医生的高度重视。本文对老龄患者口腔种植治疗的特殊性、种植成功率、老年患者的全身系统疾病考量和用药考量等方面进行探讨,以供临床参考。     

Oral implant treatment for elderly patients

随着材料和技术的进步,现代口腔种植学得到了快速的发展。种植牙已成为恢复缺失牙的首选治疗方式。尽管在健康成人中,种植牙已经取得了很高的成功率,但对于老龄患者,随着身体机能的下降和伴发其他系统性疾病,种植治疗的风险相应地增加。老龄患者在进行种植治疗时应该考虑哪些影响因素以及如何预防可能的风险和并发症,应引起口腔种植医生的高度重视。本文对老龄患者口腔种植治疗的特殊性、种植成功率、老年患者的全身系统疾病考量和用药考量等方面进行探讨,以供临床参考。     

牙周病骨量不足患者的种植修复

牙周病是人类最常见的口腔疾病之一,在我国成人牙周病患病率达70%,是造成牙列缺损及牙列缺失的主要原因。随着口腔种植临床技术的不断进步,其在牙周病造成缺失牙患者治疗中应用渐趋广泛。由于牙周病患者种植条件的特殊性及牙周致病菌造成的种植术后风险增高,都增加了牙周病患者种植的难度。     

牙周病患者种植修复

牙周病就是牙齿周围组织的疾病.牙周病发展的最终结果会造成牙齿的脱落.在其它缺失牙修复方式不能适用于牙周病患者时,种植修复为牙周病患者带来了效果更好的修复方案.但由于牙周病的发展容易影响到种植体的愈合及长期效果,因此必须进行完善的牙周治疗及维护,严格掌握牙周病患者进行种植牙修复的适应症和种植时机.在种植修复完成后必须坚持按时复诊并进行牙周维护及种植体维护.牙周病患者种植治疗前后给与足够的重视,也可以达到良好的临床效果.     

颌骨放疗区种植修复及其并发症防治的研究进展

手术结合放射治疗是口腔颌面部肿瘤的常规治疗手段。近年来,越来越多的患者选择种植牙修复口腔颌面部术后缺失的牙齿。种植体与周围骨组织形成良好的骨结合是种植牙成功的关键。然而,放疗后颌骨组织会遭受一定的损伤,影响种植体的骨结合成功率,增加并发症的风险。该文就颌骨放疗区种植修复及其并发症防治的研究进展作一综述。     

抗栓药物对骨整合的影响

随着口腔种植技术的发展,越来越多的抗栓治疗患者选择种植牙修复口内缺失牙齿.而种植牙成功的关键在于种植体与周围骨组织之间形成良好的骨整合.抗栓药物(如华法林、肝素、阿司匹林、肝素等)对种植牙骨整合的利弊逐渐引起口腔医生的关注,下面针对这一问题作一综述.     

人工种植牙修复下颌切牙缺失风险评估

目的:规避下颌切牙缺失采用人工种植牙修复的失败风险.方法:收集1998-2008年对下颌切牙缺失采用人工种植牙治疗的病例,并对骨劈开、植骨、骨牵引手术方式及即刻与延期种植时机等临床诸多因素进行风险评估分析.结果:临床上对于下颌切牙缺失采用人工种植牙修复是可行的,但失败率高于其他区域.讨论:本研究对下颌切牙缺失采用人工种植牙修复失败率高分析如下;采用了常规直径种植体、与固有牙槽骨宽度、牙缺失时间、牙龈牙周等口腔环境密切相关.由于下颌切牙缺失后所表现最明显的特征就是牙槽骨量不足,因此,对下颌切牙牙种植常常需要其他辅助手术增加了种植失败率.结论:对下颌切牙区牙进行牙种植前风险评估,可以最大程度规避牙种植的失败风险.     

人工种植牙的临床应用

目的：运用人工种植牙技术对牙缺失患者进行口腔修复。方法：运用CDIC钛种植体口腔内牙缺失区骨内种植,3－6月后作种植义齿修复,临床观察3－5年。结论：人工种植牙技术临床应用效果好,使用方便。     

即刻种植牙的研究进展

即刻种植牙已成为口腔种植学界研究的热点,与传统种植技术相比,即刻种植牙缩短了治疗时间,减少了手术次数,能更好的保存牙槽嵴宽度和高度,更有效的维持牙齿或牙列缺失部位的美学形态,种植成功率与传统种植牙成功率统计学分析没有显著性差异。本文就即刻种植的微创拔牙技术,种植体形态选择,骨缺损的处理,牙龈生物类型选择,软组织的闭合作一综述。     

老年口腔牙列缺损患者微创种植围手术期的护理

目的：探讨老年口腔牙列缺失患者微创种植牙的围手术期护理方法。方法：对2010年1月至2012年10月间在解放军总医院口腔种植科行微创种植手术的患者115例进行回顾性分析,总结老年微创种植牙的围手术护理方法。结果：全部患者在种植手术过程中生命体征平稳,种植体植入顺利患者感觉良好,种植体存活率达94.01％,术后未出现种植体周围炎等并发症,患者基本能按要求维护种植体。结论：口腔种植围手术期良好的护理是种植牙手术成功的关键因素之一,细致精心的口腔护理可提高种植体存活率,促进患者顺利康复。     

248例牙周病伴糖尿病患者的种植义齿治疗

目的：通过牙周病伴糖尿病失牙患者种植义齿修复综合治疗的长期观察,了解糖尿病患者接受种植治疗后可能产生的效果以及探讨实施种植义齿修复的风险和处理对策。材料和方法：本中心统计了2000至2008年间在所属医疗机构接受种植义齿治疗的1240例牙周病患者（平均每人缺牙超过3枚）,其中确诊为II型糖尿病的患者有248例,共植入牙种植体1190枚（CDIC 857枚,Replace 333枚）,约占牙周病患者总数的20%;男性136例,女性112例;最低年龄28岁,最高年龄93岁,平均53岁。该类型患者种植治疗前的空腹血糖水平最高者为12.3mmol/L;最低为6.3mmol/L;平均水平8.3mmol/L;种植术前控制血糖平均水平≤7.4mmol/L。术前对患者局部骨量水平进行检测评估,全部病例符合牙种植手术最基本要求,酌情采用即刻种植和延期种植两种手术方式;选用CDIC和Replace两个牙种植体系统;种植术式基本采用不翻瓣和骨膨胀的微创植入术;义齿修复时间选择在术后6个月进行;种植术前和术后针对患者具体情况给予控制高血糖可能导致风险的相应对策和补充措施。结果：本次研究病例统计为1-8年的在院治疗病例,其中种植义齿修复前（术后6个月时间内）植体脱落数量有6枚（约5‰）,术后1年存留率为98.4%、5年存留率为95.4%、8年存留率为89.4%,保存种植体及种植义齿使用最长时间〉96月,最短时间1月。患者空腹血糖水平控制平稳,均无较大波动。患者对种植义齿修复的满意度较高。讨论：国内外学者的研究表明,糖尿病的高发病率是直接导致牙周病患者增加和失牙率升高的重要因素之一。在牙列缺损或缺失的患者中,同时伴有糖尿病的患者其缺牙情况较单纯因龋病或根尖周病而致的牙列缺损或缺失情况为多、牙槽骨吸收严重、余留天然牙条件较差、传统固定桥和活动义齿修复困难等特点。从牙周病伴糖尿病患者（Ⅱ型糖尿病）的义齿修复治疗方式选择而言,有效控制其血糖水平在一个相对稳定或接近正常范围时,口腔及牙槽骨等局部条件允许,是可以采用种植义齿修复治疗,非绝对禁忌。长期的临床观察也表明,植入体可以达到与未患糖尿病患者相似的骨结合水平。本中心针对牙周病伴糖尿病的失牙患者,采用了血糖水平监测控制、即刻种植或即刻修复的风险控制、抗生素应用的控制、修复时间的控制、不良生活习惯风险的控制以及定期口腔及种植义齿的保健维护等多种风险综合控制措施,确保了该类患者种植义齿的较好应用。结论：在严格掌控适应症的选择和风险控制的情况下,牙周病伴（Ⅱ型）糖尿病患者也能像正常牙缺失患者一样享有接受种植治疗的机会。     

牙周病伴2型糖尿病248例种植义齿治疗总结

目的 探讨牙周病伴2型糖尿病患者实施种植义齿治疗的风险和处理对策.方法 回顾分析2000至2008年在成都华西牙种植医院、华西口腔深圳门诊部、华西口腔重庆门诊部接受种植义齿治疗的248例牙周病伴2型糖尿病患者,以种植体存留率为评价指标,对数据进行统计分析.结果 248例患者选用Nobel Replace和CDIC两个种植系统,采用不翻瓣和骨膨胀的微创植入术,共植入牙种植体1190枚(Nobel Replace 333枚、CDIC 857枚).6枚(0.5％)种植体在术后6个月愈合期内脱落,术后1年种植体存留率为98.4％ (1165/1184)、5年存留率为95.3％ (487/511)、8年存留率为89.2％ (91/102).结论 严格掌握适应证和控制风险的情况下,牙周病伴2型糖尿病患者种植修复可获得较高的满意度.     

Combined periodontal and implant treatment of a case of aggressive periodontitis

Aggressive periodontitis renders a great challenge to clinicians with regards to treatment and prosthodontic rehabilitation. A compromised remaining dentition and a tendency toward refractory disease make it difficult to establish a treatment plan that renders an adequate long-term prognosis. Although the use of implants has become a common treatment modality, limited data are available on the use of dental implants in patients with aggressive periodontitis, especially for cases necessitating the use grafting procedures preceding implant placement. In this case report the successful treatment of a patient with aggressive periodontitis by the combined use of periodontal and implant treatment necessitating preceding augmentive procedures is described.     

Understanding peri-implantitis: a strategic review

The high survival rate of osseointegrated dental implants is well documented, but it is becoming increasingly clear that successfully integrated implants are susceptible to disease conditions that may lead to loss of the implant. Although placement and restoration usually are included in the domain of the periodontal, oral and maxillofacial surgery, or prosthetic specialist, given the increasing numbers of patients treated with osseointegrated fixtures, it is increasingly likely that maintenance of these implants by the general dentist will become much more common. However, the surrounding tissues may be subject to inflammatory conditions similar to periodontal disease and so require maintenance. This article discusses the background, cause, and diagnosis of peri-implant disease, as well as the maintenance, care, and treatment of peri-implant infection in osseointegrated implants.     

Clinical follow-up of unilateral, fixed dental prosthesis on maxillary implants

Aims/Background: The aims of the present study were to evaluate (1) the success rate of unilateral maxillary fixed dental prosthesis (FDPs) on implants in patients at a periodontal clinic referred for periodontal treatment, (2) the prevalence of varying mechanical and biological complications and (3) effects of potential risk factors on the success rate. Material and methods: Fifty consecutive patients were invited to participate in a follow‐up. The patients had received FDPs on implants between November 2000 and December 2003 after treatment to achieve optimal peridontal health, and the FDPs had been in function for at least 3 years. A questionnaire was sent to the patients before the follow‐up examination. Forty‐six patients with 116 implants were examined. The follow‐up comprised clinical and radiographic examinations and evaluations of treatment outcome. Results: Before implant treatment, 13% of the teeth were extracted; of these, 80% were extracted due to periodontal disease. No implants had been lost before implant loading. One implant in one patient fractured after 3 years of functional loading and three implants in another patient after 6.5 years. The most frequent mechanical complications were veneer fractures and loose bridge screws. Patients with peri‐implant mucositis had significantly more bleeding on probing around teeth and implants. Patients with peri‐implantitis at the follow‐up had more deep periodontal pockets around their remaining teeth compared with individuals without peri‐implantitis, but these differences were not significant. Smokers had significantly fewer teeth, more periodontal pockets ≥4 mm and a tendency towards greater marginal bone loss at the follow‐up, compared with non‐smokers. Conclusion: In the short term, overloading and bruxism seem more hazardous for implant treatment, compared with a history of periodontitis. To cite this article:
Wahlström M, Sagulin G‐B, Jansson LE. Clinical follow‐up of unilateral, fixed dental prosthesis on maxillary implants
Clin. Oral Impl. Res. 21 , 2010; 1294–1300.
doi: 10.1111/j.1600‐0501.2010.01948.x     

In the dental implant era,why do we still bother saving teeth?

Teeth are vital sensory organs that contribute to our daily activities of living. Unfortunately, teeth can be lost for several reasons including trauma, caries, and periodontal disease. Although dental trauma injuries and caries are more frequently encountered in a younger population, tooth loss because of periodontal disease occurs in the older population. In the dental implant era, the trend sometimes seems to be to extract compromised teeth and replace them with dental implants. However, the long‐term prognosis of teeth might not be comparable with the prognosis of dental implants. Complications, failures, and diseases such as peri‐implantitis are not uncommon, and, despite popular belief, implants are not 99% successful. Other treatment options that aim to save compromised or diseased teeth such as endodontic treatment, periodontal treatment, intentional replantation, and autotransplantation should be considered on an individual basis. These treatments have competing success rates to dental implants but, more importantly, retain the natural tooth in the dentition for a longer period of time. These options are important to discuss in detail during treatment planning with patients in order to clarify any misconceptions about teeth and dental implants. In the event a tooth does have to be extracted, procedures such as decoronation and orthodontic extrusion might be useful to preserve hard and soft tissues for future dental implant placement. Regardless of the treatment modality, it is critical that strict maintenance and follow‐up protocols are implemented and that treatment planning is ethically responsible and evidence based.     

Reliability of periodontal diagnostic tools for monitoring peri‐implant health and disease

The prevalence, causes and consequences of crestal bone loss at dental implants are a matter of debate. In recent years, a high prevalence of peri‐implant soft‐tissue inflammation, associated with peri‐implant bone loss, has been reported and the need for treatments similar to those offered for natural teeth affected by periodontitis has been proposed. This suggestion is based on the assumption that periodontal indices, such as probing pocket depth and bleeding on probing, are reliable indicators of the peri‐implant tissue conditions and good predictors of future bone loss. However, based on a critical review of the literature in the present paper, it is concluded that periodontal indices are not reliable either for identifying peri‐implant disease or for predicting future risk for peri‐implant crestal bone loss and implant failure. The long‐term experiences with dental implants, presented in the literature, indicate that the presence of bleeding on probing, probing pocket depths much larger than 4 mm and some bone loss seem to reflect, in most instances, normal conditions of well‐functioning dental implants, bearing in mind that healing of dental implants is the result of a foreign body reaction with the formation of scar tissue. Therefore, the use of probing pocket depth and bleeding on probing assessments may lead to over‐diagnosis and possibly to over‐treatment of assumed biofilm‐mediated peri‐implantitis lesions. It is the opinion of the authors of this review that a treatment should only be initiated when a clinical problem is present based on patient's symptoms (discomfort, pain), the presence of swelling, redness and pus, and significant crestal bone loss over time (as verified with radiographs). The treatment should aim at resolving the infection, which could include removal of the implant.     

Hierarchical decisions on teeth vs. implants in the periodontitis-susceptible patient: the modern dilemma

It is estimated that advanced periodontitis typically affects about 10% of most adult populations studied. These individuals can be considered highly susceptible to periodontitis and often present difficulties for clinicians in therapeutic decision making, especially when dental implants are involved. Poor plaque control and smoking are well established risk factors for periodontitis, as well as for peri-implant disease. Long-term follow-up studies have clearly demonstrated that treatment of periodontal disease, even if advanced, can be successful in arresting disease progression and preventing (or at least significantly delaying) tooth loss. With the increasing development of implant dentistry, traditional well documented and evidence-based therapies to treat periodontal diseases may sometimes not be used to their full potential. Instead, there appears to be an increasing tendency to extract periodontally compromised teeth and replace them with implants, as if implants can solve the problem. However, peri-implant diseases are prevalent, affecting between 28% and 56% of people with implants, and (at the implant level) 12-43% of implants. A history of periodontal disease, smoking and poor oral hygiene are all risk factors for developing peri-implantitis. Unlike periodontitis, there are currently no predictable means for treating peri-implantitis, although resective surgery seems to be the most effective technique. Consequently, if implant treatment is considered in patients who are susceptible to periodontitis, it should be preceded by appropriate and adequate periodontal treatment or re-treatment to control the condition, and should be followed by a stringent supportive maintenance program to prevent the development of peri-implant disease. The decision whether implant treatment should be performed should be based on an assessment of the patient's risk profileat the subject level, as well as at the site level.     

Implant maintenance for the prevention of biological complications: Are you ready for the next challenge?

With increasing knowledge of wound biology and material sciences, the provision of dental implants as a treatment modality has become increasingly predictable and more commonly used to replace missing teeth. However, without appropriate follow up, peri‐implant diseases could develop and affect the long‐term success of implants. Currently, there is not enough focus on the prevention of peri‐implant diseases, as compared to the definition of the disease, its prevalence, and treatment. In the present study, we aim to summarize various factors influencing the successful maintenance of dental implants and highlight current gaps in knowledge. Factors influencing the successful maintenance of dental implants can be divided into three categories: implant‐, dentist‐, and patient‐related factors. Patients with dental implants are often more dentally aware, and this offers an advantage. Compared to gingiva, peri‐implant mucosa responds at a different pace to the bacterial challenge. Dental practitioners should be aware of how treatment protocols affect long‐term success, and be vigilant in detecting peri‐implant diseases at an early stage. Compared to periodontal maintenance, less longitudinal studies on implant maintenance are available, and therefore, there is a tendency to rely heavily on information extrapolated from the periodontal literature. More studies on the significance of implant maintenance care are required.     

Osteopathology induced by bisphosphonates and dental implants: clinical observations

Objectives

Although there are many reports about risk factors for the development of BP-associated osteonecrosis of the jaws, the role of dental implants as a local risk factor is still discussed, especially in patients with oral BP treatment. Until now, a few case reports and surveys display a possible minor risk in patients with oral BP therapy, whereas the avoidance of implant placement is generally accepted in patients with intravenous BP therapy.

Patient and methods

In this study, the cases of 14 patients with osteonecrosis of the jaws in association with BP therapy and dental implant placement were analyzed carefully with a detailed literature review.

Results

Of 14 patients, nine had underlying malignant disease and five patients had osteoporosis. In ten patients, implants were placed either in the posterior mandible or maxilla; the mean interval between implant insertion and disease onset was 20.9 months. Pain (n12) and signs of infection (n10) were the most common symptoms. Histologically, signs of infection were found in nine of 11 analyzed patients with presence of Actinomyces in six patients. Two patients turned out to have infiltration of underlying malignant disease.

Conclusions

Posteriorly placed implants seem to be of higher risk of development of osteonecrosis of the jaws. Not only the implant placement but also the inserted implant itself seems to be a continuous risk factor.

Clinical relevance

The herein elaborated risk factors help dentists plan dental rehabilitation with implants in this high-risk group of patients and indicate careful and regular dental recall.