异体脱细胞真皮基质修复犬即刻种植软组织创口的实验研究

目的：评价异体脱细胞真皮基质（ADM）修复犬即刻种植软组织创面的效果。方法：选取成年杂种犬6只,全麻后拔除双侧下颌第四前磨牙,立即植入12枚BLB种植体。应用ADM修复即刻种植后软组织缺损创面。术后3个月行二期手术,2周后行烤瓷冠修复并功能负荷1个月。术后观察种植体骨结合、ADM修复创面的愈合情况,并制作种植体-牙槽骨-牙龈切磨片进行组织学观察。结果：术后所有创面完全封闭愈合,种植体周围软组织解剖形态无明显改变;种植体颈部软组织形成了类似天然牙结合上皮的形态。结论：ADM取材广泛,具有良好的即刻种植创面封闭作用,且能增加软组织量,修复美学效果好;种植体周围软组织能形成类似天然牙的结合上皮。     

非血管化骨移植种植体以及即刻种植体与软组织结合的实验观察

目的:观察非血管化骨移植种植以及即刻种植体钛金属表面与软组织的结合状况,分析影响二者结合的因素。方法:拔除狗的一侧下颌前磨牙,4周后截除无牙下颌骨段,自体非血管化髂骨移植同时植入纯钛种植体修复下颌骨缺损。对照组动物拔除一侧下颌前磨牙时同期在牙槽窝内植入同样的种植体,缝合牙龈。在术后4、8、16周处死动物,以40g/L中性多聚甲醛灌注固定后,取种植体颈部周围软组织。肉眼观察2组动物种植体与周围软组织结合的紧密程度;HE染色观察结合上皮的组织结构;透射电镜观察结合上皮与种植体结合面细胞超微结构。结果:2组动物在术后4周时,种植体顶端已出龈暴露在口腔内,颈部周围的软组织已达初步封闭;两者的结合还较疏松,软组织较薄,细胞膜的表面突起较少。术后8周时,种植体的颈部软组织已完全封闭,软组织与钛表面结合紧密,即刻种植组动物可见明显的结合上皮;超微结构可见结合上皮有较多的细胞膜突起。术后16周,2组的结果与8周时相似。整个实验过程未发现桥粒结构的形成。结论:在没有明显创伤和感染的情况下,两者均可形成良好的结合;即刻种植体与周围软组织结合较非血管化骨移植种植体更致密。2种种植方法结合上皮与钛表面都不能形成桥粒结构。     

微创拔牙即刻种植的牙龈美学效果观察

目的探讨微创拔牙即刻种植技术的临床特点及修复后的牙龈美学效果。方法21例上前牙单个缺失病例，行不翻瓣微创拔牙同期23颗种植体即刻植入，并且同期安装愈合基台直接暴露于口腔，即非埋入式种植术式，种植体愈合6个月后进行永久修复。种植永久修复后观察时间平均27．6个月（13～51个月）。根据Jemt牙龈乳头指数（papilla index score，PIS）观察种植体永久修复12个月后的近远中牙龈乳头状况，根据Flirhauser的改良红色美学指数观察种植体永久修复1年后与相邻天然牙唇侧龈缘位置的协调性；唇侧软组织与相邻天然牙唇侧牙龈色泽协调性。结果23颗种植体均获得良好的骨结合；种植修复体近远中PIS均为Ⅱ级以上。种植修复体与相邻天然牙唇侧牙龈缘水平位置协调性一致的15颗，8颗不协调；唇侧软组织色泽与相邻天然牙协调一致的18个牙位，5个牙位有轻度差异。结论微创拔牙即刻种植术是一项要求较高的技术，多因素影响软组织美学效果，严格掌控适应证，才能获得理想修复效果。     

即刻种植联合组织清理术对犬种植体周围软组织形态的影响

目的:探讨即刻种植联合组织清理术对种植体周围软组织形态的影响。方法:选择21只成年杂种犬,建立动物模型,行即刻种植。根据不同手术方式,将其分为唇侧黏骨膜瓣滑行组、自体游离龈瓣移植组、异种脱细胞真皮基质移植组,3个月后进行烤瓷冠修复。修复后1个月处死动物,切取标本,观察3组种植体周围软组织的形态变化。采用SPSS20.0软件包对数据进行t检验。结果:3组种植体周围软组织愈合情况均呈现良好水平,其中,唇侧黏骨膜滑行组修复效果较其余2组差,主要与生理解剖结构被破坏有关。自体游离龈瓣移植组及异种脱细胞真皮基质移植组一次手术关闭创面,减少愈合负担,并对周围软组织形态不良影响较少。3组种植体龈沟探诊深度在修复前、后无显著差异;修复1个月后,3组牙龈指数均显著高于修复术前（P<0.05）,其中唇侧黏骨膜瓣滑行组附着龈宽度比修复术前显著减少（P<0.05）。结论:即刻种植联合周围组织清理技术对于周围软组织修复具有积极作用,能够取得明显的种植美学修复效果。     

牙种植体即刻种植骨愈合过程的组织学观察

目的：了解即刻种植体的骨愈合过程，验证即刻种植的可行性。方法：在１２只犬下颌前磨牙新鲜拔牙创内立即植入纯钛牙种植体，通过组织学光镜和扫描电镜观察术后２、４、６、８、１２周种植体周围骨缺损修复过程和种植体骨结合形成情况。结果：骨缺损区内血块首先机化，而后沿牙槽窝骨壁向中心方向逐渐骨化形成新骨。小于１ｍｍ骨缺损１２周内可完全修复，种植体骨结合形成；１ｍｍ以上骨缺损则不能完全修复。结论：即刻种植体周围骨缺损的修复和骨结合形成类似于拔牙创的愈合，大于１ｍｍ的骨缺损应争取植骨。     

前牙美学区即刻种植即刻美学修复的临床观察

目的：探讨前牙关学区即刻种植即刻美学修复的临床特点及修复后的美学效果。方法：18例患者22枚m和Replace种植体前牙区即刻种植即刻临时冠修复,对种植体成功率及周围牙龈附着状况进行观察,6个月后永久冠修复。结果：1枚种植体在愈合期内脱落,其余种植体在修复后12个月时均有骨结合,临床效果良好。结论：前牙美学区即刻种植即刻美学修复时多因素可影响种植体的成功率及软组织美学效果,严格掌控适应证,才能获得理想的美学效果。     

种植体生物学宽度的研究进展

种植体生物学宽度(BW)是种植体软组织愈合的基础,也是种植体软组织美学的关键.BW是指种植体或天然牙牙槽嵴顶的结合上皮和结缔组织形成的固定宽度的空间,是一种生物学封闭,这种生物学封闭可以将种植体与口腔环境隔绝,保护种植体周围骨组织,从而维持种植体的稳定.本文就BW的概念、天然牙冠延长与BW的关系、种植体与天然牙在BW上...     

根尖周感染患牙即刻种植的临床疗效观察

目的：评价根尖周感染患牙拔除后即刻种植术的临床治疗效果,探讨初期稳定性在即刻种植的重要性。方法：48例患者（男27例,女21例,年龄47.1±1.9岁）,56颗根尖周感染患牙拔除后即刻种植。修复后随访1年,观察种植体稳定性、种植体周围炎及X线变化,对临床疗效进行评价。结果：56颗种植体,1颗由于邻牙根尖周感染形成脓肿,2个月后造成种植体脱落,1颗因术中发现患牙拔除后无可用的种植骨量,充填骨粉后放弃即刻种植,其余病例临床愈合良好,可正常行使功能,1年后随访,临床治疗效果良好,成功率96.4%,种植体周围骨吸收（0.41±0.22）mm。结论：在获得良好的初期稳定性的前提下,炎症期拔牙后即刻种植可以获得满意的临床疗效。     

口腔种植学

20062524纯钛种植体表面多孔结构的制备与分析；20062525上颌窦底植骨种植效果的回顾性研究；20062526非血管化骨移植种植体以及即刻种植体与软组织结合的实验观察；20062527种植义齿固定螺丝封闭后微渗漏的定量测定／焦艳军；20062528牙种植体结合上皮形成中表皮生长园子受体表达；20062529下颌无牙颌种植后早期负重的临床研究。[编者按]     

单个前牙种植体即刻种植和即刻修复的牙龈美学效果评价

目的:评价种植体即刻种植即刻修复的牙龈美学效果及患者对美观的满意度.方法:观察28例患者28枚ITI种植体在单个前牙种植体即刻种植即刻临时冠修复,对种植义齿周围的牙龈美观状况及相应的软组织健康状况进行观察,并对患者满意度进行调查,托槽弓丝固定3个月,6个月后行永久烤瓷冠修复.结果:12个月时所有种植体都发生了骨结合现象,种植义齿周围的软组织外形正常,牙问乳头外形大小与菌斑附着,龈炎并不相关.患者对即刻种植修复的美学效果均非常满意.结论:在严格掌握适应证的前提下,单个前牙即刻种植修复比延期修复可获得更佳的软组织外形,尤其是牙间乳头外形大小达到更理想的美学效果.     

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目的观察脱细胞真皮基质（ADM）修复颊部软组织缺损的疗效。方法选择2010年11月至2012年11月在安徽医科大学附属口腔医院就诊的颊部软组织缺损患者38例,其中20例应用异种ADM治疗,18例应用异体ADM治疗。随访6个月,观察患者缺损修复治疗效果,并对2种ADM在组织相容性、引导组织再生及补片成活情况等方面进行临床效果评价。结果应用异种ADM修复的患者,修复膜完全成活18例,大部成活2例,修复区表面颜色多为粉红色,质地柔软,瘢痕轻微;应用异体ADM修复的患者,修复膜完全成活17例,1例患者术后补片与创缘边缘有约0.8cm脱离区,补片与基底组织面贴合,补片色泽呈红色,愈合尚可。38例患者均未出现明显局部或全身反应,进食基本不受影响,无明显异物感,张口度未见明显改变。结论异种及异体ADM对颊部软组织缺损的修复效果均较为满意。     

Esthetic soft tissue ridge augmentation around dental implant: Case report

The aim of this case report is to present a method to correct soft tissue ridge deformity around dental implant using acellular dermal matrix (ADM). A 25-year-old female patient presented with a missing maxillary first left premolar, which had class I soft tissue defect. The missing tooth was replaced with single implant supported prosthesis and the soft tissue defect was corrected using ADM utilizing the envelop technique. A 5-years follow-up is presented showing the long-term stability of this technique and the predictability of using the ADM as an alternative method to connective tissue graft to correct the soft tissue defect around dental implant.     

A novel surgical procedure for coronally repositioning of the buccal implant mucosa using acellular dermal matrix: a case report

Background: This case report describes a surgical procedure for coronally advancing the peri‐implant mucosa to treat a soft tissue dehiscence in a single‐tooth implant‐supported restoration in combination with an acellular dermal matrix graft. Methods: The patient was a 41‐year‐old systemically healthy, non‐smoking female. Her chief complaint pertained to the unesthetic appearance of her right lateral upper incisor, caused by recession of the mucosal margin. On examination, a 3‐mm recession could be observed. The periodontium was classified as thin. A 2‐mm band of keratinized peri‐implant mucosa was present. Keratinized gingiva was approximately 6 mm at adjacent areas. The surgical technique included a novel incision design to coronally position the flap over an acellular dermal matrix graft. Results: Partial coverage of the recession was achieved. After a 6‐month period, tissues appeared thicker than preoperatively, with no bleeding on probing and no probing depth >2 mm. The patient was satisfied with the overall treatment result. Conclusions: This case report shows the possibility of achieving partial soft tissue coverage over an implant‐supported restoration with the combined use of an acellular dermal matrix and a coronally positioned flap. A novel technique is presented that allowed advancing the flap over the graft in a single‐tooth restoration where enough keratinized tissue was present preoperatively.     

Soft tissue ridge augmentation with an acellular dermal matrix

The goal of this case report was to evaluate the use of an acellular dermal matrix for soft tissue ridge augmentation. The technique used was a modification of the procedure proposed by Langer and Calagna and involved reflecting a partial-thickness pedicle, placing an acellular dermal matrix, and covering the acellular dermal matrix with the pedicle. The increases in the quantity of tissue obtained were adequate to permit placing an esthetic fixed restoration in four of the five cases treated. In one of the five cases, the acellular dermal matrix became exposed and partially sloughed. This resulted in less of an increase in tissue than in the other cases. Histologic evaluation of this case showed that the entire acellular dermal matrix did not slough; part of the acellular dermal matrix was incorporated into the result. The use of an acellular dermal matrix for soft tissue ridge augmentation is a clinically valuable technique.     

异种脱细胞真皮基质修复骨引导再生术后软组织缺损的临床观察

目的：观察异种脱细胞真皮基质在骨引导再生术中充当屏障膜并直接修复术后软组织不足的临床效果及对引导骨再生的影响。方法：选择在中山大学附属口腔医院种植科要求种植修复治疗,但因种植区牙槽嵴萎缩,宽度不足而需先行骨引导再生术的患者7例（其中女性5例,男性2例,平均34岁）,术中用脱细胞真皮基质覆盖骨引导再生区域,并直接修补创面软组织不足,临床观察脱细胞真皮基质愈合情况。通过影像学和临床检查评价新生的引导再生骨。结果：术后2周可见创面生物膜有部分降解,骨移植材料表面有薄层胶原基质覆盖;术后3周,创面开始有少量牙龈上皮覆盖;术后4周,牙龈上皮覆盖全部创面,与周围牙龈融合。术后1年,牙种植手术中见再生骨质量好,缺牙区牙槽嵴宽度明显增宽。影像学检查显示,随愈合时间延长,骨粉颗粒高密度影像逐渐消失,与周围正常骨质间界限不清。结论：脱细胞真皮基质充当骨引导生物膜并同时修复骨增量术后软组织不足的临床效果满意。     

Acellular dermal matrix graft as a membrane for guided bone regeneration: a case report

Guided bone regeneration has been successfully used to treat several types of bone defects. Problems associated with the procedure, such as premature exposure of the membranes to the oral cavity and, consequently, contamination, may occur. The acellular dermal matrix graft material is presently used to treat several soft tissue problems. It could be used for guided bone regeneration with the advantage of forming soft tissue while acting as a barrier membrane. A patient in need of guided bone regeneration for the staged placement of an implant was treated by using the acellular dermal matrix graft material as a barrier membrane. Healing progressed uneventfully with the formation of adequate new bone and an increase in the width of keratinized tissue.     

腭侧结缔组织瓣与脱细胞真皮基质移植扩增种植体唇侧组织的效果比较

目的:比较腭黏膜下结缔组织瓣和异体脱细胞真皮基质(ADM)移植丰满种植区唇侧软组织的效果。方法:22例上前牙区单牙缺失患者,伴缺牙区唇侧牙槽外形凹陷。其中12例行牙种植术同期腭黏膜下结缔组织瓣移植术,10例行牙种植术同期种植区唇侧骨膜下ADM膜覆盖。分别于种植术前,术后2周、3个月、6个月、12个月通过石膏模型分析2组种植区牙槽嵴水平宽度的变化。采用SAS6.12软件包对2组实验数据进行t检验,以确定不同时期2组结果是否有显著性差异。结果:随访期内,2组种植体存留率为100%,种植术后2周及术后3、6、12个月腭黏膜下结缔组织瓣移植组及ADM移植组的牙槽嵴宽度较种植术前均有显著差异(P<0.05);术后各时间段2组牙槽嵴水平宽度扩增量无显著性差异(P>0.05)。结论:腭侧黏膜下结缔组织瓣移植、ADM膜骨膜下移植均能明显改善种植区唇侧丰满度,且扩增水平相近。     

颌面部皮肤黏膜缺损应用异种脱细胞真皮基质的修复效果

目的：评价异种脱细胞真皮基质修复颌面部皮肤及口腔黏膜缺损的临床疗效。方法：选择32例因外伤、口腔肿瘤和癌前病变、前庭沟加深术而导致皮肤黏膜缺损病例,以异种脱细胞真皮基质修复组织缺损,并跟踪随访患者,观察修复后的创面愈合情况。结果：所有的异种脱细胞真皮基质均完全成活,修复效果满意。结论：异种脱细胞真皮基质可作为修复颌面部皮肤黏膜缺损的一种良好材料。     

Hard and soft tissue augmentation in implant therapy using acellular dermal matrix

The use of acellular dermal matrix to correct soft and hard tissue defects involving implants is described through three case reports. Correction of a ridge deformity caused by a root fracture, submerging of an existing implant and correction of recession defects around adjacent teeth, and ridge preservation for implant placement are presented. The use of acellular dermal matrix prevented the need for a second surgical site for donor material and the possible attendant postoperative complications. It also enhanced patient comfort and satisfaction with the procedure. All three cases demonstrated excellent functional and esthetic results for both the patients and professionals involved in the therapy.