牙槽嵴扩张技术在上颌牙种植中的临床应用

目的　评价牙槽嵴扩张技术在上颌牙种植中的应用效果。方法　对49例牙槽嵴骨量不足的上颌牙种植采用骨扩张器Condenser进行牙槽嵴扩张。根椐不同的缺牙位置,植入与天然牙根直径相当的种植体,以满足患者功能与美学的需要。结果　在49例患者牙槽嵴骨量不足的缺牙区,植入了86枚种植体。术前患者上颌前牙区牙槽嵴宽度平均为3~5·1 mm,术后牙槽嵴宽度平均增加3·3~5·4 mm;术前上颌后牙区,牙槽骨高度平均为6~ 10 mm,术后牙槽骨高度平均增加2~7 mm;种植体均获得初始稳定性;术后6月,X线片显示种植体与牙槽骨形成了紧密的骨性结合骨,种植体植入6个月后进行2期修复。结论　ERE技术适用于上颌牙槽骨扩张,可达到功能与美学的要求,方法简单,值得临床推广。     

牙槽突骨挤压扩张同期种植的临床观测

目的：观测牙槽突骨挤压扩张同期种植的方法处理骨宽度不足病例的近期临床效果。方法：对56名牙槽突颊舌向骨宽度不足的患者行牙槽突骨挤压扩张同期种植的方法,植入ITI种植体61颗。术后3个月行上部冠修复。在术后即刻,术后3个月,6个月,12个月行临床检查和X线检查,观测种植体临床存活率和种植体颈部边缘骨的变化。结果：使用该方法的种植体存留率为100%,经X线检查种植体颈部边缘骨水平无明显吸收。结论：运用牙槽突骨挤压扩张同期种植的方法处理牙槽突颊舌向骨宽度不足的病例,操作简单,手术创伤小,近期可以取得较理想的临床效果,远期效果有待进一步观测。     

Split crest to enlarge horizontal dimension of alveolar ridge. an overview of techniques and case demonstration

Restoration of the edentulous alveolar ridge with dental implants often requires the ridge width to be augmented in order to allow its placement. Technique of splitting the alveolar ridge aimed to enlarge its horizontal dimension is achieved by using different osseous surgical tools to allow simultaneous or staged placement of dental implants. Treatment of the thin alveolar ridge can be carried out predictably using ridge expansion technique. Good esthetic and functional outcomes can be achieved predictably as long as the surgical principles and protocols are followed carefully. A short literature overview of split crest techniques and a case presentation is included in this article.     

Surgical correction of the atrophic alveolar ridge. A preliminary report on a new concept of treatment.

Inferior repositioning of the atrophic maxillary edentulous alveolar ridge by LeFort I osteotomy and simulataneous bone grafting, and superior repositioning of the atrophic mandibular edentulous ridge by horizontal osteotomy of the mandibular body and simultaneous bone grafting have been accomplished successfully. These two new surgical procedures add a new dimension to treatment of severe atrophy of the alveolar ridges in edentulous or partially edentulous patients.     

A modified ridge Expansion technique in the maxilla

Localized ridge expansion of a deficient edentulous maxillary alveolar ridge segment is a useful technique when the goal of surgery is to provide an increase in ridge width as a means of establishing an adequate alveolar crest capable of receiving endosseous implants. The purpose of this article is to describe several modifications to the original ridge-splitting technique for deficient maxillary ridges. These modifications include full-thickness flap reflection, elimination of vertical intraosseous incisions, and simultaneous incorporation of guided bone regeneration. The modifications help to decrease complications associated with the original ridge-splitting technique while increasing the predictability of ridge augmentation in the buccal-palatal dimension. A case is presented that demonstrates the efficacy of the modified technique.     

Relationship between size of denture foundation area and resorption of alveolar ridge in the edentulous mandible

summary The relationship between the size of the denture foundation area and the resorption of the alveolar ridge was investigated in 55 edentulous subjects. The denture foundation area was recorded using a modelling compound impression technique with border moulding. Both sides of each edentulous mandible were examined separately, making a total of 110 experimental sides in the study. On a stone cast made from each impression, the size of the superficial denture foundation area and of the projected denture foundation area on the tentative plane of occlusion of each anatomical zone were measured. The vertical height of the alveolar ridge at the lateral incisor and first molar region was also evaluated. The size of the superficial denture foundation area in the antero-lingual and postero-lingual zones showed no significant correlation with the degree of alveolar ridge resorption. The size of the projected denture foundation area on the tentative plane of occlusion in the anterior section showed negative significant correlation with the degree of alveolar ridge resorption. The size of the projected denture foundation area on the tentative plane of occlusion in the posterior section showed no significant correlation with the degree of alveolar ridge resorption.     

金属支架单套冠在牙槽嵴重度萎缩无牙颌种植固定修复中的应用

金属支架单套冠作为一种新型种植固定义齿修复技术具有独特优势。本文报道了1例牙槽嵴重度萎缩无牙颌的金属支架单套冠种植固定修复病例,修复效果良好。金属支架单套冠种植固定修复技术能有效解决牙槽嵴重度萎缩和种植修复体唇颊侧螺丝孔暴露问题,兼顾了功能与美观。     

A maxillary ridge-splitting technique followed by immediate placement of implants: a case report

Maxillary alveolar atrophy often limits the placement of dental implants. This article reports on a refinement of a technique for widening the atrophic ridge by splitting the alveolar bone longitudinally. Treatment of a patient with a severely resorbed edentulous maxilla is described. Six 4-mm wide by 13-mm long threaded Osseotite implants were placed immediately within the split ridge and surrounded with a mixture of autogenous tuberosity and bovine bone. The advantages of this technique for patients include less surgical trauma and condensed treatment time.     

Clinical assessment of 40 patients subjected to alveolar distraction osteogenesis

Alveolar bone distraction is a technique used to restore vertical defects in the edentulous alveolar ridge. The gradual growth of bone tissue has a predictable result, allowing the placement of an osseointegrated implant in an ideal position. In this study, the effectiveness of the alveolar distraction technique was verified, using an extraosseous device. The bone augmentation average was 9.5 mm in 40 patients, showing a 92.5% success rate.     

Operator agreement in the use of a descriptive index of edentulous alveolar ridge form

CAWOOD & HOWELL have proposed a classification of the anatomical form of the residual alveolar processes of edentulous patients. The purpose of this study was to test observer agreement in the clinical assessment of edentulous alveolar ridge form using this classification. This was tested in a pilot study involving 57 edentulous patients, and subsequently in a study of 557 edentulous patients. High levels of observer agreement were found when using this classification for upper and lower edentulous alveolar ridges, suggesting that the classification may be useful as a research tool.     

种植磁附着体在全口义齿修复中的临床应用

目的　探讨种植磁附着体全口义齿对下颌牙槽嵴重度吸收的无牙颌患者的修复效果。方法　采用CDIC 牙种植体及配套磁性附着体,为8例下颌牙槽嵴重度吸收的无牙颌患者在下颌两侧第一前磨牙区各植入1枚种植 体,5个月后制作下颌全口义齿并在组织面粘固磁体。对粘固磁体前、后及粘固磁体后6个月的义齿固位力、咀嚼 效率和最大咬合力进行测试。结果　种植磁附着体全口义齿在粘固磁体后及粘固后6个月的固位力、咀嚼效率、 最大咬合力均较放置磁体前明显提高,其差异具有统计学意义(P<0·01)。结论　对牙槽嵴重度吸收的无牙颌患 者,采用种植磁附着体全口义齿修复能显著提高义齿的固位力、咀嚼效率及最大咬合力。     

Expression of endothelial adhesion molecules in the alveolar ridge mucosa,gingiva and periimplant mucosa

OBJECTIVES: The purpose of this study was to analyze the expression of adhesion molecules on endothelial cells in the alveolar ridge mucosa, the gingiva and the periimplant mucosa in humans. MATERIAL AND METHODS: Twelve partially edentulous subjects were included in the study. In each subject, one soft tissue biopsy was harvested from the edentulous alveolar ridge mucosa, one from a tooth site and one from an implant site. After 3 weeks of undisturbed plaque accumulation, an additional biopsy was obtained from one tooth and one implant site in each subject. The tissue samples were snap frozen and prepared for immunohistochemical analysis. RESULTS: In the alveolar ridge mucosa, smaller proportions of endothelial cells expressing ICAM-1, ELAM-1 and VCAM-1 were observed than in the gingiva. ELAM-1-positive cells occurred in lower numbers than in periimplant mucosa. After 21 days of plaque accumulation, ELAM-1 was increased in tooth sites, but decreased in periimplant mucosa. CONCLUSION: The results of the present study indicated that the proportions of activated endothelial cells and the extravasation of leukocytes is larger in gingiva and periimplant mucosa than in alveolar ridge mucosa. This might be due to the less permeable keratinized epithelial layer in the edentulous ridge mucosa, which offers proper protection against microbial pathogens. The greater expression of endothelial cell adhesion molecules during experimental gingivitis, compared to periimplant mucositis, may reflect its longer history of repeated antigenic assaults.     

Ridge augmentation with dense hydroxylapatite/resorbable suture matrix

The atrophic edentulous ridge represents one of the greatest challenges faced in general practice. An estimated 20 million adults in the U.S. are edentulous in at least one arch and a significant number of these patients experience problems with their prostheses from alveolar bone loss. Many of these patients, for various reasons, are not candidates for endosseous dental implants. Alveolar ridge augmentation is a viable option in many of these cases; however, this procedure has been unpredictable because of particle migration. Presented here is a method of ridge augmentation with dense hydroxylapatite beads linked in a resorbable suture matrix to prevent particle migration during healing. This technique may be performed with minimally invasive surgery, providing long-term prosthetic support.     

Extraoral placement of a subperiosteal tissue expander for reconstruction with hydroxylapatite of the severely atrophic mandibular alveolar ridge

A technique is described using a subperiosteal tissue expander and particulate hydroxylapatite for reconstruction of the class IV edentulous mandibular alveolar ridge. The expander is placed under direct visualization via an extraoral approach so that it can be precisely positioned with relation to the inferior alveolar nerve. A fibrous capsule, having ideal ridge structure forms around the expander, and hydroxylapatite can be injected into this capsule from the intraoral route. The rationale for this technique and its advantages are discussed. It has been used in 17 patients with excellent results.     

帐篷螺丝技术在上前牙区连续缺失种植修复中的疗效评价

目的:评价帐篷螺丝植骨技术在上前牙区连续多牙缺失水平向骨增量术中的临床应用效果。方法:使用帐篷螺丝技术(screw-tent technique)对9例上前牙连续缺失(21个位点),骨缺损严重的患者进行水平向骨增量,6~9个月后行种植体植入术,植入术后6个月行种植修复,并追踪观察修复后12个月的修复效果。结果:9例患者共植入21枚种植体,无一松动或者脱落,并获得较满意的修复效果。术前牙槽嵴宽度为(2.41±0.49)mm,术后6个月牙槽嵴宽度为(8.27±0.79)mm,对比植骨术前和术后,差异有统计学意义(P<0.05)。修复完成后12个月牙槽嵴宽度为(7.74±0.52),对比种植术后和修复后12个月,差异有统计学意义(P<0.05)。结论:螺丝技术在上前牙连续缺失的水平向骨增量中,可获得较理想的水平向骨增量效果及修复效果。但由于观察时间较短,其远期效果仍需要进一步的观察研究。     

松软牙槽嵴无牙颌的全口义齿修复

目的 探讨松软牙槽嵴无牙颌的全口义齿修复要点.方法 选择松软牙槽嵴无牙颌患者31例.修复前询问患者义齿使用习惯,检查口腔及旧义齿情况,进行必要的修复前手术,择期重新修复.在修复后6个月、1年、2年后复查,根据病历记录检查患者口腔和义齿情况是否有改变.结果 义齿修复后的2年中,牙槽嵴的松软范围没有明显扩大,义齿使用效果良好.结论 伴有松软牙槽嵴的无牙颌全口义齿修复时,应该注重印模的准确性、前牙与牙槽嵴顶的位置、前牙的覆(牙合)与覆盖,指导患者正确使用义齿并定期复查,可取得良好治疗效果.     

Incision design in implant dentistry based on vascularization of the mucosa

OBJECTIVES: The delivery of an adequate amount of blood to the tissue capillaries for normal functioning of the organ is the primary purpose of the vascular system. Preserving the viability of the soft tissue segment depends on the soft tissue incision being properly designed in order to prevent impairment of the circulation. A knowledge of the course of the vessels as well as of their supply area are crucial to the decision of the incision. The aim of this study was to visualize the course of the arteries using different techniques, to perform macroscopic- and microscopic analyses, and to develop recommendations for incisions in implant dentistry. MATERIAL AND METHODS: The vascular systems of seven edentulous human cadavers were flushed out and filled with either red-colored rubber bond or Indian ink and formalin mixture. After fixation a macroscopic preparation was performed to reveal the course, distribution and supply area of the major vessels. In the area of the edentulous alveolar ridge specimens of the mucosa were taken and analyzed microscopically. RESULTS: The analyses revealed the major features of mucosal vascularization. The main course of the supplying arteries is from posterior to anterior, main vessels run parallel to the alveolar ridge in the vestibulum and the crestal area of the edentulous alveolar ridge is covered by a avascular zone with no anastomoses crossing the alveolar ridge. CONCLUSION: The results suggest midline incisions on the alveolar ridge, marginal incisions in dentated areas, releasing incisions only at the anterior border of the entire incision line, and avoidance of incisions crossing the alveolar ridge.     

种植磁性覆盖义齿的临床效果观察

目的探讨种植磁附着体全口义齿对下颌牙槽嵴重度吸收的无牙颌患者的修复效果。方法采用C D I C牙种植体及配套磁性附着体,为15例下颌牙槽嵴重度吸收的无牙颌患者在下颌两侧第一前磨牙区各植入1枚种植体,4～6个月后制作下颌全口义齿并在组织面粘固磁体。进行咀嚼效率和患者满意度测定。结果种植磁附着体全口义齿在粘固磁体后及粘固后2周的固位力和咀嚼效率均较放置磁体前明显提高,且患者满意度提高。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的临床效果好。     

Panoramic radiographic examination: a survey of 271 edentulous patients

The aim of this study was to quantify the frequency of positive radiographic findings in edentulous arches. Panoramic radiographs from 271 patients who were edentulous in one or both arches were evaluated for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramina at or near the crest of the residual alveolar ridge, and maxillary sinus proximity to the crest of the residual alveolar ridge. One or more of these radiographic observations were found in 51.7% of the examined films. The most frequent finding (30.6%) was close approximation of the maxillary sinus to the crest of the ridge. These results underscore the importance of panoramic examination of edentulous patients in detecting potential problems before complete denture treatment. However, prescribing such an examination in patients seeking replacement dentures requires a thorough patient history and clinical examination.     

运用微翻瓣牙槽嵴保存术改善重度骨破坏下颌第二前磨牙拔除后种植条件（附1例2年随访报告）

种植修复已被广泛应用于牙列缺损或缺失的功能重建。罹患重度牙周病变需要拔除的牙齿常存在广泛的牙槽骨吸收破坏。其中下颌第二前磨牙根尖毗邻颏孔区,由于其位置特点使得该处根尖区炎症进展易波及下颌管,一旦保留无望的牙拔除后,其种植修复治疗亦存在较大难度与风险。在拔牙同期应用牙槽嵴保存术可恢复和维持良好的牙槽嵴软硬组织轮廓,为种植治疗提供有利条件。文章完整展示了1例下颌第二前磨牙拔除同期行微翻瓣牙槽嵴保存术,术后进行种植修复及2年随访观察的全过程,为存在严重牙槽骨破坏的下颌第二前磨牙的治疗方案设计与临床处置提供了一定参考。