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对患者进行牙种植支持式修复设计时,首先应考虑到修复体的生物力学状态。任何一个牙种植支持式的修复,如果不符合生物力学原则,有可能导致生物力学方面的并发症并影响到牙种植修复的长期稳定性。牙周病所致无牙颌患者通常有较严重的牙槽嵴萎缩,有较大的颌间距离,修复后通常有较长的牙冠,在这类患者的修复设计中对其生物力学特点应有更多的考虑。本文讨论了在这类患者修复设计中生物力学因素及其与生物力学并发症的关系,并对如何有效修复设计进行了讨论。     

CDIC柱状螺纹种植体系统-临床技术与应用

CDIC柱状螺纹种植体系统 ,是华西医科大学卫生部口腔种植中心研制的新一代纯钛种植体系统 ,临床应用技术是一个成功的种植体系统的“软件”。本文重点介绍了该系统临床操作技术和临床应用的情况。     

种植义齿患者心理初探

对286名种植义齿患者的心理状况进行了调查分析。结果表明：患者对种植义齿的要求依次是美观(45.8％)．舒适(32.2％)和方便(18.3％)；疼痛是患者最担心的问题(68.6％)在引导患者就医的媒介方面，经医生介绍者占32.6％，由其他人介绍者占33.7％．看电视者占28．2％，经报刊和广播途径就医者分别占34％和21％。患者对种植义齿效果满意者占53．7％．较满意者占38．5％，不满意者占7.8％。     

Peri-implant conditions in periodontally compromised patients following maxillary sinus augmentation. A long-term post-therapy trial

Augmentation of the maxillary sinus in the atrophied edentulous posterior maxilla is an integral part of implant prosthodontics. This study examined the clinical outcome in 50 periodontally compromised successfully treated subjects with severe maxillary atrophy following oral implantation with Bråemark. IMZ or Frialit-2 endosseous implants between 1991 and 1994. Simultaneous sinus augmentation was achieved using auto-genous bone grafts harvested from the anterior mandible. Oral implants in 37 periodontally healthy patients directly placed in the stable local maxillary bone served as controls. The oral rehabilitation included implant supported restorations or removable superstructures over a period between 3 and 5 years. The peri-implant status of implant abutments inserted in the periodontal compromised augmented maxilla resulted in values comparable to the local maxillary bone except for the GCF rates with enhanced levels of 63.9±49.9 (controls 37.9±40.7). The average peri-implant Periotest values in the augmented maxillary sinus (test group) were ?3.1 PT and +0.2 PT in the controls. The Periotest scores in the sinus area ranked between ?7.0 and +5.0 with mean PT values of ?1.5 for IMZ, ?3.2 for Bråemark and ?4.0 for Frialit-2 abutments. The functional integration of oral implants following sinus augmentation with autologous bone grafts and conventionally placed endosseous implants in the local bone was similar. The additional implant stabilization within the mandibular cortical bone grafts resulted in very low Periotest scores. In periodontally compromised subjects treated for chronic adult periodontitis with minimal maxillary bone height less than 5 mm the endosseous implantation with simultaneous sinus augmentation is recommended as an appropriate technique for long-term oral implant rehabilitation.     

Comparison of interproximal soft tissue height for single implants and contra-lateral natural teeth

Objective: To compare the interproximal soft tissue dimensions adjacent to single implant restorations in the premolar–molar position with those adjacent to the contra-lateral natural teeth.
Material and methods: Twenty-five patients with a single-tooth implant in premolar–molar position and healthy contra-lateral teeth were enrolled in this retrospective cross-sectional study. The reason for the extraction was periodontitis. Radiographs were used to measure the shortest distance from the tip of the papilla to the crestal bone in single implants and contra-lateral teeth. A Wilcoxon's signed-ranks test was used to examine the differences between the interproximal soft tissue dimensions adjacent to the single-tooth implant restorations (IS-STI) from those of the contra-lateral natural teeth (IS-NT).
Results: We found no significant difference between the mesial IS-STI and the mesial IS-NT (3.28±0.83/3.31±0.62; P =0.861), or between the distal IS-STI and the distal IS-NT (3.09±0.72/3.3±0.63; P =0.263).
Conclusions: The interproximal soft tissue height adjacent to single-implant-supported restorations in the premolar–molar position is similar to that adjacent to the contra-lateral natural teeth.     

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??Objective    To evaluate clinical influence of the different angulated abutments on the implant teeth in the anterior region. Methods    Totally 56 patients with 77 Straumann implants in the anterior region were followed up for 6-36 months. Implant restorations were divided into two groups according to their abutments. Cumulative survival rate was calculated by life-table analysis. Evaluate the soft tissue around single -tooth implant in anterior maxilla with a newly developed pink esthetic score??PES??. The software of SPSS 17.0 was used for statistical analysis. Results    Implant cumulative survival rate with angulated abutments was 96.4%??and with 0°abutment it was 100%. There was 9.1% biomechanical complications in 77 implants. No significant difference in annual crestal bone loss or biomechanical complications was found among 2 groups??P > 0.05??. The PES assessment score of prosthesis with angulated abutments was lower than  that with 0°abutment in both the baseline period and follow-up period. Conclusion    There is no significant difference between angulated abutments and 0°abutment in peri-implant crestal bone loss and biomechanical complications. The clinical influence of implant restorations with 0°abutment is better than that with angulated abutments.     

Biomechanical and histological behavior of zirconia implants: an experiment in the rat

Objective: This study aimed at evaluating the integration of zirconia implants in a rat femur model.
Material and methods: Zirconia implants with two distinct surface topographies were compared with titanium implants with similar topographies. Titanium and zirconia implants were placed into the femurs of 42 male Sprague–Dawley rats. Four groups of implants were utilized: machined zirconia implants, zirconia implants with a rough surface, machined titanium implants, and titanium implants with an electrochemically roughened surface. After a healing period of 28 days, the load-bearing capacity between the bone and the implant surface was evaluated by a push-in test. Additionally, after a healing period of 14 and 28 days, respectively, bone tissue specimens containing the implants were processed and histologically analyzed.
Results: The mean mineralized bone-to-implant contact showed the highest values after 14 and 28 days for the rough surfaces (titanium: 36%/45%; zirconia: 45%/59%). Also, the push-in test showed higher values for the textured implant surfaces, with no statistical significance between titanium (34 N) and zirconia (45.8 N).
Conclusions: Within the limits of the animal investigation presented, it was concluded that all tested zirconia and titanium implant surfaces were biocompatible and osseoconductive. The presented surface modification of zirconia implants showed no difference regarding the histological and biomechanical results compared with an established electrochemically modified titanium implant surface.     

不同角度基台Straumann种植系统行前牙种植修复短期临床效果评价

目的    评价不同角度基台用于前牙种植义齿修复的临床效果。方法    选择2013年1月至2015年10月来齐河县人民医院口腔科接受前牙区种植修复的患者56例,共植入77颗Straumann种植体并完成单冠修复,修复完成后根据选用的基台分为直基台组（49颗）和角度基台组（28颗）。随访6 ~ 36个月,分别记录2组种植义齿机械并发症的发生情况,拍摄平行投照X线片测量种植体周围骨吸收量,采用寿命表法计算两组基台种植义齿的3年累积存留率,应用红色美学指数（pink esthetic score,PES）对上颌前牙区单牙种植修复后软组织的美学效果进行评价。应用SPSS 17.0软件包对数据进行统计学分析。结果    角度基台组的3年累积存留率为96.4%,直基台组为100%。种植义齿机械并发症的总体发生率为9.1%,两组基台种植义齿的机械并发症发生率及年均骨吸收量的差异均无统计学意义（均P > 0.05）。无论在基线期还是随访期,角度基台组的PES总分均明显低于直基台组（P < 0.05）。结论    角度基台与直基台种植义齿修复在种植体周围骨吸收程度及机械并发症发生率方面无明显差异,前牙区种植义齿修复采用直基台的临床美学效果要优于角度基台。     

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目的评价不同角度基台用于前牙种植义齿修复的临床效果。方法选择2007年6月至2012年6月来中国医科大学I：／腔医学院种植中心接受前牙区种植修复的患者138例,共植入231颗ITI种植体并完成单冠修复,修复完成后根据选用的基台分为0。（直基台）、15。和200基台组。随访6～66个月,分别记录3组种植义齿机械并发症的发生情况,拍摄x线片测量种植体周围骨吸收量,采用寿命表法计算不同角度基台种植义齿的5年累积存留率,应用SPSS13．0软件包对数据进行统计学分析。结果所有种植义齿机械并发症的发生率为8．2％。3组不同角度基台种植义齿的机械并发症发生率及年均骨吸收量差异均无统计学意义（均P〉0．05）。150和20。基台组的5年累积存留率为97．8％,0。基台组为98．9％。结论种植义齿的基台角度与种植体周围骨吸收程度及机械并发症发生率无相关性,15。和20。的角度基台应用于前牙区种植义齿可取得较好的临床修复效果。     

Biologic outcome of implant-supported restorations in the treatment of partial edentulism. part I: a longitudinal clinical evaluation

Abstract: The purpose of this study was to predict the outcome of implant restorations in the treatment of partial edentulism, taking into account implant interdependency and the effect of several confounding variables. Between December 1982 and June 1998, 1956 Brånemark system^® implants (1212 and 744 in the maxilla and mandible, respectively, 846 distal to first premolars) were installed in 660 patients (248 males) at the Department of Periodontology of the University Hospitals of the Catholic University of Leuven. Of the 810 restorations installed at the Department of Prosthetic Dentistry of the same hospital, 235 were single crowns, 166 were supported by implants and teeth and 409 were free-standing fixed partial prostheses. An additional 87 restorations was placed in private dental offices and were not included. The patients were followed from implant installation until June 1999. The estimated cumulative survival rates were 91.4% for all implants and 95.8% for all restorations over a period of 16 years. Estimated cumulative survival rates from loading for implant-tooth connected and free-standing implants were, respectively, 93.6% and 97.2%. Neither jaw site nor implant position (anterior–posterior) had any significant effect on the outcome. Short implant length, high number of implants per patient, low number of implants per prosthesis, implants loaded by acrylic-veneered restorations and implants combined with bone grafting present a higher risk hazard for implant failure. The idea of not splinting the implants in a fixed partial prosthesis is promising but needs replication before accepting it.     

Influence of Different Operatory Setups on Implant Survival Rate: A Retrospective Clinical Study

Background: Surgery performed under sterile operating conditions, as well as atraumatic surgery, has been stated to be among the most important requirements for successful osseointegration. However, there are few reports concerning the sterile surgical technique in association with implant placement, and the appropriate level of operatory setup is not fully known.
Purpose: The purpose of this study was to analyze implant survival rate using a simplified surgical operatory setup compared with the use of the original Brånemark System® (Nobel Biocare AB, Göteborg, Sweden) protocol.
Materials and Methods: A total of 1,285 consecutively treated patients were included in the study. Four thousand implants were placed during the period of 1985 to 2003. Group A (using the Brånemark System protocol) comprised of 654 patients and 2,414 implants. Group B (using a simplified operatory setup) comprised of 631 patients and 1,586 implants. Healing was evaluated after 6 months of clinical function. Failure was defined as the removal of implants because of nonosseointegration. Statistic analysis was performed using t -test for paired data. The level of significance was set at 5% for comparison of data.
Results: No significant difference with regard to complications and implant survival rate was found in the study.
Conclusion: The result from the present study suggests that a simplified operatory setup does not affect the survival rate of oral implant treatment.     

To what extent does the crown–implant ratio affect the survival and complications of implant-supported reconstructions? A systematic review

Objective: To evaluate the occurrence of biological and technical complications with respect to the crown–implant ( C/I ) ratio of implant-supported reconstructions.
Material and methods: Electronic (MEDLINE) and hand searches were conducted for longitudinal prospective studies with a follow-up period of at least 4 years. One reviewer performed screening and data abstraction. The following complications were evaluated: implant survival, peri-implant crestal bone loss, implant fracture, and technical complications related to implant components and suprastructure.
Results: The search provided 41 articles and abstracts, seven of which were selected for full-text analysis. Only two articles were finally included. A qualitative data analysis revealed that the survival rate of implant-supported reconstructions with a C/I ratio of more than 2 was 94.1%. In addition, peri-implant crestal bone loss seemed not to be influenced by the C/I ratio of the implant rehabilitation, except in one study, which noted greater crestal bone loss with lower (<1) compared with higher (>2) C/I ratios. Technical complications related to implant components and suprastructure according to different C/I ratios were not found in any of the studies.
Conclusions: Despite the diversity among studies with respect to data collection and study design, the current literature shows that the C/I ratios of implant-supported reconstructions do not influence peri-implant crestal bone loss.     

Clinical Evaluation of 209 All‐Ceramic Single Crowns Cemented on Natural and Implant‐Supported Abutments with Different Luting Agents: A 6‐Year Retrospective Study

Background: The Procera AllCeram? system (Nobel Biocare AB, Göteborg, Sweden) is a valid alternative to metal–ceramic restorations. However, limited long‐term data of its use for single crowns on natural and implant‐supported abutments are available. Purpose: The present study aimed at evaluating the clinical performances of Procera AllCeram single crowns in both anterior and posterior regions of the oral cavity either on natural tooth or implant abutments over a period of 6 years. Materials and Methods: Two hundred nine single crowns were fabricated and used in 112 patients. Zinc phosphate and resin luting agents were used to cement the restorations. The crowns were evaluated according to the California Dental Association's quality assessment system. Results: Three crowns were lost at follow‐up. Of the 206 restorations, which completed the 6‐year follow‐up, 9 crowns were affected by mechanical complications and 7 crowns failed. All surviving crowns were ranked as either excellent or acceptable. Cumulative survival and success rates of 95.2 and 90.9%, respectively, were recorded. Conclusions: Within the limitations of the present study, Procera AllCeram crowns proved to be a reliable clinical option to restore both anterior and posterior missing teeth either on natural or implant abutments. The resin cement used in the present study performed better than the zinc phosphate luting agent.     

Prognosis of immediately loaded implants and their restorations: a systematic literature review

Immediate loading of oral implants has become popular because of the increasing demands of a shortened treatment time. This literature review evaluates the prognosis of immediately loaded implants and their restorations with immediate or delayed implant placement. Special attention was given to the impact of type of jaw, bone quality, implant length, time of implant placement and type of restoration. An electronic (PubMed) and a manual search in relevant journals were conducted until February 2012. Only publications in English, in peer-reviewed journals, were considered. Nine studies met the inclusion criteria: five studies dealt with fixed restorations, two studies with removable rehabilitation of edentulous jaws and two studies dealt with partially edentulous patients. Implant survival rates ranged from 95·8% to 100%, implant success rates in the treatment for the mandible from 79% to 100% and restoration survival rates for both jaws from 96·4% to 100%. Within the limits of this review, appropriate patient selection, primary implant stability, splinting of implants and the expertise of surgeons seem to be important for the prognosis of immediately loaded implants and their restorations. Good bone quality and use of long implants appear to play a role. However, careful interpretation is required because conclusions are based on articles with low level of evidence. While immediate loading of oral implants in the mandible shows encouraging and predictable results, further multicenter randomised controlled clinical trials with sufficient statistical power are needed to examine (i) the outcome of immediately loaded implants in the maxilla and (ii) the outcome of immediate loading of immediately placed implants.     

种植覆盖义齿修复牙槽骨严重萎缩的无牙下颌

目的：本文报告用Replace种植体或MIC种植体支持、用夹子和杆固定种植覆盖义齿修复牙槽嵴严重萎缩的无牙下颌患者的治疗程序，重点介绍了修复体制作要点，评价了种植覆盖义齿的修复效果。方法：在每个无牙下颌前牙区植入2～3枚Replace种植体、或MIC种植体。连接基台，制作做固位用的杆结构。覆盖义齿通过放置在组织面的塑料或合金夹子固位到杆结构上.用该方法修复严重萎缩的无牙下颌19例，其中，17位患者按期进行了复查，从种植效果和修复效果两个方面对复查患者的治疗结果进行了评价。结果：17位按期复诊者的43枚种植体及其支持的杆结构稳定。修复后咀嚼功能恢复良好，面容和语音功能有显著改观，患者对种植修复治疗结果都感到满意。结论：用种植组合体固住的下颌半口覆盖义齿修复严重萎缩的无牙下颌，能够有效地恢复咀嚼功能，改善面容，提高语音的清晰度，达到预期的效果。     

口腔种植修复中附着龈重建的回顾性分析

目的: 分析附着龈重建应用于口腔种植修复中的临床效果。方法: 选取2011年3月~2015年3月在我院接受口腔种植修复的患者70例,随机分为观察组和对照组,各35例,对照组患者接受常规的牙龈缝合修复,观察组患者则采用附着龈重建处理,分析比较两组患者修复治疗后附着龈宽度的改善情况。结果: 治疗后,观察组患者附着龈宽度的恢复情况、炎症发生情况、出血指数等方面均显著优于对照组(P<0.05)。结论: 附着龈重建方式在口腔种植修复中具有良好的临床效果,有利于患者附着龈宽度的恢复,值得在临床上推广和应用。     

A survey on undergraduate implant dentistry education in Europe

Introduction:  The aim of the survey was to assess the status of implant dentistry education and addressed various aspects related to competence level, practical implementation and barriers for further development in the field.
Materials and methods:  An e-mail survey was performed amongst 73 opinion leaders from 18 European countries invited to the Association for Dental Education in Europe (ADEE) workshop on implant dentistry.
Results:  Forty-nine surveys were returned (67%) and it was found that theoretical and pre-clinical courses to an average of 36 h are given to undergraduates; 70% reported that students assist or treat patients with prosthetics; 53% reported that students assist with surgery and only 5% is operating patients. In 23% of the schools optional undergraduate courses are available and 90% offer postgraduate training. Barriers for including prosthetics and surgery are lack of time, funding or staff. Partial restorations, including surgery, in the posterior regions may be provided by dentists after attendance at additional courses but complex treatments should be limited to specialists.
Conclusion:  This survey confirms that implant dentistry is part of the undergraduate curriculum, albeit with a disparity in time. Whereas implant dentistry is an important part of clinical practice, coverage in the curriculum is limited and when compared with 10 years ago, even stagnating. Priorities within the curriculum should be evaluated depending on demands and treatment needs of the population. To optimise education, learning guidelines should be developed, based on the expected competencies for practicing dentists. Undergraduate education may start the process that must continue through all levels of education, including the postgraduate level.     

自主研发CAD/CAM种植导板制作系统在无牙颌种植修复中的临床应用研究

目的评价自主研发CAD/CAM种植导板制作系统在无牙颌种植修复中的临床应用。方法选择5例单颌无牙颌患者。锥形束CT扫描采集数据,导入自主研发种植导板软件进行导板的数字化设计,快速成型机制作种植导板。在导板引导下进行无牙颌种植手术,植入ITI种植体。3个月后复查,行种植义齿修复。术后定期随访。结果为5例患者制作完成丙烯酸树脂CAD/CAM种植导板,在导板引导下采用不翻瓣术式共植入38枚ITI种植体,初期稳定性良好,术后反应小。术后3个月骨结合良好,仅1枚种植体脱落。5例患者均采用固定式种植修复,术后6个月及1年的随访显示,修复体功能和美观良好。结论该自主研发的CAD/CAM种植导板制作系统应用于无牙颌种植手术,能实现术前精确设计和术中精确控制种植体位置,减少了手术创伤和术后并发症,取得良好的种植修复效果。