3D打印可摘局部义齿支架的技术现状与发展趋势

3D打印可摘局部义齿支架正逐渐替代传统铸造支架技术,其“数据获取-支架设计-支架加工”的工艺流程也日趋成熟。简要概述3D打印可摘局部义齿支架技术的发展历程,对其具体工艺流程涉及的技术现状进行了详细介绍,并评述未来该领域的五大发展趋势(智能化、功能化、平台化、国产化、非金属趋势)。     

3D打印在口腔种植学中的应用研究进展

3D打印技术是一种增材制造技术,因可减少材料的耗费及在计算机的辅助下可以精确地再现所需要的模型,已广泛应用于制造、设计、医学、建筑、航天及生物工程等领域.该技术的出现提高了种植手术的精确性,满足了患者个性化的需求,因此极大地加快了种植学的临床发展进程.文章主要就3D打印在口腔种植学中的种植区骨增量的应用、种植体及种植导...     

3D打印技术在口腔材料领域的研究进展

3D打印技术具有精确、快速、易于成型的特点,目前已广泛应用于社会生活的各个领域,也为口腔材料学的发展带来了新的机遇和挑战。文章主要就3D打印技术在口腔材料领域的应用现状做一综述,包括常用的方法、基本步骤、可打印材料以及当下面临的问题等4个方面。     

3D打印技术在口腔材料领域的研究进展

 3D打印技术具有精确、快速、易于成型的特点，目前已广泛应用于社会生活的各个领域，也为口腔材料学的发展带来了新的机遇和挑战。文章主要就3D打印技术在口腔材料领域的应用现状做一综述，包括常用的方法、基本步骤、可打印材料以及当下面临的问题等4个方面。     

3D打印技术在口腔颌面修复中的应用

3D打印及其相应计算机辅助医疗模拟技术能根据患者需要,快速制备适合不同患者个性化要求的生物医用材料,并能对材料的微观结构进行精确控制,以精确修复病变组织或器官,并可通过相应的计算机软件辅助进行口腔颌面外科手术模拟操作等,改进治疗方法,提高医疗质量。因此,这种新兴技术在生物医学领域中的应用,尤其在生物医用材料开发、生物组织工程技术中的应用具有独特的优势。本文通过查阅近年来3D打印技术在口腔颌面修复领域中的相关文献,以综述3D打印技术在该领域的应用动态及其进展。     

3D打印在口腔美学修复中的应用

3D打印技术可完成结构复杂物体的打印,在口腔修复领域已有一定应用,未来有望替代大部分传统修复技术。在口腔美学修复中如何保证分析设计阶段初设的轮廓外形与颜色等与患者得到的最终修复体一致,一直是困扰口腔医师和技师的难题。3D打印的蜡型、树脂冠桥等可用于美学修复的美学分析和设计结果的输出预告,一对一地传递并指导最终修复体的设计和制作。3D打印的目标修复体导板（TRSguide）既为美学修复制定了可预览的修复蓝图,让口腔医师和技师能检测患者重建的口腔功能和美学的相关信息;又能指导实施符合牙体保存和活髓保护理念的理想牙预备,做到真正的全程精准与微创。这些新的数字化技术进展使得美学修复焕然一新。本文对3D打印在口腔美学修复中的应用进行介绍。     

口腔3D打印材料的研究现状

3D打印在口腔中的的应用已经非常普遍,可以立体、直观、清晰、全面的显示颌面部复杂的解剖结构,对牙齿以及颌骨周围组织的关系还有患者个性化的解剖结构都能以实物的复制体精确地展示出来,对指导临床治疗以及医生在制定手术计划时起了非常大的作用。该技术在颌骨手术,种植,烤瓷冠桥修复领域应用已比较广泛。然而,目前3D打印在口腔有些领域的应用还存在一些问题,比如活动义齿金属支架和全瓷冠桥等,其中打印材料也是重要的影响因素,为了明晰其研究发展动态,本文将对口腔3D打印材料的研究进展做一综述。     

牙槽骨增量中3D打印个性化支架材料的研究现状

牙槽骨骨量严重不足的患者需在种植前行骨增量手术,其成功与否取决于骨增量材料的稳定性和骨再生空间的维持能力。支架材料为骨再生提供了空间结构和成骨环境,对骨增量的效果至关重要。随着计算机辅助设计和计算机辅助制造的发展,不同材料制备的3D打印个性化支架应运而生。本文针对不同材料制造的3D打印个性化支架进行综述,讨论了钛网、聚醚醚酮网以及可吸收高分子复合支架材料的特性与应用,评价应用效果和未来发展方向。     

Effectiveness of Cepharanthin in decreasing interruptions during radiation therapy for oral cancer

Objectives To examine the effectiveness of Cepharanthin (Kakensyoyaku, Tokyo, Japan) at decreasing side effects during radiation therapy for oral cancer and thereby allowing the completion of radiation therapy without interruption.Methods Two hundred fifteen patients diagnosed with oral cancers were assigned to either Cepharanthin or control groups and underwent external beam irradiation. The completion of the course of radiation therapy and the occurrence of side effects such as mucositis, dysgeusia, and xerostomia during the radiation therapy were evaluated and compared.Results The completion rate was 87.4% for the Cepharanthin group versus 67.0% for the control group, and the difference was statistically significant (P < 0.01). Mucositis did not appear in 58 of 127 cases (45.7%) in the Cepharanthin group or in 21 of 88 cases (23.9%) in the control group. Mucositis developed in 24.6% of the Cepharanthin group and 53.7% of the control group within 2 weeks of irradiation. There were significant relationships between the use of Cepharanthin and the development and timing of mucositis (both P < 0.01).Conclusions Cepharanthin improved the completion of radiation therapy without interruption and reduced or delayed the development of mucositis during radiation therapy for oral cancer.     

口腔癌的放射治疗

早期口腔癌单用放疗或手术常有同等良好的疗效。对大部分中晚期口腔癌患者,放疗作为综合序列治疗的组成部分,在术前、术中和术后应用,能改善局部控制率,对部分肿瘤有降低远处转移率的意义。因病期过晚、复发和无法手术的患者可以单独应用放疗,也可与手术、化疗联合应用,以达到减瘤和延长生存期的姑息性疗效。放疗新设备、新技术和新方法(超分割放疗、三维适形放疗与调强放疗、现代近距离放疗、同期放化疗等)的应用与放射治疗效果的提高有关。作者对口腔癌的术后放疗、颈部放疗、组织瓣和钛板整复后的放疗作了重点评述。     

Boron neutron capture therapy as a novel modality of radiotherapy for oral cancer: Principle and antitumor effect

Radiotherapy is essential for the treatment of oral cancer, especially in advanced cases. There has been marked progress in this field due to the prevalence of intensity-modified radiation therapy and introduction of particle radiotherapy using protons and carbon-ions. However, these treatments are still non-selective. Boron neutron capture therapy (BNCT) is a unique modality in which neutron beams destroy only boron compound-bearing tumor cells while leaving the surrounding normal tissues intact. Thus, BNCT is a selective form of radiotherapy, if high tumor/normal tissue ratio in boron concentration could be achieved. The principle of BNCT, and the basic study of the mechanism by which BNCT exerts antitumor effects using oral squamous cell carcinoma (SCC) cells and oral SCC xenografts in mice are described.     

重组人p53腺病毒联合放疗治疗晚期口腔癌的护理

目的探讨重组人p53腺病毒（tAd-p53）联合放射治疗晚期口腔癌患者的护理。方法对2009年1月至2012年4月在中国人民解放军总医院接受rAd-p53注射联合放射线治疗晚期口腔癌的患者,治疗前给予心理护理及健康指导．注射过程中做好护理配合．严密观察治疗后病情变化,及时处理发热、局部肿胀、疼痛、胃肠道反应等不良反应,做好放疗后皮肤护理、口腔护理及饮食护理,观察疗效并总结各项护理要点。结果22例患者均顺利完成rAd-p53联合放射治疗,其中部分缓解10例（45．5％）、稳定8例（36．4％）、进展4例（18．1％）。全部病例均无并发症及严重不良反应的发生。结论正确合理的护理是rAd-p53瘤内注射联合常规放疗治疗晚期口腔癌的重要环节,可有效减少不良反应的发生,减轻患者痛苦,达到提高治疗效果和生活质量的目的。     

Accuracy of intraoperative frozensection in assessing margins in oral cancer resection

Objectives  

To study the accuracy of intraoperative frozen section diagnosis in assessing margins in oral cancer resection and to evaluate the role of frozen section diagnosis as a guide in resection of oral cancer lesions.     

Patterns of referral of patients undergoing surgical management for oral cancer

BACKGROUND: Oral cancer is most often diagnosed by dentists or dental specialists. We were interested in analyzing demographic and referral data for a cohort of patients referred for the management of oral cancer to our unit. METHODS: A consecutive review of all patients treated by oral and maxillofacial surgery at the Austin and Repatriation Medical Centre over the last 10 years. Inclusion criteria included those patients with malignant oral and perioral disease that underwent surgical management. Exclusion criteria included those patients who did not have malignant oral disease, who did not have surgical management and those patients who were not treated by our unit as the primary surgeon. RESULTS: A total of 113 patients were identified. The mean age for presentation for the group was 61.6 years and the male to female ratio was 1.2:1. Approximately 70 per cent of patients were smokers or had smoked in the past. Over the last 10 years there has been a steady increase in referrals to our unit. Over half of all patients referred were from the Royal Dental Hospital of Melbourne while the majority of the remainder of the referrals were from private oral and maxillofacial surgeons. A significantly increased number of referrals from other sources were identified. Surveillance techniques that can be used in general dental practice are also described. CONCLUSIONS: A high proportion of referrals from dental sources highlights the importance of the dentist and dental specialist in the diagnosis and referral of patients with suspected oral cancer. Patients can either be referred to a dental hospital, private oral and maxillofacial surgeons or directly to a public hospital oral and maxillofacial surgery unit treating oral cancer, such as the one at the Austin and Repatriation Medical Centre.     

Alterations of white blood cell histograms before and after radiotherapy combined with chemotherapy in oral cancer patients

Summary The patterns of the white blood cell histogram, which showed white blood cell differentials by size through electrical resistance, were evaluated for oral cancer patient. The alterations of their patterns coincided with those of white blood cell differentials by morphological analysis on the manual smears. White blood cells, especially, lymphocytes and monocytes, have a close relation to the immunocompetence for cancer paient as already reported. Therefore, the white blood cell histogram will have a possibility to use as a simple immunocompetent parameter, when further direct study related to the immunocompetency is performed. The patterns of the white blood cell histograms in the course of the radiotherapy were different depending on the antitumor agent combined. The differences of the patterns were clearly observed in the region of the lymphocytes and the monocytes.     

头颈部癌放疗患者口腔念珠菌定植特征及分析

目的 了解头颈部癌(head and neck cancer,HNC)接受放射治疗患者临床分离口腔念珠菌的菌株定植特征,为临床防治方案的制定提供依据。方法 随机抽取60例HNC患者,于放疗前、放疗期间、放疗结束采用口腔含漱法取样,CHROMagar显色培养基、API 20C AUX 酵母菌鉴定系统进行分离培养鉴定,比较2组念珠菌的检出率和不同念珠菌种的检出量的差异。采用SPSS 17.0软件包进行统计学处理。结果 60例HNC放疗患者中,54例出现口干和吞咽困难,50例产生放射性口腔黏膜炎（radiation-induced oral mucositis,RIOM）,18例感染口腔念珠菌病;60例HNC放疗患者放疗期间和放疗结束口腔念珠菌的检出率分别为56.7%和63.3%,较放疗前（26.7%）明显升高,具有显著差异(χ²=18.320,P<0.001);54例临床分离株以白念菌为主（n=42）,其次是近平滑念珠菌（n=6）、热带念珠菌（n=4）和光滑念珠菌（n=2）;放疗患者口腔念珠菌致病菌的检出率量为30%,定植菌占46.7%。结论 HNC放疗患者口腔念珠菌的定植率明显升高,念珠菌感染可能是RIOM发生的重要原因。     

基于德尔菲法构建老年口腔癌患者围术期口腔护理方案

目的 构建老年口腔癌患者围术期口腔护理方案。方法 在前期指南内容分析、医护患相关人群深入访谈的基础上,根据老年口腔癌患者的临床特点、治疗阶段,结合PDCA循环,构建老年口腔癌患者围术期口腔护理方案初稿,采用德尔菲法对16位相关领域专家进行2轮函询,以确定方案。采用Excel 2016、SPSS 25.0软件包进行统计描述和统计分析。结果 2轮专家咨询回收率均为100%,整体专家权威系数为0.84。经过2轮专家咨询,各指标的变异系数为0~0.240,整体协调系数为0.171,形成了术前、术后、放化疗时期3个阶段的口腔护理方案。术前阶段包括4个维度,12个一级条目,56个二级条目;术后阶段包括4个维度,18个一级条目,102个二级条目;放化疗阶段包括4个维度,13个一级条目,35个二级条目。结论 老年口腔癌患者围术期口腔护理方案符合老年口腔癌围术期患者特点,能够满足该群体的口腔护理需求,方案构建具有可靠性,能为临床实践提供参考。     

Supragingival and subgingival microbiota from patients with poor oral hygiene submitted to radiotherapy for head and neck cancer treatment

ObjectiveThis case-control study aimed to evaluate the effects of conventional radiotherapy (RT) on the prevalence and populations of oral microorganisms in head and neck cancer patients who did not receive adequate preventive dental care. It was hypothesized that side effects of radiotherapy could be associated with radiation dose, microbiological aspects, and socioeconomic conditions of the patients.DesignTwenty-eight dentate patients with head and neck cancer submitted to RT were included in the study. Radiation dose received varied from 4320 to 7020 cGy. Patients with the same demographic and health conditions, but no history of cancer or antineoplastic treatment were used as controls. Clinical examinations were carried out before RT, 15–22 days after starting RT, immediately after and 6 months after RT. Supra and subgingival biofilms were collected and cultivated onto selective and non-selective media. Isolates were identified by biochemical and physiological characteristics. Stimulated and unstimulated salivary flow rate and saliva buffer capacity were also determined.ResultsMucositis, dermatitis, xerostomia, dysgeusia, dysphagia and candidiasis were common after starting RT and during the treatment period. Xerostomia was followed by a decrease in salivary pH and buffer capacity, which showed association with the increase of cariogenic cocci and yeast populations, which were also associated with deterioration of hygiene. Candida and family Enterobacteriaceae showed increased prevalence with RT, and were associated with the occurrence of mucositis and xerostomia.ConclusionsModifications in oral biofilms of irradiated patients showed association with xerostomia and hygiene conditions, which reinforces the necessity of improving patient compliance to oral health care programs.