异体脱细胞真皮基质在种植区唇侧软组织处理中的应用

目的观察异体脱细胞真皮基质(ADM)植入后增加上前牙种植区唇侧软组织厚度的疗效。方法将50例单个上前牙缺失病例随机分为实验组和对照组,前者行种植术伴种植区唇侧ADM骨膜下植入,对照组行单纯种植术。测量手术前、手术后12周种植区牙槽嵴水平宽度及种植体周围牙周指数。结果术后12周两组种植体留存率均为100％;实验组牙槽嵴宽度较术前平均增加(3．10±0．64)mm,对照组增加(0．30±0．50)mm,两组间比较,差异有统计学意义(P<0．05);术后12周实验组牙槽嵴平均宽度为(11．50±1．48)mm,对侧同名牙区牙槽嵴平均宽度为(11．60±1．60)mm,两者间差异无统计学意义(P>0．05)。结论ADM能通过增加水平向软组织量改善种植区唇侧的美学效果。     

腭侧旋转结缔组织瓣在上前牙种植修复中的临床研究

目的:探讨腭侧旋转结缔组织瓣在上颌前牙种植修复中的临床意义。方法:26例上颌前牙种植二期修复时,唇侧软组织有轻度缺损或凹陷,在牙槽嵴顶种植体位置作“H形”切口,形成颊侧带蒂粘骨膜瓣尖端带有腭侧的结缔组织瓣。将腭侧结缔组织旋转折叠,插入颊侧龈瓣内侧。愈合基台挤压龈乳头瓣诱导种植体周围龈乳头成形。2~4周后上部冠修复。6月后测量腭侧旋转结缔组织瓣移植前后唇侧牙龈丰满度等变化。结果:所有种植体均稳固,唇侧龈缘基本对称,手术前后唇侧软组织丰满度差为(1.10±0.45) mm,外形有明显改善,龈乳头顶到牙冠邻面接触点的距离为(2.05±0.76) mm。结论:腭侧旋转结缔组织瓣手术方法简单、易行,针对唇侧软组织缺损较少的部位可以较好地改善上颌前牙美学区种植义齿的软组织凹陷问题。     

上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。     

骨劈开技术在上颌前牙区种植术中的应用

目的：评价骨劈开术在上颌前牙区种植术中的临床应用效果。方法：42例患者,缺失上前牙1-4颗,牙槽嵴可利用骨高度〉10mm,宽度3-5mm。采用骨劈开术形成唇侧骨瓣,在腭侧骨板与唇侧骨瓣之间植入直径3.5mmAnkyl os种植体83枚,劈开部位应用GBR技术,6个月后行二期手术和固定修复。结果：二期手术时所有种植体稳固,1例（2枚种植体）唇侧骨板部分吸收,产生2.0mm种植体颈部唇侧暴露。其余种植体被骨质完全包绕,牙槽嵴宽度增加2.8-4.1 mm,平均增宽3.5mm。83枚种植体完成固定修复,经过2年的追踪观察,无一种植体松动或脱落。结论：上颌牙槽嵴骨宽度为3-5mm时,采用骨劈开术能有效增加骨量,获得满意的临床疗效。     

埋伏正中牙的诊断定位及手术治疗

目的：探讨埋伏正中牙的定位及手术方法,方法：主要运用头影像位测量片为分析断20例埋伏正中牙的振腭侧位置,分别运用唇侧梯形瓣术式、腭侧舌形瓣术式及牙槽嵴顶部切口拔除。结果：术前确定埋伏正中牙位居振侧者2例,腭侧者15例,唇腭侧正中份者3份,与术中所见一致。唇侧梯形瓣及牙槽嵴顶部切口术式的术后愈合良好,而腭侧舌形瓣术式的术后有9例分别出现瓣膜肿胀,穿孔及出血,结论：头影侧位测量片是判断埋伏正中牙唇腭位置的有效方法,腭侧舌形瓣术式应注意术后并发症。     

改良血管化骨膜-结缔组织瓣在上颌前牙区即刻种植中的应用

目的:通过探索改良血管化骨膜-结缔组织瓣移植技术在上颌前牙区即刻种植中的应用,评价其临床效果。方法:30颗因外伤无法保留的上前牙,即刻种植时采用腭侧血管化骨膜-结缔组织瓣覆盖种植区,唇侧嵌插在半厚瓣下,观察术后临床效果。结果:30颗种植体即刻种植时,软组织创口均可达到无张力关闭。移植瓣成活率达96.67%。最终修复时,粉红美学评分(Pink Esthetic Score, PES)达12.20分。修复后半年近远中龈乳头、软组织外形及PES较修复完成时有所改善,且差异有统计学意义;修复后1年与半年相比,差异无统计学意义。结论:上颌前牙区即刻种植联合改良血管化骨膜-结缔组织瓣能够无张力关闭种植创口,修复后粉红美学效果良好。     

龈下结缔组织瓣在上前牙种植二期手术中的应用

目的:评估龈下结缔组织瓣在上前牙种植二期手术中的应用效果.方法:选择上前牙单颗缺失行种植修复,且种植二期手术术前评估为种植体唇侧软组织丰满度不足的患者,共40例.按随机数字表法将患者分成2组,观察组20例,二期手术时应用龈下结缔组织瓣改善种植体唇侧软组织形态;对照组20例,行常规嵴顶切开翻瓣完成二期手术.选取二期手术术...     

腭侧入路牙槽突裂植骨术的初步应用与评价

目的 改进牙槽突裂植骨术的技术方法,并对腭侧入路牙槽突裂植骨术的即刻效果进行初步评价。方法 选取20名非综合征性单侧牙槽突裂患者为研究对象,其中不完全性牙槽突裂患者8名,完全性牙槽突裂患者12名。 对20例患者实施腭侧入路牙槽突裂植骨术,在术前和术后分别拍摄锥形束CT（CBCT）片,使用Image-Pro Plus 5.1软 件测量相关数据并进行统计学分析。结果 20名患者中总体植入骨量比率为88%,唇侧植入骨量比率为93%,腭侧植入骨量比率为84%。结论 腭侧入路牙槽突裂植骨术弥补了既往腭侧植入骨量不足的缺点,裂隙内鼻腔瓣三角瓣的切口设计兼顾了鼻底裂隙和唇侧裂隙的关闭,避免大范围的松弛切口以及颊侧黏膜推进瓣的应用。     

上颌前牙区骨量不足时牙种植技术

临床上对上颌前牙区骨量不足时牙种植常感到束手无策。本文通过对24例这类患者种植36颗BLB种植体进行总结，将种植区骨缺损分为四类，即唇侧齿槽嵴沟状凹陷性骨缺损；种植区骨量宽度不足；上颌前分牙槽后缩以及唇侧齿槽骨进基底部凹陷。采用邻位骨瓣转移术、牙槽膨胀技术、联合正颌外科种植技术等进行牙种植，临床跟踪6至24月均未发现牙龈萎缩及种植体松动，功能行使正常，X线片示：种植体骨界面愈合良好。作者认为，该手术方法简单，创伤小，改善了种植区条件，拓宽适应证，有利于推广使用。     

牙种植术中植骨材料的研究进展

种植区骨量是影响种植体成功率的重要因素,在骨量不足或拔牙术后即刻种植的情况下采取骨移植的方法可以增加骨量,增加牙槽嵴的高度和丰满度,提高种植成功率.本文主要阐述植骨材料在牙种植术中的应用及研究进展.     

冠向复位瓣联合结缔组织移植重建上颌种植义齿周围软组织缺损的临床研究

目的评价冠向复位瓣技术联合结缔组织移植术重建种植义齿修复后软组织缺损的临床效果。方法收集11例11颗上颌前牙区单颗种植义齿修复后存在软组织严重退缩影响美观的病例,所有患者从腭部获取游离结缔组织联合冠向复位瓣技术进行上皮下结缔组织移植术重建软组织。以手术后1年为基线,临床评估软组织愈合情况,种植义齿牙龈曲线、修复体与天然邻牙唇侧龈缘位置的协调性。结果11颗种植义齿术后红色美学明显改善。追踪观察1～4年,临床效果稳定。结论采用冠向复位瓣技术联合腭部游离结缔组织重建种植义齿修复后软组织缺损短期临床效果良好,其长期稳定性有待进一步研究。     

Comparative clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recessions: six- to 12-month changes

Different techniques have been proposed for the treatment of gingival recession. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. Seven patients with bilateral Miller class I or II gingival recession were selected. Twenty-six recessions were treated and randomly assigned to the test group. In each case the contralateral recession was assigned to the control group. In the control group, a connective tissue graft in combination with a coronally positioned flap was used; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured two weeks prior to surgery and at six and 12 months post-surgery. There were no statistically significant differences between the groups in terms of recession reduction, clinical attachment gain, probing pocket depth, and increase in the width of the keratinized tissue after six or 12 months. There was no statistically significant increase in the width of keratinized tissue between six and 12 months for either group. Within the limitations of this study, it can be suggested that the acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures and that the time required for additional gain in the amount of keratinized tissue may be greater for the acellular dermal matrix than for the connective tissue procedures.     

Preservation of the ridge and sealing of the socket with a combination epithelialised and subepithelial connective tissue graft for management of defects in the buccal bone before insertion of implants: a case series

Defects in the layer of buccal bone lead to its loss after tooth extractions. This requires hard tissue grafting before implants can be put in place. The aim of this study was to evaluate the stability of hard tissue grafts inserted at the same time as the teeth were extracted. Teeth had to be extracted because of defects in the buccal bone. Extractions were combined with preservation of the ridge using autogenous and artificial bone. A combination epithelialised and subepithelial connective tissue graft was used to seal the socket. Wound healing was assessed and the width of the alveolar crest was measured after hard tissue grafting and during insertion of the implants. We studied 39 patients (20 female, 19 male, mean (SD) age 41 (7.9) years) who had 43 teeth extracted together with preservation of the ridge. One patient failed to attend for placement of the implant. Thirty-nine implants were inserted 5.3 (0.4) months after preservation of the ridge. Two patients developed partial necrosis of the combination graft, but in all other cases primary wound healing was uneventful. In three cases the bone grafts failed to consolidate. The mean (SD) width of the alveolar crest was after bone grafting 6.80 (1.20) mm and during insertion of implants 5.65 (1.50) mm; the mean resorption of the bone grafts was 1.2 (1.1) mm. We conclude that bone grafting to rebuild buccal alveolar defects at the same time that the tooth is extracted, combined with a soft tissue graft to seal the socket, showed promising results and could be an alternative treatment to delayed hard tissue grafting.     

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.     

Comparative 6-month clinical study of a subepithelial connective tissue graft and acellular dermal matrix graft for the treatment of gingival recession.

BACKGROUND: Different techniques have been proposed for the treatment of gingival recessions. This study compared the clinical results of gingival recession treatment using a subepithelial connective tissue graft and an acellular dermal matrix allograft. METHODS: Nine patients with bilateral Miller Class I or II gingival recessions were selected. A total of 30 recessions were treated and randomly assigned to the test group and the contralateral recession to the control group. In the control group, the exposed root surfaces were treated by the placement of a connective tissue graft in combination with a coronally positioned flap; in the test group, an acellular dermal matrix allograft was used as a substitute for palatal donor tissue. Probing depth, clinical attachment level, gingival recession, and width of keratinized tissue were measured 2 weeks prior to surgery and 3 and 6 months postsurgery. RESULTS: There were no statistically significant differences between the test group and the control group in terms of recession reduction, clinical attachment gain, and reduction in probing depth. The control group had a statistically significant increased area of keratinized tissue after 3 months compared to the test group. Both procedures, however, produced an increase in keratinized tissue after 6 months, with no statistically significant difference. CONCLUSION: The acellular dermal matrix allograft may be a substitute for palatal donor tissue in root coverage procedures.     

Comparison of acellular dermal graft and palatal autograft in the reconstruction of keratinized gingiva around dental implants: a case report

The use of autogenous gingival grafts has proved to be an effective and predictable way to increase the amount of keratinized gingiva. However, discomfort and pain at the donor site are unavoidable. Acellular dermal matrix (ADM) allograft can be used as a donor tissue to eliminate the need for another surgical site and alleviate pain and trauma. The purpose of this study was to evaluate the effectiveness of ADM allograft in increasing the width of keratinized gingiva around dental implants. A patient with inadequate keratinized gingiva around dental implants in maxillary and mandibular anterior regions received either an ADM graft or palatal autograft by random allocation. The width of keratinized gingiva and other clinical periodontal parameters were recorded initially and at 3 and 6 months after surgery. Both grafts provided satisfactory results. The width of keratinized tissues was increased by using the ADM allograft, but by a lesser amount than seen with the autogenous gingival graft.     

Palatal core graft for alveolar reconstruction: a new donor site

PURPOSE: A simple technique is described for alveolar reconstruction in cases where resorption has already occurred. The palatal core graft allows immediate regeneration of vertical, horizontal, and combined defects at the alveolus with minimal donor site morbidity and time consumption. MATERIALS AND METHODS: Seventeen patients (10 female and 7 male) were treated over a 1-year period. Bone core grafts from the palatal vault were harvested with a trephine and used for alveolar reconstruction in the esthetic zone. Patient age and gender, type and location of the defect, size of the graft, simultaneous tooth removal, simultaneous implant placement, need for soft tissue coverage, and postoperative complications were recorded. RESULTS: Mean length of the grafts was 12.5 mm (range 9 to 14 mm). Mean width was 7.3 mm (range 5 to 9 mm). In 11 cases, simultaneous tooth removal was performed and a connective tissue flap with posterior pedicles was used. Patients did not experience discomfort in the donor area. Sixteen cases were successfully restored with single implants and crowns DISCUSSION: Material for osseous reconstruction should ideally be autologous and easy to harvest and provoke minimal morbidity. The palatal core graft compares favorably with previously described techniques and donor sites for alveolar reconstruction. CONCLUSION: In this preliminary report, experience with a new technique for alveolar reconstruction is presented. The "palatal core graft" for alveolar reconstruction is effective and easy to harvest and has low donor site morbidity, allowing 3-dimensional restoration of alveolar defects.     

Management of gingival recession by the use of an acellular dermal graft material: a 12-case series

BACKGROUND: Different soft tissue defects can be treated by a variety of surgical procedures. Most of these techniques require the palatal area as a donor site. Recently, an acellular dermal graft has become available that can substitute for palatal donor tissue. METHODS: This study describes the surgical technique for gingival augmentation and root coverage and the results of 12 clinical cases. A comparison between the three most popular mucogingival procedures for root coverage is also presented. RESULTS: The results of the 12 patients and the 26 denuded surfaces have shown that we can obtain a mean root coverage of 74% with the acellular dermal graft. Thirteen out of the 26 denuded surfaces had complete root coverage. The average increase in keratinized tissue was 1.19 mm. It seems that the long-term results of the cases are stable. CONCLUSION: The proposed technique of root coverage with an acellular dermal graft can be a good alternative to soft tissue grafts for root coverage, and it should be part of our periodontal plastic surgery armamentarium.     

Soft tissue correction of a single-tooth pontic space: a comparative quantitative volume assessment

STATEMENT OF PROBLEM: Various augmentation procedures are recommended for the correction of localized alveolar ridge defects. However, no study has quantitatively evaluated the results of these procedures to date. PURPOSE: This study compared 2 soft tissue augmentation surgeries commonly used to alter contours of single-tooth pontic space by quantifying 3-dimensional volume changes with the optical projection Moiré method at 1 and 3.5 months after surgery. MATERIAL AND METHODS: Twenty-four patients required surgery. Each patient had a localized alveolar ridge defect, corresponding to a mesial-distal width of 1 single tooth. The defect of 12 patients was corrected with a subepithelial connective tissue graft; the remaining 12 patients were treated by receiving a free full-thickness gingival graft, which included epithelium and connective tissue with fatty tissue. Six unoperated defects of 6 patients formed the control group. For each defect, an impression was made before treatment, at 1 and 3.5 months after surgery to measure the volume changes on the dental casts with a validated projection Moiré system. Volume change was assessed relative to the preoperative dimension at the buccal and crestal aspects of the single-tooth pontic space. RESULTS: At 3.5 months postsurgery, mean volumetric gain for the connective tissue group with 159 mm(3) (SD +/- 80) was significantly greater (P =.027) than for free full-thickness gingival graft group with 104 mm(3) (SD +/- 31). CONCLUSION: The applied projection Moiré method proved its applicability in assessing 3-dimensional volume changes of pontic spaces with a single-tooth width. Volumetric assessment after 1 and 3.5 months revealed significantly greater volume gain with the subepithelial connective tissue graft in comparison to the free full-thickness gingival graft.