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因作为固定义齿基牙或充填物易脱落等原因,很多龋齿治疗充填后需行全冠修复。因其牙髓活力正常,牙体预备技术要求很高,存在一定的穿髓风险。本文对110颗活     

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提要：复合树脂直接修复技术在现阶段临床已广泛应用,有关其修复治疗后的临床疗效已有很多报道。本文介绍了有关复合树脂直接修复技术的临床疗效评估方法、标准及影响因素,为临床实际和疗效观察提供参考。     

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目的观察氟美松和甘美达局部用药治疗口腔斑纹型扁平苔藓的疗效。方法选择2006年10月至2007年10月中国医科大学口腔医学院综合急诊科就诊的口腔斑纹型扁平苔藓患者185例,随机分成4组,各组采用不同药物患处涂抹。A组用氟美松与甘美达凝胶混合均匀后患处涂抹,B组用氟美松患处涂抹,C组用甘美达凝胶患处涂抹,D组用口腔溃疡散患处涂抹,观察1～3周,对各组白色斑纹面积、充血面积的变化以及有效率进行对比分析。结果1周后A组斑纹面积缩小率达到48.68%,充血面积缩小率达到50.25%,有效率达到70.0%,斑纹面积缩小率和有效率与其他各组比较,差异有统计学意义(P<0.05),充血面积缩小率与其他各组比较差异无统计学意义(P>0.05)。2周后A组斑纹面积缩小率达到89.73%,充血面积缩小率达到84.69%,有效率达到92.0%,与其他组比较差异均有统计学意义(P<0.05)。结论氟美松和甘美达联合患处涂抹治疗口腔斑纹型扁平苔藓具有良好的临床疗效。     

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目的    探讨玻璃纤维桩联合纳米复合树脂对儿童年轻外伤恒前牙临时过渡性修复的临床效果。方法    2004年９月至2008年３月于杭州市口腔医院儿童牙科对65例78颗儿童外伤冠折恒前牙行完善的根尖诱导和根管治疗后,使用玻璃纤维桩修复后直接用纳米复合树脂修复外形作为至18岁的过渡性修复,随访3年,观察其临床修复效果。结果    术后3个月复查,未见纤维桩折断、根折、根吸收。术后6个月有1例因二次外伤发生根折。术后24个月复查,仅3例出现表面着色,未见树脂脱落,边缘渗漏偶有发生,经处理均使患者满意。术后36个月,未见纤维桩脱落、根折。结论    玻璃纤维桩和纳米复合树脂联合修复儿童外伤恒前牙是成功有效的过渡性修复方法。它能够避免直接树脂修复或断冠修复造成的反复脱落,又能降低根折风险,最大限度的保留牙体组织。     

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目的观察牙隐裂综合治疗的临床疗效。方法对2001年5月至2004年1月来沈阳市口腔医院就诊的107例牙隐裂患者的122颗患牙,采取调、带环黏固后根管治疗加全冠修复的方法修复,随访2年,复查治疗效果。结果122颗患牙中,成功91颗(74.59%),好转28颗(22.95%),失败3颗(2.46%),有效率达97.54%。结论对隐裂牙进行综合治疗,特别是采取调、带环黏固后根管治疗加全冠修复的方法疗效确切,值得推广应用。     

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??Objective    To study the effect of biofilm on treatment result of three wall intrabony graft surgery for chronic periodontitis. Methods    Select 30 cases of chronic periodontitis with the three wall intrabony and probing depth??PD??≥ 5 mm??resorption area ≤ 60° angle from January 2012 to December 2013 in Foshan Xiangyang Hospital who were randomly divided into two groups. The cover film group??15 cases??with periodontal bone grafting while covering Bio-Gide biofilms??non-membrane cap group??15 cases??only with the line of periodontal bone graft and without Bio-Gide biofilms. Six and 12 months after the visit??changes in inspection probing pocket depth??PD????clinical attachment loss??CAL????sulcus bleeding index??SBI????gingival recession??GR??and other periodontal indicators were observed?? bone mineral density and bone area district new bone height were measured by X-ray for statistical analysis??compare bone defects of the two groups. Results      In the two groups PD??CAL??SBI and GR had significant improvement at 6 and 12 months compared with preoperative ones??the differences being statistically significant??P < 0.05????but the difference between the two groups was not statistically significant??P > 0.05??. Postoperative bone mineral density and area of new bone height at 6 and 12 months were significantly higher, but the difference between the two groups was not statistically significant??P > 0.05??. Conclusion    For chronic periodontal disease three wall intrabony teeth?? periodontal bone graft without biofilm has good effect??and can simplify the procedure??reduce surgical trauma and lower operation costs.     

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??Objective   To observe the clinical curative effect of regenerative endodontic treatment on young premolar with periapical periodontitis which is caused by broken abnormal central cusp. Methods    Totally 11 young premolars with periapical periodontitis caused by fractured abnormal central cusp, consisting of 10 cases??aged 10-13 years??were collected in Department of Pediatric Dentistry of Dalian Stomatological Hospital from March 2014 to September 2015. After thorough control of inflammation??regenerative endodontic treatment was performed. X-ray observation of the periapical inflammation healing and root development was performed after operation. Results    One patient dropped out from the study because of failure of puncture bleeding??diverted to apexification????while the other 10 all received regenerative endodontic treatment??and regular postoperative observation lasted 10-23 months. All symptoms of periapical inflammation disappeared??root thickening and lengthening were observed in 10 cases. There are 2 cases of part calcification in medullary cacity. Conclusion    In the treatment of young permanent teeth with periapical periodontitis??regenerative endodontic treatment has incomparable advantages compared with the traditional apexification.     

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目的比较硅橡胶闭口式印模法和开口式印模法在无牙颌义齿修复中的临床疗效。方法收集2008年3月至2011年9月福建医科大学附属第一医院口腔科收治的无牙颌修复患者30例,按初诊时间顺序随机分为闭口式印模组和对照组,分别使用闭口式和开口式印模法制作全口义齿,3个月后复查其吸附力和压痛修改情况。结果用闭口式印模法制作的全口义齿,吸附力好于开口式印模法,其压痛修改次数也明显减少。结论对于无牙颌全口义齿的制作,硅橡胶闭口式印模法优于开口式印模法。     

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目的评价家庭夜间美白法与冷光美白技术用于着色牙漂白的临床效果。方法收集广州市东升医院口腔科2007--2010年的96例着色牙病例,分别用家庭夜间美白法（50例）与冷光美白技术（46例）进行牙齿漂白,以VITA比色板分析脱色效果,用数字化疼痛评判法（VAS）记录受试者术中牙齿敏感程度。术后及2年后复查评价疗效。结果术后家庭夜间美白组总有效率为98．0％,冷光美白组为100．0％,两组总有效率差异无统计学意义（P〉0．05）。四环素牙治疗显效率、总有效率方面：家庭夜间美白组为72．2％、94．4％,冷光美白纽为90．0％、100．0％,差异均有统计学意义（均P〈0．05）。术中VAS评判：家庭夜间美白组敏感率为84．0％,冷光美白组为80．4％,两组敏感率差异无统计学意义（P〉0．05）。所有敏感者停止用药后6～24h均能缓解。2年后复查：两组牙齿颜色均出现反色。家庭夜间美白组总有效率为32．0％,冷光美白组为28-3％,两组差异无统计学意义（P〉0．05）;与治疗结束时的总有效率差异有统计学意义（P〈0．05）。2年后检查两组牙髓活力均正常。结论家庭夜间美白法与冷光美白技术治疗着色牙效果显著,在四环素牙上冷光美白技术优于家庭夜间美白法。2年后两组牙颜色均出现反色。两种漂白方法均具有临床安全性。     

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目的    观察玻璃纤维桩加树脂核和铸造镍铬金属桩核修复上颌前磨牙的临床效果。方法    对2005年3月至2007年7月在北京市通州区新华医院口腔科行上颌前磨牙桩核冠修复的143例患者的176颗患牙,随机分为A、B两组,各88颗。分别使用玻璃纤维桩加树脂核和铸造镍铬金属桩制作桩核,然后用烤瓷全冠进行修复,随访2年,观察比较临床效果。结果    A组成功86颗,失败2颗,成功率97.7%;B组成功85颗,失败3颗成功率96.6%。两组修复成功率差异无统计学意义（P＞0.05）。结论    玻璃纤维桩加树脂核和铸造金属桩核修复上颌前磨牙,临床效果基本相同。但玻璃纤维桩在失败后的再次修复方面具有铸造桩核不能比拟的优势,因此在上颌前磨牙的桩核修复方面首选玻璃纤维桩。     

种植体支抗在口腔正畸中的应用

目的目的探讨种植体支抗在口腔正畸中的应用。方法对在我院口腔科就诊的80例安氏Ⅱ类拔牙患者采取种植体支抗的方法进行治疗,观察治疗效果。结果本组共植入种植体154个,成功149例,成功率为96.8%。失败5例,系种植体松动、脱落,原因是牙龈局部中度和重度炎症。X线头影测量分析结果显示患者的前牙内收明显,但矫治前后的骨性指标改变没有显著性。结论种植体可以提供绝对的支抗、可辅助正畸治疗。具有操作简便灵活、即刻加力、费用低廉等优点。     

微钛板支抗的临床应用和研究进展

在正畸治疗中,支抗的正确设计和对支抗的良好控制是正畸病例治疗成败的关键。传统支抗控制方法中很难提供绝对稳定的支抗,支抗不足是限制正畸治疗的重要因素之一。近年来,各种有别于传统支抗模式的种植体支抗的开发和临床应用,使支抗得到了更加有效地控制,一些传统正畸治疗中的疑难复杂病例也可以获得理想的矫治效果。作为种植体支抗的一个主要类别,微钛板支抗也在近年来得到了充分的应用,本文主要就微钛板支抗的临床应用和研究进展作一综述。     

微钛板支抗在远中移动磨牙中的临床应用

目的介绍微钛板支抗在远中移动磨牙中的临床效果及特点。方法选择7名应用微钛板矫治患者,分析其治疗前后头颅侧位片、模型等临床资料,测量磨牙远中移动量。结果 1)利用微钛板远中移动磨牙效果明显,最多可达3.5mm。2)中轻度牙列拥挤患者利用微钛板远中移动磨牙获得间隙排齐整平牙列,不需拔除双尖牙便可达到较理想的治疗效果。结论微钛板作为一种绝对支抗,远中移动磨牙有效而稳定,同时可避免常规拔牙矫治,维持上下颌第二磨牙间的全部牙齿和牙弓的连续性。     

Anatomic site evaluation of the palatal bone for temporary orthodontic anchorage devices

Objectives: The aim of the present study was to assess the micromorphologic characteristics of the palatal bone from an implantologic standpoint.
Materials and Methods: The material consisted of tissue blocks of autopsy material from 22 subjects (18 males, three females) between 18 and 63 years of age. The specimens comprised the anterior median palatal region from 5 to 10 mm behind the incisive foramen. They were prepared in the transversal plane according to ground thin-section technology. The midpalatal area as well as an area of 3 mm bilateral to the midline were assessed, and a classification of quantitative palatal bone availability was developed.
Results: The findings could be divided into three classes: (1) class I palatal bone consists almost of compact bone; (2) class II cortical bone layer on oral and nasal sides of palate, broad compact bone in the suture area (≥3 mm), loose trabecular bone lateral to the suture area; and (3) class III cortical bone on oral and nasal side, thin compact bone in the suture area (<3 mm) and loose-structured trabecular bone lateral to the suture area. In most sections (72.7%), class I characteristics were found (16 subjects). 18.2% of sections were assigned to class II (four subjects) and only 9.1% of sections were assigned to class III (two subjects).
Conclusion: These results document that in most cases a good primary stability of temporary orthodontic anchorage devices should be achieved in the midpalatal and paramedian area of the anterior palate, as the bone quantity available is high.     

正畸治疗中磨牙的拔除和保留（五十二）——骨钉牵引全牙弓后移中的咬合打开问题探讨

目的：评价各种打开前牙咬合方法在应用骨钉牵引牙弓整体远移过程中的效果及其作用机理。方法：共选取采用骨钉进行全牙弓整体后移的病例100例,其中男性22例,女性78例,年龄12～45岁,平均19.4岁。减数第二或第三磨牙者82例,不减数者18例。所有病例均采用上颌颧牙槽嵴区及下颌外斜线区骨钉牵引全牙弓远中移动。采用不同方式打开前牙咬合。结果：以临床打开咬合的效果来看,单纯应用高弹摇椅形圆丝打开咬合效果最差,应用高弹摇椅形圆丝与平导组次之,其余组均有好的咬合打开效果,最好为NiTi方丝复合牵引钩组。结论：摇椅形唇弓不适用于应用骨钉全牙弓整体向后牵引,而NiTi方丝附复合牵引钩不仅可以产生明显的前牙咬合打开效果,同时不妨碍全牙弓的整体后移,是骨钉应用的一种重要矫治手段。     

Load-related implant reaction of mini-implants used for orthodontic anchorage

Abstract: The purpose of this study was to determine the clinical and biomechanical outcome of two different titanium mini‐implant systems activated with different load regimens. A total of 200 mini‐implants (102 Abso Anchor^® and 98 Dual Top^®) were placed in the mandible of eight Göttinger minipigs. Two implants each were immediately loaded in opposite direction by various forces (100, 300 or 500 cN) through tension coils. Additionally, three different distances between the neck of the implant and the bone rim (1, 2 and 3 mm) were used. The different load protocols were chosen to evaluate the load‐related implant performance. The load was provided by superelastic tension coils, which are known to develop a virtually constant force. Non‐loaded implants were used as a reference. Following an experimental loading period of 22 and 70 days half of the minipigs were sacrificed, and implant containing bone specimens evaluated for clinical performance and implant stability. Implant loosing was found to be statistically dependent on the tip moment (TM) at the bone rim. Clinical implant loosing were only present when load exceeded 900 cN mm. No movement of implants through the bone was found in the experimental groups, for any applied loads. Over the two experimental periods the non‐loaded implants of one type of implant had a higher stability than those of the loaded implants. Dual Top^® implants revealed a slightly higher removal torque compared with Abso Anchor^® implants. Based on the results of this study, immediate loading of mini‐implants can be performed without loss of stability when the load‐related biomechanics do not exceed an upper limit of TM at the bone rim.     

The effect of retention on orthodontic relapse after the use of small continuous or discontinuous forces. An experimental study in beagle dogs

Relapse is a major concern in orthodontics for which avoidance retention is the general procedure. However, the effect of retention on relapse after active tooth movement with different force regimes has never been studied in a standardized experimental setting. Mandibular third premolars were extracted in 19 young adult beagle dogs. Three months later, the second premolars were bodily moved distally with forces of 10 cN or 25 cN. The forces were applied for 24 h d-1 or for 16 h d-1. After 4 months, relapse was allowed in half of the animals, while in the others relapse was preceded by retention for 90 d. Statistical analyses were performed on the relation between force regime, active tooth movement, retention, and relapse. Force magnitude had no effect on relapse, while continuous forces resulted in a longer-lasting and more pronounced relapse than did discontinuous forces. A significant positive correlation was found between the amount of active tooth movement and both the rate and the total amount of relapse, but not between the amount of active tooth movement and the duration of the relapse. Retention had no effect on the duration of the relapse, but it strongly decreased its total amount. Finally, the effect of retention on the amount of relapse was strongly correlated with the amount of active tooth movement.     

MEAW技术在矫治支抗丧失病例中的临床应用

目的:探讨多曲方丝弓(MEAW)技术对矫治过程中支抗丧失病例的应用。方法:减数矫治安氏Ⅱ1病例20例,男8例、女12例,年龄17~28岁,平均21.50岁。矫治过程中均出现支抗丧失,根据支抗丧失的原因,相应地减少牵引力值或停止牵引、增加支抗,并应用MEAW技术进行磨牙调整。采用PAR(peer assessment rating)指数评估矫治效果。结果:病例完成时间平均12.68月,全部病例均达到尖牙和磨牙的I类关系,牙列排齐,前牙覆牙合覆盖正常。用PAR指数评估治疗前后的模型,有55%病例极大改善,45%病例改善。结论:MEAW技术通过改善磨牙三维方向的位置,可以快速有效地解决安氏Ⅱ1减数矫治中磨牙支抗丧失问题,重建良好的咬合关系。