术前正畸对颞下颌关节关节盘及髁突位置和形态的影响

目的 探讨术前正畸对颞下颌关节关节盘及髁突位置和形态的影响。方法 选择骨性错畸形患者30例,在颞下颌关节磁共振图像上进行测量。通过关节间隙测量,判定髁突位置;通过髁突头长度、宽度和高度测量,判定髁突形态;关节盘位置和形态由直接观察判定,采用SPSS 24.0软件包对所得数据进行统计学分析,比较骨性Ⅰ、Ⅱ和Ⅲ类畸形患者在术前正畸前、后关节盘及髁突位置和形态变化。结果 术前正畸前、后关节间隙和关节间隙指数,髁突头长度、宽度和高度、关节盘前移角及关节盘形态差异均无统计学意义（P>0.05）。结论 术前正畸治疗不会导致骨性错畸形患者关节盘及髁突位置和形态改变。     

术前正畸对完全性唇腭裂牙槽突植骨疗效的影响

目的　探讨牙槽突植骨术前正畸治疗对于完全性唇腭裂牙槽突植骨长期疗效的影响。方法　选择牙弓狭窄、上颌前牙舌倾或扭转 ,可以伴有前牙反 \ ,牙槽突植骨手术不易进行的完全性唇腭裂患者 16例 ,男 9例 ,女 7例。其中单侧完全性唇腭裂 10例 ,双侧完全性唇腭裂 6例 ,共有裂隙 2 2侧 ,患者年龄 8～ 2 2岁。在牙槽突植骨前进行正畸治疗 ,植骨术后定期拍摄上颌体腔片或上颌前部咬合片 ,观察植骨疗效 ,手术后观察期为 0 5～ 4年。牙槽骨高度的评价采用Bergland标准进行。结果　术前正畸 ,特别是通过开展狭窄的上牙弓 ,能够使因存在错畸形而不易进行牙槽突植骨的唇腭裂患者顺利完成手术 ,牙槽突植骨的临床成功率达 86 %。结论　对于上牙弓狭窄 ,错畸形严重的完全性唇腭裂患者 ,应该在植骨手术前进行正畸治疗。     

Chromatic appreciation in the clinic and the laboratory

Aesthetic requirement in dentistry is getting more and more important every day. One of its basic principles is the correct selection of colour for the restorations. Colour is a quality which is modulated by a series of factors, environmental and individual, that the clinic must know. Colour measurement by the human eye can induce to an appreciation mistake if it doesn't follow a correct protocol of light conditions and observation technique, checked by the authors, simplifying it with a practical focusing. Colour measurement instruments have appeared recently, trying to correct the problems of conventional technique.     

The effects of palatoplasty and pre-surgical infant orthopedic treatment on occlusion in unilateral cleft lip and palate patients

PurposeThe aim of this study was to evaluate the effect of pre-surgical infant orthopedic treatment (Hotz plate) and type of palatoplasty on the dental arch relationship and the dental arch morphology of unilateral cleft lip and palate (UCLP) patients.Materials and methodsSeventy-four children with UCLP were divided into three groups. One group had undergone one-stage palatoplasty without Hotz plate (OSP w/o H), the second had undergone one-stage palatoplasty with Hotz plate (OSP w/H), and the third had undergone two-stage palatoplasty with Hotz plate (TSP w/H). We evaluated the dental models which were taken during initial examination at our orthodontic clinic, using the Goslon Yardstick, the 5-year-old index, and dental model analysis.ResultsRegarding both indices, there were no significant differences among the three groups. However, the dental arch width between maxillary deciduous canines in OSP w/H and TSP w/H was significantly greater than that of OSP w/o H. The dental arch width at the maxillary deciduous second molars in TSP w/H was significantly greater than in OSP w/H and OSP w/o H.ConclusionDental arch relationship in UCLP patients was not influenced by the type of palatoplasty and the use of pre-surgical infant orthopedic treatment. Our results suggest that pre-surgical infant orthopedic treatment results in the increase of anterior dental width, whereas two-stage palatoplasty is significantly effective for increasing posterior dental width in UCLP patients.     

Assessment of bruxism in the clinic

Bruxism is a much-discussed clinical issue in dentistry. Although bruxism is not a life-threatening disorder, it can influence the quality of human life, especially through dental problems, such as tooth wear, frequent fractures of dental restorations and pain in the oro-facial region. Therefore, various clinical methods have been devised to assess bruxism over the last 70 years. This paper reviews the assessment of bruxism, provides information on various assessment methods which are available in clinical situations and discusses their effectiveness and usefulness. Currently, there is no definitive method for assessing bruxism clinically that has reasonable diagnostic and technical validity, affects therapeutic decisions and is cost effective. One future direction is to refine questionnaire items and clinical examination because they are the easiest to apply in everyday practice. Another possible direction is to establish a method that can measure actual bruxism activity directly using a device that can be applied to patients routinely. More clinical studies should examine the clinical impact of bruxism on oral structures, treatment success and the factors influencing the decision-making process in dental treatment.     

术前正畸联合可吸收胶原生物膜用于牙槽突裂植骨修复30例分析

目的探讨术前正畸联合术中应用可吸收胶原生物膜对单侧牙槽突裂植骨效果的影响。方法选择牙弓狭窄、上颌前牙舌倾或扭转、牙槽突裂隙不规则、难以进行牙槽突裂植骨术的单侧完全性牙槽突裂患者30例,年龄9-13岁,先进行植骨前正畸治疗,再应用髂骨松质骨加可吸收胶原生物膜覆盖行植骨修复,术后定期拍X线片检查,观察植骨效果。牙槽骨高度评价标准采用Bergland标准进行,术后观察期为1—3年。结果30例患者术后成骨情况I型11例,Ⅱ型17例,植骨成功率达93．3％。结论对于上颌牙弓狭窄、牙槽突裂隙不规则、牙颌畸形严重的牙槽突裂患者,建议先行植骨前正畸治疗,植骨术中联合应用可吸收胶原生物膜可有效提高植骨成功率。     

Transmission of HIV in the dental clinic and elsewhere

This review focuses on the risk of transmission of HIV in dental practice in developed and developing countries; and as a result of oral sex, perinatal transmission and breast feeding. Postexposure prophylaxis (PEP) and practical measures to control cross-infection with TB are also discussed. There are few data from resource-poor countries where prevalence of HIV and risk of infection are higher – issues that deserve priority. Available information indicates that the risk of HIV transmission in the dental office is very low. Transmission of HIV from three healthcare workers to patients has been confirmed, including a dentist who infected six patients. There are >300 reports (102 confirmed) of occupational transmission to healthcare workers, including nine dental workers (unconfirmed). Exposure to HIV has been reported by 0.5% dentists/year. The risk of HIV infection after percutaneous exposure (0.3%) can be reduced by 81% with zidovudine PEP. However, risk assessment is required to assess the need and appropriate regimen. The risk of HIV transmission associated with orogenital sex exists, but is considered extremely low: barrier protection is recommended. Conversely, the proportion of babies who acquire HIV from untreated HIV-seropositive mothers is 15–25% in developed countries and 25–45% in developing countries. The frequency of HIV transmission attributable to breastfeeding is 16%. Airborne transmission of TB can be avoided by the prompt referral of known/suspected cases of active TB for chemotherapy, deferral of elective procedures until patients are not infectious, and the use of appropriate standard/isolation precautions including adequate ventilation of treatment areas.     

The effects of an immediately pre-surgical chlorhexidine oral rinse on the bacterial contaminants of bone debris collected during dental implant surgery

Dental implant surgery produces bone debris that can be used in the "simultaneous augmentation" technique. Although this debris is contaminated with oral bacteria, a stringent aspiration protocol has been shown to reduce the levels of contamination. Chlorhexidine mouthrinse is a well-proven antibacterial rinse that has been shown to reduce infectious complications associated with dental implants. This study examined the effect of pre-operative rinsing with a 0.1% chlorhexidine digluconate mouthrinse on the bacterial contaminants present in collected bone debris bone (CBD). Twenty partially edentate patients were randomly allocated into equal groups and underwent bone collection using the Frios Bone Collector (FBC) during the insertion of two dental implants. In group T a pre-operative chlorhexidine rinse was used, whilst in group C sterile water was used. For both groups, a stringent bone collection protocol was used. Bone samples were immediately transported for microbial analysis. Colonial and microscopic morphology, gaseous requirements and identification kits were utilised for identification of the isolated microbes. Thirty-nine species were identified including a number associated with disease, in particular Actinomyces odontolyticus, Clostridium bifermentans, Prevotella intermedia, and Propionibacterium propionicum. Samples from group T (chlorhexidine mouthrinse) yielded significantly fewer organisms (P < 0.001) than in group C (sterile water mouthrinse). Gram-positive cocci dominated the isolates from both groups. It is concluded that if bone debris is to be used for the purpose of immediate simultaneous augmentation, a preoperative chlorhexidine mouthrinse should be utilised in conjunction with a stringent aspiration protocol to reduce further the bacterial contamination of CBD.     

鳃裂畸形的临床分析

目的 深入了解鳃裂畸形的特点。方法 对85例鳃裂畸形进行分析，并结合文献进行探讨，结果鳃裂畸形的行烃比较，B超、CT、直接喉镜等可帮助其诊断，治疗以手术为主。结论 鳃裂畸形以手术切除为主，应注意鉴别鳃裂癌与转移至鳃裂囊肿附近的癌肿，无足够的语气表明鳃裂囊肿能够恶变。     

术前正畸对骨性Ⅲ类错颌患者颞下颌关节影响的锥形束CT研究

目的 探讨术前正畸对行正畸-正颌联合治疗的骨性Ⅲ类错颌患者颞下颌关节（TMJ）的影响。方法 选取24例行正畸-正颌联合治疗的骨性Ⅲ类错颌患者,分别在术前正畸完成前后检查并记录关节症状,并行锥形束CT（CBCT）扫描,在三维方向测量髁突各径值（d）、髁突高度（h）、不同角度下关节间隙（L）、双侧髁突间距（R）及各髁突角度值,比较和分析不同时期TMJ症状及骨性结构的变化情况。结果 术前正畸前后关节症状无明显改变;颞下颌关节骨性结构在三维方向上的各测量指标均无显著变化（P>0.05）。结论 在正畸-正颌联合治疗过程中,术前正畸不会对患者TMJ产生明显影响。     

术前鼻牙槽塑形术对婴儿期单侧完全性唇腭裂颌面三维形态影响的初步研究

目的研究婴儿期单侧完全性唇腭裂修复术前鼻牙槽塑形术及唇裂修复术期间颌面部表面形貌发育变化情况。 方法临床征集2019—2021年间南京市口腔医院口腔修复科收治单侧完全性唇腭裂患儿,筛选出10例纳入研究（6例男婴、4例女婴）,首次就诊均为出生后2周内,即行术前鼻牙槽塑形术,约3个月龄时行唇裂修复手术;治疗期间连续定期应用3dMD面部三维系统进行颌面部表面扫描,术前矫治期内时间点选择以每隔2周为1个临床记录时间（即患儿出生后第2、4、6、8、10和12周）,后续以唇裂修复手术后1周、术后6个月各为1个记录时间点,共计8个时间节点。每次收集唇腭裂患儿面部14个软组织标志点信息,并进一步分成唇部生长发育指标、鼻部生长发育指标和鼻部畸形发育指标三部分,并采用SPSS 19.0应用配对t检验对数据进行统计学分析。 结果鼻翼长度（ac′-prn）由（18.5 ± 1.6）mm减小为（17.1 ± 1.0）mm,差异有统计学意义（t = 4.03,P = 0.003）,鼻底宽度（sbal′-sn）由（20.5 ± 3.5）mm减小为（17.7 ± 3.3）mm,差异有统计学意义（t = 3.91,P = 0.004）,鼻小柱高度（sn″-c′）由（1.8 ± 0.4）mm增加为（4.7 ± 0.6）mm,差异有统计学意义（t = 4.12,P = 0.003）,矫治术前、术后对比差异均具有统计学意义;唇裂修复术后1周,患侧指标鼻小柱高度（sn″-c′）由（4.7 ± 0.6）mm增加为（5.8 ± 0.6）mm,差异有统计学意义（t = 3.41,P = 0.008）,唇高唇长增加,鼻底宽度及鼻翼长度减小,鼻小柱偏斜角度（∠α）由（29.0 ± 12.7）°减小为（5.3 ± 3.4）°,差异有统计学意义（t = 6.34,P<0.001）,健侧指标唇裂术前、术后差异均无统计学意义（P>0.05）。唇裂修复术后6个月,健侧唇部和鼻部生长发育指标保持增长趋势,患侧指标则基本保持不变。 结论术前矫治期间单侧完全性唇腭裂患儿鼻小柱高度逐渐增加、鼻翼形态改善明显,而患侧唇部和健侧鼻唇部生长发育未受限制,唇裂修复术后单侧完全性唇腭裂患儿健患侧鼻唇三角区形态对称性提高,并于术后6个月可保持治疗效果。     

A comparative clinical study of temporomandibular disorder patients in the otolaryngology clinic versus a rheumatology clinic

Objective Temporomandibular disorders (TMD) may be associated with local or widespread symptoms, including pain. The aim of this study was to compare clinical features of TMD patients presenting to an otolaryngology clinic with TMD patients presenting to a rheumatology clinic.

Methods The study included 107 patients in the otolaryngology setting and 103 patients in the rheumatology setting. A comparison between both groups was made regarding the clinical data.

Results Patients in the otolaryngology setting featured more otological symptoms, compared with those in the rheumatology setting. Otological symptoms were affirmed in 70 patients (65.4%) in the otolaryngology setting but in only 18 patients (17.5%) in the rheumatology setting (p = 0.001). Patients in the rheumatology setting showed more structural TMJ changes, compared with those in the otolaryngology setting (p < 0.01).

Conclusion Patients presenting to the otolaryngologist may clinically and pathologically represent a different cohort from those presenting to the rheumatologist.