牙附着式牵张成骨装置的研制及在牙槽突裂整复中的应用

目的:研制牙附着式口内牵张成骨装置整复牙槽突裂,探索牙槽突裂手术治疗的新途径。方法:自行研制牙附着式牵张装置,建立人工牙槽突裂的动物模型,8只成年杂种犬为实验组,对照组2只。以牙骨复合体作为转运盘,牵张器通过牙带环固定,并安装上颌牙弓弓丝。术后第7 d起,以每次0.4 mm的速度,每日2次沿弓丝方向行三维牵张成骨,直到关闭硬组织裂隙。0、14、28、63 d各处死动物2只,对照组动物在建立牙槽突裂模型12周后处死。进行X线摄片、大体标本和组织学观察。结果:利用牙附着式牵张装置,成功地进行牙槽突裂牵张成骨整复术,牙槽突硬组织裂隙关闭;骨牵张间隙完全为新生骨组织取代。结论:自行研制的牙附着式口内牵张装置设计合理,应用良好,牵张成骨提供了牙槽突裂治疗的新途径。     

正畸辅助水平向牵张成骨治疗牙槽突裂的临床探讨

目的探讨正畸辅助水平向牵张成骨治疗牙槽突裂的临床效果。方法单侧完全性牙槽突裂患者3例,缺损区域远中节段性截骨,保留其血液供应形成一含牙及种植支抗的骨运送盘,牵引骨运送盘向裂隙侧移动,运用牵张成骨的原理修复牙槽骨缺损。结果牙槽骨软硬组织缺损区完全闭合,牵张区新骨形成良好,支抗牙无明显松动及移位,牙髓活力测试正常,种植支抗稳定无松脱。结论采用正畸辅助水平向牵张成骨修复牙槽突裂临床可行。     

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。     

使用钛镍记忆合金牵张器时截骨方式的选择

目的　比较不同截骨方式对钛镍记忆合金牵张器牵张增高牙槽嵴的影响。方法　 10只成年杂种犬随机分为 3组。Ⅰ组截骨时保留舌侧部分骨皮质 ,Ⅱ组完全截骨 ,使用牵张器增高牙槽嵴 ;Ⅲ组为内固定器对照组。各组动物下颌骨左侧为实验侧 ,右侧为空白对照侧。连续测量术区颌骨高度 ,摄X线片 ,3个月后处死动物 ,进行组织学观察。结果　Ⅰ、Ⅱ组牙槽嵴均增高 ,3个月时牵张区骨密度与周围牙槽骨接近。Ⅱ组比Ⅰ组初始牵张间隙大 ,增高高度大 ,但牵张区颊舌侧均有较明显凹陷 ,而Ⅰ组牵张区形态接近正常颌骨。结论　采用保留舌侧部分骨皮质的不完全截骨方式 ,更适于使用记忆合金牵张器的牙槽嵴增高术     

牙槽突裂植骨术后上颌前部(牙合)片与CBCT评价方法的比较研究

目的 比较三维CBCT与传统上颌前部(牙合)片评价牙槽突裂植骨疗效的差异性.方法 选择唇腭裂二期牙槽突裂植骨术后三个月以上的患者39人,共计49侧裂隙.同期拍摄以裂隙为中心的上颌前部(牙合)片和牙槽突局部CBCT,根据Bergland分级标准对上颌前部(牙合)片进行植骨区牙槽突评价,并与CBCT评价结果进行比较,判断两者一致性.结果 20侧植骨区牙槽突高度为Bergland Ⅰ型和18侧BerglandⅡ型者中,牙槽突厚度分级为A1B1C1D1型者分别有9侧(45.00％)和3侧(16.67％).在上颌前部(牙合)片的评价中,45.00％ Bergland Ⅰ型和16.67％ BerglandⅡ型患者植骨区牙槽突情况与CBCT评价结果一致.55.00％ BerglandⅠ型和83.33％ BerglandⅡ型患者植骨区牙槽突情况被高估.结论 三维CBCT与传统上颌前部(牙合)片对牙槽突裂植骨疗效评价结果不一致.CBCT可以更好的评价牙槽突裂植骨疗效.     

牙槽突裂植骨术研究进展

本文阐述了牙槽突裂植入骨的来源,认为自体骨如髂骨仍是最佳材料。有研究应用重组人骨形成蛋白、小牛骨粉及生物胶原膜、组织工程成骨材料修复牙槽突裂取得一定效果。术前适当的正畸治疗对于部分牙槽突裂患者相当重要,术后正畸也必不可少。影响牙槽突裂移植骨成活率的原因较多,包括适应证的选择、手术时机及手术技巧等。应用三维CT评价牙槽突裂植骨较以往的牙片可以获得更全面的信息。     

脱钙人牙基质材料联合髂骨与单纯髂骨移植修复牙槽突裂的对比性研究

目的:研究牙槽突裂植骨修复的新方法.方法:A组62 例(74 侧)牙槽突裂患者采用单纯髂骨松质骨移植修复牙槽突裂,B组26(30 侧)例采用自体髂骨松质骨混合脱钙人牙基质材料植入牙槽突裂术区.对2 组88 例牙槽突裂患者,均于术前、术后1 周,1、2、3、6 个月和1 年摄全口曲面断层X线片及上颌前部咬合X线片,结合临床,观察骨愈合、骨吸收的情况及伤口愈合情况,根据术后3 月X线片,按Bergland等的评价标准进行分级,对2 组不同植骨材料的术后效果进行总结分析. 结果:A组Ⅰ级17 例17 侧(23%),Ⅱ级17 例20 侧(27%),Ⅲ级13 例14侧(19%),Ⅳ级15 例23 侧(31%);植入骨成活率为68.9%,临床成功率为50%.B组Ⅰ级 16侧(53%),Ⅱ级8 侧(26%),Ⅲ级4 侧(13%),Ⅳ级2 侧(6%);植入骨成活率为93.3%, 临床成功率为80%.结论: 采用脱钙人牙基质材料联合髂骨松质骨修复牙槽突裂,骨诱导作用明显,能减少骨的吸收,加速新骨形成,比单独应用髂骨植骨能明显提高临床成功率.     

下颌牵张成骨中髁突Ⅲ型胶原的免疫组化研究

目的 :观察下颌牵张成骨中髁突胶原的变化特征 ,探讨牵张成骨对关节软骨的影响。方法 :采用sabc免疫组化方法检测幼年狗在下颌双侧牵张成骨固定期的不同阶段 (0周、2周、4周、8周 )Ⅲ型胶原分布及含量的变化。结果 :Ⅲ型胶原的表达随时间的延长逐渐增加 ,至 4周达到顶峰 ,随后逐渐减弱。结论 :在下颌双侧牵张成骨中 ,幼年狗颞下颌关节发生适应性改建 ,表现为软骨细胞合成及分泌胶原的能力发生改变。     

自体颏骨、Bio-Oss骨粉、胶原膜联合修复牙槽裂

目的 研究唇腭裂术后牙槽裂植骨修复的新方法。方法 21例牙槽裂患者，取自体颏骨松质骨并与骨替代材料Bio-Oss松质骨颗粒混合后植入牙槽裂术区，在植入骨表面覆盖Bio-Gide胶原膜。Bio-Oss松质骨起弥补颏骨取骨量不足、支撑牙槽裂宽度和高度的作用，胶原膜对植入骨组织及周围血凝块有良好屏障保护作用，通过3种材料的优势组合，共同促进牙槽裂术区骨组织的重建。结果 21例患者术后伤口均获一期愈合，口鼻瘘得以严密关闭。随访6个月～3年，重建牙槽突外形和功能Ⅰ级10例，Ⅱ级8例，Ⅲ级2例，Ⅳ级1例。20例术后顺利进行后续正畸或正颌手术治疗，1例需再次进行植骨手术。结论 自体颏骨松质骨、Bio-Oss松质骨颗粒、Bio-Gide胶原膜联合应用修复唇腭裂术后牙槽裂具有方便可行、骨生成潜能好、患者痛苦少、容易被接受的优点。     

唇腭裂上颌前段牵张成骨的三维有限元分析

目的:应用有限元方法获得唇腭裂患者牙槽突裂植骨区不同骨吸收情况下颅上颌复合体对上颌前段牵张成骨的生物力学特性,为临床应用上颌前段牵张成骨纠正唇腭裂继发上颌发育不足提供理论依据。方法:采用三维有限元法,建立单侧完全性唇腭裂患者颅上颌复合体模型,模拟上颌骨前段截骨、牙槽突裂植骨及骨吸收,选取双侧第一前磨牙牙颈部节点加载位移6 mm、0.5 mm,分别用于位移规律和应力分布分析。结果:植骨不吸收时,健、患侧矢状前移和上颌骨前段逆时针旋转运动对称性、牙弓形态横向稳定性、植骨区两端高度一致性、骨缝应力分布均匀性最佳;植骨吸收部位越接近下方、吸收量越多时,健、患侧不对称前移、牙弓变形、植骨区台阶越明显。结论:植骨吸收部位越接近下方、吸收量越多时,上颌前段牵张成骨效果越差。     

Variation in periodontal referral in 2 regions in theUK

This study investigated the periodontal referral patterns of general dental practitioners (GDPs) in Northern Ireland (NI) and North West England (NWE). A questionnaire dealing with periodontal referral was sent to all 520 GDPs registered in NI and to 274 GDPs in NWE. A usable return was made by 355 (68%) in NI and 189 (70%) in NWE. The NI dentists made significantly more periodontal referrals (median 5, range 0-80) in the year preceding the survey than those in NWE (median 2, range 0-50), p<0.001. Distance was the only factor significantly related to the referral rate in both regions with those who practised more than 25 miles from a specialist referring significantly fewer patients in both regions. In NI, there was a trend towards increased periodontal referral by GDPs who had attended more postgraduate courses; however, in NWE, this was not the case. The GDPs in NWE were significantly less likely than those in NI to refer patients with medical conditions. It is concluded that there is considerable variation in periodontal referral both within and between the 2 regions studied. It is further concluded that in many cases, non-disease factors, such as the accessibility of the specialist service, have powerful effects on the decisions made by dentists and patients in these regions (NI and NWE) in relation to periodontal referral. Much of the variance in referral in North West England, as in Northern Ireland, remains unexplained.     

Trends in socioeconomic disparities in oral health in Brazil and Sweden

Celeste RK, Nadanovsky P, Fritzell J. Trends in socioeconomic disparities in oral health in Brazil and Sweden. Community Dent Oral Epidemiol 2011; 39: 204–212. © 2010 John Wiley & Sons A/S Abstract – Objectives: To describe the dynamics of trends in socioeconomic disparities in oral health in Brazil and Sweden among adults, to assess whether trends follow expected patterns according to the inverse equity hypothesis. Methods: In Sweden, we obtained nationally representative data for the years 1968, 1974, 1981, 1991 and 2000, and in Brazil, for 16 state capitals in 1986 and in 2002. Trends in the prevalence of ‘edentulism’ and of ‘teeth in good conditions’ were described in two groups aged 35–44 with lower and higher economic standards, respectively. Results: There was an annual decline in disparities in ‘edentulism’ of 0.4 percentage points (pp) (95% CI = 0.2–0.7) in Brazil and 0.7pp (95% CI = 0.5–0.9) in Sweden, as a result of improvements in both income groups. Concerning ‘teeth in good conditions’, in Brazil, there was improvement only in the higher income group and absolute disparities have increased (0.5pp annually), while in Sweden, there was a nonsignificant decrease (0.3pp annually) with improvements in both groups. Since 1991 in Sweden and in 2002 in Brazil, our measures of socioeconomic disparities in ‘edentulism’ were not statistically significant. Trends did not differ by sex or dental visit. Conclusions: Despite improvements in both income groups and a decrease in disparities in ‘edentulism’, the poorer group in Brazil has seen no improvement in ‘teeth in good conditions’ and disparities have increased. It appears that Brazil and Sweden reflect different stages of trend for ‘teeth in good conditions’ and the same stages for ‘edentulism’, represented by the inverse equity hypothesis.     

Fluorosis in relation to fluoride levels in water in central Nigeria

Abstract– Objectives : This study was conducted to examine the prevalence of dental fluorosis in relation to fluoride levels in water among children aged 12–15 years in the states of Plateau and Bauchi, Nigeria. Methods : Children ( N =203) were examined using WHO criteria. The children were from two schools and permanent residents of the communities in which the schools are located (Tilden Fulani and Kanadap). Intra-examiner reliability for determining fluorosis scores was 80%. Results : Fluoride levels in the water ranged from 0.0–0.4 mg/L. Prevalence of dental fluorosis in the sample was 51%. Forty-one percent had very mild fluorosis, 7% had mild fluorosis and 3% had moderate to severe fluorosis. The lowest DMFT was observed in the school where the fluoride level of the water ranged between 0.0 and 0.4 mg/L, and in the group with very mild fluorosis. Conclusion : Fluoride levels in water for central Nigeria were appropriate for oral health. In the areas where the children were permanent residents, factors other than the fluoride levels of the water contributed to the severity of dental fluorosis.     

Trends in endodontic claims in Italy

According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico‐legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re‐treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out‐of‐court settlements.     

Human Herpesviridae in acute necrotizing ulcerative gingivitis in children in Nigeria

Herpesviruses have been implicated in the pathogenesis of human periodontitis. The present study investigated whether herpeasviruses are present in the lesions of acute necrotizing ulcerative gingivitis. Sixty-two Nigerian children, aged 3–14 years, were studied. Twenty-two children had acute necrotizing ulcerative gingivitis and were also malnourished, 20 exhibited no acute necrotizing ulcerative gingivitis but were malnourished, and 20 were free of acute necrotizing ulcerative gingivitis and in a good nutritional state. Polymerase chain reaction methods were used to determine the presence of human cytomegalovirus (HCMV), Epstein-Barr virus type 1 and type 2 (EBV-1, EBV-2), herpes simplex virus (HSV), human herpes virus 6 (HHV-6), human papilloma virus and human immunodeficiency virus type 1 in crevicular fluid specimens collected by paper points. Of the 22 acute necrotizing ulcerative gingivitis patients, 15 (68%) revealed viral infection and 8 (36%) viral coinfection. Thirteen (59%) acute necrotizing ulcerative gingivitis patients demonstrated HCMV, 6 (27%) EBV-1, 5 (23%) HSV and 1 (5%) HHV-6. Only 2 (10%) subjects from each group not affected by acute necrotizing ulcerative gingivitis showed viral presence, and no control subject revealed viral coinfection. These findings suggest that HCMV and possibly other herpesviruses contribute to the onset and/or progression of acute necrotizing ulcerative gingivitis in malnourished Nigerian children.     

Changes in caries prevalence in Japan

In Japan, the mean DMFT at 12 years of age increased from 2.8 in 1957 to 5.9 in 1975. From the 1981 survey (DMFT=5.43), conversely, the mean DMFT decreased and reached 3.64 in 1993. The increase in caries prevalence can, without doubt, be explained by an increment of sugar consumption, since the intake of sugar increased after World War II and exceeded 18.25 kg/year (50 g/day) in 1965 and reached a maximum value (29.3 kg/year) in 1973 in Japan. On the other hand, the reason why the DMFT has decreased since 1981 is not clear. In many industrialized countries, a caries reduction has been achieved with acceptable fluoride exposure, although sugar consumption was still at a high level. However, fluoride usage was still limited during the last 2 decades in Japan. There is no community where fluoridated drinking water has been supplied since 1972. Fluoride tablet use was also discontinued for children in the 1970s. Fluoride mouthrinsing programs were available for only 19r of school children in 1992. Moreover, the market share of fluoridated dentifrices stayed at 10% until 1986 and became 30% only in 1988. An excellent correlation (r=0.91; P 0.01) is observed between the DMFT in 12-year-olds and per capita sugar consumption per year between 1957 and 1987 in Japan.     

Advances in local anesthesia in dentistry

Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.     

Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro

Jäger A, Götz W, Lossdörfer S, Rath‐Deschner B. Localization of SOST/sclerostin in cementocytes in vivo and in mineralizing periodontal ligament cells in vitro. J Periodont Res 2009; doi: 10.1111/j.1600‐0765.2009.01227.x. © 2009 John Wiley & Sons A/S Background and Objective: Cementum and bone are rather similar hard tissues, and osteocytes and cementocytes, together with their canalicular network, share many morphological and cell biological characteristics. However, there is no clear evidence that cementocytes have a function in tissue homeostasis of cementum comparable to that of osteocytes in bone. Recent studies have established an important role for the secreted glycoprotein sclerostin, the product of the SOST gene, as an osteocyte‐derived signal to control bone remodelling. In this study, we investigated the expression of sclerostin in cementocytes in vivo as well as the expression of SOST and sclerostin in periodontal ligament cell cultures following induction of mineralization. Material and Method: Immunolocalization of sclerostin was performed in decalcified histological sections of mouse and human teeth and alveolar bone. Additionally, periodontal ligament cells from human donors were cultured in osteogenic conditions, namely in the presence of dexamethasone, ascorbic acid and β‐glycerophosphate, for up to 3 wk. The induction of calcified nodules was visualized by von Kossa stain. SOST mRNA was detected by real‐time PCR, and the presence of sclerostin was verified using immunohistochemistry and western blots. Results: Expression of sclerostin was demonstrated in osteocytes of mouse and human alveolar bone. Distinct immunolocalization in the cementocytes was shown. In periodontal ligament cultures, following mineralization treatment, increasing levels of SOST mRNA as well as of sclerostin protein could be verified. Conclusion: The identification of SOST/sclerostin in cementocytes and mineralizing periodontal ligament cells adds to our understanding of the biology of the periodontium, but the functional meaning of these findings can only be unravelled after additional in vitro and in vivo studies.