Correlations between initial cleft size and dental anomalies in unilateral cleft lip and palate patients after alveolar bone grafting

Objective To determine in individuals with unilateral cleft lip and palate the correlation between initial cleft size and dental anomalies, and the outcome of alveolar bone grafting.

Methods A total of 67 consecutive patients with non-syndromic unilateral complete cleft lip and palate (UCLP) were included from the cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. All patients were operated by the same surgeon and treated according to the Uppsala protocol entailing: lip plasty at 3 months, soft palate closure at 6 months, closure of the residual cleft in the hard palate at 2 years of age, and secondary alveolar bone grafting (SABG) prior to the eruption of the permanent canine. Cleft size was measured on dental casts obtained at the time of primary lip plasty. Dental anomalies were registered on radiographs and dental casts obtained before bone grafting. Alveolar bone height was evaluated with the Modified Bergland Index (mBI) at 1 and 10-year follow-up.

Results Anterior cleft width correlated positively with enamel hypoplasia and rotation of the central incisor adjacent to the cleft. There was, however, no correlation between initial cleft width and alveolar bone height at either 1 or 10 years follow-up.

Conclusions Wider clefts did not seem to have an impact on the success of secondary alveolar bone grafting but appeared to be associated with a higher degree of some dental anomalies. This finding may have implications for patient counseling and treatment planning.     

磨牙位点保存后进行种植修复及软组织增量的1例报告

临床上,常规拔牙后牙槽骨的自然愈合存在不同程度的牙槽骨吸收［1］,影响未来的种植体植入修复位置,角度及软、硬组织处理。研究表明,采取微创拔牙和位点保存技术可以减少牙槽骨吸收,显著保留牙槽嵴宽度及高度［2-3］,减少或避免种植治疗同期实施复杂的植骨手术。另有文献指出,种植体周围至少需要2 mm的角化龈及1 mm的附着龈,方能维护种植体周围组织健康,获得长期稳定疗效。本研究完整展示了1例针对牙周 牙髓联合病变磨牙的病情分析,采取微创拔牙结合位点保存和游离龈移植术创造良好软、硬组织条件,获得最终较好种植修复效果的具体实施步骤,积累了针对此类问题的临床经验。     

抗菌性正畸粘接剂的研究进展

固定矫正器以其高效性和精确性受到广大医师的青睐,近年来得到广泛的临床应用。牙釉质脱矿是固定正畸治疗的主要合并症,不仅违背了正畸治疗的美观原则,而且还有损牙体健康,因而牙釉质脱矿现象是正畸医师不容忽视的问题。托槽通过粘接剂固定于牙面上,如果正畸粘接剂具有抗菌性能,则可以有效地预防牙釉质脱矿的发生,本文就抗菌性正畸粘接剂的最新研究进展做以下概述。     

三种数字化分析算法测量咬合接触分布及面积的对比研究

目的:研究三种数字化分析算法测量石膏牙颌模型三维咬合接触分布及面积的检测效果,并与传统咬合分析方法进行比较,探究各数字化分析算法的特点和应用。方法:选取一副正常受试者的上、下颌石膏牙颌模型,使用3shape E4牙颌模型三维扫描仪进行数字化扫描得到数字模型,在三维测量分析软件Geomagic Studio 2013及Geomagic Qualify 2013中采用“三维偏差色阶图法”、“点云统计分析法”和“虚拟咬合纸法”三种数字化分析算法获得相应的三维咬合接触分布及面积,同时使用牙合记录硅橡胶法及咬合纸扫描法两种传统咬合分析方法获得咬合接触分布和面积。各方法的咬合检测阈值为100 μm,量化评价各数字化分析算法与传统咬合分析方法的检测结果。结果:上述五种方法所得的全牙列咬合接触分布的定性评价结果基本一致,三维偏差色阶图法、点云统计分析法、虚拟咬合纸法、牙合记录硅橡胶法和咬合纸扫描法所得到的总咬合接触面积分别为133.10 mm ²、142.08 mm ²、128.95 mm ²、163.31 mm ²、100.55 mm ²。三种数字化分析算法间的检测结果差异性不大,数字化方法与传统方法检测的总咬合接触面积有一定差异。结论:三种数字化分析算法均可提供较为可靠、准确的牙颌模型咬合接触分布及面积量化分析结果,可为口腔临床修复体数字化设计制作及咬合分析提供参考。     

种植体黏膜下微生物在健康种植体和种植体周炎中的构成与差异：一项横断面研究

目的：探索种植体黏膜下微生物在健康种植体和种植体周炎中的构成与差异,并分析与临床指标存在相关性的菌种,为种植体周炎的病因学研究提供参考。方法：采用横断面研究,共纳入49例患者,20例为健康种植体,29例为种植体周炎,共采集49份黏膜下微生物样本进行16S核糖体RNA(16S ribosomal RNA, 16S rRNA)基因高通量测序。对两组样本的多样性、菌群构成和差异物种进行分析和比较,采用Spearman相关性分析评价菌种与探诊深度(probing pocket depth, PPD)之间的相关性。结果：健康组的α多样性显著低于种植体周炎组[Chao1指数：236.85±66.13 vs. 150.54±57.43,P<0.001; Shannon指数：3.42±0.48 vs. 3.02±0.65,P=0.032]。主成分分析显示,两组样本的群落结构差异有统计学意义[相似性分析(analysis of similarities, ANOSIM),R²=0.243,P=0.001]。与健康种植体相比,种植体周炎黏膜下菌斑中的牙周致病菌显著增加,包括红色...     

两种种植体支持式下颌半口固定义齿种植体应力有限元分析

目的 设计两种种植体支持式下颌半口全牙列固定义齿,研究在不同下颌骨垂直高度降低情况下种植体应力分布情况.方法 利用锥束计算机断层扫描成像(CBCT)扫描下颌骨及上部义齿,形成下颌骨基准模型,将基准模型中下颌骨垂直高度分别下降0、5、10和15mm,组装种植体后,建立颏孔前6枚平行种植体支持和“All-on-four”支持的不同下颌骨垂直高度的种植体有限元模型,分别为6-种植体模型和4-种植体模型,共两组(8个).在右下颌第一磨牙中央窝静态加载250 N垂直力,用Ansys 15.0软件进行模型各部分的应力分析.结果 在相同的加载条件下,种植体最大应力值位于颈部;两组8个模型最大应力值分布显示,不同下颌骨垂直高度下4-种植体组的最大应力值在40.12～49.06MPa之间,6-种植体组的最大应力值在80.62～109.64MPa之间;6-种植体组的最大应力值是4-种植体组的2倍.两组模型中种植体最大应力在下颌骨垂直高度降低5mm时均表现为最低,随着下颌骨垂直高度降低,应力逐渐增大,而垂直高度下降0mm的模型最大应力要略大于下降5 mm模型.结论 4-种植体和6-种植体支持的无牙颌固定义齿在相对极端的载荷下种植体都没有出现破坏性应力,4-种植体有着更加合理的应力分布;下颌骨垂直高度下降5mm组应力最小,说明适当降低垂直高度有利于种植体应力更加合理的分布.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

The Role of the Template in Prosthetically Guided Implantology

In prosthetically guided implantology, where ideal placement of implants is determined by the definitive restoration, the use of a radiographic/surgical template plays an essential role. This article describes how to fabricate a radiographic/surgical template to be used for radiographic diagnosis of the selected implant sites and as a guide during surgery for the insertion of the implant with correct angulation.     

Is antibiotic prophylaxis to prevent infective endocarditis worthwhile?

Infective endocarditis (IE) is a rare condition which is associated with considerable morbidity and mortality. Almost 100 years ago, the links between endocarditis and procedures, particularly dental procedures, were postulated. Over 50 years ago the first guidelines recommending antibiotic prophylaxis (AP), with the aim of preventing IE developing after procedures, were proposed. However, there has only ever been circumstantial evidence in humans that AP prevents IE. The rarity of IE has made a randomised controlled clinical trial impractical to date. This article outlines the history of AP and reviews the evidence base for the use of AP to prevent IE.     

微创去腐技术治疗患者龋齿的临床效果评价

目的:分析微创去腐技术治疗患者龋齿的临床效果。方法:将98例龋齿患者分为观察组和对照组。观察组患者52例,采用微创去腐技术治疗龋齿;对照组患者46例,采用传统高速牙钻去腐治疗龋齿。结果:观察组患者的疼痛评分低于对照组,两组患者的单牙治疗时间、治疗后20个月时充填物完好率对比P>0.05,并发症对比P<0.05。结论:微创去腐技术治疗龋齿患者效果显著。