前牵引矫治前牙反对颅面硬组织影响的研究

目的评价前牵引矫治AngleⅢ类功能性轻、中度骨性前牙反的临床应用效果。方法应用一种新的稳定的头颅参考系统,对15例治疗前后临床表现及X线片硬组织测量进行分析。结果15例前牵引治疗的患者侧貌改善较慢,前牵引对上前牙及对上牙槽的作用大,对上颌骨矫形作用并不大。下颌Go点及Pg点位置几乎没有改变,下颌骨发生向后下的顺时针旋转。结论前牵引产生的主要变化在上颌,主要是牙槽改变和较少的骨矫形。     

种植床自体骨移植在上颌窦闭合式提升中的临床应用

目的评价种植床自体骨植骨行上颌窦闭合式提升后同期植入种植体的临床效果。方法对上颌后牙缺失后剩余牙槽骨高度在6-10mm患者,用中空圆柱钻制备种植床,收集种植床自体骨,行上颌窦闭合式挤压提升后,植入自体骨和ITI种植体,6-9个月后行上部结构修复。结果17例患者共植入25颗种植体,平均提升上颌窦底高度为3.4mm(2-4mm),修复后追踪观察6-36个月,l颗种植体修复6个月后松动拔除。其余24颗种植体平均负载21个月,种植体稳定,未见明显骨吸收,所有病例均无上颌窦并发症。结论严格掌握适应证,种植床自体骨植骨上颌窦闭合式提升同期植入种植体,创伤小、操作较简单,无须开辟第2手术区。     

上颌前方牵引联合快速扩弓矫治骨性Ⅲ类错畸形

目的评价上颌前方牵引联合快速扩弓矫治骨性Ⅲ类错的疗效及可行性。方法选择24例青春期安氏Ⅲ类错前牙反患者,治疗前后拍摄头颅正侧位片,取模,进行测量、统计学分析。结果上颌相对于颅底前移,鼻底宽度,尖牙宽度,上颌第一磨牙宽度和覆盖都增加,其中57%为骨性改变,43%为牙性代偿。结论上颌前方牵引联合快速扩弓对于青春生长发育期安氏Ⅲ类骨性错疗效是显著的。     

快速扩弓结合前方牵引对牙颌作用的三维测量研究

目的探讨应用快速扩弓结合前方牵引矫治替牙期骨性Ⅲ类反在三维方向上的作用。方法选取30例替牙期骨性Ⅲ类反患者,应用快速扩弓结合前方牵引的方法进行治疗。分别对矫治前、后的X线头颅侧位片和石膏模型进行测量分析,并运用SPSS12.0软件进行统计学处理。结果快速扩弓结合前方牵引治疗替牙期骨性Ⅲ类反作用为:①水平方向上增加上颌牙弓宽度;②矢状方向上上颌突度的增加是上前牙唇倾,上颌骨向前生长的结果;下颌突度的减小是下颌后下旋转和髁突在关节窝内移位共同作用的结果;③垂直方向的变化与水平和矢状方向的变化密切相关,面下高度增加,下颌平面角增大。结论快速扩弓结合前方牵引治疗可有效矫正替牙期骨性Ⅲ类反,但使牙颌结构在三维方向上都产生极其复杂的不同的变化,应根据错的特点调整相应的治疗措施以使在各个方向上增加有利的变化,避免或减少不利的变化。     

Sinus Floor Augmentation With Simultaneous Implant Placement Using Choukroun's Platelet-Rich Fibrin as the Sole Grafting Material: A Radiologic and Histologic Study at 6 Months

Background: Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun's technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series. Methods: Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun's PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month post-surgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry. Results: In this study, 41 implants from three different systems with different screw designs (Biomet 3I Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean ± SD: 2.9 ± 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean ± SD: 10.1 ± 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone. Conclusions: From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun's PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane.     

前牵引矫治乳牙期严重骨性Ⅲ类错畸形的侧貌变化

目的探讨上腭快速扩大联合前牵引矫治乳牙期严重骨性Ⅲ类错畸形和矫治前后颌骨软组织侧貌头影测量值的变化。方法选择乳牙期严重骨性Ⅲ类错畸形患儿8名,患儿呈凹面型,前牙或合并后牙反,上颌相对下颌后缩,乳磨牙末端呈近中阶梯,不存在功能性下颌移位。上下牙列无牙周疾病,牙体疾病须治疗,之前未做过正畸治疗。应用上腭快速扩大联合前牵引矫治,正畸前后头影测量,采用配对t检验,统计学分析结果。结果乳牙期严重骨性Ⅲ类错畸形患儿经上腭快速扩大联合前牵引矫治6个月左右,患儿的上颌N-A增长,上颌前移,N-B缩短,下颌后旋,颌骨面角减小、软组织面角相应减小;骨组织和软组织前下面高增加,乳上切牙唇倾,乳下切牙舌倾;上唇突度增大、倾斜度减小,下唇突度减小、倾斜度减小。结论上腭快速扩大联合前牵引矫治乳牙期严重骨性Ⅲ类错畸形,凹面型显著改善且呈直面型。颌骨和软组织侧貌发生相应的改变。     

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牙源性上颌窦炎通常继发于牙周疾病或根尖周感染,常以牙痛或颌面部疼痛为主诉,约占全部上颌窦炎的lO%[1].如果忽略对其临床表现的分析和诊断,常会造成治疗不彻底,炎症反复发作,给患者带来极大痛苦.本文对54例牙源性上颌窦炎进行回顾性分析.     

VEGF and MVD expression in sinus augmentation with autologous bone and several graft materials

Objective:  The aim of this study was to assess vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) in maxillary sinus augmentation with autogenous bone and different graft materials for evaluating their angiogenic potential.
Methods:  Biopsies were harvested 10 months after sinus augmentation with a combination of autogenous bone and different graft materials: hydroxyapatite (HA, n  =   6 patients), demineralized freeze-dried bone allograft (DFDBA, n  =   5 patients), calcium phosphate (CP, n  =   5 patients), Ricinus communis polymer ( n  =   5 patients) and control group – autogenous bone only ( n  =   13 patients).
Results:  In all the samples, higher intensities of VEGF expression were prevalent in the newly formed bone, while lower intensities of VEGF expression were predominant in the areas of mature bone. The highest intensity of VEGF expression in the newly formed bone was expressed by HA ( P  < 0.001) and CP in relation to control ( P  < 0.01) groups. The lowest intensities of VEGF expression in newly formed bone were shown by DFDBA and polymer groups ( P  <   0.05). When comparing the different grafting materials, higher MVD were found in the newly formed bone around control, HA and CP ( P  <   0.001).
Conclusion:  Various graft materials could be successfully used for sinus floor augmentation; however, the interactions between bone formation and angiogenesis remain to be fully characterized.     

Assessment of Maxillary Sinus Septa Using Cone-Beam Computed Tomography: Etiological Consideration

Background: Septum presence in the maxillary sinus complicates sinus floor elevation surgery, and so it is important that septa are accurately diagnosed on preoperative imaging.
Purpose: Septa were observed regarding their relationship with the bony palate using cone-beam computed tomography (CT).
Materials and Methods: Thirty maxillary sinuses with dentate jaws of 15 dry skulls and a cone-beam CT unit were used. A septum was defined as a pointed bone structure, and an exostosis was defined as a rounded bone structure. The occurrence and locations of maxillary sinus septa and exostoses of more than 2 mm in height were evaluated. Also, angles between the direction of septum and median palatine suture were measured on axial images.
Results: Twelve septa of 11 maxillary sinuses (37%) and nine exostoses of nine maxillary sinuses (30%) were observed. Also, 42% of septa and 67% of exostoses were antero-posteriorly aligned according to the transverse palatine suture. Moreover, the mean septum angle was 57.9 degrees in the anterior maxillary sinus region, and 101.8 degrees in the transverse palatine suture region, and significant differences were noted between them.
Conclusion: Maxillary sinus septa and exostoses could be clarified regarding their relationship with the bony palate using cone-beam CT.