种植与正畸联合治疗单个牙缺失的临床应用分析

目的 探讨伴有错牙合畸形的单个牙缺失的临床治疗方法。方法 选择20例伴错牙合畸形的单个牙缺失患者,通过正畸治疗后行种植义齿修复并随访,根据患者临床和X线的检查结果及治疗前后的自我对比进行临床效果综合评价。结果 20例患者的错牙合畸形均得到精确的矫治并行种植义齿修复,随访12~18个月,种植义齿稳定无松动,效果美观;牙列齐,牙周组织无异常;咀嚼及自我感觉良好。结论 对伴有错牙合畸形的单个牙缺失患者,采用种植与正畸联合治疗的方法,可获得理想的临床修复效果。     

新生儿单侧唇腭裂术前外贴式鼻牙槽矫治器的研制及应用

  目的  自行研制口腔外粘贴式鼻牙槽矫治装置并初步探讨其对新生单侧完全性唇腭裂患儿手术前矫治的效果。  方法  自行研制外贴式鼻牙槽矫治器, 对1例出生12 d的单侧完全性唇腭裂患儿进行术前矫治, 利用上唇粘贴技术恢复口唇张力, 并以其为支抗粘接固位预制的鼻孔支撑装置对裂隙侧塌陷鼻孔进行塑形, 疗程为3个月。  结果  患儿矫治3周后牙槽突裂隙缩小3 mm, 3个月后裂隙完全关闭; 鼻小柱明显直立, 塌陷的鼻翼上抬呈圆拱状, 患侧鼻孔形态接近未裂侧鼻孔。  结论  北京协和医院口腔科研制的外贴式鼻牙槽矫治器可以有效地缩窄单侧完全性唇腭裂患儿的软硬组织裂隙, 改善鼻孔外形, 为Ⅰ期唇裂修复手术创造良好的条件。     

The myth of instant orthodontics: an ethical quandary

BACKGROUND: There is a clinical trend of using porcelain veneer restorations (PVRs) for the correction of malaligned anterior teeth. Use of PVRs for this purpose raises clinical and ethical dilemmas. TYPES OF STUDIES REVIEWED: A literature review of four different topics (PVR preparation, enamel thickness of anterior teeth, dentinal bonding adhesive effectiveness and PVR long-term success) was conducted to determine the optimal preparation for a successful PVR. The amount of tooth malalignment that may be corrected with a PVR without adversely affecting its success was calculated. RESULTS: The optimal preparation for a successful PVR may have dentin exposed in the body of the preparation. However, most of the preparation must be in enamel, and all the margins must end in enamel. The strength of a dentin bond varies greatly owing to a multistep, technique-sensitive cementation process and is weaker than an enamel bond. It is not possible to correct atypical gingival esthetics (uneven gingival margins, uneven papillae, short papillae and bulbous gingivae) resulting from malaligned teeth through use of PVRs. CONCLUSIONS: and CLINICAL IMPLICATIONS: Aligning a healthy tooth with a PVR is not a conservative procedure and more conservative treatment options (such as orthodontics, bleaching, direct bonding and enamelplasty) should be offered to the patient. In addition, the inability to restoratively improve gingival relationships with PVRs may result in achieving less-than-optimal esthetics. A clinician should present only treatment options that involve predictable, conservative restorations or that preserve healthy tooth structure. Aligning teeth with PVRs may create ethical dilemmas that can be resolved with the help of the American Dental Association Principles of Ethics and Code of Professional Conduct.     

Comparison of treatment result and compliance between private practice Medicaid and non-Medicaid orthodontic patients--a brief communication

Treatment result and compliance for orthodontic Medicaid patients were assessed and compared to non-Medicaid patients of similar initial severity. All 55 North Carolina practices providing orthodontic treatment covered by Medicaid were asked to submit their last five Medicaid cases and five non-Medicaid cases of similar initial treatment complexity Nine practices agreed to participate. Initial models, final models, and progress notes were obtained for all subjects. Casts were scored using the Peer Assessment Rating (PAR) Index to assess initial and posttreatment orthodontic status, and progress notes were reviewed for compliance data. No clinically important differences were seen between the Medicaid and non-Medicaid groups with respect to initial PAR, final PAR, percent PAR reduction, broken appointments, broken appliances, or poor oral hygiene. In this study, Medicaid and non-Medicaid patients did not differ substantially with respect to effectiveness of treatment received or their compliance with treatment.     

Orthodontic loading of titanium miniplates in dogs: microradiographic and histological evaluation

Objectives: The objectives of this animal study were to evaluate if orthodontic loading has an impact on osseointegration of screws supporting miniplates, and to describe the histological components of the bone–screw interface. Materials and methods: Eighty orthodontic miniplates were placed in the jaws of 10 dogs. After 2 weeks, a 125 g force was applied between the miniplates of one upper quadrant of each dog and between those of the controlateral lower quadrant. The others, nonloaded miniplates, were considered as controls. Five dogs were sacrificed 7 weeks after implantation and the remaining five dogs after 29 weeks [Short Term (ST) and Long Term (LT) groups, respectively]. Fluorochromes were injected at implantation and at sacrifice. Jaw quadrants were dissected, embedded, cut into undecalcified transverse sections through the screws and finally submitted to microradiographic analysis to allow assessment of bone–implant contact (BIC) and bone volume/total volume (BV/TV). The sections were observed under UV light and stained in order to examine them under ordinary light. Results: Osseointegration occurred around 90/160 screws and consisted mainly in limited repair and remodelling processes of lamellar bone, without inflammation. Wide variations were observed in BIC and BV/TV, but without any significant difference, neither between the loaded and the nonloaded screws, nor according to the direction of load, whereas they were significantly higher in the LT than in the ST group. Nonosseointegrated screws were surrounded by fibrous tissue. Osteoblastic activity, when present in front of these screws, was not sufficient to achieve stability. Conclusions: Osseointegration underlying orthodontic anchorage was not affected by loading. BIC increased with time and varied according to implantation site. Particularly the tight‐fitting screw insertion appeared crucial in determining the appropriate bone healing response.     

两种正畸黏结剂黏结后牙颊面管的临床实用性比较

背景：目前正畸后牙多以黏结颊面管来替代黏结带环来控制牙齿位置和方向,但磨牙位置靠后,磨牙颊面管的黏结相对困难;同时,后牙咀嚼受力相对较大,造成颊面管更易脱落。目的：探讨两种不同正畸黏结剂黏结牙颊面管的效果。方法：随机选择60例正畸治疗患者,每例患者右侧上下第一磨牙均采用3M Transbond ^TM光固化树脂黏结剂黏结,左侧上下第一磨牙均采用3M Unitek化学固化黏结剂黏结。详细记录4个月内颊面管黏结后的脱落情况。同时分别以3M Transbond ^TM光固化树脂黏结剂、3M Unitek化学固化黏结剂黏结人离体第一磨牙,模仿口腔正常环境和温度,冷热循环10 000次后测定黏结抗剪切强度。结果与结论：3M Transbond ^TM光固化树脂黏结剂组和3M Unitek化学固化黏结剂组的脱落率分别为10.80%和24.10%,两组间比较差异有显著性意义(P < 0.05)。体外实验结果进一步证实两种黏结剂均能满足临床要求,但3M Transbond ^TM光固化树脂黏结剂黏结强度高于3M化学固化黏结剂。提示3M Transbond ^TM光固化树脂黏结剂较3M化学固化黏结剂更适合磨牙颊面管的黏结。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

不同矫治正畸作用下牙周骨改建过程中压力侧相关因子的变化

背景：近年来研究表明核因子κB受体活化因子配体与正畸牙移动骨改建过程中破骨细胞的形成、分化和功能密切相关。 目的：观察不同矫治器正畸作用下兔牙周组织改建过程中压力侧组织核因子κB受体活化因子配体表达的变化,探讨不同矫治器的正畸效果。 方法：将64只健康大耳白兔随机分为4组：对照组、MBT矫治器组、Begg矫治器组、Damon Ⅲ矫治器组,每组16只。MBT矫治器组、Begg矫治器组、Damon Ⅲ矫治器组分别应用对应的矫治器对兔上颌切牙和第一磨牙进行矫治,近中移动牵引力为80 g;对照组不进行矫治。分别于矫治后第3,7,14,21天每组取4只白兔进行检测。 结果与结论：苏木精-伊红染色显示加力后各矫治器组压力侧牙周膜腔变窄,牙槽骨边缘出现骨吸收陷窝。抗酒石酸酸性磷酸酶染色显示,矫治7 d时,骨改建活跃,破骨细胞数量达到高峰;同时实时荧光定量PCR检测发现加力后压力侧牙槽骨组织中核因子κB受体活化因子配体mRNA的表达明显增高,并于加力后第7天达到最高峰,而后逐渐降低。加力第7天时,Damon Ⅲ矫治器组破骨细胞数量和核因子κB受体活化因子配体mRNA表达水平均明显高于MBT矫治器组和Begg矫治器组(P < 0.05)。提示在骨改建过程中核因子κB受体活化因子配体mRNA表达的变化规律与破骨细胞数量相一致,Damon Ⅲ矫治器的矫治效果优于MBT矫治器、Begg矫治器。     

磁力功能矫治器在骨性畸形中的应用

背景：骨性畸形为临床常见的颌骨畸形,给患者的功能和美观带来严重影响,患者的治疗要求强烈。近年来,磁力功能矫治器凭借其优势在骨性畸形的矫治中发挥了越来越重要的作用,磁力功能矫治器逐渐被人们熟识。 目的：探究磁力功能矫治器在矫治骨性畸形中的优势和不足,并对现阶段存在的缺陷进行综述,寻求解决方法,以期望该矫治器能在矫治骨性畸形领域有更大发展。 方法：以“magnetic, orthodontics”为检索词,检索Pubmed数据库,检索年限为1990年1月至2013年6月,限定语种为英文;以“磁力,正畸”为检索词,检索CNKI数据库、万方数据库、维普数据库,检索年限为1990年1月至2013年6月,限定语种为中文。 结果与结论：将磁力与传统功能矫治器结合,借助磁极间的吸引力和排斥力解决颌骨骨性畸形的长度、宽度和高度问题,能弥补传统功能矫治器的不足,有效发挥磁力的优势。随着磁性材料的发展和对磁性材料研究的深入,磁力矫治器在矫治骨性畸形领域势必会有更大发展。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

一种牙槽骨再生正畸治疗骨开裂、骨开窗的新术式：骨膜“包饺子”植骨法

目的 ：介绍并评价一种牙槽骨再生正畸治疗(periodontal accelerated osteogenic orthodontics, PAOO) 下前牙区唇侧骨开裂、骨开窗的新术式,即采用骨膜“包饺子”植骨法对牙根表面牙槽骨 缺损行骨增量术。方法 ：自2014年3月—2014年8月,对8例 (男2例,女6例)下前牙唇侧骨开窗、骨开裂患者行骨膜“包饺子”植骨法。首先向根方分离半厚瓣,于半厚瓣最下方切开骨膜层,仔细将骨膜层剥离牙槽骨骨膜,以利于骨膜下植入骨移植材料,最后将骨膜缝合固定于骨面,形似“饺子”, 以防止植骨材料移位与外漏。所有患者术前、术后1周进行锥形束CT(cone-beam computed tomography,CBCT)检查,评价下前牙唇侧牙槽骨高度的变化及冠1/3、中1/3、根1/3的中部牙槽骨宽度改变。采用SPSS 16.0软件包对数据进行配对t检验。结果 ：术后无严重并发症出现。CBCT显示骨植入物形态维持良好。冠1/3中部唇侧牙槽骨宽度增加(0.65±0.89) mm,牙根中部牙槽骨宽度增加(3.30±1.09) mm,根1/3中部宽度增加至(3.96±1.35) mm,所有改变均具有统计学意义（P<0.01）;下前牙垂直向牙槽骨增加(5.35±1.90) mm（P<0.01）。结论 ：采用骨膜“包饺子”植骨法能防止移植材料移位,利于其塑形,促进骨再生在需要的部位发生,最终有效增加了缺损牙槽骨的高度及宽度。该方法并发症少,近期疗效好,但远期效果有待进一步评价。     

口腔正畸临床摄影技术要点和进展

影像资料是口腔正畸不可或缺的临床资料,与牙牙合模型以及X线片一样已在正畸医生的临床工作中起着不可或缺的作用。口腔正畸学科是口腔学科中较早引入临床摄影的,这与口腔正畸不仅关注牙齿排列与咬合关系,而且在矫治设计与临床治疗中同样重视患者面部的美学特征密切相关。并且建立了比较公认的摄影内容和摄影技术。本文讨论了口腔正畸学科临床摄影的内容、特点、一般规律、规范性要求,以及与其他学科在摄影方面的不同之处,并且详细介绍了正畸患者面像和牙合像摄影的注意事项。