种植体支持义齿患者骨感知的大脑皮层适应性初步研究

目的 采用功能性核磁共振成像(functional MRI,fMBl)对"骨感知"的中枢神经基础进行初步探讨.方法 研究对象为北京大学口腔医学院·口腔医院种植中心2005-2007年无牙颌种植修复复查患者和无牙颌初诊患者20例,共分为3组进行紧咬状态的fMRI扫描,SPM 99软件包统计分析及结果判定.结果 常规全口义齿修复(A组=8例)患者在前额叶皮层激活显著,而与咀嚼运动相关的初级感觉运动皮层激活人数较少;种植体支持固定义齿(B组=3例)患者在紧咬时皮层激活与天然牙列者更为接近,在Broca'S区、初级感觉运动皮层、前运动皮层、岛叶、颞上回、丘脑、基底神经节、海马等激活较显著;种植体支持覆盖义齿(C组=9例)患者前额叶皮层、前运动皮层、顶上回、基底神经节、丘脑等激活较多见.结论 种植体支持固定义齿患者的中枢神经系统对种植体的感觉及运动反馈更加接近于天然牙列,提示种植体支持固定义齿的修复方式能够以更自然的方式恢复患者的咀嚼功能;而常规全口义齿修复患者在咀嚼功能的恢复方面与个体运用义齿的学习、记忆及适应性有更显著的关系,有更强的个体差异性.

Neuroplasticity in patients with implant supported full dentures

Objective To investigate the potential mechanism of "osseopereepfion" which is the sensory and motor experience associated with dental implants. Methods Twenty patients with implant supported full dentures or traditional full dentures were recruited in this study. Functional MRI (fMRI) scan covering the whole brain was carried out in these patients in clenching. The fMRI data were analyzed with SPM 99 software. Results In implant supported removable denture group, increased blood oxyen level dependent (BOLD) signals during clenching were found in prefrontal cortex, premotor cortex, superior parietal cortex, basal ganglion and thalamus. In implant supported fixed denture group, main activations were found in prefrontal cortex, primary sensory and motor cortex, Broca's area, premotor cortex, superior temporal cortex, insular, basal ganglion, thalamus and hippocampus. In traditional full denture group,significant activations were mainly found in prefrontal cortex, premotor cortex. Their activation maps showed the greatest individually dependent diversity. Conclusions Sensory and motor feedback of central nervous system in patients with implant support fixed dentures is close to that of natural dentition. Mastication with traditional full dentures is more likely a process of task learning, memory and adaptation, which might be a more individually dependent restoration.