自体骨游离移植修复牙槽骨缺损Ⅱ期种植修复临床报告

目的：利用自体骨游离移植以增加牙槽骨骨量,Ⅱ期种植体植入。方法：对19例牙槽嵴萎缩患者进行自体下颌正中部、髂骨取骨植骨术,Ⅱ期植入36枚种植体。结果：全部患者植骨区切口一期愈合,移植骨完全成活,植骨术后9个月进行种植体植入,种植体与移植骨结合良好。义齿修复后,随访6个月～3年,平均14月,种植体无松动、脱落。结论：该方法对于牙槽骨缺损要求种植修复的患者疗效可靠。     

环状自体骨在严重牙槽骨吸收同期种植中的应用

目的:探讨应用环状自体骨移植对严重牙槽骨吸收同期种植的骨增量手术方法。方法:9例重度牙槽骨吸收患者接受了环状自体骨移植,同期植入12枚种植体。结果:所有种植体均成功植入,初期稳定性好,全部Ⅰ期愈合,术后X线片显示骨愈合良好,垂直骨骨高度增量3.68-6.17mm。平均骨增量高度4.70mm。结论:环状自体骨用于严重牙槽嵴的吸收并同期植入种植体手术方法简单,周期短,疗效可靠,值得临床推广。     

自体髂骨游离移植加同期种植修复牙槽缺损初步观察

目的：利用自体髂骨游离移植同期种植修复牙槽缺损。方法：13例牙槽嵴萎缩患者行自体髂骨游离移植同期植入29枚种植体。结果：移植骨存活，植入的29枚种植体与移植骨结合良好，义齿修复一年后种植体无松动、脱落。结论：采用该方法可早期修复牙槽缺损，但仍需进一步观察长期效果。     

钛网结合异体骨移植和人骨形成蛋白在上颌前牙种植前牙槽嵴骨增量中的应用研究（附1例报告）

编者按：本刊特邀美国德克萨斯健康研究中心牙学院Bing-Yan Wang副教授介绍1例在上颌前牙牙槽骨严重缺损区实现骨增量的病例。在拔牙同期用异体骨和Bio-Mend延展膜进行引导骨再生术后未获得满意骨量的情况下,无法进行种植手术,术者用钛网结合异体骨移植材料和人骨形成蛋白在种植体植入前修复上前牙区部分牙缺失部位的牙槽骨缺损,最终获得成功。通过这种方法扩大了在上前牙牙槽骨严重骨缺损区种植的适应证,为患者提供了除自体骨移植以外的另一个选择。     

自体块状骨移植重建牙槽骨骨量不足后种植修复的临床观察

目的探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果。方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration,GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗。按照自体块状骨的供区来源分为颌骨组(16例34颗)和髂骨组(14例47颗)两组,通过临床随访及影像学检查,分别计算并比较其种植体存留率。结果 30例自体块状骨移植结合GBR后骨增量明显且愈合良好,术后均无明显供区并发症。同期或延期种植体植入,经平均7.8个月(4~18个月)骨结合期后,除1例种植体因松动拔除,其余29例均完成永久修复。种植体植入后平均随访期为26个月(9~68个月),植入的81颗种植体在随访期内存留率为98.76%。其中颌骨组升支取骨失败1颗,种植体存留率为97.06%;髂骨组失败0颗,种植体存留率为100%,两者统计学上无显著性差异(P>0.05)。结论自体块状骨移植重建牙槽骨骨量不足后种植修复,其种植体存留率,较骨量正常情况下的种植修复无明显差异。颌骨与髂骨两种供区的块状自体骨,其移植重建牙槽骨骨量不足均可取得理想的种植修复临床效果。但颌骨内取骨因避免了第二术区、减少手术时间、术后并发症小等优点,临床上应予以优先选择。     

BIO-OSS和BIO-GIDE在骨量不足的牙种植术中的运用

目的：通过应用BIO-OSS骨移植和BIO-GIDE引导骨再生技米于牙种植术中，观察其促进部分缺失牙槽骨再生的临床效果。方法：选择拔牙区颊侧骨扳萎缩吸收或牙槽骨缺损的患者作为研究的对象，在行种植体植入的同时行骨粉充填或在植牙前先行骨粉充填骨缺损区，再用胶原再生膜覆盖在骨移植材料上或颊侧种植体暴露和骨面，观察骨组织再生情况及种植体的稳定性。结果：1-3年的放射学和临床观察，表现为种植体周骨组织或骨缺损区骨组织有不同程度的再生，种植体稳固。结论：骨移植和引导骨再生技术用于治疗牙槽骨板萎缩吸收或缺损的患者。有提高牙种植成功率、扩大适应症的作用。     

局部牙槽骨缺损自体下颌块状骨onlay植骨重建种植技术

种植体的成功存活需要三维空间中足够的骨组织覆盖,而拔牙的手术创伤、长期的无牙状态、不合适的局部义齿、根尖周感染、其他手术创伤、先天缺牙或者外伤致牙列缺损,都有可能导致牙槽骨的高度或（和）宽度不足,限制了种植体在颌骨中的植入。重建缺损牙槽突的方法主要有自体骨移植、引导性骨组织再生、牵引成骨等。自体骨移植由于其具有骨再生作用和良好的生物相容性已经成为颌骨缺损重建的金标准,而块状自体骨onlay植骨合并种植体植入技术因其适应证广泛、手术相对容易、预后可靠、并发症少等优点已经广泛应用于临床。     

应用下颌隆突进行牙槽嵴增量和上颌窦提升：病例报告

本文报道了应用下颌隆突作为自体骨移植的供骨源进行牙槽嵴增量和上颌窦提升植骨．使种植体获得理想的植入位置。1例伴有双侧下颌舌侧隆突患者需要修复缺失的上颌磨牙和下颌前磨牙。两个缺失牙区域的牙槽嵴均存在骨量不足，种植前需要进行骨移植。下颌隆突被用于下颌牙槽嵴的侧方增量以及为增加上颌牙槽嵴垂直高度而进行的上颔窦提升。植骨术后6个月，两个植骨区均可见足够的新骨形成。植骨区新形成的骨质形态与正常骨质相一致。种植体成功植入并负重，美观和功能得到恢复。通过本病例的观察，下颌隆突可用于牙槽嵴增量和上颌窦提升。但是下颌隆突作为自体骨移植的供骨源，其疗效尚有待进一步的临床研究。     

牙槽骨劈开术同期牙种植的临床应用

目的　评价牙槽骨劈开技术在口腔种植中应用的临床效果。方法　对116例缺牙区牙槽嵴高度大于12 mm,颊舌向厚度在3~5 mm之间的牙列缺损患者,行牙槽嵴劈开同期植入种植体治疗。共植入ITI种植体147枚,Replace种植体52枚。根据骨劈开术后间隙及唇颊侧骨壁厚度等不同情况选择植入或不植入自体骨、人工骨粉等修复手段。术后6月种植修复,定期随诊。结果　种植区软组织愈合好,无红肿,颊舌向牙槽骨较种植前明显增宽。术后除1颗种植体失败取出外,其余种植体稳固,种植修复体能正常使用。复诊时X线检查骨吸收≤1 mm。结论　骨劈开术使牙槽骨宽度在3~5 mm的病例有了一期种植的可能,是一种简单有效的增宽牙槽骨的方法。     

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目的评价前牙区牙槽骨水平宽度不足的患者联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入的临床效果。方法 2004—2009年福州市第一医院口腔科就诊的前牙区牙缺失伴前牙区牙槽骨水平宽度不足的种植患者28例,联合应用骨劈开、骨挤压,填入骨粉,行骨引导再生术后同期植入40颗种植体,术后4～6个月内完成上部修复。术后1年,通过临床检查、全景片等观察效果。结果术前、后牙槽骨平均宽度分别为(3.2±0.89)mm、(6.5±0.75)mm,平均增加了(3.3±0.34)mm。术后牙槽骨宽度与术前相比,差异有统计意义(t=2.47,P<0.05)。术后无明显并发症发生,种植体行使功能良好,仅1例患者的1颗牙种植失败,种植近期成功率达97.5%。结论对前牙区牙槽骨水平宽度不足的患者,联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入,可增加骨量,获得种植体的同期植入,减少患者痛苦,改善种植修复的临床效果。     

Iliac crest autogenous bone graft versus alloplastic graft and guided bone regeneration in the reconstruction of atrophic maxillae: a 5-year retrospective study on cost-effectiveness and clinical outcome

Background: Reconstruction of the atrophic maxillae with autogenous bone graft and jawbone‐anchored bridges is a well‐proven technique. However, the morbidity associated with the concept should not be neglected. Furthermore, the costs for such treatment, including general anesthesia and hospital stay, are significant. Little data are found in the literature with regard to a cost‐benefit approach to various treatment alternates. Purpose: The aim of this retrospective study was to compare from a health‐economical and clinical perspective the reconstruction of the atrophic maxillae prior to oral implant treatment either with autogenous bone grafts harvested from the iliac crest or the use of demineralized freeze‐dried bone (DFDB) in combination with a thermoplastic carrier (Regeneration Technologies Inc., Alachua, FL, USA) and guided bone regeneration (GBR). Materials and Methods: A total of 26 patients (13 + 13) were selected and matched with regard to indication, sex, and age. The study was performed 5 years after the completion of the treatment. Implant survival, morbidity, and complications were analyzed. Furthermore, a detailed analysis of the total cost for the respective treatment modality was performed, including material, costs for staff, sick leave, etc. Results: The study revealed no statistical difference with regard to implant survival for the respective groups. The average total cost, per patient, for the DFDB group was 22.5% of the total cost for a patient treated with autogenous bone grafting procedures. Conclusions: The study concluded that reconstruction of atrophic maxillae with a bone substitute material (DFDB) in combination with GBR can be performed with an equal treatment outcome and with less resources and a significant reduced cost in selected cases compared with autogenous bone grafts from the iliac crest.     

Bone Graft Healing in Reconstruction of Maxillary Atrophy

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II). Material and Methods: Forty‐six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered. Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum‐IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty‐two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow‐up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2‐L4 (Kruskal–Wallis test, p = .017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal–Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p = .865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression). Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2‐L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.     

Vertical ridge augmentation by expanded-polytetrafluoroethylene membrane and a combination of intraoral autogenous bone graft and deproteinized anorganic bovine bone (Bio Oss)

Objective: To evaluate, from a histological and histomorphometrical perspective, the efficacy of a 1 : 1 mixture of deproteinized bovine bone mineral (DBBM) and autogenous bone graft associated with an expanded‐polytetrafluoroethylene (e‐PTFE) membrane for vertical ridge augmentation in the human. Material and methods: Seven patients with 10 surgical sites requiring vertical ridge augmentation of partially edentulous lower jaws were included in the study. The vertical augmentation procedure was performed combining a titanium‐reinforced e‐PTFE Gore‐Tex membrane with a composite graft consisting of a 1 : 1 ratio of DBBM (Bio‐Oss) and autogenous bone. Twenty‐seven Branemark implants have been inserted. Eleven biopsies from the regenerated area were analyzed histologically and histomorphometrically. Results: The healing period was uneventful in nine surgical sites. In one site the membrane showed an exposure after 3 months. At the abutment connection, all implants appeared stable and submerged by a hard regenerated tissue clinically similar to bone. The histological analysis showed new bone formation and ongoing remodelling of the autogenous bone and the DBBM particles. Conclusions: The findings from the present clinical and histological study support the use of a 1 : 1 combination of DBBM and autogenous bone chips for vertical ridge augmentation by means of guided bone regeneration techniques. The regenerated bone may lead to proper osseointegration of a dental implant inserted at the time of the regenerative procedure or after a healing period of at least 6 months. DBBM undergoes very slow resorption and substitution with new bone. Furthermore, long‐term clinical studies are needed to confirm the positive effect of DBBM in enhancing the lasting stability of the vertically augmented bone.     

牙种植术钻孔骨碎作植骨的临床研究

目的:评价在牙种植术中,钻备种植窝时收集到的自体骨颗粒单独或与Bio-Oss人工骨混合作为骨移植材料应用的临床效果。方法:34例52枚牙种植术的病例分成四组。第一组(对照组)22枚植体,单纯植入种植体,种植区无植入自体骨或人工骨。第二组6枚植体,植入螺纹种植体后,在部分暴露的植体处植入Bio-Oss人工骨。第三组8枚植体,收集种植术中准备植体窝时,在各种钻针上的自体骨颗粒,植入种植体周骨量不足区域。第四组16枚植体,自各种钻针上收集到的自体骨颗粒与Bio-Oss人工骨混合,植入种植体周骨缺损区。记录I、II期手术种植体周围骨组织高度。结果:植入术后3-12个月,II期手术时,实验组有新生骨形成,第四组(即Bio-Oss人工骨与自体骨颗粒混合物植入组),新生骨形成的量较其余组别多。结论:研究表明牙种植术中钻备种植窝时收集到的自体骨颗粒可作为有效的植骨材料,这种简单的方法避免从他处手术获得自体骨,对扩大牙种植适应症有重要意义。RRRR     

Histologic analysis of alveolar bone following guided bone regeneration

BACKGROUND: Questions on new bone quality following guided bone regeneration (GBR) with various graft materials and its importance in osseointegration have been raised. This study reports histologic analysis of bone sections from future implant sites at upper and lower jaws that were augmented with bovine porous bone mineral graft material plus a porcine collagen membrane. METHODS: Due to severe atrophy of the alveolar crest, GBR prior to implant placement was indicated in 11 patients (mean age 45.5 years). Following an average of 7 months of healing, implant placement surgery was performed. Bone sections from implant beds were fixed in formalin, decalcified in sodium citrate and formic acid, and placed in paraffin. Sections 5 to 7 microm thick were prepared, stained with hematoxylin and eosin, and analyzed under light microscopy. Results for 27 implant sites are presented. RESULTS: Compared to the lower jaw, segments from the upper jaw had a lower percentage of bone and higher percentage of residual material and vascularization. CONCLUSIONS: Within the limits of this study, we concluded that osteogenesis is completed and the rate of vascularization and osteoclastic activity was reduced by 7 months. Also, the upper jaw significantly differed from the lower jaw in bone formation, vascularization, and the amount of residual material. Thus, the anatomical location of the defect may be as important as the properties of the graft material used in obtaining successful osteogenesis using guided bone regeneration techniques.     

Treatment of severe peri‐implant bone loss using autogenous bone and a resorbable membrane. Case report and literature review.

Clinical case reports and animal studies have demonstrated that the principle of guided bone regeneration can be applied for surgical treatment of moderate to profound peri‐implant bone loss (peri‐implantitis). However, the degree of bone regeneration within the peri‐implant osseous defect was reported to be variable depending on different clinical factors and on the postoperative course. Most papers dealing with surgical treatment of peri‐implantitis advocate the use of a non‐resorbable ePTFE membrane for secluding the peri‐implant bone defect enabling bone regeneration. Additionally some surgeons fill the defects with allografts or alloplasts. The present case report demonstrates another surgical approach by using autogenous cancellous bone for grafting into the peri‐implant bone defect and placing a bioresorbable polylactide membrane as a matrix barrier. The successful out‐come of this modified surgical approach enabled the patient to maintain the implant for prosthetic reconstruction after early but severe bone loss.     

异种脱细胞真皮基质修复骨引导再生术后软组织缺损的临床观察

目的：观察异种脱细胞真皮基质在骨引导再生术中充当屏障膜并直接修复术后软组织不足的临床效果及对引导骨再生的影响。方法：选择在中山大学附属口腔医院种植科要求种植修复治疗,但因种植区牙槽嵴萎缩,宽度不足而需先行骨引导再生术的患者7例（其中女性5例,男性2例,平均34岁）,术中用脱细胞真皮基质覆盖骨引导再生区域,并直接修补创面软组织不足,临床观察脱细胞真皮基质愈合情况。通过影像学和临床检查评价新生的引导再生骨。结果：术后2周可见创面生物膜有部分降解,骨移植材料表面有薄层胶原基质覆盖;术后3周,创面开始有少量牙龈上皮覆盖;术后4周,牙龈上皮覆盖全部创面,与周围牙龈融合。术后1年,牙种植手术中见再生骨质量好,缺牙区牙槽嵴宽度明显增宽。影像学检查显示,随愈合时间延长,骨粉颗粒高密度影像逐渐消失,与周围正常骨质间界限不清。结论：脱细胞真皮基质充当骨引导生物膜并同时修复骨增量术后软组织不足的临床效果满意。     

Implants in Reconstructed Bone: A Comparative Study on the Outcome of Straumann® Tissue Level and Bone Level Implants Placed in Vertically Deficient Alveolar Ridges Treated by Means of Autogenous Onlay Bone Grafts

Purpose: To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in atrophic edentulous jaws previously reconstructed by means of autogenous onlay bone grafts; (2) to compare peri‐implant bone resorption values over time. Materials and Methods: From 2005 to 2010, 50 patients presenting with vertical or tridimensional defects of the edentulous ridges were treated with autogenous bone grafts. Three to 7 months afterward, 192 implants were placed (Group A: 97 Tissue Level implants; Group B: 95 Bone Level implants) in the reconstructed areas. After a further waiting period of 2 to 3 months, patients were rehabilitated with implant‐supported fixed prostheses. The follow‐up ranged from 12 to 68 months after the start of prosthetic loading (mean: 33 months). Results: No implants were removed (survival rate: 100%), but in Group B 13 implants (8 placed in iliac grafts, 2 placed in ramus grafts, and 3 placed in calvarial grafts) presented peri‐implant bone resorption values higher than those proposed by Albrektsson and colleagues. for successful implants: the overall implant success rate was then 100% for Group A and 86.8% for Group B. No prosthetic failures were recorded, thus leading to a 100% prostheses success rate. Conclusion: No significant differences were found between the two types of implants as far as implant survival rate is concerned, but results from this study seem to demonstrate that Tissue Level implants may present better long‐term results in terms of peri‐implant bone maintenance, as compared with Bone Level implants, when placed in reconstructed areas.     

引导骨组织再生膜应用于自身骨移植的研究现状

自身骨移植是种植术前骨增量的一种重要的技术手段。对于在常规骨移植后是否在移植物上覆盖引导骨组织再生膜,临床上存在着较大争议。笔者拟就引导骨组织再生膜在自身骨移植中的应用研究作一综述。