非翻瓣不植骨上颌窦内提升法种植义齿的临床研究

目的:研究在上颌骨骨量不足情况下,采用非翻瓣不植骨法行上颌窦内提升的种植义齿临床效果.方法:收集2013年12月～2014年12月期间,在剩余牙槽骨高度(residual bone high,RBH)不足情况下,完成的30例不翻瓣不植骨的上颌窦内提升种植术病例.随访6～12个月,平均(9.8±1.6)个月.全部病例均在术后6个月内完成上部义齿修复.观察术后种植体的稳定性、种植体周围软组织状况及种植体周围骨结合及骨量改变的情况.结果:30枚种植体中有2枚术中发现上颌窦粘膜穿通,同期放入生物膜,观察期内未出现上颌窦内炎症等并发症;在观察期内30枚种植体成功率100％.术后6个月上颌窦底种植体周围骨质增加高度平均(2.8±0.6) mm,种植体边缘骨吸收(1.3±0.4) mm.结论:在上颌骨牙槽突高度不足的情况下,非翻瓣不植骨法上颌窦内提升术是一种安全,有效的种植术式.     

牙槽窝即刻植骨延期不翻瓣牙种植的疗效评价

目的:观察拔牙后牙槽窝内即刻植骨延期不翻辩牙种植的临床效果.方法:对23例要求拔牙后作牙种植修复的病例,在拔牙后的牙槽窝即刻植入人工骨粒(bio-oss或脱钙骨).3个月后,在植骨位置行临床常规X线和骨量器检查确定足够的牙槽骨骨量并行不翻瓣牙种植.结果:通过临床和X线观察,植骨后牙槽骨外形丰满,高度和宽度基本保持.不翻瓣牙种植顺利,手术损伤反应小.36个牙种植体初期稳定性均达30N以上,随访观察6～62个月,种植全部成功.讨论:拔牙后牙槽窝即刻植骨可有效地保持牙槽骨外形,提供足够的牙槽骨高度和宽度.在足够骨量基础上行延期不翻瓣牙种植,可简化种植前检查和种植过程,减轻种植局部反应.结论:拔牙后牙槽窝即刻植骨延期不翻瓣牙种植是一种有效的临床设计方法.     

慢性中重度牙周炎患者应用种植修复的临床评价

目的:评估对中重度牙周炎患者经完善的牙周治疗及2--3度松动牙拔除后所导致的牙列缺损及牙列缺失所采用的单冠,联冠,全颌种植义齿修复的远期疗效.方法:共计十例患者经完善的牙周治疗,病情稳定后延期植入80枚种植体,即刻植入16枚植体,5---7个月种植义齿修复,根据种植体与牙槽骨之间的X线影像,牙周袋深度及临床检查等作为评价指标,评价负载后的修复效果.结果:96枚种植体中,其中两枚即刻种植于术后3周脱落,即刻种植成功率87%,种植体的平均存留率为97%,承载3.5年后骨吸收高度平均为1.73+0.13mm.结论:对中重度牙周炎进行牙周治疗,采取慎重态度,运用正确的种植方式,修复方法,则可减少牙槽骨的吸收,并获得理想的修复效果,但同时要坚持定期的口腔护理,但对这类患者的骨吸收还需进一步的远期观察.     

牙槽窝即刻植骨延期不翻瓣牙种植的疗效评价

目的:观察拔牙后牙槽窝内即刻植骨延期不翻瓣牙种植的临床效果.方法:对23例要求拔牙后作牙种植修复的病例,在拔牙后的牙槽窝即刻植入人工骨粒(Bio-oss或脱钙骨).3个月后,在植骨位置行临床常规X线和骨量器检查,确定足够的牙槽骨骨量并行不翻瓣牙种植.结果:通过临床和X线观察,植骨后牙槽骨外形丰满,高度和宽度基本保持.不翻瓣牙种植顺利,手术损伤反应小.36颗牙种植体初期稳定性均达30N以上,随访观察6～62个月,种植全部成功.结论:拔牙后牙槽窝即刻植骨,可有效保持牙槽骨外形,提供足够的牙槽骨高度和宽度.在足够骨量基础上行延期不翻瓣牙种植,可简化种植前检查和种植过程,减轻种植局部反应.     

下前牙多颗牙缺失伴水平骨缺损行外置法植骨联合数字化导板延期种植1例

本病例报道1例外置法植骨联合数字化导板延期种植在下前牙多牙缺失伴水平骨缺损的临床应用。一位53岁女性患者因重度牙周炎拔除右下中切牙、左下中切牙和左下侧切牙,要求行种植修复。CBCT显示其全口牙槽骨吸收至根分叉处,水平向骨量严重不足,采用外斜线骨块移植进行水平向骨增量配合数字化导板延期种植,精准微创地完成手术并最大程度规避术后并发症。术后1年复查,种植体无松动,CBCT示种植体周围无透影区,最终获得良好疗效。     

上颌窦内提升不植骨同期种植术——3年临床回顾性研究

目的:评价上颌窦内提升不植骨同期牙种植术的临床效果。方法:收集38例上颌窦区域牙缺失患者,采用上颌窦内提升不植骨同期牙种植手术方式,共植入58颗种植体。在植入后6个月、1年和3年随访,统计种植体的成功率以及拍摄全景片测量上颌窦成骨的高度。结果:1年时,1颗种植体未形成骨结合脱落。3年时,另1颗种植体出现松动取出。其余56颗种植体正常行使功能,3年成功率96.6%。受植区平均牙槽骨高度为(5.8±0.2) mm,术后上颌窦内提升高度为(5.1±0.3)mm。上颌窦内种植体周围见新骨形成,6个月平均成骨2.4 mm,1年平均成骨2.8 mm,3年与1年成骨无明显变化。结论:上颌窦内提升不植骨同期牙种植手术方式是可行的,上颌窦黏膜具有潜在的成骨能力。     

CDIC牙种植术（二）

１与人工牙种植术有关的辅助手术在人工牙种植术前后 ,有时根据患者的局部解剖条件和种植义齿设计制作要求 ,需要辅助进行失牙区唇 (颊 )侧植骨、前庭沟加深、系带修整、上颌窦升高、下牙槽神经解剖等手术 ,简介如下。１．１失牙区唇 (颊 )侧植骨术本手术主要对象为牙槽骨的高度适合作牙种植术 ,但唇 (颊 )侧骨质有较多缺失 ,牙槽骨厚度不足的病例。手术主要目的是恢复失牙区牙槽骨唇(颊 )侧的丰满度 ,增加牙槽骨的强度 ,同时 ,亦为骨内的种植体提供支持。有时 ,采用骨膨胀术亦可将种植体按要求植入 ,但因唇 (颊 )侧牙槽骨厚度不足 ,丰满度…     

上颌第一磨牙种植义齿临床牙冠高度与咬合力关系的研究

目的:探讨上颌第一磨牙种植义齿临床牙冠高度与咬合力的关系。方法:按种植牙与邻牙的临床牙冠高度分组,在修复完成并负载1年后,采用T-scanⅡ测量患者牙尖交错位时的咬合力,分析30例上颌第一磨牙种植病例临床牙冠高度和咬合力的关系。同时观察种植体周围骨高度丧失的情况,SPSS 17.0统计软件分析数据。结果:临床牙冠高度小于邻牙1.3倍的种植义齿,与临床牙冠高度超过邻牙1.3倍但不足1.5倍的种植义齿的咬合力有显著差异(P<0.01),且后者较前者的咬合力小。临床牙冠高度大于邻牙1.5倍的种植义齿,与临床牙冠高度超过邻牙1.3倍但不足1.5倍的种植义齿的咬合力有显著差异(P<0.01),且前者的咬合力比后者小。负载1年时,不同临床牙冠高度的种植体周围的牙槽骨高度丧失量没有明显差异(P>0.1)。结论:临床牙冠小于邻牙1.3倍的种植义齿,和临床牙冠超过邻牙1.3倍但未到1.5倍的种植义齿,以及临床牙冠大于邻牙1.5倍的种植义齿之间比较,临床牙冠高度越大,其咬合力越小。负载1年时,不同临床牙冠高度对种植体周围牙槽骨高度丧失量的影响没有明显差异。     

唇腭裂患者牙槽突裂植骨区牙移入的临床观察

目的:探讨牙槽突裂植骨区牙移入的可行性及牙移入的方式,评价移入牙的牙槽骨支持率和移植骨高度变化。方法:选取唇腭裂伴牙槽突裂患者10例,行牙槽突裂自体髂骨植骨术后,分别拍摄植骨后3个月(T1)及牙移入植骨区后(T2)的根尖片,观察牙移入植骨区的情况,测量T1和T2阶段移入牙的牙槽骨支持率,采用SPSS17.0软件包对测量数据进行配对t检验,并参照Bergland四分法评价移植骨的高度变化。结果:①牙整体移入植骨区,牙槽骨支持率为(89.85±2.51)%(T1)和(90.22±2.44)%(T2),牙移入植骨区后的牙槽骨支持率与植骨后3个月的牙槽骨支持率无显著差异(P>0.05)。②移植牙槽骨的高度在牙移入前后无显著变化。结论:唇腭裂患者植骨后,可将裂隙邻近的牙移入植骨区,获得良好的牙槽骨支持。牙的移入有助于维持移植骨高度,提高植骨的成功率。     

慢性中重度牙周炎患者应用种植修复的临床评价

目的：评估对中重度牙周炎患者经完善的牙周治疗及Ⅱ-Ⅲ度松动牙拔除后所导致的牙列缺损及牙列缺失所采用的单冠,联冠,全颌种植义齿修复的远期疗效。方法：共计十例患者经完善的牙周治疗,病情稳定后延期植入80枚种植体,即刻植入16枚植体,5-7个月种植义齿修复,根据种植体与牙槽骨之间的X线影像,牙周袋深度及临床检查等作为评价指标,评价负载后的修复效果。结果：96枚种植体中,其中两枚即刻种植于术后3周脱落,即刻种植成功率87%,种植体的平均存留率为97%,承载3.5年后骨吸收高度平均为（1.73＋0.13）mm。结论：对中重度牙周炎进行牙周治疗,采取慎重态度,运用正确的种植方式,修复方法,则可减少牙槽骨的吸收,并获得理想的修复效果,但同时要坚持定期的口腔护理,但对这类患者的骨吸收还需进一步的远期观察。     

柠檬精油对牙周致病菌抑制作用及其安全性初步研究

目的:探讨柠檬精油对牙周致病菌的体外抗菌活性及对细胞增殖的影响。方法:采用微量液体稀释法测定柠檬精油对Pg、Fn、Aa、Pi的最小抑菌浓度(minimal inhibitory concentration,MIC)及最小杀菌浓度(minimum bactericidal concentration,MBC);以较低浓度的MIC为标准稀释LEO作为实验组,采用MTT法测定柠檬精油对HUVECs的毒性作用,明确抑菌浓度下LEO的安全性。结果:柠檬精油对牙周主要致病菌均有抑菌作用,Pg、Fn、Aa、Pi的MIC分别是9.0 g/L、4.5 g/L、4.5 g/L、9.0 g/L,Aa、Fn的 MBC是9.0 g/L,Pg、Pi的MBC未测得。1/2MIC、1/20MIC浓度的LEO能够抑制人脐静脉内皮细胞的生长,而低于1/200MIC浓度的LEO则对人脐静脉内皮细胞的生长没有影响,其中1/200MIC浓度的LEO作用明显优于0.02%的CHX。结论:体外环境中,柠檬精油对牙周致病菌Pg、Fn、Aa、Pi具有抗菌活性,低浓度应用对机体相对安全。     

Computer-assisted planning for maxillofacial prosthodontic rehabilitation

Computerized tomography (CT) planning and the use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects.     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

Oropharyngeal dysphagia in amyotrophic lateral sclerosis alters quality of life

Dysphagia is one of the most important complications encountered in amyotrophic lateral sclerosis (ALS). Our aim was to determine whether oropharyngeal dysphagia impacted the quality of life (QoL) of patients with ALS. Thirty consecutive patients were recruited (31–82 years, 18 men). Swallowing function was evaluated using a standardised videofluoroscopic barium swallow. All the patients completed a specific questionnaire on quality of life in dysphagia (SWAL‐QoL) immediately after the videofluoroscopy. The results of dysphagia outcome severity scale separated 14 patients with oropharyngeal dysphagia and 16 with normal swallowing function. There was no difference in the average age, weight and body mass index of the two groups (dysphagic patients: 68 ± 11 kg versus non‐dysphagic patients: 69 ± 14 kg). Most of the dysphagic patients had a bulbar affection based on their Norris scores which determine the importance of cranial nerves illness (20 ± 8), significantly lower than those of the non‐dysphagic patients (35 ± 5) (P < 0·0001). There was no difference in the neurological peripheral symptoms evaluated by Amyotrophic Lateral Sclerosis Functional Rating Scale scores (dysphagic patients: 26 ± 7 versus non‐dysphagic patients: 27 ± 8) (ns). The swallowing quality of life questionnaire revealed that the dysphagic patients had significant burden (P < 0·001). They were affected by the necessity to applied a food selection (P < 0·01), by the increase in eating duration (P < 0·05) and described a decrease in eating desire (P < 0·05). They complained of fear regarding the risk of dysphagia (P < 0·05). They also described difficulties with oral communication (P < 0·001). All of those complained about dysphagia which impacted directly mental health (P < 0·05) and social life (P < 0·05). In conclusion, oropharyngeal dysphagia is a common symptom accompanying ALS, which alters the patient's QoL, especially social health.     

Interventional neuroradiologic procedures in the head and neck

Interventional radiology and interventional neuroradiology are evolving specialties which can aid the head and neck surgeons in the clinical management of patients with complex vascular lesions.     

Functional palatomaxillary reconstruction using free tissue transfer

The use of bone containing vascularized flaps has become the gold standard in the reconstruction of composite, post ablative palato-maxillary defects.     

小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡的疗效及免疫改变

目的:探讨小剂量短疗程泼尼松治疗顽固性复发性阿弗他溃疡(顽固性RAU)的临床疗效及对免疫指标调节的作用。方法:选择37例顽固性RAU的患者,小剂量短疗程口服泼尼松治疗1个月,前20 d 10 mg/d,之后5 d减量为7.5 mg/d,最后5 d减量为5 mg/d,治疗前后检查血常规、肝肾功能、外周血体液和细胞相关免疫指标,观察治疗1个月、停药2个月后临床疗效及不良反应,治疗1个月后免疫指标改变。结果:小剂量短疗程口服泼尼松治疗顽固性RAU的治疗1个月后总有效率为100%,停药2个月后总有效率为91.4%,治疗1个月后外周血免疫球蛋白及补体(IgG、IgA、IgM、IgE和C4)水平降低(P<0.05),免疫细胞(B、T淋巴细胞及NK细胞)比例未出现明显差异。结论:采用小剂量短疗程泼尼松治疗顽固性RAU有较好的疗效,可延长溃疡发作间歇期,降低溃疡发作的数目、面积及疼痛程度,未见不良反应的发生。调节体液免疫可能是泼尼松治疗顽固性RAU的途径之一。     

Researches on optimizing treatment of Chinese cleft lip and/or palate

We all know that the development of the sequential therapy ameliorates the clefts treatment. Modes and methods of the sequential therapy differ among different countries and places because of the differences of economy, medical system and sanitary status.     

Osteotomy versus unicompartmental arthroplasty: an algorithm for anteromedial knee osteoarthritis

Knee arthritis occupies a significant proportion of the musculoskeletal burden in the UK. Total knee arthroplasty currently comprises the mainstay of treatment. There has been a shift towards treating isolated unicompartmental osteoarthritis with bone-preserving surgical techniques, in the form of realignment osteotomy or unicompartmental arthroplasty. There are significant data regarding the survivorship of unicompartmental knee arthroplasty from the National Joint Registry data. Similar registry data are not available for osteotomy surgery yet, but the evidence suggests that unicompartmental knee arthroplasty has greater survivorship. Osteotomies can, however, deliver higher functional return. For both techniques to succeed, it is imperative that rigorous surgical decision-making, with regards to patient selection, should be followed. This paper discusses the basis for these principles and their importance in delivering optimal care. Often, these two surgical techniques are promoted as being mutually exclusive; this paper argues that, in fact, they are part of a complementary algorithm that can deliver the best outcome to the appropriately selected patient.