口腔种植外科相关颌骨解剖学研究进展

目前,种植义齿修复已经成为牙列缺损、缺失患者的最佳修复方式。通过对颌骨的精确测量,可获得种植手术所需相关解剖资料,为种植体的选择、设计及口腔种植手术的实施提供重要的参考。本文就口腔种植义齿相关的颌骨解剖测量进展作一综述。     

种植体稳定系数测定与种植体负重时机选择

目的:通过测量ITI和Osstem-SS种植系统的稳定系数(ISQ),评价这两种种植体的骨结合情况,为临床确定其上部结构修复时机提供依据。方法:93例牙列缺损患者共植入179颗种植体,根据患者种植区骨量情况分为两组,其中A组为种植区骨量良好,不需骨增量手术病例(62例);B组为种植区骨量不足,需进行骨增量手术病例(31例)。A组共植入125颗种植体,其中ITI种植系统64颗,OSSTEM-SS种植系统61颗;B组共植入54颗种植体,其中ITI种植系统28颗,OSSTEM-SS种植系统26颗。术后即刻及第4、6、8、12、16、24周分别测量各时期种植体稳定系数(ISQ),并同期进行临床和影像学检查。结果:A组中ITI种植系统术后8周ISQ值平均(74.17±1.85),进行负重;OSSTEM-SS种植系统术后12周ISQ值平均(72.00±2.59),进行负重。B组中ITI种植系统术后16周ISQ值平均(65.09±3.42),进行负重;OSSTEM-SS种植系统术后24周ISQ值平均(62.09±6.16),进行负重。负重后临床随访3-24个月所有病例均成功,咀嚼功能良好,患者满意。结论:种植体稳定系数(ISQ)能反应种植体骨结合情况,可以协助医生选择种植后合适的冠修复时机。     

自体颏部骨移植并种植体修复前牙槽骨缺损的应用研究

目的:评价自体颏部骨移植方法在前牙槽骨缺损植骨及种植的效果。方法:对16例前牙骨缺损的患者进行自体颏部骨移植,分别于植骨12～16周后植入种植体,共植入18枚种植体,术后16～20周完成修复治疗。结果:16例自体骨移植患者中,1例出现术后感染,经局部冲洗换药后后愈合良好,其余患者移植骨均已成活,修复后种植体至今均无脱落,局部外形良好。结论:自体颏部骨移植能有效恢复局部牙槽外形,为前牙美学修复提供良好的基础。     

XIVE 种植体即刻植入即刻负重的临床观察

目的:评价XIVE种植体在上颌外伤前牙区即刻种植即刻负重修复的临床效果。方法:对26例前牙区单颗或多颗无法保留的外伤残根拔除后,即刻植入XIVE种植体,并即刻负重修复。种植体扭矩控制在35Ncm左右,初期稳定性良好。平均四到五个月后行永久修复。在植入后1、2、4个月对其进行临床及影像学检查。结果:32枚种植体有2枚种植体2周后出现松动,一个月后脱落,其余30枚均在预期时间内形成良好骨性愈合,最终完成修复。结论:上颌前牙区单颗或多颗牙外伤,残根无法保留者,行即刻种植即刻负重修复是可行。早期种植修复有利于减缓牙槽骨的吸收,保留软硬组织的形态,缩短疗程。     

OSFE植骨与不植骨种植修复的临床效果对比研究

目的:比较上颌窦挤压内提升(OSFE)植骨与不植骨种植修复的临床效果。方法:选择上颌后牙区种植修复的35例患者,其剩余牙槽嵴高度(RBH)为4~8 mm,共植入43颗种植体。A组16例患者为植骨组,20个种植位点,牙槽骨可用骨高度平均(5.87±1.19)mm,植入人工骨粉后植入种植体;B组19例患者为不植骨组,23个种植位点,缺牙区牙槽骨可用骨高度平均(5.67±1.10)mm,上颌窦提升后直接植入种植体。6个月后行二期手术完成修复。采用临床检查、X线检查及视觉模拟评分法(visual analogue scale,VAS)进行效果评价。结果:两组病例的牙槽嵴高度差异比较无统计学意义。在平均约36.7个月的随访期内,A组种植体的存留率为100%(20/20),B组中有1枚种植体因咬合力过大及口腔卫生较差脱落,种植体的存留率为95.6%(22/23),两组病例的存留率比较无统计学差异。两组患者的VAS值比较亦相当。所有种植体骨结合良好,种植体周围软组织无炎症,种植义齿咀嚼功能良好。结论:在严格控制适应症、准确掌握种植技巧的前提下,RBH在4~8 mm之间的病例无需额外植入骨代替材料即可取得理想的修复效果,简化了手术的操作,减少了手术的风险和创伤,节省了手术的时间和费用,易被患者接受。     

XIVE种植体即刻植入即刻负重的临床观察

目的：评价XIVE种植体在上颌外伤前牙区即刻种植即刻负重修复的临床效果。方法：对26例前牙区单颗或多颗无法保留的外伤残根拔除后,即刻植入XIVE种植体,并即刻负重修复。种植体扭矩控制在35Ncm左右,初期稳定性良好。平均四到五个月后行永久修复。在植入后1、2、4个月对其进行临床及影像学检查。结果：32枚种植体有2枚种植体2周后出现松动,一个月后脱落,其余30枚均在预期时间内形成良好骨性愈合,最终完成修复。结论：上颌前牙区单颗或多颗牙外伤,残根无法保留者,行即刻种植即刻负重修复是可行。早期种植修复有利于减缓牙槽骨的吸收,保留软硬组织的形态,缩短疗程。     

利用共振频率分析牙种植体骨愈合期稳定性变化 与早期边缘骨吸收的关系

目的:利用共振频率测量仪(Osstell)连续监测骨愈合期种植体稳定性变化与早期边缘骨吸收的关系。方法:本研究于2010-2011年期间根据纳入及排除标准连续纳入32名成年男性患者作为实验对象共植入45枚Strauman种植体,每名患者选择一颗(4.8mm×10mm)种植体,共计32颗种植体,种植区位于下颌后牙(骨质均为Ⅱ或Ⅲ类骨)。利用共振频率分析仪(Osstell)测量种植体的稳定性,测量时间点为植入时以及术后第1,2,3,4,6,8,12周。另外,影像学分析测量32颗种植体12周时的边缘骨吸收;结果:本实验中所有种植体在12周均实现骨结合,并成功完成种植修复。通过重复性方差分析,见表1,在种植体植入时,初期稳定系数(ISQ)均值为(79.03±6.756)。术后一周,种植体稳定系数(ISQ)均值均呈下降趋势,至术后第2周时达到最低点,与植入时稳定性有统计学差异(P<0.05)。从术后第3周开始种植体稳定系数(ISQ)均值逐渐上升。其中,稳定系数(ISQ)均值在第6周时与第12周无统计学差异,已达到延期稳定期。32颗种植体在第12周的边缘骨吸收均值为(0.86±0.068mm),而在第12周的种植体的稳定系数均值与种植体植入时的稳定系数均值无统计学差异。结论:本实验通过共振频率测量仪(OsstellTM)连续监测,目前的结果认为种植体愈合期边缘骨吸收对种植体愈合期稳定性变化没有影响。     

种植修复后牙周菌群在不同时期变化的定量研究

目的观察种植修复后牙周菌群在不同时期的变化,比较牙周病人群和健康人群种植术后菌群分布差异。方法选择牙种植患者28例,接受37颗种植修复（无牙周病史19颗,有牙周病史18颗）,采取前后对照设计。采用细菌分离鉴定及菌落形成单位计数的检测方法,以正常同名天然牙为基线对照,追踪观察愈合基台龈袖口、全冠修复后1周、负荷12个月后牙龈沟菌丛变化情况。结果种植体龈沟液内的细菌数量增加构成日趋复杂,在愈合基台期细菌数量最低,冠修复后1年,两组人群的菌群数量和构成差异有显著性（P〈0．05）,而健康人群成功种植体和天然牙有相似的菌群构成;但以往有牙周病史的患者,种植体植入区域内普遍有牙周病原体量的增加。结论随着时间的延长,具有牙周病史的患者的种植体周围炎的风险增加。     

静态与动态计算机辅助种植手术在口腔种植中的应用进展

牙齿缺失是常见的口腔疾病,可导致患者咀嚼功能降低,面部形态改变。种植牙成为了修复缺失牙的最佳选择。计算机辅助技术在口腔领域的应用,为临床医生提供更多修复缺失牙的手术方法。静态计算机辅助种植手术与动态计算机辅助种植手术修复缺失牙是计算机辅助种植手术的两种主要手术方式。这两种种植手术解决了患者咀嚼功能和面部美观问题,但其在临床应用中仍有一定的局限性。本文通过论述静态计算机辅助种植手术与动态计算机辅助种植手术的概念及分类,通过论述其使用过程中的优点、缺点,对比两种手术方式植入的种植体精确度以评估其在临床中的应用,探讨如何在临床应用中减少种植体的偏差,为临床医生在种植病例的手术方法选择提供参考。     

骨诱导无机材料BAM 修复牙种植体周围骨缺损的实验研究

目的:评价骨诱导磷酸钙生物陶瓷(BAMOICPC)与可吸收胶原膜(BME-10X医用胶原膜)在牙种植体周围骨缺损中的修复能力。方法:在兔股骨上植入羟基磷灰石涂层BLB种植体,然后在其侧壁制造高4 mm、宽3 mm、深2 mm的骨缺损。对照组为单纯侧壁骨缺损,实验A组骨缺损区仅覆盖BME-10X膜,B组骨缺损区植入BAMOICPC,C组骨缺损区植入BAMOICPC并加盖BME-10X膜。于术后6个月取带种植体的骨段,通过HE染色和扫描电镜(SEM)分析。结果:对照组骨缺损区种植体表面见纤维包裹,实验A组骨缺损边界区少许骨质移行覆盖,实验B组下半部分缺损区新生骨覆盖。C组新生骨完全覆盖骨缺损区,且较B组硬度高,扫描电镜见与种植体结合更紧密。组织学观察B、C两实验组新生骨均可见比较成熟的哈弗氏管系统。结论:骨诱导磷酸钙生物陶瓷BAMOICPC是一种较理想的骨替代材料,联合运用胶原膜修复种植体周骨缺损效果佳。     

Densitometric analysis of dental implant placement between flapless technique and the two-stage technique--a pilot study

Flapless technique is a surgical approach of implant placement without raising a mucoperiosteal flap. Such approach has many advantages: shorter surgical treatment, minimal bleeding, postoperative discomfort for the patient is reduced; possibility of immediate loading of the inserted implant, faster procedure of implant placement and by that less time is needed for the complete implant-prosthetic restoration. Purpose of this pilot study was radiographic assessment of flapless technique and determination of its clinical values in comparison with two-stage dental implant technique through computerized densitometric analysis. The sample consisted of 10 patients with missing teeth in the premolar region in the upper jaw. An implant was placed in that position. In the first group of 5 patients the implants were inserted with the flapless technique, and in the other group of 5 patients implant insertion was done with a two-stage technique. All inserted implants were loaded with metal-ceramic crowns 3 months after placement. The patients were followed for 18 months through clinical follow-ups and radiovisiographical (RVG) images made after 3, 12 and 18 months. After comparing the average densities, the results showed similar decrease of density in both groups, conventional two-stage technique showed 3.24 and flapless technique 1.23. It can be concluded that flapless technique in everyday clinical usage has the same result as the two-stage dental implant technique.     

Biomechanical analysis and comparison of 12 dental implant systems using 3D finite element study

Finite element analysis plays an important role in dental implant design. The objective of this study was to show the effect of the overall geometry of dental implants on their biomechanics after implantation. In this study, 12 dental implants, with the same length, diameter and screw design, were simulated from different implant systems. Numerical model of right mandibular incisor bone segment was generated from CT data. The von-Mises stress distributions and the total deformation distributions under vertical/lateral load were compared for each implant by scores ranking method. The implants with cylindrical shapes had highest scores. Results indicated that cylindrical shape represented better geometry over taper implant. This study is helpful in choosing the optimal dental implant for clinical application and also contributes to individual implant design. Our study could also provide reference for choice and modification of dental implant in any other insertion sites and bone qualities.     

The use of metallic implants in the study of facial growth in children: method and application

On the basis of experience gained over a number of years, an account is given of the technique for insertion of the implants, the radiographic method, and the graphic procedure for preparation of growth tracings. Small pins of hard tantalum are hammered into the bone under local analgesia with a pencil-shaped instrument, in the tip of which the implant is placed. No surgical exposure is necessary. Because of remodeling resorption of the bone and eruption of the teeth, the implants can be placed only in certain places in the maxilla and mandible. In implant studies it is necessary to observe a high level of reproducibility in positioning the head in the cephalostat. An X -ray cephalostat with a built-in image intensifier has been designed which enables the position to be monitored by televison. In the graphic procedure, drawings of the arches from dental casts are incorporated in tracings of profile radiographs; the paths of eruption of the teeth and development or the arches can then be examined with the metallic implants as references.     

A new X-ray-free measurement method for postoperative 3D-position analysis of navigated inserted implants]

In this article a new X-ray-free measurement method for postoperative 3D-position analysis of dental implants is proposed. The advantage of this new method is the possibility of precise 3D comparison to preoperative planning data without the use of X-rays. Standard methods for postoperative implant analysis are performed manually on the basis of orthopantomography or computer tomography scans. The proposed method uses a navigation system and a specially designed measurement device. Analysis of the measurement data shows a mean position error of 0.2 mm +/-0.1 mm and a mean depth error of 0.4 mm +/- 0.3 mm. Thus, this method is suitable for postoperative analysis of the horizontal implant position and for comparison to preoperative planning     

Numerical investigation of bone remodelling around immediately loaded dental implants using sika deer (Cervus nippon) antlers as implant bed

This study combines finite element method and animal studies, aiming to investigate tissue remodelling processes around dental implants inserted into sika deer antler and to develop an alternative animal consuming model for studying bone remodelling around implants. Implants were inserted in the antlers and loaded immediately via a self-developed loading device. After 3, 4, 5 and 6 weeks, implants and surrounding tissue were taken out. Specimens were scanned by μCT scanner and finite element models were generated. Immediate loading and osseointegration conditions were simulated at the implant-tissue interface. A vertical force of 10 N was applied on the implant. During the healing time, density and Young’s modulus of antler tissue around the implant increased significantly. For each time point, the values of displacement, stresses and strains in the osseointegration model were lower than those of the immediate loading model. As the healing time increased, the displacement of implants was reduced. The 3-week immediate loading model (9878 ± 1965 μstrain) illustrated the highest strains in the antler tissue. Antler tissue showed similar biomechanical properties as human bone in investigating the bone remodelling around implants, therefore the use of sika deer antler model is a promising alternative in implant biomechanical studies.     

钛及钛合金种植体表面处理的研究进展

钛的优良特性早已被公认为首选牙用种植材料,其表面氧化膜是形成骨结合的关建。为了进一步增加其耐腐蚀性和生物相容性,人们采取了多种方式进行表面处理,最终达到在植入体的不同部位产生不同的粗糙表面,以利于不同细胞在不同地方的附着,增加其生物活性。同时,达到避免各种污染物对纯钛种植体影响的目的。近年来钛种植体材料表面处理已经成为研究热点,本文就表面处理的方法进行综述。     

Treatment of midfacial defects using prostheses supported by ITI dental implants

The purpose of this study was to evaluate retrospectively the use of ITI dental implants used for anchoring facial prostheses in the restorative treatment of midface defects. The authors analyzed the clinical data of 26 patients with orbital defects (n = 11), orbitonasal defects (n = 4), orbitonasomaxillary defects (n = 3), and nasal defects (n = 8). Data included age, sex, primary disease, implant position, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. Follow-up was at 1, 3, 6, and 12 months and then on a yearly basis. The authors noted the status of healing and complications, if any. In total, 62 implants were placed as follows: 27 (43.5 percent) for orbital prostheses, 12 (19.4 percent) for orbitonasal prostheses, 14 (22.6 percent) for orbitonasomaxillary prostheses, and nine (14.5 percent) for nasal prostheses. Thirty-eight implants (61.3 percent) were placed in previously irradiated areas in 18 patients (69.2 percent). Mild skin reactions together with mild accumulation of sebaceous crusting around implants were recorded in 14.2 percent of the skin observations. No patient experienced severe inflammation requiring administration of systemic antibiotics or surgical revision. Implant success was 100 percent in both irradiated and nonirradiated patients. In conclusion, ITI dental implants result in a high rate of success in retaining midface prostheses and offer good stability and aesthetic satisfaction.