微钛钉种植体治疗上前牙前突的临床研究

目的应用微钛钉种植体治疗上前牙前突,评价微钛钉种植体增强磨牙支抗的安全性、有效性。方法选择20例患者,上牙列前牙区牙齿覆盖在Ⅱ°以上,平均覆盖为8.3 mm。应用微钛钉种植体,植入上颌第一恒磨牙和第二前磨牙颊侧根尖之间的牙槽间隔,以每侧200g力滑动内收前牙。通过比较矫治前后头颅侧位片分析其治疗的有效性。结果 20例牙弓突度均得到明显改善,切牙切缘平均内收6.8mm,支抗磨牙平均前移0.6 mm,磨牙在前后向和垂直向均未发生显著性移动,均无显著性扭转,种植体保持稳定。结论微钛钉种植体能有效治疗上颌前牙前突,起到磨牙强支抗的效能。     

微种植体支抗压低上颌磨牙的研究进展

在口腔科诊疗工作中经常会见到因下颌磨牙长期缺失导致对颌磨牙伸长的情况,这将直接导致对颌磨牙修复空间不足。这种病例需要通过压低伸长的上颌磨牙来获取足够的空间,以利于下颌磨牙的修复。另外,高角和开牙合病例要想获得良好的治疗效果也需要通过压低磨牙来进行垂直向控制,因此压低上颌磨牙成为临床工作的重要内容。压低上颌磨牙的方法除了牙合垫、高位牵引头帽、手术等之外,还有微种植体支抗,它又称为"绝对支抗"由钛或合金制成,分为自攻型和助攻型。由于创伤小,植入部位灵活,手术简单,压低磨牙效果显著,所以自临床应用以来得到大力推广。因此本文就微种植体支抗压低上颌磨牙的临床应用、压低效果评价、副作用及防治措施和生物力学研究等方面作一综述。     

微种植钉支抗压低伸长磨牙在牙列缺损修复中的临床应用

目的:评价以微种植钉为支抗压低伸长磨牙在牙列缺损修复中的临床应用效果.方法:选择2008年9月1日至2009年9月1日期间,11例修复空间不足,需要压低因对颌牙缺失而伸长的上颌第一磨牙患者,男5例,女6例,年龄18～40岁,平均26岁.9位患者下颌单侧第一磨牙缺失,2位患者下颌双侧第一磨牙缺失,上颌磨牙由于对颌牙长期缺失而伸长,咬舍于对颌牙槽嵴黏膜,妨碍牙列修复治疗.利用微种植钉作为支抗,使用弹力链牵引伸长的磨牙,产生根向压入力.治疗前后拍摄头颅侧位片和曲面断层片.结果:11例患者伸长的磨牙均成功压低,获得足够的义齿修复的垂直空间,伸长磨牙平均压入3mm,成功进行了种植义齿或固定义齿修复.治疗时间平均为6个月.结论:采用微种植钉作支抗,能有效压低伸长的上颌磨牙,创造足够的义齿修复空间,且方便、高效.     

正常颌位全口义齿前牙有无正中接触的有限元分析

本文应用三维有限元法对正常颌位全口义齿前牙有无正中(牙合)接触的两种设计,进行垂直向(牙合)力作用下的应力分析。结果表明上颌基托纵折好发部位的横向拉应力及上颌前部基托下粘膜的垂直向压应力,前牙区无正中颌接触者明显小于有正中颌接触者。因此,作者认为前牙无正中(牙合)接触者可防止上颌基托纵折及减少前牙区牙槽骨过度吸收,为临床研究提供了理论依据,使正确的指导临床实践,     

矫治单侧后牙正锁(牙合)中微型钛钉种植支抗作用分析

目的:探讨矫治单侧后牙正锁(牙合)中微型钛钉种植支抗(MIA)作用。方法:选择应用钛钉MIA作为绝对支抗的错(牙合)畸形患者41例,选择11例单侧后牙正锁胎患者为研究对象,使用MIA压低伸长的上颌后牙,牵引舌侧倾斜的下颌后牙以矫正单侧后牙正锁胎。MIA植入部位为上颌后牙颊侧和腭侧根尖区,以及下颌后牙颊侧根尖牙槽间隔。观察植入术后钛钉周围组织的反应。结果:采用多部位植入钛钉TMIA、上下颌同时牵引的方法可有效矫正单侧后牙正锁(牙合),钛钉在治疗过程中保持稳定,其周围仅有轻微炎症。结论:作为骨性绝对支抗,MIA能有效压低上颌后牙,扶正舌倾的下颌后牙,矫正单侧后牙正锁(牙合)。     

主副弓丝配合矫治唇向低位上颌尖牙的临床应用（附38例病历报告）

唇向低位的上颌尖牙是常见的错(牙合)畸形。在Begg细丝弓娇治技术中,使用开张垂直曲唇弓推过低位的尖牙向远中有一定的局限性。使用钛镍丝唇弓加弹力牵引不可避免地使支抗磨牙前移。本文应用主弓丝配合钛镍丝副弓辅以弹力牵引,矫治唇向过低位上颌尖、牙取得了良好的临床效果。 临床资料 1、性别与年龄:本文报导38例,男性10例,女性28例。年令在11—17岁之间。     

第二恒磨牙正锁[牙合]畸形相关因素的研究

目的探讨引发下颌第二磨牙正锁(牙合)的相关因素,为口腔正畸临床诊断和治疗提供参考。方法随机抽取800例符合条件的病例作为研究对象。男349例,女451例,平均年龄21.7±3.31岁,其中45例发生第二磨牙正锁(牙合)。测量上颌后段牙弓间隙,下颌后段牙弓间隙,ANB角,上颌第一磨牙区和上颌第二磨牙区的牙槽弓宽度和下颌第一磨牙区和下颌第二磨牙区的牙槽弓宽度,对测量值进行统计分析。结果第二磨牙正锁(牙合)的发生率为5.6%,其性别构成差异无显著性(P>0.05)。回归方程:第二磨牙正锁(牙合)=22.9748 2.0257×上颌后段牙弓拥挤度 1.5372×下颌后段牙弓拥挤度 1.0071×ANB角度 0.3785×上颌第二磨牙处牙槽弓宽度-0.4897×下颌第二磨牙处牙槽弓宽度。结论第二磨牙正(牙合)与上颌后段牙弓拥挤有显著的相关关系,与下颌后段牙弓拥挤度、ANB角度和上颌第二磨牙处牙槽弓宽度呈正相关关系,与下颌第二磨牙处的牙槽弓宽度呈负相关关系。     

全口义齿不同牙尖斜度的有限元分析

本文重点探讨全口义齿上颌笫一磨牙近中舌尖颊面的五种不同牙尖斜度,进行垂直向(牙合)力作用下的有限元应力分析。结果表明10°牙最佳,0°牙较佳,30°牙较差,40°牙更差,20°牙比10°及0°牙差,但比30°及40°牙好,为临床应用提供理论依据。     

固定全冠桥牙体预备的不同设计对支持组织的应力分析

本文利用三维有限元方法分析固定全冠桥牙体预备不同锥度和高度对基牙支持组织的受力影响,利用右下颌第一磨牙缺失,第二前磨牙和第二磨牙进行修复的三单位全冠固定桥作为研究基础,在高度一定,锥度分别为0°、2°、6°、12°、25°时,锥度一定,(牙合)龈高度分别为4mm、5mm、6mm时,分别垂直和颊舌水平加载150N,分析不同条件下基牙支持组织的受力。研究结果表明:颊舌向水平加载基牙支持组织的受力明显大于垂直向加载基牙支持组织的受力,随着锥度的增大和(牙合)龈高度的降低,支持组织的应力减小;水平加载条件下支持组织的应力随锥度的变化更为明显。     

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。     

Tooth wear and compensatory modification of the anterior dentoalveolar complex in humans

In populations living in environments where teeth wear severely, some compensatory modification of the dentoalveolar complex is thought to occur during life whereby functional occlusion is maintained as tooth substance is lost by wear. This study investigates one aspect of this modification process: Changes in the anterior dentoalveolar complex that are accompanied with wear were examined in a series of Japanese skeletal samples. In the prehistoric Japanese hunter-gatherer population heavy wear occurs over the entire dentition. The following changes were demonstrated to have occurred in the anterior segment of the dentition accompanied by wear on the anterior teeth: The anterior teeth tip lingually with wear up to a nearly upright position to fill in interproximal spaces that would have been generated by wear, and to maintain contact relations between adjacent teeth. At the same time, the anterior surface of the maxillary alveolar process also inclines lingually to a certain extent. The amount of lingual tipping is greater in the maxillary anterior teeth than in their mandibular antagonists. It is because of this discrepancy that, with age, the horizontal component of the overlap between maxillary and mandibular anterior teeth decreases, and their bite form changes from scissor bite to edge-to-edge bite. Lesser degrees of lingual tipping of the anterior teeth were also detected in the prehistoric agriculturists and historic Japanese populations. The variation in the degree of lingual tipping observed among the samples is explained by inter-population variation in severity and pattern of tooth wear. This and other evidence suggests that mechanisms that compensate for wear in the anterior dentition may be characteristic of all living human populations, independently of the degree of wear severity endured in their environments.     

Time-related PDL: viscoelastic response during initial orthodontic tooth movement of a tooth with functioning interproximal contact-a mathematical model

Most anteroposterior orthodontic movements of posterior teeth have to overcome the "resistance" of adjacent teeth with functioning interproximal contacts. The aim of this study was to develop a mathematical model describing initial posterior tooth movement associated with functioning interproximal contacts in relation to the viscoelastic mechanical behavior of the human periodontal ligament (PDL). A linear viscoelastic 2D mathematical model was modified to depict tipping movement around the center of rotation (C(rot)) of a premolar where tipping is restrained by adjacent teeth. Equilibrium equations were applied taking into account the sagittal moment developed around the C(rot). The constants of the model were analyzed and applied to a numerical model that can simulate short-term tooth creep movement caused by a tipping force. Changes in force magnitude (0.5-3N) and crown length (6-10mm) were analyzed until no movement was observed (steady state). Premolar displacement in contact with adjacent teeth showed a non-linear progression over time with an initial sharp tipping movement followed by a transient period of 2.6-7.1min. As tipping force increased the transient period increased. A similar but smaller effect was observed with an increase in crown length. The premolar initial displacement within the arch (3.2-19.5microm) is about seven-fold smaller than retraction/protraction movement of an incisor. These suggest reduction in tooth displacement when functioning interproximal contact is present and clinically recommend establishing a space in the direction of tooth displacement before tooth movement.     

The function of the intramaxillary joint in the Round Island boa, Casarea dussumieri

The bolyeriid snakes Casarea dussumieri and Bolyeria multocarinata are unique among vertebrates in possessing an intramaxillary joint that separates the maxilla into anterior and posterior segments. In contrast to previous studies, which suggest that this joint permits enhanced elevation of the anterior maxillary teeth, our films of live Casarea show that the snout and anterior maxillary teeth are actively depressed 15° 20° below rest position through bilateral retraction of the palatomaxillary arches. Patterns of bone movement in living Casarea support the hypothesis that a caudally directed force is transmitted to the snout via the medial bones of the palatomaxillary arch, suggesting functional affinities between Casarea and higher henophidians.
The intramaxillary joint, in conjunction with the curvature of the mandibles, allows the jaws of Casarea to encircle hard, cylindrical prey held transversely in the mouth. Because the Mauritian terrestrial vertebrate fauna lacks mammals and is dominated by skinks and geckos, which Casarea is known to consume, we suggest that the intramaxillary joint functions in a manner analogous to that achieved by quite different maxillary modifications in colubrid scincivores. Although the origin of the bolyeriid intramaxillary joint remains unclear, its structural refinement and evolutionary stability may be due to selection pressures arising from limited prey diversity.     

Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements

doi: 10.1111/j.1741‐2358.2012.00648.x Biometric ratio in estimating widths of maxillary anterior teeth derived after correlating anthropometric measurements with dental measurements Objective: To correlate dental measurements i.e. combined mesiodistal width of six maxillary anterior teeth with facial measurements i.e. inner canthal distance, interpupillary distance and intercommissural width and acquire a biometric ratio to serve as a preliminary guide in selection of the maxillary anterior teeth. Background: In the absence of pre‐extraction records, the resultant denture can lead to patient dissatisfaction towards the aesthetic appeal of their dentures. The maxillary anterior teeth play a pivotal role in denture aesthetics. Various techniques and biometric ratios have been described in literature for selection of the maxillary anteriors. This study derives a biometric ratio for the same, obtained after correlating anthropometric measurements with dental measurements. Materials and methods: Two standardized digital photographs of the face were generated; one, when the facial muscles were relaxed and the other, when the subject was smiling; thereby, revealing the maxillary anterior teeth upto the canine tip. Inner canthal distance, interpupillary distance, intercommissural distance, distance between the tips of the maxillary canines and distance between the distal surfaces of the canines were measured. On the cast, the distance between tips of maxillary canines and distance between distal surfaces of maxillary canines were noted. The data was analysed using Spearman’s rank correlation coefficient. Results: A high correlation was found between the intercommissural measurement with distance between the tips of the canines on the photograph and between the tips of the canines on the cast with the interpupillary distance, giving a biometric ratio of 1:1.35 and 1:1.41 respectively. The least correlation was between the inner canthal distance and the tips of the canines measured on the photograph. Conclusions: Extra oral anthropometric measurements of the interpupillary distances and the intercommissural distances with the help of standardised photographs can help us determine the combined widths of the anterior teeth accurately, thus aiding their selection in the absence of pre‐extraction records.     

Influences of age and maxillary anterior teeth status on patient's satisfaction with dental appearance and tooth colour

doi: 10.1111/j.1741‐2358.2011.00543.x Influences of age and maxillary anterior teeth status on patient’s satisfaction with dental appearance and tooth colour Objectives: To study the impact of age, gender, tooth colour and maxillary anterior teeth status on patient’s satisfaction with their dental appearance. Material and methods: A total of 259 Caucasian subjects participated in the study (119 men, mean age 56 years; 140 women, mean age 61 years) divided into three age groups (young <35 age; middle aged 35–54 age; old ≥55 age). Their maxillary anterior teeth status was classified into three groups: (1) natural teeth (NTG) group; (2) composite filling group (CFG) and (3) porcelain‐fused‐to‐metal fixed prosthodontic restoration group (FPDG). The participants judged appearance and tooth colour using a scale with three categories: completely dissatisfied, moderately dissatisfied and completely satisfied. Results: Almost half of the participants were completely satisfied with their dental appearance and tooth colour. Half of the ‘young’ and ‘middle‐aged’ participants with natural maxillary anterior teeth were completely satisfied and half of the ‘old’ participants were moderately satisfied with their dental appearance and tooth colour. The majority of participants with composite restorations (45–51%) were moderately satisfied with their dental appearance, one‐third of ‘young’ and ‘middle‐aged’ participants were moderately satisfied or dissatisfied with their tooth colour and more than 70% of older participants were dissatisfied with their tooth colour (p > 0.05). Conclusions: Satisfaction with the appearance of the maxillary anterior teeth differed both between individuals of different age and different dental status.     

Rapid maxillary anterior teeth retraction en masse by bone compression: a canine model

Objective

The present study sought to establish an animal model to study the feasibility and safety of rapid retraction of maxillary anterior teeth en masse aided by alveolar surgery in order to reduce orthodontic treatment time.

Method

Extraction of the maxillary canine and alveolar surgery were performed on twelve adult beagle dogs. After that, the custom-made tooth-borne distraction devices were placed on beagles'' teeth. Nine of the dogs were applied compression at 0.5 mm/d for 12 days continuously. The other three received no force as the control group. The animals were killed in 1, 14, and 28 days after the end of the application of compression.

Results

The tissue responses were assessed by craniometric measurement as well as histological examination. Gross alterations were evident in the experimental group, characterized by anterior teeth crossbite. The average total movements of incisors within 12 days were 4.63±0.10 mm and the average anchorage losses were 1.25±0.12 mm. Considerable root resorption extending into the dentine could be observed 1 and 14 days after the compression. But after consolidation of 28 days, there were regenerated cementum on the dentine. There was no apparent change in the control group. No obvious tooth loosening, gingival necrosis, pulp degeneration, or other adverse complications appeared in any of the dogs.

Conclusions

This is the first experimental study for testing the technique of rapid anterior teeth retraction en masse aided by modified alveolar surgery. Despite a preliminary animal model study, the current findings pave the way for the potential clinical application that can accelerate orthodontic tooth movement without many adverse complications.

Clinical Relevance

It may become a novel method to shorten the clinical orthodontic treatment time in the future.     

Passive and active contributions to generated force and retraction in heart valve tissue engineering

In tissue engineered heart valves, cell-mediated stress development during culture results in leaflet retraction at time of implantation. This tissue retraction is partly active due to traction forces exerted by the cells and partly passive due to release of residual stress in the extracellular matrix and the cells. Within this study, we unraveled the passive and active contributions of cells and matrix to generated force and retraction in engineered heart valve tissues. Tissue engineered rectangular strips, fabricated from PGA/P4HB scaffolds and seeded with human myofibroblasts, were cultured for 4 weeks, after which the cellular contribution was changed at different levels. Elimination of the active cellular traction forces was achieved with Cytochalasin D and inhibition of the Rho-associated kinase pathway. Both active and passive cellular contributions were eliminated by lysation and/or decellularization of the tissue. Maximum cell activity was reached by increasing the fetal bovine serum concentration to 50%. The generated force decreased ~20% after elimination of the active cellular component, ~25% when the passive cellular component was removed as well and remained unaffected by increased serum concentrations. Passive retraction accounted for ~60% of total retraction, of which ~15% was residual stress in the matrix and ~45% was passive cell retraction. Cell traction forces accounted for the remainder ~40% of the retraction. Full activation of the cells increased retraction by ~45%. These results illustrate the importance of the cells in the process of tissue retraction, not only actively retracting the tissue, but also in a passive manner to a large extent.     

Traction force microscopy in rapidly moving cells reveals separate roles for ROCK and MLCK in the mechanics of retraction

Retraction is a major rate-limiting step in cell motility, particularly in slow moving cell types that form large stable adhesions. Myosin II dependent contractile forces are thought to facilitate detachment by physically pulling up the rear edge. However, retraction can occur in the absence of myosin II activity in cell types that form small labile adhesions. To investigate the role of contractile force generation in retraction, we performed traction force microscopy during the movement of fish epithelial keratocytes. By correlating changes in local traction stress at the rear with the area retracted, we identified four distinct modes of retraction. “Recoil” retractions are preceded by a rise in local traction stress, while rear edge is temporarily stuck, followed by a sharp drop in traction stress upon detachment. This retraction type was most common in cells generating high average traction stress. In “pull” type retractions local traction stress and area retracted increase concomitantly. This was the predominant type of retraction in keratocytes and was observed mostly in cells generating low average traction stress. “Continuous” type retractions occur without any detectable change in traction stress, and are seen in cells generating low average traction stress. In contrast, to many other cell types, “release” type retractions occur in keratocytes following a decrease in local traction stress. Our identification of distinct modes of retraction suggests that contractile forces may play different roles in detachment that are related to rear adhesion strength. To determine how the regulation of contractility via MLCK or Rho kinase contributes to the mechanics of detachment, inhibitors were used to block or augment these pathways. Modulation of MLCK activity led to the most rapid change in local traction stress suggesting its importance in regulating attachment strength. Surprisingly, Rho kinase was not required for detachment, but was essential for localizing retraction to the rear. We suggest that in keratocytes MLCK and Rho kinase play distinct, complementary roles in the respective temporal and spatial control of rear detachment that is essential for maintaining rapid motility.     

Cast titanium overlay denture for a geriatric patient with a reduced vertical dimension

An older patient reporting to the dental surgery for his/her dental treatment is becoming a common occurrence. Improved oral hygiene has meant that teeth are retained for a longer time, along with the potential problems of attrition, decreased vertical dimension, temporomandibular joint discomfort/strain, and poor aesthetics. The case in question is that of a 65-year-old male patient who had severe attrition in the lower arch, temporomandibular joint pain and reduced vertical dimension. The maxillary arch had previously been restored with a fixed partial prosthesis. For restoration of the lower teeth, a removable cast titanium overlay denture was fabricated incorporating an increased vertical dimension. Porcelain facings were placed to restore the aesthetics of the anterior teeth. The titanium was cast in a semi-automatic electric arc, pressure type casting machine. A titanium overlay denture with porcelain facing on the anterior teeth may provide a means of restoring a patient's concerns regarding aesthetics and function.     

双线排龈法在烤瓷冠修复牙体缺损中的临床应用

目的:探讨双线排龈法在烤瓷冠修复牙体缺损中的临床应用效果,为临床提供参考。方法:选择2014年3月至2016年3月来我院拟行烤瓷冠修复的96例患者,按照患者入院顺序交替分为观察组和对照组,每组48例。观察组48例(56颗牙)采用双线排龈法,对照组48例(52颗牙)采用单线排龈法,观察和比较两组的排龈效果及随访24周的基牙与游离龈是否完全排开,龈沟宽度是否合适,牙体预备后肩台的边缘是否清晰、连续,印模肩台是否清晰、连续,有无气泡,模型是否清晰、光滑,牙龈有无渗血等。结果:观察组基牙与游离龈排开不全、印模肩台不清晰不连续或有气泡、模型不清晰不光滑、牙龈渗血的发生率均显著低于对照组(P0.05)。修复后24周,两组的修复体边缘隐蔽性比较差异无统计学意义(P0.05),观察组0级牙数为52颗(92.9%),对照组0级牙数为41(80.8%),观察组的牙周组织情况明显优于对照组(P0.05)。结论:在前牙烤瓷冠修复中应用双线排龈法的排龈效果较单线排龈法更好。