微型种植体支抗在口腔正畸治疗中的临床效果

为了探讨微型种植体支抗在口腔正畸治疗中的临床效果,本研究选择我院收治的口腔正畸患者100例作为研究对象,根据支抗材料将患者分为观察组和对照组,50例观察组患者采用微型种植支抗技术进行治疗,50例对照组口腔正畸患者采用口外弓加强支抗技术治疗。比较两组患者术后的疗效指标(上中切牙凸距差,磨牙移位和上中切牙倾角)、咀嚼功能(咬合力和咀嚼效率)、牙龈指标(出血指数,菌斑指数和牙龈指数)及并发症。研究表明,术后第2天,观察组患者的中切牙凸距差和上中切牙倾角显著高于对照组(p=0.012,p=0.001),而磨牙移位显著低于对照组(p=0.009)。治疗1个月后,观察组患者的平均咬合力和咀嚼效率显著高于对照组(p0.05)。治疗1个月后,观察组患者的出血指数、菌斑指数和牙龈指数显著低于对照组(p0.05)。观察组患者中有6例(12.00%)患者出现不良并发症,对照组为14例(28.00%),观察组患者的术后并发症发生率显著低于对照组(p=0.036)。本研究结论初步表明,微型种植体支抗在口腔正畸治疗中的疗效优于传统支抗(口外弓加强支抗),可显著改善患者的咀嚼功能和牙龈健康,并且降低并发症发生率。     

微型种植体支抗在青少年口腔正畸治疗中的效果及安全性

目的:研究微型种植体支抗治疗青少年口腔正畸的疗效及安全性。方法:选择2013年5月-2015年5月在我院接受治疗的80例青少年口腔正畸患者,随机分为试验组和对照组。试验组给予微型种植体支抗治疗,对照组给予传统正畸治疗。观察并比较两组患者的临床疗效、不良反应及头影测量结果。结果:试验组患者的上、中切牙倾角差、上中切牙凸距差、磨牙移位的改善情况均明显高于对照组,差异有统计学意义(P0.05);与治疗前比较,两组患者治疗后U1-L1、U1-SN、L1-MP、U1-NA、L1-NB、SNA、SNB及ANB差值均有统计学意义(P0.05);试验组U1-L1、SNB显著大于对照组,其他指标均显著小于对照组,差异具有统计学意义(P0.05);试验组患者不良反应的发生率明显低于对照组,差异具有统计学意义(P0.05)。结论:与传统支抗方法相比,微型种植体支抗用于青少年口腔正畸治疗具有操作简便、疗效显著、安全性较高等优点,适合在临床推广使用。     

微型种植体支抗在口腔正畸治疗中的临床研究

目的:探讨微型种植体支抗在口腔正畸治疗中的效果。方法:将80例需口腔正畸治疗的患者随机分为两组,对照组给予传统正畸治疗,观察组给予微型种植体支抗治疗,观察和比较两组的手术成功率、治疗结果及随访2周期间不良反应的发生情况。结果:观察组手术成功率(92.5%)显著高于对照组(70.0%,P0.05)。治疗后,观察组上中切牙凸距差为(4.54±1.21)mm(增加80.9%)、上中切牙倾角为(27.27±4.45)mm(增加132.3%)、下齿槽座角为(1.49±0.53)mm(增加81.7%)、尖牙间宽度为(1.73±0.69)mm(增加143.7%)、磨牙移位为(3.25±0.73)mm(降低37.1%)、上齿槽座角为(-1.81±0.46)mm(降低147.9%),与对照组相比,均有显著性差异(P0.05)。随访2周内,与对照组相比,观察组口腔炎症、口腔感染、不适感降低以及软组织轻度浮肿等不良反应的发生率(10%)显著低于对照组(30%,P0.05)。结论:微型种植体支抗在口腔正畸治疗中能发挥理想的矫治效果,稳定性好,手术成功率和安全性均较高。     

口腔正畸MIA技术对青少年安氏Ⅱ类错[牙合]畸形患者对龈沟液MMP-2表达水平的影响

目的:探讨口腔正畸微螺钉种植体支抗(Microscrew implant anchor,MIA)技术对青少年安氏Ⅱ类错[牙合]畸形患者对龈沟液基质金属蛋白酶(Matrix metalloproteinase,MMP)-2表达水平的影响。方法:2016年1月1日至2019年12月31日选择在本院诊治的青少年安氏Ⅱ类错[牙合]畸形患者86例,根据治疗方法把患者分为MIA组与对照组,各43例,对照组给予头帽口外弓支抗技术结合直丝弓矫治器治疗,MIA组给予MIA技术结合直丝弓矫治器治疗,检测龈沟液MMP-2表达水平变化情况。结果:MIA组正畸后6个月的总有效率为97.7%,显著高于对照组的81.4%(P<0.05)。两组正畸后6个月的SNA角、OB与OJ值低于正畸前,MIA组低于对照组(P<0.05),两组正畸前后SNB角在组内与组间对比差异都无统计学意义(P>0.05)。两组正畸后6个月的龈沟液MMP-2值低于正畸前,MIA组低于对照组(P<0.05)。结论:口腔正畸MIA技术在青少年安氏Ⅱ类错[牙合]畸形患者的应用能抑制龈沟液MMP-2的表达,有利于改善患者的头颅与牙齿的X线指标,从而促进提高治疗效果。     

埋伏倒置阻生上颌中切牙不同正畸牵引方式的比较

目的:比较前方牵引器及下颌支抗颌间牵引两种正畸牵引方式矫治上中切牙埋伏倒置阻生的疗效。方法:选择10例患者10颗埋伏倒置阻生上颌中切牙,在三维CT片上的位置、三维方向和埋伏阻生的程度均相似,随机分为两组,分别行前方牵引器牵引和颌间牵引,对两组的牵引时间和成功率进行比较,分别采用t检验和x2检验进行统计学处理。结果:前方牵引组牵引时间长于颌间牵引组,有显著差异(P0.05),前方牵引组成功率为100%,颌间牵引组为60%,差异有显著性(P0.01)。结论:埋伏倒置阻生的上中切牙外科开窗术后,通过前方牵引器牵引的时间显著长于下颌支抗颌间牵引,但成功率显著高于颌间牵引。     

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)。     

埋伏倒置阻生上颌中切牙不同正畸牵引方式的比较

目的：比较前方牵引器及下颌支抗颌间牵引两种正畸牵引方式矫治上中切牙埋伏倒置阻生的疗效。方法：选择10例患者10颗埋伏倒置阻生上领中切牙,在三维CT片上的位置、三维方向和埋伏阻生的程度均相似,随机分为两组,分别行前方牵引器牵引和颌间牵引,对两组的牵引时间和成功率进行比较,分别采用t检验和x2检验进行统计学处理。结果：前方牵引组牵引时间长于颌间牵引组,有显著差异（P〈0．05）,前方牵引组成功率为100％,颌间牵引组为60％,差异有显著性（P〈0．01）。结论：埋伏倒置阻生的上中切牙外科开窗术后,通过前方牵引器牵引的时间显著长于下颌支抗颌间牵引,但成功率显著高于颌间牵引。     

Begg矫治器和直丝弓矫治器联合治疗安氏Ⅱ类1 分类错颌畸形的临床 疗效分析

目的:探讨Begg矫治器和直丝弓矫治器联合治疗安氏Ⅱ类1分类错颌畸形的临床疗效。方法:采取回顾性分析方法,调阅2010-2013年徐州矿务集团总医院安氏Ⅱ类1分类错颌畸形患者病历资料,选择病历资料完整且符合本研究要求的正畸病人病历44例进行分析,实验组22例为Begg矫治器和直丝弓矫治器联合治疗组,对照组22例为单纯直丝弓治疗组。对治疗前后的头影测量片进行扫描分析,对治疗时间及辅助支抗应用情况进行统计分析。结果:治疗完成时,Begg矫治器和直丝弓矫治器联合治疗组和单纯直丝弓治疗组的前牙覆合覆盖均减少,上切牙切缘均向远中移动,上下磨牙均伸长,前下面高度均增加,两组治疗结束后硬组织的变化无统计学差异(P0.05)。Begg矫治器和直丝弓矫治器联合治疗组与单纯直丝弓治疗组相比,治疗时间短,使用辅助支抗少,差异具有统计学意义(P0.05)。结论:Begg矫治器和直丝弓矫治器联合矫治安氏Ⅱ类1分类错颌畸形是临床上一种速度快,费用低,效果优的治疗方法。     

锥束CT在正畸治疗中上气道研究的应用

随着医学影像技术的不断进步,CBCT以能获得更加简便、安全、有效的影像学资料而获得越来越多的关注。本文从下颌后缩患者矫形治疗前后及正畸正颌联合治疗骨性Ⅲ类错猞畸形患者的上气道三维方向变化出发,对正畸治疗中上气道研究的重要性及CBCT在正畸领域尤其是上气道研究中的应用优势作一综述。     

脉冲式冲牙器预防正畸患者牙龈炎的纵向对比研究

目的:正畸患者口腔内环境往往会受到多种不良影响,造成大量微生物种群定植于牙龈周围,并形成牙菌斑改变牙周组织的形态和结构,对正畸效果及疗程产生较大不利因素,如何采用合理干预措施降低口腔正畸患者牙菌斑和牙龈炎的发生率,成为正畸是否成功的关键因素之一。本研究旨在探讨脉冲式冲牙器对正畸患者牙菌斑及牙龈炎症的影响。方法:以82例青少年正畸患者及健康志愿者为研究对象,将正畸患者随机分为研究组(41例)和对照组(41例);于正畸后30天后对患者进行口腔卫生宣教及日常刷牙方法系统培训,研究组正畸患者采用脉冲式冲牙器;于干预前后评价牙龈指数(gingival index,GI)和Quigley-Hein菌斑指数(plaque index,PI)。结果:在干预前,志愿者与正畸30天患者均存在不同程度口腔卫生问题,正畸患者GI及PI等指数明显高于健康人群,差异具有统计学意义(P0.05);经过一定周期的干预,两组正畸患者的GI均有不同程度的改善,但以研究组患者效果更为明显,差异具有统计学意义(P0.05)。结论:脉冲式冲牙器能够产生超细高压脉冲水柱,可以在正畸治疗期间有效提高菌斑清除率,减缓牙龈炎的进程,不同程度改善正畸患者口腔卫生,有助于提高正畸治疗效果。     

Configuration of anchorage holes affects fixation of the acetabular component in cemented total hip replacement--a finite element study

Our survey of current practice among UK orthopaedic surgeons shows wide variations in fixation techniques. The aim of this study, is to investigate the effect of drilling different configurations of anchorage holes in the acetabulum on implant stability. To avoid variables that could incur during in vitro testing, we used commercially available COSMOS finite element analysis package to investigate the stress distributions, deformations, and strains on the cement mantle when drilling three large anchorage holes and six smaller ones, with straight and rounded cement pegs. The results, which are in line with our in vitro studies on simulated reconstructed acetabulae, indicate better stability of the acetabular component when three larger holes than six smaller holes are drilled and when the necks of the anchorage holes are rounded. The longevity of total hip replacements could be improved by drilling three large anchorage holes, rather than many smaller ones, as initially proposed by Charnley.     

Configuration of anchorage holes affects fixation of the acetabular component in cemented total hip replacement—a finite element study

Our survey of current practice among UK orthopaedic surgeons shows wide variations in fixation techniques. The aim of this study, is to investigate the effect of drilling different configurations of anchorage holes in the acetabulum on implant stability. To avoid variables that could incur during in vitro testing, we used commercially available COSMOS finite element analysis package to investigate the stress distributions, deformations, and strains on the cement mantle when drilling three large anchorage holes and six smaller ones, with straight and rounded cement pegs. The results, which are in line with our in vitro studies on simulated reconstructed acetabulae, indicate better stability of the acetabular component when three larger holes than six smaller holes are drilled and when the necks of the anchorage holes are rounded. The longevity of total hip replacements could be improved by drilling three large anchorage holes, rather than many smaller ones, as initially proposed by Charnley.     

Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome – MONET – study

Background

In orthodontic treatment, anchorage control is a fundamental aspect. Usually conventional mechanism for orthodontic anchorage control can be either extraoral or intraoral that is headgear or intermaxillary elastics. Their use are combined with various side effects such as tipping of occlusal plane or undesirable movements of teeth. Especially in cases, where key-teeth are missing, conventional anchorage defined as tooth-borne anchorage will meet limitations. Therefore, the use of endosseous implants for anchorage purposes are increasingly used to achieve positional stability and maximum anchorage.

Methods/Design

The intended study is designed as a prospective, multicenter randomized controlled trial (RCT), comparing and contrasting the effect of early loading of palatal implant therapy versus implant loading after 12 weeks post implantation using the new ortho-implant type II anchor system device (Orthosystem Straumann, Basel, Switzerland). 124 participants, mainly adult males or females, whose diagnoses require temporary stationary implant-based anchorage treatment will be randomized 1:1 to one of two treatment groups: group 1 will receive a loading of implant standard therapy after a healing period of 12 week (gold standard), whereas group 2 will receive an early loading of orthodontic implants within 1 week after implant insertion. Participants will be at least followed for 12 months after implant placement. The primary endpoint is to investigate the behavior of early loaded palatal implants in order to find out if shorter healing periods might be justified to accelerate active orthodontic treatment. Secondary outcomes will focus e.g. on achievement of orthodontic treatment goals and quantity of direct implant-bone interface of removed bone specimens. As tertiary objective, a histologic and microtomography evaluation of all retrieved implants will be performed to obtain data on the performance of the SLA surface in human bone evaluation of all retrieved implants. Additionally, resonance frequency analysis (RFA, Osstell? mentor) will be used at different times for clinically monitoring the implant stability and for histological comparison in order to measure the reliability of the resonance frequency measuring device.

Trial registration

Current Controlled Trials ISRCTN97142521.     

The resonance frequencies and mode shapes of dental implants: Rigid body behaviour versus bending behaviour. A numerical approach

The purpose of this study was to evaluate the modal behaviour of the bone-implant-transducer (Osstell) system by means of finite element analyses. The influence of different parameters was determined: (1) the type of implant anchorage being trabecular, cortical, uni-cortical, or bi-cortical, (2) the implant diameter, (3) the length of the implant embedded in the bone, and (4) the bone stiffness. The type of anchorage determines the resulting modal behaviour of the implant-transducer system. A rigid body behaviour was found for a uni-cortical anchoring and for a homogeneous anchoring with low bone stiffness (< or =1000 MPa), whereas a bending behaviour was found for a homogeneous anchoring with a high bone stiffness (> or =5000 MPa) and for a bi-cortical anchorage. The implant dimensions influence the values for the resonance frequencies. Generally, an increase in implant diameter or implant length (in bone) results in higher resonance frequencies. This study also showed that resonance frequencies in case of rigid body behaviour of the implant-transducer system are more sensitive to changes in bone stiffness than resonance frequencies in case of bending behaviour. In conclusion, it seems that the Osstell transducer is suited for the follow-up in time of the stability of an implant, but not for the quantitative comparison of the stability of implants.     

羟基磷灰石义眼台植入联合一期钛钉打孔术的效果研究

目的：探讨国产医用钛钉系统联合改良羟基磷灰石义眼台钛钉打孔术的手术效果。方法：选择32只健康家兔并将其分两组,在球内容摘除术后分别行单纯义眼台植入及义眼台植入联合一期钛钉打孔术,于2、4、6、12w时每组分别处死4只家兔,观察和评价家兔对钛钉的生物耐受性及HA植入物的血管化过程。以动物实验为基础,对87例患者行羟基磷灰石义眼台一期植入联合钛钉打孔术,随访12个月,观察其手术效果及与此术式相关的并发症,总结分析国产医用钛钉系统联合改良羟基磷灰石义眼台钛钉打孔术的手术效果及优点。结果：动物实验显示：一期钛钉植入术未发生钛钉移位、排斥,扫描电镜结果表明：2、4、6、12w时两组HA血管化过程无显著差异,6w时钛钉周围1mm范围内与其完全对应的环行区域内血管化程度没有显著差异。临床实验显示：改良术式与二期打孔术相比,义眼片活动度显著提高（P〈0．01）,差异有统计学意义（P〈0．05）。两组术后肉芽肿的发生率比较无统计学差异（P〉0．05）。结论：一期植入钛钉生物相容性好,改良术式临床效果佳,术后并发症少。     

前牙美学区实施即刻种植及延期种植对患者唇侧骨量变化的对比研究

目的：研究对比前牙美学区实施即刻种植及延期种植对患者唇侧骨量变化。方法：选择2012 年4 月至2013 年4 月在我院 接受上颌前牙区的单颗种植手术治疗的患者96 例作为研究对象。根据数字法随机分成即刻种植组48 例（48 颗ITI种植体）与延 期种植组48 例（48 颗ITI种植体）。对比两组术后唇侧骨量情况,唇侧骨的改建情况以及术后1 年的PES评分。结果：即刻种植组 术后1 年的唇侧骨高度较术后即刻显著更高,差异有统计学意义（P＜0.05）。即刻种植组与延期种植组术后1 年水平向骨改建的 种植体冠方C 及中段M 较术后即刻显著更低,差异均有统计学意义（均P＜0.05）。即刻种植组在术后1 年的唇侧牙槽嵴的高度 降低水平明显大于延期种植组,且对于水平向骨改建方面,两组种植体中段M的差异具有统计学意义（P＜0.05）。两组在术后1 年的PES 评分上对比,差异无统计学意义（P＞ 0.05）。结论：即刻种植并未能阻止患者牙槽嵴生理吸收,但种植的美学效果亦较 好。临床运用时应加以关注,掌握好适应证,从而获得最佳疗效。值得重视。     

Present clinical applications of osseointegrated percutaneous implants

Altogether, 389 screws of commercially pure titanium have been inserted at various locations in the facial skeleton of 174 patients. The indications for treatment have been stable anchorage of an external hearing aid or a facial episthesis, in the latter case to restore the facial contours after congenital disorders or status after trauma or cancer surgery. All implants have been inserted in a two-stage procedure, the first being anchorage of the titanium elements in the bone, the second, minimally 3 months later, being establishment of a permanent skin penetration. The outcome of every inserted implant has been analyzed. Only six implants failed to become integrated in bone and had to be removed. Five of these failures occurred in previously irradiated bone, where the success rate was estimated to 85.3 percent. In nonirradiated bone, 354 of 355 inserted implants became osseointegrated, i.e., anchored in bone in a stable manner. The soft tissues were without any adverse reactions in 92 percent of the 951 clinical observations, whereas potentially serious skin complications were observed in only 2.8 percent. Presently, the longest clinical follow-up is 8 years, and 37 implants have been followed for more than 5 years. We believe that this clinical material is the first in which an uneventful bone anchorage and skin penetration have been demonstrated in consecutively operated upon clinical cases. The implants used for anchoring an external hearing aid were also successful in the sense that the patients gained 15 dB (average) in hearing threshold and showed a significantly improved discrimination score. The implants inserted to hold facial epistheses resulted in considerably improved retention and a good cosmetic outcome for the patients.     

Implant injector for retropectoral augmentation

The implant injector allows an augmentation of the breast through very small incisions with silicone gel implants without endangering them mechanically. This way the risk of damaging nerves in the axillary region is minimal, operation time is shortened, and the visible scar can be reduced considerably. Contamination of the prosthesis by the skin is avoided. Lubrication of the implant injector by peanut oil (arachis oil) is necessary. Tissue reaction induced by the oil had never been seen. None of the implants broke while using the implant injector.     

Right Internal Mammary Artery Implantation into Right Ventricular Myocardium for Revascularization of the Entire Heart: Experimental Data and Preliminary Report

The left internal mammary artery implant combined with epicardiectomy and free omental graft provides three extra-coronary sources of blood. This operation tested in dogs with 92% main-stem occlusion of three coronary arteries protected 75% of the animals. Applied clinically in over 100 patients, the operation resulted in 90% improvement. To obtain complete myocardial revascularization, the right internal mammary artery has been used as a fourth source of extra-coronary blood. In 57 animals, the right internal mammary arteries were implanted into the anterior walls of the right ventricle; in 80% this vessel formed anastomoses with the right coronary tree, and in 65% with the right and left coronary arteriolar systems. Six patients are described who underwent right internal mammary artery implantation; five of these in addition had the combined operation of left internal mammary artery implant, epicardiectomy and free omental graft. All patients had completely blocked right coronary arteries; in addition, five had advanced disease of the left coronary arterial tree.     

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。