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。     

镍铬合金烤瓷冠修复牙与对照牙牙周微生态及龈沟液蛋白水平的比较

目的观察比较镍铬合金烤瓷冠（Ni-Cr based porcelain-fused-metal crown）修复患牙与牙周健康对照牙龈下菌斑微生物分布、龈沟液总蛋白水平及牙周临床指标的差异。方法选择临床病例13例,前牙区咬合关系基本正常。采用镍铬合金烤瓷冠修复上颌切牙17颗,对侧同名健康天然牙作为对照。烤瓷冠戴入6～8个月后复诊,进行牙周健康状况的临床检查,分别取患牙、对照牙龈沟液及龈下菌斑盐水涂片。龈沟液定量并检测总蛋白水平。龈下菌斑涂片革兰染色,分类计数革兰阴性球菌、杆菌、弯曲菌、螺旋体及革兰阳性球菌、杆菌,共计数200个细菌。结果修复患牙与对照牙比较探诊深度、龈沟出血指数、龈沟液量、龈沟液总蛋白水平、龈下菌斑中革兰阴性杆菌增加,革兰阳性球菌减少,差异均有显著性（P〈0．05）。而菌斑指数及其他形态的细菌数差异无显著性。结论临床合格的镍铬合金烤瓷冠修复亦使患牙龈下菌群分布发生变化,可能是导致患牙牙龈炎症的原因之一;龈沟液量及总蛋白水平增加;牙周临床指标显示不良改变。     

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。     

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。     

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。     

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。     

标尺模板在Branemark种植修复中的制作和应用

目的:制作并观察标尺模板在指导Branemark种植手术,提高手术安全性方面的作用。方法:选择15例患者52颗种植体,铸造制作标尺模板后戴入口腔拍摄曲面体层片。根据影象所显示的适宜种植区域与颏孔、上颌窦等颌骨重要解剖结构的位置,结合上部修复设计选择Branemark种植体数量与植入点,并借助标尺模板的定位网格予以记录。手术时将标尺模板戴入口腔,根据记录结果在颌骨表面显示种植体入点与颌骨重要解剖结构的位置,指导手术进行。术后戴入标尺模板拍摄对照片,判断种植体与预定位置的吻合性。结果:52颗种植体中,除1颗种植体因术中临时改变种植位置,其余51颗种植入位置均与术前计划一致。结论:在Branemark种植修复中制作并应用标尺模板,能方便直观地帮助术者将种植体植入预定位置,避免损伤颏孔等颌骨重要解剖结构,提高了手术的正确性与安全性。     

Dentis种植系统的临床效果观察

目的：探讨Dentis种植系统的临床应用效果。方法：对132例牙列缺损患者行Dentis种植体植入,3-6个月后行上部义齿修复,并进行临床和放射学的随访观察。结果：206枚种植体中有2枚在修复后6个月内脱落,其余未见松动、脱落和植入体根周X射线透射区,留存率99.0%,成功率99.0%。结论：选择合适的病例,配合应用相应术式,Dentis种植系统的临床应用效果良好。     

螺丝固位修复和粘接固位修复在牙列缺损患者中的应用效果及对龈下菌群分布的影响

目的探讨螺丝固位修复、粘接固位修复在牙列缺损患者中的应用效果及对龈下菌群分布的影响。方法选择2016年12月至2018年12月在我院进行牙种植并完成修复体的牙列缺损患者98例,参照随机数表法将入组患者分为螺丝固位修复组和粘接固位修复组,各49例。对比两组患者修复后3个月、修复后12个月牙周健康指标[种植义齿边缘骨吸收量(MBL)、探诊深度(PD)、改良菌斑指数(mPLI)、改良出血指数(mSBI)]、咀嚼功能(咬合力、咀嚼效率)以及龈下菌群分布的差异。结果修复后3个月和修复后12个月,两组患者MBL、PD、mPLI、mSBI水平及咬合力、咀嚼效率差异无统计学意义(均P0.05);两组患者龈下产黑色素菌、伴放线放线杆菌数量差异无统计学意义(均P0.05)。螺丝固位修复组患者龈下厌氧菌、具核梭杆菌数量大于粘接固位修复组患者(均P0.05)。结论螺丝固位修复、粘接固位修复均是牙列缺损修复的有效方法,螺丝固位修复可能导致术后龈下厌氧菌繁殖增加,需进行长期监测。     

肺炎患者与健康人口咽部菌群分析

目的观察肺炎患者口咽部菌群分布情况,探讨肺炎患者与健康人群口咽部菌群分布差异。方法采集细菌性肺炎稳定期患者(29例)和健康人群(31例)咽拭子进行细菌培养,并对其咽部菌落进行计数和菌种鉴定。结果肺炎患者咽拭子培养中主要致病菌和条件致病菌检出种类和检出率较健康者明显增加,肺炎组与健康组相比需氧菌与厌氧菌的菌群密度具有上升趋势,使用t检验计算结果差异有统计学意义(P0.05)。在可培养的肺炎组人群口咽菌群中肺炎链球菌检出率最高,其次为微球菌、副溶血链球菌、甲型链球菌;在健康体检人群口咽部菌群中甲型链球菌检出率最高,其次为奇异变形杆菌、微杆菌属、轻型链球菌、颗粒链球菌。结论与健康对照组相比,肺炎患者口咽部菌群分布紊乱,且肺炎组患者呼吸道菌群数量明显增多。     

The stress model of abutment tooth and periodontal tissues with unilateral mandibular dissociation and loss by precision extracoronal attachment

In order to explore the application of the precision extracoronal attachment based on three-dimensional finite element stress model in the repair of unilateral mandibular dissociation and loss, the stress distribution of the butment and periodontal tissues when the precision extracoronal attachment was used in unilateral mandibular dissociation and loss was analyzed, so as to provide reference for the application of materials in clinical repair. In this study, the biomechanics of oral cavity and its attachment were analyzed to provide theoretical basis for model construction. Because the degree of periodontal tissue absorption and the number of abutment teeth affected the restoration effect of the coronal precision attachment, the models were established from these two perspectives. The results showed that when the periodontal tissue absorption of both abutment teeth exceeded 1/3, the method of double abutment restoration was not recommended. When three abutments were used, there was a significant decrease compared with the absorption of the periodontal tissue of the double abutment. In clinic, the stress distribution of the distal abutment teeth and its periodontal tissues can be improved by increasing the number of abutment tooth. However, since increasing the number of abutments required an increase in the amount of healthy tooth tissue, it couldn’t be blindly selected in the clinic. After comprehensive consideration, it is appropriate to choose two abutment teeth for restoration.     

Biomechanical evaluation of the natural abutment teeth in combined tooth-implant-supported telescopic prostheses: a three-dimensional finite element analysis

Telescopic overdentures supported by the combination of natural teeth and implants have been thought a valuable treatment for the severely compromised partially edentulous patients. But the combination of teeth and implants involves highly complex biomechanical problems. This study is to evaluate biomechanical behaviors of the natural abutment teeth with the treatment of combined tooth-implant supported telescopic crown prostheses in mandible through 3D FEA. According to this study, the prosthetic option supported by a combination of teeth and implants and retained by double crowns could protect teeth and their periodontal support tissues acting as a rigid splint, and may be a valuable treatment option for partially edentulous patients with severely reduced remaining teeth in mandible.     

Radiographic changes in alveolar bone height on overdenture abutments: a longitudinal study

Objective: Stabilisation of partial dentures is an important part of prosthodontic treatment, particularly in patients with an excessive reduction in alveolar bone supporting their abutment teeth. In these cases, overdenture prostheses are one possible treatment choice. Background: The aim of this study was to evaluate the effects of overdentures on the condition of alveolar bone of the remaining teeth, and to evaluate the overdenture concept in the prosthetic treatment of partially edentulous patients. Materials and methods: The investigation was conducted on 22 patients during observation periods of 6 and 10 years. After preparation, all abutment teeth were provided with either amalgam restorations or gold copings. An overdenture in the lower jaw was fabricated for every patient. A special film holder was used to repeat the X‐ray procedure in every patient in the same manner. The radiographs were evaluated using the grid scale. The alveolar bone level of all remaining teeth was evaluated on dental films by measuring the distance between the root apex and coronal border of the alveolar bone. Results: A statistically significant difference (p < 0.01) was calculated 6 years after delivery stage between distal alveolar bone levels of experimental abutments under overdentures and the remaining teeth of the control group. Alveolar bone of abutment teeth was considerably preserved, particularly in seven patients observed 10 years after provision of their dentures. Conclusion: Within the limitation of this study, the validity of the overdenture treatment in partially edentulous patients is concluded. Good oral hygiene was crucial for the success of treatment with overdentures.     

可摘局部义齿基牙易发龋坏部位致龋菌的检出比较

通过对戴入可摘局部义齿后基牙易发龋坏部位的早期细菌组成的测定,探讨可摘局部义齿与基牙龋坏之间的潜在关系。观察１２个６活动桥的２４颗基牙,其中５、７各１２颗。病人平均年龄２５５岁。采取基牙靠缺隙侧邻面１／３区域的菌斑。采用细菌培养技术,持续观察了３个月,测定了菌斑细菌的组成。结果发现,变形链球菌的检出率在实验中呈逐渐上升趋势,且在牙位７上的检出率比在牙位５上的检出率高。结论戴用可摘局部义齿造成了口腔微生态环境的改变,促进了某些致龋细菌的生长,成为基牙发生龋坏的潜在因素     

纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响

摘要 目的：探讨纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损患者美学效果及牙周组织的影响。方法：选取2018年1月至2019年3月期间我院收治的103例患者作为研究对象,按修复材料的不同分为对照组（n=52,患牙62颗）和研究组（n=51,患牙63颗）。对照组给予金属桩核、金属烤瓷冠修复,研究组给予纤维桩、纳米复合树脂结合氧化锆烤瓷冠修复。修复1年后,评价两组的修复成功率和修复效果。比较两组修复前及修复后1年的牙龈指数、菌斑指数、牙周探诊深度、龈沟液量及龈沟液中碱性磷酸酶（ALP）、天门冬氨酸转氨酶（AST）水平。结果：研究组的修复成功率比对照组高（P<0.05）。研究组修复体的表面光滑率、边缘密合性、固定良好率及颜色匹配率均明显高于对照组（P<0.05）。两组治疗后牙龈指数、菌斑指数及牙周探诊深度均明显低于治疗前（P<0.05）,龈沟液量及龈沟液中ALP、AST水平均明显低于治疗前（P<0.05）,同时研究组治疗后牙龈指数、菌斑指数及牙周探诊深度均低于对照组（P<0.05）,但两组治疗后龈沟液量及龈沟液中ALP、AST水平比较无差异（P>0.05）。结论：纤维桩、纳米复合树脂结合氧化锆烤瓷冠对根管治疗后后牙楔状缺损的修复成功率高,修复后美学效果佳,对牙周组织影响小。     

Caries and periodontal disease of the elderly in Pomerania, Germany: results of the Study of Health in Pomerania

Objective: The aim of this study was to describe the oral health status of older adults living in north‐eastern Germany. Materials and Methods: Representative samples of adults aged 60 years or older were examined as part of Study of the Health in Pomerania, a cross‐sectional, population‐based study. Data on 1446 subjects aged 60–79 years were evaluated for coronal caries using the decayed/missing/filled teeth (DMFT) index, root caries using the root caries index (RCI), calculus, plaque, bleeding on probing, pocket depth and attachment loss. Results: The prevalence of edentulousness varied from 16% in the 60–65‐year‐old group to 30% in the 75–79‐year‐old group, whereas the median number of remaining natural teeth per subject varied from 14 in the youngest age group (60–65 years) to one in the oldest (75–79 years). Among subjects aged 60–69 years, a quarter (26%) of the teeth examined had coronal restoration against 17% in the oldest age group (70–79 years). Coronal caries was found in 2% of the teeth in both age groups. Among teeth with gingival recession, 6% had fillings on root surfaces and 2% had root caries, irrespective of age. In all, 11% of the subjects had at least one untreated coronal lesion and 27% had at least one untreated root caries lesion. Plaque score, calculus score and bleeding on probing were higher in the oldest age group (70–79 years). The prevalence of periodontal disease expressed as the presence of at least one periodontal pocket of 4 mm and more, was higher in men and among the younger subjects (men aged 60–69 years: 85% vs. 71% in 70–79‐year‐old men; women aged 60–69 years: 71% vs. 62% in 70–79‐year‐olds). The prevalence of attachment loss of 3 mm or more followed a similar pattern. Conclusions: It seems therefore that in this population, the major oral health concern is related to caries and the small number of teeth retained among the dentate subjects.     

One-stage full-mouth disinfection to overcome intra-oral transmission of periodontopathogens

The oral cavity offers a range of different niches where periodontopathogens can adhere and survive (e.g. the mucosa, the tongue, the tonsils, the saliva and all intra-oral hard surfaces such as teeth, dentures, oral implants). Transmission of bacteria from one niche to another is likely to occur. Recent studies, for example, illustrated that initially sterile abutments of oral implants were rapidly colonized by bacteria from the subgingival environment around teeth. This transmission of bacteria can occur spontaneously via the saliva, or by means of oral hygiene aids and/or dental instruments. Such an intra-oral transmission, if it occurs at a high speed, could jeopardize the outcome of periodontal therapy. To overcome a bacterial transmission, a 'one-stage full-mouth disinfection' was recently introduced for the treatment of periodontal infections. This new treatment strategy resulted in significant clinical and microbiological improvements when compared with the standard sequential treatment.     

乳杆菌代谢产物对于固定矫治患者牙周指数和龈下菌群的敏感性研究

目的对已佩带固定矫治器6个月的患者采用乳杆菌DM9811代谢产物提取液制成的含漱液含漱治疗,探讨治疗前后牙周指数和牙周可疑病原菌的动态变化过程。方法采取自身前后对照和组间对照。记录治疗前后牙周指数的变化情况。并采用细菌培养鉴定法检测含漱前后龈下菌群的变化情况,测定牙周可疑病原菌的检出量和检出率。结果（1）试验组的牙龈指数（GI）、菌斑指数（PI）、龈沟出血指数（SBI）、探诊深度（PD）在治疗后均有下降,且试验组低于对照组。（2）试验组G^-产黑色素厌氧杆菌（BPAR）、梭杆菌、拟杆菌的检出量以及BPAR的检出率治疗后均有下降,试验组低于对照组;血链球菌的检出量有所上升,试验组高于对照组。结论乳杆菌DM9811代谢产物对固定矫治患者带环牙牙龈炎的各项临床指标均有改善作用,且颊侧优于舌侧;对龈下菌斑中梭杆菌、拟杆菌、BPAR等均有抑制作用,对有益菌中的血链球菌有扶植作用。     

A Cohort Study of the Impact of Tooth Loss and Periodontal Disease on Respiratory Events among COPD Subjects: Modulatory Role of Systemic Biomarkers of Inflammation

Background

In COPD patients, fatal and non-fatal respiratory-related events are influenced by age, severity of respiratory disease, and comorbidities.

Objectives

Analyze the effects of edentulism, periodontal disease and systemic biomarkers of inflammation on the occurrence of serious fatal and non-fatal respiratory-related events among subjects with COPD.

Methods

Cases were identified from Dental Atherosclerosis Risk in Communities study. Edentulism was defined as study participants without any natural teeth or implants. Participants with one or more natural teeth (comprising 11,378 subjects) were studied as dentate subjects. Periodontal disease status among dentate individuals was determined using the consensus definitions published by the joint Center for Disease Control/American Association of Periodontology working group). Adjusted Hazard Models are developed to evaluate the relationship between edentulism/periodontal disease and COPD Related Events. Models were then stratified by GOLD Stage I, II and III/IV. Serum biomarkers were also evaluated to explore the effect of systemic inflammation.

Results

A statistically significant association was found between oral health status and COPD-related events, even adjusting for conditions such as hypertension, smoking and diabetes. Edentulous individuals who had been diagnosed with COPD had a higher incidence and were at greater risk of having a COPD related event (hospitalization and death) than individuals who had teeth and whose mouths had healthy periodontal status. However, being edentulous did not convey excess risk for COPD-related events for those study participants who were classified as GOLD III/IV at baseline. Finally, we showed that individuals who had levels of serum IL-6 in the highest two quartiles were at even higher risk for COPD-related events.

Conclusions

These findings suggest that the risk for COPD-related events after adjusting for potential confounders may be attributable to both edentulism and elevated serum IL-6 levels.     

固定矫治器戴入前后牙周可疑病原菌和牙周临床指数的变化

目的:固定矫治器戴入前后的不同时间进行龈缘菌斑的微生物学检查和牙周状况的临床检查,以探讨固定矫治器戴入前后牙周可疑病原菌和牙周状况的动态变化过程.方法:选择18名固定正畸患者,于矫治器戴入前和戴入后1、3、6月分别检查16、41牙位的菌斑指数、牙龈指数、探诊深度、探诊出血,并在近中颊侧颊轴角处采集龈缘菌斑样本,采用细菌培养鉴定方法测定牙周可疑病原菌的检出量(CFU/g)和检出率.结果:与基线相比,观察期内龈缘菌斑的G￣产黑色素厌氧杆菌检出量和检出率在两个牙位均升高(P＜0.05),41的优杆菌、弯曲杆菌、拟杆菌、普氏菌亦有升高(P＜0.05).临床指标中16的牙龈指数(颊侧)和探诊深度(颊、舌侧)升高;41的菌斑指数(舌侧)降低(P＜0.05).结论:固定矫治器戴入后虽然可通过严格的口腔卫生指导有效控制牙面菌斑,但仍可引起牙周可疑病原菌增加.