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.     

微种植体支抗内收及压低上前牙的有限元研究

目的:探讨在利用微种植体支抗整体内收前牙过程中增加前牙区不同位置压低力对上颌前后牙的生物力学效应的影响。方法:采用螺旋CT扫描获取图像并结合MIMICS等软件进行三维重建,建立拔除上颌第一前磨牙整体内收前牙的三维有限元模型,分析利用第二前磨牙与第一磨牙间微种植体整体内收前牙过程中,增加前牙区不同位置压低力后前后牙的生物力学效应。结果:增加前牙区压低力后,前牙舌向倾斜移动明显减小,不同位置的垂直向力对前牙的影响不同,第一磨牙在整体内收过程中表现为远中倾斜移动。结论:1增加前牙区压低力能够实现对前牙转矩的有效控制;2增加前牙区的压低力使前牙更趋向于整体移动;3在微种植体支抗内收前牙过程实现了较好的垂直向控制。     

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)。     

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。     

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。     

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。     

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。     

不同嵌体修复MOD洞型的三维有限元分析

目的：建立近中-合面-远中（MOD）洞型嵌体修复下颌第一磨牙的计算机三维实体和有限元模型,并进行初步应力分析。方法：通过螺旋CT扫描,利用Mimics、GeomagicStudio7等图像处理软件建立第一恒磨牙的云纹点模型,通过UG软件建立下颌第一恒牙的三维几何模型,通过有限元软件ABAQUS进行网格划分,并在MSC．MARC有限元软件中建立下颌第一磨牙三维有限元模型。结果：建立起包含牙釉质、本质、髓腔以及牙槽骨的精细下颌第一磨牙三维有限元模型。结论：将CT扫描技术、数字图像处理技术与有限元方法结合起来,建立出高精度的下颌第一磨牙MOD洞型的三维有限元模型,为MOD洞型采用嵌体修复提供了研究手段．     

种植体周围炎的微生态研究进展

骨内牙种植体是近20年来发展起来的一种新型义齿修复方式,该技术作为无牙牙合进行口腔修复重建的一项常规技术,已有理想的长期组织整合修复的临床报告,应用前景十分乐观,但同时存在少数种植体失败。种植体失败在临床上表现为种植体周围炎。种植体周围炎的发生与口腔微生态环境密切相关,该文就此问题综述如下。     

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,     

Association of relatively delayed emergence of mandibular molars with molar reduction and molar position

Among 234 children examined annually from age three to 20 years at the Burlington Growth Centre, there was statistically significant cooccurrence of early and late emergence sequences of the permanent first and second molars relative to the central incisors and second premolars in the same jaw and in both jaws. Alternatively, mandibular molar delay was not accompanied by corresponding maxillary molar delay, and the mandibular molars emerged later than the maxillary molars. This was strongly associated with Angle Class II malocclusion, indicating a relationship between relative time of emergence and relative position of opposing molars. Delay of the mandibular molar relative to the successional teeth or maxillary molars was associated with increased frequency of four cusped first and second molars and agenesis of third molars, indicating a tendency for co-occurrence of delay in timing of molar emergence with reduction in structure of the molars. These relationships were evident even though emergences were affected by early loss of a deciduous second molar which increased M1I1 and M2P2 sequences by earlier emergence of M1 and delayed emergence of P2.     

Factors Predisposing to Maxillary Anchorage Loss: A Retrospective Study of 1403 Cases

Anchorage loss is very disturbing for orthodontists and patients during orthodontic treatment, which usually results in bad treatment effects. Despite the same treatment strategy, different patients show different tendencies toward anchorage loss, which influences the treatment results and should preferably be predicted before the treatment is begun. However, relatively little research has been conducted on which patients are more likely to lose anchorage. The mesial tipping of the first molar marks the onset of anchorage loss, and changes in the angulation of the first molar are closely related to anchorage loss. This cross-sectional study aimed to determine how the mesiodistal angulation of the upper first molars changes during general orthodontic treatment and to identify the individual physiologic factors leading to these changes in a large sample of 1403 patients with malocclusion. The data indicate that the upper first molars tend to be tipped mesially during orthodontic treatment, and this constitutes a type of anchorage loss that orthodontists should consider carefully. Compared to treatment-related factors, patients'' physiologic characteristics have a greater influence on changes in the angulation of the upper first molars during orthodontic treatment. The more distally tipped the upper first molars are before treatment, the more they will tip mesially during treatment. Mesial tipping of the upper first molars, and therefore, anchorage loss, is more likely to occur in adolescents, males, patients with class II malocclusion and patients who have undergone maxillary premolar extraction. This finding is of clinical significance to orthodontists who wish to prevent iatrogenic anchorage loss by tipping originally distally tipped upper molars forward, and provides a new perspective on anchorage during orthodontic treatment planning.     

华南人颅骨上、下颌臼齿磨耗与年龄变化的关系

本文以华南人103例17—73岁男性颅骨的709个臼齿为材料,研究了上下颌臼齿磨耗度与年龄的关系。将磨耗度分为九级,统计分析结果表明,华南人臼齿的磨耗度与年龄关系是密切相关的,这种相关关系,能够作为估计华南人颅骨年龄的标准。第一臼齿与第二臼齿的磨耗平均年龄比率是M1∶M2=6∶6.9;磨耗度与年龄的相关系数M1为0.91,M2为0.90,均为高度相关。并得出磨耗度的平均年龄及95％置信区间(见表3)。华南人下颌臼齿的磨耗比上颌臼齿的磨耗稍大(61.5％)。     

Brief communication: Identification reassessment of the isolated tooth Krapina D58 through occlusal fingerprint analysis

High variability in the dentition of Homo can create uncertainties in the correct identification of isolated teeth. For instance, standard tooth identification criteria cannot determine with absolute certainty if an isolated tooth is a second or third maxillary molar. In this contribution, using occlusal fingerprint analysis, we reassess the identification of Krapina D58 (Homo neanderthalensis), which is catalogued as a third maxillary molar. We have hypothesized that the presence/absence of the distal occlusal wear facets can be used to differentiate second from third maxillary molars. The results obtained confirm our hypothesis, showing a significant difference between second and third maxillary molars. In particular we note the complete absence of Facets 7 and 10 in all third molars included in this analysis. The presence of these facets in Krapina D58 eliminates the possibility that it is a third maxillary molar. Consequently it should be reclassified as a second molar. Although this method is limited by the degree of dental wear (i.e., unworn teeth cannot be analyzed) and to individual molars in full occlusion, it can be used for tooth identification when other common criteria are not sufficient to discriminate between second and third maxillary molars. Am J Phys Anthropol 143:306–312, 2010. © 2010 Wiley‐Liss, Inc.     

A short review on the root canal configuration of primary maxillary molars

It is of interest to compile available information on the root canal morphology of primary maxillary molars from known literature. The literature resources used to collect data include Medline/PubMed, The Cochrane Central Register of Clinical Trials, SIGLE and Science Direct. Data consists of type of population, number of teeth per study, number of root canals, canal length and type of root canal configuration. We used data from a total of 13 studies (951 primary maxillary molars). Maxillary molars (1st and 2nd) are dominant for two roots variant. The first molar the mean root length ranges from 7.9mm - 8.1mm. The second molar ranges from 7.2mm-8.5mm. Type I (explain in a phrase) canal morphology is the common variant in both the molars. Data shows that Root Canal morphology shows variations with the diagnostic aid (example micro CT) used and in different ethnic populations.     

Contours of maxillary molars studied in Australian aboriginals

Distances from the central pit to the perimeter of the crown of permanent upper molars were measured on standardized occlusal photographs of dental casts representing 210 male and 181 female Aboriginals from Yuendumu in the Northern Territory of Australia. In both males and females the first molar was the largest tooth but it showed least variability. Variabilities of the distances tended to be greater for radii constructed in the buccolingual direction than for the transverse mesiodistal radii. The most marked size reduction in the molar series from first to third related to the distolingual part of the crown, which was also the most variable region. Size differences between molars in the mesial contour radii were not marked. Sexual dimorphism was evident in most crown radii, being most marked for the second molar.     

Molar development in common chimpanzees (Pan troglodytes)

Numerous studies have reported on enamel and dentine development in hominoid molars, although little is known about intraspecific incremental feature variation. Furthermore, a recent histological study suggested that there is little or no time between age at chimpanzee crown completion and age at molar eruption, which is unlikely given that root growth is necessary for tooth eruption. The study presented here redefines growth standards for chimpanzee molar teeth and examines variation in incremental features. The periodicity of Retzius lines in a relatively large sample was found to be 6 or 7 days. The number of Retzius lines and cuspal enamel thickness both vary within a cusp type, among cusps, and among molars, resulting in marked variation in formation time. Daily secretion rate is consistent within analogous cuspal zones (inner, middle, and outer enamel) within and among cusp types and among molar types. Significantly increasing trends are found from inner to outer cuspal enamel (3 to 5 microns/day). Cuspal initiation and completion sequences also vary, although sequences for mandibular molar cusps are more consistent. Cusp-specific formation time ranges from approximately 2 to 3 years, increasing from M1 to M2, and often decreasing from M2 to M3. These times are intermediate between radiographic studies and a previous histological study, although both formation time within cusps and overlap between molars vary considerably. Cusp-specific (coronal) extension rates range from approximately 4 to 9 microns/day, and root extension rates in the first 5 mm of roots range from 3 to 9 microns/day. These rates are greater in M1 than in M2 or M3, and they are greater in mandibular molars than in respective maxillary molars. This significant enlargement of comparative data on nonhuman primate incremental development demonstrates that developmental variation among cusp and molar types should be considered during interpretations and comparisons of small samples of fossil hominins and hominoids.     

Does space in the jaw influence the timing of molar crown initiation? A model using baboons (Papio anubis) and great apes (Pan troglodytes, Pan paniscus)

Radiographic and histological studies of baboon (Papio hamadryas, P. anubis) and chimpanzee (Pan troglodytes) permanent tooth development have found that periods of molar crown mineralization overlap markedly in chimpanzees but are staggered in baboons. Here we test the hypothesis that these intertaxon differences in molar initiation are primarily due to the space available in the mandibles of each species for these teeth. This study includes radiographic, linear measurement, and three-dimensional (3D) coordinate landmark data taken from baboon (Papio anubis n=51) and great ape (Pan paniscus n=43, P. troglodytes n=60) mandibles and permanent molars across a broad developmental range for each taxon. Unexpectedly, 3D multivariate statistical shape analysis of the molar crypt, crown, and root data shows that all three species trajectories of molar row shape change are indistinguishable from each other. Qualitative analysis of these 3D data reveals subtle and inconclusive intergeneric differences in the space maintained between adjacent molars during growth. The space distal to each newly initiated molar is slightly greater in the baboon. Bivariate analyses comparing molar row and mandibular corpus proportions in Papio and Pan fail to show clear or consistent taxonomic differences in the ratio of space afforded developing molars in the alveolar bone. Thus, there is a poor correlation between mandibular proportion and both intermolar spacing and 3D molar development pattern. Contrary to earlier studies, these results suggest that pattern of molar crown initiation and temporal overlap of adjacent mineralizing crowns is not significantly different between Papio and Pan. This may be due in part to the inclusion here of not only 3D molar crown data but also 3D molar crypt data. This study strongly refutes the hypothesis that space available in the mandible directly underlies different times of permanent molar crown initiation between Papio and Pan.     

Morphologic characteristics of the Alaskan Eskimo dentition. III. Number of cusps on the upper permanent molars

A study of 35 coastal and 64 inland Alaskan Eskimos revealed a reduction in the number of cusps from the first to the third maxillary molar. While 97% of the first molars had four cusps, only 39.6% of the second molars and 15.2% of the third molars had that number. The reduction occurs through elimination of the hypocone. No statistically significant sex difference in the trend towards reduction in the cusp numbers was found. In the inland female group the occurrence of four cusps in the maxillary second molar was statistically higher than in the coastal female group. This may be due to a more pronounced racial admixture of white people along the coast. A similar difference, although not statistically significant, was found in the corresponding male groups. Alaskan Eskimos have a tendency towards a lower frequency of four cusps on all three maxillary molars than Aleuts. Only the second molar exhibited a statistically significant difference in this respect. A statistical evaluation revealed that in the Alaskan Eskimo maxillary first and third molars the reduction of cusps is independent of the size and form of the molars and of the suppression of the third molar. For the second molar, however, the groups with four well-developed cusps showed significantly larger buccolingual diameter.     

Hypocone reduction and Carabelli's traits in contemporary Jordanians and the association between Carabelli's trait and the dimensions of the maxillary first permanent molar

The objective of this study is to determine the prevalence of expression and bilateralism of two dental morphological traits in contemporary Jordanians: The hypocone reduction trait on the maxillary second permanent molar and Carabelli's trait on maxillary permanent first and second molars. Furthermore, inter-trait correlation and the relationship of Carabelli's traits with upper first molar dimensions were investigated. Three hundred subjects of school children at their 10th grade and of an average age of 15.5 +/- 0.4 years were involved. Alginate impressions for the maxillary arch were taken, dental casts were reproduced. The selected accurate casts were of 132 male- and 155 female-students. The frequencies of hypocone reduction trait on the maxillary second molar and Carabelli's trait on the maxillary molars were examined. Buccolingual and mesiodistal diameters of the maxillary first molar were measured and recorded. Paired Sample t test and Nonparametric Correlation analysis were used for data analysis. Hypocone reduction trait on the maxillary second molar was found in 29.8% of the examined students. Positive forms of Carabelli's trait on first and second molars were observed in 65.0% and 3.8%, respectively. Nonparametric correlation analysis revealed positive association between Carabelli's trait on first molar and hypocone reduction trait on the maxillary second molar. The presence of Carabelli's trait on first molar was strongly associated with the increase of buccolingual, but not the mesiodistal, diameter. Bilateralism was found highly significant in the tested traits and both genders (p < 0.001). This finding might be a sign of relatively low environmental stresses in the living Jordanian population and/or great ability of its individuals to buffer the adverse effects of such stresses.