下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

快速成型技术在口腔颌面外科的应用

在上世纪末期,随着快速成型技术和三维重建技术逐步应用于口腔颌面外科领域,为实现个体化诊断、治疗疾病带来了革命性的变化。传统诊断口腔颌面部骨性疾病是通过X线片、CT等影像学检查得到,只能大致估计疾病的范围及严重程度,而对于复杂的骨性疾病,如先天性颌骨畸形、颌面部多发性骨折等,就存在相当大的局限性,     

联合方法测量工作长度应用于颌骨囊肿受累牙根管治疗的研究

目的：研究颌骨囊肿受累牙根管治疗中采用联合方法测量根管工作长度的效果。方法：选取36 例颌骨囊肿受累患牙需术前 根管治疗的患者,共135 颗患牙,186 个根管,随机分为两组,实验组（93 个根管）采用电测法联合纸尖法测量根管工作长度,对照 组（93 个根管）则采用电测法联合X 线法测量根管工作长度。对比两组根管充填后的充填效果。结果：实验组的根管恰填率为 90.32%,高于对照组的79.57%（P＜0.05）。结论：采用电测法联合纸尖法测量颌骨囊肿受累牙根管工作长度,准确率高,根管充填 效果好且安全。     

口腔种植材料表面特性与生物膜形成研究进展

人类口腔环境为微生物提供了适宜生存的条件,多种微生物在牙齿表面形成了由基质包裹相互粘附的口腔生物膜,口腔生物膜是口腔微生物生存、代谢和致病的基础。随着1965年Brånemark种植体在临床上的成功应用,种植相关材料周围致病菌导致的种植体周围炎成为种植修复最常见的并发症之一,影响种植修复的远期效果。种植体周围炎引起了许多关注,并且口腔种植材料表面的特性和口腔生物膜的形成密切相关。本文就种植材料及天然牙齿表面的生物膜形成、种植材料表面特性对口腔生物膜及细菌粘附的影响因素、增强种植材料抗菌性能的方法以及未来的研究方向等作一综述。     

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。     

鼻内窥镜辅助下大型颌骨囊肿开窗减压并拔除埋藏智齿病例报告及文献复习

摘要 目的：分析大型颌骨囊肿开窗减压术联合鼻内窥镜辅助下拔除低位埋藏智齿的临床应用效果。方法：选择9例大型颌骨含牙囊肿患者,自磨牙或磨牙后区或者磨牙后外侧前庭沟处开窗形成引流通道,在鼻内窥镜下联通各个囊腔并拔除因被囊肿挤压而低位埋藏的第三磨牙,术后以阻塞器维持开窗口并保持日常冲洗治疗,观察术后囊肿大小及囊壁周围骨质变化情况。结果：术后随访6-18个月,9例含牙囊肿治疗效果明显,有效率为100%。术后复查对比入院时均有不同程度的骨再生,囊腔皆有明显缩小,局部畸形及损伤也有不同程度恢复,其中3例均未行II期刮治术,无复发。结论：颌骨囊肿的开窗治疗保留了颌骨的形态及功能,对于提升患者的生活质量效果明显;同时,鼻内窥镜在颌骨大型囊肿中引导连通各个囊腔以及拔除因囊肿移位的牙齿发挥了重要作用。     

口腔种植的新型钛材料生物安全性研究

目的:在动物体内进行新型钛材料的生物安全性研究。方法:采用TAI纯钛板材(Ti≥99.9%,宝鸡英耐特有色金属有限公司),通过对钛材料的喷砂、酸蚀、碱热等处理后,构建微纳双级骨仿生结构。对处理材料进行扫描电镜观察后,再经过兔皮下实验、小鼠急性溶血性实验确定此种材料的体内安全性。结果:1.扫描电镜结果显示:经过喷砂酸蚀碱热处理后的实验组具有微纳复合结构,与骨组织表面形态更为接近,从仿生学出发,更利于骨组织愈合与抑制骨组织周围炎的发生。2.皮下植入实验结果:经过喷砂酸蚀碱热处理后的实验组与只经过喷砂酸蚀的对照组对生物组织无明显刺激,未见明显的周围组织炎。3.急性毒性实验:未见经过喷砂酸蚀碱热处理后的实验组与只经过喷砂酸蚀的对照组出现明显的生物学反应,未见明显体重下降。结论:新型表面处理钛材料在生物安全性的动物体外实验方面无异常,可以进行下一步实验。     

血水草生态解剖学特征及其药理功能研究进展

血水草(Eomecon chionantha Hance)是罂粟科(Papaveraceae)白屈菜族(Chelidonium)血水草属(Eomecon)多年生药用草本植物,为我国独属独种的特有物种.广泛生长于荫凉潮湿的生态环境,体内含有丰富的生物碱,具有抗菌、抑菌、灭螺功能作用,是一种开发生态型绿色药物的优良野生植物.从血水草的生态解剖学特征、化学成分和药理功能作用方面的研究进行了综述,可为血水草的资源保护、生态功能研究和开发生态型绿色药物提供系统性途径,并对今后的研究和发展提出了展望.     

慢性牙周炎对牙种植修复的疗效影响

目的:分析慢性牙周对种植义齿修复疗效的影响。方法:选择2013年7月至2015年6月在宝鸡市中医医院接受牙种植修复治疗的慢性牙周炎患者52例(70枚)作为观察组及同期接受牙种植的牙周健康患者49例(69枚),作为对照组。观察分析两组患者种植修复1、3、6、12个月的边缘骨吸收量(MBL)、改良菌斑指数(m PLI)、改良龈沟出血指数(m SBI)、探测深度(PD)以及种植体龈沟液IL-1、IL-6水平的变化情况。结果:种植1年后,对照组的种植成功率为97.10%(67/69),观察组的种植成功率为91.42%(64/70),两组比较差异无统计学意义(P0.05)。种植1个月及3个月后,两组的m PLI、m SBI、PD以及MBL比较无明显差异(P0.05);种植6个月后,观察组的m SBI、PD以及MBL显著高于对照组(P0.05),m PLI仍无明显变化。此外,种植1个月、3个月时,对照组的IL-1β未检出;6个月后,观察组的IL-1β显著高于对照组(P0.05);种植3个月后,观察组的IL-6显著高于对照组(P0.05)。结论:慢性牙周炎可降低牙种植修复治疗的疗效,可能与种植体周围炎的发生有关。     

微螺钉种植体支抗的临床应用现状

微型种植体支抗是近年来发展起来的颇有前景的一种正畸支抗,其创伤性小、操作简单、成本低,能够提供稳定的骨性支抗,支抗疗效可靠,形式灵活,对患者合作依赖性较小。本文就微型种植支抗在口腔正畸学中的应用情况作一综述。     

Jaw mechanism and dental function in the late cretaceous basal eusuchian Iharkutosuchus

Iharkutosuchus makadii is a basal eusuchian crocodylian with multicusped teeth discovered from the Upper Cretaceous of Hungary. Skull and dentition morphology indicates an active food processing for this crocodylian. First among crocodylians, a combination of different analyses, including cranial adductor muscle reconstruction, tooth wear pattern, and enamel microstructure studies, is applied here to support this hypothesis. Data provide unambiguous evidence for significant dental occlusion that was a result of a unique, transverse mandibular movement. Reconstruction of the jaw adductors demonstrates strong muscles responsible for slow but active jaw closure as the motor of transverse jaw movement; nevertheless muscles producing rapid jaw closure were reduced. Macrowear orientations show a dominantly transverse movement of the mandibles completed by a slight anteroposterior component. Along with quadrate morphology, macrowear further indicates that this motion was accomplished by alternate rotation of the mandibles about the quadrate condyles. Dental morphology and wear patterns suggest two types of power stroke: a slicing–crushing stroke associated dominantly with anterior tooth–food–tooth contact (with a low degree of transverse mandibular movement) during in the early stage of mastication, and a grinding stroke with significant posterior tooth–tooth contact and a dynamic transverse movement occurring later. The patterns of microwear show a diverse diet for Iharkutosuchus including both soft and hard items. This is also supported by the microstructure of the thick, wrinkled enamel built up mostly by poorly developed columnar units. Based on wear patterns, ontogenetic variation in feeding habits of Iharkutosuchus is also recognized. J. Morphol., 2009. © 2009 Wiley‐Liss, Inc.     

Mechanical Response of Bone under Short-term Loading of a Dental Implant with an Internal Layer Simulating the Nonlinear Behaviour of the Periodontal Ligament

We consider a non-standard design for a fixed dental implant, incorporating a soft layer which simulates the presence of the periodontal ligament (PDL). Instead of being aimed at causing an a priori defined stress/strain field within the surrounding bone, upon loading, such a design simply tries to better reproduce the natural tooth–PDL configuration. To do this, the mechanical properties of the internal layer match those of the PDL, determined experimentally to be strongly nonlinear. Three-dimensional finite element analyses show that the presence of such a layer produces (i) a prosthesis mobility very similar to that of a healthy tooth, for several loading conditions, and (ii) a stress/strain distribution substantially different from that arising, upon loading, around a conventional implant. The lack of knowledge of the real mechanical fields existing, under loading, in the bone around a healthy tooth makes it very difficult to state that the stress distribution produced by the modified implant is “better” than that produced by the standard one. Nevertheless, the comparison of the results obtained here, with those of previous refined analyses of the tooth–PDL–bone system, indicates that the modified implant tends to produce a stress distribution in the bone, upon loading, closer to “natural” than that given by the standard one, within the limits imposed by the presence of threads coupling the implant with the bone.     

The Threaded Dental Implant as a Reference Object for Image Alignment

This paper presents a method that uses the threaded dental implant as a reference object for the inter-image alignment necessary for digital subtraction radiography. The implant is furthermore used to define a measurement coordinate system and to automate the placement of reference areas used for contrast correction. The method is intended for studies of diffuse bone density changes in the vicinity of the implant. The method is shown to be insensitive to large variations in exposure time and geometry, and is together with the contrast correction method of Ruttimann et at., able to detect clinically invisible simulated bone density changes.     

Implant-supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report

doi: 10.1111/j.1741‐2358.2011.00561.x Implant‐supported palatal lift prosthesis in a patient with velopharyngeal incompetence: a case report Objective: To describe the use of dental implants in the treatment of velopharyngeal incompetence. Background: Velopharyngeal incompetence is characterized by the inability to contract the tissues of the soft palate. The most common causes are neuromuscular problems resulting from concussion and degenerative conditions of the central nervous system. Materials and methods: The treatment using palatal lift prosthesis is well established in the literature; however, reports on the use of osseointegrated implants are scarce. Rehabilitation using only this type of fibromucosal support is difficult in edentulous patients, since the prosthesis has a palatal lift extension. Results: The implants provided retention and stability to the prosthesis, improving swallowing and speech and contributing to improve the patient’s quality of life. Conclusion: This article reports the rehabilitation of a patient with a totally edentulous maxilla with velopharyngeal incompetence using an implant‐retained palatal lift prosthesis.     

On the Effects of Cyclic Transversal Forces on Osseointegrated Dental Implants: Experimental and Finite Element Shakedown Analyses

This paper is concerned with the mechanical strength of fixed osseointegrated dental implants subjected to cyclic external loads, applied mainly in a direction orthogonal to their axis. Such a loading condition, seen as a basic design action for the implant, has been given little attention so far. Experimental results and numerical simulations, performed on two- and three-dimensional Finite Element models, are discussed. The shakedown theory is used to show that a common implant design (threaded fixture-abutment-connection screw) is susceptible of low-cycle fatigue failure under loading conditions well within the working range, even if the same design is able to withstand loading of the same type, but applied monotonically, much in excess of the working values. The shakedown analyses give an indication of several possible failure modalities: the low-cycle fatigue either of the implant or of the connection screw, or the loosening of the connection screw itself. Experimental and numerical results are in good qualitative agreement, and both suggest that the issue of transversal cyclic loading on fixed dental implants should be carefully reconsidered in the design phase.     

Stress distribution in cylindrical and conical implants under rotational micromovement with different boundary conditions and bone properties: 3-D FEA

Factors related to micromovements at bone-implant interface have been studied because they are considered adverse to osseointegration. Simplifications are commonly observed in these FEA evaluations. The aim of this study was to clarify the influence of FEA parameters (boundary conditions and bone properties) on the stress distribution in peri-implant bone tissue when micromovements are simulated in implants with different geometries. Three-dimensional models of an anterior section of the jaw with cylindrical or conical titanium implants (4.1 mm in width and 11 mm in length) were created. Micromovement (50, 150, or 250 μm) was applied to the implant. The FEA parameters studied were linear vs. non-linear analyses, isotropic vs. orthogonal anisotropic bone, friction coefficient (0.3) vs. frictionless bone-implant contact. Data from von Mises, shear, maximum, and minimum principal stresses in the peri-implant bone tissue were compared. Linear analyses presented a relevant increase of the stress values, regardless of the bone properties. Frictionless contact reduced the stress values in non-linear analysis. Isotropic bone presented lower stress than orthogonal anisotropic. Conical implants behave better, in regard to compressive stresses (minimum principal), than cylindrical ones, except for nonlinear analyses when micromovement of 150 and 250 μm were simulated. The stress values raised as the micromovement amplitude increased. Non-linear analysis, presence of frictional contact and orthogonal anisotropic bone, evaluated through maximum and minimum principal stress should be used as FEA parameters for implant-micromovement studies.     

Implant overdentures for edentulous elders: study of patient preference

Background: Studies show that elders wearing implant overdentures have improved nutrition and quality of life. However, upfront costs of this therapy are high, and the income of elderly edentulous populations is low. Objectives: This study was designed (i) to measure the preferences of edentulous patients for mandibular two‐implant overdentures using Willingness‐To‐Pay (WTP) and Willingness‐To‐Accept (WTA), (ii) to assess the effect of long‐term financing on WTP and (iii) to assess the desired role of health care plans in financing dental prostheses. Methods: Edentulous elders (68–79 years; n = 36) wearing maxillary dentures and either a mandibular conventional denture (CD, n = 13) or a two‐implant overdenture with ball attachments (IOD, n = 23) participated in this study. All had received their prostheses 2 years previously, as part of a randomised clinical trial. A three‐part questionnaire was completed during a 20‐min interview with a trained researcher. Results: Forty‐six per cent (6/13) of the CD wearers and 70% (16/23) of the IOD wearers were willing to pay three times more than the current cost of conventional dentures for implant prostheses. These percentages were increased to 77% (CD) and 96% (IOD) if participants could pay for implant overdentures in monthly instalments. Eighty‐six per cent (31/36) of all participants in both groups (21/23 IOD; 10/13 CD) thought that the government should cover at least some of the cost of implant overdentures. Conclusions: This study shows that, the majority of elderly edentate individuals who have not experienced mandibular two‐implant overdenture therapy are willing to pay the cost, particularly when payment can be made in monthly instalments.     

Tooth-root form and function in platyrrhine seed-eaters

Research into the functional and adaptive basis of tooth crown form has provided a useful framework for the inference of diet in extinct primates. However, our understanding of variation in tooth-root form is limited. Studies within the clinical literature emphasize the influence of tooth-root surface area on stress resistance, but it is not known if root form has diversified during primate evolution in relation to dietary specialization. This hypothesis was tested by quantifying maxillary canine and postcanine tooth-root surface areas in four platyrrhine species that differ in the material properties of their diet: Cebus apella, Cebus albifrons, Chiropotes satanas, and Pithecia pithecia. Pairwise comparisons between closely related taxa support predictions based on dietary differences. Taxa that regularly consume resistant seeds (Cebus apella and Chiropotes satanas) exhibit significantly larger relative surface area values for those teeth used in seed processing than closely related taxa that consume resistant foods less often (Cebus albifrons and Pithecia pithecia). Additionally, relative molar-root surface area appears to be greater in Pithecia than in Chiropotes, as predicted from the more folivorous diet of Pithecia. Tooth-root surface area was also found to vary along the tooth row and should therefore have a significant influence on antero-posterior bite-force gradients. The results of this study suggest a close relationship between tooth-root form and patterns of occlusal loading. Further elucidation of this relationship could improve our inferences of diet in extinct taxa, and augment research into the mechanics and evolution of feeding.