成功的种植牙

Successful Implant for the Patients with Compromise Situation

自从1962年第一例种植牙成功的应用于临床后,口腔修复进入了一个崭新的时代。在过去的几十年中,植牙技术被广泛应用于:1.取代缺失的牙齿;2.作为固定修复和活动修复的基牙;3.作为口腔颌面膺复的支点和依靠;4.作为正琦治疗中的支点和依靠。但总体说来,修复缺失的牙齿还是种植牙最主要的功能。牙齿缺失常常会造成严重的牙槽脊的萎缩,特别是在缺牙时间较长的病人中尤为常见。上下颌后牙区由于解剖的原因,加上牙槽脊高度的降低,使得临床医生必须先做一些辅助的手术才能使得种植成为可能。比如:牙槽脊增高术,下齿槽神经移位术和上颌窦底部升高术。尽管这些手术在临床上被广泛地运用,但它们毕竟有风险,而使得疗程延长,更增加了病人在花费上的负担。过去,许多人认为短于10毫米的种植体的成功率会为之下降,但近年来大量的临床实践证明并不是这么回事。由于种植体表面处理得到改进,这些短种植体也愈来愈得到临床医生的重视。随着短种植体的大量的临床应用,临床研究发现短种植体的5年生存率与长种植体相比没有区别。因此,由于上颌窦或下齿槽神经的位置而造成种植困难的病例,选择短种植体将是一种不错的选择。牙槽脊增高术,上颌窦增高术和短种植体的应用等,将在会上详细讨论。

Since the first implant was successfully inserted into patient's alveolar bone,the restoration of missing teeth has been entered into a brand new era.During the past decades,implant therapy has been shown to be good choices for:1.Replace individual teeth;2.Support fixed and removable prostheses;3.Anchor maxillofacial prostheses;4.Act as anchorage for orthodontic movement.Above all,replace missing teeth is still the major reason for dental implant.After tooth loss,however,severely atrophic residual alveolar ridge are quite common,especially in patients who have been edentulous for a long period of time.Posterior areas of maxilla and the mandible are areas where clinicians have greater anatomical limitations.Reduced alveolar bone height,very often represents a contraindication to implant therapy,unless a procedure such as ridge augmentation,mandibilar nerve relocaiton and sinus floor elevation is performed.Although widely used,these techniques imply greater morbidity,longer treatment times and higher costs.In the past several years,it has been thought that the success rates decreased with implants less than 10mm.This is being challenged by newer forms,changed surface textures and treatments.Roughened surface,square threads,and plate form implants with greater surface area have been used successfully.The usage of short implant has been more popularized and clinical investigations have demonstrated that short implants(5.7mm)have no significant different of 5 year survive rate when compare longer implants(8mm).Sinus cavity in the maxillar and alveolar nerve proximity in the mandible are clinical situations where short implants may be considered as an alternative treatment option.Several clinical cases will be discussed with surgical procedures and short implants.