黄连解毒汤加减联合Onlay植骨术治疗重度牙周炎的临床效果

目的:探讨黄连解毒汤加减联合Onlay植骨术治疗重度牙周炎的临床效果。方法:选择2021年9月—2023年5月于遂宁市中心医院口腔分院就诊的重度牙周炎患者92例,采用随机数字表法分成常规组和中药组,每组46例。常规组采用Onlay植骨术治疗,中药组在常规组的基础上采用黄连解毒汤加减治疗。观察两组患者的中医证候积分、牙龈出血指数(BI)、牙周袋深度(PD)、附着丧失(CAL)、菌斑指数(PLI)水平、白介素-23(IL-23)、白介素-1β(IL-1β)、基质金属蛋白酶-8(MMP-8)、基质金属蛋白酶抑制剂-1(TIMP-1)、牙槽嵴骨量、临床疗效及不良反应发生情况。结果:治疗前,两组患者中医证候积分比较,差异无统计学意义(P>0.05);两组患者PD、BI、PLI、CAL水平比较,差异无统计学意义(P>0.05);两组患者IL-23、IL-1β、MMP-8及TIMP-1水平比较,差异无统计学意义(P>0.05);两组患者牙槽嵴骨量比较,差异无统计学意义(P>0.05)。治疗后,中药组患者BI、PD、CAL、PLI水平、中医证候积分与IL-23、IL-1β及MMP-8水平均低于常规组(P<0.01);中药组TIMP-1水平与牙槽嵴骨量高于常规组(P<0.01);中药组患者治疗总有效率高于常规组(P<0.05);不良反应总发生率两组差异无统计学意义(P>0.05)。结论:黄连解毒汤加减联合Onlay植骨术治疗能够改善患者牙周情况及龈沟液生化指标,降低中医证候积分,提高患者牙槽嵴骨量与临床疗效,安全性较高。

全程健康教育联合围术期护理在改良Onlay植骨术患者护理中的效果评价

探讨针对改良Onlay植骨术患者采用全程健康教育联合围术期护理的影响效果。方法 选取我院2020年4月-2021年12月期间收治行改良Onlay植骨术患者(共90例),作为参考对象。分为参照组和试验组,参照组45例,试验组45例,参照组采用围术期常规护理措施,试验组采用全程健康教育联合围术期护理措施干预,根据所得数据,对比两组患者种植体存活、WES、PES等手术效果与SAS、HAMA以及并发症发生情况。结果 采用全程健康教育联合围术期护理措施干预后,试验组患者种植体存活、WES、PES等手术效果优于参照组(P<0.05),试验组患者SAS、HAMA评分优于参照组(P<0.05),试验组患者并发症发生情况小于参照组(P<0.05)。结论 针对改良Onlay植骨术患者采用全程健康教育联合围术期护理,可以提高治疗效果,改善患者的负性心理,减少了其并发症的发生,值得临床应用。

Influence of Abutment Material on the Stress of Implant-supported All-ceramic Single Crown

In order to investigate the influence of abutment material on the stress of implant-supported all-ceramic single crown, a 3D finite element model of implant-supported mandibular first premolar was computed by COSMOS/M 2.85 software. Alumina, zirconia, and titanium were used as abutment materials respectively. Vertical 600 N and horizontal 225 N load was applied on the occlusal surface. The results show that the stress distribution of implant-supported single crown was similar for different abutment materials. Maximum stresses within the crown were higher when titanium abutment was used. Maximum stress of titanium abutment was lower than that of ceramic abutment. Within the screw and fixture, maximum stresses had no difference under vertical loading but higher as titanium abutment was used under horizontal loading. There was no difference of maximum stress within the bone when different abutment materials were used. The present findings indicate that the abutment material had no influence on the stress distribution of implant-supported all- ceramic single crown but maximum stress when the titanium abutment was lower than that of ceramic abutment.

Influence of Different Luting Agents on the Stress Distributions of Implant-supported All-ceramic Single Crown

The purpose of this study was to investigate the influence of different luting agents on the stress distribution within the crown, abutment and peri-implant bone of implant-supported all-ceramic single crown. A three-dimensional finite element model of an implant-supported single crown for the first premolar of mandible was created by COSMOS 2.85. Resin-modified glass ionomer and two different resin adhesives were used to cement the crown and abutment. Vertical 600 N and horizontal 225 N loads were applied to stimulate the condition of chewing. The stress distributions within the all-ceramic crown, abutment and peri-implant bone were analyzed. The experimental results show that the stress distributions of all-ceramic crown, abutment, implant and peri-implant bone were similar when different luting agents were used. The result of present study indicated that luting agents had no influence on the stress distributions of implant-supported all-ceramic single crown.

The Effect of Alumina Content on Fracture Property of All-ceramics Zirconia

The purpose of the present study was to evaluate the effect ofA1203 content on the fracture property of all-ceramics ZrO2. To improve the all-ceramics ZrO2 restoration mechanics properity ,96 samples containing 0,5,10 and 15 wt% of A1203 particles were prepared by cold isostatic pressing （200 MPa） and 1 550 ℃ sintered .The phase was analyzed by X-ray diffraction analysis and the bulk densities of the samples were made using Archimedes principle. Samples were randomly divided into four groups. In each group, 24 specimens were prepared so that the angle between notch and specimen＇s long axis is 90° and 60°. Notch depths were 1 mm for all samples. Samples were loaded with three-point bending method. 90° cut samples were used to measure fracture toughness while 60°cut samples were used to observe fracture curve by taking points on the fracture extension path under microscope, plotting points on coordinates, generating fitting curve by software ＂Origin＂, and analyzing the microstructure of the specimen fracture surfaces by scanning electron microscopy （SEM）.The results show that the increment ofA1203 has insignificant effect on the densification of all-ceramic ZrO2.XRD analysis shows that the specimen is comprised of t-ZrO2 and a- A1203 before fracture while fracture surface is m-ZrO2, t-ZrO2 and a-A1203. ZrO2 containing 10% A1203 has the optimum mechanical properties and unconspicuous crack propagation and distribution. The observations may provide a reference for the materials selection, shaoe design, and production orocess of all-ceramic crown and bridge.

Insightful Understanding of the Role of the Mechanical Properties in Defining the Reliability of All-Ceramic Dental Restorations: A Review

Since the last two decades, restorative dentistry has been witnessing an increased acceptance of the use of the well-known all-ceramic materials for the fabrication of single dental restorations, such as inlays, onlays, crowns, anterior and posterior fixed partial dentures (PFPDs). These restorations certainly offer the potential for better biocompatibility coupled with superior aesthetic qualities, especially when compared with the conventional prostheses made from porcelain that is fused with metal ceramic restorations. However, brittleness and extreme sensitivity of all-ceramic materials to micro-like defects or cracks that are inherently present, or may grow, in their microstructure during different laboratory fabrication steps, during necessary clinical adjustments, or from post-placement chewing activity, remain major shortcomings of these dental restorations. In fact, many researchers are of the opinion that the improved mechanical properties can significantly improve the lifetime of all-ceramic restorations and result in enhanced reliability. Therefore, efforts of researchers, as well as manufacturers, have been directed towards the improvement of the mechanical properties in order to overcome such limitations. This article reviews the characterization of the most important mechanical properties that can delineate the behavior of all-ceramic dental materials upon loading. These include fracture mechanics, the brittle nature of ceramics, the relationship between microstructural features and fracture behavior, sources of cracks and flaws that may initiate a fracture and the effect of different fabrication procedures and/or clinical adjustments on the mechanical behavior of dental ceramics are also reviewed and discussed.

3D打印白硅钙石支架材料在大鼠Onlay骨移植中的应用

目的评价3D打印白硅钙石(bredigite,BRT)骨支架材料在大鼠Onlay骨移植中的效果。方法通过3D打印技术制备骨BRT支架材料作为实验组,β⁃磷酸三钙(β⁃tricalcium phosphate,β⁃TCP)骨支架材料作为对照组,通过扫描电镜(scanning electron microscopy,SEM)、X射线衍射(X⁃ray diffraction,XRD)、力学测试和体外降解测试实验对其进行表征观察。建立SD大鼠颅骨Onlay骨移植的动物模型,根据移植物的不同,分为自体骨移植组(Auto组)、β⁃TCP组及BRT组。术后12周获取标本行大体观察、micro⁃CT扫描检测分析、组织学HE染色。结果SEM观察显示,BRT有规则的多孔结构,XRD衍射峰较为锐利。与β⁃TCP组(11.29±1.30)MPa相比,BRT支架材料(46.80±3.44)MPa具有更好的力学强度(P<0.001);在体外第35天时,BRT降解率为27.18%±1.41%,并且在降解过程中释放钙、镁、硅离子。micro⁃CT及组织学染色实验结果提示,Auto组有一定程度的骨吸收,β⁃TCP和BRT组均有一定新骨生成。micro⁃CT和组织学定量结果,BRT组新生骨组织占比分别为16.83%±2.11%和19.08%±2.17%,均高于β⁃TCP组(8.48%±1.85%,10.81%±1.33%)(P<0.05)。结论3D打印BRT骨支架材料促进Onlay骨移植中的骨再生。

Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision

Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The mean
standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.82
3.97 to 10.88
5.57);so did postvoid residual urine(71.12
74.98 mL to 15.00
28.30 mL),and maximum flow rate(7.88
1.72 mL/s to 25.82
5.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.

超嵌体

Overlay于1992年由刘洪臣翻译为超嵌体,定义为覆盖整个咬合面的嵌体,并收录于2000年由人民军医出版社正式出版发行的《口腔医学专业术语词典》。但在实际应用中的难点是如何与高嵌体区别,其后作者根据临床应用实践和文献,并与国内外同行商榷,修改其定义为修复伴邻面较大缺失空间的牙体缺损、恢复邻接关系的覆盖或不全覆盖咬合面的一种嵌体修复方式。固位方式包括活髓牙的箱式固位或无髓牙的髓腔固位,其修复边缘位于牙颈部之上。超嵌体有利于保护牙体缺损剩余牙体组织,避免了充填窝洞形成的悬突及牙体充填物的折裂,突出了超嵌体的特点和优越性。

CAD/CAM全瓷高嵌体与树脂复合陶瓷高嵌体修复对后牙牙体缺损的研究进展

计算机辅助设计与制作(CAD/CAM)系统,因其具有高效率、高精确性等优点,逐渐在后牙牙体缺损修复中得到广泛的应用。通过研究CAD/CAM全瓷高嵌体、树脂复合陶瓷高嵌体在后牙牙体缺损修复中的应用,对两种方法的材料、后牙牙体治疗相关临床应用、应用期间注意要点及应用效果差异进行比较,以期为后牙牙体缺损的治疗提供临床选择依据。本文通过对研究国内外CAD/CAM全瓷高嵌体与树脂复合陶瓷高嵌体修复对后牙牙体缺损的治疗新进展进行归纳与分析。CAD/CAM技术临床应用普及有利于提升医院在口腔医学领域的核心竞争能力,且高质量的牙体修复有益于提升民众的口腔健康,亦可节约社会医疗资源。

颏部块状骨onlay植骨在上颌前牙区种植修复的临床应用

目的:研究评价块状骨onlay植骨恢复上颌前牙区的三维骨量继而种植体植入修复的效果。方法:对8例上前牙缺牙后牙槽嵴重度吸收或缺损患者进行自体下颌颏部取块状骨onlay植骨,恢复牙槽骨的形态,平均3个月后植入了21颗种植体,术后6个月行种植体暴露术,暴露后4周行全瓷冠修复。结果:所有病例术后随访平均12个月,重建的牙槽骨唇侧丰满,种植体无松动,无脱落,唇侧牙龈无退缩,达到了良好的美学修复效果。结论:自体下颌颏部块状骨onlay植骨技术可以有效恢复牙槽嵴的三维骨量,从而保证骨量不足种植修复的成功,效果可靠。

超薄钛膜联合onlay骨移植在牙种植中的临床应用

评估超薄钛膜联合onlay骨移植在牙种植中的临床应用。上颌前牙区骨质缺损的牙种植患者12例,行颏部来源的块状骨onlay骨移植,表面覆盖超薄钛膜,植骨术后没有明显并发症出现,1例患者植骨术后10 d超薄钛膜少许暴露,局部修剪清洁后无明显感染发生。3～6个月后二期手术时暴露种植区见onlay骨移植与基骨愈合良好,onlay骨移植吸收约7.5%,完成共21颗种植体植入。超薄钛膜可明显减少onlay骨移植的吸收并促进其于基骨的愈合。

Onlay岛状皮瓣尿道成形术治疗儿童尿道下裂适应证及并发症防治

目的探讨Onlay术式治疗儿童尿道下裂的适应证及并发症防治。方法作者对2010年3月-2016年4月就诊于我院小儿外科的7例尿道下裂儿童行Onlay尿道成形术治疗,回顾性分析该术式的适应证及并发症的防治。结果 7例患儿年龄1.5～8岁,平均4.32岁,其中6例为初次手术,1例因外院行阴茎下屈畸形矫治、尿道成形术后尿道外口位于冠状沟、阴茎根部尿瘘、阴茎下屈畸形而行二次手术。术前阴茎头发育小,直径约0.8 cm者1例;阴茎头扁平缺乏锥形外观、直径约1.0 cm者3例。7例均存在不同程度的阴茎下屈畸形,其中2例伴有阴茎逆时针扭转;6例初次手术者中包皮脱套即可完全纠正阴茎下屈4例,另2例表现为阴茎头近端阴茎轻度下屈畸形。1例二次手术者表现为阴茎头下屈畸形,均通过阴茎背侧白膜紧缩缝合技术完全纠正下屈畸形。阴茎下屈畸形完全纠正后,尿道外口位于冠状沟、阴茎体以及阴茎阴囊连接部。尿道缺损长度1.5～4.0 cm,平均2.64 cm。裁取的包皮内板岛状皮瓣宽度为0.5～1.0 cm,平均0.7 cm。7例术后阴茎均伸直状态,无尿道狭窄,排尿通畅;6例初次手术者中,5例无尿瘘,1例岛状皮瓣坏死、阴茎头渗血、尿道外口退至阴茎阴囊连接部;1例二次手术者冠状沟尿瘘,呈滴尿状态;1例包皮切口腹侧裂开。结论 Onlay术式治疗儿童尿道下裂的适应证：1）尿道板具有一定的厚度及延展性、对阴茎腹侧不形成牵拉,或尿道板虽对阴茎腹侧形成轻度牵拉、但通过阴茎背侧白膜紧缩缝合技术可纠正此牵拉;2）阴茎下屈畸形完全纠正、解剖至阴茎腹侧出现尿道海绵体时,尿道外口可能后退至冠状沟、阴茎体及阴茎阴囊连接部。阴茎头及尿道板切开深度适宜及有效止血是预防术后并发症的关键。

后牙高嵌体和[牙合]贴面修复的4年临床随访

目的:对比后牙高嵌体和[牙合]贴面修复体在不同性别、不同牙位、活髓牙和根管治疗牙上的4年临床成功率,探讨与全冠对比这种修复方式的优劣及更细化的适应证。方法:对2016—2019年由同一位术者诊治的共102位患者的124颗患牙进行前磨牙及磨牙计算机辅助设计/计算机辅助制造(computer aided design/computer aided manufacturing,CAD/CAM)二硅酸锂增强玻璃陶瓷高嵌体或者[牙合]贴面修复,其中活髓牙43颗,根管治疗牙81颗,咬合面修复体厚度为1.5 mm。在修复4年后进行回顾性调查,记录修复体生存率、修复体失败原因、患者满意率,比较活髓牙和根管治疗牙之间、修复牙位之间的修复体生存率。结果:活髓牙和剩余牙体组织较多的根管治疗牙修复4年后的生存率分别为95.5%和90.0%,平均生存率为91.9%。活髓牙的生存率高于根管治疗牙,但是差异无统计学意义,牙位之间生存率差异无统计学意义。失败原因有修复体崩瓷或折裂、修复体脱落、基牙劈裂、邻接触点下方继发龋,以及邻接触点松弛导致食物嵌塞等。患者总体满意率为91.5%。结论:玻璃陶瓷高嵌体和[牙合]贴面的4年生存率低于全冠修复体,并发症多于单冠修复体,应根据基牙牙髓活力和牙体组织剩余量来慎重选择其适应证,牙体组织剩余过少时最好选择桩核冠来进行修复,应保证修复体充分强度和厚度,预防食物嵌塞的发生,由于基牙预备量少,有对牙髓和牙周组织刺激小等优点,可推荐为试用修复方式。

下颌骨取骨onlay植骨改善种植骨量不足的临床研究

目的:评价应用下颌骨取骨onlay植骨改善种植术前重度萎缩牙槽嵴的手术方法及疗效。方法:18例患者接受了下颌骨来源的onlay植骨术,手术同期或术后4～6个月共植入22颗种植体,并于术后4～6个月暴露种植体,最终完成烤瓷冠修复。结果:植骨术后无并发症发生,2例骨吸收较明显,其余均顺利植入种植体,二期手术时骨吸收平均20%。所有病例均最终完成种植修复,观察6～28个月,无种植体脱落。结论:下颌骨取骨onlay植骨修复重度萎缩的牙槽嵴操作简便,效果可靠。

Onlay植骨中局部运用载唑来膦酸胶原膜对骨吸收的影响

目的探讨局部应用唑来膦酸是否可抑制骨吸收,维持骨增量效果。方法雄性健康新西兰兔15只,依照观察时间的不同随机分为3组,每组5只。按照随机对照原则将双侧下颌骨分为实验组和对照组。双侧受植区植入相同大小(10 mm×5 mm×2 mm)自体胫骨,钛钉固定,实验组和对照组分别在移植骨表面覆盖载唑来膦酸胶原膜和空载胶原膜。于术后4、8、12周时各处死5只动物。离体标本拍摄X线片,利用图像处理软件间接测量其骨高度值。结果同时期对照组平均骨高度降低百分比大于实验组,且均表现为边缘骨高度降低大于中央。4、8周时两组移植骨平均骨高度降低百分比差异无统计学意义(P>0.05),12周时差异有统计学意义(P<0.05)。结论自体骨移植的实验性onlay植骨术中,局部应用唑来膦酸可抑制骨吸收,骨增量维持效果较好。

聚合瓷高嵌体与全瓷冠在下颌第一磨牙缺损修复中的应用及对咀嚼功能和美学效果的影响

目的:探讨聚合瓷高嵌体与全瓷冠在下颌第一磨牙缺损修复中的应用及对咀嚼功能和美学效果的影响。方法:选取笔者医院2020年1月-2021年12月收治的120例第一磨牙缺损患者作为研究对象,按照随机数字表法分为对照组(60例,采用全瓷冠修复)和观察组(60例,采用聚合瓷高嵌体修复)。观察两组患者的修复效果、牙周健康指标、咀嚼功能、美学效果及不良事件发生情况。结果:治疗后12个月,观察组修复总有效率高于对照组(P<0.05);观察组牙周健康指标评分均低于对照组(P<0.05);观察组咀嚼功能显著高于对照组(P<0.05);观察组患者的表面光滑、边缘密合性、固定良好及颜色匹配评分高于对照组(P<0.05);观察组继发龋、牙冠折裂、牙龈红肿、咬合痛不良事件发生率低于对照组(P<0.05);观察组患者修复成功率及存活率高于对照组(P<0.05)。结论:与全瓷冠治疗比较,应用聚合瓷高嵌体修复下颌第一磨牙缺损能够提高患者远期修复效果,改善牙周健康状况,提升咀嚼功能及美学效果。

超声骨刀在自体下颌块状骨Onlay植骨术中的应用

目前患者对缺牙后尤其是前牙区缺牙修复的美观要求越来越高,但由于各种原因造成的牙槽骨严重缺损,剩余骨量既无法保证种植体在正确轴向及位点植入并获得良好的初期稳定性,也无法保证后期修复的美学要求.针对骨量不足种植的骨增量方法有很多种[1],其中绝大多数的方法如骨劈开、上颌窦底提升、块状骨移植、下颌神经移位等都需要进行骨切割.传统方法就是用骨锯或高速涡轮机切割骨组织,局麻时常会引起患者紧张恐惧,由于切割骨量不易掌握,精确性差,容易造成术中神经血管损伤,术后创面出血,肿胀和疼痛等并发症.超声骨刀的应用很好地解决了上述问题,它具有精确性高,选择性切割,不损伤软组织,出血少,手术野清晰以及创伤小等优点[2].目前国内外对超声骨刀在外科手术中的应用报道较多,在口腔领域的应用也日趋广泛,但在骨量不足种植时的骨移植方面报道较少.笔者针对其在颌面部块状骨移植方面的应用进行了初步观察,现总结报告如下.

椅旁CAD/CAM高嵌体修复老年磨牙大面积缺损的临床观察

目的:探究数字化椅旁计算机辅助设计/计算机辅助制造(CAD/CAM)高嵌体对老年磨牙大面积缺损患者的修复效果。方法:选取2016年7月~2020年6月本院收治的75例(75颗缺损牙)老年磨牙大面积缺损患者,行根管治疗后采用椅旁CAD/CAM进行高嵌体修复。评价修复后12、24个月的修复效果,并于修复后24个月调查患者满意度,检测修复前和修复后12、24个月的龈沟液内肿瘤坏死因子-α(TNF-α)和基质金属蛋白酶8(MMP-8)水平。结果:修复后12、24个月的修复合格率分别为97.33%、93.33%,修复后24个月患者在修复体颜色、外形及舒适度三方面的满意率分别为98.67%、97.33%、100%。修复后12、24个月的患牙龈沟液内TNF-α及MMP-8水平较修复前下降(P<0.05)。结论:CAD/CAM技术制作的高嵌体对于老年磨牙大面积缺损的修复效果良好,患者满意度高,可作为老年磨牙大面积缺损的有效治疗方案。

1例颏部供骨Onlay植骨术患者围手术期的护理

上颌后牙区因骨质疏松、密质骨较薄、上颌窦气腔化及其它各种原因较易引起牙槽骨萎缩，因此上颌后牙区种植修复时常遇有牙槽骨高度不足的问题^[1]。针对牙种植的骨增量方法有多种，但对于牙槽骨重度缺损，剩余骨量无法保证种植体在正确轴向及位点植入并获得良好的初期稳定性。