A Case Report of Immediate Implant Placement Combined with Flap Surgery,Guided Bone Regeneration and Non-submerged Healing with a Labial Bone Wall Defect in the Esthetic Zone

[Basckground]This case report presented a methodology for immediate implantation in the esthetic zone with a facial bone defect along with flap surgery,guided bone regeneration,and non-submerged healing.[Case presentation]A 27-year-old female patient was complaining of the aesthetic complication that was caused via metallic staining of the neck of ceramic crowns in the maxillary right anterior region for one year.She has experienced immediate implantation along with flap surgery,guided bone regeneration(GBR),and non-submerged healing.The torque of the implant reached to the 35 N·cm to confirm primary stability.Six months after surgery,the healing abutment and the implant were fixed,the gingiva was healthy in the surgical area,and the nearby teeth and the opposite teeth were normal.[Results]The results of cone-beam computer tomography(CBCT)revealed that bone defects were filled with the newly formed bone.At the same time,the final impressions accomplished,and an all-ceramic crown was fit-placed.As a whole,the patient satisfaction rate was high.[Conclusions]Immediate implant placement with flap surgery,GBR,and non-submerged healing with a facial bone wall defect in the esthetic zone is an achievable process.

GUIDED TISSUE REGENERATION AROUND DENTAL IMPLANTS IN IMMEDIATE EXTRACTION SOCKETS:COMPARISON OF RESORBABLE ANDNONRESORBABLE MEMBRANES

This study was per formed to compare the efficacy of guided tissue regeneration (GTR) around dentalimplants immediately placed into extraction sockets by resorbable of nonresorbable membranes. Mandibular. P2, P3, and P4 of four aduIt beagle dogs were extracted bilaterally, and buccal standard defects were cre-ated and measured. Eighteen commercially pure titanium Steri-Oss implant fixtures were placed into thefresh extraction sockets. Four implants were untreated controls, four implants received polytetrafluoro-ethylene (e-PTFE, Gore-Tex) membranes, five implants received collagen membranes (ParaGuide), andfive implants received polyglactin 910 mesh (Vicryl). After l4 weeks, clinical measurements were takenand the dogs were sacrificed and all specimens retrieved for histologic and histomorphometric evaluation.The average gain in bone height was 2. 1mm for untreated control sites, 3. 3mm for Gore-Tex sites,3. 8mm for collagen sites, and 1. 3mm for polyglactin 910 sites. The greatest gain in bone height and volume was seen for two sites that received Gore-Tex membranes and remained covered for the entire evalua-tion interval. The results of this study indicate that Gore-Tex and collagen membrane preduced gdri re-sults for GTR around Implants immediately placed into extraction sockets. Since collagen membrane doesnot cause obvious infection and does not need the surgical reentry for membrane removal, it can be a validalternative to Gore-Tex membrane to improve bone regeneration around dental implants, while polyglactin910 mesh seems not suitable to be used as GTR membrane in immediate implantation for its hIgh infectionrate.

Surface demineralized freeze-dried bone allograft followed by reimplantation in a failed mandibular dental implant

The removal of a failed implant with high torque causes significant damage to the surrounding tissue,compromising bone regeneration and subsequent osseointegration in the defect area.Here,we report a case of carrier screw fracture followed by immediate implant removal,bone grafting and delayed reimplantation.A dental implant with a fractured central carrier screw was removed using the bur-forceps technique.The resulting three-wall bone defect was filled with granular surface demineralized freeze-dried bone allograft(SD-FDBA).Cone-beam computerized tomography was performed at 1week,6months and 15months postoperatively and standardized for quantitative evaluation.The alveolar bone width and height at 15months post-surgery were about 91%of the original values,with a slightly lower bone density,calculated using the gray value ratio.The graft site was reopened and was found to be completely healed with dense and vascularized bone along with some residual bone graft.Reimplantation followed by restoration was performed 8months later.The quality of regenerated bone following SD-FDBA grafting was adequate for osseointegration and longterm implant success.The excellent osteogenic properties of SD-FDBA are attributed to its human origin,cortical bone-like structure,partly demineralized surfaces and bone morphogenetic protein-2-containing nature.Further investigation with more cases and longer follow-up was required to confirm the final clinical effect.

Immediate implant placement in combination with platelet rich-fibrin into extraction sites with periapical infection in the esthetic zone:A case report and review of literature

BACKGROUND In this case,platelet-rich fibrin(PRF)was added to guided tissue regeneration as a biomaterial in proper order for immediate planting in aesthetic area with periapical infection.CASE SUMMARY With the history of endodontic failure in maxillary central incisor,a 34-year-old female patient required the extraction of maxillary anterior residual root and immediate implantation.Cone beam computed tomography and clinical observation were used to assess the regeneration of soft and bone tissue.Before operation,cone beam computed tomography showed the anterior residual root had serious periapical periodontitis with insufficient labial bone in the aesthetic zone.The patient underwent immediate implant placement and reconstruction of the bone substitution by modified guided bone regeneration.The barrier was a three-layer structure of PRF-collagen membrane-PRF that covered the mixture of PRF and Bio-Oss to promote both osteogenesis and soft tissue healing.At 6 mo postoperatively,the definitive crown was placed after accomplished finial impression.One-year follow-up showed a satisfactory aesthetic effect with no obvious absorption of the labial bone and soft tissue.CONCLUSION The use of PRF in combination with guided bone regeneration can serve as a reliable and simple adjuvant for immediate implanting in infected socket and result in a stable osteogenic effect with good aesthetic outcome.

Systematic evaluation of three porcine-derived collagen membranes for guided bone regeneration

Guided bone regeneration is one of the most common surgical treatment modalities performed when an additional alveolar bone is required to stabilize dental implants in partially and fully edentulous patients.The addition of a barrier membrane prevents non-osteogenic tissue invasion into the bone cavity,which is key to the success of guided bone regeneration.Barrier membranes can be broadly classified as non-resorbable or resorbable.In contrast to non-resorbable membranes,resorbable barrier membranes do not require a second surgical procedure for membrane removal.Commercially available resorbable barrier membranes are either synthetically manufactured or derived from xenogeneic collagen.Although collagen barrier membranes have become increasingly popular amongst clinicians,largely due to their superior handling qualities compared to other commercially available barrier membranes,there have been no studies to date that have compared commercially available porcine-derived collagen membranes with respect to surface topography,collagen fibril structure,physical barrier property,and immunogenic composition.This study evaluated three commercially available non-crosslinked porcine-derived collagen membranes(Striate+TM,Bio-Gide®and CreosTM Xenoprotect).Scanning electron microscopy revealed similar collagen fibril distribution on both the rough and smooth sides of the membranes as well as the similar diameters of collagen fibrils.However,D-periodicity of the fibrillar collagen is significantly different among the membranes,with Striate+TM membrane having the closest D-periodicity to native collagen I.This suggests that there is less deformation of collagen during manufacturing process.All collagen membranes showed superior barrier property evidenced by blocking 0.2–16.4µm beads passing through the membranes.To examine the immunogenic agents in these membranes,we examined the membranes for the presence of DNA and alpha-gal by immunohistochemistry.No alpha-gal or DNA was detected in any membranes.However,using a more sensitive detection method(real-time polymerase chain reaction),a relatively strong DNA signal was detected in Bio-Gide®membrane,but not Striate+TM and CreosTM Xenoprotect membranes.Our study concluded that these membranes are similar but not identical,probably due to the different ages and sources of porcine tissues,as well as different manufacturing processes.We recommend further studies to understand the clinical implications of these findings.

牙槽突扩张术联合GBR植骨术同期种植牙在牙齿发育异常患者中的应用效果

目的:探讨牙槽突扩张术联合骨引导再生(GBR)植骨术同期种植牙在牙齿发育异常患者中的应用效果。方法:纳入87例(94牙)牙齿发育异常患者为研究对象,根据治疗方式不同分为常规组(n=37,40牙)和GBR组(n=50,54牙)。常规组行牙槽骨劈开术治疗;GBR组行牙槽突扩张术联合GBR植骨术治疗,术后随访1年。比较两组患者治疗有效率、手术基本情况(手术时间、离院时间及骨愈合时间);术后1个月及6个月种植体稳定性[稳定系数(ISQ)];术后1年种植体周围软组织情况[红色美学标准(PES)评分]、种植体周围牙槽骨吸收值及种植体周围牙整齐度;手术并发症及术后1年修复体并发症发生情况。结果:GBR组患者治疗有效率高于常规组(P<0.05);骨愈合时间短于常规组(P<0.05);两组患者手术时间及离院时间比较,差异无统计学意义(P>0.05)。术后1个月及6个月,GBR组患者种植体ISQ高于常规组(P<0.05)。术后1年,GBR组患者种植体周围软组织PES评分、种植体周围牙槽骨吸收值、牙整齐度高于常规组(P<0.05)。两组患者手术并发症比较,差异无统计学意义(P>0.05);GBR组患者术后1年修复体并发症总发生率低于常规组(P<0.05)。结论:牙槽突扩张术联合GBR植骨术同期种植牙治疗有效率高,且牙齿发育异常患者预后效果更好。

引导骨再生术在前牙区种植中的应用及对美学效果和临床疗效的影响

目的:探讨前牙区种植联合引导骨再生术的临床应用价值。方法:选取2022年1月-2022年10月笔者医院接受前牙区种植的142例患者,采用随机数字法将患者分为对照组(n=70)和观察组(n=72)。对照组单纯进行牙种植,观察组在牙种植基础上联合引导骨再生术治疗。通过临床资料收集比较两组治疗前和治疗6个月后的牙槽骨密度、植骨厚度和成骨厚度、牙周探诊深度(Periodontal depth,PD)、临床附着丧失(Clinical attachment loss,CAL)、牙龈退缩(Gingival recession,GR)、红色美学指数(Pink esthetic scores,PES)、临床疗效和并发症。结果:术后6个月,两组牙槽骨密度、植骨厚度和成骨厚度均高于术前,且观察组高于对照组(均P<0.05);术后6个月,两组PD、CAL及GR均低于术前,且观察组PD、CA及GR均低于对照组(P<0.05);术后6个月,两组PES指标评分均高于术前,且观察组高于对照组(P<0.05)。观察组总有效率95.83%,高于对照组的91.43%(P<0.05);观察组并发症发生率1.39%,低于对照组的8.57%(P<0.05)。结论:前牙区种植联合引导骨再生术美学效果好、PES评分高,临床总有效率高且并发症发生率低,具有较高的临床应用价值。

牙种植同期植骨术围术期高血压的相关危险因素

目的:探索牙种植同期植骨术中,围术期高血压的特点及相关危险因素。方法:对北京大学口腔医院某门诊科室2021年9月至2022年8月的728例牙种植及植骨术患者进行回顾性队列研究,分析研究对象围术期高血压与性别、年龄、手术时长、植骨术式4种暴露因素的关联性。结果:牙种植同期植骨术中,收缩压平均波动幅度为9.93%±6.63%(最大值50.41%),舒张压平均波动幅度为12.45%±8.79%(最大值68.75%),平均动脉压平均波动幅度为10.02%±6.61%(最大值为49.48%)。围术期高血压的发病率为26.77%。男性、年龄≥60岁、手术时长>60 min是围术期高血压的危险因素(P<0.05),相对危险度(95%CI)分别为1.74(1.21~2.50)、2.35(1.54~3.58)和1.65(1.15~2.38)。引导性骨再生术、上颌窦内提升术、上颌窦外提升术3种植骨术式围术期高血压发病率差异无统计学意义(P>0.05),但不同植骨方式下围术期高血压的影响因素不同。引导性骨再生术围术期高血压的危险因素为男性、年龄≥60岁和手术时长>60 min(P<0.05);上颌窦内提升术围术期高血压的危险因素为年龄≥60岁(P<0.05);而对于上颌窦外提升术,男性、年龄≥60岁、手术时长>60 min都不是围术期高血压的危险因素(P>0.05)。结论:牙种植同期植骨术中存在一定的围术期高血压风险,男性、年龄≥60岁和手术时间>60 min对围术期高血压的影响程度与植骨方式有关。

口腔硬组织修复材料仿生设计制备和临床转化

口腔疾病几乎涉及到每个个体,严重影响人民健康和生活质量,已经成为制约国民经济发展和社会资源积累的重要问题。牙齿和颌骨是行使口腔功能和支撑外貌轮廓的重要结构基础。小范围牙齿缺损可能引发牙本质过敏症,大范围缺损则会导致牙齿形态和功能破坏,而牙齿缺失常造成牙槽骨吸收低平,不利于后续修复。临床上牙本质过敏症治疗手段非常有限,以牙本质小管封闭为主,其效果不佳且易复发;材料充填是牙体缺损治疗的主要手段,但现有材料与牙齿力学性能匹配差,界面结合不足,修复体寿命短;而牙槽骨低平的垂直骨增量则是世界性难题。究其原因,是缺乏对牙齿微观结构及其构效关系的深入解析,缺少对牙槽骨再生微环境的深入认识,导致材料设计忽视了从微观结构功能仿生到宏观效果实现的协同考量。因此,发展牙齿/颌骨结构与功能高度仿生的修复材料新技术与临床新策略是目前口腔医学研究的重要战略方向。

种植同期引导骨再生术后唇侧骨吸收及边缘骨吸收的风险因素

目的:分析上颌前牙区,延期种植同期进行引导骨再生(guided bone regeneration,GBR)术后6个月唇侧骨吸收的影响因素。探究种植二期手术时种植体唇侧骨宽度对种植体边缘骨吸收的影响。方法:本研究为回顾性队列研究,随访至最终修复后1年。采用锥形束CT(cone beam CT,CBCT)测量术后即刻(T1)和术后6个月(T2)种植体唇侧水平骨宽度和垂直骨高度,采用广义线性混合模型分析影响因素。根据T2时的唇侧骨宽度,将种植体分为3个队列:0骨壁组、骨壁<2 mm组和骨壁≥2 mm组,探究组间边缘骨吸收差异。结果:共纳入57例患者,94枚种植体。容纳性骨缺损、种植体连接愈合基台与更少的骨吸收显著相关;在修复后1年的随访中,组间边缘骨吸收差异无统计学意义;种植位点行软组织增量手术与更少的边缘骨丧失显著相关。结论:GBR术中使用愈合基台更有利于维持水平、垂直骨量;软组织增量手术利于维持稳定的边缘骨水平。

口腔种植治疗中骨再生材料的研究现状

当前口腔种植临床治疗中,需要涉及骨组织再生的病例逐年增加,对相关生物材料的要求日益提高。本文旨在回顾总结口腔种植骨再生材料的研究现状。结合骨再生应用的具体特点,探讨影响材料性能的生物化学及物理学性质,并对当前骨再生材料研究领域的热点重点问题进行讨论。最后进一步展望未来口腔骨种植再生材料的研究方向,以期推动下一代口腔骨再生材料的发展。

牙周炎患者种植牙同期行引导骨组织再生术的美学修复效果及对牙槽骨吸收的影响研究

目的:探究伴牙周炎患者种植牙同期行引导骨组织再生术(Guided bone regeneration,GBR)治疗的美学修复效果及对牙槽骨吸收的影响。方法:病例选取笔者医院2019年6月-2021年6月收治的牙周炎牙种植患者78例作为研究对象,按照随机数字表法分为对照组和观察组,对照组给予患者常规种植修复,观察组在对照组基础上采用GBR治疗,比较两组患者术后6个月、12个月的牙周探查深度(Periodontal exploration depth,PD)、改良龈沟出血指数(Sulcular bleeding index,mSBI)、改良菌斑指数(Plaque index,mPLI)、骨吸收量以及美学修复效果。结果:术后6个月、12个月,观察组患者的mSBI均低于对照组患者(P<0.05)。种植体周围骨吸收量比较,术后12个月两组患者的近中骨吸收量和远中骨吸收量均较术后6个月显著降低(P<0.05),且术后12个月观察组患者的近中骨吸收量和远中骨吸收量均显著低于对照组。美学效果比较,观察组患者术后6个月、12个月红色美学指数评分均显著高于对照组(P<0.05),且术后12个月两组红色美学指数评分均显著高于术后6个月(P<0.05),术后6个月、12个月,两组白色美学指数评分差异无统计学意义(P>0.05),且两组术后12个月与术后6个月白色美学指数评分比较,差异无统计学意义(P>0.05)。结论:牙周炎患者牙种植同期应用GBR能有效改善患者牙周健康指标,防止种植体周围骨吸收,进而提高种植体留存率,满足患者治疗中种植美学的要求。

锥形术CT测量分析下颌第一磨牙拟种植区剩余牙槽嵴的骨量

背景:随着口腔领域的发展与进步,口腔种植技术逐渐成为替代传统义齿的主流选择。近年来,多种骨增量技术的成熟以及口腔数字化领域的不断发展,使种植适应证不断扩大,种植手术的成功率也越来越高。但是种植手术前使用锥形术CT对剩余牙槽嵴骨量进行准确测量并且个性化制定合适的种植方案,成为一部分临床医师的难题。目的:采用锥形束CT对下颌第一磨牙拟种植区剩余牙槽嵴骨量进行测量分析,为优化下颌第一磨牙区种植方案的设计提供参考。方法:采用回顾性研究设计,纳入205例下颌第一磨牙缺失患者的锥形术CT影像,测量下颌第一磨牙拟种植区剩余牙槽嵴高度及宽度,并将剩余牙槽嵴形态分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4类(Ⅱ、Ⅲ、Ⅳ类剩余牙槽嵴为骨量不足),统计分析下颌第一磨牙剩余牙槽嵴高度、宽度、形态频数分布,不同性别患者下颌第一磨牙剩余牙槽嵴高度和牙槽嵴顶宽度的差异,剩余牙槽嵴高度与剩余牙槽嵴顶宽度、剩余牙槽嵴底宽度的相关性,年龄与剩余牙槽嵴顶宽度、高度的相关性。结果与结论:①下颌第一磨牙拟种植区剩余牙槽嵴高度平均为(12.14±2.96)mm,其中<12 mm者占43.41%(89/205),下颌第一磨牙拟种植区牙槽嵴顶宽度平均为(6.80±1.65)mm,其中<6 mm者占26.34%(54/205);②男性下颌第一磨牙剩余牙槽嵴高度高于女性,但差异无显著性意义(P>0.05),男性下颌第一磨牙剩余牙槽嵴顶宽度宽于女性,差异有显著性意义(P<0.01);③剩余牙槽嵴高度与剩余牙槽嵴顶宽度和剩余牙槽嵴底宽度呈负相关(P<0.05);年龄与剩余牙槽嵴顶宽度呈正相关(P<0.05),与剩余牙槽嵴高度无明显相关性(P>0.05);④剩余牙槽嵴形态Ⅰ类占58.05%(119/205),Ⅱ类占9.27%(19/205),Ⅲ类占20.49%(42/205),Ⅳ类占12.19%(25/205),其中多数为Ⅲ类剩余牙槽嵴骨量不足,临床医生需要根据剩余牙槽嵴类型个性化设计最佳的种植方案。

不同口腔修复膜材料在牙种植中的引导骨再生效果分析

目的分析不同口腔修复膜材料在牙种植中的引导骨再生效果。方法50例牙种植患者,以电脑随机法分为对照组和观察组,每组25例。对照组患者予以钛膜修复,观察组患者予以海奥口腔修复膜修复。比较两组患者种植成功率、口腔功能指标评分、术后并发症发生情况、植骨高度和成骨厚度。结果观察组种植成功率96.00%与对照组的72.00%相比较高,差异有统计学意义(P<0.05)。观察组的美观程度评分(48.11±0.32)分、固化程度评分(47.96±2.15)分、语言功能评分(48.82±1.12)分、咀嚼功能评分(48.75±1.06)分与对照组的(42.66±0.42)、(42.85±2.49)、(44.90±1.12)、(44.64±1.31)分相比较高,差异有统计学意义(P<0.05)。观察组术后并发症发生率4.00%与对照组的28.00%相比较低,差异有统计学意义(P<0.05)。观察组植骨高度(2.51±0.35)mm、成骨厚度(2.66±0.53)mm与对照组的(2.04±0.23)、(2.20±0.32)mm相比较高,差异有统计学意义(P<0.05)。结论海奥口腔修复膜在牙种植中的引导骨再生效果较好,术后并发症的发生几率更低。

美学区分阶段骨增量联合邻牙显微根尖手术的 治疗策略:临床诊治流程及实践病例

前牙美学区种植手术中,通常需要结合不同的骨增量手术,来实现理想的前牙骨弓轮廓和软组织的协调。然而,种植位点邻牙的慢性根尖周围炎症可能成为潜在的感染源,这可能导致早期的骨增量失败,或者进一步影响种植体的根部引发逆行性种植体周炎。本文详细阐述了1例前牙美学区骨缺损伴邻牙根尖周病变的典型病例,通过使用牙本质壳技术与显微根尖手术相结合的方式进行分阶段骨增量并完成种植修复,避免种植相关骨增量手术中开辟第二术区取骨的创伤,为口腔内存在阻生齿等无功能天然牙的骨缺损修复治疗病例提供了一种微创治疗的选择,同时在种植手术过程中消除邻牙潜在的感染源,从而保证了口腔治疗远期效果的可预测性。

自体骨-异种骨混合的钛网支撑的引导骨再生伴角化龈增量的美学区连续牙列缺损种植修复一例

本病例报告了一例自体骨-异种骨混合的钛网支撑的引导骨再生(guided bone regeneration,GBR)伴角化龈增量的美学区连续牙列缺损种植修复。患者因外伤致上颌前牙区骨折、水平向骨丧失,连续多颗天然牙缺失。临床治疗取自体骨混合去蛋白牛骨矿物质(deproteinized bovine bone mineral,DBBM)异种骨填入骨缺损区,在唇侧放置钛网和生物可吸收性胶原膜。半年后行简易修复导板引导下种植体植入,二期术前行角化龈增量,临时修复体佩戴6个月后完成最终美学修复。结果可见,自体骨-异种骨混合的钛网支撑的GBR获得了理想的骨增量效果,为种植体植入提供了理想的位点,同时角化龈增量手术为最终美学修复提供了令医患满意的临床效果。因此,自体骨-异种骨混合用于钛网支撑的GBR是一种增加前牙区水平骨量的有效方法。

帐篷式骨增量技术用于修复上前牙单牙缺失的美学效果及其对牙槽骨宽度的影响

目的:探究帐篷式骨增量技术对上前牙单牙缺失患者的治疗效果及对牙槽骨宽度的影响。方法:选取汉滨区第三人民医院2020年2月-2021年2月收治的80例上前牙单牙缺失患者为研究对象,按治疗方法不同分为研究组(帐篷式骨增量技术)38例和对照组(引导骨再生技术)42例,比较两组的种植情况、红白美学指数评分、牙槽骨宽度、龈沟液骨代谢指标、牙周情况以及术后并发症发生率。结果:种植体植入3个月后,两组患者均无种植体松动、脱落等现象,影像学检查无透影区,种植成功率均为100%;术后6个月,研究组种植区周围红色美学指数评分高于对照组(P<0.05),两组白色美学指数评分差异无统计学意义(P>0.05)。术后6个月,两组患者牙槽骨宽度均显著增加(P<0.05),且研究组术后6个月牙槽骨宽度高于对照组(P<0.05);两组龈沟液中骨保护素(Osteoprotegerin,OPG)水平显著降低,骨桥蛋白(Osteopontin,OPN)水平显著升高(P<0.05),研究组OPG水平高于对照组(P<0.05),OPN水平低于对照组(P<0.05);两组患者牙龈指数、牙菌斑指数以及探诊深度差异均无统计学意义(P>0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:帐篷式骨增量技术应用于上前牙单牙缺失种植成功率较高,能提高修复后美学效果,增加牙槽骨宽度,减缓骨吸收,术后并发症及对牙周影响均较小,值得推广应用。

美学区应用不可吸收性屏障膜进行骨增量的5年临床观察

本文报告了1例使用异种骨和致密型聚四氟乙烯(dense polytetrafluoroethylene,dPTFE)膜与生物可吸收性胶原膜Bio-Gide双层覆盖的引导骨再生(guided bone regeneration,GBR)伴软组织增量的美学区连续牙列缺损种植修复的病例。患者因外伤导致上颌前牙区连续多颗牙缺失伴有较严重的水平向和轻微的垂直向骨丧失。在导板辅助下植入种植体的同时,使用去蛋白牛骨矿物质(deproteinized bovine bone mineral,DBBM)+dPTFE+Bio-Gide进行GBR,6个月后先后通过同种异体脱细胞真皮基质AlloDerm+隧道瓣和结缔组织瓣(connective tissue graft,CTG)+改良隧道瓣进行软组织增量,临时修复体牙龈塑形后,完成最终美学修复,恢复了患者的功能和美观。戴牙5年后的临床随访可见,DBBM+dPTFE+Bio-Gide的GBR获得了理想的骨增量效果,AlloDerm/CTG+隧道瓣的软组织增量为最终的美学修复提供了令人满意的临床效果。

Accuracy Assessment of a Novel Radiographic Method to Evaluate Guided Bone Regeneration Outcomes Using a 3D-Printed Model

The aim of this study was to evaluate the accuracy and reproducibility of a morphological contour interpolation(MCI)based segmentation method for the volumetric measurement of bone grafts around implants.Three 3D-printed models(one with a cylinder and two with a geometrically-complex form)were fabricated to simulate implant placement with a simultaneous guided bone regeneration(GBR)procedure.All models were scanned using a cone beam computed tomography(CBCT)instrument with the same parameters.The true volumes of the bone grafts in the models were assessed using computer-aided calculation(controls).For the test measurements,both manual and MCI-based methods were used.A comparison between the measured and true volumes was performed to evaluate the accuracy.The coefficients of variation of repeated measurements were calculated to evaluate the reproducibility.In addition,the execution time was recorded and a comparison between the two methods was performed.The high accuracy of the MCI-based method was found with differences between the measured value and actual volume,which never exceeded 7.3%.Excellent reproducibility was shown,with coefficients of variation never exceeding 1.1%.A shorter execution time was observed for the MCI-based method than for the manual method.Within the confines of this study,the MCI-based method may be suitable for volumetric measurements of grafted bone around implants.

上颌侧切牙重度畸形舌侧沟多学科联合治疗1例并文献复习

畸形舌侧沟是上颌切牙尤其是侧切牙常见的发育畸形,常引起牙周组织的破坏。本文报告1例畸形舌侧沟引发的牙周-牙髓联合病变误诊为单纯的根尖周囊肿的病例,经完善根管治疗及根尖周囊肿刮除术后病程迁延不愈,造成患牙区域颊、颚侧骨板缺如,后通过拔除患牙同期行位点保存术,后期配合种植修复,得到临床治愈。畸形舌侧沟隐匿性强、临床表现往往不典型,如有上颌侧切牙脓包反复发作或深牙周袋持续存在,应完善影像学检查,必要时行牙周翻瓣术探查牙根面形态。