implantology

内植学
  • 文章类型: Journal Article
    使用牙科植入物对完全或部分无牙的患者进行康复是最常用的外科手术之一。Branemark的工作,观察到嵌入兔骨中的一块钛变得牢固附着且难以去除,介绍了骨整合的概念和革命性的现代牙科。从那以后,对改善植入材料以增强材料-组织整合的需求不断增长。人们坚信,纳米级材料将产生高效的下一代植入物,低成本,和高容量。这篇综述的目的是探讨纳米材料在植入学中的贡献。已经提出了多种纳米材料作为植入物表面定制的潜在候选者。它们可以具有固有的抗菌特性,为骨整合提供增强的条件,或充当生物分子和药物的储库。二氧化钛纳米管单独或与生物试剂或药物组合用于增强牙科植入物中的组织整合。关于免疫调节,为了避免植入物排斥,二氧化钛纳米管,石墨烯,石墨烯生物聚合物已经被成功利用,有时负载抗炎药和细胞外囊泡。可以通过金属纳米颗粒和壳聚糖或带有抗生素物质的混合涂层的固有抗菌特性来实现种植体周围炎的预防。为了改善耐腐蚀性,已经探索了各种材料。然而,尽管这些修改已经显示出了有希望的结果,未来的研究对于评估它们在人类中的临床行为并进行广泛的商业化是必要的。
    Rehabilitation of fully or partially edentulous patients with dental implants represents one of the most frequently used surgical procedures. The work of Branemark, who observed that a piece of titanium embedded in rabbit bone became firmly attached and difficult to remove, introduced the concept of osseointegration and revolutionized modern dentistry. Since then, an ever-growing need for improved implant materials towards enhanced material-tissue integration has emerged. There is a strong belief that nanoscale materials will produce a superior generation of implants with high efficiency, low cost, and high volume. The aim of this review is to explore the contribution of nanomaterials in implantology. A variety of nanomaterials have been proposed as potential candidates for implant surface customization. They can have inherent antibacterial properties, provide enhanced conditions for osseointegration, or act as reservoirs for biomolecules and drugs. Titania nanotubes alone or in combination with biological agents or drugs are used for enhanced tissue integration in dental implants. Regarding immunomodulation and in order to avoid implant rejection, titania nanotubes, graphene, and biopolymers have successfully been utilized, sometimes loaded with anti-inflammatory agents and extracellular vesicles. Peri-implantitis prevention can be achieved through the inherent antibacterial properties of metal nanoparticles and chitosan or hybrid coatings bearing antibiotic substances. For improved corrosion resistance various materials have been explored. However, even though these modifications have shown promising results, future research is necessary to assess their clinical behavior in humans and proceed to widespread commercialization.
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  • 文章类型: Journal Article
    这项研究旨在从组织学上评估XPEED®和SLA表面对放置在人体骨骼中的钛牙植入物在3周和5周时的矿物质附着率(MAR)的影响。总的来说,本研究包括17个钛牙科植入物,其具有XPEED®表面(n=9)用作测试,SLA表面(n=8)用作对照。每个患者在活检前2周以12小时间隔接受四剂四环素500mg。进行了植入物取回,并在落射荧光显微镜下仔细处理并进行组织形态学评估。在3周和5周,新形成的骨出现与两种类型的测试表面直接接触。在3周,MAR值为,分别,XPEED®植入物为2.0(±0.18)μm/天,SLA植入物为1.5(±0.10)μm/天(p=0.017)。在5周,注意到XPEED®和SLA植入物的MAR值较低,1.2(±0.10)μm/天和1.1(±0.10)μm/天,分别(p=0.046)。通过线性回归分析对时间和植入物表面的总体评估显示,与3周相比,5周时的成骨细胞活性降低(p<0.005)。本研究的结果表明,在3周和5周愈合时,在具有XPEED®表面的植入物周围,骨并置速率发生得更快。MAR值可以支持在早期加载方案中使用具有XPEED®表面的植入物。
    This study aimed to histologically evaluate the effects of XPEED® and SLA surface on the mineral apposition rate (MAR) at 3 and 5 weeks in titanium dental implants placed in human bone. In total, 17 titanium dental implants with XPEED® surface (n = 9) used as test and SLA surface (n = 8) used as control were included in this study. Each patient received four doses of tetracycline 500 mg at 12 h intervals 2 weeks prior to biopsy retrieval. Implant retrieval was performed, and retrieved biopsies were carefully treated for histomorphometric evaluation under epifluorescence microscopy. At 3 and 5 weeks, newly formed bone appeared in direct contact with both types of tested surfaces. At 3 weeks, the MAR value was, respectively, 2.0 (±0.18) μm/day for XPEED® implants and 1.5 (±0.10) μm/day for SLA implants (p = 0.017). At 5 weeks, lower MAR values for both XPEED® and SLA implants were noted, with 1.2 (±0.10) μm/day and 1.1 (±0.10) μm/day, respectively (p = 0.046). The overall evaluation by linear regression analysis for both time and implant surfaces showed a decreased osteoblast activity at 5 weeks compared to 3 weeks (p < 0.005). The results of the present study show that the bone apposition rate occurs faster around implants with XPEED® surface at 3 weeks and 5 weeks of healing. MAR values may support the use of implants with XPEED® surfaces in early loading protocols.
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  • 文章类型: Journal Article
    目的:由于口颌系统的动态特性,模拟植入物支撑修复体所经历的循环载荷的疲劳寿命实验是至关重要的考虑因素。这项研究的目的是研究不同的冠和基台材料对单种植体支撑冠疲劳失效的影响。
    方法:为10种不同的植入物支撑单冠设计创建了模型,其中包括两种氧化锆增强的硅酸锂(结晶和预结晶),整体式焦硅酸锂,聚合物渗透陶瓷网,和由氧化锆和钛基台支撑的聚醚醚酮。在颊舌方向上以30°角在上颌第一前磨牙的pal尖上施加179N的循环载荷,频率为1Hz。
    结果:在带有钛基台的模型中,聚合物渗透的陶瓷网络模型对植入物中的疲劳破坏值具有较低的循环数(5.07),桥台(2.30),和螺丝(1.07)相比,其他人。在带有氧化锆基台的模型中,与其他模型相比,结晶氧化锆增强的硅酸锂模型对基台疲劳破坏值的循环次数更高(8.52)。根据疲劳标准,聚醚醚酮种植体冠可能在不到五年的时间内失效,而其他种植体冠在所有模型上都表现出无限的寿命。
    结论:基台材料的类型对植入物的疲劳破坏值的循环次数有影响,基台,和螺丝,但对皇冠材料没有影响。氧化锆基台证明了更长的疲劳寿命,因此,应考虑用于植入物支撑的单冠。
    OBJECTIVE: Due to the dynamic character of the stomatognathic system, fatigue life experiments simulating the cyclic loading experienced by implant-supported restorations are critical consideration. The aim of this study was to examine the effect of different crown and abutment materials on fatigue failure of single implant-supported crowns.
    METHODS: Models were created for 10 different designs of implant-supported single crowns including two zirconia-reinforced lithium silicates (crystallized and precrystallized), monolithic lithium disilicate, polymer-infiltrated ceramic networks, and polyetheretherketone supported by zirconia and titanium abutments. A cyclic load of 179 N with a frequency of 1 Hz was applied on palatal cusp of a maxillary first premolar at a 30° angle in a buccolingual direction.
    RESULTS: In the models with titanium abutments, the polymer-infiltrated ceramic network model had a lower number of cycles to fatigue failure values in the implant (5.07), abutment (2.30), and screw (1.07) compared to others. In the models with zirconia abutments, the crystallized zirconia-reinforced lithium silicate model had a higher number of cycles to fatigue failure values in the abutment (8.52) compared to others. Depending on the fatigue criteria, polyetheretherketone implant crown could fail in less than five year while the other implant crowns exhibits an infinite life on all models.
    CONCLUSIONS: The type of abutment material had an effect on the number of cycles to fatigue failure values for implants, abutments, and screws, but had no effect on crown materials. The zirconia abutment proved longer fatigue lifetime, and should thus be considered for implant-supported single crowns.
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  • 文章类型: Journal Article
    目的:本研究的目的是评估使用四种不同制造商工作流程打印的手术指南的准确性。
    方法:48个手术指南(BlueSky计划,BlueSkyBio)是使用四种不同的打印机生产的,严格遵守每个制造商的说明。使用的打印机是三台DLP打印机(SolFlex170(VC),Nextdent5100(ND),D30+Rapidshape(RS))和一台SLA打印机(Formlabs3B+(FL))。该研究评估了整个表面的真实性和准确性,感兴趣区域(RoI)(咬合和引导区),在几个批次的重复性,和导向孔的直径和xyz轴。将印刷指南数字化,并与CAD设计对照样品(对照X,Geomagic)。进行描述性统计和Kruskal-Wallis检验以及事后Mann-Whitney检验(α=0.05)。
    结果:统计学分析显示,在整体区域和RoI中,各组之间的真实性和准确性存在差异(p=0.00)。ND组表现出最高的可重复性。只有RS组表现出与主样本相当的导孔直径(5.27±2.12mm;p=0.104)。在x轴和z轴的组间没有观察到统计学差异。然而,在y轴上,VC组差异有统计学意义(p=0.01)。
    结论:结果表明,DLP组具有更好的总体准确性,而SLA组在RoI中取得了最好的成绩。制造商的工作流程证明了RoI中批次之间的高再现性。RS组的值与主试样的导孔直径最相似,在导向孔方向偏差最小。
    结论:种植位置是长期成功的关键因素,它可能会受到3D打印手术指南的准确性的影响。因此,使用可用的印刷技术分析导向孔的最终尺寸和方向是至关重要的。
    OBJECTIVE: The aim of this study was to assess the accuracy of surgical guides printed using four different manufacturer workflows.
    METHODS: Forty-eight surgical guides (BlueSky Plan, BlueSky Bio) were produced using four different printers, with strict adherence to each manufacturer\'s instructions. The printers used were three DLP printers (SolFlex170 (VC), Nextdent5100 (ND), D30+Rapidshape (RS)) and one SLA printer (Formlabs3B+ (FL)). The study evaluated the trueness and precision of the overall surface, the region of interest (RoI) (occlusal and guide zone), the repeatability in several batches, and the guide hole\'s diameter and xyz axes. The printed guides were digitized and compared with the CAD design control specimen (Control X, Geomagic). Descriptive statistics and Kruskal-Wallis tests with post-hoc Mann-Whitney tests were performed (α=0.05).
    RESULTS: Statistical analysis revealed differences in trueness and precision were found between groups in the overall zone and RoI (p=0.00). The ND group demonstrated the highest repeatability. Only the RS group exhibited a comparable guide hole diameter to the master specimen (5.27±2.12 mm; p=0.104). No statistical differences were observed between groups in the x and z axes. However, in the y-axis, the VC group displayed statistically significant differences (p=0.01).
    CONCLUSIONS: The results showed that the DLP groups had better overall accuracy, while the SLA group had the best results in the RoI. The manufacturer\'s workflows demonstrated a high reproducibility between batches in the RoI. The RS group had values most similar values to the guide hole diameter of the master specimen, with minimal deviations in guide hole orientation.
    CONCLUSIONS: Implant position is a crucial factor in the long-term success, and it can be affected by the accuracy of the 3D printed surgical guide. Therefore, it is critical to analyze the final dimensions and the direction of the guide hole using available printing technologies.
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  • 文章类型: Journal Article
    钛植入物通过表面碳氢化合物沉积经历老化过程,导致润湿性和生物活性降低。等离子体处理显着减少表面碳氢化合物,从而提高种植体的亲水性和增强骨整合过程。这项研究调查了等离子体表面处理对呈现纳米结构钙掺入表面(XPEED®)的植入物的骨与植入物接触(BIC)的影响。在随机对照试验(RCT)设计之后,在上颌骨后部接受植入物手术的患者接受了额外的等离子治疗(n=7)或未治疗(n=5)3.5×8mm植入物,这些植入物在4周的愈合期后进行组织学检查.组织形态分析显示,经等离子体处理的植入物表现出38.7%的BIC率,而未经处理的植入物为22.4%(p=0.002)。表明骨整合潜力增强。组织学图像还显示,与未处理的标本相比,等离子体处理的植入物周围的骨形成和成骨细胞活性增加。结果表明,等离子体处理提高了表面亲水性和生物响应,促进钛植入物周围的早期骨形成。这项研究强调了表面修饰在优化植入物整合中的重要性,并支持使用等离子体治疗来增强骨整合。从而改善植入物牙科的临床结果,并为即时和早期加载方案提供益处,特别是在软骨条件下。
    Titanium implants undergo an aging process through surface hydrocarbon deposition, resulting in decreased wettability and bioactivity. Plasma treatment was shown to significantly reduce surface hydrocarbons, thus improving implant hydrophilicity and enhancing the osseointegration process. This study investigates the effect of plasma surface treatment on bone-to-implant contact (BIC) of implants presenting a nanostructured calcium-incorporated surface (XPEED®). Following a Randomized Controlled Trial (RCT) design, patients undergoing implant surgery in the posterior maxilla received additional plasma-treated (n = 7) or -untreated (n = 5) 3.5 × 8 mm implants that were retrieved after a 4-week healing period for histological examination. Histomorphometric analysis showed that plasma-treated implants exhibited a 38.7% BIC rate compared to 22.4% of untreated implants (p = 0.002), indicating enhanced osseointegration potential. Histological images also revealed increased bone formation and active osteoblastic activity around plasma-treated implants when compared to untreated specimens. The findings suggest that plasma treatment improves surface hydrophilicity and biological response, facilitating early bone formation around titanium implants. This study underscores the importance of surface modifications in optimizing implant integration and supports the use of plasma treatment to enhance osseointegration, thereby improving clinical outcomes in implant dentistry and offering benefits for immediate and early loading protocols, particularly in soft bone conditions.
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    文章类型: Journal Article
    高危患者的植入物支持康复对牙科团队构成了重大挑战。合并症的存在和感染风险的增加可以,例如,导致植入物丢失的风险更高。为了以尽可能少的并发症完成治疗,特殊回忆,详细的诊断,基于这些发现的风险分析是必不可少的。所有考虑的目的是将有疾病史的患者的感染风险降至最低,并争取适当的功能和美学治疗成功。特别是在美学领域,除了外科手术的一般健康风险,在规划中越来越多地考虑美学方面。本文描述了透析患者的单个前牙的植入物-假体置换。几个方面(定期透析,缺少颊层,高微笑线,功能风险)增加了这种情况下并发症的风险。
    Implant-supported rehabilitation in high-risk patients poses significant challenges for the dental team. The presence of comorbidities and increased infection risk can, for example, lead to a higher risk of implant loss. For the therapy to be completed with as few complications as possible, special anamnesis, detailed diagnostics, and a risk analysis based on those findings are indispensable. The aim of all considerations is to keep the risk of infection for the patient with a disease history to a minimum and to strive for an appropriate functional and esthetic therapeutic success. Particularly in the esthetic zone, in addition to the general health risks of the surgical procedure, esthetic aspects are increasingly taken into account in planning. The present article describes the implant-prosthetic replacement of a single anterior tooth in a dialysis patient. Several aspects (regular dialysis, missing buccal lamella, high smile line, functional risk) increased the risk of complications in this case.
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    文章类型: Journal Article
    目的:本回顾性病例系列的目的是纵向评估植入物前庭方面的软组织体积变化与应用后角化粘膜厚度(KMT)和宽度(KMW)的关系。显微外科包膜技术结合结缔组织移植物(CTG)。
    方法:共有12名健康患者接受了12个放置在上颌骨后部或下颌骨的牙种植体。该研究涉及使用微创单切口技术采集12个CTGs,利用包膜技术移植到前庭种植体周围软组织,然后插入12个螺钉固定的IPSe.max冠。
    结果:所有地区的愈合过程都很顺利,所有患者均随访5年。KMT的评估显示在手术后的前6周下降幅度最大(5.5±0.79至4.59±0.62mm),然后稍微下降到4±0.85毫米,之后,它保持在4±0.36毫米,直到2年的时间点。手术后的第二年和第三年之间,KMT进一步减少了3.59±0.42毫米,然后保持不变,直到5年的研究期结束。关于KMW的观察结果略有不同,测量显示在前6周最大的下降(从2.5±0.42到1.5±0.42毫米),一直维持到1年的时间点。手术后的第一年和第二年,KMW增加到2±0.60毫米,并在未来3年内保持水平,在2±0.85毫米。
    结论:当前的研究证明了使用微创收获CTG和显微外科包膜技术的组合持续5年的优势。
    OBJECTIVE: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG).
    METHODS: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns.
    RESULTS: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm.
    CONCLUSIONS: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years.
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  • 文章类型: Case Reports
    背景:本文旨在展示一种引导骨再生(GBR)的案例,该案例利用从拔除的第二磨牙加工的部分去矿质牙本质板,用于水平增加后脊以进行植入物放置。
    结果:一名60岁的患者在30号部位出现水平脊缺陷,以及经过牙髓治疗的31号牙齿反复腐烂。提出了一种治疗计划,以拔出31号牙齿,并利用牙齿上的牙本质移植物在30号位置进行隆脊。在无创伤拔除31号牙齿后,将其切成1毫米厚的牙本质板,灭菌,并进行处理以获得脱矿质的牙本质移植物。在中体切口和全层皮瓣抬高后,用10mm固定螺钉将牙本质板适应于位置#30的颊部缺损,钢板和颊骨之间的间隙用0.5cc用盐水水合的50/50皮质松质骨同种异体移植物填充,覆盖有胶原膜,然后是初级闭合。6个月时,获得了术后锥形束计算机断层扫描(CBCT)来评估脊部宽度,揭示了足够的脊部宽度以实现最佳植入物放置.在CBCT上可见不透射线的牙本质板,描绘了与牙槽的整合。按照外科植入物准备方案,将4mm直径和8.5mm长度的植入物置于可恢复驱动的位置。
    结论:该病例报告了GBR使用部分脱矿质的牙本质板作为自体骨块移植的替代方法,用于水平隆脊的未来植入物放置。
    结论:本案例介绍了一种新颖的方法,该方法利用从拔牙中提取的部分去矿质牙本质板进行引导骨再生,展示其在解决山脊不足方面的潜在功效。成功,在这种情况下,依赖于细致的牙齿切片和牙本质移植物的处理,将移植物精确地适应和固定到残留的山脊上,并实现原封不动的愈合。成功的局限性包括拔牙的可用性与隆脊和不稳定的移植物固定的需要相吻合。
    BACKGROUND: This article intends to showcase a case of guided bone regeneration (GBR) utilizing a partially demineralized dentin plate processed from an extracted second molar for horizontal augmentation of the posterior ridge for implant placement.
    RESULTS: A 60-year-old patient presented with horizontal ridge deficiency at site #30 and an endodontically treated tooth #31 with recurrent decay. A treatment plan was proposed to extract tooth #31 and utilize a dentin graft from the tooth for ridge augmentation at site #30. Following the atraumatic extraction of tooth #31, it was sectioned into a 1 mm thick dentin plate, sterilized, and processed to obtain a demineralized dentin graft. Following a mid-crestal incision and full-thickness flap elevation, the dentin plate was adapted on the buccal defect of site #30 with 10 mm fixation screws, and the gap between the plate and the buccal bone was filled with 0.5 cc of 50/50 cortico-cancellous bone allograft hydrated with saline, covered with collagen membrane followed by primary closure. At 6 months, a postoperative cone-beam computed tomography (CBCT) was obtained to evaluate the ridge width revealing sufficient ridge width for optimal implant placement. The radio-opaque dentin plate was visible on the CBCT depicting integration with the alveolar ridge. Following surgical implant preparation protocol, a 4 mm diameter and 8.5 mm length implant was placed in a restoratively driven position.
    CONCLUSIONS: This case reports favorable outcomes for GBR using a partially demineralized dentin plate as an alternative to an autogenous bone block graft for horizontal ridge augmentation for future implant placement.
    CONCLUSIONS: This case introduces a novel method utilizing partially demineralized dentin plates derived from extracted teeth for guided bone regeneration, showcasing its potential efficacy in addressing ridge deficiencies. Success, in this case, relies on meticulous sectioning of the tooth and processing of the dentin graft, precise adaptation and fixation of the graft to the residual ridge, and achieving primary closure for undisturbed healing. Limitations to success include the availability of teeth for extraction coinciding with the need for ridge augmentation and unstable graft fixation.
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  • 文章类型: Journal Article
    评估眶下孔与眶下边缘的极下位置的发生频率,这可能会潜在地干扰四侧或单侧双韧带植入物的放置。
    对60例患者进行CBCT扫描,以确定眶下孔(IOF)和眶后边缘(IOR)。测量了两者之间的距离。在值增加的情况下,我们进行了虚拟手术计划,以评估两个Zygoma植入物是否可以放置在一个zy骨.
    60例中有2例显示IOF的位置更差,减少可用的骨骼数量,从而导致四核zy瘤或单侧;双zy骨植入物不可行。
    测量IOF与IOR的距离是值得纳入QuadZygoma或单侧双zygoma植入手术计划的重要步骤。
    暂无摘要。
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  • 文章类型: Journal Article
    引言当前的研究着手评估植入物的早期存活率并确定相关参数。方法这项研究跨越了2021年和2022年,包括所有种植牙的人。各种标准,比如年龄,性别,上颌骨/下颌骨,植入位置,立即植入,植入物直径,植入物长度,和其他人,用于确定研究中的植入物存活率。使用多元逻辑回归模型来显示植入物早期生存率的风险变量,在采用卡方检验过滤后,进一步包括p<0.05的成分。结果目前的研究包括128例患者的单一植入程序,包括70名男性和58名女性。早期生存率为91.40%,植入后保留了117个植入物。显示与早期生存率相关的风险变量为30-60岁的患者(OR:2.542),立即植入(OR:3.742),和植入物长度小于10毫米(OR:3.972)。结论年龄,牙齿位置,植入物长度,和即刻植入是导致我们受试者的植入物早期存活率超过91%的风险变量。
    Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects\' above 91% early survival rate of implants.
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