Objective:To evaluate the clinical application effects of a domestic bone-level implant system for restoring single tooth loss, and provide clinical evidence for the promotion and application of domestic implants.Methods:A prospective, multicenter clinical trial was conducted from April 2018 to January 2020 in three institutions: Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Department of Stomatology, The First Affiliated Hospital of Zhejiang University School of Medicine, and Department of Stomatology, The Third Hospital of Hebei Medical University. The trial planned to include 100 patients for single tooth implantation and restoration, followed up for 1 year, to evaluate the implantation success rate and other related outcomes.Results:This study screened a total of 142 patients and ultimately included 100, comprising 43 males and 57 females with age of (47.0±12.2) years. Ninety-eight out of 100 patients completed a one-year follow-up (98.0%), while 2 patients terminated the trial early due to implant loosening (2.0%). After a one-year follow-up, the implants of the 98 patients were all functioning successfully, with a success rate of 98.0% (98/100). The patients were satisfied with the overall restoration effect.Conclusions:This study indicates that the domestic bone-level implant system has achieved favorable short-term clinical outcomes for single-tooth implantation and restoration.

The problems caused by proximal contact loss(PCL)of dental implants have been a mainstream research topic in recent years,and scholars are unanimously committed to analyzing their causes and related factors,aiming to identify solutions to the problems related to PCL.The effects of the anterior component of force(ACF),the lifelong re-molding of the adult craniofacial jaw and alveolar socket,and the osseointegration characteristics of dental implants are the main causes of PCL.On the one hand,the closing movement of the mandible causes the ACF of the tooth to move through the posterior molar cusp.Moreover,drifting between the upper and lower posterior teeth and mandibular anteri-or teeth can cause the anterior teeth of the upper and lower jaws to be displaced labially.On the other hand,reconstruc-tion of the jaw,alveolar socket and tooth root,the forward horizontal force of the masticatory muscles,the dynamic com-ponent of the jaw and the forward force generated by the oblique plane of the tooth cusp can cause the natural tooth to experience near-middle drift.Additionally,natural teeth can shift horizontally and vertically and rotate to accommodate remodeling of the stomatognathic system and maintain oral function.Nevertheless,the lack of a natural periodontal mem-brane during implant osseointegration,the lack of a physiological basis for near-medium drift,the small average degree of vertical motion and the integrated silence of dental implants without the overall drift characteristics of natural teeth increases the probability of PCL.The high incidence of PCL is clearly associated with the duration of prosthesis delivery and the mesial position;but it is also affected by the magnitude of the bite force,occlusion,the adjacent teeth,restora-tion design,implant location,jaw,and patient age and sex.PCL has shown a significant correlation with food impaction,but not a one-to-one correspondence,and did not meet the necessary and sufficient conditions.PCL is also associated with peri-implant lesions as well as dental caries.PCL prevention included informed consent,regular examinations,se-lection of retention options,point of contact enhancement,occlusal splints,and the application of multipurpose digital crowns.Management of the PCL includes adjacent contact point additions,orthodontic traction,and occlusal adjust-ment.Existing methods can solve the problem of food impaction in the short term with comprehensive intervention to seek stable,long-term effects.Symmetric and balanced considerations will expand the treatment of issues caused by PCL.

Bone stability is precisely controlled by osteoclast-mediated bone resorption and osteoblast-mediated bone formation. When the balance is broken, the integrity of the bone structure will be destroyed. Inflammasomes are important protein complexes in response to pathogen-related molecular models or injury-related molecular models, which can promote the activation and secretion of proinflammatory cytokines and activate a local inflammatory response. NOD-like receptor thermal protein domain associated protein (NLRP) 3 inflammasome can promote bone resorption through the activation of the proinflammatory cytokines interleukin (IL)-1β, IL-18 and the induction of caspase-1-mediated pyroptosis. Inhibiting the production of NLRP3 inflammasome may be beneficial to improve comfort and bone stability. The presence of metal particles and microorganisms around implants can activate NLRP3 and promote bone absorption. NLRP3 inflammasome plays an important role in the maintenance of bone stability around implants, however, most studies focus on orthopedic implants and periodontitis. This article reviews the effects of NLRP3 inflammasome on bone formation, resorption and pain induced by implants, and the possibility of NLRP3 as a target for preventing peri-implantitis is discussed.

口腔修复学是以临床技能为主导的重要学科,作为口腔医学体系中的核心课程,在医学教育信息化建设的背景下如何将传统课堂、实验室教学与临床技能培训三环节有机结合,成为当前口腔修复学教育重点思考的问题.文章从线下、线上和线上-线下混合教学模式三方面展开,论述口腔修复学传统课程的教育特点,线上教学模式的优势与挑战,线上-线下混合教学模式的实施效果,从提升教师教学能力、推进医学虚拟仿真教学技术、建设课程思政等角度分析混合式教学模式的改进策略.探讨口腔修复学的教学现状及存在的问题,结合当前岗位胜任力的培养模式,旨在进一步改进教学模式,提升教学质量,以期为口腔修复学教学改革提供参考.

目前"5+3"专业学位研究生临床教学与规范化培训联合培养缺乏全方位评价体系,理论知识掌握和临床技能操作的考核评价体系较为完备,但是缺乏针对学生人文精神的培养与评估的相关内容,为此,本文尝试探索并创建以临床胜任力为导向的形成性评价体系.通过在临床胜任力导向的培养过程中发现问题,找到问题背后的成因,提出改进措施,以期达到提高临床教学效率的结果,将研究生培养为具有优秀临床能力、创新科研思维、良好人文素养和国际竞争力的引领医学发展的卓越领军人才,符合新时代人民群众对口腔临床医生的新要求.临床胜任力不仅包括理论知识和实践能力,更注重临床人文胜任力,以临床胜任力培养为导向的医学人才培养与临床教学相辅相成.研究主要从临床胜任力培养的改革及形成性评价的改革两方面展开论述.

The emergence profile design of the implant prosthesis will not only affect the aesthetic effect of the prosthesis, but also affect the health of the tissues around the implant. Good emergence profile design helps to form a perfect soft tissue barrier,prevent microbial invasion, protect surrounding soft and hard tissues, and avoid aesthetic and biological complications. On the basis of understanding the biological characteristics of the tissue around the implant and based on the patient’s soft and hard tissue conditions,designing a reasonable implant placement position to protect the health of the tissue around the implant is crucial to the success of the implant and also a necessary factor for the design of the emergence profile.

目的:探索和实践口腔修复印模技能诊断性考评联合角色互演的教学模式.方法:选择口腔修复科轮训的24名学员,随机分为实验组(n=12)与对照组(n=12),采用技能评分表考评结合考评角色互演,并调查学员满意度来评估教学质量.结果:实验组出科成绩比对照组高2.25分,学员满意度100％.结论:诊断性考评联合角色互演的教学模式有助于提升学员临床技能.

种植体愈合方式分为埋入式和非埋入式两种.埋入式愈合在种植体植入后便关闭黏膜创口,可封闭种植体与口腔环境的连通,增加种植体稳定性,促进骨结合;但需进行二次手术,手术创伤较大,且恢复时间长.非埋入式愈合中,种植体的愈合基台穿龈,其仅需一次手术,便捷省时;但易受口腔肌肉活动等的影响,不适于种植体初期稳定性差的情况.两种愈合方式各有利弊,而现鲜见关于二者在临床效果比较方面的综述和临床选择指南方面的报道.本文通过比较埋入式和非埋入式愈合在微生物聚集程度、骨组织吸收程度、软组织预后、种植体成功率、患者满意度等方面的研究结果,得出在同时满足两种愈合方式种植条件的情况时,二者在临床效果方面没有明显差异.因此临床医生可依据种植体初期稳定性、缺牙区骨组织和软组织条件、患者便利性和疼痛耐受度、患者美学要求等方面进行考虑,综合二者利弊,对埋入式和非埋入式愈合进行选择.而对于糖尿病患者,则更推荐埋入式愈合.

种植体的初期稳定性和边缘骨水平与周围骨结合密切相关,是临床诊疗中获得较高存活率和成功率的关键因素.牙种植体形态和结构设计包括种植体外部形态、颈部设计、螺纹和凹槽设计、直径和长度、与基台的连接方式等,这些设计会对初期稳定性和边缘骨水平产生不同的影响,从而影响种植体-骨界面的整体稳定性.该文就牙种植体形态结构设计的研究进展进行综述,为临床医生在诊疗过程中选择合适的种植体提供一定帮助.

侧壁开窗上颌窦底提升的关键是暴露和提升窦底黏骨膜,而骨窗的设计是暴露窦底黏骨膜的重要影响因素.传统骨窗设计为单窗且较大,若存在窦间隔情况会设计2～3个骨窗以避开窦间隔,骨窗下界一般位于上颌窦底上方3～5 mm处.近年来,有较多学者在骨窗的大小、高度和离牙槽嵴顶距离方面不断改良,减少术中、术后不适,增加了患者满意度.本文通过对近期文献的查阅对骨窗的尺寸、位置、外形及数字辅助开窗技术进行综述.

越来越多的患者对前牙区的美学结果要求越来越高,牙龈边缘、牙龈顶点、牙龈乳头、牙龈粉红色美学评分(PES)和牙龈轮廓等都是影响前牙区牙龈美学的重要因素.基台是连接种植体和上部修复体的重要修复结构,基台的特征如基台的材料、制作方式、颜色、穿龈轮廓的形态和基台的表面性状会对牙龈美学产生不同的影响.本文旨在介绍基台的特征、种植体周围牙龈的厚度以及感知美学等对牙龈美学的影响,力求为临床医生在前牙美学区设计合适的种植修复基台提供一定帮助.

Rehabilitation and reconstruction of atrophic edentulous predicament represents significant challenges for implant dentists due to the anatomical conditions of the edentulous jaw. Implant-supported fixed complete dental prostheses represent a scientifically and clinically validated treatment for recovering patients, masticatory function and esthetic effect. However, the highly demanding implant surgical techniques and complex rehabilitation procedures for immediate functional reconstruction make it difficult to achieve the desired treatment outcomes. The application of digital and CAD/CAM technology in various stages of the treatment process is logical for patients and dentists. This article summarizes the workflow of digital-assisted implantation with immediate functional reconstruction of atrophic edentulous combined with a clinical case. Digital-assisted diagnosis, design, implantation, immediate reconstruction and final rehabilitation can optimize the implant surgery and immediate rehabilitation workflow, improve the accuracy of implant-supported immediate functional reconstruction, reduce the demand for a large amount of bone graft, and achieve higher patient satisfaction. The “prosthetic-oriented, begin with the end in mind” concept of edentulous jaw implant prosthetics can accurately and efficiently restore the patient,s beauty and chewing function in a minimally invasive manner, and is worthy of clinical promotion.

Biomineralization has intrigued researchers for decades. Although mineralization of type I collagen has been universally investigated, this process remains a great challenge due to the lack of mechanistic understanding of the roles of biomolecules. In our study, dentine was successfully repaired using the biomolecule polydopamine (PDA), and the remineralized dentine exhibited mechanical properties comparable to those of natural dentine. Detailed analyses of the collagen mineralization process facilitated by PDA showed that PDA can promote intrafibrillar mineralization with a decreased heterogeneous nucleation barrier for hydroxyapatite (HAP) by reducing the interfacial energy between collagen fibrils and amorphous calcium phosphate (ACP), resulting in the conversion of an increasing amount of nanoprecursors into collagen fibrils. The present work highlights the importance of interfacial control in dentine remineralization and provides profound insight into the regulatory effect of biomolecules in collagen mineralization as well as the clinical application of dentine restoration.

Establishing a stable resin-dentin hybrid layer is an effective method to improve the adhesion durability of the restoration.The biomodification of dentin by cross-linkers can enhance the mechanical properties of collagen and resistance to enzymatic hydrolysis while,inhibiting the process of demineralization and promoting the remineralization of dentin,which has the potential clinical applicability of preventing dental caries and improving adhesive property.This review summarizes the biomodification of dentin type Ⅰ collagen by different cross-linkers.

水化硅酸钙类生物材料（CSH）能够在潮湿和血液污染环境中发生自固化反应。CSH具有优良的生物相容性,能诱导磷灰石的形成,使磷灰石成核再矿化并诱导新矿化组织形成。上述这些理化和生物学特性使CSH在根管倒充、盖髓、根管封闭、牙本质再矿化和牙髓再生等口腔医学领域应用范围越来越广。目前,CSH在牙髓再生、牙本质再矿化以及骨和牙骨质再生愈合中发挥关键作用。未来,新的再生齿科将以CSH的不断演变而不断创新。

This novel biomimetic mineralization technique provides an efficient method to produce an advanced mineralized matrix.

浓缩生长因子作为新一代血小板浓缩制品,内含纤维蛋白及多种生长因子,对组织的修复再生具有重要意义.本文就浓缩生长因子的发展过程、制备、主要成分以及与口腔种植软组织和硬组织增量相关的研究、应用进行综述.

Objective: To observe the effect of adenosine triphosphate (ATP) phosphorylation on type Ⅰ collagen mineralization and explore the role of small molecule compound ATP in biomimetic mineralization. Methods: Fourier transform infrared spectroscopy (FT-IR) was used to analyze the phosphorylation of collagen molecules by different concentrations (0, 25, 50, 100 mmol/L) of ATP. The concentration of 50 mmol/L ATP was chosen to construct the phosphorylated collagen mineralization model. Transmission electron microscopy (TEM) was used to observed the ultrastructure of mineralized collagen and the collagen mineralization rate was further calculated by ImageJ software. The surface morphology of the collagen gel ATP group and the control group was observed by scanning electron microscopy (SEM) and the elemental analysis was performed by using an X-ray energy spectrometer. The artificial demineralized dentin samples were mineralized for 2 days and 4 days to compare the effect of ATP on dentin remineralization by SEM. Results: FT-IR analysis showed that the formation of new peaks at wavenumbers of 642, 818, and 902 cm(-1) indicated that ATP can phosphorylate type Ⅰ collagen. Through TEM and SEM observation, the mineralization degree of type Ⅰ collagen and demineralized dentin pretreated with 50 mmol/L ATP were significantly higher than that of the control group. Compared with the control group [(31.65±1.62)%], the mineralization rate of collagen in the ATP group [(100±0)%] was significantly increased after 2 days of mineralization (P<0.05). Conclusions: ATP phosphorylation can effectively promote the mineralization process of type Ⅰ collagen.

Peri-implantitis is a kind of serious complication after tooth implantation. The absorption of alveolar bone lead to the exposure of rough implant surface, which would result in poor long-term therapeutic effect. Implantoplasty promises a better long-term therapeutic effect than bone augmentation technique. This article will introduce implantoplasty from two aspects: therapeutic effect and its influencing factor, safety and effectiveness.

目的 探究不同种植即刻修复方式对关学区单牙种植修复治疗疗效的影响.方法 研究分析2014年8月-2016年8月于浙江大学医学院附属第一医院口腔医学中心行上颌美学区单牙种植修复并即刻修复的51例患者,其中采用Ti-base基台,CAD-CAM树脂临时冠修复患者27例(研究组),采用成品临时基台,同期制作临时树脂冠患者24例(对照组).患者修复后随访时间均为18～42个月,分析比较两组患者临时修复期间及永久修复后的临床疗效.结果 即刻修复后6个月,研究组种植体周围探诊i深度(PD)与对照组无显著性差异(P＞0.05),研究组改良龈沟出血指数(mBI)、菌斑指数(PLI)低于对照组,差异有统计学意义(P＜0.05).永久修复后1年,研究组种植体边缘骨吸收量与对照组无显著差异,研究组单牙红色美学评分(PES)略高于对照组,差异无统计学意义(P＞0.05).结论 Ti-base基台,CAD-CAM树脂临时冠种植修复短期内可减少种植体周茵斑积聚,减轻牙龈炎症,但不影响种植修复的长期疗效,两种临时修复方式均能达到良好的远期美学效果.