Objective To investigate the clinical effect of lithium disilicate glass ceramic cantilever resin-bonded fixed partial dentures (CRBFPDs) on single anterior tooth loss to provide a reference for the selection of restoration methods for single anterior tooth loss. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-two patients with less than two anterior teeth with monomaxillary loss were included in this study. After 6 months, 1 year, 2 years, and 3 years, the aesthetic and functional effects of the restorations and the periodontal health status were evaluated, and the visual analog scale (VAS) was used to assess patient satisfaction. Results During the observation period, the connector fractured in one case within 3 months. One case had debonded within 2 years. The aesthetic restoration effect of all lithium disilicate glass ceramic CRBFPDs was categorized as Class A. The periodontal health was good, there was no clinical absorption in the soft and hard tissues of the abutment or subbridge, periodontal status according to the evaluation indices was classified as class A, and the total satisfaction rate of the patient was 100%. Conclusion For single anterior tooth loss patients, lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture can achieve the restoration effect of less invasion, better adhesion, aesthetics, comfort and good biocompatibility. With high patient satisfaction, it can be considered an ideal restoration method for replacing a single anterior tooth.

背景:目前,因牙周炎、创伤等原因导致的牙缺失后骨量缺损较为普遍,各类骨增量技术仅解决了一部分此类难题.目前常用的各类骨增量技术均存在不同程度的局限性.为改善上述问题,一项改良技术——环状植骨术的提出,为临床工作者提供更多骨增量方案选择.目的:归纳环状植骨术相关研究动态,对环状植骨术的临床应用情况进行综述.方法:由第一作者应用计算机检索PubMed、万方、维普、知网、CBM数据库,以"dentition defect,bone augmentation,dental implants,bone defect,bone graft material,bone ring technique"为英文关键词,以"牙列缺损,骨增量,牙种植体,骨缺损,骨移植材料,环状植骨术"为中文关键词,检索时限为1986年1月至2022年2月,共搜索到431篇文献,并进行筛选、归纳分析与总结,最终纳入60篇相关文献进行综述.结果 与结论:①环状植骨术并同期植入种植体具有缩短治疗时间、减少患者二次手术痛苦等优点,且因其良好的机械性能,更利于软硬组织形态的重建与恢复;②但其也存在固定不牢、自身供骨量无法满足严重骨量缺损、部分患者无法接受开辟第二术区等局限;③仍需要更多高质量、长时间、大样本的随访研究,不断改良环状植骨术,使其更好地应对各类牙列缺损伴骨缺损患者的种植治疗.

背景:全瓷悬臂式粘接桥,其从治疗时间、侵入性、美观性及价格等多方面体现出来的优势,使其成为目前临床口腔前牙美学修复中热门的话题.目的:总结归纳全瓷悬臂式粘接桥临床技术难点上的解决策略以及在前牙应用的优势,并介绍目前现有的全瓷悬臂式粘接桥的临床随访方法,以期在前牙牙列部分缺损的美学修复领域提供临床及科研指导.方法:由第一作者检索Web of Science、PubMed、中国知网和万方数据库检索1955-2021年发表的文献,英文检索词为"Denture,Partial,Fixed,Resin-Bonded,Resin Bonded Bridge,Maryland Bridge,Adhesive bridge,single-retainer,all-ceramic";中文检索词为"粘接桥、马里兰桥、粘接固定桥、全瓷、悬臂式、单端",经筛选后纳入60篇文献进行综述分析.结果 与结论:①通过选择氧化锆瓷材料进行有效的表面预处理能较好地预防折裂发生;设计近缺隙侧盒状洞形及舌隆突处钉洞固位形为现在专家共识之一,能有效减少粘接桥脱落的发生,提高远期存留效果;在满足适应证的条件下,全瓷悬臂式粘接桥的龋坏牙周病等并发症发生率较低,美学效果好,存留时间长,可作为永久性修复体使用.②对于临床研究,除统计基本的存留率成功率外,推荐同步使用口腔健康相关生活质量表、满意度问卷调查以及美国公共卫生协会修复体评价标准等进行评估,以此全面评估修复效果.③但值得注意的是,不同研究对存留率和成功率的定义不同,对数据统计造成一定的偏差,因此全瓷悬臂式粘接桥的实际临床效果还值得进一步探究.

Background Observational studies have demonstrated a link between shortened telomere lengths(TL) and chronic periodontitis. However, whether the shortened TL is the cause or the result of periodontitis is unknown.Therefore, our objective was to investigate a bidirectional causal relationship between periodontitis and TL using a two-sample Mendel randomized (MR) study. Methods A two-sample bidirectional MR analysis using publicly available genome-wide association study (GWAS) data was used. As the primary analysis, inverse variance weighting (IVW) was employed. To identify pleiotropy, we used leave-one-out analysis, MR-Egger, Weighted median, Simple mode, Weighted mode, and MR pleiotropy residual sum and outlier (MR-PRESSO). Results In reverse MR results, a genetic prediction of short TL was causally associated with a higher risk of periodontitis (IVW: odds ratio [OR]: 1.0601, 95% confidence interval [CI]: 1.0213 to 1.1002; P =0.0021) and other complementary MR methods. In the forward MR analysis, periodontitis was shown to have no significant effect on TL (IVW: p = 0.7242), with consistent results for the remaining complementary MR. No pleiotropy was detected in sensitivity analysis (all P>0.05). Conclusion Our MR studies showed a reverse causal relationship, with shorten TL being linked to a higher risk of periodontitis, rather than periodontitis shorten that TL. Future research is needed to investigate the relationship between cell senescence and the disease.

BackgroundWhether there is an association between TFAs and periodontitis is unclear. The purpose of this study was to investigate the relationship between moderate/severe periodontitis and plasma level of elaidic acid, a major trans-fatty acid component, in American adults.MethodsThe National Health and Nutrition Examination Survey (NHANES) years 2009–2010 were used to screen a total of 1,610 people. The independent variable of interest is plasma elaidic acid level, the dependent variable is periodontitis, and the covariates include socio-demographic variables, lifestyle variables, systemic diseases, etc. The distribution of variables in the covariate differences between the different independent groups according to tertile was investigated using a multiple linear regression model. To examine the association between plasma elaidic acid levels and moderate/severe periodontitis, three models were used.ResultsMultiple logistic regression analysis showed a significant association between plasma elaidic acid level and moderate/severe periodontitis after adjustment for potential confounders (OR = 1.021, 95%CI: 1.004–1.039, P = 0.01394). Subjects with the highest tertile of plasma elaidic acid levels were 51.9% more likely to have periodontitis compared with subjects with the lowest tertile of plasma elaidic acid levels (OR = 1.519, 95% CI: 1.136–2.030, P = 0.00477). No possible sources of heterogeneity were identified in the subgroup analyses.ConclusionPlasma elaidic acid levels are associated with periodontal disease in American adults.

PURPOSE:To assess the effect of nongrafted and grafted materials on transalveolar sinus floor elevation (TSFE) with implant placement.MATERIALS AND METHODS:Relevant studies published between January 1, 1994, and July 31, 2021, were selected by searching Embase, PubMed/MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials. The study subjects were restricted to humans, and the language was limited to English. The study was confined to randomized controlled trials, controlled clinical trials, and observational studies (prospective and retrospective cohort) related to TSFE with and without bone-grafting materials. Two reviewers independently extracted study data and conducted quality assessments according to the Cochrane handbook and NOS scale. RevMan 5.3 and Stata 15.1 software were then used to analyze the research data that met the inclusion criteria.RESULTS:A total of nine articles were included, including 421 implants in the graft group and 502 implants in the nongraft group. Meta-analysis showed that there was no significant difference in the implant failure rate (RR = 1.03, 95% CI: 1.00, 1.06, P = .08) or marginal bone loss (SMD = 0.06, 95% CI: -0.23, -0.35, P = .69) between implants with and without graft materials after TSFE. The amount of endosinus bone gain in the nongraft group was significantly lower than that in the graft group (SMD = -1.07, 95% CI: -1.73: -0.41, P = .0001).CONCLUSION:TSFE in implants with or without grafting can achieve similar results, but there may be more bone gain in TSFE with grafting.

目的:目前临床上关于上颌窦提升的同时是否使用植骨材料的观点尚未达成共识,仍存在争议.为此,文章对穿牙槽嵴顶上颌窦底提升术并同期植入种植体,使用和不使用骨移植材料的临床疗效进行对比分析.方法:通过计算机检索中国知网、万方、维普、CBM、Embase、PubMed、Web of Science和Cochrane图书馆数据库中所有公开发表的国内外有关穿牙槽嵴顶上颌窦提升术后与使用骨移植材料有关的临床研究.最终由2位评价员按照Cochrane手册和NOS量表进行文献质量评价后,应用RevMan 5.3软件及Stata 15.1软件对最终符合纳入标准的研究数据进行Meta分析.结果:①最终共纳入11篇文献,有6篇为随机对照试验,剩余5篇为前瞻性队列研究,共包括994枚种植体,其中植骨组399枚,不植骨组595枚;②Meta分析结果显示:上颌窦内提升术同期植入种植体使用与不使用骨移植材料两者的术后种植体失败率(RR=0.57,95％CI:0.28-1.18,P=0.13)及种植体周围骨吸收量(SMD=0.03,95％CI:-0.23-0.29,P=0.80)差异均无显著性意义;不植骨组黏膜穿孔风险要低于植骨组(RR=0.33,95％CI:0.12-0.96,P=0.04);但是不植骨组日后上颌窦内新骨形成量明显低于植骨组(SMD=-0.89,95％CI:-1.08至-0.70,P<0.05).结论:上颌窦内提升同期植入种植体植骨与不植骨均可以获得可预期效果,两组在种植体失败率、种植体周围骨吸收量方面两组无显著差异,植骨组可以获得更多的新骨量,但是植骨组黏膜穿孔率高于不植骨组.因此临床中选择上颌窦内提升同期植入种植体不使用骨移植材料具有更多优点,且安全性较高.但由于文章纳入的研究质量限制,尚有许多不足之处,期待未来能有更多具有高质量水平的随机对照试验,在多中心、大样本的分析下得出更可靠的结论.

背景:对种植体表面进行药物涂层可显著提高种植体周围骨结合形成,降低种植修复难度.目的:综述不同药物涂层对种植体骨结合的影响.方法:由第一作者应用计算机以"implant,osseointegration,surface coatings,systemic drugs,carrier"为英文检索词,以"种植体,骨结合,涂层,系统性药物,载体"为中文检索词,应用计算机检索PubMed、维普、万方、知网数据库中1986年1月至2020年7月已发表的相关文献,并进行筛选、归纳与总结,最终纳入67篇相关文献进行综述.结果 与结论:种植体表面药物涂层经载体局部释放后对种植体骨结合均有一定促进作用,显著提高了种植体与骨组织结合强度及种植体的成功率和最大负荷,尤其减少了骨质疏松症所带来的种植失败发生率.而目前要将这种新型涂层技术大量应用于临床还亟需深入探讨载体材料与药物结合的牢靠性、药物的释放量与释放率难以控制,局部靶组织初始缓释浓度高以及种植体植入机体后的生物相容性、长期稳定性等问题.因此,面对复杂的口腔微环境,以及患者身体状况诸多因素的影响,还有待后期进一步在临床试验中逐一验证,从而发挥药物涂层技术在口腔种植领域方面的积极作用.

马凡综合征(marfan syndrome,MFS)是常染色体显性遗传的结缔组织疾病,由微纤维蛋白1基因突变引起,突变类型多,表型差异大,临床诊断困难.主要造成眼部、骨骼及心血管系统异常.而口腔颌面部异常表现可帮助口腔医生在早期发现马凡综合征.本文就该病的发病机制、口腔颌面部临床表现、诊断及治疗作一综述.

背景:目前对种植体根尖周病变的认识尚不充分.目的:结合最新的与种植体根尖周病变临床症状、致病因素及治疗方法相关的研究动态,对种植体根尖病变的病因机制及治疗方法的研究进展作一综述.方法:由第一作者应用计算机以“apical peri-implantitis,retrograde peri-implantitis,dental implant,implants periapical lesion”为英文检索词,以“根尖性种植体周围炎,逆行性种植体周围炎,口腔种植体,种植体根尖病变”为中文检索词,检索PubMed、维普、万方、知网数据库中1985年1月至2019年11月已发表的相关文献,对种植体根尖病变的病因、临床表现、治疗方案等进行归纳与总结.结果 与结论:种植体根尖病变可能是由感染、骨灼热、骨质量差、全身及局部因素等引起,临床表现为种植体根尖周围区域黏膜颜色发红、肿胀或形成瘘道、按压有疼痛,影像学显示种植体根尖周围区域低密度放射暗影.治疗方法主要包括邻牙根管治疗、外科清创、种植体根尖切除、引导性骨组织再生及全身应用抗生素等.因此,熟悉掌握种植体根尖病变的相关病因和治疗方法,可为临床中种植体根尖病变的预防和治疗提供积极的指导作用.

背景:牙种植区域的牙槽骨骨量不足增加了种植手术难度,植骨材料的出现成功解决了此类难题.在所有单一植骨材料中,异种煅烧骨被广泛用于治疗骨缺损,但单独使用煅烧骨时仍然存在一些缺点.目的:结合最新的相关研究动态,对异种煅烧骨材料修复骨缺损的相关研究进展作以综述.方法:第一作者以“calcined bone,xenogeneic bone,bone augmentation,bone substitute”为英文检索词,以“煅烧骨、异种骨、骨增量、骨替代材料”为中文检索词,应用计算机检索PubMed、维普、万方、知网数据库中1986年1月至2019年11月己发表的相关文献,并进行筛选、归纳与总结,最终纳入69篇相关文献进行综述.结果 与结论:在所有骨移植材料中,异种煅烧骨的结构与人类骨骼相似,具有良好的互连孔性,便于血管因子和骨原细胞进入,为新骨形成提供了通道和支架作用,同时具有良好的生物相容性及一定的降解作用,受到临床医生们的青睐.但其本身仍然存在溶解度较低、吸收缓慢、机械性能较差等不足,这就促使研究者们研发出将煅烧骨与陶瓷、聚合物、骨诱导因子及金属离子等其他材料复合,发挥出所参与材料的优点,从而使复合材料成为骨增量材料的首选.

背景:目前唑来膦酸虽能有效地预防绝经后妇女的骨丢失,但其对下颌骨的影响及其机制尚不清楚.目的:观察去势大鼠经低剂量唑来膦酸作用后下颌骨组织病理学改变,探讨RANKL/RANK/OPG信号系统在唑来膦酸抑制骨吸收过程中的调控效应与机制.方法:取36只雌性SD大鼠随机分为对照组、模型组和治疗组,后2组大鼠行两侧卵巢切除术,建立骨质疏松模型;对照组行假手术去除同等质量卵巢周围的脂肪.去卵巢3个月后,治疗组皮下一次性注射唑来膦酸20 μg/kg,对照组和模型组皮下注射相应剂量的盐水;用药1周后拔除大鼠左侧下颌磨牙,拔牙后4周麻醉动物取出拔牙侧下颌骨组织.通过影像学X射线大致观察大鼠拔牙窝剩余牙槽骨状况,苏木精-伊红染色检测下颌骨皮质和骨松质的病理结构改变,TUNEL凋亡实验检测凋亡的成骨细胞数量,利用免疫组织化学技术检测下颌牙槽骨内细胞核因子κB受体活化因子配基(RANKL)、骨保护素、细胞核转录因子(NF-κB)的表达情况,最后Western blot检测核因子κB受体活化因子配基、细胞核转录因子蛋白的表达.结果 与结论:①拔牙4周后,治疗组相较模型组牙槽骨骨吸收减少,拔牙窝底有新骨形成;②苏木精-伊红染色可见,模型组的骨皮质变薄,骨小梁结构变细,甚至出现断裂,大量骨吸收陷窝,成骨细胞较少;治疗组骨皮质增厚,骨小梁结构正常,只有少量骨吸收陷窝,成骨细胞增多;③治疗组的成骨细胞凋亡数目显著低于模型组(P＜0.001);④免疫组织化学染色可见,治疗组RANKL蛋白、NF-KB p65蛋白表达显著低于模型组(P＜ 0.001,P＜0.002),骨保护素蛋白表达显著高于模型组(P＜ 0.001);⑤Western Blot结果显示,与对照组相比较,模型组的RANKL、NF-κB蛋白高表达,治疗组其表达量显著降低(均P＜0.001);⑥结果说明,唑来膦酸可通过下调细胞核转录因子信号通路抑制破骨细胞的分化,同时调控成骨细胞的凋亡.

背景:课题组前期研究已经证实煅烧骨/壳聚糖复合材料的微观结构与自然骨组织相似,安全无毒,抗压强度良好,并且能够促进成骨细胞的增殖及黏附,因此继续研究其对骨髓间充质干细胞成骨分化的作用具有重要意义.目的:探讨煅烧骨/壳聚糖复合材料对骨髓间充质干细胞成骨分化的影响.方法:将煅烧骨/壳聚糖复合材料与SD大鼠骨髓间充质干细胞体外共培养并进行成骨诱导,成骨诱导1,2,3周时,采用实时荧光定量PCR检测成骨分化相关基因的表达.结果与结论:煅烧骨/壳聚糖复合材料能促进骨髓间充质干细胞的增殖黏附,并促进成骨相关基因碱性磷酸酶、Ⅰ型胶原、骨钙素的表达,具有诱导骨髓间充质干细胞成骨分化的作用.

背景:壳聚糖具备优异的理化性能与良好的生物相容性,但其缺乏骨结合的生物活性,需要与其他材料复合用于骨组织修复中.目的:将煅烧骨与壳聚糖复合,分析其理化性能和细胞毒性.方法:采用溶液共混法制备煅烧骨与壳聚糖质量比分别为1/2、1/1、2/1的复合材料,表征3种复合材料的理化性能.在第5代小鼠成纤维细胞L929中分别加入3种复合材料浸提液,CCK-8法检测复合材料的细胞毒性.结果 与结论:①X射线衍射和红外光谱显示,3种复合材料的主要成分均为羟基磷灰石与β-磷酸三钙,并且随着煅烧骨比例的增加,复合材料中的羟基磷灰石/β-磷酸三钙的特征衍射峰逐渐增强;②扫描电镜显示,煅烧骨颗粒较均匀地分散于壳聚糖介质中;③随着煅烧骨比例的增加,复合材料的抗压强度逐渐降低;④培养7d时,3种复合材料浸提液中的细胞生长良好,形态无明显变化;培养9d的时间内,3种复合材料浸提液中的细胞相对增殖率均在90％以上,细胞毒性均为1级,符合生物材料的安全标准;⑤结果表明,煅烧骨/壳聚糖复合材料具备良好的结构特征、理化性能及合适的抗压强度,并且安全无毒.

BACKGROUND: Insufficient bone mass in the posterior maxilla region often increases the difficulty of dental implantation. The application of maxillary sinus floor elevation successfully solves this problem. In the surgery bone grafting can be used to obtain sufficient bone mass. However, nonuse of graft materials can shorten the cycle of patient's treatment and reduce trauma and cost. OBJECTIVE: Combining the latest relevant research trends, to review the advances in the study of maxillary sinus floor elevation with and without bone grafting. METHODS: The first author searched PubMed, VIP, WanFang and CNKI databases using computer for relevant articles published from January 1985 to August 2018. The key words were "dental implant, maxillary sinus, bone augmentation, bone substitute" in English and Chinese, respectively. Finally, 78 articles were included in result analysis after screening and summarizing. RESULTS AND CONCLUSION: Ideal results can be achieved in the maxillary sinus floor elevation with or without simultaneous bone grafting In addition, the nonuse of grafting materials have the advantages of simplifying surgical procedures, shortening treatment cycles, reducing trauma and pain, reducing treatment costs, reducing complications and failure rates, thus gaining the favor of doctors and patients. Therefore, the maxillary sinus floor elevation without simultaneous bone grafting will be the primary choice of the doctors engaged in dental implantation in the future.

It is well known that extensive osteoclast formation plays a key role in osteoporosis in post-menopausal women and the elderly. The suppression of extensive osteoclastogenesis and bone resorption may be an effective preventive strategy for osteoporosis. Zoledronic acid (ZOL) has been indicated to play an essential role in regulating bone mineral density and has already been used in large clinical trials. However, the effects of ZOL on osteoclastogenesis remain to be fully elucidated. Therefore, the present study aimed to determine the effects of ZOL on osteoclastogenesis, and to explore the corresponding signalling pathways. By using a cell viability assay, as well as in vitro osteoclastogenesis, immunofluorescence and resorption pit assays, we demonstrated that ZOL (0.1-5 mu M) suppressed receptor activator of nuclear factor-kappa B ligand (RANKL)-induced osteoclast differentiation and bone resorptive activity. Furthermore, western blot analysis and reverse transcription-quantitative PCR indicated that ZOL inhibited the RANKL-induced activation of NF-kappa B and the phosphorylation of JNK in RAW264.7 cells, and subsequently decreased the expression of osteoclastogenesis-associated genes, including calcitonin receptor, tartrate-resistant acid phosphatase and dendritic cell-specific transmembrane protein. ZOL inhibited osteoclast formation and resorption in vitro by specifically suppressing NF-kappa B and JNK signalling. On the whole, the findings of this study indicate that ZOL may serve as a potential agent for the treatment of osteoclast-associated diseases, including osteoporosis.

上颌前牙美学区因外伤而导致恒牙缺失的病例较为常见,缺牙区因长时间缺少功能性刺激而发生牙槽骨的吸收,造成缺牙区牙槽骨唇舌向宽度缩窄,软组织塌陷,严重的软硬组织量不足使种植美学修复面临巨大的挑战.目前临床中已有多种修复技术用以改善前牙区软硬组织不足造成的美学缺陷,包括引导骨再生技术[1]、使用牙龈颜色的丙烯酸树脂、在修复体颈部加龈瓷[2]等.现将1例上颌中切牙缺失通过种植体植入术同期GBR后利用个性化全瓷基台修复病例报告如下.

前牙缺损是口腔中较为常见的疾病,由于前牙位置的特殊性,前牙的缺失不仅会导致咀嚼功能受到影响,还会对患者的美观产生较大的影响,因此,上前牙缺失后患者的修复愿望是较为强烈的;而种植修复作为一种修复缺失牙的方式,其具有不损伤邻牙、舒适美观、咀嚼效率高的优点,已经成为一种修复缺失牙的理想方式.同时,在修复的过程中,除了关注牙齿本身的修复之外,牙齿周围组织如牙龈等软组织的红色美学修复也是需要注意的,逼真自然的牙齿和良好美观牙龈形态才能带给患者满意的修复效果.现将1例上颌切牙缺失后种植修复缺失牙并通过个性化基台恢复牙龈形态的病例报告如下.