Doctor 2/2018

2-2018 Visit Infodent International at SINODENTAL 9-12 June 2018 Booth X67

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DOCTOR牙医 Infodent International •1 2018

ImplantBook 2018 Dealers e Dentists: Download your copy from www.implant-book.com to discover new brands and products

Manufacturers: Learn more about ImplantBook on www.implant-book.com to reach your next partner

The ultimate global guide 2017

The ultimate global guide 2018 DENTAL IMPLANTS

Iris View

OSSEOINTEGRATION &BIOMATERIALS

Polaris

AROUND IMPLANTOLOGY

Nuvolina

3D PRINTERS

The best lights, for the best implants.

EQUIPMENT PIEZOSURGERY

www.gcomm-online.com

SOFTWARE RADIOLOGY CONGRESSES

Gcomm Cover DEF.indd 1

Topic: Dental Implants pag. 9 - 65

Topic: Equipment & Supplies for Dental Implants pag. 81 - 98

Topic: Software pag. 117 - 125

21/12/16 11:45

COMPANY LIST

implant-book.com

implant-book.com

代理商，牙医:下载ImplantBook 2018完整 版免费从 www.implant-book.com, 以便找到新品牌和产品

制造商: 点击www.implant-book.com 了解更多 ImplantBook杂志, 以通达您的业务合作伙伴

The Chapters: Dental Implants, Osseointegration & Biomaterials, Around Implantology, Congresses, Company List For more, please write to prc@infodent.com | 如需了解更多信息，请发送电子邮件到 prc@infodent.com

Technology that innovates Skema 6 combines the best of Castellini technology with the practicality and effectiveness of multiple integrated systems. Ample scope for personalisation ensures the achievement of outstanding clinical and specialist performance via a precise, interactive control panel, available as a Full Touch version with a 5.7” glass display.

Cutting-edge configuration is completed via the availability of highly advanced dynamic instruments, an innovative multimedia system, all the main certified hygiene devices and the latest exclusive functions from Castellini.

SINODENTAL · 9-12 June 2018

Booth D61-D66 China National Convention Centre (CNCC) · No. 7, Tianchen East Road, Chaoyang District, Beijing, P. R. China

卡斯特里尼

CONTENTS 目录

Editorial

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新闻评论

Press Review

China, still a land of opportunity 中国，依然是那片充满了机会的土地

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Highlights

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22 Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report 三氧化矿物骨料在治疗根尖开口并伴有牙周内切 病变恒牙中的应用 一个病例报告

6 安福士 L9 侧递式 ANTHOS Classe L9 Side Delivery 7 公理福V286 – 一生好伙伴 Victor V286 a lifetime partner

30 Marginal bone level around conical connection tapered implants with platform switching: A multicenter retrospective study at 14 months follow-up 具有平台转换装置的锥形种植体周围的边缘骨水 平：一个随访了14个月的多诊所合作回顾性研究

与卡斯特里尼(CASTELLINI) 一同触摸未来 Touch the future with Castellini 8 赛特伟邦 STERN S320TR STERN WEBER Stern S320TR 9 迈锐(MYRAY) - 性能卓越、用户友好的解决方 案 MyRay, solutions which bring you performance and user-friendliness.

日历

Calendar

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infodent.com infodent@infodent.com

• CEO: Baldo Pipitone baldo.pipitone@infodent.com • General Manager: Paola Uvini paola@infodent.com • Editorial Director: Silvia Borriello infodent@infodent.com • Marketing Consulting Manager: Riccardo Bonati riccardo.bonati@infodent.com • Exhibition Manager: Alessia Murano alessia.murano@infodent.com • Newsroom: Nadia Coletta nadia@infodent.com Claudia Ragonesi pressoffice@infodent.com • Social: Ilaria Ceccariglia ilaria.ceccariglia@infodent.com • Graphic Dept.: Silvia Cruciani silvia.cruciani@infodent.com Lorenzo Burla lorenzo.burla@infodent.com • Account Dept.: Alessandra Mercuri alessandra.mercuri@infodent.com

12 Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance 阻生弯曲上切牙正畸中的直丝弓矫治器定位技巧

• Translator: Zhuoling Xiong 熊卓玲 renmei1@126.com - Tel: +39 331 2507669 Publishing House: Infodent S.r.l.

Str. Cassia Nord Km 86,300 01100 Viterbo - Italy Tel: +39 0761 352 198 Fax: +39 0761 352 133 VAT 01612570562 Printer: 宁波市镇海印颂电子商务有限公司 No.1 Qiujing Road, Shiqi town, Yinzhou District, Ningbo, Zhejiang, China. +86 0574 8658 2081 n°2/2018 - aut. trib. VT n°528 del 21-07-2004 Doctor by Infodent International is the title of this magazine as well as an applied for trademark. Any use there of without the publisher’s authorization is to be deemed illegal and shall be prosecuted.

Trade Shows and Conferences for Dental Practitioners 牙科技术会议及展览会

Cover page: My Ray (Cefla Group) Via Bicocca, 14/C I-40026 Imola (BO) - Italy imaging@my-ray.com +39 0542 653441

Anthos.....................................................................................................................p. 25 Castellini..................................................................................................................p. 2 CEDE 2018.......................................................................................................p. 42 Dentag....................................................................................................................p. 29 Dental World Hungary.........................................................................III Cover DenTech China 2018............................................................................II Cover FDI World Dental Congress 2018....................................................p. 41 IDEA 2018.........................................................................................................p. 47 ImplantBook..........................................................................................................p. 1 Maco International.......................................................................Back Cover Sidex 2018..........................................................................................................p. 4 Stern Weber.......................................................................................................p. 35 Suzhou Victor Medical Equipment..................................................p. 10

The ultimate global guide 2017

DOCTOR牙医 Infodent International •2 2018

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EDITORIAL Doctor by Infodent International: The Best Of In this latest Doctor by Infodent International edition we decided to propose some of our very popular and most wanted scientific articles again, to satisfy the requirements of most of our readers to have a “very best of” of our magazine to read during Sinodental trade show.

The first article was published in Doctor by Infodent International 1/2016: this orthodontic article has been written by D. Celli., A. L. Grego, S. Sferra and R. Deli from Catholic University of Sacred Heart, Rome (Italy) and its topic is “Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance”. The aim of this article is to describe the orthodontic management of root dilaceration of an impacted maxillary tooth following trauma to its deciduous predecessors, to show the clinical management of root dilaceration of a maxillary central incisor and describe how the dilacerated tooth was successfully moved into alignment in a young patient with a proper multidisciplinary approach, using the simple and effective straightwire technique.

The second one concerns endo-perio diseases, mineral trioxide aggregate and open apex. “Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report” has been published in Doctor by Infodent International 2/2016 - China Dental Show (CDS) edition.

This article describes the successful therapy of immature mandibular premolars with large open apex, resorption, and endo-perio lesions. In the presented case, the canal was filled with the MTA material. At present, the treated tooth is asymptomatic, and a three-year follow-up radiographic examination demonstrated the dramatic regeneration of periradicular tissues and the new hard tissue formation in the area of the affected teeth.

The last article “Marginal bone level around conical connection tapered implants with platform switching: A multicenter retrospective study at 14 months follow-up” was issued on Doctor by Infodent International 2/2016 – DenTech China edition. The article key words are bone loss, conical connection, platfom switching and tapered implants and its authors are J. Ekstein, M. Tandelich, J. Nart, J.L. Calvo Guirado and L. Shapira.

The long-term success of dental implants mainly depends on marginal bone stability around the fixtures. The development of prosthetic abutments with reduced width in relation to the implant prosthetic platform (platform switching) and/or tighter implant/abutment connections seem to have a potential in reducing crestal bone resorption.

The aim of the present study was to examine the effect of platform switching and conical connection design, on marginal bone loss around newly designed dental implants.

Results showed that one hundred and twelve conical tapered platform-switched implants were placed in three different centers in 37 patients, with mean age of 53 years. The survival rate was 100% after an average follow-up of 14 months. During the first year, marginal bone loss was 0.67±0.45mm. No statistically significant differences were recorded between the different centers.

牙医杂志集锦 在这个最新的牙医杂志版本中，我们决定再次提出一些我们 非常受欢迎和最受欢迎的科学文章, 以满足大多数读者的要 求，让我们的杂志的“最好的”在Sinodental展览期间阅读。 第一篇文章发表在牙医杂志1/2016: 这篇齿列矫正文章的作 者是D. Celli, A. L. Grego, S. Sferra 及 R. Deli (意大利罗马圣 心天主教大学), 题目是“阻生弯曲上切牙正畸中的直丝弓矫 治器定位技巧”。 目的：描述由于前乳牙创伤而引起的上颌切牙阻生弯曲的正 畸操作方案，展示上中切牙牙根弯曲的临床操作，叙述如何 通过合适的多学科方法用一个最简单而有效的直丝弓技术把 一个年幼患者的弯曲牙成功地移到对齐于牙列的位置。 第二篇文章关于内切牙周疾病，三氧化矿物骨料，根尖开 口。“三氧化矿物骨料在治疗根尖开口并伴有牙周内切病变 恒牙中的应用一个病例报告”在牙医杂志2/2016 - 中国国际 口腔设备器材博览会(CDS)版已经出版。本文介绍一个有先 尖开口大、再吸收、内切牙周病变的未成熟下前磨牙的成 功 治疗案例，在这个案例中，病变牙根管中填充了MTA材 料。目前，被治疗的牙显示出无症状，并且通过三年的随 访放射检查证明了在受影响牙的区域中产生了显著的根尖 周组织再生和硬组织新生迹象。 最后的文章 “具有平台转换装置的锥形种植体周围的边缘骨 水平：一个随访了14个月的多诊所合作回顾性研究摘要” 在 牙医杂志2/2016 - 第二十一届中国国际口腔器材展览会暨学 术研讨会 (DenTech China) 版已经出版。牙科种植体要获得 长期的成功，主要取决于种植体周围边缘骨的稳定性，义 齿基台相对种植体平台（平台转换）缩窄和/或加紧种植体 和基台的连接，似乎对减小牙槽骨的吸收有潜在的作用。 本次研究的目的在于分析平台转换和锥形链接设计对最新 设计的种植体周围边缘骨流失情况的影响。结果112个锥形 平台转换连接种植体被植入三个中心的37个患者口腔内， 患者平均年龄为53岁。平均随访14个月后，种植体的成活 率为100%。在第1年中边缘骨的流失量为0.67±0.45mm。 三 个不同中心的受试者记录之间没有明显的统计学差异。

DOCTOR牙医 Infodent International •2 2018

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highlights

ANTHOS

Classe L9 Side Delivery Top-of-the-range Classe L9 floor-fixed treatment centre features the latest evolution of the Full Touch control panel, a new patient chair, and can fit the complete range of hygiene devices and the full multimedia system with the new HD camera. Highly compact, the Classe L9 will fit any surgery and adapt to most every operating style. Classe L9 puts patients who prefer to settle into the patient chair without seeing the instruments at their ease. Full freedom of movement and unlimited space allow for unobstructed workflows where dentist and team can operate unhindered, confidently and professionally.

赛特伟邦 （STERN WEBER） 安福士 L9 侧递式 STERN S320TR 顶级的安福士L9落地式治疗台具有一系列的最新革命性科 技装备，触摸式控制面板、新型病人椅，全能消毒装置以 及整合新HD内窥镜的多媒体系统。高度紧凑的空间使L9 适用于任何外科治疗和日常诊疗。由于看不到器械，当患 者坐入L9病人椅后会感到非常舒适轻松。自由的移动及无 拘束的工作空间带来畅快的操作流程，医生及其团队均可 无阻碍、自信且专业地进行治疗。 www.anthos.com

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。 A级系列 完整的A级系列口腔综合治疗台的设计宗旨是尽可 能提供最大的灵活性，使牙医可以选择最适合其 操作风格和专业需求的人体工学和功能设置。 A5级可提供6种不同的配置。 适合各种操作风格的 人体工学，整合的安福士品牌器械，脚控和手术 灯的扩展性选择，不同的卫生学系统、可选配置 和颜色主题，从每个方面讲都具有多样的变化。 选择 A7 +级的牙医知道他们可以根据当前和未 来的特殊需求对其口腔综合治疗台进行个性化定 制，无论他们的专业领域属于常规牙科还是种植 科。鉴于搭载了向所有的可整合安福士设备开放 的基础技术配置接口，这款高端的治疗台可以在 现场或在未来与超高性能器械仪器、X-射线装 置、多媒体系统以及先进的卫生学设备相匹配， 达到扩展功能的目的。

基于分体落地式的主体特征，S320TR在保证患者椅 运行的独立性同时，依然具备极高的稳定性和充分的 治疗操作空间。作为来自意大利的最新型号款式，牙 医在诊断上能够获得崭新的操作体验。 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 符合人体工程学结构以及自身出色的性能），TR系列 最大限度的为您提供前所未有的丰富的新的机遇。 医生位的良好机动性保证了此种操作风格的完美定 位性和移动操作的优化流畅性。医生位采用铸铝支架 臂，具备出色的稳定性，再加上通过按键操作进行高 度调节，可以让牙科医生从容而安心的工作。由于采 用了最新的数码电子科技，使得S320TR给牙科医生 们带来了最好的操作体验。

www.anthos.com

sternweber.com

ANTHOS. THE BRAND WITH LIMITLESS SOLUTIONS FOR DENTISTS ALL AROUND THE WORLD. The Classe A range Developed to provide as much flexibility as possible, the full Classe A range of units enables dentists to select the ergonomic and functional set-up best suited to their operating style and professional needs.

Classe A5 can be supplied in 6 different configurations. Ergonomics to suit every operating style, integrated Anthos brand instruments, an extensive choice of foot controls and operating

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lights, various hygiene systems, options and colour schemes: versatility in every sense of the word.

Dentists who choose Classe A7 Plus know they can personalise their dental unit according to the specific needs of today and tomorrow, whatever their field of specialization, from conservative dentistry to implantology. Thanks to the underlying technological configuration, open to all integrated Anthos systems, this premium treatment centre can be expanded, immediately or at a later date, with ultra-high performance instruments, X-ray and multimedia systems, and advanced hygiene devices.

DOCTOR牙医 Infodent International •1 2018 6 Doctor DOCTOR 牙医 Infodent International •2 2018 Os 牙医 Infodent International •3/2017

STERN WEBER Stern S320TR Characterised by a floor-mounted unit body, which remains independent from the patient chair and its movements, the S320TR models provide stability and extensive operating space. This latest model from the Italian brand lets dentists explore new capabilities within the diagnostic field.

By taking the guiding principles behind Stern Weber’s advanced dental unit development program – sturdiness, compactness, user-friendliness, ergonomics and performance – the TR Series maximises them as never before

so as to provide you with a wealth of new opportunities.

Excellent manoeuvrability of the dentist’s module ensures perfect positioning and optimises fluidity of the movements associated with this operating style. The outstanding stability of the dentist’s module and its cast aluminium support arm, coupled with a telescopic height adjustment function operated via the keypad, allows the dentist to work calmly and confidently. Thanks to the latest digital electronics, the S320TR brings out the dentist’s very best. sternweber.com

highlights

VICTOR V286 – a lifetime partner

迈锐(MYRAY) - 性能卓越、 用户友好的解决方案。

作者投稿指南

赛特伟邦 （STERN WEBER） STERN S320TR

Built with premium quality materials for lasting service and superb reliability, the V286 boasts cast aluminium structural elements for increased stability and injection moulded plastics to provide an excellent surface finish.

Developed and engineered in Europe, the latest treatment centre in the 迈锐Hyperion X9 体现了一种模块化概念，覆 Victor range not only seduces from a design point of view, but can also 盖了从 2D 全景成像、头影测量到具有真正 count on the latest solutions in terms of ergonomics and space-efficiency. 的全颌弓容积扫描范围的3D 锥形束立体断层 Advanced electronics allow extensive personalisation for up to 5 diffe的所有拍摄功能。 rent operators. Synchronised patient chair movements (lift capacity can 迈锐Hyperion 通过全局的360°扫描进行 reach up to 190 kg)X9 enable maximum comfort and soft upholstery is an 容积采集，可以有效消除所得图像中的伪 attractive option.The unit can be fitted with up to 4 dynamic instruments, 影。它可以在极低的X-射线剂量下实现高分 including the high-performance brushless micromotor manufactured in 辨率成像，从而提供超凡的图像质量、精致 Italy.

Dentists can select operating parameters and visualise key settings on the的细节呈现以及即时的诊断结果。 new, large 3-digit LCD control panel.The LCD display provides details MyRay, solutions which 11 cm FOV, but it can also be 的扫描视野宽度为Ø 11厘 of 迈锐Hyperion operating status X9 and includes a self-diagnostic system. bring you performance equipped with a large image and user-friendliness. detector, 8 cm high and extend米，它可以配备大号图像传感器器提供检测 able to 13 cm, or a small version 区高度8厘米（可扩展到13厘米）的视野；也 Hyperion X9 is a modular conthat limits the height of the ex公理福V286 – 一生好伙伴 cept which covers all aspects amined region to 5 cm, extend可提供较小版本的传感器器，提供检测区高 from 2D panoramic imaging, able to 8 cm. 度5厘米（可扩展到8厘米）的视野。 精心挑选优质材料保证持久运行及超凡的可靠性，V286采用铸 through cephalometric配，体现奢华。治疗台可以配备4组可动器械，包括意大利原装 exams up The software processes all types to cone beam 3D with true full of acquired data, including 3D 其软件可在不到1分钟内处理所有采集数据 进口的高性能无碳刷电动马达。口腔医生可以通过带有新款三 铝结构部件来增加稳定性，和注塑塑料工艺来提供出色的表面 arch volumetric scan capability. data, in less than a minute. The 并完成重建，包括3D数据。X9所提供图像信 Hyperion X9 performs a voluquantity and quality of the in位液晶数字屏幕的控制面板调整及观察参数和设置。液晶面板 处理。作为最新款的公理福口腔综合治疗台，结合了美观设计 metric acquisition with a full 360° formation X9 provides and the 息的数量、质量以及管理这些数据的便捷方 与最新人体工学及空间利用理念的V286在欧洲开发并完成工程 scan capable of eliminating the simple way you can manage that 可以显示操作状态的细节，并进行自我诊断。 式有助于进行更高效的诊断，并为达到有效 artefacts of the resulting image. data makes for a clearer diagnosis 学测试。高级的电子电路允许最多5位不同操作者的个性化设 High resolution at extremely low and helps effective planning, ready 治疗进行有效的规划。 X-ray doses: excellentMore quality, finfor efficient treatment. details on www.victordentalequipment.com 置。最新的具有同步功能的病人椅（最大可以提升190公斤的 est details, immediate diagnosis. www.my-ray.com A级系列 www.victordentalequipment.com 重量）可确保患者的最佳舒适度，也有柔软的沙发皮垫可供选 Hyperion X9 scans 更多信息请详见 with a Ø www.my-ray.com

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。

完整的A级系列口腔综合治疗台的设计宗旨是尽可 能提供最大的灵活性，使牙医可以选择最适合其 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 运行的独立性同时，依然具备极高的稳定性和充分的 与卡斯特里尼(CASTELLINI) A5级可提供6种不同的配置。 适合各种操作风格的 Skema 6 brings dentistry a step closer to the future, with a host of innova治疗操作空间。作为来自意大利的最新型号款式，牙 tive solutions enabling excellent hygiene, total control and enviable comfort, 人体工学，整合的安福士品牌器械，脚控和手术一同触摸未来 医在诊断上能够获得崭新的操作体验。 both for patients and medical staff. 灯的扩展性选择，不同的卫生学系统、可选配置 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 和颜色主题，从每个方面讲都具有多样的变化。 将公司80年的历史、创新精神及丰富的临 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 与卡斯特里尼(CASTELLINI)一同触摸未来 选择 A7 +级的牙医知道他们可以根据当前和未床专业经验熔于一体创造出一流的口腔综 符合人体工程学结构以及自身出色的性能），TR系列 6。 来的特殊需求对其口腔综合治疗台进行个性化定合治疗台Skema 最大限度的为您提供前所未有的丰富的新的机遇。 制，无论他们的专业领域属于常规牙科还是种植 将公司80年的历史、创新精神及丰富的临床专业经验熔于 医生位的良好机动性保证了此种操作风格的完美定 卡斯特里尼Skema 6，集高科技器械、触摸屏控制 科。鉴于搭载了向所有的可整合安福士设备开放界面和整合式的内建系统，可满足从牙体牙髓到 一体创造出一流的口腔综合治疗台Skema 6。 位性和移动操作的优化流畅性。医生位采用铸铝支架 的基础技术配置接口，这款高端的治疗台可以在种植等各专业口腔医生高品质临床需求的理想工 臂，具备出色的稳定性，再加上通过按键操作进行高 现场或在未来与超高性能器械仪器、X-射线装具。它还可以提供高端卫生消毒设备，经意大利 卡斯特里尼Skema 6，集高科技器械、触摸屏控制界面和整合 度调节，可以让牙科医生从容而安心的工作。由于采 大学测试认证有效，为医生提供舒适的符合人体 式的内建系统，可满足从牙体牙髓到种植等各专业口腔医生 置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 Touch the future with Castellini ably, enjoying total peace of mind. 工学的感控解决方案，使他们可以平静专注地对 Skema 6 is equipped with Implantor LED, 高品质临床需求的理想工具。它还可以提供高端卫生消毒设 们带来了最好的操作体验。 达到扩展功能的目的。 Eighty years of experience, innovation an extremely lightweight induction micro-

待患者。 Skema 6 装备的LED光纤种植电马达，其 备，经意大利大学测试认证有效，为医生提供舒适的符合人 sternweber.com 具有超轻的重量，高达5.3Ncm的扭矩，可耐全面 into a high-class unit: Skema 6.

5.3 Ncm, fully autoclavable and suitable for 体工学的感控解决方案，使他们可以平静专注地对待患者。 integrated endodontics and implantology. 高温高压灭菌，可用于包括根管及种植等临床应 Eighty ofwith experience, and clinical expertise Skema 6 装备的LED光纤种植电马达，其具有超轻的重量， Skema 6 years

by Castellini, its high-tech in- innovation Full Touch consolle, available as an optional, 用。本机还可以选配具有坚固的5.7英寸触摸屏用 STERN WEBER struments, touchscreen controls and inteso as to provide you with a wealth of features aSkema tempered glass display and 5.7” concentrated a high-class unit: 6.

ANTHOS. THEinto BRAND lights, various hygiene systems, options grated systems, offers dental professionals touchscreen interface. 高达5.3Ncm的扭矩，可耐全面高温高压灭菌，可用于包括 Stern S320TR new opportunities. 户界面的全触摸屏控制器。 WITH LIMITLESS and colour schemes: versatility in every the ideal tool for high-performance treat- Skema 6 brings dentistry a step closer to Excellent manoeuvrability of the den凭借高效的卫生学解决方案、全面操控体验以及 根管及种植等临床应用。本机还可以选配具有坚固的5.7英 SOLUTIONS FOR DENTISTS ofwith the aword. ment including conservative dentistry, end- thesense future, host of innovative soSkema 6 by Castellini, with its high-tech instruments, touchscreen controls and Characterised by a floor-mounted unit tist’s module ensures perfect positionodontics and implantology. advanced lutions enabling ALL AROUND THEThe WORLD. Dentists whoexcellent choose hygiene, Classe total A7 Plus令人羡慕的舒适度，无论医生及护士团队均可轻 寸触摸屏用户界面的全触摸屏控制器。 body, which remains independent from ing and optimises fluidity of the moveintegrated systems, professionals theenviable ideal tool for high-performanhygiene devices, fully offers certifieddental by leading control comfort, both know and they can personalise theirfordental松体会Skema6带领牙科界更进一步迈入未来。 the patient chair and its movements, ments associated with this operating Italian universities, together with a design patients and medical staff. 凭借高效的卫生学解决方案、全面操控体验以及令人羡慕 ce treatment including conservative dentistry, endodontics and implantology.

Touch theconcentrated future with and clinical expertise motor withCASTELLINI electronic torque control up to www.anthos.com

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Developed to provide as much flexibiltoday and tomorrow, whatever their to- 的舒适度，无论医生及护士团队均可轻松体会Skema6带领 The advanced devices, fully certified by leading Italian universities, tions, enables the hygiene dentist to work comfortcastellini.com castellini.com and extensive operating space. This latdentist’s module and its cast aluminium ity as possible, the full Classe A range field of specialization, from conservagether with a design which ensures functionally ergonomic solutions, enables the 牙科界更进一步迈入未来。 est model from the Italian brand lets support arm, coupled with a telescopic of units enables dentists to select the tive dentistry to implantology. Thanks dentists explore new capabilities height function operated 7 DOCTOR 牙医 Infodentwithin International •1 adjustment 2018 dentist to work comfortably, enjoying peace of mind.technological conergonomic and functional set-up best total to the underlying 1 the dentist to Doctorfield.

Os 牙医 Infodent International •3/2017 the diagnostic via the keypad, allows Skema is equipped with LED, anopen extremely lightweight suited to6their operating style andImplantor pro- figuration, to all integrated An- in- castellini.com By taking the guiding principles behind work calmly and confidently. Thanks fessional needs. systems, this premium duction micromotor with electronic thos torque control up to 5.3treatment Ncm, fully VISIT USWeber’s AT IDSadvanced 2017, HALL 11.1,toBOOTH B011 Stern dental unit the latestA010 digital / electronics, the Classe A5 canand be supplied differ- centre can be expanded, immediately autoclavable suitable infor6 integrated endodontics and implantology. development program – sturdiness, S320TR brings out the castellini.com 欢迎至IDS2017展会，HALL 11.1dentist’s very ent configurations. Ergonomics to suit or at a later date, with ultra-high percompactness, user-friendliness, ergobest.

Full Touch consolle, as an features a tempered display every operating style,available integrated An-optional, formance instruments, X-ray glass and mul馆，A010/B011展台 nomics and performance – the TR Seand touchscreen thos 5.7” brand instruments,interface. an extensive timedia systems, and advanced hygiene

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DOCTOR牙医 Infodent International •1 2018 Doctor Os 牙医 Infodent International •3/2017

DOCTOR牙医 Infodent International •2 2018

7

highlights

安福士 (ANTHOS) -向全世界牙 医提供无限解决方案的品牌。 STERN WEBER

赛特伟邦 （STERN WEBER） STERN S320TR 赛特伟邦 （STERN WEBER） STERN S320TR

赛特伟邦（STERN WEBER） STERN S320TR A级系列 完整的A级系列口腔综合治疗台的设计宗旨是尽可 STERN S320TR 能提供最大的灵活性，使牙医可以选择最适合其 Characterised by a floor-mounted unit body, which remains indepen- 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 dent from the patient chair and its movements, the S320TR models 运行的独立性同时，依然具备极高的稳定性和充分的 A5级可提供6种不同的配置。 适合各种操作风格的 provide stability and extensive operating space.This latest model from 治疗操作空间。作为来自意大利的最新型号款式，牙 the Italian brand lets dentists explore new capabilities within the dia人体工学，整合的安福士品牌器械，脚控和手术 医在诊断上能够获得崭新的操作体验。 gnostic field. 灯的扩展性选择，不同的卫生学系统、可选配置 By taking the guiding principles behind Stern Weber’s advanced dental 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 和颜色主题，从每个方面讲都具有多样的变化。 unit development program – sturdiness, compactness, user-friendli- 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 选择 +级的牙医知道他们可以根据当前和未 安福士 (ANTHOS) ness,A7 ergonomics and performance-向全世界牙 – the TR Series maximises them as 符合人体工程学结构以及自身出色的性能），TR系列 来的特殊需求对其口腔综合治疗台进行个性化定 never before so as to provide you with a wealth of new opportunities. 最大限度的为您提供前所未有的丰富的新的机遇。 医提供无限解决方案的品牌。 制，无论他们的专业领域属于常规牙科还是种植 医生位的良好机动性保证了此种操作风格的完美定 Excellent manoeuvrability of the dentist’s module ensures perfect 科。鉴于搭载了向所有的可整合安福士设备开放 位性和移动操作的优化流畅性。医生位采用铸铝支架 A级系列 positioning and optimises fluidity of the movements associated with 的基础技术配置接口，这款高端的治疗台可以在 完整的A级系列口腔综合治疗台的设计宗旨是尽可 this operating style. The outstanding stability of the dentist’s module 臂，具备出色的稳定性，再加上通过按键操作进行高 现场或在未来与超高性能器械仪器、X-射线装 安福士 (ANTHOS) -向全世界牙 能提供最大的灵活性，使牙医可以选择最适合其 and its cast aluminium support arm, coupled with a telescopic height 度调节，可以让牙科医生从容而安心的工作。由于采 置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 adjustment function operated via the keypad, allows the dentist to 基于分体落地式的主体特征，S320TR在保证患者椅 操作风格和专业需求的人体工学和功能设置。 医提供无限解决方案的品牌。 运行的独立性同时，依然具备极高的稳定性和充分的 work calmly and confidently.Thanks to the latest digital electronics, the 们带来了最好的操作体验。 达到扩展功能的目的。 A5级可提供6种不同的配置。 适合各种操作风格的 治疗操作空间。作为来自意大利的最新型号款式，牙 S320TR brings out the dentist’s very best. 人体工学，整合的安福士品牌器械，脚控和手术 www.anthos.com sternweber.com A级系列 医在诊断上能够获得崭新的操作体验。 www.sternweber.com 灯的扩展性选择，不同的卫生学系统、可选配置 完整的A级系列口腔综合治疗台的设计宗旨是尽可 赛特伟邦（Stern Weber）以持续开发先进的牙科设备 STERN WEBER so as to provide you with a wealth of 和颜色主题，从每个方面讲都具有多样的变化。 能提供最大的灵活性，使牙医可以选择最适合其 ANTHOS. THE BRAND lights, various hygiene systems, options 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 Stern S320TR new opportunities. 基于分体落地式的主体特征，S320TR在保证患者椅 WITH LIMITLESS and colour schemes: versatility in every 选择 A7 +级的牙医知道他们可以根据当前和未 操作风格和专业需求的人体工学和功能设置。 符合人体工程学结构以及自身出色的性能），TR系列 Excellent manoeuvrability of the denSOLUTIONS FOR DENTISTS sense of the word. 运行的独立性同时，依然具备极高的稳定性和充分的 Characterised by a floor-mounted unit tist’s module ensures perfect position来的特殊需求对其口腔综合治疗台进行个性化定 A5级可提供6种不同的配置。 适合各种操作风格的 最大限度的为您提供前所未有的丰富的新的机遇。 ALL AROUND THE WORLD. Dentists who choose Classe A7 Plus 治疗操作空间。作为来自意大利的最新型号款式，牙 body, which remains independent from ing and optimises fluidity of the moveknow they can personalise their dental 制，无论他们的专业领域属于常规牙科还是种植 人体工学，整合的安福士品牌器械，脚控和手术 医生位的良好机动性保证了此种操作风格的完美定 the 医在诊断上能够获得崭新的操作体验。 patient chair and its movements, ments associated with this operating The Classe A range unit according to the specific needs of the S320TR models provide stability style. The outstanding stability of the 科。鉴于搭载了向所有的可整合安福士设备开放 灯的扩展性选择，不同的卫生学系统、可选配置 位性和移动操作的优化流畅性。医生位采用铸铝支架 Developed to provide as much flexibil- today and tomorrow, whatever their and 赛特伟邦（Stern extensive operating space.Weber）以持续开发先进的牙科设备 This latdentist’s module and its cast aluminium ity as possible, the full Classe A range field of specialization, from conserva的基础技术配置接口，这款高端的治疗台可以在 臂，具备出色的稳定性，再加上通过按键操作进行高 和颜色主题，从每个方面讲都具有多样的变化。 est 为基本指导原则（秉持-坚固、紧凑、操作友好方便、 model from the Italian brand lets support arm, coupled with a telescopic of units enables dentists to select the tive dentistry to implantology. Thanks dentists explore new capabilities within height adjustment function operated 现场或在未来与超高性能器械仪器、X-射线装 度调节，可以让牙科医生从容而安心的工作。由于采 选择 andA7 +级的牙医知道他们可以根据当前和未 ergonomic functional set-up best to the underlying technological conthe 符合人体工程学结构以及自身出色的性能），TR系列 diagnostic field. via the keypad, allows the dentist to suited to their operating style and pro- figuration, open to all integrated An置、多媒体系统以及先进的卫生学设备相匹配， 用了最新的数码电子科技，使得S320TR给牙科医生 来的特殊需求对其口腔综合治疗台进行个性化定 By taking the guiding principles behind work calmly and confidently. Thanks 最大限度的为您提供前所未有的丰富的新的机遇。 fessional needs. thos systems, this premium treatment Stern Weber’s advanced dental unit to the latest digital electronics, the 们带来了最好的操作体验。 达到扩展功能的目的。 制，无论他们的专业领域属于常规牙科还是种植 Classe A5 can be supplied in 6 differ- centre can be expanded, immediately 医生位的良好机动性保证了此种操作风格的完美定 development program – sturdiness, S320TR brings out the dentist’s very ent 科。鉴于搭载了向所有的可整合安福士设备开放 configurations. Ergonomics to suit or at a later date, with ultra-high per位性和移动操作的优化流畅性。医生位采用铸铝支架 www.anthos.com sternweber.com compactness, user-friendliness, ergobest. every operating style, integrated An- formance instruments, X-ray and mulnomics and performance – the TR Se的基础技术配置接口，这款高端的治疗台可以在 臂，具备出色的稳定性，再加上通过按键操作进行高 thos brand instruments, an extensive timedia systems, and advanced hygiene ries maximises them as never before sternweber.com choice of foot controls and operating devices. 现场或在未来与超高性能器械仪器、X-射线装 度调节，可以让牙科医生从容而安心的工作。由于采 STERN WEBER so as to provide you with a wealth of ANTHOS. THE BRAND lights, various hygiene systems, options Stern用了最新的数码电子科技，使得S320TR给牙科医生 S320TR new opportunities. 置、多媒体系统以及先进的卫生学设备相匹配， DOCTOR 牙医 Infodent International 2018 WITH LIMITLESS and•1 colour schemes: versatility in every Excellent manoeuvrability of the denSOLUTIONS FORInfodent DENTISTS sense•3/2017 of the word.

Doctor Os 牙医 International 们带来了最好的操作体验。 达到扩展功能的目的。 Characterised by a floor-mounted unit tist’s module ensures perfect positionALL AROUND THE WORLD. Dentists who choose Classe A7 Plus

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know they can personalise their dental www.anthos.com The Classe A range unit according to the specific needs of Developed to provide as much flexibil- today and tomorrow, whatever their ity as possible, the full Classe A range field of specialization, from conservaANTHOS. THEto BRAND lights, various hygiene systems, options of units enables dentists select the tive dentistry to implantology.

Thanks WITH colour schemes: versatility in every ergonomic andLIMITLESS functional set-up best to theand underlying technological consenseopen of thetoword. suitedSOLUTIONS to their operatingFOR style DENTISTS and pro- figuration, all integrated AnALL AROUND THE WORLD.thos systems, Dentists this whopremium choose Classe A7 Plus fessional needs. treatment theyexpanded, can personalise their dental Classe A5 can be supplied in 6 differ- centreknow can be immediately The Classe AErgonomics range according to the specificperneeds of ent configurations. to suit or at unit a later date, with ultra-high to provide as much todayinstruments, and tomorrow, every Developed operating style, integrated An-flexibilformance X-ray whatever and mul- their ity as possible, the full A range field of specialization, from conservathos brand instruments, an Classe extensive timedia systems, and advanced hygiene of units enables dentists to select the tive dentistry to implantology.

Thanks choice of foot controls and operating devices. ergonomic and functional set-up best to the underlying technological consuited牙医 to their operating style and pro-•1 2018 figuration, open to all integrated AnDOCTOR Infodent International fessional needs. thos systems, this premium treatment Doctor Os 牙医 Infodent International •3/2017 Classe A5 can be supplied in 6 differ- centre can be expanded, immediately ent configurations. Ergonomics to suit or at a later date, with ultra-high perevery operating style, integrated An- formance instruments, X-ray and multhos brand instruments, an extensive timedia systems, and advanced hygiene choice of foot controls and operating devices.

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DOCTOR牙医 Infodent International •1 2018 DOCTOR 2018 Doctor Os 牙医 牙医 Infodent Infodent International International •2 •3/2017

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SCIENTIFIC UPDATE Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance

Author D. Celli.

A. L. Grego, S. Sferra, R. Deli Catholic University of Sacred Heart, Rome Italy

e-mail: simonesferra @hotmail.it KEY WORDS

dilacerated teeth; straightwire appliance; impacted maxillary central incisor.

Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance TO CITE IN THIS ARTICLE: Celli D, Greco AL, Sferra S, Deli R. Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance. Eur J Paediatr Dent 2015; 16(3): 191-196.

ABSTRACT

Aim:To describe the orthodontic management of root dilaceration of an impacted maxillary tooth following trauma to its deciduous predecessors, to show the clinical management of root dilaceration of a maxillary central incisor and describe how the dilacerated tooth was successfully moved into alignment in a young patient with a proper multidisciplinary approach, using the simple and effective straightwire technique.

Case report: After surgical exposure and orthodontic traction, the impacted dilacerated tooth was brought to alignment in the arch. The patient’s chewing and speech function, and aesthetics were restored. The radiograph shows that the root is finally straight and relatively well developed. This approach avoids extraction and prosthetic rehabilitation of the dilacerated tooth.

INTRODUCTION Andreasen et al. [1971] defined dilaceration as the abrupt deviation of the long axis of the crown or root portion of the tooth, which is due to a traumatic non-axial displacement of already formed hard tissue in relation to the developing soft tissue [Andreasen et al., 1971].

The knowledge regarding how, where and when the traumatic injury has occurred is very important in order to make a precise diagnosis during the emergency visit, and to adopt the correct and most efficient clinical procedure [Ribeiro and Campos, 2009].

The aetiology of dilaceration is not fully understood. There are two main explanations of its causes: an acute mechanical injury to the primary predecessor tooth, which causes dilaceration of the underlying developing succedaneous permanent tooth; idiopathic developmental disturbances as the cause of dilacerations, mainly in cases where there is no clear sign or history of traumatic injury [Topouzelis et al., 2010; Smith and Winter, 1981; Jafarzadeb and Abbott, 2007; Stewart, 1978]. The treatment of a dilacerated anterior tooth includes surgical exposure followed by orthodontic traction; endodontic treatment or apicectomy may be associated [Lin, 1999]. Alternatively, treatment often involves surgical removal followed by orthodontic therapy to either close the space or keep it open until the patient reaches an age when implants or prosthetic treatment can be performed.

This article presents a patient with a dilacerated maxillary right central incisor managed with a multidisciplinary approach. The dilacerated tooth was disimpacted and aligned using a simple and effective method by strategic positioning of a straightwire appliance.

CASE REPORT Diagnosis and treatment plan A 9-year-old Caucasian girl was referred by her general dentist to our examination. The chief concern was the non-eruption of the maxillary right central incisor. His parents mentioned a traumatic injury affecting the frontal oral region when the child was 5 years old.

Clinical examination revealed that the patient had a symmetric face and brachyfacial type.

Intraoral examination showed an early mixed dentition and an Angle Class I molar and canine relationship. The impaction of the maxillary right central incisor had resulted in drifting of the adjacent teeth with 12

DOCTOR牙医 Infodent International •2 2018

a resultant midline deviation (Fig. 1). A metal chain showed through the gingival tissues of tooth 1.1 area because her general dentist had performed a surgical exposure and applied a traction chain. We performed an occlusal radiograph that showed a bracket bonded to the palatal surface of the impacted tooth (Fig. 2).

Palpation of the vestibular mucosa indicated a bulge in the upper anterior area where the dilacerated incisor was probably located.

Cephalometric, panoramic and occlusal radiographs revealed that the permanent maxillary right central incisor was impacted and displayed root dilaceration. Its apical foramen appeared as a circular radiopaque area with a dark radiolucent spot in the center, known as the ‘Bull’s eye’. The tooth’s morphology and position were clearly visible in the lateral cephalometric radiograph showing a horizontally displaced tooth, with its crown rotated more than 100° from normal, and its incisal tip just below the floor of the nose (Fig. 3).

The palatal surface of the crown was facing forward “like the hand of a traffic policeman” and the root was shortened. It was not possible to exactly define the root apex on the conventional radiographs.

The analysis of the lateral cephalometric radiograph disclosed a skeletal Class II occlusion with a balanced facial pattern (Table 1).

The aim of the treatment was to guide the impacted incisor into proper alignment with the adjacent incisor teeth and to re-create a complete anterior dentition. The treatment aimed at obtaining proper crown and root alignment without further root damage while maintaining the vitality and integrity of the root of the dilacerated tooth. The purpose of the treatment was, also, to extrude the tooth with all its supporting tissues (alveolar bone and attached gingiva) and to evaluate the long-term gingival and periodontal conditions.

The approach was multidisciplinary involving a combined surgical/ orthodontic treatment.

Treatment progress A STEP (Leone®, Florence, Italy) straightwire appliance was placed on the maxillary permanent teeth to create space for the impacted central incisor (Fig. 4). Prefabricated Ni-Ti, round section, 0.014 and 0.016-inch arch wires were used to align and to level the maxillary anterior teeth. Then an open-coil spring was positioned on 0.018

Fig.1d

Fig.1e

Fig.1a

Fig. 1(a-i) Pre-treatment extraoral and intraoral photographs.

Fig.1c

Fig.1b

Fig. 2(a-b) Pre-treatment panoramic and maxillary occlusal radiographs.

Fig.1f

Fig.1h

Fig.1g

Australian archwire between teeth 2.1 and 1.2 to open up space in the arch to full availability for the dilacerated tooth.

After adequate space was obtained and the tooth began to erupt, the surgery was planned. Surgical exposure of the permanent maxillary right central incisor ensued with apical repositioning flap, so that a button could be bonded onto the labial tooth surface. The placement of a button on the labial surface allows for better palatal movement of the crown (Fig. 5). Orthodontic traction of the permanent maxillary right central incisor was accomplished by attaching the traction chain to archwires.

Alignment and leveling was then continued using a 0.020 Australian archwire with a vertical occlusal step

SNA SNB ANB Wits appraisal SN/Go-Gn FMA SN/ANS-PNS ANS-PNS / Go-Gn +1 / ANS-PNS IMPA -1 / A-Pg +1 / A-Pg OVJ OVB

Pre-treatment 81 76,5 5,5 2 34 26 8 22 112 102 2 8 5 4

Fig.1i

with an eyelet on extrusion axis. Traction was activated changing the elastic cotton thread every 2 weeks until the crown of the permanent maxillary right central incisor appeared properly oriented in the oral cavity.

The traction force was about 40 g.This treatment stage lasted 6 months (Fig. 6).

Next, the button was removed from the labial surface of the permanent maxillary right central incisor and a bracket was bonded. Prefabricated round section Ni– Ti archwires with 0.014 and 0.016 inches were used again, in sequence, on the upper teeth.

In the same time a straightwire appliance was placed on the mandibular permanent teeth.

After that, Australian 0.018 and 0.020 inch archwire were used for the total alignment of the permanent

Post-treatment 82 78 4 0 37 28 14 23 118 96 2 4 2 2

Fig.2a

Fig.3a Fig.3a

Fig. 3a Pre-treatment cephalogram showing the dilacerated maxillary incisor; Fig. 3b Celophametric tracing Table 1 Cephalometric data.

Fig.2b

Fig.3b

DOCTOR牙医 Infodent International •2 2018

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SCIENTIFIC UPDATE Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance

Fig.4a

Fig. 4(a-f) Intraoral view before surgery.

Fig. 5(a-b) Surgical exposure of the impacted tooth.

Fig. 6(a-f) Progress of the orthodontic traction.

Fig.4d

Fig.4b

Fig.4e

maxillary right central incisor.

The right central incisor was brought closer to alignment, so an orthodontic bracket was bonded upside down on the labial surface to initiate labial root torque using a 0.019 x 0.025 Ni-Ti archwire. The strategic positioning of the bracket allowed a better position of the tooth root and harmonic gingival margin of the two central incisors (Fig. 7).

Treatment continued with a 0.019 x 0.025-inch SS wire with tie-back. After about 3 months the bracket on the 1.1 was repositioned normally. The finishing stage was performed by 0.018 Australian archwire.

Treatment results After 26 months of treatment the brackets were removed and permanent retention was bonded to the lingual surface of the lower anterior teeth. At the end of the treatment, the free and attached gingiva of the

Fig.4c

Fig.4f dilacerated tooth appeared acceptable (Fig. 8). The dilacerated impacted teeth was properly aligned in the dental arch restoring the masticatory, phonatory functions and patient’s aesthetics. The root appears radiographically aligned and not severely compromised (Fig. 9-11). The patient was referred to the conservative dentist for restoration of the incisal margin. The one-year follow-up showed a good maintenance of the result. Aesthetic periodontal surgery and a prosthetic treatment might be recommended in adulthood (Fig. 12).

DISCUSSION Most studies of dilaceration have concerned the maxillary central incisors, as was the case in the present study. McNamara et al. [1998] successfully aligned dilacerated maxillary central incisors planning a therapy that encompassed endodontic treatment and apico-

Fig.5b

Fig.5a

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Fig.6a

Fig.6b

Fig.6c

Fig.6d

Fig.6e

Fig.6f

DOCTOR牙医 Infodent International •2 2018

Fig.7a

Fig.7c

Fig.7b

Fig.7d

ectomy. Dilacerated impacted teeth can be properly aligned in the dental arch by appropriate treatment, which frequently requires cooperation among orthodontists, periodontists, paedodontists, endodontists, and/or prosthodontists. In the present study, no endodontic treatment or apicoectomy was needed during or after treatment, as has sometimes been required in similar cases.

A dilacerated tooth is said to be more resistant to extrusion than a tooth with a normal root, making the apical area more prone to resorption. However, in our patient, no severe root resorption could be detected, suggesting that, in the case of dilaceration, root resorption can hardly be predicted. Radiographic checkups during orthodontic traction are advisable [Cozza et al., 2005].

The success rate of an impacted dilacerated tooth alignment mainly depends on the following factors: - position and direction of the impacted tooth; - degree of root formation; - degree of dilaceration; - availability of space for the impacted tooth.

Machtei et al. [1990] also include the condition of the periodontium. McNamara et al. [1998] underline the decisive significance of the post-traumatic condition of the Hertwig’s epithelial root sheath for a successful therapeutic outcome, since normal root development depends on its integrity.

A dilacerated tooth with an obtuse inclination angle, a lower position in relation to the alveolar crest combined with an incomplete root formation has a better prognosis for orthodontic traction.

Fig.8a

Fig.8b

Fig.8c

Fig.8e

Fig.8f

Fig.8g

Fig. 7(a-d) Strategic positioning of the bracket bonded upside down.

Fig. 8(a-o) Records after debonding.

Fig.8d

Fig.8h Fig.8o

Fig.8i

Fig.8l

Fig.8m

Fig.8n

DOCTOR牙医 Infodent International •2 2018

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SCIENTIFIC UPDATE Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance

Fig.9

Fig. 9 Post-treatment panoramic radiograph showing no signs of root resorption of the aligned left central incisor.

Fig. 10a A Post-treatment cephalogram proving that penetration of the cortical bone from the dilacerated root apex was avoided; b cephalometric tracing.

Fig. 11 Superimpositions of the lateral cephalograms showing the dental and skeletal changes during orthodontic treatment: superimposition on the anterior cranial base (S-N).

Fig.10a

CONCLUSION The factors that determined a positive outcome are the following.

- The strategic placement of the straightwire appliance allows correct positioning of the tooth root and harmonic gingival margin of the two central incisors.

- The placement of buttons on the labial surface allows the palatal movement of the crown.

- The use of light and constant orthodontic forces (40 g) exerted by means of traction chain and elastic cotton thread before and NiTi superelastic wires.

REFERENCES › Andreasen JO, Sndström B, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors.

A clinical and histologic study of 117 injured permanent teeth. Scand J Dent Res 1971 ; 79:219–83. › Cozza P, Marino A, Condo, R. Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report. J Clin Pediatr Dent Winter 2005 ; 30(2):93-7, . › Jafarzadeb H, Abbott P. Dilaceration: review of an endodontic challenge. J Endod 2007 ; 33:1025–30.

Fig.10b

Fig.11

› Lin YTJ. Treatment of an impacted dilacerated maxillary central incisor. Am J Orthod Dentofacial Orthop 1999 ; 115:406–9. › Machtei EE, Zyskind K, Ben-Yehouda A. Periodontal considerations in the treatment of dilacerated maxillary incisors. Quintessence Int 1990; May 21(5):357-60. › McNamara T, Woolfe SN, McNamara CM. Orthodontic management of a dilacerated maxillary central incisor with an unusual sequel. J Clin Orthod 1998; 32:293–7. › Ribeiro D, Campos V. Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years. Dental Traumatology 2009 ; 25:300–304. › Stewart DJ. Dilacerate unerupted maxillary central incisors. Br Dent J 1978 145: 229–33. › Smith DMH, Winter GB. Root dilaceration of maxillary incisors. Br Dent J 1981; 150:125–7. › Topouzelis N, Tsaousoglou P, Pisoka V, Zouloumis L. Dilaceration of maxillary central incisor: a literature review.

Dental Traumatology 2010; 26:427–433. › White SC, Pharoah MJ, Oral radiology: principles and interpretation. 4th ed., St Louis: Mosby; 2000.

Fig. 12 (A-L) One year post-treatment.

Article courtesy of: European Journal Of Paediatric Dentistry; Vol 16/3 - 2015 © Ariesdue

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Fig.12a

Fig.12b

Fig.12c

Fig.12d

Fig.12e

Fig.12f

Fig.12g

Fig.12h

Fig.12i

Fig.12l

DOCTOR牙医 Infodent International •2 2018

阻生弯曲上切牙正畸中的直丝弓矫治器 定位技巧 文章来源: Celli D, Greco AL, Sferra S, Deli R. Management of impacted dilacerated maxillary incisor with strategic positioning of a straightwire appliance. Eur J Paediatr Dent 2015; 16(3): 191-196.

摘要

目的：描述由于前乳牙创伤而引起的上颌切牙阻生弯曲的正畸操作方案，展示上中切牙 牙根弯曲的临床操作，叙述如何通过合适的多学科方法用一个最简单而有效的直丝弓技术把 一个年幼患者的弯曲牙成功地移到对齐于牙列的位置。 病例报告 通过手术暴露和正畸牵引后，阻生弯曲牙移到于牙列排齐。患者的咀嚼功能、说话功能和 美观度均得到恢复，X光片显示，牙根最后变直并相对得到发育。这个方法避免了弯曲牙的拔 除和假体修复。 引言 Andreasen等学者在[1971]年给弯曲牙下了一 个定义：弯曲牙就是牙齿的牙冠长轴与牙根比 例有严重偏差，这是由于已经形成的硬体组织 相对于发育中的软组织有一个创伤性非轴向移 位而造成的。 在急诊中，知道在何时、何地、如何造成创 伤对于做出一个精确的诊断是非常重要，如此 才可以采用正确的最有效的临床步骤。[Ribeiro 和 Campos在 2009年提出]。 目前还尚未完全理解弯曲牙的病因，现在有 两种主流的解释;由于乳牙受到急性机械性创伤 而导致下层正在发育的恒压变弯曲；特发性发 育障碍引起的牙弯曲，这种情况，一般均在没 有明显的创伤痕迹和创伤史的病例中[Topouzelis 等在2010年报道; Smith 和Winter在 1981年报 道; Jafarzadeb 和Abbott也在2007年报道; Stewart 在1978年报道]。 弯曲牙的治疗程序包括手术暴露和之后的正 畸牵引，还可能有配合性的根管治疗和根尖切 除术 [Lin,在1999年提出]。其他的治疗方案经常 包括外科手术摘除，之后进行正畸治疗来闭合 空间，或者保留空间一直等到患者可以接受种 植或假体治疗的年龄。 本文介绍了如何把一个多学科方法的操作流 程用在一个有弯曲上中切牙的患者上。通过运 用一个简单而有效的直丝弓矫治器定位技巧， 在实验的结果，弯曲牙已被去除阻力，并最终 被排齐。 病例报告 诊断和治疗方案 一个9岁的白人女孩被她的牙医推荐给我们的 试验，患者主要症状是上右中切牙阻生，她的 父母提到，孩子在5岁的时候有过一次跌打性 损伤擦伤了她的前额口腔区域。

临床检查显示患者有对称的颅面部。 口腔检查显示有早期的牙列混合不齐，犬牙 和磨牙之间形成一个I类角。右上中切牙的阻 生导致其远离了邻近牙，最终出现中线偏差 （图1）。1.1牙区的牙龈组织上有根金属链， 因为她的牙医已经给她进行了手术暴露并放置 了一根牵引链。我们给患者做了X咬合线片， 结果显示有一个支架和阻生牙的颚面粘合在一 起（图2）。 前庭黏膜的触诊显示，在上前方有个隆起的 部位，很有可能就是阻生牙所在位置。根据X 头影、全景X光片和咬合面结果发现，上颌右 侧中切恒牙阻生并显示牙根弯曲。根尖孔显示 有一个圆形区域，在该圆形区域的中心还有一 个可透射暗斑，该暗斑被称为“靶心”。外侧牙 齿的位置和形态清晰可见，头部测量的X线片 显示了一颗平躺的牙齿，牙冠从正常牙冠的位 置旋转了100°，牙尖就在鼻腔基下方(图3)。 牙冠的颚面朝向前方，就像交通指挥警察的手 一样，牙根缩短；因此不可能精确地在X成像 上确定根尖。 X头影的侧面分析显示一副II型闭塞骨架和均 衡的面型（表1）。 治疗的目标是引导阻生牙到正确地于邻近的 牙对齐，并重新打造一个完整的前牙。治疗的 目的是在维持阻生牙牙根的活力和完整性的前 提下避免牙根进一步受损，并实现对牙冠和牙 根的正确定位。治疗的目标还有，挤压其所有 的周围组织（牙槽骨和附着龈），并评估牙龈 和牙周的长期状况。 这是一个综合了多个学科的治疗方法，是个 外科手术和正畸治疗的结合。

Author D. Celli.

A. L. Grego, S. Sferra, R. Deli 意大利罗马圣心天主 教大学

e-mail: simonesferra @hotmail.it 关键词：弯曲牙； 直丝弓矫治器；阻 生上中切牙。

治疗过程 为了给阻生中切牙疼出空间，我们在上颌恒 牙上固定了一个STEP（由意大利佛罗伦萨的 DOCTOR牙医 Infodent International •2 2018

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阻生弯曲上切牙正畸中的直丝弓矫治器定位技巧

Fig.1d

图 1(a-i)

Fig.1e

治疗前口内和口外 照片。 图 2(a-b)

治疗前的全景和上 颌咬合X线片。

Fig.1a

Fig.1b

Fig.1c

Fig.1f

Fig.1g

Fig.1h

图 3a

治疗前的X线投影 显示弯曲的上切 牙。 图 3b Celophametric tracing Table 1 Cephalometric data.

Leone公司生产）直丝弓矫治器(图4). 用预制的Ni-Ti 0.014 和 0.016英寸的弓丝来调 整和整平上颌前牙。然后，一个开放式的螺旋 弹簧被固定在2.1号牙 和 1.2号牙之间的0.018英 寸澳大利亚弓丝上，以便于在弓内给弯曲牙打 开足够的空间。 获得足够的空间后，阻生牙亦开始长出，手术 计划已经完成。上颌中切恒牙手术暴露后接着 进行顶端折翼重新定位，如此，在唇齿面上可 以粘贴一个按钮。唇面上的按钮可以使牙冠颚 更好的运动（图5）。 通过连接牵引链和弓丝完成了右上中切恒牙 的正畸牵引。 之后，用0.020英寸的澳大利亚弓丝与挤压轴 上的小孔来垂直咬合并继续进行排齐和整平；

Fig.2a

Fig.2b

Fig.3a

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Fig.3b

Fig.1i

通过每2周更换一次弹力棉线，牵引被激活， 直到上颌中切恒牙牙冠在口腔的正确位置上为 止。牵引力大约40克，这个治疗阶段持续了6 个月（图6）。 接下来，从上颌右中切恒牙的唇面移除了按 钮，并粘合了一个支架。预制的Ni–Ti 0.014 和0.016英寸的圆弓丝被用在上牙上。 与此同时，在下颌恒牙上放置了一个直丝弓 矫治器。 之后的整个上颌右中切牙排齐过程都用 0.018 和0.020 英寸的澳大利亚弓丝。 右中切牙被调整到里中切线更近的地方，一个 正畸支架被倒置在弯曲牙的唇面上，用一根 Ni-Ti 0.019 x 0.025的弓丝来启动唇根扭矩。这 种战略性的支架定位可以保证两颗中切牙更好

SNA SNB ANB Wits appraisal SN/Go-Gn FMA SN/ANS-PNS ANS-PNS / Go-Gn +1 / ANS-PNS IMPA -1 / A-Pg +1 / A-Pg OVJ OVB

Pre-treatment 81 76,5 5,5 2 34 26 8 22 112 102 2 8 5 4

Post-treatment 82 78 4 0 37 28 14 23 118 96 2 4 2 2

图 4(a-f)

Fig.4a

Fig.4b

术前口内视图。

Fig.4c

图 5(a-b)

阻生牙的手术暴 露。 图 6(a-f)

Fig.4d Fig.4d

正畸牵引的进度。 Fig.4e

的牙根位置和协调的龈缘（图7）。 用一根带有一个系带的 0.019 x 0.025英寸的不 锈钢丝继续治疗，约3个月后，1.1齿上的支架 被放正。最后一步用的是 0.018英寸的澳大利 亚弓丝。 治疗结果 治疗26个月后，支架被摘除，恒牙被粘合 在下前牙的靠舌面上。在治疗结束时，独立 的已连接的弯曲牙牙龈似乎到了可以接受的程 度(图8)。阻生弯曲牙已经被适当地排齐在牙 列中，恢复了患者的咀嚼、发音和审美功能。 从X光线角度来讲，牙根最终被排齐并且没有 受到严重的损害（图9至11）。患者后来被转 至原来的牙医处进行切缘恢复。为期一年的

Fig.4f

随访发现维持了良好的手术结果。在成年后， 患者有可能需要接受牙周审美手术和修复治疗 (图12)。 讨论 如这项研究一样，很多关于弯曲牙的研究中 提到了上颌中切牙。 McNamara 等用一个综合了根管治疗和根 尖切除术的治疗方法，在 [1998]年成功地排齐 了弯曲的上颌中切牙。通过一个适当的治疗方 案，阻生弯曲牙可以被排齐在牙列中，这往往 需要正畸医生、牙周医生、牙髓医生和假牙医 生之间的合作。不同于一些其他类似的案例， 在本次实验中没有必要进行牙髓治疗和根尖切 除术。

Fig.5b

Fig.5a

Fig.6a

Fig.6b

Fig.6c

Fig.6d

Fig.6e

Fig.6f

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SCIENTIFIC UPDATE

图 7(a-d)

阻生弯曲上切牙正畸中的直丝弓矫治器定位技巧

Fig.7a

Fig.7c

Fig.7b

Fig.7d

弯曲牙被认为比正常牙根的牙更耐挤压，使得 心尖区更容易再吸收。但总的来说并没有发现 明显的严重的牙根再吸收，需要强调一点，在 弯曲牙中，牙根再吸收现象很难被预测。正畸 牵引期间最好进行X光线检查 [Cozza 等在 2005 年提出]。 影响一个阻生弯曲牙的排齐成功率的因素有 如下几种; - 阻生牙的位置和朝向 - 牙根的形成程度； - 弯曲程度； - 阻生牙的可用空间。 Machtei 等 [1990年的报告中]则认为应该还包 括牙周组织的条件，McNamara 等[在1998年的 报告中]却强调了牙根外部Hertwig外皮细胞的

伤后条件对一个成功的治疗结果有关键性的作 用，因为正常牙根的发育取决于它的完整性。 在正畸牵引中，一个钝角倾斜而且位置低于牙 槽嵴却有完整成形牙根的弯曲牙会有一个更好 的预知结果。

结论 决定能否取得一个良好结果的因素如下; 战略性定位直丝弓矫治器可以正确定位牙 根，并且使两颗中切牙的龈缘有较好的协调 性。 按钮放置在唇面上可以使牙冠颚运动不被 限制。 通过牵引链、弹力棉线和超弹性NiTi丝发 挥的作用而施加柔和恒定的矫治力(40克)。

支架倒装固定战略 定位。 图 8(a-o)

剥离后的记录。

Fig.8e

Fig.8a

Fig.8b

Fig.8f

Fig.8g

Fig.8c

Fig.8d

Fig.8h Fig.8o

Fig.8i

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Fig.8l

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Fig.8m Fig.8n

图9

Fig.9

Fig.10a

参考文献 › Andreasen JO, Sndström B, Ravn JJ. The effect of traumatic injuries to primary teeth on their permanent successors.

A clinical and histologic study of 117 injured permanent teeth. Scand J Dent Res 1971 ; 79:219–83. › Cozza P, Marino A, Condo, R. Orthodontic treatment of an impacted dilacerated maxillary incisor: a case report. J Clin Pediatr Dent Winter 2005 ; 30(2):93-7 . › Jafarzadeb H, Abbott P. Dilaceration: review of an endodontic challenge. J Endod 2007 ; 33:1025–30. › Lin YTJ. Treatment of an impacted dilacerated maxillary central incisor. Am J Orthod Dentofacial Orthop 1999; 115:406–9. › Machtei EE, Zyskind K, Ben-Yehouda A. Periodontal considerations in the treatment of dilacerated maxillary incisors. Quintessence Int 1990; May 21(5):357-60. › McNamara T, Woolfe SN, McNamara CM. Orthodontic management of a dilacerated maxillary central incisor

Fig.10b

治疗后的全景X线 片显示被排齐的上 中切牙根没有再吸 收现象。

Fig.11

with an unusual sequel. J Clin Orthod 1998; 32:293–7. › Ribeiro D, Campos V. Prevalence of sequelae in the permanent anterior teeth after trauma in their predecessors: a longitudinal study of 8 years. Dental Traumatology 2009; 25:300–304. › Stewart DJ. Dilacerate unerupted maxillary central incisors. Br Dent J 1978 145: 229–33. › Smith DMH, Winter GB. Root dilaceration of maxillary incisors. Br Dent J 1981; 150:125–7. › Topouzelis N, Tsaousoglou P, Pisoka V, Zouloumis L. Dilaceration of maxillary central incisor: a literature review.

Dental Traumatology 2010; 26:427–433. › White SC, Pharoah MJ, Oral radiology: principles and interpretation. 4th ed., St Louis: Mosby; 2000.

Fig.12a

Fig.12b

Fig.12c

Fig.12d

Fig.12e

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Fig.12g

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Fig.12i

Fig.12l

图 10a

治疗后的X头影证 明避免了根尖的皮 骨质渗透； b 头影测量跟踪。 图 11

横向X线头影测量 表明正畸治疗过程 中的牙齿和骨骼的 变化：前颅底部的 上面。 图 12 (A-L) 治疗一年后。

Article courtesy of: European Journal Of Paediatric Dentistry; Vol 16/3 - 2015 © Ariesdue

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SCIENTIFIC UPDATE Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report

Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report TO CITE IN THIS ARTICLE: Olczak K, Pawlicka H. Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report. Eur J Paediatr Dent 2015; 16(4): 287-289.

Author K. OLCZAK H. PAWLICKA Department of Endodontics, Medical University of Lodz, Poland

e-mail: kolczak@op.pl KEY WORDS

Endo-perio diseases; Mineral trioxide aggregate; Open apex.

ABSTRACT Background Mineral trioxide aggregate (MTA), one of the latest materials applied in dentistry, has a variety of potential uses. Numerous studies emphasise its biocompatibility with periodontal and hard tissues, as well as excellent sealing and regeneration abilities.

Case report This article describes the successful therapy of immature mandibular premolars with large open apex, resorption, and endo-perio lesions. In the presented case, the canal was filled with the MTA material. At present, the treated tooth is asymptomatic, and a three-year follow-up radiographic examination demonstrated the dramatic regeneration of periradicular tissues and the new hard tissue formation in the area of the affected teeth.

INTRODUCTION Endodontic treatment of permanent teeth with incomplete root apex development, apical periodontitis and bone loss poses a challenge to the dentist [Andreasen et al., 2002; Felippe et al., 2005]. For many years, multi-appointment therapy has been performed using calcium hydroxide dressings. Such a treatment is however long-term and associated with the risk of root weakening and tooth fracture. Additionally, there is a fear that the patient will not see the dentist regularly to change temporary dressings [Andreasen et al., 2002]. In this situation, the application of mineral trioxide aggregate (MTA) seems to be a better treatment [Parirokh and Torabinejad, 2010]. MTA was developed in the early 90ties at the Loma Linda University in the USA, and in 1998 was introduced in the dental market as ProRoot MTA® (Dentsply Tulsa Dental Specialties, Tulsa, USA) [Torabinejad et al., 1994; Torabinejad et al., 1995]. Since that time, it has been successfully used in different clinical cases such as apexification of teeth with incomplete root development, direct pulp capping, pulpotomy and pulpectomy, repair of perforations of root and pulp chamber floor, treatment of tooth resorption, and retrograde canal filling during root resection [Roberts et al., 2008]. Numerous reports emphasise that MTA may improve the outcome of not only endodontic treatment but periodontal as well [Katsamakis et al., 2013; Srinivasan et al., 2009].

medical history revealed that the girl suffered from asthma and received inhaled corticosteroids. On the basis of earlier treatment records it was found that after trephination of tooth #35, the calcium hydroxide dressing was inserted into the canal. Since then (1.5 year), no endodontic procedures were performed. On admission to the Endodontic Clinic, an extensive cavity within the tooth crown filled with a temporary dressing and a deep pathological pocket were visible. The dental radiograph showed the incompletely developed root apex with a very wide apical foramen, thin root wall, a bony pocket and chronic periradicular periodontitis around tooth #35 indicating an endo-perio lesion (Fig. 1). Due to a very bad condition of the tooth and a concomitant malocclusion, the patient was referred to the orthodontist for consultation whether tooth #35 should be treated or extracted for orthodontic reasons. The specialist diagnosed severe retrognathia and tooth abnormalities (crowding of upper teeth), and advised the endodontist to treat and retain tooth #35 as long as possible. The involved tooth was treated at the Endodontic Clinic using a dental operating microscope and a rubber dam for tooth isolation. After the removal of the dressing, a hemorrhagic exudate from the canal was observed. Approximate working

REPORT A 12-year-old female patient was referred to the Endodontic Clinic of the Medical University of Lodz (Poland) to continue root canal treatment that had been started two years earlier at a private dental office. A 22

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Fig.1

Fig. 1 Preoperative radiographic examination showing radiolucency at the apical and mesial area of tooth #35.

The apex is clearly open.

Fig.3 length was established with an electronic apical locator and radiographs. The root canal was cleaned with 2.5% NaOCl and NaCl. Next, the canal was delicately dried with paper points and the calcium hydroxide dressing (Calxyl®, OCO Präparate) was placed for two weeks.

At the first appointment, instructions on oral hygiene were given to the patient and rinsing of the oral cavity was recommended after each application of inhaled corticosteroids.The patient had in fact many teeth with fillings and carious lesions.

After two weeks, the calcium hydroxide dressing was removed by instrumentation and irrigation with 2.5% NaOCl and 17% EDTA. Additionally, ultrasonic activation of a #25 K-file passively placed in the canal was carried out to improve canal debridement and Calxyl®.

The canal was finally filled. At first, the periapical region of the canal was filled with small pieces of resorbable collagen sponge (Biokol®, Stalmed). Next, small portions of the MTA material were inserted into the canal and condensed vertically using pluggers. In this way, the entire canal was filled with MTA. In the region of the pericoronal canal orifice, a sterile cotton pellet saturated with physiological saline was placed on MTA (Fig. 2). A tight dressing (GC Fujii Triage®) was inserted into the crown. After two days, the cotton pellet was removed and the permanent filling (Tetric Evo Ceram® Ivoclar Vivadent®) was placed. Root canal retreatment of tooth #36 was also carried out. The patient visited the endodontist again after the following one and three years, despite the recommended earlier follow-ups.

Clinical examination did not present any pathological changes in the tooth and the periodontal ligament. On the basis of the radiograph, bone regeneration and healing of apical periodontitis were observed (Fig. 3, 4).

DISCUSSION Modern endodontics offers different treatment possibilities, even in very complicated endo-perio lesions of immature teeth [Felippe et al., 2006; Kottoor and Velmurugan, 2013; Parirokh and Torabinejad, 2010]. In the presented case report, the incompletely developed root apex with a large open apical foramen, external root resorption, endo-perio lesions, extensive apical periodontitis involving the mesial side of the alveolar process along with the bony pocket were diagnosed.

Additionally, a long time that had passed from the trephination to the final root canal filling was considered a

Fig.3

Fig. 2 Postoperative radiograph showing the root canal filled with MTA.

Fig.4

poor prognostic factor. After preparing an access cavity to the tooth at the private dental office, a calcium hydroxide dressing was inserted into the canal and was left in the tooth for a period of 1.5 year. Long-term calcium hydroxide dressings weaken the root structure, possibly by naturalizing, denaturing, or dissolving the acidic components of dentine [Andreasen et al., 2002]. Moreover, the inadequate dressing within the tooth root and the crown undoubtedly contributed to ongoing bacterial infection. Despite such an unfavourable situation, the treatment was successful. Both, the root canal and periodontal treatment as well as canal filling with the MTA material were the factors which determined the success of therapy. Numerous studies emphasise very good biocompatibility, and antibacterial and antifungal activity of this material [Ferk et al., 2011; Al-Kahtani et al., 2005; Srinivasan et al., 2009].

MTA also possesses excellent sealing properties and the ability to harden in the presence of fluids including blood [Tang et al., 2002; Torabinajed et al., 1994]. MTA has low solubility in tissue fluids (less than 3%), therefore it does not undergo resorption [DaSilva et al., 2010]. MTA induces proper growth and development of the new root, bone and periodontal cells including periodontal ligament [Guven et al., 2007; Katsamakis et al., 2013]. MTA has stimulated the expression of osteocalcin, alkaline phosphatase, collagen type 1, and bone sialoprotein in cementoblast cell cultures [Hakki et al., 2009; Hakki et al., 2012]. The research also indicated that after MTA application, the human periodontal fibroblasts presented attachment, normal growth, and functions [Hakki et al., 2009; Lin et al., 2004]. A great advantage of this material is its strong alkaline pH and pH-related beneficial therapeutic activity. While hardening, the pH of MTA equals 10.2 and increases up to 12.5 during the first hours [Torabinejad et al., 1994; Torabinejad et al., 1995]. Calcium hydroxide also possesses alkaline pH, however it should not remain in the canal longer than two weeks as this time is optimal for its antibacterial activity and drying of exudate. In the presented case, a short-term placement of calcium hydroxide was justified by the presence of a large amount of exudate and concomitant infection of the root canal and periodontal tissues. MTA filling is a quicker and more effective method than using calcium hydroxide. In the case of canals with an excessively widened apical foramen, it is recommended to create a barrier in the apical region with a resorbable col-

Fig. 3 Follow-up after 1 year after therapy completion.

Fig. 4 Follow-up after 3 years after therapy completion.

Article courtesy of: European Journal Of Paediatric Dentistry; Vol 16/4 - 2015 © Ariesdue

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SCIENTIFIC UPDATE Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions. A case report lagen sponge and then to condensate small portions of MTA. This procedure prevents excessive extrusion of MTA outside the root to the periapical tissues and enables the material to be condensed [D’Arcangelo et al., 2007].The root canal with incomplete development of the root and/or its external resorption can be filled with MTA entirely or in two stages, in which MTA is inserted into the periapical part, and the remaining canal is filled with gutta-percha and sealer (most frequently thermoplastic gutta-percha is used) [D’Arcangelo et al., 2007]. In our patient, the entire canal was filled with MTA because the root (and the canal) was very short and the root walls were thin. Due to the unfavourable ratio of the crown length to the root length, future prosthodontic reconstruction (post and core crown) was excluded. The cavity within the crown and the coronal part of the root were restored with light-cured composite, which strengthens the tooth tissues.

After filling the entire or part of the canal with MTA, radiological examination and follow-ups are recommended. MTA due to 20% bizmuth oxide content is radiopaque [Song et al., 2006].

CONCLUSION To sum up, the application of MTA in the treatment of nonvital teeth with the incompletely developed root and/or its external resorption and apical periodontitis involving endo-perio lesions is an efficient method of treatment, resulting in a good state of the tooth retained in the oral cavity and healing of inflammatory lesions in the bone and periodontium. Short-term treatment is an additional advantage of the MTA material.

REFERENCES › Al-Kahtani A, Shostad S, Schifferle R, Bhambhani S. In vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices. J Endod 2005; 31:117-119. › Andreasen JO, Farik B, Munksgaard EC. Long-term calciumhydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002; 18: 134-137. › D’Arcangelo C, D’Amario M, L’Aquila Ch. Use of MTA for orthograde obturation of nonvital teeth with open apices: raport of two cases. Oral Surg Oral Med Oral Pathol 2007; 104: e98-e101. › Dominguez M, Munoz L, Aznar MT. Study of calcium hydroxide apexification in 26 young permanent incisors.

Dent Traumatol 2005; 21:141-145. › Felippe MC, Felippe WT, Marques MM, Antoniazzi JH. The effect of renewal of calcium hydroxide paste on the a exification and periapical healing of teeth with incomplete root formation. Int Endod J 2005; 38: 436-442. › Ferk S, Simeon P, Matijevi J, Prpi M, Ani I, Juki K. Antibacterial Effect of Mineral Trioxide Aggregate and Amalgam.

Acta Stomatol Croat 2011; 45: 8-12. › Guven G, Cehreli ZC, Ural A, Serdar MA, Basak F. Effect of mineral trioxide aggregate cements on transforming

24

DOCTOR牙医 Infodent International •2 2018

growth factor beta1 and bone morphogenetic protein production by human fibroblasts in vitro. J Endod 2007; 33: 447–50. › Hakki SS, Bozkurt SB, Hakki EE, Belli S. Effects of mineral trioxide aggregate on cell survival, gene expression associated with mineralized tissues, and biomineralization of cementoblasts. J Endod 2009; 35:513-519. › Hakki SS, Bozkurt SB, Ozcopur B, Purali N, Belli S. Periodontal ligament fibroblast response to root perforations restored with different materials: a laboratory study. Int Endod J 2012; 45: 240-248. › Hayashi M, Shimizu A, Ebisu S. MTA for Obturation of Mandibular Central Incisors with Open Apices: Case Report. J Endod 2004; 30: 120-122. › Katsamakis S, Slot DE, Van der Sluis LWM, Van der Weijden F. Histological response of the periodontium to MTA: a systematic review. J Clin Periodontol 2013; 40: 334-344. › Kottoor J, Velmurugan N. Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review. Int J Paediatr Dent 2013; 23: 310–316. › Lin CP, Chen YJ, Lee YL, Wang JS, Chang MC, Lan WH, Chang HH, Chao WM, Tai TF, Lee MY, Lin BR, Jeng JH. Effects of root-end filling materials and eugenol on mitochondrial dehydrogenase activity and cytotoxicity to human periodontal ligament fibroblasts. J Biomed Mater Res B Appl Biomater 2004;71:429–440. › Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413. › Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater 2008; 24: 149–64. › da Silva WJ, Souza PH, Ribeiro EA. Mineral trioxide aggregate as root canal filing material: comparative study of physical properties. Rev Odonto Ciênc 2010, 25: 386-390. › Simon S, Rilliard F, Berdal A, Machtou P. The use of mineraltrioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J 2007; 40: 186-97. › Song JS, Mante FK, Romanow WJ, Synnkcung K. Chemical analysis of powder and set forms of Portland cement, gray ProRoot MTA, white ProRoot MTA, and grey MTA-Angelus.

Oral Surg Oral Med Oral Pathol 2006; 102: 809-815. › Srinivasan V, Waterhouse P, Whitworth J. Mineral Trioxide Aggregate in paediatric dentistry. J Clin Pediatr Dent 2009; 19: 34–47 › Tang HM, Torabinajed M, Kettering JD. Leakage evaluation of root end filling materials using endotoxin. J Endod 2002; 28: 5-7. › Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 1995; 21: 349–353. › Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR. Dye leakage of four root end filling materials: effects of blood contamination. J Endod 1994; 20: 159-163.

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SCIENTIFIC UPDATE

三氧化矿物骨料在治疗根尖开口并伴有牙周内切病变恒牙中的应用一个病例报告

三氧化矿物骨料在治疗根尖开口并伴有 牙周内切病变恒牙中的应用 一个病例报告 文章来源: Olczak K, Pawlicka H. Mineral trioxide aggregate in treatment of permanent teeth with open apex and endo-perio lesions.

A case report. Eur J Paediatr Dent 2015; 16(4): 287-289.

摘要 背景：三氧化矿物骨料（简称MTA），它是口腔医学中最新被应用的材料之一，具有多种潜 在用途。大量的研究均强调了它与牙周组织和硬组织的生物相容性、良好的密封性和再生 能力。 病例报告：本文介绍一个有先尖开口大、再吸收、内切牙周病变的未成熟下前磨牙的成功 治疗案例，在这个案例中，病变牙根管中填充了MTA材料。目前，被治疗的牙显示出无症 状，并且通过三年的随访放射检查证明了在受影响牙的区域中产生了显著的根尖周组织再生 和硬组织新生迹象。 K. Olczak, H. Pawlicka

波兰罗茨大学医学院 牙体牙髓科 电子邮箱: kolczak@op.pl 关键词 : 内切牙周疾病； 三氧化矿物骨料； 根尖开口

引言 对牙医来说，根尖发育不完整、根尖周炎 和骨量流失的情况在治疗恒牙牙髓的过程 中是个很大的挑战 [Andreasen 等在2002年报 告；Felippe 等也在 2005年提出]。多年来，多 种预约治疗一直把氢氧化钙作为敷料来使用， 但是这种治疗方法周期长，而且会带来牙根弱 化和齿断裂的风险。再者，还有一种风险就 是，患者有可能会不定期去看牙医进行更换临 时敷料 [Andreasen 等在 2002年提出]。在这种 情况下，运用三氧化矿物骨料似乎是一个更好 的治疗方法 [Parirokh 和Torabinejad在2010年 提出]。三氧化矿物骨料在90年代早期由美国的 罗马琳达大学研发出来，并在1998年以ProRoot MTA为名被引进牙科市场（由美国塔尔萨 市的“Dentsply Tulsa Dental Specialties”公司生 产）[Torabinejad 等在 1994年报道; Torabinejad 等在1995年报道]。从那以后，它被成功地应 用在多个临床病例中，如根系发育不完整牙的 根尖诱导成形术、直接盖髓术、活隋切断术和 牙髓摘除术，牙根穿孔和根髓室底板的修复， 再吸收牙的治疗和牙根切除术后的逆行根管填 充[Roberts 等在 2008年报道]。大量的报告指 出，MTA不仅能够提高牙髓疾病的治疗结果， 还能改善牙周疾病的治疗结果 [Katsamakis 等 在2013报告; Srinivasan 等在 2009年报道]。

病例报告 一个12岁的女性患者被转诊至波兰罗茨医科 大学的牙髓诊所继续根管治疗，两年前，她在 一个私人牙科诊所开始接受治疗。病例显示， 女童患有哮喘，并接受过吸入性激素治疗。之 前的治疗记录表明，患者的35号牙齿通过环钻 后，在根管中填充了氢氧化钙敷料。从那以后 （1年半），没有再进行过根管治疗。入住到 牙髓诊所时，可见一个宽阔的牙洞中填充了临 时敷料，还有一个很深的病变口袋。牙科X光 片显示，牙根先尖发育不完整且有一个宽的根 尖孔，薄牙根壁，骨骼突出的牙周袋和35号牙 26

DOCTOR牙医 Infodent International •2 2018

周围的慢性根尖周炎和牙周炎表明有牙周内切 病变（图1）。鉴于很糟糕的牙齿状况，外加 咬合不良的情况，患者被推荐到正畸医生处， 咨询是否继续治疗35号牙或出于正畸原因而进 行拔除。专家诊断后，确诊出患者有严重下颌 后缩和牙齿异常（上牙拥挤），并建议牙髓病 科医师对35号牙进行治疗并保留尽可能长的时 间。在牙髓诊所，用牙科手术显微镜和橡皮障 对所涉及牙进行了隔离。去除敷料后，在根管 中发现了血性渗出物。用电子根尖定位仪和X 光片测定了大致工作长度。用2.5%的次氯酸钠 和氯化钠溶液冲洗了根管。接下来，用纸尖 轻轻地干燥根管，并填入氢氧化钙敷料(Calxyl OCO Präparate)2周。第一次会诊后，医师给 患者提供了关于口腔卫生的指导，并要求每次 使用吸入性激素后都进行口腔的清洗。事实上 患者的牙齿也确实有很多的填充物和龋损伤。 两周后，利用牙科仪器，再用2.5%次氯酸钠 和17%的EDTA溶液冲洗 ，清除了氢氧化钙敷 料。此外，为了改善根管的清创效果并更好地 清除氢氧化钙敷料，进行超声激活了一个无源 性放置于根管中的25号K-锉。最后，根管被重 新填充；首先，在根尖区域填充了吸收性胶 原海绵(Biokol®, Stalmed)；接下来，少部分的 MTA材料被填入根管中并用填充器垂直压紧。 用这种方式，MTA材料填充了整个根管。在 冠周管口区域，把一个饱和了生理盐水的无菌

图 1 术前X线片检查显示35 号牙的根尖和内侧区 域透亮，说明根尖是 开口的。 Fig.1

Fig.3

棉球放置在MTA材料上(图2)。一种密封敷料 (GC Fujii Triage®)被填入牙冠内。两天后，棉 球被摘除，并放置了永久性填充物(Tetric Evo Ceram由® Ivoclar Vivadent公司生产 )。同时也 对36号牙齿的根管进行了治疗。 患者在治疗结束后一年和三年时随访了牙髓 医师，虽然医生早前建议的随访时间比这个要 短，临床检查中没有出现任何关于牙齿和牙周 韧带的病理改变。在X光片上，观察到了骨再 生和根尖牙周炎愈合的迹象(图3和4)。

讨论 现代的根管治疗术给我们提供了不同治疗方 法的可能性，即使是在不成熟牙有非常复杂的 内切牙周病变的情况下[Felippe 等在 2006报道; Kottoor 和 Velmurugan在2013年报道; Parirokh 和Torabinejad在 2010年报道]，在本病例报告 中，发育不完整的根尖有一个很宽的根尖孔， 牙根外部再吸收，内切牙周病变和大范围的根 尖周炎一直到牙槽骨的内侧。再者，本病例中 的患者牙齿的环钻和填充之间的间隔时期很 长，这样长的间隔时间被认为是个不良预后因 素。在私人牙科诊所中，患者的牙齿被开孔后 在根管中填充了三氧化钙敷料，在之后1年半 的时间里，三氧化钙敷料一直被留在根管中。 而长期把三氧化钙敷料留在牙齿内会使牙根结 构变弱，这很有可能是牙质的酸性成分被同 化、溶解或被改变性质而造成（由Andereasen 等在2002年提出）。此外，在根管和牙冠中没 有填充足够的敷料，毫无疑问，这也引发了持 续的细菌感染。尽管情况如此不利，但我们的 治疗取得了成功；进行根管和牙周治疗并用 MTA材料填充根管，这是两个促进治疗成功的 重要因素。 大量研究表明，此材料有非常好的生物相容 性、抗菌性和抗真菌活性[Ferk 等在 2011年提 出; Al-Kahtani 等在2005年报道过; Srinivasan 等

Fig.3

Fig.4

在2009年报道过]。MTA还有很好的密封性， 并且在有包括血液的液体存在下也有很好的固 化能力[Tang 等在2002年报道; Torabinajed 等在 1994年报道]。MTA在在组织性溶液中有低溶 解性(小于3%)，因此它不耐吸收[DaSilva 等在 2010年报道]。MTA能诱导新根、骨、牙骨细 胞包括牙周韧带的正常生长和发育[Guven 等在 2007年报道; Katsamakis 等在2013年报道]。MTA 促进了骨钙蛋白、碱性磷酸酶、骨胶原1型和 骨粘稠蛋白在骨质细胞培养液中的表现[Hakki 等在 2009年报道; Hakki 等在2012年报道]。该 研究还表明，在应用MTA材料后，人的牙周成 纤维细胞呈现出连接状态，并恢复了正常功能 和正常的发育[Hakki 等在2009年报道; Lin 等在 2004年报道]。这种材料一个很大的优点是其 具有强碱性PH值和于PH值相关的有益治疗活 性，在硬化过程中，MTA的PH值在最初的几 个小时中从10.2增加至10.5[Torabinejad 等分别 在1994年和1995年报道]。

图 2 术后X光片显示 根管中填充了MTA 材料。 图 3 治疗结束后1年 时的随访。 图 4 治疗结束后3年 时的随访。

氢氧化钙也具有碱性PH值，但它留在根管中 的时间不应该超过两周，因为氢氧化钙具有最 佳抗菌活性和干燥渗出物的时间为两周。在本 病例中，我们使用了短期的氢氧化钙敷料，因 为患者牙内有大量的渗出物和根管与牙周组织 的伴发性感染。比起使用氢氧化钙，使用MTA 材料是个更快更有效的方法，在根尖孔被过度 扩大的情况下，建议先用吸收性胶原海绵创建 一个屏障，再用少部分的MTA材料聚合。这种 方法可以防止MTA材料过度挤压根尖周组织， 并使材料易于凝结[D’Arcangelo 等在2007年报 道]。牙根根管发育不完整或根外吸收的情况 下，可以全部用MTA材料填充，也可分两步 填充，就是在根尖部填充MTA材料，剩下的部 分用牙胶和密封材料（目前应用得最多的是热 塑性牙胶） [D’Arcangelo 等在2007年报道]。 在我们的患者牙齿中，整个根管中都填充了 MTA材料，因为该患者的牙根(和根管)非常 短，并且牙根壁也很薄。由于牙冠和牙根比例 的不利性，后来的口腔修复（桩核冠）被排 DOCTOR牙医 Infodent International •2 2018

27

SCIENTIFIC UPDATE

三氧化矿物骨料在治疗根尖开口并伴有牙周内切病变恒牙中的应用一个病例报告

除。通过用光固化复合法来增强牙齿组织的方 法修复了冠内的空洞和牙根顶部。 在根管的一部分或整个根管被填充MTA材料 后，要求进行影像检查并跟进后期随访。由于 MTA材料中有20%的含量为氧化铋，所以具有 不投射性[Song 等在 2006年报道]。 结论 综上所述，在牙根发育不完整并且根外部有 再吸收现象还伴有根尖周炎和牙周病变的非活 髓牙中运用MTA材料是个有效的治疗方法，从 而使牙齿以一个良好的状态保留在口腔内，并 且愈合了骨及牙周组织中的炎症病变。可以实 现短期治疗也是MTA材料的一个附加优点。

参考文献 › Al-Kahtani A, Shostad S, Schifferle R, Bhambhani S. In vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices. J Endod 2005; 31:117-119. › Andreasen JO, Farik B, Munksgaard EC. Long-term calciumhydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol 2002; 18: 134-137. › D’Arcangelo C, D’Amario M, L’Aquila Ch. Use of MTA for orthograde obturation of nonvital teeth with open apices: raport of two cases. Oral Surg Oral Med Oral Pathol 2007; 104: e98-e101. › Dominguez M, Munoz L, Aznar MT. Study of calcium hydroxide apexification in 26 young permanent incisors.

Dent Traumatol 2005; 21:141-145. › Felippe MC, Felippe WT, Marques MM, Antoniazzi JH. The effect of renewal of calcium hydroxide paste on the a exification and periapical healing of teeth with incomplete root formation. Int Endod J 2005; 38: 436-442. › Ferk S, Simeon P, Matijevi J, Prpi M, Ani I, Juki K. Antibacterial Effect of Mineral Trioxide Aggregate and Amalgam.

Acta Stomatol Croat 2011; 45: 8-12. › Guven G, Cehreli ZC, Ural A, Serdar MA, Basak F. Effect of mineral trioxide aggregate cements on transforming growth factor beta1 and bone morphogenetic protein production by human fibroblasts in vitro. J Endod 2007; 33: 447–50. › Hakki SS, Bozkurt SB, Hakki EE, Belli S. Effects of mineral trioxide aggregate on cell survival, gene expression associated with mineralized tissues, and biomineralization of cementoblasts. J Endod 2009; 35:513-519. › Hakki SS, Bozkurt SB, Ozcopur B, Purali N, Belli S. Periodontal ligament fibroblast response to root perforations restored with different materials: a laboratory study. Int Endod J 2012; 45: 240-248. › Hayashi M, Shimizu A, Ebisu S. MTA for Obturation of Mandibular Central Incisors with Open Apices: Case Report. J Endod 2004; 30: 120-122. › Katsamakis S, Slot DE, Van der Sluis LWM, Van der Weijden F. Histological response of the periodontium to MTA: a systematic review. J Clin Periodontol 2013; 40: 334-344.

28

DOCTOR牙医 Infodent International •2 2018

› Kottoor J, Velmurugan N. Revascularization for a necrotic immature permanent lateral incisor: a case report and literature review. Int J Paediatr Dent 2013; 23: 310–316. › Lin CP, Chen YJ, Lee YL, Wang JS, Chang MC, Lan WH, Chang HH, Chao WM, Tai TF, Lee MY, Lin BR, Jeng JH. Effects of root-end filling materials and eugenol on mitochondrial dehydrogenase activity and cytotoxicity to human periodontal ligament fibroblasts. J Biomed Mater Res B Appl Biomater 2004;71:429–440. › Parirokh M, Torabinejad M. Mineral Trioxide Aggregate: A Comprehensive Literature Review—Part III: Clinical Applications, Drawbacks, and Mechanism of Action. J Endod 2010; 36: 400-413. › Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: a review of the literature. Dent Mater 2008; 24: 149–64. › da Silva WJ, Souza PH, Ribeiro EA. Mineral trioxide aggregate as root canal filing material: comparative study of physical properties. Rev Odonto Ciênc 2010, 25: 386-390. › Simon S, Rilliard F, Berdal A, Machtou P. The use of mineraltrioxide aggregate in one-visit apexification treatment: a prospective study. Int Endod J 2007; 40: 186-97. › Song JS, Mante FK, Romanow WJ, Synnkcung K. Chemical analysis of powder and set forms of Portland cement, gray ProRoot MTA, white ProRoot MTA, and grey MTA-Angelus.

Oral Surg Oral Med Oral Pathol 2006; 102: 809-815. › Srinivasan V, Waterhouse P, Whitworth J. Mineral Trioxide Aggregate in paediatric dentistry. J Clin Pediatr Dent 2009; 19: 34–47 › Tang HM, Torabinajed M, Kettering JD. Leakage evaluation of root end filling materials using endotoxin. J Endod 2002; 28: 5-7. › Torabinejad M, Hong CU, McDonald F, Pitt Ford TR. Physical and chemical properties of a new root-end filling material. J Endod 1995; 21: 349–353. › Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR. Dye leakage of four root end filling materials: effects of blood contamination. J Endod 1994; 20: 159-163.

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SCIENTIFIC UPDATE Marginal bone level around conical connection tapered implants with platform switching

Author

J. EKSTEIN1, M.TANDELICH1, J. NART2, J.L. CALVO GUIRADO3, L. SHAPIRA4 1 Department Of Periodontology, The Hebrew University – Hadassah Faculty Of Dental Medicine, Jerusalem, Israel 2 Department Of Periodontology, International University Of Cataluña, Barcelona, Spain 3 Department Of General And Implant Dentistry, Faculty Of Medicine And Dentistry, University Of Murcia, Spain 4 Professor And Chair Department Of Periodontology The Hebrew University – Hadassah Faculty Of Dental Medicine, Jerusalem, Israel KEY WORDS

Bone loss; conical connection; platfom switching; tapered implants

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Marginal bone level around conical connection tapered implants with platform switching: A multicenter retrospective study at 14 months follow-up TO CITE IN THIS ARTICLE: Ekstein J, Tandelich M, Nart J, Calvo Guirado Jl, Shapira L Marginal Bone Level Around Conical Connection Tapered Implants With Platform Switching: A Multicenter Retrospective Study At 14 Months Follow-Up. J Osseointegr 2016;8(1):3-7.

ABSTRACT Aim The long-term success of dental implants mainly depends on marginal bone stability around the fixtures.

The development of prosthetic abutments with reduced width in relation to the implant prosthetic platform (platform switching) and/or tighter implant/abutment connections seem to have a potential in reducing crestal bone resorption. The aim of the present study was to examine the effect of platform switching and conical connection design, on marginal bone loss around newly designed dental implants.

Materials and Methods Subjects who underwent implant therapy in three different centers, were enrolled in the present retrospective study. Patients were rehabilitated with tapered platform-switched dental implants. To evaluate marginal bone level changes over time, the mesial and distal bone height was radiographically evaluated on the day of implant placement (baseline) and 14 months post-implantation.

Results One hundred and twelve conical tapered platform-switched implants were placed in three different centers in 37 patients, with mean age of 53 years. The survival rate was 100% after an average follow-up of 14 months. During the first year, marginal bone loss was 0.67±0.45mm. No statistically significant differences were recorded between the different centers.

Conclusions Within the limitations of the present retrospective study, limited marginal bone loss and 100% implant survival rate were observed over 14 months of follow-up.The results showed high crestal bone stability around the newly designed conical tapered platform-switched implants.

INTRODUCTION

The successful replacement of lost natural teeth by osseointegrated implants is a major advance in clinical dental treatment. Implant therapy has made a substantial improvement in terms of survival rate. Nowadays, dental implants report a high survival rate: on average, only 2.5% of all implants placed are lost before loading, and after the prosthetic reconstruction the failure rate varies between 0.5 – 1.3% per year (1). Therefore, the main focus of the dental community today is on the success rate of the dental implant and the stability of the results. The long-term success of endosseous implants depends mainly on the preservation of bone support.

Indeed, maintenance of osseointegration and stability in marginal bone level are imperative to this success.

Peri-implant marginal bone loss is influenced by many factors and by multiple phenomena (2). Those might include the surgical technique (3), implant positioning (4), tissue thickness (5), the presence of a micro-gap (6) at the implant-abutment interface (7), and the implant

DOCTOR牙医 Infodent International •2 2018

design (8). All of them can also influence the stability of the marginal bone crest. The criteria to define success in implant dentistry are under constant debate, but the achievement and maintenance of osseointegration are recognized as crucial factors, and marginal bone loss (MBL) is therefore a key consideration. The ubiquitous loss of up to 2 mm of bone around implant neck during the first year after functional loading has widely been considered acceptable by the dental community and has even been considered a successful outcome in some classifications and consensus statements (9,10). However, tissue stability is expected at one year after placement, and a loss of more than 0.2 mm per year is regarded as undesirable (9). Other Authors have claimed that a marginal bone loss of 1.5 mm in the first year (11), 1.8 mm (12), or 1.5–2 mm (13) represents a good outcome. A MBL of less than three threads has also been proposed as a success criterion (14,15), despite the variability in inter-thread distances among different implant systems. Implant design concepts to diminish crestal bone loss have been

developed and embedded in dental implant structure.

The development of prosthetic abutments with reduced width in relation to the implant prosthetic platform (platform switching concept), and an internal conical implant-abutment connection, seem to have a potential in reducing crestal bone resorption. Implants with platform switching show a lesser crestal bone loss, improved crestal bone preservation and lead to controlled biological space reposition and to stable aesthetic outcomes (16). A recent meta-analysis revealed significantly less bone loss around implants with a platform switching configuration compared with the standard platform matching implant-abutment design (17).

The aim of the present retrospective study was to examine the effect of a newly designed conical tapered platform-switched implant on the marginal bone level over 14 months of follow-up.

MATERIALS AND METHODS

Data collection In the present retrospective observational study were enrolled patients who underwent implant therapy in three different centers: one in Jerusalem (Israel) (LSresearch supervisor), one in Barcelona (Spain) (JN research supervisor) and one in Murcia (Spain) (JG research supervisor). All subjects were treated with tapered dental implants, with internal conical implantabutment connection and a built-in platform switching (MIS C1 Conical Connection, MIS, Israel).

Inclusion and exclusion criteria Patients were included in the study according to the following criteria: 1. implant placement performed at least three months after tooth extraction; 2. medical history without any contraindications to implant therapy; 3. pre-existing bone, radiographically examined by a CT scan, adequate to allow the placement of at least 3.75-mm-diameter and 10-mm-long implants with a potential minor horizontal bone augmentation.

Exclusion criteria were: 1. subjects with systemic diseases such as diabetes; 2. pregnant and lactating subjects; 3. subjects with habit of severe bruxism or clenching; 4. subjects treated with radiation to the head within the past 12 months; 5. subjects treated with bisphosphonate within the past 12 months; 6. subjects smoking more than 10 cigarettes/day.

Surgical procedure All surgeries were performed by three practitioners: 2 periodontists (LS and JN) and one oral surgeon (JG).

All surgeries were performed under local anesthesia, and with antibiotic premedication of 2 g of amoxicillin (Moxypen, Teva, Israel and Actimoxi, Clariana, Spain).

The antibiotic medication was continued, 500 mg 3 times a day, for up to 5 days. In cases where bone was

missing around the implant’s neck, a GBR (Guided Bone Regeneration) procedure was performed using a xenograft bone substitute (Osteobiol® GenOs, Tecnoss, Torino, Italy) and a collagen membrane (Osteobiol® Evolution, Tecnoss, Torino, Italy). The patients were instructed with oral hygiene, and rinsing with 0.2% chlorhexidine solution twice a day until suture removal, starting the day of surgery.

Patients were instructed with analgesic medications post-surgery as needed. Suture removal took place 7-10 days post-surgery. All implants were placed in a submerged protocol; they were reentered and exposed by elevating a mini full-thickness flap 2-4 months after implant installation. At least 2 weeks later, the implants were loaded. Following the prosthetic reconstruction, the patients were seen at least every 6 months for professional plaque control by a dental hygienist and for follow-up appointments by the prosthodontist.

Radiographic examination and evaluation All implants were examined by means of radiographs taken immediately after implants placement (time point 0: T0, baseline) and radiographs obtained on average fourteen months post-implantation (time point 1: T1).

The radiographs were both intraoral periapical ones, obtained using the parallel technique with film holders, or panoramics (Gendex, Hatfield, PA, USA); a digital intraoral imaging system was used (Digora phosphor plate reader, Soredex Tuusula, Finland). All the X-rays were scanned and uploaded into the computer in order to assess marginal bone level changes over time. The measurements were taken on the computer screen using the “ImageJ” software (http://rsbweb. nih.gov/ij/download.html). Only the vertical periimplant bone level was assessed; this was defined as the vertical distance between a reference point at the implant shoulder and the most coronal bone-implant contact (Fig. 1).

Changes in marginal bone level were expressed as differences in the measured values on radiographs (T1-T0=∆IBL). Marginal bone loss was calculated by multiplying the actual implant length with the bone loss from a constant referral point of the implant-abutment connection (∆IBL), all divided with the implant length measured on the x-rays.

Fig. 1 Measurement of the vertical peri-implant bone level, obtained as the vertical distance between a reference point at the implant shoulder and the most coronal boneimplant contact.

Fig.1

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SCIENTIFIC UPDATE Marginal bone level around conical connection tapered implants with platform switching

Table 1 The ∆IBL + SD (standard deviation) in the three different centers.

No statistical difference between the three centers.

LS, Lior Shapira; JN , Jose Nart; JG, José Guirado.

Fig 2 Comparison between the three different centers regarding the ∆IBL. No statistical difference was found. LS, Lior Shapira; JN , Jose Nart; JG, José Guirado; SE , Standard error; SD, Standard deviation.

Table 2 ∆IBL+SD (standard deviation) for gender and smoking (<10 cigarettes/day). No statistical difference between the groups.

The calculating equation was as follows:

Marginal bone loss = Actual implant length X (∆IBL)

Implant length on x-ray

The radiographic measurements were independently performed by a blinded periodontist, experienced with oral radiology (MT).

implants. The mean age of the patients was 53±13 years (range 29-79); ten of them were smokers (<10 cigarettes/day). Thirty implants were placed in 18 patients by LS, 36 in 7 patients by JG, and 36 in 12 patients by JN. Forty-nine implants were placed in the maxilla, while 63 in the mandible; 54 implants had “regular diameters” of 3.75 mm and 44 implants of 4.2 mm, whereas 14 implants were considered as “wide” implants (5 mm in diameter). Considering the implants’ length, 28 were 13 mm long, 51 were 11.5 mm long, 29 were 10 mm long, and 4 were 8 mm long.

Statistical methods The primary outcome variable was ∆IBL. The hypothesis tested was that the average ∆IBL values would be significantly smaller than those accepted in the literature. For statistical analysis STATISTICA v7.0 software (StatSoft, Inc.;Tulsa, OK) was used. Descriptive statistics were used to explore the demographic data of the patients. Bi-nominal patient and implant descriptive variables were defined (such as smoking, center of treatment, follow-up x-ray, etc.). T-test was utilized to describe the amount of MBL found between groups of each describing variable. Data analysis was done based on the patient mean MBL and on each implant MBL. For all statistical analysis, a P value of <0.05 indicated statistical significance.

The implants were restored with porcelain crowns up to six months from the day of implantation. None of the implants failed during the study, resulting in a survival rate of 100% after one year. Paired t test and non-parametric signed t test for paired samples showed no difference between the MBL on the mesial and on the distal aspect of the implants.

The marginal bone loss from baseline to 14 months was 0.67±0.45 mm. There was no statistical difference in the measured MBL between the three centers (Table 1, Fig. 2).

RESULTS A total of 37 subjects (20 males and 17 females) were treated with 112 conical tapered platform-switched

Surgical sequence and outcome As an example, figures 3 to 10 illustrate a case treated by LS (Jerusalem center, Israel).

CENTER

LS

JG

∆IBL

0.79±0.5

0.56±0.4

JN 0.67±0.2

AVERAGE 0.67±0.45

No difference was found in marginal bone loss between male and female, and between smokers and non-smokers (Table 2).

Fig.3

Fig.4

MALE/FEMALE ∆IBL

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0.62±0.3/0.8±0.48

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SMOKER/NON SMOKER 0.54±0.33/0.77±0.41

DISCUSSION The results of the present study demonstrated limited bone level changes within the first year after implant installation. The bone loss measured around the implant neck was clinically significantly smaller than the implant success criteria of 2 mm (9, 10). The crestal bone resorption is often related to the microgap at the interface between the implant and the abutment, mainly when it is close to the surrounding bone (9, 18). This gap facilitates bacterial infiltration and colonization close to the crestal bone, causing an inflammatory process which results in bone resorption (19). Therefore, the prevention of microbial leakage at the implant-abutment connection is a major challenge for the construction of modern two-stage implant systems. The preservation of peri-implant bone is a major factor in the long-term prognosis of prosthetic rehabilitations supported by implants. The crestal

bone loss can lead to the collapse of soft tissues and adversely affect the aesthetics of the implantsupported prosthetic elements. The adverse effects of the micro-gap are greatly reduced with thicker residual bone, as the distance between the micro-gap and the crestal bone increases. Conical connections inherently keep the implant-abutment interface away from the crestal bone (a.k.a. platform switching or platform shifting), thus promoting better biologic and aesthetic results. Implants with platform switching show lesser crestal bone loss, improved crestal bone preservation, and lead to controlled biological space reposition. All of these features lead to stable aesthetic outcomes (20) and to “complications free” survival rates up to 20 years of follow up, for fixed restorations supported by conical connection implants (21). A recent metaanalysis revealed a significantly less mean bone loss around implants with a platform switching implantabutment configuration compared with the standard

Fig.5

Fig.6

Fig.7

Fig.8

Fig 3 Implants replacing teeth 24-25.

Fig. 4 Guided bone regeneration with a collagen membrane.

Fig. 5 Flaps are repositioned and sutured.

Fig. 6 Four months later- prior to stage 2 surgery – implant exposure.

Fig.9

Fig. 7 Exposure of implants – note new bone formation.

Fig.10

FIG. 8 Healing abutment and suturing.

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SCIENTIFIC UPDATE Marginal bone level around conical connection tapered implants with platform switching platform matching implant-abutment design (17). The internal conical implant-abutment connection is considered to be mechanically more stable and tighter than flat-to-flat connections or tube-in-tube connections (22). By minimizing micro-movements at that junction, bone loss at the crestal level is reduced (23). Load distribution is also more favorable around implants that possess conical connections, thereby preserving the marginal bone (22, 23, 24, 25). The conical connection design simplifies maintenance and ensures reliability in all clinical situations (26). These qualities, also possessed by the implant system used in the present study, result in a higher ability to preserve bone (22, 24, 26). Data from several implant manufacturers showed that different implant systems yielded different results with regard to bone level changes, but always better than 2 mm of bone loss, that was historically considered acceptable (27, 28, 29). A recent metaanalysis reported mean marginal bone level changes of 0.24 mm (Astra Tech Dental Implant System), 0.75 mm (Brånemark System), and 0.48 mm (Straumann Dental Implant System) after five years of follow-up, in comparison with bone levels at the time of prosthetic loading (29). These extraordinary stable results should raise the question whether or not a stricter success criteria regarding marginal bone loss should be developed, as the tested implants can provide significantly better results. In conclusion, within the limitations of the present retrospective study, a limited marginal bone loss and 100% implant survival rate were observed over 14-months of follow-up.

The results showed high crestal bone stability around the conical tapered platform-switched implants.

Disclosure The implants and prosthetic parts were kindly provided by MIS Implants (Israel) for 3 all centers. JN, JG and LS are ad-hoc consultants for the same Company. No other financial support was given to this follow-up study.

REFERENCES

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success. Int J Oral Maxillofac Implants 1986; 1: 11-25.

10. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P,Trisi P, Steigmann M, Rebaudi A, Palti A, Pikos MA, Schwartz-Arad D, Choukroun J, Gutierrez-Perez JL, Marenzi G, Valavanis DK. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 2008; 17: 5-15.

11. Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res 2012; 91: 242-248.

12. Roos-Jansaker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteenyear follow-up of implant treatment. Part II: presence of peri-implant lesions. J Clin Periodontol 2006; 33: 290-295.

13. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 2000; 71: 546-549.

14. Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects with progressive bone loss at implants. Clin Oral Implants Res 2005; 16: 440-446.

15. Qian J, Wennerberg A, Albrektsson T. Reasons for marginal bone loss around oral implants. Clin Implant Dent Relat Res 2012; 14: 792-807.

16. Canullo L, Fedele GR, Iannello G, Jepsen S. Platform switching and marginal bone-level alterations: the results of a randomized-controlled trial. Clin Oral Implants Res 2010; 21: 115-121.

17. Strietzel FP, Neumann K, Hertel M. Impact of platform switching on marginal peri-implant bone-level changes. A systematic review and meta-analysis. Clin Oral Implants Res 2014.

18. Hermann JS, Cochran DL, Nummikoski PV, Buser D. Crestal bone changes around titanium implants. A radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol 1997; 68: 1117-1130.

19. Covani U, Marconcini S, Crespi R, Barone A. Bacterial plaque colonization around dental implant surfaces. Implant Dent 2006; 15: 298-304.

20. Cumbo C, Marigo L, Somma F, La Torre G, Minciacchi I, D’Addona A. Implant platform switching concept: a literature review. Eur Rev Med Pharmacol Sci 2013; 17: 392-397.

21. Mangano C, Iaculli F, Piattelli A, Mangano F. Fixed restorations supported by Morse-taper connection implants: a retrospective clinical study with 10-20 years of follow-up. Clin Oral Implants Res 2015; 26: 1229-1236.

22. Yamanishi Y, Yamaguchi S, Imazato S, Nakano T, Yatani H. Influences of implant neck design and implant-abutment joint type on peri-implant bone stress and abutment micromovement: three-dimensional finite element analysis. Dent Mater 2012; 28: 1126-1133.

23. Pessoa RS, Muraru L, Junior EM, Vaz LG, Sloten JV, Duyck J, Jaecques SV. Influence of implant connection type on the biomechanical environment of immediately placed implants - CT-based nonlinear, three-dimensional finite element analysis. Clin Implant Dent Relat Res 2010; 12: 219-234.

24. Sannino G, Barlattani A. Mechanical evaluation of an implant-abutment self-locking taper connection: finite element analysis and experimental tests. Int J Oral Maxillofac Implants 2013; 28: e17-26.

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SCIENTIFIC UPDATE

Author

J. EKSTEIN1, M.TANDELICH1, J. NART2, J.L. CALVO GUIRADO3, L. SHAPIRA4 1 以色列耶路撒冷希

伯来大学口腔医学系 牙周病科 2 西班牙巴塞罗那加 泰罗尼亚国际大学牙 周病科 3 西班牙穆尔西亚大 学医学牙科学系一般 牙科和种植科 4 以色列耶路撒冷希 伯来大学哈达撒牙科 学系特聘教授

具有平台转换装置的锥形种植体周围的边缘骨水平：一个随访了14个月的多诊所合作回顾性研究

具有平台转换装置的锥形 种植体周围的边缘骨水 平：一个随访了14个月的 多诊所合作回顾性研究 文章引自 Ekstein J, Tandelich M, Nart J, Calvo Guirado Jl, Shapira L Marginal Bone Level Around Conical Connection Tapered Implants With Platform Switching: A Multicenter Retrospective Study At 14 Months Follow-Up. J Osseointegr 2016;8(1):3-7.

摘要 目的牙科种植体要获得长期的成功，主要取决于种植体周围边缘骨的稳定性，义齿基台相对 种植体平台（平台转换）缩窄和/或加紧种植体和基台的连接，似乎对减小牙槽骨的吸收有潜 在的作用。本次研究的目的在于分析平台转换和锥形链接设计对最新设计的种植体周围边缘 骨流失情况的影响。 材料和方法在三个不同的牙科诊所里接受了种植治疗的研究对象被纳入本次回顾性研究。患 者们接受了植入锥形平台转换连接装置的种植体。在接受治疗后对边缘骨水平的变化进行评 估，在植入种植体的当天（测量基线） 和种植后14个月时用X线片估量了近中和远端骨的高度。 结果112个锥形平台转换连接种植体被植入三个中心的37个患者口腔内，患者平均年龄 为53岁。平均随访14个月后，种植体的成活率为100%。在第1年中边缘骨的流失量为 0.67±0.45mm。 三个不同中心的受试者记录之间没有明显的统计学差异。 结论根据本回顾性研究，经过14个月的随访，我们观察到了有限的边缘骨流失和100%的成活 率。结果表明，最新设计的具有平台转换装置的锥形种植体周围的牙槽骨有很好的稳定性。 引言 在临床牙科治疗中，成功地用骨整合种植体来 替补丢失的自然牙是一个很大的进步，植入疗 法在成活率方面取得了显著的改进。如今，牙 齿种植体的报道成活率都很高：一般来讲，只 有2.5%的种植体在义齿加载之前丢失，假牙修 复后，每年的平均失败率在0.5-1.3%之间（1）。 因此，今天的牙科界主要专注于种植体的成活 率和结果的稳定性上。骨内种植能否取得长久 的成功主要取决于支持骨的保存情况。事实 上，保持边缘骨水平的骨整合和稳定性对种植 成功是必不可少的。 种植体周围骨边缘损失会受到很多因素和现象 的影响（2), 这些可能包括外科手术（3), 植入 物的定位（4), 牙周组织的厚度（5), 在种植体 基台的连接处有很小的间隙（6), 种植体的设计 （8) 等等等。所有这些都有可能影响边缘骨嵴 的稳定性。

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定义种植牙成功的标准还有待讨论，但取得并 维护良好的骨整合是被公认的关键因素，因此 边缘骨的流失是一个很关键的因素。 功能加载后的一年内，种植体颈部周围的牙 槽骨不可避免的流失在小于2mm的牙槽骨的 情况，在牙科界被认为是可以接受的；在一些 个别的共识声明中甚至认为是一个圆满的结 果（9，10)。但是牙龈组织的预见稳定性应该 维持到放入种植体一年以后，并且如果每年 流失的量要是超过0.2mm的话，算是不乐观的 情况（9)。但是，也有一些作者声称第一年的 边缘骨流失量在1.5mm(11),1.8mm(12),或者1.52mm(13)可以算作是个满意的结果。尽管不同 系统的植入物之间的线程有一定的可变性，小 于3个线程的变化也被认为是个成功的标准。 以减少牙槽骨损失为设计理念而设计的种植体 已经被研发出来，并融合在种植体的结构之 中。义齿基台相对种植体平台（转换平台）缩 窄和/或加紧种植体和基台的连接，似乎对减

小牙槽骨的吸收有潜在的作用。平台转换连接 装置种植体的使用显示出更少的牙槽骨损失， 提高了牙槽骨的保存，并导致控制生物空间的 吸收和稳定的审美结果（16)。最近的一项汇总 分析显示，与标准的种植体基台配置的种植体 设计相比，平台转换装置的种植体周围骨流失 量明显地减少（17)。 本次研究的目的在于分析平台转换和锥形链接 设计对最新设计的种植体周围边缘骨的流失情 况的影响。

材料和方法 数据的收集 本次回顾性观察研究中的患者所接受治疗的 中心：其中一个在以色列的耶路撒冷（由LS 担任研究主管), 另外一个在西班牙的巴塞罗 那（由JN担任研究主管), 还有一个在西班牙 的穆尔西亚（由JG担任研究主管)。所有受 试者的口腔均用锥形种植体，里边用锥形种 植体基台链接和一个平台转换装置（MISC锥 形链接系列种植体由以色列MIS公司提供)。 入选和排除标准 受试患者是根据以下几条标准筛选出来： 1. 拔牙后最少三个月以上才载入种植体 2. 无任何妨碍植入治疗的病史 3. 通过CT扫描和X线检查，残留骨应该允许 植入至少直径3.75mm和10mm长的种植体。 和次水平骨增量的潜能。 排除标准为： 1.全身性疾病患者，如糖尿病患者 2.孕期和哺乳期患者 3.有严重的夜磨牙和咬牙习惯者 4.在过去的12个月接受过头部放射治疗者 5.在过去的12个月内接受过双磷酸盐治疗者 6.每日吸烟超过10支的患者

们接受口腔卫生指导，并用0.2%的氯己定溶液 每天冲洗2次，从手术单天开始到缝合线拆除 为止。根据需要给患者术后止疼用药指示。手 术后7-10天后拆除缝合线。所有的种植体都通 过浸入式放置；在安装完种植体之后的2至4个 月时，通过翻起一小瓣牙周组织使其暴露并再 次安装。至少2周之后，种植体已被装载，根 据修复指南，装载之后，所有患者至少每6个 月就需要接受一个专业牙科医师的菌斑控制检 查。

X线检查和评估 所有种植体在植入后立即用X线片检查（时间 点1：T0 基线), 在种植后的平均时间为14个月 时又做了一次X线片检查(时间点1：T1)。通过 对胶片架或全景进行并行计算技术，我们获得 了包括口腔和根尖的X线片（美国产Gendex全 景X线摄影机); 使用了一个口内数字成像系统 （芬兰图苏拉的Soredex公司的Digora荧光板读 数器)。用”ImageJ”软件在电脑上采集了所有的 尺寸。只对种植体周围的垂直骨层次进行了评 估；这个尺寸是种植体的颈部至种植体圆底部 与骨接触点之间的垂直距离(图1)。

图1

种植体周围垂直骨水 平尺寸，是种植体 的颈部到种植体圆 底部与骨接触点之间 的距离

边缘骨水平在前后两个X线片上的测量值显示 出差异(T1-T0= ∆IBL)。边缘骨的流失量是通过 相乘实际种植体长度和复诊时的恒定点至种植 体基台链接处的距离 (∆IBL)，最后除以在X线片 上测量所得的种植体长度。 计算公式如下: 边缘骨流失量= 种植体实际长度X (∆IBL) X线片上测量出的种植体长度

X线片的测量由一个在口腔放射方面有丰富经 验且对本研究不知情的牙周病医师完成(MT)。

手术过程 所有手术均由三个医务人员执行：两个牙周 医师(LS和JN)和一个口腔外科医生（JG）。所 有手术均在局部麻醉状态下完成，并在术前 用2克的阿莫西灵抗生素（以色列Teva公司的 Moxypen, 西班牙Clariana公司的Actimoxi)。 手术结束后，使患者继续服用抗生素，一日3 次，每次500毫克，服用5天。在种植体颈部周 围骨遗失的病例中，用异种骨（意大利都灵 Tecnoss公司的Osteobiol® Gen-Os）和胶原膜 （意大利都灵Tecnoss公司的Osteobiol® Evolution）代替的方法进行了引导骨再生术，患者

Fig.1

DOCTOR牙医 Infodent International •2 2018

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SCIENTIFIC UPDATE 具有平台转换装置的锥形种植体周围的边缘骨水平：一个随访了14个月的多诊所合作回顾性研究

表一

三个中心的∆IBL + SD（标准偏差）值没 有统计差异 LS,代表Lior Shapira; JN ,代表Jose Nart; JG 代表José Guirado. 图2

关于 ∆IBL，三个中 心的结果对比没有统 计差异LS,为人名 Lior Shapira的缩写; JN 为 Jose Nart的缩写; JG为 José Guirado的缩写; SE 代表标准误差; SD 代表标准偏差

表2

根据性别和吸烟情况 分组做出的∆IBL+SD（标准偏差）值没 有统计差异

统计方法 主要结果的变量是 ∆IBL，本次测试的假设命题 为，这些变量是否会低于那些已在一些文献中 被接受的变量。 在统计分析过程中使用了STATISTICA v7.0软 件（美国塔尔萨StatSoft 软件公司），用描述 性统计法来探索患者的统计数据，定义了双向 性患者和种植的描述性变量（如是否吸烟、受 诊诊所、后继的X线片等）。 用T检验法描述了每个被描述的小组之间出现 的MBL量。基于患者的平均MBL量和每个种植 体的MBL量来完成数据分析。 在所有的统计分析中，一个P值为<0.05表示统 计差异。

29根的长度为10mm，还有4根的长度为8mm. 从种植第一天起至六个月的时间里，所有的种 植体都有一个烤瓷冠。 在整个研究过程中，没有种植体出现种植失败 现象，一年后的结果是成活率为100%。 通过配对T检验和非参数T检验配对样品，显示 出近中的种植体近中和远端的表面MBL量没有 差异。 从基线到14个月时边缘骨的流失量为0.67±0.45 mm，三个中心所测量到的MBL值之间没有显 著性差异（表1，图2） 在男性患者和女性患者之间没有边缘骨流失量 的差异，吸烟者和非吸烟者之间的边缘骨流失 量也没有差异（表2）。

结果 一共在37个（20个男性和17个女性）研究对象 的口腔内植入了112根锥形平台转换链接装置 的种植体，患者平均年龄为53±13岁（从29岁 到79岁）；其中10个患者为吸烟患者（每日吸 烟量为少于10支），有30根种植体被LS植入18 个患者的口腔内，有36根种植体被LG植入7个 患者的口中，36根种植体被JN植入12个患者的 口中。其中49根种植体被种植在上颌骨中，其 他的63根种植体被种植在下颌骨中；有54根种 植体有常规直径为3.75mm，44根种植体的直径 为4.2mm,而其他的14根种植体被认为是属于宽 种植体（5mm的直径）。至于长度，其中有28 根的长度为13mm,有51根的长度为11.5mm，有

手术顺序和结果 图3至图10是一个由LS治疗的病例图片(以色列 耶路撒冷的牙科中心)。

CENTER

LS

JG

∆IBL

0.79±0.5

0.56±0.4

JN 0.67±0.2

AVERAGE 0.67±0.45

讨论 本次研究的结果表明，种植体装载一年之内 出现有限的骨水平变化。从临床意义上讲， 从种植体周围骨测量到的骨流失量明显地小 于2毫米的种植成功标准（9,10)。牙槽骨的吸 收经常与种植体和基台交接处存在微小间隙 有关，尤其是当这个微小间隙靠近周围骨时 (9,8)。这个小间隙促进了细菌的渗透并向接近 牙槽骨的地方扩张，引发牙槽骨炎症，最后

Fig.3

Fig.4

MALE/FEMALE ∆IBL

38

0.62±0.3/0.8±0.48

DOCTOR牙医 Infodent International •2 2018

SMOKER/NON SMOKER 0.54±0.33/0.77±0.41

导致骨吸收（19）。因此，在种植体的交接处 预防细菌渗透是现代两阶段式种植体生产中的 主要挑战。保存种植体周围的骨，是保证种植 体支撑的修复牙愈后效果的主要因素，牙槽骨 的散失可能导致软组织的崩塌，并对种植体支 撑的修复牙产生不利的影响；较厚的剩余骨可 以大大地降低微小间隙的不利影响，是因为微 小间隙和牙槽骨之间的距离会因剩余骨的厚度 的增加而增加。锥形链接的种植体可以保持自 身的基台界面（又名平台转换或交换）与牙槽 骨的距离，因此促进改善生物学和美学效果。 平台转换装置的种植体显示出更小的牙槽骨损 失，提高牙槽骨的保存，并能够控制生物空间 的重新定位，所有这些特点促成了稳定的美学 效果（20）。并保证无并发症，存活率高，20年 之间可以用一个种植体来装载修复义齿（21)。 最近的一项汇总分析表明，于标准的基台配置 种植体相比，平台转换装置的种植体周围骨流

失量明显地减少（17）。人们认为内部为锥形 结构的种植体基台的链接从机械角度来讲更加 稳固，它比平面对平面和管中管式的链接更紧 密（22）。通过最小化交接处的微小移动减少 了牙槽骨平面骨的流失（23）。有锥形链接装 置的种植体的周围还有利于负载的分部，从而 能够更好地保留边缘骨（22，23，24，25）。 锥形链接设计简化维护，并确保所有临床情况 下的可靠性（26）。此次研究中所用的种植体 也都具备这些优点，所以导致了更好的骨保存 能力（22，24，26）。 来自一些种植体制造商的数据表明，用不同系 统的种植体产生不同的于骨水平变化结果，但 骨损失量总是少于2毫米，而2毫米的骨流失量 在种植史上被认为是可以接受的（27, 28, 29) 。 一个最近的汇总分析报告指出，经过5年的随 访，于义齿装载时的于骨水平相比，不同种 植体的骨损失量如下：（Astra tech dental im-

Fig.5

Fig.6

Fig.7

Fig.8

图 3 种植体代替了牙

齿的位置

图 4 用胶原膜引导骨

再生

图 5 翻起的组织瓣被 放回原处并被缝合 图 6 四个月后的第 二部手术进行种植体 暴露 图 7 种植体暴露时发

Fig.9

现有新骨形成

图 8 愈合基台并缝合

Fig.10

DOCTOR牙医 Infodent International •2 2018

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SCIENTIFIC UPDATE 具有平台转换装置的锥形种植体周围的边缘骨水平：一个随访了14个月的多诊所合作回顾性研究

plant）种植体的平均边缘骨水平变化值为0.24毫米，(Branemark system)种植体的变化值为0.75毫米、(Stramann dentalimplant system)为0.48毫米（29）。从这些显著的稳定结果 来看，我们应该提出一个问题：如果试验中的种植可以提 供更好的结果的话，是否应该制定一个更加严格的关于种 植成功的标准。 通过本次回顾性研究，在14个月的随访后，观察到了有限 的边缘骨流失和100%的种植体成活率。这个结果显示了有 平台转换装置的锥形种植体周围牙槽骨有更好的稳定性。

申明 承蒙以色列的MIS Implants公司提供了3个中心中所用的种 植体和义齿，JN 、JG和LS都是以上公司的特聘顾问。 在本次研究中没有得到来自其它方面和其他形式的经济支 持。 参考文献 1. Holm-Pedersen P, Lang NP, Muller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res 2007; 18 Suppl 3: 15-19.

2. Albrektsson T, Buser D, Sennerby L. On crestal/marginal bone loss around dental implants. Int J Oral Maxillofac Implants 2012; 27: 736-738.

3. Barros R, Novaes AJ, Papalexiou V. Buccal bone remodeling after immediate implantation with a flap or flapless approach: A pilot study in dogs. Titanium 2009; 1: 25-51.

4. Caneva M, Botticelli D, Rossi F, Cardoso LC, Pantani F, Lang NP. Influence of implants with different sizes and configurations installed immediately into extraction sockets on peri-implant hard and soft tissues: an experimental study in dogs. Clin Oral Implants Res 2012; 23: 396-401.

5. Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996; 23: 971-973.

6. Dias EC, Bisognin ED, Harari ND, Machado SJ, da Silva CP, Soares GD, Vidigal GM, Jr. Evaluation of implant-abutment microgap and bacterial leakage in five external-hex implant systems: an in vitro study. Int J Oral Maxillofac Implants 2012; 27: 346-351.

7. Broggini N, McManus LM, Hermann JS, Medina RU, Oates TW, Schenk RK, Buser D, Mellonig JT, Cochran DL. Persistent acute inflammation at the implant-abutment interface. J Dent Res 2003; 82: 232-237.

8. Shin YK, Han CH, Heo SJ, Kim S, Chun HJ. Radiographic evaluation of marginal bone level around implants with different neck designs after 1 year. Int J Oral Maxillofac Implants 2006; 21: 789-794.

9. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986; 1: 11-25.

10. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P,Trisi P, Steigmann M, Rebaudi A, Palti A, Pikos MA, Schwartz-Arad D, Choukroun J, Gutierrez-Perez JL, Marenzi G, Valavanis DK. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 2008; 17: 5-15.

11. Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res 2012; 91: 242-248.

12. Roos-Jansaker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteenyear follow-up of implant treatment. Part II: presence of peri-implant lesions. J Clin Periodontol 2006; 33: 290-295.

13. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 2000; 71: 546-549.

14. Fransson C, Lekholm U, Jemt T, Berglundh T. Prevalence of subjects

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with progressive bone loss at implants. Clin Oral Implants Res 2005; 16: 440-446.

15. Qian J, Wennerberg A, Albrektsson T. Reasons for marginal bone loss around oral implants. Clin Implant Dent Relat Res 2012; 14: 792-807.

16. Canullo L, Fedele GR, Iannello G, Jepsen S. Platform switching and marginal bone-level alterations: the results of a randomized-controlled trial. Clin Oral Implants Res 2010; 21: 115-121.

17. Strietzel FP, Neumann K, Hertel M. Impact of platform switching on marginal peri-implant bone-level changes. A systematic review and meta-analysis. Clin Oral Implants Res 2014.

18. Hermann JS, Cochran DL, Nummikoski PV, Buser D. Crestal bone changes around titanium implants. A radiographic evaluation of unloaded nonsubmerged and submerged implants in the canine mandible. J Periodontol 1997; 68: 1117-1130.

19. Covani U, Marconcini S, Crespi R, Barone A. Bacterial plaque colonization around dental implant surfaces. Implant Dent 2006; 15: 298-304.

20. Cumbo C, Marigo L, Somma F, La Torre G, Minciacchi I, D’Addona A. Implant platform switching concept: a literature review. Eur Rev Med Pharmacol Sci 2013; 17: 392-397.

21. Mangano C, Iaculli F, Piattelli A, Mangano F. Fixed restorations supported by Morse-taper connection implants: a retrospective clinical study with 10-20 years of follow-up. Clin Oral Implants Res 2015; 26: 1229-1236.

22. Yamanishi Y, Yamaguchi S, Imazato S, Nakano T, Yatani H. Influences of implant neck design and implant-abutment joint type on peri-implant bone stress and abutment micromovement: three-dimensional finite element analysis. Dent Mater 2012; 28: 1126-1133.

23. Pessoa RS, Muraru L, Junior EM, Vaz LG, Sloten JV, Duyck J, Jaecques SV. Influence of implant connection type on the biomechanical environment of immediately placed implants - CT-based nonlinear, three-dimensional finite element analysis. Clin Implant Dent Relat Res 2010; 12: 219-234.

24. Sannino G, Barlattani A. Mechanical evaluation of an implant-abutment self-locking taper connection: finite element analysis and experimental tests. Int J Oral Maxillofac Implants 2013; 28: e17-26.

25. Hansson S. Implant-abutment interface: biomechanical study of flat top versus conical. Clin Implant Dent Relat Res 2000; 2: 33-41.

26. do Nascimento C, Miani PK, Pedrazzi V, Goncalves RB, Ribeiro RF, Faria AC, Macedo AP, de Albuquerque RF, Jr. Leakage of saliva through the implant-abutment interface: in vitro evaluation of three different implant connections under unloaded and loaded conditions. Int J Oral Maxillofac Implants 2012; 27: 551-560.

27. Berglundh T, Abrahamsson I, Lindhe J. Bone reactions to longstanding functional load at implants: an experimental study in dogs. J Clin Periodontol 2005; 32: 925-932.

28. Engquist B, Astrand P, Dahlgren S, Engquist E, Feldmann H, Grondahl K. Marginal bone reaction to oral implants: a prospective comparative study of Astra Tech and Branemark System implants. Clin Oral Implants Res 2002; 13: 30-37.

29. Laurell L, Lundgren D. Marginal bone level changes at dental implants after 5 years in function: a meta-analysis. Clin Implant Dent Relat Res 2011; 13: 19-28.

C10 M72 Y0 K18

BUENOS AIRES 2018

C0 M10 Y95 K0

World Dental Congress

ITME M M O A PASSION FOR MANY, A C

NT

L AL R FO

CALENDAR 日历 TRADE-SHOWS AND CONFERENCES FOR DENTAL PRACTITIONERS

牙科技术会议及展览会

Calendar

AUGUST

Annual Congress on Endodontics and Prosthodontics

VIDEC 2018 The 11th Vietnam International Dental Exhibition & Congress

17-18 08 2018 Tokyo - Japan

22-24 08 2018 Hanoi - Vietnam

Venue: Radisson Hotel Narita 650-35 Nanae Tomisato-Shi Chiba,Japan 286-022

Organised by: Vietnam Odonto-Stomatology Association (VOSA) 40B Trangthi Street Hanoi Phone:+84 4 826 9723 Fax:+84 4 825 8882

endodontics.conferenceseries.com

Venue: Cultural Palace No. 91 Tran Hung Dao, Tran Hung Dao Dist.

Hanoi, Vietnam

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DOCTOR牙医 Infodent International •2 2018

AUGUST

SEPTEMBER

HK IDEAS 2018 Hong Kong International Dental Expo And Symposium

CDS - China Dental Show 2018 - The 20th CSA Annual Meeting

24-26 08 2018 Hong Kong - Hong Kong

29-08/01-09 2018 Shanghai - China

Organised by: Hong Kong Dental Association 8/F., Duke of Windsor Social Service Building 15 Hennessy Road, Wanchai Hong Kong Phone: +852 2528 5327 Fax: +852 2529 0755 Email: hkideas@hkda.org Website: www.hkda.org

Organized by: Chinese Stomatological Association (CSA) and Reed Sinopharm Exhibitions Co., Ltd. 15th Floor, Tower B, Ping An International Finance Center, No.1-3, Xinyuan South Road, Chaoyang District, Beijing, P.R. China Phone: +86 10 84556607 Website: www.reed-sinopharm.com

Venue: Hong Kong Convention and Exhibition Centre Hong Kong

www.hkideas.org

CDS SHOW TEAM Ms. Effy Zhao Phone: +86 010 8455 6622 Email: jingliang.zhao@reedsinopharm.com Venue: National Exhibition and Convention Center Shanghai, China

www.chinadentalshow.com

DOCTOR牙医 Infodent International •2 2018

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Calendar

SEPTEMBER

OCTOBER

IADR-SEA 2018 / SEAADE 2018 - 32nd Annual Scientific Meeting of the International Association for Dental Research South-East Asia Division / 29th Annual Meeting of the South -East Asian Association for Dental Education (SEAADE)

DenTech China 2018 The 22nd International Exhibition and Symposium on Dental Equipment Technology and Products

11-14/09/2018 Da Nang - Vietnam Organized by: Faculty of Odonto-stomatology, University of Medicine and Pharmacy at Ho Chi Minh City Address: No 652 Nguyen Trai, District 5, Ho Chi Minh City, Vietnam Phone: +84 28 38 554 208 Email: iadrseaade2018@gmail.com Website: iadr-seaade2018.com Venue: Furama Resort Da Nang Da Nang, Vietnam

www.iadr-seaade2018.com

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DOCTOR牙医 Infodent International •2 2018

31-10/03-11 2018 Shanghai - China UBM China (Shanghai) 9F, CIROS Plaza, No 388 Nanjing West Road, Huangpu Shanghai, 200003 China International Developing Manager: Sandra Shen Phone: +86 21 61573953 // +86 21 61573953 Email: sandra.shen@ubm.com Venue: Shanghai World Expo Exhibition and Convention Center Shanghai - China

www.dentech.com.cn/en-us/index

International Dental Exhibition Africa

4TH INTERNATIONAL TRADE SHOW FOR THE DENTAL SECTOR IN AFRICA!

13TH-15TH DECEMBER 2018 UNECA CONGRESS CENTER

ADDIS ABABA ETHIOPIA

www.idea-africa.com

Calendar

NOVEMBER

DECEMBER

ACOMS Taipei 2018 13th Asian Congress on Oral & Maxillofacial Surgery

Vietnam Medi-Pharm 2018 Dental Vietnam 2018 Hanoi - The 25th International Medical, Hospital & Pharmaceutical Exhibition - The International Dental

08-11 11 2018 Taipei - Taiwan Venue: Taipei Marriott Hotel Taipei, Taiwan

2018acoms.com/cms-user

06-08 12 2018 Hanoi - Vietnam Organised by: rade Fair & Advertising JSC (VINEXAD) Address: 9 Dinh Le St., Hanoi, Vietnam Phone: +84 90 4811648 Fax: +84 24 37911864 Email: contact@vinexad.org.vn Website: medipharm.vinexad.org.vn Venue: Hanoi International Center for Exhibition (ICE) Hanoi Vietnam

www.medipharm.vinexad.org.vn/en#

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DOCTOR牙医 Infodent International •2 2018

8000 visitors

400 brands

3000

congress participants

50

from countries

XVIII. Dental World 8

NETWORKING & REVENUE Dental World Budapest Hungary October 11-12-13

11-12-13 October 2018 Budapest, Hungary Book your place to the biggest Dental Exhibition in the Central-Eastern European region!

Get your clients from 10 countries, meet with international business partners, establish a new perspective in Central-Eastern Europe!

D ENTA LWO RLD.HU Fashion Show

Live surgery

Dental Unit Arena

Dental World 2017 exhibition

CONICAL ACTIVE

Conical Connection Implant www.macointernational.com

Cover maco Doctor 2 2016.indd 1

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