牙周病案例 牙槽骨再生 无望牙保留治疗

我是热爱口腔医学的医师。毕业于加州大学口腔医学院,学成回国后,致力于牙周病学的临床和研究。这里记录我的案例,特别是关于牙周病的治疗,牙槽骨再生和无望牙的保留治疗。

自体骨+种植一例

发布时间:2020-12-01 10:46  | 文章分类:种植浏览次数:771  |  评论:0  | 推荐数:0

自体骨+种植一例

Name: 周女士

Gender:   女 Female

Age: 37

Nationality:   中国 PRC

Employment:

某航空公司地勤人员

Ground Crew of Some 

Certain Airlines 

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Chief Complaint

缺失21、22三年要求种植修复

Unpleasing smile due to missing 

left central incisor  (maxilla)

Chief Complaint

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主诉 Chief Complaint

现病史 History of present complaint

  1. 三年前,因21、22松动,在其他口腔诊所诊断为“牙周病”,在进行相关治疗6个月后无法保留被拔除Tooth No.21、22 has been removed by another dentist some 3-year ago due to instability of the 2-tooth and then undertook  relative therapy for 6 months because of “periodontitis”.Finally judged as “hopeless”.

  2. 患者来到诊所要求种植修复21、22,上部结构用贵金属烤瓷冠。

    The patient showed up in the surgery for replacing the missing teeth with 2 implants supported precious metal porcelain .

   3.患者对现在的活动修复义齿不适应。

Patient is unsatisfied with her current partial removable denture.

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患病及牙病史Medical and Dental History

1.既往身体健康,无传染病(甲、乙、丙肝或携带;艾滋病等),无糖尿病或其他代谢性疾病;无心血管疾病;Medically fit and healthy;

2.无吸烟及饮酒嗜好;

    No smoking and alcohol drinking habit;

3.无吸毒史及其他不良嗜好;

    No parafunctional habit;

4.正常饮食;Normal food diet;

5.口腔卫生习惯一般:每日刷牙一次,但有良好的卫生依从性。

Oral hygiene on average ,good compliance with Dr.’s suggestion.

临床检查 Clinical Examination

1.无牙周病(龈沟深度<3mm);

 Periodontal status WNL: <3mm);

2.口腔卫生需要进一步改进; Oral hygiene can be better;

3.合关系基本正常(个别正常合)             Occlusion acceptable (Individually

normal occlusion);

4.没有迹象表明夜磨牙或其他合干扰;

No sign of bruxing or occlusal interferences



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临床检查 Clinical Examination

1.切龈距离10mm,修复空间较大;

   Space between incisor line and surface of gum :10mm;

2.用卡尺+针刺牙龈法计算,21、22的牙槽嵴宽度为4mm,唇侧骨皮质不足.

Wr=W-(Wg1+Wg2);

Ridge width at 21、22 shows 4mm(by caliper +model+ needling)

3.牙龈生物类型:较薄<2mm

   Gingival biotype: thin

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放射学检查 Radiographic examination-Panoramic 

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模型和全景片确定植体位置 Model and panoramic on implant site

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治疗计划 Treatment Plan

1.采集模型、测量牙龈宽度,钢珠法计算全景片精确度;

 测量可用骨高度及宽度(已如前所述),制作外科模板

   Surgical Guide Stent,Panoramic, Model, Caliper and needling Measurement( Finished on last piece) 

2.植骨后经历6个月的愈合期、延期种植;

  6 months of healing period;

3.BEGO 锥柱状种植体2枚,规格:S3.25mm*L11.5mm;

   2 BEGO coned-parallel implants:S3.25mm*L11.5mm;

4.修复方法:根转移、钛基台 Titanium abutment with root switching ;

5.贵金属烤瓷冠修复  Precious porcelain crown .


外科模板“锁定”植体位置 Implant positioning and surgical stent

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M-D:12=4.5mm,11=6.5mm 

Vertical Height:6.5mm,7.5mm

Ratio:12=0.692,11=0.867

M-D(12+11)=11mm

M-D(Edentulous)=12mm

According to “Golden Section Proportionality”,the Ratio of Width/Height=0.66-0.8,

Evidence-Based Medicine:

1.Bone Conditon;

2.Soft Condition;

3.Dentition Condition;

4.Whether does They Match to Adjacent Teeth?

植骨  Augmentation

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自体植骨:同时增加高度和宽度

Autogenous bone grafting to widen and elevate

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自体植骨:同时增加高度和宽度

Autogenous bone grafting to widen and elevate

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自体骨骨重建原则 Principle of Reconstruction by Autogenous Boneimage.png

Bone Regeneration


1.骨生成 Osteoproduction 

2.骨引导 Osteoconduction

3.骨诱导 Osteoinduction


Autogenous Block Bone:

1.部位: 颏部根尖下方5mm,避开正中联合;下颌升枝外斜线;髂嵴

2.原则:受植区良好血流灌注;坚固内固定;  必要的厚度≥4mm;形态匹配 

延期种植 Implant placement

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Radiographic (panoramic) controll

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 促进和维护口腔卫生

Increasing Oral Hygiene  & Controlling Plaque

  1. 口腔卫生指导;

  2. 2.及时、定期进行洁治;

  3. 3.使用漱水: 3.1 用0.12%-2%的氯已定(洗必泰),Bid,30-60S/t 3.2 用0.8%的天然丙酮-丁酮同分异构体(马蓝素),Bid,1-3M/t


Second stage

1.采用闭合式印模技术取模(距首次手术时间12个月);

   Impression taking on the 25th of April (close tray);

2.种植体根转移印模,BEGO预成纯钛基台,贵金属烤瓷冠修复21、22,粘结式固位;

   Cementation retained permanence crown (precious metal porcelain) on titanium

   abutment (BEGO) with root switching.

愈合基台摘除后 Uncovery


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树脂印模帽,转移杆将种植体位置转移至模型 

Pick-up impression with modified (concave) transfer coping

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愈合基台成型牙龈

Healing abutment with root switching to boost the biotype!!!

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1周拆线,3周后修复1 w healing

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  永久性纯钛基台,种植体根转移

Titanium abutment with root switching

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改色为VitaA1贵金属烤瓷冠修复21、22 

Restoration with precious metal porcelain

 种植修复前后对比

  Comparing with the former and today 

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修复后带着自信的微笑

Smile with self-confidence after successful implants

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Discuss

1.Concept of Dental Aesthetics:

    Based on Mathematics,

    Based on Engineering/ Technology,

    Based on Art

    Evidence-Based Medicine 

2.Prosthetic Aesthetics

3.Surgical Aesthetics: Reconstruction of Alveolar & Gingiva

4.Stable Aesthetics Producing from Macroscopic 

   Shape & Microcosmic Structure /Texture /Topography

Thank you for your attention!


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石全贵医师
我是热爱口腔医学的医师。毕业于加州大学口腔医学院,学成回国后,致力于牙周病学的临床和研究。这里记录我的案例,特别是关于牙周病的治疗,牙槽骨再生和无望牙的保留治疗。
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