tóm tắt tiếng anh nghiên cứu điều trị mất răng hàm trên từng phần bằng kỹ thuật implant có ghép xương

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tóm tắt tiếng anh nghiên cứu điều trị mất răng hàm trên từng phần bằng kỹ thuật implant có ghép xương

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1 A. INTRODUCTION Nowadays, thanks to new applications of science and technology in medicine, dentistry has made incredible steps in the restoration of missing teeth . The best fixed prosthodontics treatment is the dental implant. This method helps to rehabilitate masticatory function, high aesthetics, long-term survival, prevent the jaw bone resorption, occlusal stability and protect the integrity of remaining teeh; therefore patients’ life quality is improved. Due to these reasons, implant technique is the best choice for losing teeth patients. One of the important factors in this technique is that it needs sufficient bone volume to ensure the success of masticatory and aesthetic functions. Maxillary bone is spongy and finely trabecular, thus it usually leads to more bone resorption. Moreover, the anatomical features of the bone plante at labial aspect in the incisor region is very thin while the molar region relate to maxillary sinus, so in this anatomical area, bone defect volume is common and causes many problems for dentists in placing dental implant. On the other hand, maxillary anterior teeth play an important role in aesthetic aspect in which clinicians around the world call ”Challenging area” in dental implant. Because of those clinical situations and demands in reality, we conduct the research "Research on treatment of partial edentulous maxillae by dental implant with bone grafting technique” with the following objectives: 1. Describe clinical and X-ray characteristics of partial edentulous patients who treated by the dental implant with bone grafting technique. 2. Evaluate results of dental implant of patients group above. 3. Comment some factors affecting papillae around dental implant. IMPORTANCE OF THE DISSERTATION Implant technique in the maxillae ussually has difficulties because of bone volume in three-dimension, because the maxilla structure is spongy , contains nasal cavity and maxillary sinus the bone resorption is fast after losing teeth.To achieve the required bone volume, most cases of putting implant in front of maxillae have to 2 graft onto the bone surface or sinus lift in the posterior area. The factors: bone width, keratinized mucosa, time after prosthesis, connection design and surface treatment of the implant neck area affect the bone resorption and the papillae size around the implant that is still a matter to be examined and identified to contribute planning the implant in order to achieve best results. PRACTICAL IMPLICATIONS AND NEW CONTRIBUTIONS 1. Being the research to evaluate results of implant with grafting mixing autografts and nondemineralized, free dried bone allografts in patients with partial edentulous maxillae. In Vietnam, there are no such study about implant for only maxillae up to now. Therefore these research’s results confirmed the necessity and the science of this apexic. 2. Factors affect the papilae size around implant: soft tissue biotype, time, keratinized mucosa and bone resorption level. 3. Research conducted putting implant and grafting mixing autologous bone and free dried bone allografts, then assessed by X-ray and Periotest machine which showed good bone osseointegration. 4. Applying CT.cone beam film in planning and assessing treatment results is the best method now. Using Periotest machine to avaluate bone integrating level is safe and highly reliable. 5. Closed sinus augmentation technique by opening the sinus floor is the safe and well stable method. DESSERTATION STRUCTURE Beside introduction, conclusion and recommendation parts, the dessertation includes 4 chapters: Overview of research issues: 38 pages. Objects and Methodology: 21 pages. Results: 30 pages. Discussion: 40 pages. The dessertation has 34 tables, 7 diagrams, 72 images and 172 references (10 in Vietnamese and 162 in English). 3 B. DESSERTATION’S CONTENT Chapter 1. OVERVIEW 1.2. The changes of edentulous ridge after losing teeth: Teeth and attached tissue of cementum,periodontal ligament and bone bunch make a functional unit. Thus masticatory force is tranmitted from crowns through tooth roots and attached tissues to supported hard tissues in the alveolar bone. Losing teeth lead to significant decrease of edentolous ridge size. It is the reason why implanting usually combined bone grafting techniques in order to ensure the reasonable bone volume around the implant. 1.3. Osseointegration : Be the direct connection of the structure and function betwwen Implant and surrounding bone structure. 1.4. Bone grafting materials: Bone grafting materials have many different purposes in bone regeneration: Support for membrane, act like a flame to develope bone, stimulate bone growth, be a mechanical barrier against pressure from the soft tissue covering above, etc. They include some kinds of bone grafting materials and biological membranes: - Bone grafting materials: Autograft, allograft, xenografts , alloplastics. - Biological membranes: Collagen membrane, PTFE membrane, Titanium membrane. 1.6.Histological processing in bone grafting procedure: The healing and regeneration of grafting bone includes three mechanisms: Contact osteogenesis, osteoconduction, osteoinduction. Bone regenerating procees must have one of there mechanisms involved in. 1.7. Bone grafting techniques 1.7.1. Grafting bone regeneration with guides (GBR): Over the past 20 years, there has been a significant progress in the development of the GBR technique in dental Implant field. GBR has become a basic technique in regenerating the defects of alveolar bones which makes it possible to perform implant for patients. This progress is an important part of fast development of dental Implant over time. 1.7.2. Bone grafting and Sinus lift technique: Sufficient bone is the main factor for the success of dental implant in the maxillae. If the bone height between sinus 4 floor to maxillary edentulous ridge crest is less than 10 mm , the bone grafting to lift sinus floor or alveolar bone graft should be conducted to be able to place implant ≥ 10mm in diameter and make prosthesis. Now with better equipment such as Piezoelectric or safe sinus-lift kits, sinus augmentation is safer and safer, then indicating bone graft for sinus augmentation to implant is more popular. 1.8. Soft tissue characteristics around implant:Surface of the mucosa around the implant is also covered by keratinized mucosa and thin epithelial barrier (like junctional epithelim surrounding tooth) opposited healing abutment. The width of the epithelium barrier consists of only a few layers of cells and its end point located approximately 2mm from the tip of soft tissue contour and 1-1.5mm from the edentulous ridge crest. Connective tissues on the bone contact directly with the surface (TiO2) of the implant. Collagen fibers in the connective tissues derive from the periosteum of edentulous ridge crest and extend to the soft tissue contour. Vascular system of the muscosa around the implant is mainly from the supraperiosteal blood vessels on the outside of the alveolar ridge. These blood vessels put out branches which supply the Alveolar mucosa, then put forth numerous branches to the subepithelial plexus, located immediately beneath the oral epithelium of the free and attached gingiva. The connective tissues of trans- mucosal attachment on the implant surface contain a few blood vessels and all of them are determined as the end branches on the periosteum. 1.9. How to connect and handle neck-area implant technique to reduce bone resorption level: Neck area of the implant bears biggest impacts on its surrounding bone structure and is usually vanised bone before and after bearing impacts. Base on biological principles, there is always bone resorption around the implant. Albertktson and colleagues (1986) suggested that the implant is considered successful if the degree of bone resorption is 1mm in the 1st year and 0.2 mm for each next year. Today, with technology progress, the bone resorption level has been reduced much. One of important factors is that the design to change the connecting position between the Implant and Presthesis abutment (called Platform Switching or Platform Shifitng ) and surface treatment of the implant neck area with Laser. 1.11. Successful percentage of the dental implant: By surface-treatment technology, research of variable and convenient connecting form as well as 5 equipment and materials used in bone graft , positive results in bone defect applied GBR technique, simplier and safer sinus augmentation technique, the implant field has been developed strongly recently, and the successful percentage in the implant is going to 100% which are the incentives for Clinician in this field. Chapter 2. Objects and Methodology 2.1. Research objects Research objects are patients who are 18 years old and over, lose partial maxillae and are implanted with nondemineralized, freeze-drying allogeneic bone plots mixed with autologous bone grafts , the surgeries have been conducted at the Hanoi National Hospital of Odonto-Stomatology from 2009 – 2012. 2.1.1. Selective criteria - Patients with partial edentulous maxillae whose the height of useful bone was 5.5to under 10 mm in posterior area and ≥ 10 mm in anterior area, the minimum width of bone was 4mm, the minimum distance is 6mm, the gap from bone crest to surface of opposite teeth was ≥ 5mm - Voluntarily agreed to participate in the study. 2.1.2. Exclusion criteria: - Patients with contraindications with implant such as: cardiovascular diseases, diabetes and maxillary sinus diseases. - Completely edentulous patients - Patients have undergone radiation therapy in the head-face-neck area. 2.2. Research time and place: From 1/2009 to 3/2009 at Implant Department of Hanoi National Hospital of Odonto – Stomatology. 2.3. Methodology 2.3.1. Research design: Controlled experimental study 2.3.2. Method to identify model size - Model size calculation formula: 2 2 2 2/1 ∆ = − s Zn α 6 In which: n (model size), s (standard deviation), Δ (estimated error), 2 2/1 α − Z is confidence coefficient = 1.96 (standard unit in the meaning ofα = 0.05). According to Linkevicius study (2009), using standard deviation and estimated error which were 0.164 and 0.03 respectively gave the results that the minimum model size was 115. In fact, we conducted the research on 126 implants of 70 patients. 2.4. Means and research materials. 2.4.1. Implant system. In this research we used 2 implant systems namely Planton (Japan) and Biohorizons (America) due to their similare features as following: - Be similar in diameter and length, the way of inside hexagons connection, tooth shaped implant with spiral grooves, Titanium alloy material with the same force- bearing level at 32 – 35 N/cm. - Both have small diameter implant (3.0 mm) with two components which used for limited bone width anterior region. In Vietnam, at the time of reasearch, there were only these two systems which had such kind of implant. - They both designed modernly and suit with current trends for the conservation purposes of bone and soft tissues around the implant. Planton system was designed to connect implant and abutment to increase the amount of connective tissues of bone crest area, then to protect bone crest from adverse factors (bacteria, toxins, micro motion, etc) in the oral environment in order to be lower the bone resorption level. Biohorizons was designed 3mm in neck area with small spiral grooves and had surface treatment by Laser Lok technology to creat stronger soft tissue attachment which was called soft tissue intergration to protect bone crest around implant neck area. 2.4.2. Bone graft materials . Nondemineralized, freeze-drying allergenic bone used in this research was Miner Oss bone (America) with 50% of trabecular bone to increase osteoinductional factors and 50% of cortical bone to mantain during 1 year while helping new bone grow well. In addition, we always took bone broken during drilling or in scrapers to use to stimulates bone regeneration ability which only had in autologous bone. Hence bone defects in this research had all factors of contact osteogenesis, osteoconduction and osteoinduction ( in the autologous bone and allogenous bone) to ensure better bone grafting results. 7 - Absorbable collagen membranes with sizes of 10 x 20 mm, 20 x 30 mm or 30 x 40 mm used in the reasearch were called Mem-Lok (America) for Trademark which had capability of seft-absorption for 26 – 38 weeks. Mem-Lok membranes had holes with sufficient sizes to assist large molecules to transfer neccessary nutrients of healing process and easily adapt to variety kinds of bone defects. 2.5. Research Procedure 2.5.1. Clinical examinations. 2.5.2. X-ray screening 2.5.3. Evaluating the defect forms to choose suitable surgery method. 2.5.4. Other clinical tests. 2.5.5. Implant placement 2.5.6. Expose the implant and putting Healing abutment for prosthesis. 2.5.7. Make prosthesis in the labo 2.5.8. Connecting the crown to the abutment 2.8. Data processing: SPSS 16.0 software and some statistical algorithms. Chapter 3. RESEARCH RESULTS 3.1. Clinical features and X-ray of edentulous region. 3.1.1. Distribution of research subjects by gender and age: The total number of subjects in this research was 70 patients, in which female: male ratio was 64.3%: 35.7%, average age was 42.2 ± 14.8. There was no difference between male and female in age groups with p>0.05. 3.1.5. Bone density: D3 bone was the most common type with 68/126 cases (54%) found mainly in the back teeth. D2 bone accounted for 36.5% with 46/126 cases and concentrated in the front teeth. D4 bone was rare with 12/126 cases , equal to 9.5%, and only saw in the back maxillary teeth. There was a relationship between bone density and maxillary position with p < 0.001. 8 3.1.6. Distribution the location of bone defect Table 3.9. The distribution of bone defect region in edentulous position Edentulous position Bone defect region Anterior teeth Posterior teeth General n % n % n % Neck 29 59.2 18 23.4 47 37.3 Crown 20 40.8 17 22.1 37 29.4 Apex 0 0.0 42 54.5 42 33.3 Total 49 100.0 77 100.0 126 100.0 p <0.001 bone defect in the implant neck area was met in 47/126 cases accounting for 37.3%. bone defect in the implant crown area had 37/126 cases with 29.4% and the 3rd type of bone defect fell into 33.3%. For back teeth, the most popular bone defect region belonged to implant neck area (59.2%). The difference between bone defect region and edentulous position had meaning with p<0.001. 3.1.7. Soft-tissue biotype: For anterior teeth, thin soft tisue type was more popular with 55.1%, while for posterior teeth, thick soft tissue one owned the largest percent of 53.2%. 3.1.8. Size of dental implant: Main diameter of 3.3-3.8 mm was used most (46.8%). All 3.0mm main diameter was for front teeth, while 4.6-4.7-5.8 kinds only applied for back teeth. Bone group of which width was over 9mm was suitable with 4.6-4.7 main diameter accounting for 84.4%, and it was just 60.6% that bone group with under 6mm width used main diameter of 3.3 – 3.8mm. The relationship between main diameter and bone width had meaning with p<0.001. 3.2.Implant results 3.2.1. The initial stability Diagram 3.1.Initially stable level In the research our initially stable level was over 35N/cm at 66.67% which was two times higher than the initial stable level of 20-35 N/cm. 3.2.2. Injury status 9 3.2.2.1. Level of pain after surgery: Slightly painful level was at the apex percent with 39.7%, while painless level was 23% which was seen most in the apex bone defect region with 19/29 cases or 65.5%. At the crown and neck bone defect region of dental implant, the moderately painful level accounted for 53.2% and 40.5% respectively. Whereas, this proportion in the apex bone defect region of implant was just 16.7%. The differences had statistical meaning with p<0.001. 3.2.2.2. Swelling after surgery: Major cases of bone grafting had swelling reaction with 87/126 cases (69%). This ratio was lower by the bone defect positions of neck, crow and apex of implant, namely 48.3%, 33.3% and 18.4% respectively. In the both two first bone defect positions (neck and crown), the cases of swelling were always higher than no swelling cases with 89.4% and 78.4%, meanwhile it reversed in apex. There was a relationship between the posapexerative swelling and bone defect region with p<0.001. 3.2.2.3. Dehiscence: Table 3.20.Relationship between dehiscence and bone resorption preprosthesis (in mm) Bone resorption Open wounds Mesial Distal P n X ± SD n X ± SD Yes 18 0.41 ± 0.12 18 0.43 ± 0.14 >0.05 No 105 0.33 ± 0.08 105 0.32 ± 0.08 >0.05 p 0.005 0.001 Table 3.20 demonstrated that cases of dehiscence during 7-10 days had higher bone resorption level compared to cases without dehiscence. The differences had statistical meaning with p=0.005 for mesial side and p= 0.001 for distal side. 10 3.2.3. Bone resorption before prosthesis (in mm): Table 3.21. Relationship between soft tissues and bone resorption for pre- prosthesis (mm) Bone resorption Soft tissue Mesial Distal P N X ± SD n X ± SD Thin 60 0.39 ± 0.09 60 0.38 ± 0.11 >0.05 Thick 63 0.29 ± 0.06 63 0.30 ± 0.07 >0.05 p 0.000 0.000 Table 3.21 indicated that patients with thin soft tissue had mean bone resorption level of 0.39 ± 0.09 for mesial side and 0.38 ± 0.11 for distal side. For patients with thick soft tissue, mean bone resorption level for mesial side was 0.29 ± 0.06 and one for distal side was 0.30 ± 0.07. The difference between thin and thick bone tissues in bone resorption level had statistical meaning with p< 0.0001. 3.2.4. The width of keratinzed mucosa: Table 3.22. Relationship between bone defect region and changes of keratinzed mucosa width after and before Osteopenia position Width of keratinized mucosa Neck Crown Apex n X ± SD n X ± SD n X ± SD Before surgery 44 6.45±0.9 6 37 6.62±0.8 7 42 6.89±1.02 After surgery 44 5.05±1.1 3 37 5.37±1.0 42 6.55±0.95 p 0.000 0.000 0.117 Implants inserted in bone defect positions of neck and crown: Changes of the keratinized mucosa width before and after surgery had statistical meaning with p<0.05. Implants inserted in bone defect positions of apex: Changes of the keratinized mucosa width before and after surgery had statistical meaning with p>0.05. 3.2.6. Successful percent: 97.6%; eliminated percent: 2.4%. 3.2.9. Results on functional rehabilitation: The ability to rehabilitate masticatory function of implant prosthesis was always good with high proportions in different points of evaluation which increased by time (77.2%; 90.6%; 94.6% và [...]... length of implant Our research demonstrated that implants with 10 – 12 mm in length were witnessed most at 77% (97 implants) and mainly fell into the back teeth with 75.3% of 97 implants This result is also consistent with studies of Guirado (2010) which conducted 60 implants with sinus augmentation bone graft in 50 patients by 3 implant systems: Osseotite® Certain® Prevail® and gave the result: 10 implants... type, edentulous area and genders of patients at p>0.05 4.1.8 Implant size 4.1.8.1 Relationship between edentulous areaand implant diameter In our research we excluded the implant with 3.0mm diameter used only for anterior edentulous area Most common kind of implant diameter in our research was 3.3-3.8 mm accounting for 46.8% Most of this implants were inserted in the area with small bone width (lower... There were 29/126 implants with over 12 length , 86% of which were used for front teeth This position usually had convenient height to choose implants with 12-15 mm in length in order to overcome disadvantages for small diameter implants which were seen in front teeth because of thin bone or for teeth with narrow mesial -distal gap In Reas and colleagues’ research (2012), 45/48 implant implants carried... colleagues (2008) grafted allogeneic bone for 42 implants in 10 patients with small defects in the neck area, and there were 42 successful cases Dahlin and colleagues (2010) grafted autologous bone for 41 Noble Biocare implants in 20 patients using bone regeneration technique with guidance, and just one implant fail For the back teeth, bone defect region of the implant s apex was majority at 54.5%, therefore... initial stability of the implant then it was easy to deviate when drilling Our research of bone density on jaw arch and by ages was reasonable to studies of Pham Thanh Ha, Do Dinh Hung, Fud and Turkyilmaz (2008) 4.1.6 Distribution of bone defect region In the maxillary front teeth, bone defect region of implant neck area accounted for 59.2% as the highest percent, following by implant crown bone defect... Kim and colleagues (2009) of 339 Implants on 108 patients from 2003 – 2007 in 5 clinical centers, the width of keratinized mucosa around Implant was 2.43 counted from the edge of prosthesis in the Implant to the boundary of attached tissue – mobile tissue The results showed that the width of keratinized mucosa had effects to gum recession and bone resorption level around Implant Eber and Wang (2003) also... diameter kind (4%) Hence, in this research, the implants with small and medium diameter were commonly used It is also suitable with the trend of clinicians in the world now thanks to technology to produce these small implants has been gain 17 many advances in load-bearing design Moreover, clinicians realize that maintaining an amount of full bone tissue around the implant, especially buccal alveolar bone,... on for maxillary front teeth had the length of over 13 mm, accounting for 93.75% Thus the choice of length of implants for edentulous area in our research is suitable with researches in over the world 4.2 Results of implant placement 4.2.1 Initially stablility In our research, we performed implant procedure in maxillae with insufficient bone, however, thanks to bone distraction instruments and drill... augmentation technique to graft bone was applied to increase the height to be enough for implant abutment with ≥ 10 mm in length 4.1.7 Soft-tissue biotype Soft-tissue biotype was one important factor to estimate aesthetic abilities of prosthetic after the implant as well as to estimate the mucosa resorption and phlogistic around the implant in the future.Statistical results of our research showed that thick and... density in the implant area, the most common type was D3 bone with 54% D2 bone was more popular in the front edentulous area(69.4%) while in the 23 back one it was D3 bone (68.8%) D4 bone was just seen in the posterior area with 9.5% - For the back teeth, implant- apex bone defect region had highest percent with 54.2% while for the front teeth, main bone defect region was the neck of the implant at 59.2% . technique. 2. Evaluate results of dental implant of patients group above. 3. Comment some factors affecting papillae around dental implant. IMPORTANCE OF THE DISSERTATION Implant technique in the maxillae. treatment of the implant neck area affect the bone resorption and the papillae size around the implant that is still a matter to be examined and identified to contribute planning the implant in order. indicating bone graft for sinus augmentation to implant is more popular. 1.8. Soft tissue characteristics around implant: Surface of the mucosa around the implant is also covered by keratinized mucosa

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