Mataga I
Shigaku. 1989 Oct;77(SPEC):1257-66.
In recent, dental implants have been developed and practiced among many dental practitioners depending on the increase of success rate. Also some types of dental implants have been imported from foreign countries in order to obtain more increased masticatory function and esthetics in Japan. On the other hand, some kinds of implant materials such Co-Cr, titanium, ceramics and artificial materials are provided to reconstruct the mandible combined with autogenous bone graft following excision of tumors in the Japanese oral and maxillofacial surgery field. It is my opinion that the success of reconstructive surgery is based on the reconstruction of mandibular bone and the reconstruction of masticatory function by dental implant on the point of oral rehabilitation to reach that the patient should live in comfort. It is well known that not every reconstruction can be satisfactory due to postoperative infection, implanted substances exposed to intra-oral and/or extra-oral sites and/or resorption of the grafted bone under a long term observation. Based on these reasons, we have reconstructed the mandible with revascularized osteomyocutaneous flaps using the microvascular anastomoses technique to reconstruct the defect and to prevent bone resorption. However, even if the reconstruction was achieved successfully, post-operative problems could come into existence due to masticatory, swallowing or speech dysfunctions. These are often caused by loss of soft tissue, deformities of the alveolar ridge or contour of the mandible. Therefore, some kinds of dental implants have been tried in some countries for the reconstruction of the edentulous mandible in order to improve the post-operative functions. The TM-Implant (Transmandibular Implant), which was deviced by Dr. Hans Bosker, Netherland, is one of these dental implants. We tried to apply for two oral cancer cases who had been resected and/or reconstructed mandibles using this implant as the first experience in our country (Fig. 5). The first patient segmentally resected mandible was reconstructed by the revascularized iliac bone, the second patient was marginal resected mandible with tumor (Fig. 6-13). Results of these two implant cases, using TM-Implant, showed significant improvement of oral function thanks of the stability of dentures after the second phase of reconstruction. Dental implants can attribute the functional improvement for oral cancer patients in the future. Strict diagnosis of the bone condition before surgery and careful surgical procedure, whenever dental implants are used, are required to avoid postoperative complications.(ABSTRACT TRUNCATED AT 400 WORDS)
近年来，随着成功率的提高，种植牙技术在众多牙科医生中得到了发展和应用。在日本，为了获得更强的咀嚼功能和美观效果，也从国外引进了一些类型的种植牙。另一方面，在日本口腔颌面外科领域，在肿瘤切除后，会使用钴铬合金、钛、陶瓷及人工材料等多种种植材料结合自体骨移植来重建下颌骨。我认为，从口腔修复的角度来看，重建手术的成功基于下颌骨的重建以及通过种植牙实现咀嚼功能的重建，从而使患者能够舒适地生活。众所周知，由于术后感染、植入物暴露于口腔内和/或口腔外部位以及/或者在长期观察下移植骨的吸收，并非每一次重建都能令人满意。基于这些原因，我们采用微血管吻合技术，用带血管蒂的骨肌皮瓣重建下颌骨，以修复缺损并防止骨吸收。然而，即使重建手术成功，由于咀嚼、吞咽或言语功能障碍，术后问题仍可能出现。这些问题通常是由软组织缺失、牙槽嵴畸形或下颌骨外形改变引起的。因此，一些国家尝试使用各种种植牙来重建无牙下颌骨，以改善术后功能。荷兰的汉斯·博斯克尔博士设计的TM种植体（经下颌种植体）就是其中一种种植牙。我们作为国内首例，尝试将这种种植体应用于两例口腔癌患者，这两名患者的下颌骨已被切除和/或重建（图5）。首例患者下颌骨节段性切除后用带血管蒂的髂骨重建，第二例患者下颌骨边缘性切除肿瘤（图6 - 13）。这两例使用TM种植体的病例结果显示，在二期重建后，由于义齿的稳定性，口腔功能有了显著改善。种植牙未来可为口腔癌患者的功能改善做出贡献。无论何时使用种植牙，术前都需要对骨状况进行严格诊断，并进行仔细的手术操作，以避免术后并发症。（摘要截选至400字）
