正畸治疗与种植体周牙龈乳头美学重建

正畸技术已经被应用于种植美学领域,在种植体植入前对种植区域的硬软组织作相应的处理,以促进种植体周牙龈乳头的愈合和再生。本文就与种植体周牙龈乳头美学重建有关的各种种植前正畸治疗方法作一综述。     

Straumann种植体在上颌前牙区即刻种植修复中的应用

目的 评估Straumann种植体即刻种植修复上颌前牙区的近期临床效果。方法 临床选择28例上前牙残根患者,在拔牙后即刻植入Straumann种植体40枚。其中11例15个牙位行不翻瓣种植,17例25个牙位采取翻瓣GBR技术即刻种植。3～9个月后行永久性修复。随访3～36月,临床观察种植体、基台和牙冠的稳固性,牙龈组织、龈乳头情况及牙冠美观状况。结果 所有种植体均发生骨结合,无松动现象,未见种植体周围炎表现,即刻种植存活率为100%。不翻瓣种植病例的唇侧龈缘无明显退缩,牙龈乳头无明显丧失;翻瓣植骨的病例唇侧牙龈缘少许退缩,牙龈乳头轻度丧失。修复体外形美观,周围牙龈形态正常,功能良好,患者满意。结论 在严格掌握适应证和注意术中术后各种细节的情况下,应用Straumann种植体即刻种植修复上颌前牙区可获得理想的美学修复效果。     

前牙区即刻种植的美学效果观察

目的：探讨前牙区即刻种植永久修复后的牙龈美学效果。方法：22例前牙缺失病例,行不翻瓣拔牙同期植入28颗种植体,上前牙24颗采用非埋入式种植术式,下前牙4颗采用埋入式种植术式,种植体愈合3-4个月进行永久修复。随访时间为12-30个月（平均18个月）。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12个月后的牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果：28颗种植体留存率100%。Miller分类,18颗种植体牙龈边缘无退缩;8颗种植体牙龈边缘Ⅰ类退缩;2颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论：前牙区即刻种植,延期修复是一项较成熟的手术方法,但须严格掌握适应症,才能获得良好的修复效果。     

前牙区即刻种植22例临床观察

目的:探讨前牙区即刻种植永久修复后的牙龈美学效果。方法:22例前牙缺失病例,行不翻瓣拔牙同期植入28颗种植体,上颌前牙24颗采用非埋入式种植术,下颌前牙4颗采用埋入式种植术,种植体愈合3～4个月进行永久修复。随访12～30个月(平均18个月)。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12个月后的牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果:28颗种植体留存率100%。Miller分类,18颗种植体牙龈边缘无退缩;8颗种植体牙龈边缘Ⅰ类退缩;2颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论:前牙区即刻种植,延期修复是一项较成熟的手术方法,但须严格掌握适应证,才能获得良好的修复效果。     

单个前牙种植体即刻种植和即刻修复的牙龈美学效果评价

目的:评价种植体即刻种植即刻修复的牙龈美学效果及患者对美观的满意度.方法:观察28例患者28枚ITI种植体在单个前牙种植体即刻种植即刻临时冠修复,对种植义齿周围的牙龈美观状况及相应的软组织健康状况进行观察,并对患者满意度进行调查,托槽弓丝固定3个月,6个月后行永久烤瓷冠修复.结果:12个月时所有种植体都发生了骨结合现象,种植义齿周围的软组织外形正常,牙问乳头外形大小与菌斑附着,龈炎并不相关.患者对即刻种植修复的美学效果均非常满意.结论:在严格掌握适应证的前提下,单个前牙即刻种植修复比延期修复可获得更佳的软组织外形,尤其是牙间乳头外形大小达到更理想的美学效果.     

上颌前牙美学区连续多颗牙缺失即刻种植的临床研究

目的分析不同牙种植系统上颌美学区即刻种植对种植体周围骨组织吸收的影响,并探讨改良微创"H"形切口在上颌美学区多颗相邻牙即刻种植修复的应用技巧及美学影响因素。方法选取2011年1月—2015年1月在我院口腔科接受牙体种植修复的患者58例,所有患者均在牙槽嵴顶作微创"H"切口,种植体采用潜入式手术。根据患者种植的牙体系统,将患者分为3组:3I组、DIO组、Replace组。随访12个月,观察患者种植体周围骨吸收量、探诊深度及术后龈沟出血指数。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12月后牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果 3组患者的周围骨组织骨吸收量在植入术后6个月均呈稳定的趋势,不同的种植体增长的幅度不同,差异无统计学意义(P>0.05),DIO组患者第3个月的骨吸收量显著高于Replace组和3I组,其差异具有统计学意义(P<0.05)。术后不同时期,3组患者的龈沟出血指数与天然牙相比,6个月时,DIO组患者的龈沟出血指数虽然高于天然牙,差异无统计学意义(P>0.05);9、12个月时,3组患者的龈沟出血指数与天然牙差异无统计学意义(P>0.05);术后6个月,3组患者的探诊深度呈稳定的趋势,各个时期3组患者的探诊深度略高于天然牙,差异无统计学意义(P>0.05)。159颗种植体存留率100%,Miller分类,136颗种植体牙龈边缘无退缩;18颗种植体牙龈边缘I类退缩;5颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论不同牙种植体系统对美学区多颗相邻牙即刻种植的种植体周围骨组织及软组织均具有较理想的稳定性及美学效果。改良微创"H"形切口为相邻多颗牙即刻种植的应用技巧提供了临床依据,值得临床推广。     

上颌前牙即刻种植即刻修复的临床应用研究

目的:评估上颌前牙区即刻种植即刻修复的临床应用效果,特别是美学效果,并探讨其临床应用技巧及美学影响因素。方法:选择16例共18颗无法保存的上前牙,微创拔除后即刻植入Xi ve或Repl ace种植体共18枚,均于48小时内完成临时固定修复,4～6个月后完成最终修复。种植永久修复后追踪观察12～36个月,观察种植体周围软硬组织情况,统计种植义齿存留率、牙龈乳头充盈指数以及修复体与相邻天然牙唇侧牙龈的协调性、患者主观满意度。结果:在观察期内18枚种植体均获得了良好的骨结合,种植体无松动,种植体周围未见病理性骨吸收,存留率为100%;18枚种植修复体周围共34个牙龈乳头充盈指数均为2到3度,其中24个(70.6%)为3度;15枚种植修复体唇侧龈缘位置与相邻天然牙协调无差异,3枚轻度差异;16枚种植修复体与相邻天然牙牙龈颜色质地协调无差异,2枚轻度差异。患者主观满意度VAS值平均达91.5。结论:在严格掌握适应证的前提下,应用正确的手术技巧对无法保存的上前牙进行微创拔除后即刻种植即刻修复能获得理想的临床效果,特别是美学效果。     

种植体周围龈沟液标记物的研究进展

种植体周围炎(peri-implantitis),是发生在正常行使功能的骨性结合种植体周围组织的慢性进展性炎症,能使牙槽骨丧失形成种植体周围袋,当骨结合区完全吸收后,种植体会松动脱落,导致种植失败.与自然牙一样,种植体周围也存在着龈沟.种植体周围龈沟液是否具有与自然牙龈沟液相似的特征,是否可以反映种植体周围组织的变化,正逐渐为学者们所重视.本文就种植体龈沟液中相关标记物的研究进展做一综述.     

牙龈原位扩增技术在上颌前牙即刻种植中的应用

目的研究牙龈原位扩增技术在上颌前牙即刻种植中的短期临床效果。方法对16例拟行即刻种植的上颌前牙残根残冠使用牙龈原位扩增技术,待获得足够牙龈软组织后进行即刻种植,经软组织塑形后,完成最终上部结构。随访3～12个月,对种植体周围软硬组织进行评价。结果16例种植体均获得良好骨结合,种植体无松动、无脱落。种植体周围软硬组织状态良好,美学效果满意。结论上颌前牙即刻种植应用牙龈原位扩增技术短期临床效果满意。     

牙龈生物型对种植牙美学影响的研究进展

种植修复后常见的美学问题及其处理受到越来越多学者的重视,而牙龈生物型是影响种植修复后美学的主要因素之一,对种植体周围软硬组织的长期稳定和美观有较大的影响,对牙龈生物型进行术前评估具有重要的临床意义.笔者将从牙龈生物型的概念、对牙龈退缩和牙龈红色美学的影响以及对种植体周围软硬组织的影响等几个方面进行综述.     

Correlation of papilla to crestal bone levels around single tooth implants in immediate or delayed crown protocols.

PURPOSE: The purposes of this study are to determine if there is a difference in the papilla fill between implant and teeth comparing immediate provisionalized and delayed single tooth implant restorations, and to determine the relationships between the vertical and horizontal bone levels to papilla filling the inter-dental region with single implant restorations. PATIENTS AND METHODS: Two groups of patients treated with single tooth implant restorations were prospectively followed. One group had immediate provisionalization of their implants, and the second group a delayed approach. Serial radiographs and photographs were used to collect bone level measurements for the vertical distance between contact point to bone level on the adjacent tooth, implant, and the midcrestal region. The horizontal distances were also recorded. Papilla morphology was scored 1 through 4. Univariate analysis was used to evaluate the relationships between bone levels and papilla morphology. RESULTS: There were no differences between papilla or bone levels comparing immediate provisionalization to delayed approaches. There were significant ( P < .05) relationships between the vertical distance from contact point to bone levels, with the distance from the contain point to the adjacent tooth the distance most critical to papilla maintenance. There were no significant relationships between horizontal distance and papilla maintenance. CONCLUSION: As the distance from the contact point to the implant increased, there was a significant chance of loss of papilla. There was no difference between delayed or immediate provisionalization and papilla scores. The horizontal distance from adjacent tooth bone level did not correlate to papilla score within the range of clinically relevant distances.     

牙种植中牙龈乳头保护与重建的研究进展

牙龈乳头亦称牙间乳头,呈锥形充满于相邻两牙接触区龈方的龈外展隙中。种植义齿要获得与天然牙相协调的美观效果,牙龈乳头是其中不可或缺的一部分,而种植义齿受到局部各种因素的影响后,牙龈乳头容易低平,形成牙间的"黑三角"影响美观,在前牙区尤为明显。本文就解决种植义齿中"黑三角"问题的研究进展作一综述。     

上颌前牙种植体周围牙龈乳头重建的临床研究

目的:寻找上颌前牙种植的牙龈乳头重建的方法. 方法:选择30例上颌前牙种植二期术患者随机分实验与对照组,实验组上颌前牙种植区正中偏腭侧作横切口,并保留龈乳头,钝性剥离颊腭侧龈组织瓣及龈乳头瓣,以基台弧度为模板,制备适当宽度有蒂龈组织瓣,并旋转植入近远中龈乳头瓣下方,基台挤压龈乳头瓣诱导种植体周围龈乳头成形;上部结构(基台)精细研磨,重建无缝隙冠龈连接,精度贵金属烤瓷修复.对照组上颌前牙种植区正中切口,剥离粘骨膜瓣,上愈合基台,常规牙龈缝合;基台研磨贵金属烤瓷修复.分别于种植修复后3、6、12月测量上颌前牙种植周龈乳头高度.和评价龈乳头外形.结果:实验组龈乳头恢复明显好于对照组(p<0.01),龈乳头外形明显优于对照组(p<0.01).结论:上颌前牙种植的龈乳头重建方法简单,可行.     

影响上颌中切牙单个种植修复体龈乳头高度的因素分析

目的分析影响上颌中切牙单个种植修复体龈乳头高度的因素，探讨促进种植修复美学效果的相关因素。方法选择16例上颌中切牙单个种植修复患者（30个龈乳头），通过分析临床资料、口内照片、X线片和研究模型，得到龈乳头高度及相关因素数据，采用多重线性回归方法进行分析。结果16例患者中切牙种植修复体龈乳头高度为（4．01±1．85）mm，影响龈乳头高度的相关因素按作用由大到小的排列顺序为：种植修复体外冠接触点高度、邻近天然牙邻面牙槽嵴顶高度、邻近天然牙邻面牙槽嵴顶到外冠接触点的垂直距离、种植修复体外冠邻面凸度、种植体基台与邻牙牙根距离、冠根长度比例、种植修复体邻面牙槽嵴顶高度、种植修复体外冠唇面凸度、探诊深度。结论中切牙种植修复体龈乳头高度受多种因素影响。     

Disparity in embrasure fill and papilla height between tooth‐ and implant‐borne fixed restorations in the anterior maxilla: a cross‐sectional study

Purpose

The objective of the present study was to compare inter‐proximal fill and papilla height between different embrasures.

Material & Methods

One hundred and fifty non‐smoking consecutive patients (mean age 54, range 32–73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician.

Results

Tooth‐pontic and tooth‐implant embrasures demonstrated comparable inter‐proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant‐implant and implant‐pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic‐pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002).

Conclusions

The re‐establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant‐borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.     

Ӱ����ֲ����Χ����ͷ�߶ȵķ������ؼ�����Ʋ���

??With the increasing clinical application of dental implants??the criteria for defining successful implants become more stringent. Decrease or loss of peri-implant papilla can result in esthetic and functional problems??such as "black triangle" and food impaction??which become one of the reasons for implant failure. How to prevent the height decrease of peri-implant papilla and how to rebuild peri-implant papilla are the important topics in implant dentistry. Patients with periodontitis face higher risk of papilla height decrease. The present article is aimed to review and evaluate the risk factors of the decrease of papilla height??and the methods of prevention and rebuilding. We also emphasize the high risk of patients with periodontitis regarding the interproximal bone loss.     

Controlled orthodontic extrusion to create gingival papilla: a case report.

Prosthetic dental restorations alone do not produce esthetics. They must be in harmony with the surrounding gingiva, especially the gingival papilla. This case report describes the enhancement of the gingival papilla between an implant replacing the maxillary left central incisor and a provisional crown on the maxillary left lateral incisor. Esthetic harmony was disrupted by the absence of an interproximal papilla. First, provisional crowns on the implant and adjacent tooth were used in an attempt to remodel the interproximal gingival tissue, but the esthetic result was not satisfactory. The second attempt involved orthodontic extrusion of the lateral incisor in an incisal direction. The gingival tissue migrated incisally, thus restoring the deficient papilla and establishing restorative and gingival harmony. Both the implant and the lateral incisor were restored with ceramic crowns.     

Interproximal tissue dimensions in relation to adjacent implants in the anterior maxilla: clinical observations and patient aesthetic evaluation

Objectives: This clinical study aimed to assess (i) interproximal tissue dimensions between adjacent implants in the anterior maxilla, (ii) factors that may influence interimplant papilla dimensions, and (iii) patient aesthetic satisfaction. Material and methods: Fifteen adults, who had two or more adjacent implants (total of 35) in the anterior maxilla, participated in the study. The study design involved data collection from treatment records, clinical and radiographic assessment, and a questionnaire evaluating aesthetic satisfaction. Results: The median vertical dimension of interimplant papillae, i.e., distance from tip of the papilla to the bone crest, was 4.2 mm. Missing papilla height (PH) at interimplant sites was on average 1.8 mm. Median proximal biologic width at interimplant sites was 7 mm. The most coronal bone‐to‐implant contact at implant–implant sites was located on average 4.6 mm apical to the bone crest at comparable neighbouring implant–tooth sites. The tip of the papilla between adjacent implants was placed on average 2 mm more apically compared with implant–tooth sites. The contact point between adjacent implant restorations extended more apically by 1 mm on average compared with implant–tooth sites. Median missing PH was 1 mm when an immediate provisionalization protocol had been followed, whereas in the case of a removable temporary it was 2 mm. Split group analysis showed that for missing PH≤1 mm, the median horizontal distance between implants at shoulder level was 3 mm. Patient satisfaction with the appearance of interimplant papillae was on average 87.5%, despite a Papilla Index of 2 in most cases. Conclusions: The apico‐coronal proximal biologic width position and dimension appear to determine papilla tip location between adjacent implants. There was a significant association between the provisionalization protocol and missing PH, which was also influenced by the horizontal distance between implants. Patient aesthetic satisfaction was high, despite a less than optimal papilla fill.     

Dimensions of hard and soft tissue around adjacent,compared with single-tooth,zirconia implants

Preservation or regeneration of the papilla has always been a challenge around consecutive implants or with implants next to teeth, and many studies have evaluated the papilla’s behaviour and patterns based on surgical technique and prosthetic design, though evidence about its behaviour around zirconia implants is scarce. The aim of this study was to evaluate papilla behaviour between implants and teeth (tooth-implant group) and between consecutive implants (implant–implant group). Ninety patients with 122 zirconia implants (Straumann^® PURE Ceramic Implant) were examined at the one-year follow up. We measured the effect of the distance: first from the base of the contact point of the crowns to the contact with bone at the implant site (D1); secondly, to the contact with the bone at the neighbouring tooth or implant site (D2); and thirdly on the papillary deficit (D3). In both the tooth-implant group and the implant–implant group, D1 and D2 correlated significantly with the papillary deficit (D3), whereas D2 was the major determinant factor (Spearman’s rho = 0.60). In both groups, when D1 and D2 were <6 mm, the papilla was present every time. The papillary deficit was significantly greater in the tooth-implant group than in the implant–implant group (p = 0.048). We conclude that the ideal distance from the base of the contact point to the bone contact at the implant and to the bone contact at the adjacent tooth in both groups is <6 mm. The height of the bone on the teeth adjacent to implants has a significant impact on that of the papilla.