牙周炎患者种植体即刻负载的研究进展

即刻负载由于可以为患者提供即刻的功能和美观而成为近年来的研究热点。牙周炎患者作为一个广泛的特殊患者群体,长期以来学者在其种植修复方面持保守态度。然而近年来,随着种植技术的发展以及种植材料的进步,越来越多的学者对牙周炎患者采用即刻负载并获得了成功。有学者进一步指出:将即刻种植与即刻负载联合应用,可以在最短的治疗时间内获得最佳的疗效。本文就国内外学者对牙周炎患者即刻负载的研究进展作一综述。     

临时种植体即刻负载在半颌即刻种植中的应用

目的：评价临时种植体即刻负载在半颌即刻种植中的应用效果。方法：20例半颌即刻种植患者行136枚即刻种植体植入,采用95枚临时种植体即刻负载恢复患者牙列。3-6月后行固定修复。结果：即刻负载临时种植体和即刻种植体成功率达100%。结论：临时种植体即刻负载半颌即刻种植是很好的临床方法。     

美学区域即刻种植修复22颗的临床研究

目的探讨美学区域即刻种植修复的临床应用及疗效。方法14例患者美学区域新鲜拔牙创即刻植入22颗种植体并行即刻临时修复,3-6个月后制作终义齿,临床观察8-22个月。结果22颗种植体永久修复后6-12个月,X线观察种植体颈部边缘骨吸收均小于1.5 mm,种植体无松动脱落。结论严格掌握适应证,保证种植体良好的初期稳定性,行无功能的临时修复,美学区域行即刻种植修复能够获得良好的临床效果。     

前牙种植体即刻种植修复牙龈软组织指标观察

目的　评价种植体即刻种植修复临床效果及美学意义。方法　 18例患者 18枚Camlog种植体在前牙区即刻种植即刻临时冠修复 ,对种植体成功率及周围牙龈附着水平进行观察 ,6个月后永久冠修复。结果　 12个月时所有种植体都发生了骨结合现象 ,牙龈变化平均为 0 .75mm ,在允许范围内。患者对种植即刻修复效果满意。结论　在严格掌握适应证前提下 ,前牙美学区单牙种植体即刻修复与延期修复相比在种植成功率、种植体周围软组织组织学变化上差异无显著性     

改良式引导骨再生术+即刻修复技术在上前牙即刻种植中的应用评价

目的评估一种改良式引导骨再生术(guided bone regeneration,GBR)+即刻修复技术在上前牙即刻种植中的应用效果,特别是美学效果,并探讨其临床技巧及美学影响因素。方法选择15例单颗上前牙进行即刻种植,微创拔牙后即刻植入Replace、Straumann或Ankylos种植体共15枚,采用改良式GBR+即刻修复,均于2 h内完成临时修复。4⁶个月后完成最终修复。种植修复完成后随访66个月后完成最终修复。种植修复完成后随访6²4个月,观察种植体周围软硬组织情况,统计种植义齿存留率、种植修复体与相邻天然牙唇侧牙龈的协调性和患者主观满意度。结果在观察期内,15枚种植体均获得了良好的骨结合,无松动,未见病理性骨吸收,存留率为100%;12枚种植修复体唇侧龈缘位置与邻牙协调无差异,3枚轻度差异;14枚种植修复体与邻牙牙龈颜色质地协调无差异,1枚轻度差异。患者主观满意度VAS平均值为92。结论改良式GBR+即刻修复技术在上前牙即刻种植中,有助于获得理想的前牙美学效果,缩短治疗周期。     

前牙美学区即刻种植即刻美学修复的临床观察

目的：探讨前牙关学区即刻种植即刻美学修复的临床特点及修复后的美学效果。方法：18例患者22枚m和Replace种植体前牙区即刻种植即刻临时冠修复,对种植体成功率及周围牙龈附着状况进行观察,6个月后永久冠修复。结果：1枚种植体在愈合期内脱落,其余种植体在修复后12个月时均有骨结合,临床效果良好。结论：前牙美学区即刻种植即刻美学修复时多因素可影响种植体的成功率及软组织美学效果,严格掌控适应证,才能获得理想的美学效果。     

种植体颈部裂开致即刻种植即刻负重修复失败1例

即刻种植即刻负重修复具有早期恢复患者美观和功能，缩短种植周期，减少手术次数、手术创伤小、患者痛苦小等优点。本文报道1例种植体颈部裂开致即刻种植即刻负重修复失败的病例。     

隐形即刻义齿和胶连即刻义齿临床疗效对比分析

目的:比较两种不同材质即刻义齿的临床疗效差异,为临床工作提供指导依据.方法:选择63例需制作即刻义齿的患者,同时制作隐形即刻义齿和胶连即刻义齿各1副,先后戴用两种义齿,对美观、咀嚼功能、舒适度、固位及稳定等性能进行对比分析.结果:经卡方检验两种即刻义齿在美观、舒适、异物感等方面P＜0.01具有显著临床意义,隐形即刻义齿明显优于胶连即刻义齿；在固位、稳定、咀嚼功能方面P＞0.05差异无统计学意义,临床意义不明显.结论:隐形即刻义齿总体性能明显优于胶连即刻义齿,值得临床推广.     

Bicon可吸收胶原塞在即拔即种牙中的临床应用

目的：观察Bicon可吸收胶原塞在即拔即种牙术中的临床疗效。方法：将16例患者19颗牙齿即刻拔除,即刻植入种植体,同时应用Bicon可吸收胶原塞覆盖于牙槽嵴顶封闭创1：2。术后当天、1周、1月、3月、6月及修复后每6个月行X线曲面断层片和临床检查,评价Bicon可吸收胶原塞在种植体周围引导骨组织再生修复的效果。结果：随访6。24个月,16例19枚即刻植入种植体除1枚1周后伤1：2裂开外,其余均稳固无松动,种植体周围无炎症及明显骨吸收,未出现X线透射影,临床修复效果好,种植体存活率达100％。结论：Bicon可吸收胶原塞生物相容性好,能促进骨缺损的再生修复,可成功地应用于即刻种植修复中。     

Soft tissue dimensions in flapless immediate implants with and without immediate loading: an experimental study in the beagle dog

Objective: The aim of the present study was to evaluate the peri‐implant soft tissue dimensions in flapless immediate implants with and without immediate loading. Material and methods: This study was carried out on six beagle dogs. Four implants were placed (two per side) immediately after tooth extraction (third and fourth premolars). Flapless immediate implant placement was performed in one hemimandible (control). The same procedure was performed in the contralateral side and immediate prosthesis was connected (test). After 3 months of healing, the dogs were sacrificed. Results: None of the implants and prosthesis were lost. Barrier epithelium in the loaded group was 2.51 mm at the buccal and 2.34 mm at the lingual aspect. In the no loaded group, the results were similar, 2.54 and 2.2 mm at the buccal and lingual side, respectively. Connective tissue in the loaded group was 1.38 mm at the buccal and 0.65 mm at the lingual aspect, and in the no loaded group 1.48 mm at the buccal and 0.53 mm at the lingual side. Biological width dimensions were 3.9 mm at the buccal and 2.95 mm at the lingual aspect for the loaded group, and 4.01 and 2.64 mm at the buccal and lingual aspect for the no loaded group. Conclusions: The results of the present study suggested that soft tissues dimensions around immediate implants with immediate loading were similar to immediate implants without loading. To cite this article:
Blanco J, Carral C, Liñares, A, Pérez J, Muñoz F. Soft tissue dimensions in flapless immediate implants with and without immediate loading: an experimental study in the beagle dog.
Clin. Oral Impl. Res. 23 , 2012; 70–75.
doi: 10.1111/j.1600‐0501.2011.02183.x     

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经典的Brnemark种植理论提出,种植体植入后应该经过3～6个月的无负载愈合期,待种植体与骨组织形成骨整合后才能进行修复,我们称之为种植体传统负载(conventional loading)模式。     

Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone

Aim: To compare the immediate restoration of single implants in the esthetic zones performed on implants placed immediately after tooth extraction or 8 weeks later (immediate replacement vs. immediate restoration). Methods: Sixteen patients (10 women and 6 men) with a mean age of 35 years (ranging from 21 to 49 years old) were treated from 2004 to 2005 for single‐tooth replacement in the upper arch. The patients were randomly divided into two groups: in the test group patients received implants placed and restored (non‐occlusal loading) at the time of tooth extraction; in the control group implants were placed 8 weeks after tooth extraction and immediately restored. All the patients received tapered effect (TE) implants from the Straumann Dental Implant System. The following parameters were evaluated at the moment of provisional restoration (within 48 h after implant placement) and at the 2 years follow‐up visit: marginal bone resorption, papilla index, position of the mucosal margin. The implant stability quotient was measured at the moment of implant placement and at the moment of the delivery of the definitive restoration. Results: No statistically significant differences were found in any of the studied parameters between the test and the control groups (P>0.05). The implant stability quotient values between the test and control groups were significant (P<0.05) at the moment of implant placement but were no more significant at the loading of the definitive restoration (P>0.05). Conclusion: The results of the present study suggest that immediate replacement without functional loading may be considered a valuable therapeutic option for selected cases of single‐tooth replacement in the esthetic area when TE implants are used. Implant stability at the moment of implant placement is slightly inferior in the immediate replacement group, but it does not affect the treatment result.     

上颌前牙区即刻种植修复软组织改变的临床研究

目的：观察即刻种植修复在上颌前牙区牙龈组织萎缩高度及患者自主满意程度,探讨提高前牙美容效果的临床技巧。方法：15例前牙缺失患者在不翻瓣拔牙的条件下同期植入ITI种植体18枚,48小时内完成上部临时固定修复,种植体植入后3个月进行永久修复。测量术后1月,3月,6月,12月牙龈萎缩高度及永久修复后患者主观满意程度。结果：18枚种植体均形成良好的骨结合,无炎症发生。1月后牙龈平均萎缩高度为(0.31±0.28）mm,3月为(0.60±0.44)mm,6月为(0.28±0.32)mm,12月为(0.32±0.60)mm。患者主观满意程度达8.8分。结论：三维位置正确的种植体可获得良好的美学效果和长期稳定性,在严格把握适应症的前提下,上前牙即刻种植修复可获得理想的临床效果。     

Immediately restored single implants in the aesthetic zone of the maxilla using a novel design: 1-year report

Objectives: To evaluate immediate placement and immediate restoration of a novel implant with a 12°‐angled prosthodontic platform, in fresh extraction sockets of the aesthetic zone of the maxilla. Materials and methods: Tapered, roughened surface implants of 4 mm (n=15) or 5 mm (n=13) diameter were placed in 27 participants (mean age: 47.1 years; range: 21–71 years) requiring an immediate replacement of single anterior maxillary teeth. Provisional screw‐retained all‐ceramic crowns were placed within 4 h following optical impressions. At 8 weeks (baseline), definitive screw‐retained all‐ceramic crowns were placed in occlusion. Results: Twenty‐six of the 28 implants met the inclusion criteria at surgery. Marginal bone levels revealed bone gain between surgery and baseline, and between baseline and 1 year of 0.2 mm (SD 0.75) and 0.78 mm (SD 2.45). Mean mid‐buccal mucosal margins showed gains of 0.2 mm (SD 0.44). Prosthodontic maintenance and the aesthetics of the screw‐retained implant crowns were facilitated by the external hex 12°‐angled prosthodontic platform on the novel implant design, re‐orientating the access cavity to the palatal or occlusal surfaces. All‐ceramic implant crowns showed a high success rate with low maintenance issues over 1 year. Conclusion: Tapered, roughened‐surfaced implants with a novel 12°‐angled prosthodontic platform immediately placed in fresh extraction sockets, immediately restored with provisional crowns and subsequent definitive crowns at 8 weeks were successful for 1 year. To cite this article:
Brown SDK, Payne AGT. Immediately restored single implants in the aesthetic zone of the maxilla using a novel design: 1‐year report.
Clin. Oral Impl. Res. 22 , 2011; 445–454.