薄龈生物型患者前牙区的即刻种植即刻修复

目的 评估美学区不翻瓣即刻种植即刻修复+软组织增量技术在薄龈生物型患者中的临床应用效果。方法 选择12例薄龈生物型患者,上颌中切牙或侧切牙无法保留,进行不翻瓣即刻种植、即刻修复,4个月后进行软组织移植,再过3个月后完成最终修复。修复后随访1年,观察种植体周围软硬组织情况,统计种植体存留率、种植体唇侧骨板厚度、种植修复体与邻牙唇侧牙龈的协调性和患者主观满意度。结果 在观察期内,所有种植体均获得了良好的骨整合,存留率100%。CBCT测量,3例种植体唇侧骨板厚度大于1.5 mm,9例大于2 mm。10例种植修复体唇侧龈缘位置与邻牙协调无差异,2例轻度差异;全部12例种植修复体与邻牙牙龈颜色质地协调无差异。患者主观满意度VAS平均值为95。结论 不翻瓣即刻种植即刻修复+软组织增量是针对薄龈生物型患者美学区种植的有效技术,能减少美学并发症,获得稳定的美学效果以及很高的患者满意度。     

骨性安氏II类1分类成年患者拔牙矫治前后牙周表型的评估分析

目的　分析不同牙周表型的骨性安氏II类1分类成年患者拔牙矫治后上切牙区唇侧骨开裂、骨开窗及牙根吸收情况。方法　研究纳入24例骨性安氏II类1分类成年患者，通过术前CBCT和数字化印模数据的重叠，对前牙牙龈厚度进行无创的定量测量。根据术前上中切牙牙龈厚度将研究对象分为薄龈生物型组（牙龈厚度<1.5mm）和厚龈生物型组（牙龈厚度≥1.5mm）。使用CBCT测量正畸治疗前后上切牙唇侧牙槽骨骨开裂、骨开窗及牙根吸收的程度。结果　骨性安氏II类1分类成年患者术前骨开裂和骨开窗的发生率为31.2%和18.8%，经拔牙正畸治疗后增加至75%和20.8%。薄龈生物型组术后上前牙唇侧牙槽嵴顶至釉牙骨质界距离为3.19 ± 0.43mm，显著高于厚龈生物型组（2.16 ± 0.11mm），但该距离与牙龈厚度无显著相关性（r= -0.1108，P= 0.6146）。牙根吸收程度和牙龈厚度呈正相关（r=0.4223，P=0.0447），且厚龈生物型组牙根吸收量为2.24 ± 1.24mm，显著高于薄龈生物型组（1.08 ± 0.73mm）。结论　骨性安氏II类1分类成年患者经拔牙正畸治疗后上切牙区唇侧牙槽骨骨开窗、骨开裂及牙根吸收均加重，其中薄龈生物型组垂直牙槽骨吸收风险较大，厚龈生物型组骨开窗及牙根吸收风险较大。     

上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究

目的 探讨唇侧骨板部分缺损的患者行即刻种植和延期种植对术后软硬组织变化情况及美学效果的影响。方法 将40例唇侧骨板呈有利型裂开式骨缺损,且缺损高度不超过4 mm的上颌单颗前牙患者分为即刻种植组（20例）和延期种植组（20例）,两组均在全程导板引导下植入Nobel Active种植体,种植体颈部平台位于唇侧龈缘根方3～4 mm。植入后两组均行即刻修复,并应用Bio-Oss骨粉及Bio-Gide膜同期行引导骨再生术（guided bone regeneration,GBR）。比较两组种植体成功率、种植体唇侧骨板厚度变化、种植体唇侧轮廓厚度变化以及红色美学评分（pink esthetic score,PES）。结果 两组患者的种植体成功率均为100%,随访期间未发生并发症。两组术后唇侧骨板均在种植体颈部观察到最大的骨吸收量,术后12个月即刻种植组的颈部骨吸收量为（1.29±0.71）mm,延期种植组为（1.43±0.19）mm,但两组间在各测量位点骨吸收量差异均无统计学意义。即刻种植组和延期种植组术后6个月及12个月唇侧龈缘最高点以及近远中牙龈乳头高度的变化量差异均无统计学意义;PES评分在...     

不同牙龈生物型在牙冠延长术后牙周稳定性的评价

目的 评价不同牙龈生物型在牙冠延长术后牙周的稳定性。方法 选取需行前牙牙冠延长术的30例患者共128颗患牙,分为薄龈生物组（n=52）和厚龈生物组（n=76）,牙周基础治疗后行牙冠延长术,检测术前、术后2周、术后1、3、6个月两组患者牙龈缘位置,牙周探诊深度（PD）以及龈沟出血指数（SBI）并进行分析。结果 两组术后PD和SBI较术前均有明显改善（P<0.05）,手术前后两组之间的PD和SBI均无明显差异（P>0.05）,术后3个月薄龈生物型龈缘位置已基本稳定,术后6个月厚龈生物型组龈缘冠向移位更明显。结论 冠延手术后,厚龈生物型需要更长的恢复期稳定龈缘位置,修复体的制作应在术后6个月以后进行。     

不同术式上颌窦提升术应用于上颌后牙种植修复临床疗效评价

目的    评价上颌窦内、外提升术应用于上颌后牙区垂直骨量不足的种植义齿修复临床疗效。方法    选择中国医科大学附属口腔医院种植中心2007年6月至2012年6月收治的上颌后牙缺失行种植义齿修复患者127例,植入种植体216颗。其中,上颌窦外提升术、内提升术及常规种植术的种植体数分别为40、61、115颗。于种植术后随访6 ~ 60个月,通过临床及影像学检查比较各组间种植体累计存留率、骨结合状况和种植体周围骨吸收状况。结果    在随访期内,各组间种植体5年累计存留率及完成上部结构修复1年内种植体周围骨吸收差异均无统计学意义（P > 0.05）,且种植术后1年的骨吸收量平均每年小于0.2 mm。结论    上颌窦内、外提升术与常规种植术种植义齿修复效果无明显差异,种植体成功与否关键在于手术适应证的选择及相关手术技巧的掌握。     

即刻修复1年后种植体周围边缘骨吸收的临床评价

目的 观察即刻修复种植体的临床存活率和种植体周围边缘骨的变化,对影响种植体即刻修复的相关因素进行初步探讨.方法 选择75名患者行种植后即刻修复,共植入种植体171颗,其中ITI种植体110颗,奥齿泰SSⅡ种植体61颗.在术后即刻、术后6个月和术后12个月行X线检查,评价即刻修复后种植体周围边缘骨的变化.结果 ITI和奥齿泰SSⅡ种植体临床存活率分别为100%～98.4%.即刻修复后种植体周围边缘骨吸收主要发生在修复后6个月内.在上颌骨,2组种植体的边缘骨吸收量差异无统计学意义(P＞0.05);在下颌骨,2组种植体在植入时边缘骨高度和术后6个月骨吸收量差异有统计学意义(P＜0.05).单冠修复组在6～12个月期间的种植体边缘骨吸收更为显著.结论 在获得良好的种植体初期稳定性并进行合理的控制耠力下进行即刻修复,可以取得满意的临床效果.即刻修复后种植体周围边缘骨吸收主要取决于一段式种植体的植入深度.     

根盾技术和不翻瓣即刻种植在不同牙龈生物型的种植美学比较

目的 评估不翻瓣即刻种植(immediate implant placement, IIP)和采用根盾技术(socket-shield technique, SST)即刻种植术在不同牙龈生物型上颌前牙区单牙种植的美学和临床效果。方法 研究共纳入30例需要进行上颌前牙单牙即刻种植和即刻修复并符合适应证的成年患者，随机分为试验组SST(n=15)和对照组IIP(n=15)组。并根据插入牙龈沟内的牙周探针的可见性，将患者分为薄龈生物型和厚龈生物型。术后即刻修复，4个月后完成最终修复，于12个月后复诊并进行临床检测。通过石膏模型数据分析种植位点唇侧轮廓突度、唇侧龈缘位置变化并采用粉色美学评分(PES)评估美学效果。临床检查包括改良龈沟出血指数(mSBI)、统计并发症及患者对治疗过程的满意度。结果 12个月后复查，种植体存留率100%。唇侧轮廓突度变化IIP组(-0.49±0.18)mm, SST组(-0.21±0.18)mm(P<0.05),其中薄龈生物型中IIP组(-0.58±0.17)mm, SST组(-0.20±0.19)mm(P<0.05)。唇侧龈缘位置变化IIP组(-0....     

4种不同穿龈高度的修复基台对边缘骨吸收影响的5年临床观察

目的 评价不同穿龈高度的修复基台在种植修复5年后的长期临床疗效。方法 选取2015年1月至2015年9月于南昌大学第四附属医院口腔科就诊的牙列缺损行种植修复的患者,根据完成最终修复时选用修复基台的不同穿龈高度将其分为4组：A组（≤1 mm）、B组（2 mm）、C组（3 mm）、D组（4 mm）,根据分组情况分别测量每颗种植体在种植即刻、完成最终修复时以及修复负荷至少5年之后的曲面体层放射线片,分析种植体颈部的骨组织变化情况。结果 在观察期内,经过至少5年的功能性负荷,63颗种植体的留存率为96.83%;4组种植体的周围骨组织吸收量中A组[T2-T1:(-0.627±1.030) mm]与B组[T2-T1:(-0.017±0.424)mm]的差异具有统计学意义（P<0.05）;不同穿龈高度的修复基台与种植体颈部平台暴露关系差异具有统计学意义（P<0.05）。结论 自锁锥度固位种植体在完成最终修复时选用不同的穿龈高度的修复基台对种植体周围骨组织的吸收量有一定的影响,在植入深度相同的情况下用长穿龈修复基台可以减少在功能负荷后种植体颈部平台的暴露,从而降低种植体受周围环境感染的风险...     

不同种植深度Ankylos种植体边缘骨吸收的对比研究

目的：对比分析后牙区不同种植深度种植体边缘骨吸收差异。方法：选择2010年1月～2014年1月间后牙区接受Ankylos系统种植修复患者72例,共植入113颗种植体,根据种植深度分为3组：0 mm组（平齐骨缘）,1 mm组（骨缘下1 mm）,2 mm组（骨缘下2 mm）。随访24～66个月,测量种植体边缘骨吸收量,并评估种植体功能负载2年后颈部边缘骨水平的变化及3组之间的差异。应用SPSS 13.0软件包对数据进行统计学分析。结果：3组不同种植深度的种植体周围骨质年均骨吸收量之间对比,差异无统计学意义（P＞0.05）。功能负载2年后,0 mm组边缘骨水平稳定于种植体平台水平或以上的位点占28.6％,1 mm为52.3％,2 mm为70.4％,3组对比差异有统计学意义（P﹤0.05）。结论：在平台转移设计的Ankylos系统,种植深度低于牙槽嵴水平有利于种植体周围骨组织稳定。     

美学区软组织水平和骨水平植体周围骨丧失和牙龈生物型的分析

目的: 植体周围一定程度的骨丧失可能会给牙种植治疗的美观效果带来不利影响。这种情况可能更容易影响软组织水平（Tissue-Level, TL）设计,因此,当强调形态的美观自然性时,骨组织水平（Bone-Level, BL）设计可能更有优势。除了植体的设计,牙龈生物型也被认为是维持牙槽骨稳定的重要因素。本研究拟针对具有不同牙龈生物型的患者,在其美学区域行软组织水平和骨水平牙种植治疗,探究其骨丧失的程度。材料和方法: 对41位患者行20个TL和22个BL种植治疗,术后即刻、术后随访对这42个位点行口内影像学检查;运用计算机技术行牙槽骨高度测量分析;运用TRAN法鉴定患者的牙龈生物型。结果: TL组平均4.9年的存留期里,厚龈型的12颗植体周围平均骨丧失0.21mm（SD：0.43mm）;薄龈型的8颗植体周围平均骨丧失0.05mm（SD：0.47mm;P=0.31）。BL组平均1.9年的存留期里,厚龈型的14颗植体周围骨丧失为-0.03mm（SD：0.38mm）,薄龈型的8颗植体周围骨丧失为+0.09mm（SD：0.32mm;P=0.84）。结论: 分析得到的数据发现,牙槽骨高度的变化与种植设计或是牙龈生物型并无直接相关性。然而在选择种植设计之前,评价软组织的厚度是有利的,其中BL种植设计更能获得自然的外形。为实现以上评价目的,TRAN法是最快速、简易的方法。     

种植位点附着龈厚度增量的研究进展

在种植治疗中,种植体的成功取决于多种因素,良好的软硬组织是其中重要的一方面.种植体周围附着龈厚度不仅影响种植体的长期稳定性,还是保证种植修复美学效果的关键因素,种植美学强调了应纳入更多因素来界定种植体的成功标准,焦点已从单纯的种植体存活转移到获得长期美学效果,强调了病人对最终效果满意的重要性.牙齿缺失以后,缺牙区周围软...     

Hard and soft tissue changes after crestal and subcrestal immediate implant placement

Background: The purpose of this study is to assess the influence of the placement level of implants with a laser‐microtextured collar design on the outcomes of crestal bone and soft tissue levels. In addition, we assessed the vertical and horizontal defect fill and identified factors that influenced clinical outcomes of immediate implant placement. Methods: Twenty‐four patients, each with a hopeless tooth (anterior or premolar region), were recruited to receive dental implants. Patients were randomly assigned to have the implant placed at the palatal crest or 1 mm subcrestally. Clinical parameters including the keratinized gingival (KG) width, KG thickness, horizontal defect depth (HDD), facial and interproximal marginal bone levels (MBLs), facial threads exposed, tissue–implant horizontal distance, gingival index (GI), and plaque index (PI) were assessed at baseline and 4 months after surgery. In addition, soft tissue profile measurements including the papilla index, papilla height (PH), and gingival level (GL) were assessed after crown placement at 6 and 12 months post‐surgery. Results: The overall 4‐month implant success rate was 95.8% (one implant failed). A total of 20 of 24 patients completed the study. At baseline, there were no significant differences between crestal and subcrestal groups in all clinical parameters except for the facial MBL (P = 0.035). At 4 months, the subcrestal group had significantly more tissue thickness gain (keratinized tissue) than the crestal group compared to baseline. Other clinical parameters (papilla index, PH, GL, PI, and GI) showed no significant differences between groups at any time. A facial plate thickness ≤1.5 mm and HDD ≥2 mm were strongly correlated with the facial marginal bone loss. A facial plate thickness ≤2 mm and HDD ≥3 were strongly correlated with horizontal dimensional changes. Conclusions: The use of immediate implants was a predictable surgical approach (96% survival rate), and the level of placement did not influence horizontal and vertical bone and soft tissue changes. This study suggests that a thick facial plate, small gaps, and premolar sites were more favorable for successful implant clinical outcomes in immediate implant placement.     

三种种植系统周边骨质吸收的对比研究

目的：用全景片评估平齐对接种植系统、平台转换种植系统边缘骨吸收的差别。方法：植入平齐对接种植体（Noble Replace）54枚，小平台转换种植体（Osstem GS）14枚，斜肩式平台转换种植体（Bicon）25枚。在种植体植入当天、负载3个月后分别进行全景片检查，测量种植体边缘牙槽骨高度，计算牙槽骨丧失量。SPSS14．0软件进行统计分析。结果：功能负载3个月后，平齐对接种植体近、远中边缘骨吸收量分别为1．88mm±1．49mm、1．81mm±1．34mm；斜肩式平台转换种植体为-0．68mm±0．99mm、-1．17mm±1．37mm;小平台转换种植体为0．53mm±1．48mm、0．74mm±0．99mm。三种种植体两两比较，P〈0．05，相互之间存在显著性差异。结论：应用平台转换技术可减少种植体边缘骨吸收，不同的平台转换设计，其保存种植体周围骨质的能力明显不同。     

Evaluation of peri-implant marginal bone loss using modified abutment connections at various crestal level placements

The purpose of this study was to evaluate crestal bone loss around 282 two-piece implants with straight (n = 193) and platform-switched (n = 89) abutment connections after placement at various crestal levels. Implants were assigned into two groups according to straight and platform-switched abutment connections. Each group was further subdivided into three groups depending on the location (supracrestal, crestal, or subcrestal) of the implant cervical platform. Linear measurements of bone resorption were made from the implant's platform to the first point of bone-to-implant contact at the time of implant placement and 2 years postrestoration. Data were statistically analyzed. Statistically significant differences were found between subgroups in both straight and platform-switched categories. The only nonstatistically significant difference (P = .341) arose when comparing the supra- and subcrestal locations in the straight abutment connection group. The platform-switched group exhibited significantly less bone loss (P = .046) only in subcrestal locations. The platform-switched concept was not beneficial during the overall comparison, but it was for the subcrestal location of the abutment connection. Crestal placement of the implant-abutment connection resulted in higher marginal bone resorption in both straight and platform-switched abutments.     

Crestal bone changes on platform-switched implants and adjacent teeth when the tooth-implant distance is less than 1.5 mm

Because of the peri-implant bone resorption that occurs when a non-platform switched implant is exposed to the oral environment, it has been recommended to maintain 1.5 mm between the tooth and implant to preserve the bone adjacent to the teeth. Several studies have documented that platform-switched implants have less peri-implant bone resorption than matched implants. This retrospective radiographic analysis studied 70 platform-switched implants placed less than 1.5 mm from an adjacent tooth and with prostheses loaded for a minimum of 6 months. The mean distance between the implant and tooth was 0.99 mm (range, 0.20 to 1.49 mm); the mean horizontal and vertical bone resorption was 0.36 and 0.43 mm, respectively. The mean bone peak reduction was 0.37 mm. The results confirm that the use of platform-switched implants reduces bone resorption after two-piece implants have been uncovered and that it is possible to place this type of implant 1 mm from teeth while maintaining the bone level adjacent to them (the bone peak).     

即刻种植和早期种植对前牙美学区种植体周围软组织的影响分析

目的:分析即刻种植和早期种植对前牙美学区种植体周边软组织的影响。方法:随机抽取我院于2015年8月至2019年8月期间收治的60例单颗前牙缺失患者,其中有30例患者于拔牙后行即刻种植(观察组),30例拔牙后行早期植入(对照组),均予以Astra Tech种植体及种植体植入半年后给予氧化锆全瓷修复,并在半年后复查,对比分析两组患者的红色美学评分(PES)等。结果:两组患者对比PES总分和各节点PES评分无明显差异(P>0.05)而在各节点PES评分中,牙龈生物型和牙槽骨缺损、远中龈乳头,缺失牙位和牙龈高度及缺牙原因和近、远中龈高度存在显著相关性。结论:即刻种植和早期种植对前牙美学区种植体周边软组织之间的影响差异不明显,对前牙美学区种植体修复时软组织美学产生的主要影响包括缺失牙位、牙龈生物型及缺牙原因。     

Gingival dimensions after root coverage with free connective tissue grafts

Abstract. Traumatic injury in the presence of a thin and narrow zone of gingival tissue may lead to gingival recession. Especially in class I and II recessions, root coverage may be accomplished with connective tissue grafts. In order to prevent recurrent recession, altering gingival dimensions width and thickness might be of advantage. In the present study, dimensions of gingiva were followed for 1 year after root coverage with connective tissue grafts. The study population consisted of 18 patients with a total of 28 class I or II recessions. Gingival width and depth of the recession were measured with a caliper, and thickness of the marginal tissue with an ultrasonic device. Periodontal probing depth was determined with a pressure-controlled electronic probe. Mean (±sd) recession depth at baseline was 3.l±l.4 mm. After 12 months, coverage amouted to 74±30%. Width of gingiva rose from 2.1±1.0 mm to 3.2±1.4 mm. whereas thickness was increased from 0.8±0.3 mm to 1.5±0.7 mm, on average. No significant alteration of periodontal probing depth was observed but a mean gain of clinical attachment of 1.7± 1.1 mm was ascertained. In a multiple regression analysis, recession depth and presence of the recession in the maxilla, but not tooth type significantly influenced relative root coverage (R²-=0.34, p <0.01). Attachment gain after surgery depended on baseline attachment loss and was negatively influenced by smoking. The present results point to the possibility of doubling gingival thickness after root coverage with connective tissue crafts.     

牙龈生物学类型对上颌单牙种植后龈乳头美学效果的影响

目的 评估牙龈生物学类型对上颌前牙区单牙种植修复后龈乳头美学效果的影响.方法 32例上颌前牙区单牙缺失的患者,按软组织厚度分组,Ⅰ组：16例,厚度1.5 mm～3 mm;Ⅱ组：16例,厚度3.1 mm～4.5mm.共植入32枚ITI种植体,术后2～3个月常规修复,于修复完成当日（基线期）和6个月后（随访期）,应用龈乳头充填指数（PFI）评估种植体周围龈乳头形态.比较基线期和随访期各组PFI变化,并进行统计学检验.结果 观察期内两组均无种植体松动脱落.两组在随访期的PFI均显著高于基线期（P＜0.05）,Ⅱ组在基线期的PFI显著高于Ⅰ组（P＜0.05）,两组之间的PFI变化有显著性差异（P＜0.05）.结论 牙龈生物学类型是影响种植修复后龈乳头美学的重要因素,软组织较厚者龈乳头美学效果更好.     

Effects of Flapless Implant Surgery on Soft Tissue Profiles: A Prospective Clinical Study

Background: Flapless implant surgery has been suggested as a suitable treatment modality for the preservation of soft tissue after implant placement. Purpose: The purpose of this study was to determine the extent of soft tissue profile changes around implants after flapless implant surgery. Materials and Methods: A total of 44 patients received 76 implants using a flapless implant procedure. The marginal level of the peri‐implant soft tissue was evaluated using dental casts 1 week, 1 month, and 4 months after implant placement. Results: The mean soft tissue levels around implants showed 0.7 ± 0.3 mm of coronal growth 1 week after surgery. At 1 month, the levels were 0.2 ± 0.2 mm coronal growth and at 4 months, the values were 0.0 ± 0.3 mm. Soft tissue profiles assessed 4 months after flapless implant placement were similar to profiles assessed immediately before implant placement. Conclusion: Flapless implant surgery is advantageous for preserving mucosal form surrounding dental implants.