种植个性化转移杆在上颌前牙种植美学修复中的应用

目的观察个性化转移杆技术和树酯暂时冠种植体周围软组织塑形对上颌前牙种植美学效果的影响,应用种植个性化转移杆在上颌前牙种植美学中加工的技术特点、临床效果。方法 2009年7月至2011年2月共16例连续在北京大学口腔医院种植科就诊的上颌前牙缺失患者纳入本研究,所有患者均进行了本研究所采用的种植体周围软组织美学处理技术,并对最终种植修复体进行修复效果的美学评估。美学评价指标包括牙龈乳头水平及种植体唇侧软组织丰满度。结果 16例患者共植入18枚种植体,平均追踪时间11.6个月,至最后一次复查未见种植体脱落。牙间乳头0度为0牙位,Ⅰ度为1牙位,Ⅱ度为7牙位,Ⅲ度为10牙位,Ⅳ度0牙位。唇侧丰满度0度为0牙位,Ⅰ度18牙位,Ⅱ度0牙位。结论尽最大可能保存软硬组织的形态结构并重建与重塑软组织是治疗过程中需要考虑的主要因素。然而修复过程中基台及上部结构的形态与大小也将对最终美学修复效果起到至关重要的影响,应用个性化转移杆精确转移种植体周围软组织信息,临床操作容易,技术可行,修复后种植美学效果好。     

上颌前牙美学区域种植修复的特殊处理

背景与目的：研究表明口唇部作为面部关注的中心对患者的自信心与社会认可度有着显著影响,牙齿美学修复是上颌美学区域牙齿缺失患者主要关注焦点。美学区域是唇部组织在最大运动状态下（大笑）所显露的区域,包括牙齿、牙龈及相邻的软组织;而这些组织的质地、结构、形态是否正常,能否与周围邻牙及软组织协调,将明显影响患者容貌美观,进而影响患者的心理健康与社会生活。种植修复因其长期成功率高,对邻牙没有损害,重建口颌功能效果好而被广大医生和患者所接受,成为牙齿缺失首选的修复方法。如何使上颌前牙美学区域种植修复体能最大限度模仿天然牙的美学成为目前口腔种植学界研究的热点与难点。本研究目的旨在探讨上颌美学区域不同缺牙情况下种植修复使所需做的特殊处理,技术特点及临床效果。材料与方法：57例连续在北京大学口腔医院种植科就诊的上颌前牙缺失患者纳入本研究,按照北京大学口腔医学院种植科诊疗常规完成种植前常规检查、制定治疗计划,治疗前签种植治疗同意书。57例病例分二组：I组为翻瓣植骨组39例,其中种植同期行引导骨再生植骨28例,种植前行外置法植骨11例。在种植体暴露后6周行种植体支持的过渡义齿修复,以进行牙龈诱导塑形;II组为不翻瓣即刻种植组18例,种植体暴露愈合4周行种植体支持的过渡义齿修复,进行牙龈诱导塑形。美学评价指标包括牙龈乳头水平及种植体唇侧软组织丰满度。根据Jemt1997年牙间乳头的分类标准测量种植修复后牙间乳头的高度。结果：57例患者共植入73种植体,其中ReplaceSpeedy（NobelBiocare,G？teborg,Sweden）36枚,Ankylos（DENTSPLYFriadent,Mannheim,Germany）20枚,Camlog（Camlog,Wimsheim,Germany,CamlogRootline）17枚,平均追踪时间32.7月（24-64月）,至最后一次复查未见种植体脱落。I组中11例种植前行外置法植骨（2例髂骨取骨,9例外斜线取骨）,28例种植同期行引导骨再生技术（Bio-Oss＆Bio-Gide,GeistlichPharmaAG,Switzerland）,共植入种植体53枚,牙间乳头为0度0牙位,Ⅰ度5牙位,Ⅱ度32牙位,Ⅲ度16牙位,Ⅳ度0牙位。唇侧丰满度0度10牙位,Ⅰ度38牙位,Ⅱ度5牙位。II组中所有病例均为在拔牙同期植入种植体,并于拔牙窝间隙内同期植入人工骨材料（Bio-Oss,1-2mm,GeistlichPharmaAG,Switzerland）,共植入种植体20枚,牙间乳头为0度0牙位,Ⅰ度0牙位,Ⅱ度1牙位,Ⅲ度19牙位,Ⅳ度0牙位。唇侧丰满度0度1牙位,Ⅰ度19牙位,Ⅱ度0牙位。结论：上颌前牙美学区域种植修复的美学效果主要受到种植区域是否有骨组织支持和修复体周围软组织的质与量的影响。尽最大可能保存软硬组织的形态结构并重建与重塑软组织是治疗过程中需要考虑的主要因素。外置法植骨技术与引导骨再生技术能有效重建种植体周围的骨组织以维持其周围软组织的稳定。不翻瓣即刻种植技术能保存天然牙的软硬组织结构形态且手术创伤小,临床效果肯定。而修复过程中基台及上部结构的的形态与大小将对最终美学修复效果起到至关重要的影响。     

微创拔牙即刻种植的牙龈美学效果观察

目的探讨微创拔牙即刻种植技术的临床特点及修复后的牙龈美学效果。方法21例上前牙单个缺失病例，行不翻瓣微创拔牙同期23颗种植体即刻植入，并且同期安装愈合基台直接暴露于口腔，即非埋入式种植术式，种植体愈合6个月后进行永久修复。种植永久修复后观察时间平均27．6个月（13～51个月）。根据Jemt牙龈乳头指数（papilla index score，PIS）观察种植体永久修复12个月后的近远中牙龈乳头状况，根据Flirhauser的改良红色美学指数观察种植体永久修复1年后与相邻天然牙唇侧龈缘位置的协调性；唇侧软组织与相邻天然牙唇侧牙龈色泽协调性。结果23颗种植体均获得良好的骨结合；种植修复体近远中PIS均为Ⅱ级以上。种植修复体与相邻天然牙唇侧牙龈缘水平位置协调性一致的15颗，8颗不协调；唇侧软组织色泽与相邻天然牙协调一致的18个牙位，5个牙位有轻度差异。结论微创拔牙即刻种植术是一项要求较高的技术，多因素影响软组织美学效果，严格掌控适应证，才能获得理想修复效果。     

上颌前牙单牙不翻瓣即刻种植修复的临床研究

目的：旨在探讨上颌美学区域单牙不翻瓣即刻种植修复的技术特点及临床效果。材料与方法：16例上颌前牙单牙进行不翻瓣即刻种植修复。纳入条件：唇侧骨板完整,唇侧牙槽嵴骨面距龈缘3mm左右。微创拔牙,偏腭侧植入种植体,同时种植体植入深度为龈缘下3mm左右。种植体与唇侧骨板之间间隙至少2mm,间隙内植入BioOss颗粒。薄龈生物型、术前龈缘高度偏根方的患者,进行结缔组织移植。术后4-6周采用种植体支持过渡义齿修复,进行牙龈诱导塑形。采用Jemt牙间乳头的分类标准测量种植修复后牙间乳头的高度。采用PES（pinkestheticscore）评分系统评价软组织整体美学效果。PES涉及种植体周围软组织美学的多个因素,包括种植体两侧龈乳头高度、边缘龈水平、软组织轮廓、牙槽突度、软组织质地、软组织颜色7组评分指数,每组由低到高有0、1、2三个记分值,总分最低为0,最高为14。采用CBCT评估唇侧骨板厚度。结果：16位患者16颗种植体平均追踪时间21.8月（12-34月）,至最后一次复查种植体无脱落。根据Jemt牙间乳头评估标准：0度0牙位,Ⅰ度0牙位,Ⅱ度2牙位,Ⅲ度14牙位,Ⅳ度0牙位。PES评分：12分2牙位,13分8牙位,14分6牙位。CBCT显示唇侧骨板厚度得到维持。结论：不翻瓣即刻种植技术可以获得可靠的美学效果,前提是需严格适应证选择,评估局部位点软硬组织解剖条件,采用微创拔牙技术,保证种植体三维方向的准确性,尤其是种植体在唇舌向的位置与轴向,以及种植体植入的深度。并根据位点牙龈情况进行相应的软组织处理,合理选择过渡义齿的方式和戴用时机进行牙龈诱导,并注意修整修复体的唇侧穿龈轮廓为凹形设计,勿使其膨大。     

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。     

临时冠塑形对前牙种植美学的临床观察

目的 在前牙区通过利用临时冠对种植体周围软组织进行塑形,观察最终修复的美学效果及软组织的稳定性。方法 选取本院种植科21例上前牙需要种植病例,牙种植后即刻或延期行临时冠修复,对种植体周围软组织进行塑形,待软组织稳定后,行个性化转移杆取模,制作最终修复体,使用红色美学指数（PES）来评价种植体周围软组织的美学效果。结果 11例患者PES≥12,9例8≤PES≤11,获得较好的美学效果。1例患者前牙区种植体支持固定桥修复,由于牙槽骨水平吸收,牙龈退缩,后期通过牙龈瓷进行美学处理。21例患者最终修复后观察1年,通过PES再次评价,同样获得较好的美学效果。结论 前牙种植术后利用临时冠对软组织进行塑形,能够将软组织调整到较好的美观外形,并且形态较稳定。此方法在前牙区种植修复是必要的,值得在临床中广泛推广。     

上颌前牙翻瓣与不翻瓣即刻种植修复临床效果比较研究

目的    评估翻瓣与不翻瓣即刻种植修复病例的种植体存留率、软组织美学效果及种植体周围骨吸收情况。方法    2007年8月至2011年3月共41例在北京大学口腔医院种植科就诊的上颌前牙区单牙即刻种植患者纳入本研究,分为不翻瓣组（20例）和翻瓣组（21例）,两组均采用种植体支持暂时冠进行牙龈诱导塑形。评估两组修复后1、3年的骨吸收量并进行统计学分析。美学评价指标包括牙间乳头外形指数及种植体唇侧牙龈丰满度。结果    41例患者共植入41枚ReplaceSpeedy®种植体,追踪时间24 ~ 67个月,平均42.4个月,至最后一次复查未见种植体脱落。不翻瓣组与翻瓣组修复后1、3年的牙间乳头外形指数和唇侧牙龈丰满度比较,差异均无统计学意义（均P > 0.05）。修复后1、3年,不翻瓣组骨吸收量分别为（0.50 ± 0.04）mm和（0.55 ± 0.04）mm,翻瓣组分别为（0.59 ± 0.03）mm和（0.67 ± 0.03）mm,两组差异有统计学意义（P < 0.05）。两组患者对修复后美学效果满意,不翻瓣组患者对治疗过程舒适度的满意度高于翻瓣组。结论    上颌前牙翻瓣与不翻瓣即刻种植技术在选择合适的适应证及采用适当的技术时均能取得满意的临床效果。经种植体支持暂时冠牙龈诱导塑形,修复后牙龈稳定。两组种植体边缘骨水平稳定,不翻瓣组骨吸收低于翻瓣组。两组患者均对修复后美学效果满意,患者对不翻瓣即刻种植满意度更高。     

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。     

上颌前牙种植美学修复的临床研究

目的:探讨上颌前牙种植美学修复的方法与效果。方法:选择30例上前牙缺失患者随机分实验与对照组,实验组15例常规植入种植体,牙槽嵴顶与唇侧植骨,二期术牙龈成形与重建,技师和比色仪相结合比色,贵金属烤瓷修复;对照组15例常规植入种植体,唇侧植骨,二期术牙龈成形,临床比色板比色,贵金属烤瓷修复;分别于种植修复后3、6、12月由医师/患者对修复体形态,色泽,牙龈形态,色泽,丰满度,龈缘曲线,牙间乳头,以及邻牙与对侧同名牙协调性进行美学评分,得出满意度。结果:实验组满意度87%,对照组33%;实验组不满意度7%,对照组53%。结论:上颌前牙种植美学修复方法可行,效果显著。     

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。     

A zirconia implant-crown system: a case report

Exposed metal crown margins in the porcelain-fused-to-metal technique might be an esthetic problem. Therefore, all-ceramic crown systems are used for restoring teeth and dental implants. In addition, the gray color of a titanium implant might hamper the esthetic appearance of the entire reconstruction in cases of thin peri-implant soft tissue or tissue retraction. To further improve the esthetic aspect of dental implants, efforts are undertaken to develop implant systems fabricated out of tooth-colored materials that are biocompatible and able to withstand masticatory forces. One such material may be zirconia. The present article presents a case in which an all-ceramic custom-made zirconia implant-crown system was used for the replacement of a single tooth.     

个性化基台-冠一体式临时修复体在美学区种植修复中的应用

目的本文针对美学区种植修复中软组织塑形的难题,介绍了一种改良的个性化基台-冠一体式临时修复体的设计制作方法。方法牙种植体植入3个月后,通过数字化技术镜像缺失牙对侧同名牙的形态,设计制作个性化基台-冠一体式临时修复体,佩戴3个月后观察种植体周软组织塑形效果,制作、戴入永久修复体并随访1年。结果患者戴入永久修复体后随访一年,种植体周软组织塑形效果稳定,粉红色美学评分稳步上升达12分。X线根尖片显示种植体周边缘骨水平稳定。结论个性化基台-冠一体式临时修复体应用于美学区种植修复取得了良好的软组织塑形效果。     

Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach

Immediate implant placement is considered the treatment of choice for single tooth replacement in the esthetic area. However, this treatment is associated with several critical drawbacks related to the inadequate assessment/management of the soft and hard peri-implant tissues and their subsequent remodeling, resulting in peri-implant soft-tissue defects that can lead to impaired esthetic outcomes in time. We describe in detail how the mucogingival approach to immediate implant placement ensures a standard result regardless of the baseline soft-hard tissue situation. Fully guided implant placement guarantees an adequate three-dimensional implant placement, the flap design makes it possible to perform bone augmentation with complete visibility of the area being treated, allows soft tissue augmentation with proper fixation of the connective tissue graft, and the placement of an immediate provisional ensures stabilization of the peri-implant tissues throughout the healing period.     

Management of interdental papillae loss with forced eruption, immediate implantation, and root-form pontic

BACKGROUND: A 25-year-old Asian woman complained of an unesthetic black triangle between her upper right front teeth. Defective interdental papillae may result from external root resorption, which makes esthetic restoration more difficult. A combined use of forced eruption, immediate implant placement, and a root-form pontic made a successful esthetic and functional restoration. METHODS: The treatment sequences of this patient included short-term forced eruption, subsequent immediate implant placement after tooth extraction, and a provisional root-form pontic restoration. A final prosthesis was completed 6 months later, followed by clinical maintenance. RESULTS: Papillae were augmented by forced eruption. After immediate implantation and root-form pontic placement had been performed, the peri-implant soft and hard tissues were manipulated and maintained in a stable state. CONCLUSIONS: We successfully reconstructed the interdental papillae and replaced the deficient tooth with an immediate implantation. During 2 years of follow-up, the implant and peri-implant structures remained stable and healthy.     

Optical phenomenon of peri-implant soft tissue. Part II. Preferred implant neck color to improve soft tissue esthetics

OBJECTIVES: The purpose of this study was to investigate an optical solution to eliminate the undesirable shine-through effect of implants on peri-implant mucosa by selecting an optimized implant neck color based on an objective and quantifiable method. MATERIAL AND METHODS: The optical effect of color strips on 15 peri-implant mucosal sites of 14 patients with Straumann single-tooth implant replacements in the maxillary anterior region was analyzed. The color differences between the peri-implant mucosa with insertion of each of eight different color strips (white, black, light pink, pink, light orange, orange, gold, violet) and the gingiva of an adjacent or contralateral tooth without any color strips were compared for the selection of optimal color of implant neck. Spectrophotometric color measurements were performed to compare the color difference index (DeltaE) and color coordinates (DeltaL*, Deltaa*, Deltab* and DeltaC*). RESULTS: The colors of the peri-implant mucosa with color strips and the gingiva of natural tooth demonstrated that the test site soft tissue with color strips of light pink, pink, light orange and orange showed a significantly smaller DeltaE value (P<0.05). Moreover, light pink exhibited the lowest mean DeltaE value of 2.6+/-0.6, indicating a clinically indistinguishable color difference. CONCLUSIONS: The results suggest that it is possible to improve gingival esthetics by coloring the implant neck, most effectively with light pink, to mask the impact of the underlying titanium implant. The use of implants with optimized neck colors to correct an esthetic deficiency may be a feasible approach to establish improved peri-implant soft tissue esthetics.     

应用游离龈移植术增宽磨牙缺失区域角化组织利于种植治疗的临床观察（附1例3年随访报告）

种植体周围良好的软组织条件是保证种植体长期健康与稳定的前提,也是种植治疗取得良好生物学与美学效果的基础。而由于牙周炎症造成的破坏、拔牙后组织改建或个体差异等原因,种植位点常出现角化组织宽度的不足甚至缺如,不利于菌斑控制,给种植治疗带来一定风险。游离龈移植术（free gingival graft,FGG）是牙周临床常用的软组织增量方法,可显著增加种植体周围角化组织宽度。文章展示了1例左下磨牙连续缺失病例应用FGG增宽角化组织后行种植修复并获得良好修复效果的诊疗过程,为此类病例的临床处置积累了一定经验。     

A retrospective analysis of peri-implant tissue responses at immediate load/provisionalized microthreaded implants

PURPOSE: The aim of this retrospective study was to examine the peri-implant tissue status at immediately provisionalized anterior maxillary implants 12 to 30 months following tooth replacement. MATERIALS AND METHODS: This is a retrospective study of 43 microthreaded, TiO2 grit-blasted implants placed in healed ridges and immediate extraction sockets to restore maxillary anterior and premolar teeth in 28 patients. The cortical bone position relative to the implant reference point was evaluated at implant placement and 6 to 30 months following restoration. Radiographs were assessed using 7x magnification. The distance from the reference point to the cortical bone was measured to +/- 0.1 mm. The relationship of the peri-implant mucosa to the incisal edge of the definitive prosthesis was recorded. RESULTS: Four implants in 3 individuals failed during the first 6 weeks following placement and provisional loading. Cortical bone adaptation from the time of implant placement up to 30 months following restoration ranged from 0.0 mm to 1.5 mm (average, 0.33 +/- 0.40 mm mesially and 0.28 +/- 0.37 mm distally). The mean radiographic measurements from the interproximal crestal bone to the contact point were 4.53 +/- -0.91 mm (mesial) and 4.06 +/- 0.98. Maintenance and growth of papilla was observed in this group of immediate provisionalized single-tooth implants. Definitive abutment or abutment screw loosening was not observed. DISCUSSION: The linear clinical and radiographic measures of peri-implant tissue responses suggest that proper implant placement is followed by supracrestal biological width formation along the abutment and preservation of toothlike tissue contours. This may influence buccal peri-implant tissue dimensions. CONCLUSIONS: Generalized maintenance of crestal bone and the increased soft tissue dimension with maintenance of peri-implant papilla were identified as expected outcomes for immediate loading/provisionalization of microthreaded, TiO2 grit-blasted implants. Control of peri-implant tissues can be achieved to provide predictable and esthetic treatment for anterior tooth replacement using dental implants.