上颌单颗前牙位点保存后邻面牙槽嵴高度的早期变化

目的 探讨位点保存术对上颌单颗前牙拔除后邻面牙槽嵴高度早期变化的影响,为种植修复龈乳头美学效果提供参考依据。方法 选择需拔除上颌单颗前牙的30例患者为研究对象,将其随机分为试验组和对照组,每组15例。试验组在拔牙同时进行位点保存术（牙槽窝内植入 Bio-Oss骨粉,表面游离龈移植缝合固定）,对照组拔牙后未行其他处理。术后7 d及术后6个月,佩戴个性化数字化放射导板行锥形束CT检查,测量2组近远中邻面牙槽嵴及唇侧中央牙槽嵴高度的变化。结果 试验组近中、远中邻面及唇侧中点的牙槽嵴吸收高度分别为（0.358±0.151）mm、（0.322±0.180）mm、（0.826±0.307）mm,对照组近远中邻面及唇侧中点的牙槽嵴吸收高度分别为（0.653±0.260）mm、（0.667±0.274）mm、（1.510±0.625） mm。统计分析表明,试验组的牙槽嵴吸收高度小于对照组（P<0.05）,近中、远中邻面牙槽嵴的吸收高度均小于唇侧（P<0.05）。结论 位点保存术可以减少牙拔除后牙槽嵴高度的吸收,提高种植修复龈乳头美学效果。     

上颌单颗前牙位点保存后邻面牙槽嵴高度的早期变化

目的 探讨位点保存术对上颌单颗前牙拔除后邻面牙槽嵴高度早期变化的影响,为种植修复龈乳头美学效果提供参考依据。方法 选择需拔除上颌单颗前牙的30例患者为研究对象,将其随机分为试验组和对照组,每组15例。试验组在拔牙同时进行位点保存术（牙槽窝内植入 Bio-Oss骨粉,表面游离龈移植缝合固定）,对照组拔牙后未行其他处理。术后7 d及术后6个月,佩戴个性化数字化放射导板行锥形束CT检查,测量2组近远中邻面牙槽嵴及唇侧中央牙槽嵴高度的变化。结果 试验组近中、远中邻面及唇侧中点的牙槽嵴吸收高度分别为（0.358±0.151）mm、（0.322±0.180）mm、（0.826±0.307）mm,对照组近远中邻面及唇侧中点的牙槽嵴吸收高度分别为（0.653±0.260）mm、（0.667±0.274）mm、（1.510±0.625） mm。统计分析表明,试验组的牙槽嵴吸收高度小于对照组（P<0.05）,近中、远中邻面牙槽嵴的吸收高度均小于唇侧（P<0.05）。结论 位点保存术可以减少牙拔除后牙槽嵴高度的吸收,提高种植修复龈乳头美学效果。     

种植体黏膜与种植体乳头水平及周围软组织稳定性的关系探讨

目的: 探讨种植体黏膜（dental implant mucosa,DIM）与种植体乳头（dental implant papilla,DIP）水平及周围软组织稳定性的关系。方法: 选择2015年1月—2019年1月于青岛市海慈医院接受口腔种植体修复的患者86例,从治疗起随访至2020年12月,分别于植入物放置即刻（T0）、4周（T1）、2年（T2）和随访结束（T3）时检测边缘骨吸收水平（MBLs）、中颊黏膜水平（MBMLs）、DIP、改良龈沟出血指数（mSBI）、改良出血指数（mBI）植入物稳定性系数（ISQ）水平及之间的相关性。采用SPSS 23.0软件包对数据进行统计学分析。结果: 随访1.0~5.2年,平均（4.79±0.34）年,脱落2例,最终纳入患者84例（95颗种植体）。与T0时相比,T1、T2、T3时mSBI、mPLI、mBI、邻牙接触点的远端骨水平、中骨水平依次显著降低（P<0.05）,DIP高度显著升高;T0、T1、T2、T3时,PD、MBLs、MBMLs水平相比差异无统计学意义（P>0.05）。邻牙接触点的远端骨水平、中骨水平可影响DIP高度（P<0.05）。DIP增加49例,丧失46例;T0时,DIP增加、丧失组的ISQ水平均较高;T1时较T0时DIP增加、丧失组的ISQ水平降低（P<0.05）;T2、T3时,DIP增加组ISQ值显著大于丧失组（P<0.05）。结论: DIM、DIP水平之间存在依赖性,种植体周围软组织的稳定性取决于角化组织高度和DIP高度。     

Critical horizontal dimensions of interproximal and buccal bone around implants for optimal aesthetic outcomes: a systematic review

Objective: This systematic review was initiated to explore the critical horizontal interproximal and buccal bone dimensions around implants for an optimal aesthetic outcome.
Materials and methods: Pubmed, the Cochrane and the ISI web of Science databases were searched to identify eligible human studies that reflect on the aesthetic outcome of implants in relation to the thickness of the buccal bone after osteotomy preparation, and in relation to the tooth-to-implant or interimplant distance. Vertical bone dimensions were not considered.
Results and discussion: Articles relating horizontal buccal bone dimensions to aesthetic outcome could not be retrieved. The relation between horizontal buccal bone dimensions and vertical bone resorption could also not be confirmed. In relation to horizontal interproximal bone dimensions, some uniformity was detected among the limited number of articles.
Conclusions: Interproximally, a 3 mm interelement distance seems to result more frequently in an adequate papillary fill. In the bucco-oral direction, there is insufficient evidence to set a threshold for minimal buccal bone thickness to ensure an optimal aesthetic outcome. Many additional factors appear to be of importance and interact with each other.     

The soft tissue barrier at implants and teeth

In the present animal experiment. analyses and comparisons were made between the structure and composition of clinically healthy supraalveolar soft tissues adjacent to implants and teeth. 5 beagle dogs were used. The right mandibular premolar region was selected in each dog for placement of titanium implants. while the left mandibular premolar region served as control. Extractions of the mandibular premolars were performed. healing allowed, following which titanium fixtures were installed in the edentolous premolar region. Abutment connection was carried out 3 months later. After another 2 months of healing. plaque control was initiated and maintained for 8 weeks. At the end of the plaque control period. clinical examinations were performed and biopsies harvested from the implant site and the contralateral premolar tooth region. Following fixation and decalcification, all tissue samples were embedded in EPON and examined by histometric and morphometric means. The result from the analyses demonstrated that the peri‐implant mucosa which formed at titanium implants following abutment connection had many features in common with gingival tissue at teeth. Thus, like the gingiva. the peri‐implant mucosa established a cuff‐like barrier which adhered to the surface of the titanium abutment. Further. both the gingiva and the peri-implant mucosa had a well‐keratinized oral epithelium which was continuous with a junctional epithelium that faced the enamel or the titanium surface. In the periimplant mucosa. the collagen fibers appeared to commence at the marginal bone and were parallel with the abutment surface. All gingival and peri‐implant units examined were free from infiltrates of inflammatory cells. It was suggested that under the conditions of study. both types of soft tissues. gingiva and peri‐implant mucosa. have a proper potential to prevent subgingival I plaque formation.     

Astra Tech single-tooth implants: an audit of patient satisfaction and soft tissue form

AIM: To investigate patient centred outcomes, soft tissue morphology, and bone levels. MATERIAL AND METHODS: Sixty-six subjects, who had completed treatment for a single implant restoration at least l year previously. Appearance was recorded photographically and bone levels and interdental contact points measured from intra-oral radiographs using a x 7 scale loupe. Subjects completed a satisfaction questionnaire. RESULTS: Subjects were highly satisfied with all aspects of the restoration including the appearance of the soft tissue (median shape/colour score 6 on scale 1-6). Twenty-eight sites in 20 subjects had no contact point between implant crown and adjacent tooth. A normal height papilla was judged to be present in 19 of these sites. These were excluded from the subsequent analysis. In the remaining 46 subjects with contact points the presence (JEMT score 3) or deficiency (score 1/2) of the papilla was significantly related to the distance to the bone level on the adjacent tooth and implant head. Differences were observed between the mesial and distal aspects of the implant restoration. CONCLUSIONS: Examining clinicians were more critical of the restorations than the patients. The presence of a complete papilla was associated with a slightly greater distance from contact point to bone level than previously reported.     

牙种植体周软组织的处理

牙种植体(以下简称种植体)周软组织形成的"袖口"、附着龈宽度、唇侧软组织丰满度和牙龈乳头状况都可影响种植体骨整合和美学效果.通过游离牙龈移植、带蒂牙龈移植、黏膜培养细胞移植法、异体脱细胞真皮基质移植法和正畸助萌法可增加种植体周附着龈宽度.美学区通常具有充足的附着龈,但其软组织形态和龈乳头高度等都可影响软组织整体美观效果,通过软组织切口设计、个别临时冠引导法、种植体牙龈乳头重建法和不翻瓣技术可保存或改善美学区软组织,实现种植美学修复.     

Mechanical attachment of soft fibrous tissues to implants by using mesh structures

Objectives: Increase of soft tissue attachment is a major concern for improving the design of novel dental implants. This study evaluated the use of mesh structures placed on the implant surface for the anchorage of fibrous tissues. Material and methods: Specimens were prepared by covering their surfaces with a nylon mesh. The following mesh spacings were used: 30, 46, 100, 200, and 500 μm. The specimens were retrieved along with the surrounding subcutaneous tissues at 4 weeks after their implantation into the dorsal subcutaneous tissues of rats. A tensile test was performed by using a material testing machine, and the load required to tear the tissue from the mesh was measured. Histological sections stained with hematoxylin–eosin or Azan were prepared and examined by performing light microscopy. The amount of fibrous tissue contributing to the mechanical attachment of the fibers to the mesh was qualitatively evaluated by performing image analysis. Results: The attachment strength was the greatest in the 200‐μm mesh‐spacing group and considerably greater than that in the 30‐μm mesh‐spacing group. In addition, the effective width of the anchoring fibrous tissues was the greatest in the 200‐μm mesh‐spacing group. As compared with the other groups, the 200‐ and 500‐μm mesh‐spacing groups exhibited a considerably greater width of the anchoring fibrous tissues. Conclusions: The efficiency of mesh structures for the attachment of soft tissues to implants was demonstrated. A mesh spacing of approximately 200 μm was observed to be favorable for the anchorage of fibrous tissues.     

Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration

The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.