上颌前牙单牙种植区采用钛膜引导成骨的效果观察

研究目的:上颌前牙单牙种植区,种植体颈部唇侧裂开性骨缺损或唇侧骨板厚度小于0.5mm时,采取不可吸收性钛膜引导成骨的效果及修复效果的前瞻性研究.材料及方法:2004年6月-2008年12月,在北京大学口腔医学院种植中心,18例上颌前牙单牙缺失患者(男12例,女6例,年龄19-56岁,平均38.6岁),要求采取种植修复,身体健康,不吸烟.种植体植入后唇侧颈缘出现裂开性骨缺损或唇侧骨板厚度小于0.5mm,采用少量自体碎骨和瑞士盖式Bio-Oss骨粉充填骨缺损后,不可吸收性钛膜覆盖植骨区,并用小膜钉固定钛膜,软组织辫充分缓冲无张力后关闭术区.愈合6个月后行二期手术,取出钛膜,测量种植体唇侧骨板的厚度.二期术后2个月进行种植修复,修复效果的观察,采用Furhauser的改良红色美学指数(Defined pink es-thetic score)观察种植体修复后的软组织美学效果.结果:18例病例中,没有一例出现伤口的裂开以及感染.放射学观察18颗种植体均获得骨结合.种植体植入时,唇侧骨板的厚度(平均0.17mm),种植二期手术,即暴露种植体取出钛膜时,测量唇侧骨板的厚度为1.5mm-3.5mm,平均2.14mm,平均增加1.91mm..13例完成永久修复,并观察1年以上,软组织美学效果,采用Furhauser的红色美学指数,PES最高得分14分,最低得分9分,平均12.15分,龈缘水平线位置平均为1.77mm,牙根区的软组织的凸度平均为1.85mm,此两项得分较高,与植骨及成骨效果有密切关系.结论:在上颌前牙区单牙种植时,采取不可吸收性钛膜引导成骨,解决种植体唇侧颈部骨板裂开性骨缺损及厚度不足效果可靠.     

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...     

上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。     

应用CBCT对上颌前牙区即刻种植后唇侧骨板变化的评价

目的:应用锥束CT(CBCT)观察上颌前牙区即刻种植后唇侧骨板的变化。方法:30例上前牙即刻种植患者,微创拔牙后植入种植体,植入唇侧骨下1mm,唇侧跳跃间隙在1.0-2mm之间,15例对照组患者跳跃间隙不做处置,15例实验组患者跳跃间隙内放置骨粉。应用CBCT分别测量术后当日及术后3个月、6个月种植体平肩台处唇侧骨壁的厚度,所有数据取平均值。结果:对照组三个时间点唇侧骨板厚度分别为1.82mm、0.83mm、0.75mm;实验组三个时间点唇侧骨板厚度分别为2.25mm、2.13mm、2.06mm。讨论:上颌前牙区种植体唇侧骨板的存在及厚度对美学修复具有决定性的作用,因此对即刻种植后对唇侧骨壁三维变化客观直接的认识具有重要意义,从CBCT图像上可以清晰的看到即刻种植后唇侧骨壁的变化,参考手术前后的骨量变化,根据术前牙槽骨形态设计种植位点具有重要意义。结论:CBCT评价种植体周围的骨量变化是一种客观直接的手段     

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。     

钛网联合浓缩生长因子重建上前牙唇侧骨板重度缺损的临床疗效评价

目的:在上颌前牙唇侧骨板重度缺损的重建术中,应用钛网联合浓缩生长因子(concentrate growth factors,CGF)并且同期植入种植体,观察唇侧骨板修复情况以及种植体唇侧颈部新生边缘骨的稳定性.方法:选择20例上颌前牙唇侧骨板重度缺损患者,其中15例为单侧中切牙缺失,5例为双侧中切牙缺失,共25个植入位点.在种植体植入同期进行钛网联合CGF的复合引导骨再生(GBR)技术,埋入式愈合6个月后进行常规二期手术,临时修复3个月后进行永久修复.观察二期手术时骨缺损的修复情况,测量二期手术时、永久修复后3、6、12、18个月种植体唇侧颈部的骨厚度和边缘骨高度.应用SPSS19.0软件包对数据进行非参数多样本检验、Fierdman检验.结果:二期手术时唇侧骨板重建完整,新骨爬行至种植体顶端,唇侧颈部骨厚度平均为(2.69±0.154) mm;修复后3、6、12、18个月,唇侧颈部骨厚度分别为(2.67±0.152) mm、(2.66±0.153) mm、(2.65±0.153) mm和(2.65±0.151) mm,以种植体-基台连接处为基线,唇侧颈部边缘骨高度分别为基线下(0.02±0.048) mm、(0.69±0.085) mm、(0.87±0.019)mm和(0.87±0.013) mm.统计学分析表明,修复后3～12个月,唇侧颈部骨厚度随时间显著减小(P＜0.001),以种植体-基台连接处为基线,唇侧颈部边缘骨高度随时间亦显著降低(P＜0.001);两者在12个月和18个月的差异无显著性(P＞0.05).结论:钛网联合CGF的复合GBR技术能有效重建上前牙唇侧重度骨缺损,颈部新生边缘骨厚度和高度在永久修复1年后趋于稳定,是一种值得临床推广应用的有效和可靠的方法.     

“夹心植骨”预防骨劈开术后唇颊侧骨壁吸收的临床研

研究背景：当牙槽嵴尤其是上颌前牙区牙槽嵴宽度不足时,采用骨劈开同期种植体植术能获得可靠地临床效果。然而许多研究和作者本人的临床观察均发现,采用该手术后常见种植体唇侧骨壁部分吸收,致种植体唇侧上、中部多个螺纹暴露于骨面,其表面仅有软组织覆盖,当患者的附着龈较薄时甚至会透出种植体的颜色,这种状况无疑将对种植义齿的长期美观效果和寿命产生严重的不利影响。研究目的：评价＂夹心植骨＂法防止骨劈开后唇颊侧骨壁吸收的临床效果。方法：36例上颌前牙缺失区牙槽嵴宽度2～4mm,有足够骨高度患者,采用骨劈开术同期植入种植体,共植入植体40枚,其中16枚种植体唇侧骨瓣较稳固,可与种植体紧密相贴,直接采用颗粒骨移植材料（天博骨粉或Bio-Oss）和胶原膜覆盖（海奥修复膜或Bioguide膜）,作为对照组。将24枚种植体唇侧骨瓣撑开,在种植体唇侧面与骨瓣之间形成1mm左右的间隙,间隙内填入颗粒骨移植材料（天博骨粉或Bio-Oss）,使种植体唇侧骨质总厚度大于1mm,覆盖胶原膜（海奥修复膜或Bioguide膜）,无张缝合创口。6个月后行Ⅱ期手术,翻瓣检查种植体唇侧骨质状况和骨壁厚度。结果：对照组16枚种植体唇侧骨壁均有不同程度吸收,种植体上部有3～5个螺纹暴露于骨面;24颗采用夹心植骨的种植体唇侧均有坚实的骨质,未见骨吸收和螺纹暴露,种植体唇侧骨壁厚度均大于1mm。结论：骨劈开术中在唇颊侧骨瓣和种植体表面之间夹心植入颗粒状骨移植材料,能有效地防止唇侧骨壁吸收,保证种植体唇侧有足够厚度完整的骨质覆盖。     

钛膜在种植即刻修复中引导骨再生的临床效果与体会(附临床病案3例)

目的:评价钛膜在种植即刻修复中治疗种植体周围骨缺损的临床效果,探讨其是否适用于种植即刻修复.方法:3例下颌前牙唇侧骨量不足的牙种植病例,缺损区域植骨覆盖钛膜,并行椅旁即刻修复.术后连续进行临床观察和X线检查.结果:3例均在术后1-2周出现软组织瓣裂开、钛膜暴露,局部冲洗清洁,钛膜保留一月后取出,观察到钛膜覆盖下区域有软组织侵入.讨论:钛膜的固有缺陷以及即刻修复时基台周围缺乏血供的黏膜是造成钛膜高暴露率的原因.结论:鉴于种植即刻修复的特殊性,为避免由于钛膜自身缺陷而造成的膜暴露问题,建议在种植即刻修复中应用更有利于软组织生长的胶原膜作为引导骨再生技术中的屏障膜.     

纯钛膜在种植外科中应用效果的初步研究

目的 评价无孔纯钛膜治疗种植体周围骨缺损的临床效果，并探讨其应用技巧。方法 81例患者的92颗种植体周围骨缺损均采取自体碎骨及Bio-Oss人工骨移植充填后，国产无孔纯钛膜覆盖治疗，术后6～10个月行种植Ⅱ期手术，同时取出钛膜。结果 5例(6颗种植体)发生种植术后软组织瓣早期裂开或穿孔，钛膜外露且早期取出；其余76例软组织瓣愈合良好，原骨缺损完全骨性修复。结论 钛膜有良好的生物相容性，有效地防止移植的骨代用品移位、纤维结缔组织长入，其塑形性好，能维持较大的骨再生修复空间，骨生成量大。     

翻瓣GBR在薄骨壁表型上颌单颗前牙即刻种植即刻修复中的临床效果

目的 探讨唇侧骨壁较薄（<1 mm）的上颌单颗前牙行即刻种植即刻修复时,同期翻瓣行引导骨再生术（guided bone regeneration, GBR）对术后软硬组织变化情况及美学效果的影响。方法 纳入34例唇侧骨壁较薄（<1 mm）的上颌单颗前牙患者,根据即刻种植即刻修复时是否同期行翻瓣GBR分为两组,统计比较两组病例的种植体存留率、种植体唇侧骨厚度及变化量、种植体唇侧软组织高度变化量、红色美学评分（pink esthetic score, PES）以及患者满意度评分。结果 术后12月时两组患者的种植体存留率均为100%,随访期间均未发生种植并发症。术后12月时,翻瓣GBR组唇侧骨壁平均厚度超过2 mm,唇侧骨嵴的平均高度为1.39 mm,而不翻瓣组唇侧骨壁平均厚度不足2 mm,唇侧骨嵴的平均高度为1.03 mm,二者的差异均有统计学意义（P<0.05）。但翻瓣GBR组唇侧骨吸收量在各测量位点均较不翻瓣组更大（P<0.05）。两组间唇侧龈缘位置最高点以及近远中龈乳头高度变化量在术后6月及12月差异均无统计学意义（P>0.05）。翻瓣GBR组与不翻瓣组...     

上颌中切牙种植修复结合软硬组织增量后的临床和影像学效果初步分析

目的    应用种植同期结合引导性骨再生（guided bone regeneration,GBR）技术及不同软组织处理方式修复缺失的单颗上颌中切牙,评价其软硬组织的增量效果。方法    纳入于2013—2014年就诊于北京大学口腔医院牙周科因单颗上颌中切牙缺失而接受种植治疗的患者6例。所有患者在种植同期行GBR,并接受不同软组织处理方式。最终修复7 ~ 24个月后,记录患者上颌前牙区牙周状况,通过影像学检查定量测量种植体唇侧骨高度及骨壁厚度,利用标准化临床照片,定量测量种植体与对照牙牙龈顶点的位置关系,以及种植体近远中龈乳头高度和充满程度,并应用粉色美学评分（pink esthetic score,PES）评价美学效果。结果    所有种植体在复查时均处于健康稳定的牙周状态。5颗种植体在复查时可观察到垂直向及水平向骨增量,种植体唇侧中央肩台根方2、4、6 mm处平均骨壁厚度分别为（1.7 ± 1.1）mm、（2.3 ± 1.1）mm、（2.2 ± 1.3）mm。种植体牙龈顶点相比对照牙（同颌对侧中切牙）平均更偏向远中（1.0 ± 0.6）mm,偏向根方（0.4 ± 0.8）mm;远中龈乳头平均高度（2.8 ± 0.5）mm和充满程度（76.9 ± 19.2）%低于近中龈乳头［（4.2 ± 0.7）mm,（89.8 ± 11.1）%］,平均PES为（11.5 ± 1.4）分。结论    对于缺牙区存在软硬组织缺损的患者,上颌中切牙种植同期结合GBR及不同软组织处理方式,可获得较为充足的骨增量效果及与对照牙相对协调的软组织形态,一定程度上改善美学效果。     

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??Objective    Implant therapy combined with simultaneous guided bone regeneration??GBR??and different soft tissue management was applied to patients to repair their missing maxillary center incisors. This article aims to analyze the effects of hard and soft tissue augmentation quantitatively. Methods    Six patients who accepted implant therapy in combination with simultaneous GBR and different soft tissue management for their single missing maxillary central incisor were screened. They were called for a review visit at 7 to 24 months after final restoration. The clinical periodontal status of the maxillary anterior teeth was examined??and the bone height and thickness at middle labial aspect of implants were measured by CBCT quantitatively. The relationship of gingival zenith position between implants and the control teeth??as well as the papilla height and filling degree of implants were measured quantitatively on the standardized photographs. Pink esthetic score??PES??was applied to evaluate the esthetic effect. Results    All the implants were in stable and healthy periodontal status at the review visit. Vertical and horizontal bone augmentation could be observed on 5 implants. The mean facial bone thickness at 2??4??and 6 mm apical to implant shoulder was??1.7 ± 1.1??mm????2.3 ± 1.1??mm??and??2.2 ± 1.3??mm??respectively. The mean position of gingival zenith of implants was??1.0 ± 0.6??mm more distally??and??0.4 ± 0.8??mm more apically??compared to the control teeth. The mean height??2.8 ± 0.5??mm and filling ??76.9 ± 19.2??% of distal papilla of implants were less than those of mesial papilla??4.2 ± 0.7??mm??and ??89.8 ± 11.1??%. Mean PES was 11.5 ± 1.4. Conclusion    For the patients with bone and soft tissue defect at edentulous areas??implant therapy combined with GBR and different soft tissue management for the missing maxillary center incisors can obtain adequate bone augmentation and harmonious soft tissue profile to the control teeth??and consequently improve esthetic outcomes in a certain degree.     

预成型钛网在美学区引导骨再生的短期临床效果观察

目的:观察预成型钛网在上前牙种植时重建唇侧骨板重度缺损的短期临床效果.方法:唇侧骨板重度缺损的前牙种植患者,术中用预成型钛网维持成骨空间,联合骨粉、富血小板纤维蛋白(platelet rich fibrin,PRF)和胶原膜引导骨再生(guided bone regeneration,GBR).CBCT测量二期手术时、...     

CGF凝块用于早期种植的临床及组织学观察1例

目的:浓缩生长因子(condensed growth factor,CGF),有促进骨和软组织早期愈合的作用,拔牙窝软组织愈合的早期种植被认为相对于即刻种植有更好的可预见性,本病例旨在探讨单独使用CGF凝块促进拔牙窝早期成骨并进行前牙区拔牙后早期种植的可行性.方法:患者年轻女性,上中切牙残根齐龈,高笑线、唇侧骨板菲薄、薄龈生物型,为美学高风险患者,采用CGF凝块和CGF膜进行牙槽嵴保存,8周后种植并同期GBR,术区环钻取骨进行组织学观察.种植5个月后临时冠修复,临时冠佩戴6个月全瓷基台全瓷冠永久修复,6个月后进行PES、WES美学评分及CBCT检查.结果:拔牙后八周的组织切片观察到骨代谢活跃,有成熟骨小梁形成,PES、WES美学评分均为9.CBCT显示植体唇侧骨板厚度大于2mm.结论:该病例显示CGF凝块单独使用有促进早期成骨的作用,在唇侧骨板未完全吸收时开始种植可能提高GBR植骨效果,并获得较满意的前牙区种植美学.该方法仍需大样本临床试验进行验证.     

钛网在上前牙唇侧重度骨缺损种植中的临床研究

目的:探讨在上前牙种植时使用钛网联合胶原膜和富血小板纤维蛋白(platelet rich fibrin,PRF)在修复唇侧骨板重度缺损的骨再生效果.方法:选择20例上前牙种植唇侧骨板重度缺损的患者,随机分为两组.一组使用骨粉+胶原膜+PRF进行骨增量,一组使用钛网+骨粉+胶原膜+PRF进行骨增量.埋入式愈合6个月二期手...     

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??Objective    To compare the changes of the periimplant papilla index and labial gingiva fullness between flap and flapless immediate implant placement after reshaping the perimplant soft tissue using implant supported provisional prostheses. Methods    From August 2007 to March 2011??41 patients were enrolled in Department of Implant Dentistry??School and Hospital of Stomatology??Peking University. The patients were classified into two groups. Group ??immediate implant using flapless technique and Bio-Oss Collagen in 20 cases. Group ??immediate implant placement using guided bone regeneration??GBR??after flap reflection in 21 cases. All the patients underwent sequential gingival architecture remodeling using implant-supported temporary prostheses. Marginal bone resorption after loading of 1 and 3 years were measured and statistical analysis was conducted. Esthetic evaluations included papilla index and the labial gingiva peri-implant soft tissue fullness. Results    Totally 41 implants were placed in 41 cases with ReplaceSpeedy® implants. The mean follow-up was 42.4 months??24-67 months??and no implant was lost until the last recall. One and three years after final restoration delivered?? papilla index and labial gingiva fullness were compared between two groups and no significance was observed ??P > 0.05??. After 1 and 3 years??marginal bone resorption was??0.50 ± 0.04??mm and??0.55 ± 0.04??mm in flapless group????0.59 ± 0.03??mm and??0.67 ± 0.03??mm in flap group respectively??and statistical significance was observed between two groups??P < 0.05??. Patients’ satisfaction was high in both groups and treatment comfort was higher in flapless group. Conclusion    The clinical results and gingival stability is predictable in choosing flap or flapless immediate implant technique in the maxillary anterior teeth when proper indication and technique are selected. Using implant supported provisional prostheses can reshape and stabilize periimplant soft tissue and the short-term results are predictable. Marginal bone level was stable and less bone resorption was founded in flapless group compared with flap group. Patients in both groups were satisfied with the clinical results and treatment comfort and flapless group had higher patient satisfaction.     

Effects of guided bone regeneration with non-resorbable and bioabsorbable barrier membranes on osseointegration around hydroxyapatite-coated and uncoated threaded titanium dental implants placed into a surgically-created dehiscence type defect in rabbit tibia: a pilot study

The purpose of this study was to evaluate the effects of guided bone regeneration (GBR) with either a non-resorbable (ePTFE) or bioabsorbable barrier membrane (RSLT) on osseointegration and extent of bone formation around hydroxyapatite-coated (HA) and uncoated threaded titanium (Ti) dental implants placed into surgically-created dehiscence type defects in rabbit tibia. A dehiscence type bone defect, approximately 3 mm in width and height was surgically created on the outer surface of the bone in each tibia of 9 rabbits. For the conventional group, either a HA or a Ti implant was then placed at this site. After the same procedure was performed as in the conventional group, the implant site of the GBR group was covered with either an ePTFE or a RSLT. After 4 months, the rabbits were sacrificed. Specimens were prepared and examined histometrically. It was found that the mean percentage of osseointegration tended to increase in HA compared to Ti implants, both with and without membranes. There was a tendency that the extent of newly regenerated bone was higher in the GBR group than that in the conventional group.     

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。     

Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases

The esthetic outcome of an implant-supported restoration is first of all dependent on the soft tissue volume. Since the labial bone plate resorbs in every direction after tooth extraction, even when an implant is placed immediately, most patients end up with compromised esthetics. Twenty-four patients were treated consecutively with implants placed in the maxillary anterior area at the time of tooth extraction using two different treatment modalities. The first 12 patients were treated without raising a flap, whereas a subepithelial connective tissue graft was placed using the tunnel technique in the labial area of the subsequent 12 patients at the time of tooth extraction and implant placement. The dimension of the labial volume was measured before treatment and 6 months after implant placement. The results show an average loss of volume in the nongrafted group of 1.063 mm, whereas in the grafted group, there was a slight gain of 0.34 mm. These results demonstrate the effectiveness of placing a soft tissue graft at the time of immediate implant placement in the esthetic zone.