骨劈开技术在上颌前牙区种植术中的应用

目的：评价骨劈开术在上颌前牙区种植术中的临床应用效果。方法：42例患者,缺失上前牙1-4颗,牙槽嵴可利用骨高度〉10mm,宽度3-5mm。采用骨劈开术形成唇侧骨瓣,在腭侧骨板与唇侧骨瓣之间植入直径3.5mmAnkyl os种植体83枚,劈开部位应用GBR技术,6个月后行二期手术和固定修复。结果：二期手术时所有种植体稳固,1例（2枚种植体）唇侧骨板部分吸收,产生2.0mm种植体颈部唇侧暴露。其余种植体被骨质完全包绕,牙槽嵴宽度增加2.8-4.1 mm,平均增宽3.5mm。83枚种植体完成固定修复,经过2年的追踪观察,无一种植体松动或脱落。结论：上颌牙槽嵴骨宽度为3-5mm时,采用骨劈开术能有效增加骨量,获得满意的临床疗效。     

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。     

前牙区微创骨劈开同期种植的短期临床疗效观察

目的:评价前牙区行微创骨劈开术并同期植入种植体的临床疗效。方法:前牙缺失患者15名,植入种植体21颗。缺牙区牙槽嵴呈薄刃状,宽度约2～4mm,平均为3.3mm。局部浸润麻醉下行嵴顶小切口,微翻瓣,仅暴露嵴顶部分,先锋钻定位,刃状骨凿将颊舌侧骨板分开并将颊侧骨板向外移位,基底部仍与基底骨相连,形成青枝骨折,相应扩孔钻行种植窝的精确预备并收集自体骨屑,同期植入种植体,两侧的骨沟隙内填入自体骨屑或自体骨与人工骨混合物,严密缝合创口,术后6个月行二期手术。结果:术后CBCT影像未见唇侧骨板折断、游离,患者术后疼痛、肿胀等不良反应轻微,二期手术时可见种植体周围骨成形理想,修复完成后种植体行使功能良好。讨论:微创骨劈开术可以减小创伤,保留骨组织并提高种植体周围骨密度,同期植入种植体缩短了患者就诊疗程,保存牙槽嵴劈开后的骨宽度,该技术应用于前牙区能取得良好的临床效果。结论:微创骨劈开术是解决前牙区水平骨量不足的一种可预测的有效的骨增量方法。     

美学区种植同期应用异种骨行引导骨再生术后愈合期间唇侧骨改建的临床研究

目的: 研究美学区种植同期应用异种骨行引导骨再生（GBR）术后愈合期间的唇侧骨改建。方法: 纳入2015年9月—2016年4月在上海交通大学医学院附属第九人民医院口腔种植科行GBR同期种植体植入的上前牙23例。术前、手术当天及二期手术阶段拍摄锥形束CT（CBCT）,记录牙龈厚度（>2 mm或≤2 mm）、骨质分类及使用的屏障膜。利用iCAT Vision数字化软件对种植体颈部肩台下2 mm（C）、体部中点（M）及根尖处（A）唇侧骨板进行测量,测量线与种植体长轴垂直。将纵切线向近中及远中各移动1 mm,得到新的纵切面,以同样方法测量唇侧骨板厚度并记录数值。在术前CBCT上测量牙槽嵴形态特征,记录牙槽嵴高度、倒凹深度及牙槽嵴宽度。采用SPSS 21.0软件包对数据进行统计学分析。结果: 种植体肩台下2 mm、体部中点及根尖处的平均骨吸收值分别为（0.70±0.59）mm、（0.85±0.72）mm和（0.55±0.51）mm,吸收率分别为23.07%、18.53%和12.97%。与植骨吸收相关的自变量中,相关分析表明,倒凹深度和年龄与植骨吸收量显著相关（P<0.05）;将所有变量纳入多重线性回归并行逐步回归分析,仍具有统计学意义的变量为倒凹深度（P<0.05）。结论: 美学区种植同期应用异种骨行GBR术后愈合期间唇侧会有一定程度的骨吸收。患者年龄及牙槽嵴倒凹对GBR术后愈合期内种植体唇侧骨板的改建具有一定影响。牙槽嵴倒凹越大,GBR术后愈合期内唇侧骨板吸收越少。     

美学区种植同期应用异种骨行引导骨再生术后愈合期间唇侧骨改建的临床研究

目的: 研究美学区种植同期应用异种骨行引导骨再生（GBR）术后愈合期间的唇侧骨改建。方法: 纳入2015年9月—2016年4月在上海交通大学医学院附属第九人民医院口腔种植科行GBR同期种植体植入的上前牙23例。术前、手术当天及二期手术阶段拍摄锥形束CT（CBCT）,记录牙龈厚度（>2 mm或≤2 mm）、骨质分类及使用的屏障膜。利用iCAT Vision数字化软件对种植体颈部肩台下2 mm（C）、体部中点（M）及根尖处（A）唇侧骨板进行测量,测量线与种植体长轴垂直。将纵切线向近中及远中各移动1 mm,得到新的纵切面,以同样方法测量唇侧骨板厚度并记录数值。在术前CBCT上测量牙槽嵴形态特征,记录牙槽嵴高度、倒凹深度及牙槽嵴宽度。采用SPSS 21.0软件包对数据进行统计学分析。结果: 种植体肩台下2 mm、体部中点及根尖处的平均骨吸收值分别为（0.70±0.59）mm、（0.85±0.72）mm和（0.55±0.51）mm,吸收率分别为23.07%、18.53%和12.97%。与植骨吸收相关的自变量中,相关分析表明,倒凹深度和年龄与植骨吸收量显著相关（P<0.05）;将所有变量纳入多重线性回归并行逐步回归分析,仍具有统计学意义的变量为倒凹深度（P<0.05）。结论: 美学区种植同期应用异种骨行GBR术后愈合期间唇侧会有一定程度的骨吸收。患者年龄及牙槽嵴倒凹对GBR术后愈合期内种植体唇侧骨板的改建具有一定影响。牙槽嵴倒凹越大,GBR术后愈合期内唇侧骨板吸收越少。     

“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。     

骨劈开技术在上颌前牙区种植的临床效果观察

目的 评价上颌前牙区牙槽骨水平宽度不足的种植牙患者应用骨劈开技术增宽牙槽嵴的临床效果。方法 选择19例上前牙缺失患者,有充足的牙槽嵴高度(≥12 mm),但牙槽嵴骨宽度仅3~5 mm,行骨劈开术同期植入种植体治疗。共植入种植体29枚,其中ITI种植体21枚,Replace种植体8枚。根据骨劈开术后间隙及唇侧骨壁厚度等不同情况选择植入或不植入人工骨粉修复手段,术后6个月暴露种植体,完成上部修复,定期随诊。结果 术后无明显并发症发生,修复完成后经过6~24个月追踪观察,种植体行使功能良好,无松动或脱落。结论 当上颌前牙区牙槽嵴宽度为3~5 mm时,通过使用骨劈开术来增加牙槽嵴的宽度,是一种使种植体能够获得同期植入的有效方法。     

骨劈开、骨挤压联合GBR技术同期植入种植体的临床疗效评价

目的:采用CBCT及临床检查的方法评价骨劈开、骨挤压联合GBR技术同期植入种植体的的临床疗效。方法:采用CBCT检查术前牙槽骨的形态和骨量,唇舌向牙槽骨厚度介于2.5-4mm的病例适用这种技术。方法如下:使用1.0mm细钻针作为引导钻沿种植体拟植入方向钻入所需深度,然后使用骨劈开器沿钻孔方向劈开牙槽嵴,使用BICON手用扩孔器械逐级备洞,并挤压劈开的唇侧骨板,收集自体骨骨屑,同时撑开牙槽骨增加宽度,植入种植体。在骨质缺损区暴露的种植体表面和较薄的唇侧骨板表面先铺放获得的自体骨屑,然后再铺放人工骨粉,最后以胶原膜覆盖植骨区。6个月后,CBCT复查,完成修复。随访2年。结果:40例患者接受了这种骨增量技术治疗,共植入56颗种植体,均获得成功,平均增加牙槽骨宽度3.5mm。讨论:牙缺失后常常造成骨量不足,单一技术的运用不能获得良好的骨增量效果。骨劈开、骨挤压联合GBR技术是一种综合性的微创骨增量技术,获得了肯定的临床效果。结论:骨劈开、骨挤压联合GBR技术并同期植入种植体是一种有效的骨增量种植方式。     

牙槽骨劈开术同期牙种植的临床应用

目的　评价牙槽骨劈开技术在口腔种植中应用的临床效果。方法　对116例缺牙区牙槽嵴高度大于12 mm,颊舌向厚度在3~5 mm之间的牙列缺损患者,行牙槽嵴劈开同期植入种植体治疗。共植入ITI种植体147枚,Replace种植体52枚。根据骨劈开术后间隙及唇颊侧骨壁厚度等不同情况选择植入或不植入自体骨、人工骨粉等修复手段。术后6月种植修复,定期随诊。结果　种植区软组织愈合好,无红肿,颊舌向牙槽骨较种植前明显增宽。术后除1颗种植体失败取出外,其余种植体稳固,种植修复体能正常使用。复诊时X线检查骨吸收≤1 mm。结论　骨劈开术使牙槽骨宽度在3~5 mm的病例有了一期种植的可能,是一种简单有效的增宽牙槽骨的方法。     

上颌即刻种植后牙槽骨改建的CBCT分析

目的:分析即刻种植术后可能影响上颌牙槽嵴改建的因素。方法:共80例接受上颌即刻种植的患者,在上颌前牙及前磨牙区拔牙后即刻植入80枚种植体。检查并记录如下数据:1种植体表面距颊侧牙槽嵴外侧骨板的距离;2种植体颊侧水平骨缺损距离;3种植体颊侧垂直缺损距离。并于术后4个月行二期手术时复查上述数据。依据以下3个原则进行分析:颊侧牙槽骨厚度;缺牙位置;是否因牙周病拔牙。结果:当颊侧骨板较厚时,牙槽嵴吸收量较少。前磨牙区域牙槽嵴吸收量较少。结论:颊侧骨板的厚度及缺牙位置均有可能影响术后牙槽嵴的改建。在行即刻种植术时,临床医师必须密切关注种植体颊侧骨板的厚度,水平缺损的宽度等条件。     

Dental cone beam computed tomography analyses of postoperative labial bone thickness in maxillary anterior implants: comparing immediate and delayed implant placement

This study aimed to evaluate the influence of labial alveolar bone thickness and the corresponding vertical bone loss on postoperative gingival recessions around anterior maxillary dental implants. Using cone beam computed tomography (CBCT) scanning, the temporal changes of three-dimensional images of alveolar bone were monitored to determine hard and soft tissue outcomes of two different implant placement techniques: delayed two-stage and immediate placement. Furthermore, for the delayed two-stage placement, guided bone regeneration was applied using either nonresorbable or resorbable membranes combined with anorganic bovine bone matrix. The comparative results suggested that gingival recessions were significantly lower in delayed two-stage placement, especially when using a nonresorbable membrane, compared to immediate placement, and labial bone thickness, measured by CBCT, offered an effectual indicator to assess gingival recession in the anterior region.     

根形骨块onlay移植治疗上颌前牙种植术所需的牙槽骨骨量不足

目的:研究根形骨块移植治疗上颌骨前部骨量不足的效果。方法:通过对7例患者前牙区的26个牙位进行根形植骨术,重建牙槽骨的形态后植入种植体,术后随访时间平均10个月。结果:重建的牙槽骨唇侧丰满,骨面根形逼真,种植体无松动,无脱落,唇侧牙龈无退缩。结论:根形植骨术是治疗上颌多颗前牙缺失伴水平向骨量不足的有效手段。     

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。     

Marginal bone loss adjacent to conventional and immediate loaded two implants supporting a ball-retained mandibular overdenture: a 3-year randomized clinical trial

Objectives: The aim of this study was to evaluate and compare marginal bone loss and clinical outcomes of conventionally and immediately loaded two implants supporting a ball‐retained mandibular overdenture. Materials and methods: Thirty six completely edentulous patients (22 males and 14 females) were randomly assigned into two groups. Each patient received two implants in the canine area of the mandible after a minimal flap reflection. Implants were loaded by mandibular overdentures either 3 months (conventional loading group) or the same day (immediate loading group) after implant placement. Ball attachments were used to retain all overdentures to the implants. Vertical and horizontal alveolar bone losses were evaluated in both groups 1 and 3 years after implant placement using multislice computed tomography, which allow evaluation of peri‐implant buccal and lingual alveolar bone. Plaque scores, gingival scores, probing depths and periotest values (PTVs) were evaluated at 4 months (baseline), 1 and 3 years after implant placement. Clinical and radiographic evaluations were performed at distal, labial, mesial and lingual peri‐implant sites. Results: After 3 years of follow‐up period, the immediate loading group recorded significant vertical bone loss at distal and labial sites than the conventional loading group and no significant differences in horizontal bone loss between groups were observed. Probing depth at distal and labial sites in the immediate loading group were higher than the conventional loading group, while plaque scores, gingival scores and PTVs showed no significant differences between the two groups. A low level of positive correlation between plaque scores, gingival scores, probing depths and vertical bone loss was noted. Conclusion: Immediately loaded two implants supporting a ball‐retained mandibular overdenture are associated with more marginal bone resorption and increased probing depths when compared with conventionally loaded implants after 3 years. The bone resorption and probing depths at distal and labial sites are significantly higher than those at mesial and lingual sites. Clinical outcomes do not differ significantly between loading protocols. To cite this article :
Elsyad MA, Al‐Mahdy YF, Fouad MM. Marginal bone loss adjacent to conventional and immediate loaded two implants supporting a ball‐retained mandibular overdenture: a 3‐year randomized clinical trial.
Clin. Oral Impl. Res. 23 , 23, 2012 496‐503.
doi: 10.1111/j.1600‐0501.2011.02173.x     

美学区即刻种植牙槽嵴及唇侧骨壁宽度变化的CBCT研究

目的利用CBCT研究上前牙即刻种植后牙槽嵴的宽度及唇侧骨壁的变化。方法即刻种植患者术后（T1）、术后6个月（T2）、术后1年（T3）行CBCT检查,测量位点包括从种植体肩台到根尖点（0、2、4、6、8mm）的5个距离,测量线与种植体长轴垂直,测量数据包括牙槽骨厚度及种植体唇侧骨厚度。结果 T2-T1为-1.21±0.39mm,T3-T1为-1.42±0.56mm,6个月时唇侧骨壁变化为-1.11±0.24mm,占牙槽骨变化的91.73%,12个月时唇侧骨壁变化为-1.26±0.37mm,占牙槽骨变化的88.65%。结论即刻种植后牙槽骨宽度变化主要在拔牙后的6个月内,其中唇侧骨壁的变化量约占总宽度变化的90%。     

Relationship Between Biotype and Bone Morphology in the Lower Anterior Mandible: An Observational Study

Background: Different clinical parameters have been advocated as potential predictors of alveolar and basal jawbone morphology. The aim of this study is to describe, by tomographic means, alveolar and basal osseous dimensions of the anterior mandible in healthy individuals and evaluate potential correlations with biotype, along with other clinical parameters. Methods: One hundred consecutive healthy patients needing surgery in the posterior mandible were enrolled in this observational study (group 1 = 50 patients with thin biotype; group 2 = 50 patients with thick biotype). Data were collected for: 1) Little irregularity index for anterior crowding; 2) molar and canine class relationship; 3) previous orthodontic treatment; 4) gingival recession; and 5) band of keratinized gingiva for each of the six anterior mandibular teeth (#22 through #27). At the most mid‐buccal computerized tomography slice of each tooth, other parameters were measured, including: 1) distance from the cemento‐enamel junction to the bone crest; 2) tooth torque (TT); 3) labial cortical bone thickness (BT) for alveolar and basal bone; and 4) BT 5 and 10 mm apical to the tooth apex. Data were statistically analyzed, and significance was set at P ≤0.05. Results: Mean thickness of alveolar bone ranged from 6.66 to 4.51 mm (standard deviation [SD] = 1.46 for tooth #27; SD = 1.01 for tooth #25) whereas mean thickness of basal bone ranged from 8.9 to 8.2 mm (SD = 2.06 for tooth #22; SD = 2.06 for tooth #26). Mean thickness of bone at 5 mm from apex ranged from 11.94 to 10.47 mm (SD = 2.96 for tooth #25; SD = 2.22 for tooth #22), whereas mean thickness of bone at 10 mm from apex ranged from 13.75 to 11.08 mm (SD = 2.79 for tooth #25; SD = 2.53 for tooth #27). No statistically significant differences were detected among biotypes, whereas: 1) TT, 2) age, and 3) smoking habit were often predictors of reduction in BT in a multiple linear regression model. Male sex was often a predictor of positive changes in BT, and previous orthodontic therapy was a protective factor against developing bone loss >5 mm. Conclusions: Although some differences were detected among biotypes, data indicate that biotype does not play a fundamental role in influencing alveolar BT, whereas other variables (i.e., TT, sex, age, and smoking habit) do influence alveolar BT. Further studies are needed to better understand the extent of influence of each clinical variable.     

上颌切牙不翻瓣即刻种植的临床效果

目的评估上颌切牙单牙不翻瓣即刻种植对牙槽骨和牙龈附着的影响。方法选择15例上颌前牙区因外伤、残根或根折等需拔除患牙行即刻种植修复的患者,共15颗切牙,术前行X线曲面断层片及牙科CT检查,评估牙槽骨高度、厚度与牙龈附着情况,微创拔除患牙后作植入前评估,采用不翻瓣即刻种植方法植入Anky-los种植体15颗,骨缺隙部分填充骨粉,穿龈愈合。术后5个月复诊行上部结构修复,对比术前与修复后的牙槽骨与牙龈退缩情况。结果 15颗种植体成功完成上部结构修复。修复时和术前比较,牙槽骨吸收(1.10±0.26)mm,牙龈退缩(0.81±0.31)mm,牙龈乳头形态保存良好。结论上颌切牙位点使用不翻瓣即刻种植,能有效保护种植区牙槽嵴,从而防止牙龈出现明显退缩,有利于维持种植区的美学效果。     

Resorption of labial bone in maxillary anterior implant

PURPOSE

The purpose of this study was to evaluate the amount of resorption and thickness of labial bone in anterior maxillary implant using cone beam computed tomography with Hitachi CB Mercuray (Hitachi, Medico, Tokyo, Japan).

MATERIALS AND METHODS

Twenty-one patients with 26 implants were followed-up and checked with CBCT. 21 OSSEOTITE NT® (3i/implant Innovations, Florida, USA) and 5 OSSEOTITE® implants (3i/implant Innovations, Florida, USA) were placed at anterior region and they were positioned vertically at the same level of bony scallop of adjacent teeth. Whenever there was no lesion or labial bone was intact, immediate placement was tried as possible as it could be. Generated bone regeneration was done in the patients with the deficiency of hard tissue using Bio-Oss® (Geistlich, Wolhusen, Switzerland) and Bio-Gide® (Geistlich, Wolhusen, Switzerland). Second surgery was done in 6 months after implant placement and provisionalization was done for 3 months. Definite abutment was made of titanium abutment with porcelain, gold and zirconia, and was attached after provisionalization. Two-dimensional slices were created to produce sagittal, coronal, axial and 3D by using OnDemand3D (Cybermed, Seoul, Korea).

RESULTS

The mean value of bone resorption (distance from top of implant to labial bone) was 1.32 ± 0.86 mm and the mean thickness of labial bone was 1.91 ± 0.45 mm.

CONCLUSION

It is suggested that the thickness more than 1.91 mm could reduce the amount and incidence of resorption of labial bone in maxillary anterior implant.     

多种微创技术在前牙区种植中的应用

目的：总结不翻瓣技术、骨劈开与BICON手用扩孔钻等多种微创技术在前牙区种植的临床应用。方法：0研究包括34例患者前牙区51个植入位点。常规CBCT术前检查,剩余骨量的唇舌向宽度4.52±1.26mm（均数±标准差）,唇侧骨缺损垂直向高度为1.56±0.25mm（均数±标准差）,唇侧骨壁存在不同程度的倒凹及缺损。对于嵴顶骨量宽度大于5mm时,只采用嵴顶切口并向邻牙延伸的不翻瓣技术,当根部有倒凹时,增加倒凹区的横行切口,在保证可接受的种植体植入方向的前提下,避免唇侧骨壁的穿通;若有部分穿通,可植入少量BIOSS骨粉覆盖。当嵴顶骨量宽度在3-4mm时,特别是在中切牙区,为植入4-4.5mm直径的种植体,采用骨劈开以及结合BICON系统特有的手用扩孔系列钻技术,很好地完成了骨嵴的扩展,植入理想的4.5mm直径的BICON植体,并保证了种植体颈部唇腭侧1-1.5mm的骨质。当嵴顶骨量宽度小于3mm或唇侧凹陷明显时,可以适当降低嵴顶的高度,到宽度有3mm时,采用上述的方法,此时,可以适当分离唇侧的粘骨膜,保留BICON种植体特有的塑料愈合帽适当长度,使之起到一定的帐篷支撑效应,塑料柱周围植入BIO-COLLAGEN,并采用胶原膜覆盖,最终达到垂直骨增量的目的。部分病例此时可以附加垂直切口,保证切口在无张力状态下缝合。结果：垂直向骨增量1.41±0.32mm（均数±标准差）,唇舌向骨增量2.35±0.41mm（均数±标准差）,保证了种植体周围至少1mm的骨量。在3至6个月的随访期内,无种植体松动脱落和明显的骨吸收,CBCT显示种植体周围植入Bio-Oss部位有高密度影像,提示新骨形成良好。结论：我们采用不翻瓣技术、骨劈开与BICON手用扩孔钻联合技术、膜引导与BICON植体的帐篷支撑效应联合技术等微创技术完成了骨量不足的前牙区种植修复,常规修复前CBCT检查,修复6个月后复查,显示骨组织稳定,修复效果良好,是值得推广的一系列微创技术。