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。

Clinical study of esthetic outcome of immediate flapless implant replacement of single anterior tooth

Objective： The purpose of this study is to evaluate the esthetic outcome of immediate implant replacement of single anterior tooth with flapless technique.Methods and materials： 16 patients were enrolled in this clinical observation.Including criteria： 1.Intact facial alveolar bone;2.The distance between facial alveolar crest and gingival margin around 3mm.Minimally invasive tooth extraction was carried out in each case.After careful probing of the bony architecture,implant was placed around 3mm below gingival margin and a little toward the palatal side with the axis palatal to the connection line of the incisal edges.There should be at least 2mm void between implant and the facial wall,which would be impacted with BioOss granules （0.25-1mm,Geistlich,Switzerland）.Soft tissue graft was done for thin biotype. Implant supported resin crown was delivered 4 to 6 weeks after implant placement to achieve soft tissue remodeling before final restoration.Esthetic evaluations included papilla and overall soft tissue esthetics.Peri-implant papilla was evaluated according to the Papilla fill index （PFI） developed by Jemt.Pink esthetic score （PES ） developed by Fuerhauser was utilized to evaluate the peri-implant soft tissue around the single-tooth implant crown.Facial bone thickness was measured with CBCT. Results： The mean follow up of the 16 patients was 21.8 months （12-34 months）.Cumulative survival rate was 100% during the observation period.14 patients had score 3 according to PFI while only 2 patients had score 2.The PES was 13 in 8 patients and 14 in 6 patients.The facial bone remained stable according to CBCT.Conclusion： Immediate implant replacement of single anterior tooth with flapless technique could achieve predictable esthetic outcome while highly technique demanding.Soft and hard tissue anatomy should be carefully assessed as regards to indication.Ideal 3D implant position and under contour design of the transmucosal part of prosthetic crown was critical to the esthetic outcome.