上颌前牙区根盾术即刻种植与常规即刻种植的临床效果评价

目的 比较上颌前牙美学区根盾术即刻种植与常规即刻种植唇侧骨量的厚度变化及临床效果,探讨根盾术的临床操作要点。方法 收集2017年9月—2019年3月行上颌前牙美学区即刻种植患者48例,随访18~36个月,其中26例为常规即刻种植组（RI组）,22例为保留唇侧牙根片的根盾术即刻种植组（SS组）,比较2组患者种植体成功率,距种植体肩台0 mm（I0）、3 mm（I3）、6 mm（I6）的唇侧骨量厚度变化,术后18个月时粉色美学指数（PES）、改良龈沟出血指数（mSBI）以及临床满意度。采用SPSS 25.0软件包对数据进行统计学分析。结果 2组种植体成功率均为100%。术后6个月及18个月,SS组唇侧骨量厚度变化量低于RI组,在I0、I3处有统计学差异（P小小小0.05）; SS组PES评分高于RI组,但无统计学差异;改良龈沟出血指数无统计学差异,2组均获得较高的患者满意度。结论 相对于常规即刻种植,根盾术即刻种植在短时间内可以较好地维持种植体颈部唇侧骨量及软组织轮廓,对成功率无明显影响,建议将牙根片制备至平齐骨面,厚度约1 mm,种植体唇侧保留约1~2 mm“跳跃间隙”,植入低替代率骨移植材料,但临床操作要求较高。

Comparison of socket-shield technique and routine immediate implantation in anterior maxillary region

PURPOSE: To compare the changes in the thickness of labial bone mass and clinical effects between socket-shield technique and routine immediate implant placement in the aesthetic area of anterior maxillary region, and discuss operation details of the socket-shield technique. METHODS: Forty-eight patients were included for immediate implantation between September 2017 to March 2019 in the Affiliated Hospital of Qingdao University. Of them, twenty-six patients underwent routine immediate implantation(RI group), while 22 patients received socket-shield technique(SS group). The follow-up periods were 18-36 months, and the following parameters were employed for comparison: implant success rate, the changes of labial bone plate at 0 mm (I0), 3 mm (I3) and 6 mm (I6) below the shoulder of the implant, the pink aesthetics index(PES) at the last follow-up, gingival sulcus bleeding index and clinical satisfaction. SPSS 25. 0 software package was used for data analysis. RESULTS: The success rate in both groups was 100%. At 6 months and 18 months after operation , the changes of labial bone plate in SS group were lower than those in RI group, with significant difference at I0 and I3. PES score in SS group was higher than that in RI group, but with no significant difference. There was no significant difference in the modified sulcus bleeding index between these two techniques, and both groups obtained high patient satisfaction. CONCLUSIONS: Compared with routine immediate implantation, socket-shield technique maintains bone mass in the labial side of the neck of the implant and soft tissue profile in a short period of time, but has no obvious effect on the success rate. However, these two methods still need long-term clinical observation. It is recommended to prepare root film to the level of the bone surface, with a thickness of about 1 mm,keep a gap of about 1-2 mm on the labial side of the implant and then fill the bone graft material into the defect site. Pitifully, this technique needs highly difficult requirement of clinical procedure.