上颌前牙区单牙种植钛膜引导成骨的美学效果观察

目的上颌前牙单牙种植采取不可吸收性无孔纯钛膜进行引导骨再生,对成骨效果以及修复后软组织美学效果进行观察。方法 2004年6月至2009年12月,在北京大学口腔医学院种植中心,20例上颌前牙单牙缺失种植患者（男12例,女8例,年龄19~56岁,平均34.0岁）。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等于0.5mm,采用少量自体碎骨和Bio-Oss骨粉充填骨缺损后,以钛膜覆盖植骨区,并用小膜钉固定。愈合5~6个月行Ⅱ期手术,取出钛膜,测量种植体唇侧骨板的厚度。Ⅱ期术后2个月进行种植修复。使用PES（pink esthetic score）评分对种植修复体周围软组织进行评价。结果 20例病例中,没有一例出现伤口的裂开及感染。20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0.23mm,种植Ⅱ期手术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2.33mm,平均增加2.10 mm。PES平均得分为10.05±1.57。结论在上颌前牙区单牙种植时,采取钛膜引导成骨,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,牙龈软组织的近期效果良好。

Esthetic outcome of guided bone regeneration with titanium membrane in single anterior maxillary implant site

Objective To evaluate the esthetic outcome of guided bone regeneration(GBR) using non-resorbable titanium membrane in single anterior maxillary implant site.Methods From June,2004 to December,2009,20 consecutive patients treated in the Center of Oral Implantology,Peking University School of Stomatology were enrolled in this study.These patients(12 males,8 females,mean age of 34.0 years old ranging from 19～56 years) underwent implant replacement for single maxillary anterior tooth presented either with bone dehiscence in the coronal part of the implant or with remaining labial bone of less than 0.5mm after implant insertion.GBR was performed with autogenous bone,Bio-Oss(from Geistlich,Switzerland) and non-resorbable titanium membrane.Titanium tacks were used to stabilize the membrane.Tension free wound closure was achieved.Second stage surgery was performed 5-6 months later and titanium membrane was removed.The thickness of labial bone was measured.Implant restoration was done 2 months after the second stage surgery.Esthetic outcome of soft tissue was assessed with Pink esthetic score(PES).Results Of the 20 patients,none had wound dehiscence or infection and all of the 20 implants achieved osseointegration verified by X-ray examination.The mean value of labial bone thickness was 0.23mm upon implant placement,while at the second stage surgery it increased to 1.5mm～3.5mm,with an average of 2.33mm(increased by 2.10mm as compared to that before GBR).Implant restoration was done 2 months after the second stage surgery.The mean PES was 10.05±1.57.Conclusion Using titanium membrane in GBR could achieve predictable gaining in the thickness of labial bone in the treatment of bone dehiscence and labial bone deficiency in single anterior maxillary implant site and thus would achieve predictable esthetic outcome of soft tissue upon implant restoration.