上颌美学区改良盾构术与常规不翻瓣即刻种植即
背景:常规盾构术可减少上前牙即刻种植即刻修复后唇侧束状骨的吸收,但该技术对术者要求很高,种植体植入时容易造成唇侧余留牙片的松动,导致手术失败。
目的:评价上颌美学区改良盾构术与常规不翻瓣即刻种植即刻修复的临床效果。
方法:纳入2016年9月至2017年8月滨州医学院附属医院收治的60 例口腔修复科患者,其中男33 例,女27 例,年龄20-81 岁,包括中切牙38 例、侧切牙22 例,随机分2 组:试验组30 例接受改良盾构术即刻种植即刻修复,对照组30 例接受常规不翻瓣即刻种植即刻修复。1年后复诊,记录种植体存留率,测量两组红色美学指数评分,锥形束CT 检测种植体颈部及其根方2,4 mm 的唇侧骨板厚度,调查患者对种植义齿的满意度。研究经过滨州医学院附属医院医学伦理委员会的审核批准(医院伦理批件号:2019-LW-025)。
结果与结论:①两组种植体存留率均为100%;②试验组术后1年的红色美学指数评分高于术前、对照组(P< 0.05),对照组术后1年的红色美学指数评分低于术前(P< 0.05);③试验组术后1年的植体颈部及其根方2,4 mm 唇侧骨厚度吸收均小于对照组(P< 0.05);④试验组患者满意度高于对照组(P< 0.05);⑤结果表明,改良盾构术即刻种植即刻修复有利于唇侧骨厚度的维持,能获得更好的美学效果。
BACKGROUND:The conventional shield technique can reduce the absorption of labial fasciculate bone after immediate implantation of anterior teeth,but it is highly demanded by the implants are implanted,it is easy to loosen the remaining teeth on the labial side,resulting in failure of the operation.
OBJECTIVE:To evaluate the clinical effects of a modified socket shield technique for immediate implant and immediate restoration and flapless immediate implant and immediate restoration in maxillary aesthetic area.
METHODS:Sixty patients were randomly chosen with failing tooth from September 2016 to August 2017 in Department of Stomatology in Affiliated Hospital of Binzhou Medical samples included 33 males and 27 females,aged from 20 to 81 were 38 cases of central incisor and 22 cases of lateral patients were randomly divided into two 30 patients in the experimental group received a modified socket shield technique for immediate implant and immediate 30 patients in the control group received conventional flapless immediate implant and immediate return visit after 1 year,the retention rate of the implant and pink esthetic score were recorded; the buccal bone thicknesses of the implant neck and roots 2,4 mm were observed by cone beam computed tomography; and the patient satisfaction was study was approved by the Medical Ethics Committee of the Affiliated Hospital of Binzhou Medical College (Hospital Ethics Approval Number:2019-LW-025).
RESULTS AND CONCLUSION:(1) The survival rate of both groups was 100%.(2) One year after operation,the pink esthetic score of the experimental group was higher than the preoperative score and that in the control group (P< 0.05).The pink esthetic score of the control group was lower 1 year after surgery than preoperative score (P< 0.05).(3) One year after operation,the buccal bone thickness loss of the implant neck and roots 2,4 mm in the experimental group was lower than that in the control group (P< 0.05).(4) The satisfaction rate of the experimental group was higher than that in the control group (P< 0.05).(5) The results showed that the modified socket shield technique used for immediate implant and immediate restoration can maintain the buccal bone thickness and improve the aesthetic effect.
0 引言 Introduction
上颌前牙区种植是现代口腔种植的热点,也是种植的难点。随着口腔种植技术的不断发展及生物组织材料的更新,患者对牙种植的要求也越来越高,人们不仅要求缩短治疗周期,对美学及功能也提出了更高的要求。研究表明,上前牙即刻种植、即刻修复可取得良好的临床效果[1-3],但其唇侧骨厚度仍存在不同程度的骨吸收[4-5]。HüRZELER等[6]2010年首次提出了盾构术,即刻种植前保留部分唇侧牙根结构,从而保存原天然牙与唇侧骨板之间的牙周膜,减少唇侧束状骨的吸收。近几年国内外学者对该技术进行了尝试,均取得了不错的临床效果[7-9],但常规盾构术对术者要求很高,种植体植入时容易造成唇侧余留牙片的松动,导致手术失败。研究对常规盾构术技术进行了改良,在种植体与唇侧牙片预留2 mm的跳跃间隙并植入异种骨替代材料Bio-Oss骨粉,评价上颌美学区改良盾构术与常规不翻瓣即刻种植即刻修复的临床效果,以期为上前牙即刻种植方案提供一些临床参考。
1 对象和方法 Subjects and methods
1.1 设计 前瞻性、双盲、随机对照研究,术者及患者均不知情分组情况。