上颌前牙单牙不翻瓣即刻种植修复的临床研究

Extraction Site Preservation

SU Yucheng，GE Yi

(Dental Implant Center，Peking Union Medical College Hospital(PUMCH)，

Chinese Academy of Medical Sciences(CAMC))

【Abstract】Objective:To evaluate the result of extraction site preservation before implant placement in preserving alveolar ridge and soft tissue．Methods:In29incisor and premolar sites，DBBM were implanted after tooth extraction and the wound was covered by free palatal mucosal flap．Implant was placed after6months and restored after another4months．From2002－05to2004－03，8patients with37teeth lost in anterior mandible were received sandwich bone graft and36implants were placed totally．24implants were placed at the same time and12implants were implanted after4months．The final restorations were delivered3to6months later．Results:All bone grafts survived and all implants succeeded and osteointegrated．Follow－up were from5．3to7．1years．

上颌前牙单牙不翻瓣即刻种植修复的临床研究

陈波林野邱立新王莺李率邸萍李健慧

(北京大学口腔医学院种植科)

【摘要】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(pink esthetic score)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

CHEN Bo，QIU Lixin，LIN Ye，DI Ping，WANG Ying，LI Shuai

(Department of Oral Implantology，Peking University，School and hospital of Stomatology)

【Abstract】Objective:The purpose of this study is to evaluate the esthetic outcome of immediate implant replacement of single ante-rior tooth with flapless technique．Methods and materials:16patients were enrolled in this clinical observation．Including criteria:1．

Intact facial alveolar bone;2．The distance between facial alveolar crest and gingival margin around3mm．Minimally invasive tooth ex-traction was carried out in each case．After careful probing of the bony architecture，implant was placed around3mm 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 least2mm 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 delivered4to6weeks 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 u-tilized 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 the16patients was21．8months(12－34months)．Cumulative survival rate was100%dur-ing the observation period．14patients had score3according to PFI while only2patients had score2．The PES was13in8patients and14in6patients．The facial bone remained stable according to CBCT．Conclusion:Immediate implant replacement of single anteri-or tooth with flapless technique could achieve predictable esthetic outcome while highly technique demanding．Soft and hard tissue anat-omy should be carefully assessed as regards to indication．Ideal3D implant position and under contour design of the transmucosal part of prosthetic crown was critical to the esthetic outcome．

前牙区即刻种植和延迟种植软硬组织的保存比较:临床研究

王莺林野陈波邱立新张宇胡秀莲

(北京大学口腔医学院种植科)

【摘要】目的:即刻种植被广泛认为是可靠而成功率相当高的治疗方法。主要的优点是:1、缩短疗程;2、保存牙槽骨;3、易于确定种植体位置。拔牙后3－12个月牙槽骨吸收程度最明显。拔牙后即刻种植被认为是保留牙槽骨的最好方法，但是有学者认为拔牙植骨后延迟种植对于美学效果更加可靠。我们总结了上颌前牙区即刻种植和延迟种植的两组病例，对其牙槽骨的变化和软组织变化进行追踪和测量。材料方法:组一:即刻种植拔牙前拍摄，不翻瓣拔牙后行即刻种植，种植系统为Nobel Biocare Replace或Ankylos。在种植体骨壁之间填塞Bio－Oss骨颗粒和Bio－Gide胶原膜。仔细关闭伤口，以确保初期愈合。术后6个月拍3D锥形束CT，并开始修复(临时或者永久修复)。组二:延迟种植拔牙同时植入Bio－col骨胶原，3个月后行种植体植入，之后6个月开始临时修复。种植体植入后6个月拍摄3D锥形束CT。结果:通过3DCT观察，两组患者的牙槽骨都得到了比较好的保存，牙龈的边缘水平和牙龈乳头的高度都比较理想。第二组患者在拔牙后和种植后牙龈乳头变圆钝，有不同程度的萎缩现象，但是在临时修复后3个月出现自动恢复的现象。结论:两组患者都显示出美学效果良好，说明这两种方法都可以比较可靠地达到良好的美学效果。即刻种植更显示出缩短疗程的优势;而延迟种植需要更长的治疗时间。我们建议在前牙即刻种植或延迟种植时使用引导骨再生技术，同时使用移植骨材料和隔离膜。在组织稳定性和美学效果的稳定性方面还需要长期的前瞻性临床观察。

Immediate placement of implants has been found to have a high rate of success．The main advantages are:1\shorter time of treatment; 2\conservation of the crest bone;3\exact positioning of the implant．It was shown that major changes in an extraction site occur in the first3months after tooth extraction especially the buccal bone and the interdental crest．While many researchers believe that delayed implant placement for anterior teeth is more predictable for the esthetic result．This study is to observe the clinical result of immediate implant and delayed implant，and also measure the volume through3D－CT．Group1:Immediate implant9Patients presented untreat-able anterior upper teeth．Cone Beam CT were took before surgeries．Teeth were extracted without flap reflection，and implants(Nobel Biocare Replace/Ankylos)were inserted simultaneously．Bio－Oss granules and Bio－Gide membrane were used to fill the gap be-tween the implant and the bone wall．Mattress suture was adopt on both sides of the healing abutment to achieve the primary wound clo-sure．Cone beam CT was took after6months from the day of implants placement．Group2:Delayed implant5patients presented two un-treatable anterior upper teeth．We follow the delayed implant protocol．Teeth were extracted with bone(Bio－Oss/Bio－col)graft．Im-plants(Nobel Biocare Replace/Ankylos)were placed following two stage protocol with guided bone regeneration(Bio－Oss granule and Bio－Gide mambrane)after3months．6months after the implant placement，healing abutments were placed．Cone bean CT was took