中国实用口腔科杂志

中国实用口腔科杂志

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上颌中切牙种植修复结合软硬组织增量后的临床和影像学效果初步分析

王浩杰1a，2，甄敏1a，胡文杰1a，王翠1a，贾鹏程1a，徐涛1b，刘云松1c   

  1. 1. 北京大学口腔医学院·口腔医院a牙周科，b急诊科，c修复科；口腔数字化医疗技术和材料国家工程实验室；口腔数字医学北京市重点实验室，北京  100081. 2. 北京大学第三医院口腔科，北京  100191
  • 出版日期:2018-07-15 发布日期:2018-11-08
  • 基金资助:

    首都卫生发展科研专项基金（2011-4025-04）

  • Online:2018-07-15 Published:2018-11-08

摘要：

目的    应用种植同期结合引导性骨再生（guided bone regeneration，GBR）技术及不同软组织处理方式修复缺失的单颗上颌中切牙，评价其软硬组织的增量效果。方法    纳入于2013—2014年就诊于北京大学口腔医院牙周科因单颗上颌中切牙缺失而接受种植治疗的患者6例。所有患者在种植同期行GBR，并接受不同软组织处理方式。最终修复7 ~ 24个月后，记录患者上颌前牙区牙周状况，通过影像学检查定量测量种植体唇侧骨高度及骨壁厚度，利用标准化临床照片，定量测量种植体与对照牙牙龈顶点的位置关系，以及种植体近远中龈乳头高度和充满程度，并应用粉色美学评分（pink esthetic score，PES）评价美学效果。结果    所有种植体在复查时均处于健康稳定的牙周状态。5颗种植体在复查时可观察到垂直向及水平向骨增量，种植体唇侧中央肩台根方2、4、6 mm处平均骨壁厚度分别为（1.7 ± 1.1）mm、（2.3 ± 1.1）mm、（2.2 ± 1.3）mm。种植体牙龈顶点相比对照牙（同颌对侧中切牙）平均更偏向远中（1.0 ± 0.6）mm，偏向根方（0.4 ± 0.8）mm；远中龈乳头平均高度（2.8 ± 0.5）mm和充满程度（76.9 ± 19.2）%低于近中龈乳头［（4.2 ± 0.7）mm，（89.8 ± 11.1）%］，平均PES为（11.5 ± 1.4）分。结论    对于缺牙区存在软硬组织缺损的患者，上颌中切牙种植同期结合GBR及不同软组织处理方式，可获得较为充足的骨增量效果及与对照牙相对协调的软组织形态，一定程度上改善美学效果。

关键词: 种植, 美学, 引导性骨再生, 软组织增量

Abstract:

Objective    Implant therapy combined with simultaneous guided bone regeneration（GBR）and different soft tissue management was applied to patients to repair their missing maxillary center incisors. This article aims to analyze the effects of hard and soft tissue augmentation quantitatively. Methods    Six patients who accepted implant therapy in combination with simultaneous GBR and different soft tissue management for their single missing maxillary central incisor were screened. They were called for a review visit at 7 to 24 months after final restoration. The clinical periodontal status of the maxillary anterior teeth was examined，and the bone height and thickness at middle labial aspect of implants were measured by CBCT quantitatively. The relationship of gingival zenith position between implants and the control teeth，as well as the papilla height and filling degree of implants were measured quantitatively on the standardized photographs. Pink esthetic score（PES）was applied to evaluate the esthetic effect. Results    All the implants were in stable and healthy periodontal status at the review visit. Vertical and horizontal bone augmentation could be observed on 5 implants. The mean facial bone thickness at 2，4，and 6 mm apical to implant shoulder was（1.7 ± 1.1）mm，（2.3 ± 1.1）mm，and（2.2 ± 1.3）mm，respectively. The mean position of gingival zenith of implants was（1.0 ± 0.6）mm more distally，and（0.4 ± 0.8）mm more apically，compared to the control teeth. The mean height（2.8 ± 0.5）mm and filling （76.9 ± 19.2）% of distal papilla of implants were less than those of mesial papilla（4.2 ± 0.7）mm，and （89.8 ± 11.1）%. Mean PES was 11.5 ± 1.4. Conclusion    For the patients with bone and soft tissue defect at edentulous areas，implant therapy combined with GBR and different soft tissue management for the missing maxillary center incisors can obtain adequate bone augmentation and harmonious soft tissue profile to the control teeth，and consequently improve esthetic outcomes in a certain degree.

Key words: implant, esthetic, guided bone regeneration, soft tissue augmentation