Abstract:

Objective    To compare the changes of the periimplant papilla index and labial gingiva fullness between flap and flapless immediate implant placement after reshaping the perimplant soft tissue using implant supported provisional prostheses. Methods    From August 2007 to March 2011，41 patients were enrolled in Department of Implant Dentistry，School and Hospital of Stomatology，Peking University. The patients were classified into two groups. Group Ⅰ：immediate implant using flapless technique and Bio-Oss Collagen in 20 cases. Group Ⅱ：immediate implant placement using guided bone regeneration（GBR）after flap reflection in 21 cases. All the patients underwent sequential gingival architecture remodeling using implant-supported temporary prostheses. Marginal bone resorption after loading of 1 and 3 years were measured and statistical analysis was conducted. Esthetic evaluations included papilla index and the labial gingiva peri-implant soft tissue fullness. Results    Totally 41 implants were placed in 41 cases with ReplaceSpeedy® implants. The mean follow-up was 42.4 months（24-67 months）and no implant was lost until the last recall. One and three years after final restoration delivered， papilla index and labial gingiva fullness were compared between two groups and no significance was observed （P > 0.05）. After 1 and 3 years，marginal bone resorption was（0.50 ± 0.04）mm and（0.55 ± 0.04）mm in flapless group，（0.59 ± 0.03）mm and（0.67 ± 0.03）mm in flap group respectively，and statistical significance was observed between two groups（P < 0.05）. Patients’ satisfaction was high in both groups and treatment comfort was higher in flapless group. Conclusion    The clinical results and gingival stability is predictable in choosing flap or flapless immediate implant technique in the maxillary anterior teeth when proper indication and technique are selected. Using implant supported provisional prostheses can reshape and stabilize periimplant soft tissue and the short-term results are predictable. Marginal bone level was stable and less bone resorption was founded in flapless group compared with flap group. Patients in both groups were satisfied with the clinical results and treatment comfort and flapless group had higher patient satisfaction.

Key words: implant, flapless, maxillary anterior teeth, esthetics

摘要：

目的    评估翻瓣与不翻瓣即刻种植修复病例的种植体存留率、软组织美学效果及种植体周围骨吸收情况。方法    2007年8月至2011年3月共41例在北京大学口腔医院种植科就诊的上颌前牙区单牙即刻种植患者纳入本研究，分为不翻瓣组（20例）和翻瓣组（21例），两组均采用种植体支持暂时冠进行牙龈诱导塑形。评估两组修复后1、3年的骨吸收量并进行统计学分析。美学评价指标包括牙间乳头外形指数及种植体唇侧牙龈丰满度。结果    41例患者共植入41枚ReplaceSpeedy®种植体，追踪时间24 ~ 67个月，平均42.4个月，至最后一次复查未见种植体脱落。不翻瓣组与翻瓣组修复后1、3年的牙间乳头外形指数和唇侧牙龈丰满度比较，差异均无统计学意义（均P > 0.05）。修复后1、3年，不翻瓣组骨吸收量分别为（0.50 ± 0.04）mm和（0.55 ± 0.04）mm，翻瓣组分别为（0.59 ± 0.03）mm和（0.67 ± 0.03）mm，两组差异有统计学意义（P < 0.05）。两组患者对修复后美学效果满意，不翻瓣组患者对治疗过程舒适度的满意度高于翻瓣组。结论    上颌前牙翻瓣与不翻瓣即刻种植技术在选择合适的适应证及采用适当的技术时均能取得满意的临床效果。经种植体支持暂时冠牙龈诱导塑形，修复后牙龈稳定。两组种植体边缘骨水平稳定，不翻瓣组骨吸收低于翻瓣组。两组患者均对修复后美学效果满意，患者对不翻瓣即刻种植满意度更高。

关键词: 种植, 不翻瓣, 上颌前牙, 美学