即刻种植与过渡义齿修复的四年疗效观察一例

The observation of rehabilitation with immediate implantation and temporary denture for four years:a case report.

目的:报告一例临床采用即刻种植结合过渡义齿修复的方法维持拔牙窝的骨量及软组织附着,从而达到种植义齿的美学和功能修复,通过定期随访观察,研究临床应用此方法的可行性及远期效果。方法:患者男,18周岁,外伤根折后3天,X线片见牙槽骨内残留部分断根,断面位于牙槽嵴顶下约2.0mm,该患牙牙周间隙增宽,尤其根尖处更为明显,未见外伤性骨折线。手术采用微创拔牙器械拔除断根,预备种植窝,即刻植入Replace种植体(5.0×13mm)一颗,种植体颈部唇侧与骨壁间约有1.0mm间隙,未加任何人工骨诱导材料,上永久基台(Replace美观基台)后拉拢缝合,术后十天拆线。并且结合过渡义齿修复,在种植体植入术后二十天,制取口腔内印模,灌制模型,临床医生在模型上以自凝树脂材料在Replace美观基台上为患者制作临时过渡义齿,调磨脱离咬合接触,表面高度抛光、消毒后,在患者口腔内试戴并固定。于种植体植入后6个月将过渡义齿拆下,采取闭口式印模方法种植体水平制取印模,(由于当时科室无人工牙龈,作者自行发明利用瑞士康特"安菲"缩合型硅橡胶印模材的细部印模材料代替人工牙龈,)灌制模型,送技工中心制作种植义齿上部钛合金烤瓷冠。结果:通过种植后定期随访直至术后四年,发现种植体愈合良好,无软组织感染及种植体周围炎,从X线片可见种植体-骨界面结合良好,无牙槽嵴顶骨吸收,四年后的牙槽嵴顶仍位于种植体与基台连接处,牙龈组织形态及龈缘位置比刚修复初期更为美观,修复效果十分理想,患者对该种植义齿的美观和功能都非常满意。结论:采用即刻种植结合过渡义齿修复的方法能够最大限度的维持拔牙窝的骨量及软组织附着,减少人工骨粉、生物膜的使用几率,减少手术创伤,缩短了疗程,减轻患者的痛苦及经济负担。并且这两种方法的结合能够引导早期软组织和骨围绕过渡义齿进行重建,有利于种植义齿的美学修复,建议无论在前牙区、后牙区种植修复适应症允许的情况下,均可考虑应用这两种方法。

Objective:To report a case of rehabilitation with the methods of immediate implantation and temporary denture to keep the bone and soft tissue,so that to obtain better aesthetic effect and function.Through periodical observation,we studied the feasibility and future effect of these methods.Methods:patient,male,18-years old,had been broken for 3 days.The left part of the root under top of alveolar about 2.0 mm was found from X-ray.The periodontal space of the tooth was wider,especially at apical site.No fracture because of accident was found.Operation:the left root was extracted with special facilities for immediate implantation to minimize trauma,then prepared the hole for inserting implant,immediately inserted one implant(Replace,5.0×13mm)in it.There was about 1.0 mm space between edge of alveolar bone and the cervical of implant.No other artificial materials were used.We put Replace aesthetic abutment on implant and stitched.The stitch was removed after 10 days.20 days after operation,we took impression for patient and made temporary denture on aesthetic abutment with resin on the model.After removing the touched area,polishing and sterilizing denture,we tried it on the patient and fixed.After six months,we removed the temporary denture,took final impression,made model and sent it to factory to finish the crown.Results:Through following observation for four years,it can be found that the implant was healed well and no soft tissue inflammation or periimplantitis was found.There was no alveolar bone absorption and we can see the integration of bone and implant from X-ray.The height of the alveolar bone was still at the connection area of implant and abutment after four years,and the shape and position of gum was more beautiful than original stage.The effect of rehabilitation was very ideal,and the patient was satisfied with the aesthetics and the function of the restoration.Conclusion:The methods of immediate implantation and temporary denture can keep maximum bone and soft tissue,which reduce the probability of using artificial bone and membrane,lessen trauma,shorten period of treatment and allay the pain and economic burden of patient.The combination of these two methods can also lead bone and soft tissue restructure around the temporary denture at early stage,which contributes to aesthetic restoration.The results of this case suggest that we can consider to use these two methods at both anterior and posterior area implantation if the conditions are permitted.