应用羟基磷灰石生物陶瓷引导骨再生对单牙种植修复体周围牙龈的影响

The Effects of Guided Bone Regeneration with Coralline Hydroxyapatite on Gingival Morphology of Single Implant Prostheses

目的:探讨伴有不同程度骨缺损的单牙缺失区引导的再生骨对种植修复体周围牙龈形态美学的影响。材料与方法:对53例单牙缺失伴有不同程度牙槽骨缺损的病人进行标准牙种植手术,同期应用羟基磷灰石生物陶瓷行骨引导再生术,观察骨愈合和引导再生骨的形成情况。在修复即刻、修复后半年和1年时,对种植体顶骨缘吸收和种植修复体周围牙龈形态、龈缘水平、牙龈质地、龈乳头结构和龈缘出血状况的变化进行评价。结果:引导的再生骨充满骨缺损,骨质良好。在修复后1年,4例出现种植体顶边缘骨吸收超过1个螺纹,与骨缺损类型无关。随功能负重时间延长,种植修复体牙龈美学效果改善明显,但牙龈形态和龈乳头结构不完整在骨缺损较大病例中的发生率明显高于小型骨缺损病例。结论:羟基磷灰石生物陶瓷充具有良好的引导骨再生作用,充足的引导再生骨是维持种植修复体周围牙龈正常形态结构的决定性因素。

Objective:To probe the effects of guided regenerative bone on the esthetic outcomes of peri-implant gingival tissue in the site of single tooth-loss with various extent of alvoelar defect.Material and Methods:53 patients that suffered from missing single tooth and presenting various extent of alveolar defect were treated with standard protocol of implant-surgery.Meanwhile the guided bone regeneration procedures were performed with coralline hydroxyapatite.The situation of bone healing and guided bone regeneration were observed.Marginal bone level around implant shoulder and the morphology,marginal level,the quality,the pappilar architecture and marginal bleeding of the gingiva surrounding implant prostheses were evaluated at this very day,6-and 12-month follow-up after accomplishing implant restoration,respectively.Results:The guided regenerative bone is fine and covers the defects completely.At 1 year follow-up,the marginal bone resorption beyond 1 screw are found in 4 patients which is not relative with the defect type.The gingival esthetic outcomes surrounding implant prostheses is improved very much with functional loading-time increasing;but the occurrence of unmatched gingival shape and papillar architecturec in the patients with larger alveolar defect is heavier than the patients with smaller defect significiantly.Conclutions:The bone substitute coralline hydroxiapatite is well able to guide new bone to regenerate.The sufficient guided regenerative bone plays important role in maintaining peri-implant natural gingival pattern.