上颌前牙区牙槽嵴骨劈开增量同期种植术的临床研究

Maxillary anterior alveolar bone augmentation using a split-crest technique

目的 :评价骨劈开增宽上颌前牙槽嵴 ,同期植入种植体的临床效果。方法 :15例患者 ,缺失上前牙1～4颗 ,有充足的牙槽嵴高度 (>13mm) ,但牙槽嵴骨厚度仅2～3mm ,采用骨劈开术 ,形成唇侧骨瓣。在唇侧骨瓣与腭侧骨板间植入3.4～4.5mm直径的Frialit-2种植体共25枚,骨板间隙充填Bio -Oss骨粉 ,覆盖Bio -Gide胶原膜或纯钛膜 ,无张力下缝合黏骨膜瓣。术后第10天和6个月时拍X线根尖周片观察种植体骨结合状况 ,并于术后6个月时行Ⅱ期手术 ,翻开软组织瓣 ,检查骨增量效果和种植体稳固性 ,测量牙槽嵴骨的宽度和拆除钛膜。结果 :1枚种植体术后1个月脱落 ,其余种植体稳固 ,且完全被骨质包埋 ,X线根尖周片证实种植体骨结合良好 ,牙槽嵴宽度增加达3～5mm ,平均增宽4.4mm。Ⅱ期手术时种植体成活率96 %。24枚种植体完成金属烤瓷修复 ,经2年的追踪观察,无一种植体松动或脱落。结论 :当前牙区牙槽嵴骨厚度2～3mm时 ,采用骨劈开术增宽牙槽嵴 ,使植种植体获得同期植入是一种行之有效的方法。

Objactive:To evaluate clinical effectiveness of split-crest technique for immediate implant placement in-to the bone narrow of maxillary anterior alveolar ridge.Methods:15patients missing1to4maxillary anterior teeth were enrolled in this study.The patients had sufficient vertical bone height but the bone width only2to3mm at the implant sits.Two longitudinal cuts through the buccal cortical plates were made with a chisel in mesial and distal parts of the edentulous ridge.The cuts must be at least2mm away from the adjacent roots of tooth.A chisel was then used to make a cross cut on the ridge crest and spread apart the two cortical plates,provoking a greenstick fracture of baccal cortical plate.25Frialit-2implants(3.4-mm,3.8-mm and4.5-mm diameter)were then placed.The gaps between two cortical plates was filled with Bio-Oss and cov-ered with titanic membrane or Bio-guide membrane.Periapical radiographs were taken to observe peri-im-plant bone responses at10days and6months postoperatively.The buccal flaps were reflected and stability of implants was examined,the crest bone width was measured at6months after implants placement.Healing abut-ments were then placed.Results:One of the15patients lost1implant at1month postoperativly.Radiographs showed that the rest24implants had a perfect osseointegration A gain in crest bone width of the rest14patients varied between3mm and5mm and the average gain was4.4mm.The96%implant survival rate was ob-tained.at6months postoperatively.24implants were constructed with metal-ceramic,none of them was loose or lost after they was loaded for2years.Conclusions:This technigue of split-crest could be effective and pre-dictable for horizontal ridge augmentation associated with immediate implant placement.