多种微创技术在前牙区种植中的应用

Minimally Invasive Implantation Techniques used In the Esthetic Zone

目的:总结不翻瓣技术、骨劈开与BICON手用扩孔钻等多种微创技术在前牙区种植的临床应用。方法:0研究包括34例患者前牙区51个植入位点。常规CBCT术前检查,剩余骨量的唇舌向宽度4.52±1.26mm(均数±标准差),唇侧骨缺损垂直向高度为1.56±0.25mm(均数±标准差),唇侧骨壁存在不同程度的倒凹及缺损。对于嵴顶骨量宽度大于5mm时,只采用嵴顶切口并向邻牙延伸的不翻瓣技术,当根部有倒凹时,增加倒凹区的横行切口,在保证可接受的种植体植入方向的前提下,避免唇侧骨壁的穿通;若有部分穿通,可植入少量BIOSS骨粉覆盖。当嵴顶骨量宽度在3-4mm时,特别是在中切牙区,为植入4-4.5mm直径的种植体,采用骨劈开以及结合BICON系统特有的手用扩孔系列钻技术,很好地完成了骨嵴的扩展,植入理想的4.5mm直径的BICON植体,并保证了种植体颈部唇腭侧1-1.5mm的骨质。当嵴顶骨量宽度小于3mm或唇侧凹陷明显时,可以适当降低嵴顶的高度,到宽度有3mm时,采用上述的方法,此时,可以适当分离唇侧的粘骨膜,保留BICON种植体特有的塑料愈合帽适当长度,使之起到一定的帐篷支撑效应,塑料柱周围植入BIO-COLLAGEN,并采用胶原膜覆盖,最终达到垂直骨增量的目的。部分病例此时可以附加垂直切口,保证切口在无张力状态下缝合。结果:垂直向骨增量1.41±0.32mm(均数±标准差),唇舌向骨增量2.35±0.41mm(均数±标准差),保证了种植体周围至少1mm的骨量。在3至6个月的随访期内,无种植体松动脱落和明显的骨吸收,CBCT显示种植体周围植入Bio-Oss部位有高密度影像,提示新骨形成良好。结论:我们采用不翻瓣技术、骨劈开与BICON手用扩孔钻联合技术、膜引导与BICON植体的帐篷支撑效应联合技术等微创技术完成了骨量不足的前牙区种植修复,常规修复前CBCT检查,修复6个月后复查,显示骨组织稳定,修复效果良好,是值得推广的一系列微创技术。

Purposes： To perform clinical effect of minimally invasive techniques,such as flapless technique,bone splitting and BICON hand reaming drills,collagen membrane guiding and tent-pole effect of BICON implant,in implantation of the esthetic zone with insufficient bone mass.Methods： 34 patients with 51 implant sites were included in this study.Preoperative CBCT scan as routine examination was taken in the esthetic zone.The remaining bone width of labial to palatal was 4.52 ± 1.26mm （Mean ± standard deviation） and the vertical height of labial depression was 1.56±0.25 mm （Mean ± standard deviation）.Varying degrees of undercut and the defect existed in labial bone.When the width of alveolar ridge was more than 5 mm,we adopted flapless technique which only had a ridge incision and extended to adjacent teeth.When there was undercut on labial bone,we added a horizontal incision at this zone to make sure of the acceptable direction of the implant and also to avoid penetrating labial bone,if some parts happened to penetrate,Bio-Oss grafts could be used.If the width of alveolar ridge was between 3-4 mm,in order to place the implant of 4-4.5mm in diameter,we take an effective bone splitting technique and the unique series of hand reaming drills of the BICON system,as a result,we got ideal ridge width and placed BICON implants of 4.5mm in diameter and guaranteed 1-1.5 mm bone mass at implant neck both labial and palate.When the width of crest bone was less than 3mm or labial depression was significant,we reduced crest height to get 3 mm width,then used the above method,additionally we retained BICON unique healing plastic post to proper length which played supporting effect as tents,then we placed BIO-COLLAGEN around it and covered it with collagen membrane to achieve vertical bone mass.In some cases we had additional vertical incision to guarantee the sutures without tension.Results： The vertical bone incremental was 1.41 ± 0.32 mm （mean ± standard deviation） and the bone incremental of labial to tongue was 2.35 ± 0.41mm （mean ± standard deviation）.It could ensure that there was at least 1mm bone mass around the implants.No implant mobility or rapid bone loss was found during a follow up period of 3 to 6 months.X-ray showed high density image and prompted that new bone were forming around implants.Conclusion： We combined minimally invasive techniques,such as flapless technique,bone splitting and BICON hand reaming drills,collagen membrane guiding and tent-pole effect of BICON implant.CBCT inspection before restoration was taken,and reviewed after 6 months.It indicated these minimally invasive techniques would be recommended.