上颌前牙单牙种植修复中过渡义齿对软组织成型作用的临床研究

Effect of provisional restoration on shaping the contour of the soft tissue during maxillary single tooth implant procedure

目的:评价上颌前牙单牙种植患者在种植修复过程中采用粘接桥和种植体支持的临时冠对软组织形态进行维持并成型的临床效果,探讨在种植修复的不同阶段采用临时修复体对软组织进行干预的可行性和技术细节。方法:北京大学口腔医院种植科2008年9月至2010年12月间上颌前牙单牙种植修复患者29例(男17例,女12例)作为实验组,在拔牙窝愈合期使用粘接桥进行临时修复,种植体植入后则采用种植体支持的临时冠诱导牙龈,对软组织形态进行干预和诱导;同期符合相同入组条件的29例患者作为对照组,在拔牙后戴压膜过渡义齿(或不戴义齿),直至永久修复完成。在拔牙前、种植体支持的临时冠戴用结束时对软组织进行美学评价,计算粘接桥的存留率、再粘接率,种植体支持的过渡义齿完好率,并请患者对修复美学效果和治疗过程进行满意度评价。结果:粘接桥戴用时间为2.2～5.1个月,平均3.7个月;种植体支持的临时冠戴用时间为6.2～13.1个月,平均8.3个月。至戴用期结束时,粘接桥存留100%,再粘接率为16.2%;种植体支持的临时冠存留率为100%。在永久修复完成时,实验组的软组织美学评价分值高于对照组(7.48±0.51 vs.5.69±0.71,P<0.000 1)。实验组患者在各治疗阶段对修复美学效果的评价满意率均为100%,粘接桥的再粘接率为16.2%。结论:采用粘接桥和种植体支持的临时冠在上颌前牙单牙种植美学修复中对软组织的维持和成型技术临床可行、近期美学效果可靠,患者满意度较高,但需严格把握适应证。

Objective： To evaluate the influence of soft tissue aesthetic outcomes following application of adhensive fixed partial denture and implant supported temporary restoration in maxillary single tooth implant procedure.Discuss the feasibility and details of the shaping the soft tissue by combine adhensive fixed partial denture and implant-supported temporary restoration.Methods： The study included 29 patients（Male： 17,Female： 12） with hopeless maxillary single tooth from Sept.2008 to Dec.2010.All patients received tooth extraction and implant treatment in department of oral implantology,Peking University School and hospital of Stomatology.The adhesive fixed partial denture as a provisional restoration was used to support the soft tissue of the tooth extraction socket after tooth extraction.The average time of patient wearing adhensive fixed partial denture was 3.7 months.The implant supported temporary restoration was delivered to shape the soft tissue after implant placement.The average time of implant supported provisional restoration using was 8.3 months.Soft tissue esthetic condition was evaluated through 4 main index reference pink esthetic score（PES） before tooth extraction and at the time of the final restoration.Clinical observe items also included the survival rate of fixed partial denture and rate of re-adhesive,integrity of temporary restoration and degree of satisfaction of the patients.The control group included 29 cases with removable denture or without temporary restoration.The base line differences between control group and experiment group were not statistically significant.Results： The survival rate of both the adhensive partial denture and implant-supported provisional restoration was 100%.The re-adhesive rate of adhesive partial denture was 16.2% during follow-up period.The PES at the time of final restoration were significant different between two groups by t test（7.48±0.51 vs.5.69±0.71,P0.000 1）.Patients were satisfied with the clinical results.Conclusion： This study indicates that fixed partial restoration and implant-supported provisional restoration could be used to support and to shape the soft tissue contour and to improve the aesthetic effects.