前牙区即刻种植及早期种植的临床疗效探讨

CLINICAL EFFICACY OF IMMEDIATE IMPLANTATION VERSUS EARLY IMPLANTATION IN THE ANTERIOR MAXILLA

目的 探讨上颌前牙区即刻种植术及早期种植术的临床疗效及两者的差异。方法 对我院27例上前牙病变患者进行微创拔牙,术后分别行即刻种植体植入、术后4～8周及12～16周早期种植体植入,共植入种植体32颗,其中伴骨缺损者采用引导骨组织再生技术（GBR）,同期植入工骨粉及生物膜,关闭创口。种植体植入后3～6个月后行永久修复。随访种植义齿情况,时间6～24个月。在此期间进行x线检查种植体周骨量吸收情况;检查种植体周牙龈及龈乳头外形,且通过牙龈乳头充盈指数及视觉模拟评分法评价临床成功率及美学修复效果。结果 32颗种植体存留率为96.9%;种植体周未见病理性骨吸收;牙龈形态良好,色泽正常,患者主观满意度VAS值平均达96.3。两者在组织稳定性和美学效果的稳定性方面的差异无统计学意义。结论 在严格掌握适应症的前提下,对上颌前牙区进行即刻种植或早期种植都能获得较为良好的临床效果。但在适应症的选择和临床操作方面,早期种植比即刻种植更具优势。

Objective To compare the clinical efficacy of immediate implantation and early implantation in the anterior maxilia. Methods 27 cases of dental lesions in the anterior maxilla in our hospital were treated with minimally invasivc extraction. A total of 32 implants were immediately or early （4 ～ 8weeks or 12 - 16weeks） implanted after minimally invasive extraction. Guided bone regeneration （GBR） was used to treat bone defects around implants with implanted artificial bone dust and biomembrane, and then with wound closure. Permanent restorations were performed 3 ～ 6 months after implantation. During 6 to 24 months＇follow - up of implant denture, the data of bone resorption surrounding implants by x ray, gingival contour and gingival papilla appearance, visual analogue scales （VAS） and papilla index score（PIS） were used to assess clinical success rates and aesthetic effects. Results Implant survival rate of 32 implants was 96.9%. Pathological bone resorption was not observed in peri - implant bone. Value of VAS was as high as 96.3% because of shapely gingival in a normal color. There were no significant differences in the periodontium stability and aesthetic effects between the two groups. Conclusion With rigorous indication, both immediate implantation and early implantation could achieve satisfactory esthetical effects after minimally invasive extraction in the anterior maxilla. But early implantation is superior to immediate implantation in the aspects of indication and operation.