个性化纯钛基台在后牙种植修复中的临床应用

Clinical evaluation on aesthetic effect of custom titanium abutment for dental implant restoration in posterior region

目的：评价后牙单颗植入过深或牙龈黏膜组织过厚的种植体进行个性化纯钛基台冠修复效果,并观察其对软组织健康及同期整复的疗效。方法：选择行后牙区单颗Straumann软组织种植体患者56例,共植入60颗种植体,将其分为2组。观察组30颗种植体采用个性化纯钛基台修复,种植体颈部均位于龈下大于2 mm或种植体颈部牙龈厚度不一致,肩台设计为齐龈肩台。对照组30颗种植体采用成品纯钛基台,要求种植体颈部位于龈上,齐龈或位于龈下小于2 mm。2组牙冠均选择以粘结固位方式CAD/CAM紫晶全瓷冠修复。观察1-2 a复查,检测种植体改良菌斑指数（m PLI）、改良出血指数（m SBI）等临床指标,比较牙龈软组织的健康程度,及记录龈乳头位置及高度来评价牙龈整塑效果。结果：经1-2 a随访观察,2组牙龈健康比较,差异无显著性（P〉0.05）。但观察组对龈缘位置及龈乳头高度均有较好的塑形效果,与对照组比较差异有统计学意义（P〈0.05）。结论：个性化纯钛基台同成品基台相比,可以依据牙龈厚度设计基台高度及外形,为患者提供最适合的穿龈高度,从而达到高美观性、高生物相容性、较好的软组织塑形及整复效果,是后牙种植义齿修复选择的一种好方法。

Objective： To evaluate the aesthetic effect of restoration with custom titanium abutment in posterior region and to observe the clinical status of soft tissue health and the restitution effect of the same period. Methods： 56 patients were selected,who accepted the operation of single soft tissue implant at posterior region. The total implants number was 60,which were divided into two groups randomly： an experimental group and a control group. The experimental group was restored by the CAD / CAM custom titanium abutment,and the implant neck was located about 2mm subgingivally. The implantshoulder（ IS） was flush with the gums. The control group used the finished titanium abutment. The implant neck was required to be located on the gingiva,flush with it or less than 2mm below it. All of the crowns were CAD / CAM all-ceramic crows using cement-retained mode. During the follow-up of 1 to 2 years,m PLI and m SBI and other clinical indicators were monitored and compared with the health status of the soft tissue,while papilla positions were recorded to evaluate the gingival shaping situation. Results： After 1 - 2 years of follow-up observation,there was no significant difference between custom titanium abutments and finished abutments in gingival health（ P〉0. 05）. However,the gingival shape was better and the position of papillae was more stable after using custom abutment. There were significant differences between the two groups（ P〈0. 05）.Conclusion： Compared with the finished abutment,the custom abutment can be designed according to the height and shape,so as to provide the most suitable transgingival height for patients,and achieve the perfect effect in aesthetics,biocompatibility,soft tissue remodeling and restoration. It is a good way for posterior implant prosthesis.