前牙美学区不翻瓣种植与翻瓣种植对种植体周围组织的影响

Effects of flapless versus flap implant surgery on tissues surrounding implants in esthetic zone

目的评价在前牙美学区不翻瓣种植与翻瓣种植对种植体周围组织的影响。方法将上颌前牙区接受单颗种植修复患者20例分为不翻瓣种植组与翻瓣种植组，每组各10例。种植体愈合6个月完成冠修复。术后6个月、12个月锥形束CT影像学检查，评价种植体唇舌侧骨量高度改变。冠修复完成后6个月、12个月，检测种植体牙周探诊深度（PD）、改良龈沟出血指数（mSBI）、龈乳头指数（PPI），并应用红色美学评分（PES）标准进行美学评价，采用SPSS13．0软件包对数据进行统计学分析。结果种植术后6个月、12个月，不翻瓣种植唇舌侧骨吸收均低于翻瓣种植，其中术后6个月唇侧骨吸收，差异有统计学意义（P〈0.05）；冠修复完成后6个月、12个月，两组PES值差异无统计学意义（P〉0.05），不翻瓣种植PES值均高于翻瓣种植，并且不翻瓣种植冠修复后12个月PES值升高，差异有统计学意义（P〈0．05）。结论在严格把握适应证隋况下，采用不翻瓣微创种植，短期临床美学效果较好。

Objective To evaluate the effects of flapless versus flap implant surgery on the tissues surrounding the implants in the esthetic zone. Methods A controlled study was conducted in 20 patients with a single implant in the anterior esthetic zone, as compared with the flapless and traditional flap implant placement. 6 and 12 months after the implant ation, the vertical reduction of labial and lingual bone were assessed by cone beam computed tomography （CBCT） ; 6 and 12 months after the crowns restoration, the peri-implant soft tissues were examined by probing depth （PD）, modifica- tion sulcus bleeding index （mSBI）, papillary index （PPI） and evaluated by pink esthetic score （PES） standard. Results The vertical reduction of the flapless labial and lingual bone was lower than that of the flap, in which the change of labial bone was statistical differences at 6 months after implant surgery between groups （P 〈0.05）. The differences of PES between two groups were not statistically significant, although PES increased over time in both groups, which the flapless group had a significantly change in PES from crown placement to 12 months （P〈0.05）. Conclusions A flapless implant surgery in sufficient bone support may provide a better short-term esthetic result, whereas the longterm effects need further studies.