上颌前牙美学区连续多颗牙缺失即刻种植的临床研究

Clinical study on immediate implant of multiple adjacent teeth in maxillary anterior esthetic zone

目的分析不同牙种植系统上颌美学区即刻种植对种植体周围骨组织吸收的影响,并探讨改良微创"H"形切口在上颌美学区多颗相邻牙即刻种植修复的应用技巧及美学影响因素。方法选取2011年1月—2015年1月在我院口腔科接受牙体种植修复的患者58例,所有患者均在牙槽嵴顶作微创"H"切口,种植体采用潜入式手术。根据患者种植的牙体系统,将患者分为3组:3I组、DIO组、Replace组。随访12个月,观察患者种植体周围骨吸收量、探诊深度及术后龈沟出血指数。根据Miller牙龈边缘组织退缩分类及Jemt牙龈乳头指数,分别观察种植体永久修复12月后牙龈边缘退缩及牙龈乳头状况;根据Albrektsson种植体成功标准,观察所植入的种植体状况。结果 3组患者的周围骨组织骨吸收量在植入术后6个月均呈稳定的趋势,不同的种植体增长的幅度不同,差异无统计学意义(P>0.05),DIO组患者第3个月的骨吸收量显著高于Replace组和3I组,其差异具有统计学意义(P<0.05)。术后不同时期,3组患者的龈沟出血指数与天然牙相比,6个月时,DIO组患者的龈沟出血指数虽然高于天然牙,差异无统计学意义(P>0.05);9、12个月时,3组患者的龈沟出血指数与天然牙差异无统计学意义(P>0.05);术后6个月,3组患者的探诊深度呈稳定的趋势,各个时期3组患者的探诊深度略高于天然牙,差异无统计学意义(P>0.05)。159颗种植体存留率100%,Miller分类,136颗种植体牙龈边缘无退缩;18颗种植体牙龈边缘I类退缩;5颗种植体牙龈边缘Ⅱ类退缩。种植修复体近远中Jemt牙龈乳头指数均为Ⅱ级以上。结论不同牙种植体系统对美学区多颗相邻牙即刻种植的种植体周围骨组织及软组织均具有较理想的稳定性及美学效果。改良微创"H"形切口为相邻多颗牙即刻种植的应用技巧提供了临床依据,值得临床推广。

Objectives To analyze the influence of different dental implant systems utilized for immediate implant in maxillary esthetic zone on peri-implant bone resorption,and to investigate the techniques and esthetic factors of applying the improved minimally invasive H-shaped notch to the immediate implant of multiple adjacent teeth in maxillary anterior esthetic zone. Methods 58 patients who were subjected to dental implantation and restoration from January 2011 to January 2015 were included in the study. The improved minimally invasive H-shaped notch was used in all the patients. Based on the implanted dental systems,they were divided into three groups： group 3I,group DIO,and group Replace. The follow-up time was 12 months,during which their peri-implant bone resorption,probing depth,and sulcus bleeding index after surgery were observed. The gingival marginal tissue recessions were analyzed according to Miller＇s classification and interproximal papillae was analyzed according to Jemt＇s classification. The stability of the implants was analyzed according to Albrektsson＇s criteria of success. Results Six months after surgery,the peri-implant bone resorption of patients in all groups was stable,showing no significant differences among different dental implant systems（ P〉0. 05）,but the peri-implant bone resorption of different dental implants increased differently that the bone resorption of group DIO in the 3rdmonth was evidently higher than that of group Replace and group 3I,which was statistically significant（ P〈0.05）. During different postoperative periods,the sulcus bleeding index of the patients in all groups was compared with natural teeth. In the 6thmonth,though the sulcus bleeding index in group DIO was higher than natural teeth,the difference was not statistically significant（ P〉0.05）; in 9thand 12 thmonths,compared with natural teeth,the differences of sulcus bleeding index were still not statistically significant（ P〉0.05）. six months after surg-ery,the probing depth in all the groups was stable and was slightly higher than natural teeth at various periods,but the difference was not significantly significant（ P〉0. 05）. The success rate of 159 implants was 100%. No marginal tissue recessions were found in 136 implant sites. The marginal tissue recession index scores of Ⅰ were observed in 18 implant sites,thetissue recession index scores of Ⅱ in 5 implant sites. The mesial and distal papilla index scores of all implant sites were above Ⅱ. Conclusion In the immediate implant of multiple adjacent teeth in esthetic zone,different dental implant systems have both stable and aesthetic effects on the peri-implant bone and soft tissues. The improved minimally invasive H-shaped notch can provide the clinical basis for implantation in maxillary esthetic zone.