上颌前牙区域拔牙后行不翻瓣即刻种植术的临床疗效

Clinical efficacy of flapless immediate implant surgery in maxillary esthetic region after teeth extraction

目的探讨上颌前牙区域不翻瓣即刻种植术的临床效果。方法选择90例上颌前牙具有拔牙指征的患者,在拔牙后即刻植入Straumann种植体108枚。其中48例(56个牙位)拔除患牙同期行不翻瓣即刻种植术(不翻瓣组),42例(52个牙位)拔除患牙同期行传统翻瓣联合引导骨再生即刻种植术(翻瓣组),所有患者于术后3～6个月取模行永久性冠修复。随访3～12个月,比较两种手术方式的效果。结果种植体均发生骨结合,即刻种植留存率100%。锥形束CT扫描显示,各随访时间点不翻瓣组颊舌向骨宽度丧失量小于翻瓣组(P<0.05),两组垂直向骨高度丧失量差异均无统计学意义(P>0.05)。软组织美学评分显示,不翻瓣组唇侧龈缘无明显退缩且龈乳头无明显丧失,翻瓣组的唇侧龈缘有少许退缩且龈乳头轻度丧失,各随访时间点不翻瓣组红色美学指数评分高于翻瓣组(P<0.05)。结论严格掌握适应证的情况下,上颌前牙区域拔牙后行即刻种植时采用不翻瓣偏腭侧技术,近期美学修复效果优于传统翻瓣技术。

Objective To study the clinical efficacy of flapless immediate implant inclined to the palate in the maxillary anterior tooth region.Methods After teeth extraction,108 Straumann implants were implanted immediately in 90 cases of maxillary anterior teeth with extraction indications,of whom 48 cases(56 teeth,group A) accepted flapless immediate implant inclined to the palatal side and 42 cases(52 teeth, group B) were treated with traditional flap immediate implant combined with guided bone regeneration technique. The patients of two groups were treated with permanent crown restorations 3-6 months after operation.The clinical efficacy between two groups was compared.Results Osseointegration was present in all immediate implants.The cone beam CT scan imaging showed that the horizontal bone width loss in group A was less than that in group B(P<0.05).There was no statistical significance in the vertical bone height loss between two groups in the follow-up time of 3-6 months(P>0.05).The esthetic score of soft tissue showed that there was no labial margin recession and gingival papilla loss in group A,but there was a slight labial margin recession and gingival papilla loss in group B.The pink ethetic scores during follow-up were higher in group A than those in group B(P<0.05).Conclusion With rigorous indication,the efficacy of flapless immediate implant inclined to the palate in the maxillary anterior tooth region is more reliable than the traditional flap implant technique.