单个种植体颊侧牙槽嵴保存和结缔组织移植的临床美学效果分析

Analysis of clinical aesthetic effect of buccal alveolar ridge preservation and connective tissue transplantation with single implant

目的:评估接受单个种植体颊侧牙槽嵴保存(alveolar ridge preservation,ARP)和结缔组织移植(connective tissue transplantation,CTG)的牙缺失患者3年临床美学效果。方法:选择2014年5月—2016年5月南方医科大学顺德医院口腔科收治的43例牙缺失患者,分别进行拔牙、ARP、种植体植入、CTG和永久修复。评估患者术后第1年和第3年探诊出血发生率、探诊深度、边缘骨吸收、种植体红、白色美学效果,CTG前、CTG后即刻、术后第1年和第3年种植体颊侧黏膜厚度。采用视觉模拟评分法分别从咀嚼功能、整体美观、附着高度和色泽评估患者满意度,观察术后3年种植体情况,记录患者随访期间并发症发生情况。采用SPSS 20.0软件包对数据进行统计学分析。结果:术后第1年随访率为100%,术后第3年随访率为90.70%。术后第1年和第3年,种植体红、白美学效果较满意。术后第3年,近中龈乳头评分显著高于术后第1年(P<0.05)。CTG后即刻、术后第1年和第3年,种植体颊侧黏膜厚度较CTG前显著增加(P<0.05);术后第1年和第3年,种植体颊侧黏膜厚度较CTG前分别增益1.02 mm(相对稳定性:90.12%)和1.01 mm(相对稳定性:84.31%);CTG后即刻、术后第1年和术后第3年,患者对种植体咀嚼功能、整体美观、附着高度和色泽的满意度评分均>8分。种植体3年存留率为100%,种植体3年成功率为97.44%。随访期间,2例患者出现种植体周围黏膜炎,经洁牙等清洁处理后缓解,未出现组织瓣坏死、开口受限及舌运动障碍等并发症。结论:ARP与CTG对牙缺失患者具有良好的临床和美学效果,3年内CTG对种植体颊侧黏膜厚度表现为增厚且相对稳定性良好,值得临床推广应用。

PURPOSE:To evaluate the clinical aesthetic effect of buccal alveolar ridge preservation(ARP)and connective tissue transplantation(CTG)in patients who received a single implant.METHODS:Forty-three patients with tooth loss admitted to the Department of Stomatology of Shunde Hospital of Southern Medical University from May 2014 to May 2016 were included in the study.Tooth extraction,ARP,implant implantation,CTG and permanent repair were performed respectively.The incidence of bleeding,depth of probing,marginal bone resorption,and red-white aesthetic effect of implants were evaluated 1 year and 3 years after surgery.The buccal mucosa thickness of implants before,immediately after CTG,1 year and 3 years after surgery were measured.The patient satisfaction was evaluated by visual analogue scale(VAS)from masticatory function,overall aesthetics,attachment height,and color,respectively.The implant conditions at the third year after surgery were observed,and complications during follow-up were recorded.SPSS 20.0 software package was used for statistical analysis of the data.RESULTS:The follow-up rate in the first year after surgery was 100%,and that in the third year after surgery was 90.70%.One year and 3 years after operation,the aesthetic effect of the implant was satisfactory.At the 3 rd year after operation,the scores of the near middle gingival papillary were significantly higher than that at the 1 st year after operation(P<0.05).The buccal mucosal thickness of the implant immediately after CTG and 1 year and 3 years after surgery increased significantly compared with that before CTG(P<0.05).The buccal mucosal thickness of the implant increased 1.02 mm(relative stability:90.12%)1 year after operation and 1.01 mm(relative stability:84.31%)3 years after operation,respectively.The satisfaction scores of the patients on chewing function,overall aesthetics,attachment height and color of the implant immediately after CTG,one year after surgery and 3 years after surgery were all>8.The 3-year survival rate of the implants was 100%,and the 3-year success rate of the implants was 97.44%.During the follow-up,two patients developed peri-implant mucositis,which was relieved after tooth cleaning,but no complications such as tissue flap necrosis,limited opening and tongue movement disorder occurred.CONCLUSIONS:ARP and CTG have good clinical and aesthetic effects on patients with tooth loss.In three years,the buccal mucosal thickness of the implant can be increased and relatively stable,which is worthy of clinical promotion and application.