微创拔牙即刻种植即刻修复对上颌中切牙美学效果和唇侧骨板改建的影响

Effect of Immediate Implantation and Immediate Repair after Minimally Invasive Tooth Extraction on Aesthetic Effect of Maxillary Central Incisor and Reconstruction of Labial Bone Plate

目的:探讨微创拔牙即刻种植即刻修复对上颌中切牙美学效果和唇侧骨板改建的影响。方法:选取2014年1月-2018年9月来院就诊因单颗上颌中切牙残冠而接受微创拔牙及种植修复来院就诊的108例患者,根据治疗方式的不同分为三组。A组:41例,采用微创拔牙延期种植即刻修复;B组:32例,采用微创拔牙即刻种植延迟修复;C组:35例,采用微创拔牙即刻种植即刻修复。修复完成当天及修复后1年,进行白色美学指数(WES)和红色美学指数(PES)评分。修复后1年,采用视觉模拟评分法(VAS)评价患者满意度。种植当天和修复后6个月,测量患者唇侧骨板厚度,并计算骨量变化和骨吸收率。结果:三组患者种植成功率和修复1年后种植体存留率均达100.00%。修复完成当天和修复后1年,A、B、C三组PES均依次显著升高(P<0.05),且修复后1年均显著高于修复完成当天(P<0.05)。C组整体美观、附着高度以及咀嚼功能满意度均显著高于A、B两组(P<0.05)。种植当天和修复后6个月,B、C两组各部位唇侧骨板厚度均显著大于A组(P<0.05);与种植当天相比,修复后6个月A组各部位唇侧骨板厚度显著下降(P<0.05),B、C两组唇侧骨板骨量降低水平均显著小于A组(P<0.05),A组骨吸收率显著高于B、C两组(P<0.05)。结论:美学区单颗上颌中切牙微创拔牙后即刻种植即刻修复,可显著降低唇侧骨板改建中水平方向的骨吸收,促进早期诱导牙龈塑形,提升种植体周围软组织美学效果,提高患者满意度。

Objective To investigate the effect of immediate implantation and immediate repair after minimally invasive tooth extraction on aesthetic effect of maxillary central incisor and reconstruction of labial bone plate.Methods From January 2014 to September 2018,108 patients in the department of stomatology of our hospital who received minimally invasive tooth extraction and implant repair due to a single residual crown of maxillary central incisor were selected.According to different treatment methods,they were divided into three groups:group A(41 cases)was treated with minimally invasive tooth extraction delayed implantation and immediate repair,group B(32 cases)was treated with minimally invasive tooth extraction immediate implantation and delayed repair,group C(35 cases)was treated with minimally invasive tooth extraction immediate implantation and immediate repair.White Aesthetic Index(WES)and Pink Aesthetic Index(PES)were scored on the day of completion of repair and one year after the repair.One year after repair,visual analog scale(VAS)was used to evaluate the patients'satisfaction.On the day of implantation and 6 months after repair,the thickness of the patient's labial bone plate was measured,and bone mass changes and bone absorption were calculated.Results The implant success rate and implant survival rate after one year of repair in the three groups were 100.00%.On the day of completion of repair and 1 year after repair,the PES of group A,B and C increased significantly in turn(P<0.05),and 1 year after repair was significantly higher than that on the day of completion of repair(P<0.05).The overall aesthetic appearance,attachment height and satisfaction degree of chewing function in group C were significantly higher than those in groups A and B(P<0.05).On the day of implantation and 6 months after repair,the thickness of labial bone plates in both groups B and C was significantly higher than that in group A(P<0.05).Compared with the day of implantation,the thickness of labial bone plate in each part of group A decreased significantly 6 months after repair(P<0.05).The reduction of labial bone mass in group B and group C was significantly lower than that in group A(P<0.05),and the bone absorption rate in group A was significantly higher than that in group B and group C(P<0.05).Conclusion In aesthetic area,immediate implantation and immediate repair of a single maxillary central incisor after minimally invasive tooth extraction can significantly reduce the horizontal bone absorption in the reconstruction of the labial bone plate,promote early induction of gingival shaping,improve the aesthetic effect of soft tissue around the implant,and improve patient satisfaction.