上颌磨牙即刻种植的可行性分析

Feasibility analysis of immediate implant placement in the maxillary molar region

目的探讨上颌磨牙区翻瓣、微创拔牙后即刻种植的临床效果及可行性,为上颌磨牙区的即刻种植提供参考。方法选择2018年6月至2020年6月就诊于青岛大学附属医院口腔颌面外科,拟行上颌磨牙拔除后即刻种植的患者41例(共41个牙位),其中男性24例,女性17例,年龄为(49.7±1.8)岁(18~66岁)。术前拍摄锥形束CT进行测量分析;术中切开翻瓣,微创拔牙,彻底清除软硬组织表面的炎性肉芽组织,在正确的三维位置制备种植窝、植入种植体,记录种植体完全就位时的扭矩值和种植体稳定系数(implant stability quotient,ISQ);采用非埋入式愈合。术后6个月拍摄锥形束CT并检测ISQ值后行牙冠修复。永久修复后12个月拍摄锥形束CT。评价指标为术后6个月的种植体存留率和完成修复后12个月的成功率;术后即刻、6个月以及永久修复后12个月种植体的颊腭侧、近远中跳跃间隙大小及术后即刻和6个月种植体ISQ值。结果41例患者共植入41枚种植体,种植体植入后6个月存留率为100%(41/41);完成修复后12个月种植修复成功率为100%(41/41)。种植体植入时扭矩为(42.77±0.79)N·cm。术后即刻种植体颊侧和腭侧跳跃间隙分别为(3.15±0.16)和(2.86±0.18)mm,近远中跳跃间隙分别为(2.94±0.19)和(3.77±0.21)mm,术后6个月及牙冠修复后12个月随访锥形束CT显示种植体周围均无跳跃间隙。术后即刻与6个月种植体的ISQ值[分别为(74.78±0.59)和(80.20±0.49)]的差异有统计学意义(t=-9.03,P<0.001)。结论上颌磨牙区翻瓣、微创拔牙和彻底清除软硬组织表面的炎性肉芽组织后即刻种植可行,牙槽骨与种植体能实现良好的骨结合,临床治疗效果满意。

Objective To study the clinical outcomes and feasibility of immediate implantation after flap surgery and minimally invasive extraction in the maxillary molar area and to provide a reference for it.Methods Forty-one patients(41 molars in total)with maxillary molars that could not be preserved,treated from June 2018 to June 2020 at the Department of Oral and Maxillofacial Surgery at the Affiliated Hospital of Qingdao University,were selected.There are 24 males and 17 females with the age of(49.7±1.8)years(range 18-66 years).Pre-operative cone-beam CT(CBCT)was taken for measurement and analysis.After flap surgery and minimally invasive tooth extraction,the inflammatory granulation tissues attached to the soft and hard tissues were completely scraped and clipped,followed by the preparation of the implants in the correct three-dimensional position.Torque value and implant stability quotient(ISQ)were recorded after implant placement and with non-submerged healing.CBCT examination was taken 6 months after surgery and ISQ value was checked before crown restoration.CBCT examination was also taken 1 year after the permanent restoration.The survival rate of 6 months after surgery,the success rate of 1 year after permanent restoration,and the size of jump gaps immediately after surgery,6 months after surgery,1 year after permanent restoration respectively,were performed.The ISQ values were compared immediately and 6 months after surgery.Results A total of 41 implants were placed in 41 patients.Six months after surgery,the survival rate was 100%(41/41).Twelve months after permanent restoration,the success rate of the implant restoration was 100%(41/41).The torque value after implant implantation was(42.77±0.79)N·cm.The buccal and palatal jump gaps were(3.15±0.16)mm and(2.86±0.18)mm immediately after surgery,respectively.The mesial and distal jump gaps were(2.94±0.19)mm and(3.77±0.21)mm,respectively.CBCT showed that no jump gap around the implants at 6 months after surgery and 1 year after permanent restoration.The ISQ values at immediately and 6 months after surgery were(74.78±0.59)and(80.20±0.49)respectively,and the difference was statistically significant(t=-9.03,P<0.001).Conclusions Immediate dental implantation in the correct three-dimensional position could achieve good osseointegration by means of flap surgery,minimally invasive extraction and thorough removal of inflammatory tissue on the surface of soft and hard tissues.The clinical outcomes were satisfactory.