下颌第一磨牙种植体解剖式愈合基台与成品愈合基台的临床应用对比研究

A comparative study of the clinical application of anatomical healing abutments versus finished healing abutments for mandibular first molar implants

目的 探讨下颌第一磨牙解剖式愈合基台对种植修复后牙龈软组织形态变化,以及对种植体周围牙龈成型、食物嵌塞、患者满意度等的影响,为临床上选择愈合基台提供依据。方法 选取湖南中医药大学附属口腔医院(长沙市口腔医院口腔)种植中心2020年9月至2021年9月期间下颌第一磨牙单颗缺失接受种植修复的患者26例,其中男性12例,女性14例,随机分为对照组(13例14颗种植体)和试验组(13例14颗种植体);试验组应用解剖式愈合基台4周后行冠修复,对照组应用成品愈合基台4周后行冠修复;设定5个时间观测点(二期手术前、二期手术后4周、冠修复即刻、冠修复后4周、冠修复后12周),二期手术前和二期手术后4周分别采用3Shape口内扫描仪扫描下颌,对软组织的变化进行定量分析,比较两组愈合基台对牙龈成型的影响;比较冠修复后4周和冠修复后12周两组修复体食物嵌塞发生率;比较冠修复即刻、冠修复后4周和冠修复后12周两组患者的满意度。结果 种植二期手术后4周试验组牙龈近远中龈乳头向冠方增加值高于对照组,近中试验组为0.50(0.26,0.72)mm,对照组为0.27(0.24,0.38)mm,差异有统计学意义(P=0.029),远中试验组为0.48(0.26,0.62)mm,对照组为0.23(0.13,0.39)mm,差异有统计学意义(P=0.004);颊舌向龈缘顶点向冠方成型差异无统计学意义(P>0.05);两组颊、舌侧龈缘中1/3顶点根方0、1、2 mm处颊、舌侧软组织的颊舌向的变化差异无统计学意义(P>0.05)。对照组与试验组冠修复后4周、冠修复后12周观察的食物嵌塞发生率差异无统计学意义(P>0.05)。冠修复即刻、冠修复后4周和冠修复后12周试验组满意度评分均较对照组高,组间差异有统计学意义(P<0.05)。结论 下颌第一磨牙种植体的解剖式愈合基台在软组织塑形方面优于成品愈合基台,近端和远端龈乳头的冠状面均有所增加,患者满意度较高。

Objective To evaluate the effect of anatomical healing abutments for mandibular first molars on the morphological changes of gingival soft tissue after implant restoration,as well as on peri-implant gingival molding,food ingrowth and patient satisfaction,to provide a basis for clinical selection.Methods Twenty-six patients who received implant restoration for a single missing mandibular first molar between September 2020 and September 2021 at the Oral Implant Center of Changsha Stomatological Hospital were randomly divided into a control group (13 cases with 14 implants)and a trial group (13 cases with 14 implants),of which 12 were male and 14 were female;the trial group had anatomical healing abutments applied for 4 weeks and then underwent crown restoration,while the control group finished five time points (before the second stage surgery,4 weeks after the second stage surgery,immediately after the crown restoration,4weeks after the crown restoration,and 12 weeks after the crown restoration).A 3Shape intraoral scanner was used to scan the jaw before and 4 weeks after the second stage surgery to quantify the soft tissue changes and compare the effect of the healing abutment on gingival molding between the two groups.The incidence of food impaction was recorded and compared between the two groups at 4 weeks and 12 weeks after crown restoration.Patient satisfaction was recorded and compared between the two groups immediately after crown restoration,4 weeks after crown restoration and 12 weeks after crown restoration.Results Four weeks after implant surgery,it was observed that the gingival proximal and distal gingival papillae increased on the coronal side in the test group compared to the control group,0.50 (0.26,0.72) mm in the near-medium test group and 0.27 (0.24,0.38) mm in the control group,with a statistically significant difference (P=0.029),and 0.48 (0.26,0.62) mm in the far-medium test group and 0.23 (0.13,0.39) mm in the control group,with a statistically significant difference (P=0.004).There was no statistically significant difference (P>0.05) in the buccolingual to gingival margin apex to coronal molding or in the buccolingual to lingual soft tissue at 0,1,or 2 mm of the root of the middle 1/3 apex of the buccal and lingual gingival margins between the two groups.Compared to the control group,there was no statistically significant difference in the incidence of food impaction observed 4 weeks and 12 weeks after crown restoration in the test group (P>0.05).The satisfaction scores were higher in the trial group than in the control group immediately,4 weeks,and 12 weeks after crown restoration,and the difference between the groups was statistically significant (P<0.05).Conclusion The anatomical healing abutment for the implant mandibular first molar was superior to the finished healing abutment in terms of soft tissue contouring with an increase in the coronal aspect of the proximal and distal gingival papillae,resulting in high patient satisfaction.