应用种植体平台转移理念修复龈下牙体缺损的临床效果

Clinical Effect of Applying Implant Platform Switching Concept to Restore Subgingival Tooth Defect

目的:探讨将种植体平台转移理念应用于天然牙龈下牙体缺损修复的临床效果。方法:选取2020-2021年于惠州口腔医院修复科就诊的11例患者,12颗冠折至龈下3 mm达牙槽嵴顶,难以常规进行冠修复的残冠为研究对象,模仿平台转移种植体的修复平台和基台连接部位与牙槽嵴顶的接触形式,设计冠修复体边缘与天然牙龈下断端的连接形式,进行冠或桩核冠修复。先行垂直向牙龈切除术暴露患牙断面,然后根据缺损大小树脂核或纤维桩核充填缺损,充填物距离断面边缘1~2 mm;设计冠边缘不与基牙断面对接,而是形成内凹的微小肩台,冠边缘离牙槽嵴顶有微小的距离,类似种植体平台转移;术后1个月、6个月从患牙的牙周状况和功能两个方面评估修复效果。结果:11颗患牙修复1个月、6个月后牙周健康,牙龈无明显退缩,咬合稳定,患者自诉功能良好;1颗患牙术后1个月因口腔卫生不佳龈边缘略有红肿,经洁治处理后牙龈恢复健康。结论:将种植体平台转移理念应用于天然牙,通过垂直向牙龈切除术加冠(或桩核冠)修复龈下缺损残冠的方法,简化了临床操作,修复效果良好,增加了残冠的保留机会。

Objective:To explore the clinical effect of applying implant platform switching concept to restore natural subgingival tooth defect.Methods:A total of 11 patients with 12 residual crowns who had crown fracture to subgingival 3 mm reaching the alveolar ridge crest and couldn’t be restored by conventional crown restoration and were admitted to Department of Restoration,Huizhou Stomatological Hospital from 2020 to 2021 were selected as the study subjects.The connection form between the natural subgingival tooth stump and the crown prosthesis edge was designed by imitating the contact form of the connection part between the platform switching implant and the abutment with the alveolar ridge crest to undergo crown or post-core crown restoration.First,the broken surface of the affected teeth was exposed by vertical gingivectomy,and then the defect was filled with resin core or fiber post-core according to the size of the defects,and the filling was 1~2 mm away from the edge of the broken surface.Instead of docking with the abutment tooth broken surface,the crown edge formed a concave tiny shoulder and had a tiny distance from the alveolar ridge crest,which was similar to implant platform switching.The periodontal status and function of the affected teeth were used to evaluate the restoration effect at 1 month and 6 months after surgery.Results:At 1 month and 6 months after restoration,the periodontal status of 11 affected teeth was healthy and the occlusion was stable.The patients self-reported good function;one affected tooth was slightly red and swollen due to poor oral hygiene at postoperative 1 month,and the gingival status returned to health after scaling treatment.Conclusion:The method of applying the concept of implant platform switching to natural tooth and restoring the residual crown with subgingival defect by vertical gingivectomy and crown(or post-core crown) simplifies the clinical operation,achieves satisfactory restoration effect and increases the chance of retaining the residual crown.