根盾术应用于美学区即刻种植即刻修复1例及文献回顾

Application of socket⁃shield technique for immediate implant placement and provisionalization in esthetic zone:a case report and literature review

目的探讨根盾术(socket⁃shield technique,SST)联合即刻种植即刻修复(immediate implant placement and provisionalization,IIPP)在前牙美学修复中的应用效果。方法针对唇侧骨壁菲薄的上前牙残根,应用根盾术维持唇侧软硬组织丰满度,联合即刻种植即刻临时冠修复恢复牙体外形及进行牙龈塑形。结果即刻种植即刻修复在最短时间内恢复了患牙的形态与功能,应用根盾术后18个月的随访中患者缺牙区唇侧软硬组织轮廓得到较好的保存,呈现出较佳的美学效果。文献回顾结果表明,根盾术的适应证为无保留价值的上前牙,且患牙唇侧牙体、牙周及根尖周组织健康且完整;根盾术可有效维持美学区种植体唇侧软硬组织轮廓,但关于理想根片的冠方高度及厚度、根片与种植体间间隙管理等技术细节尚未达成共识,需要更多临床研究和组织学证据指导临床决策,数字化技术有助于提高种植体植入及根片预备的准确性。结论根盾术联合即刻种植即刻修复在美学区的正确应用有助于美学效果,长期疗效尚需更多高质量的循证医学依据,临床应用时应严格把握适应证。

Objective To investigate the effect of the socket-shield technique(SST)concurrent with immediate im-plant placement and provisionalization(IIPP)in the aesthetic restoration of anterior teeth.Methods A case of maxil-lary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness,combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding.Results Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time.The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST,which presented a better aesthetic result.The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth,whose dental,periodontal and periapical tissues are healthy and intact.In the esthetic zone,root shielding is effec-tive in maintaining the soft and hard tissue contour on the labial side of the implant.However,there is no consensus on the technical details of SST,such as the ideal coronal height and thickness of the shield,and the management of the gap between the shield and the implant.Thus,more clinical studies and histologic evidence are needed to provide a refer-ence for clinical decision-making.In addition,digital technology can improve the accuracy of implant placement and shield preparation.Conclusion The correct application of SST combined with IIPP in the esthetic zone can ensure es-thetic results.However,more high-quality evidence-based medical evidence is needed for its long-term efficacy,and in-dications should be strictly controlled during clinical application.