改良牙根屏障技术即刻种植即刻修复后口内美学区软组织轮廓动态监测及美学评估

Dynamic monitoring and esthetic evaluation of dimensional changes in the peri-implant soft tissue contour after the immediate implant placement and provisionalization with the modified socket-shield technique in the esthetic zone

目的探讨改良牙根屏障技术(MSST)即刻种植即刻修复后1年内种植位点唇侧软组织的动态变化,为评估MSST对种植体周软组织的作用提供依据。方法前瞻性纳入2022年1月至2024年1月于重庆医科大学附属口腔医院种植科完成MSST美学区即刻种植即刻修复术后1年的患者,分别于术前和术后3、6、12个月使用口内扫描仪获取患者口内光学模型,导入Geomagic Studio 2013软件进行多时间点虚拟轮廓重叠配准,于多个层面分析种植位点唇侧软组织轮廓变化,精确计算术后各时间点唇侧龈缘顶点冠根向变化量、龈乳头冠根向变化量及唇侧软组织轮廓唇腭向厚度平均变化量,并通过粉色美学评分进行美学效果评价。结果共纳入患者22例(22枚种植体),患者年龄为(40±13)岁(21~75岁),包括9例男性和13例女性,12个月的随访观察期内,所有种植体均无不良事件发生。术后12个月种植位点唇侧龈缘顶点冠根向变化量为0.08(0.07)mm,近中龈乳头冠根向变化量为0.19(0.25)mm,远中龈乳头冠根向变化量为0.19(0.10)mm,唇侧软组织轮廓唇腭向厚度平均变化量为(0.39±0.09)mm,轮廓塌陷主要发生于龈缘根方2 mm内。种植位点唇侧牙槽骨高度变化量为(0.17±0.08)mm,种植体肩台根方1、3、5 mm处水平向唇侧牙槽骨厚度变化量分别为(0.13±0.08)、(0.12±0.10)、0.04(0.17)mm。粉色美学评分为13.00(2.25)分,所有种植位点均获得理想的美学效果。结论利用MSST于美学区行即刻种植即刻修复,12个月随访观察期内,种植位点唇侧软组织轮廓变化微量。

ObjectiveTo accurately measure the dynamic changes of peri-implant soft tissue within one year after the immediate implant placement and provisionalization with the modified socket-shield technique(MSST)in the esthetic zone,and to provide a basis for evaluating the effect of the modified socket-shield technique on the maintenance of peri-implant soft tissue.MethodsA total of 22 patients(22 implants)were prospectively included 1 year after completion of immediate implant placement and provisionalization(IIPP)within MSST in the esthetic zone from January 2022 to January 2024 at the Department of Oral Implantology in the Stomatological Hospital of Chongqing Medical University.The intraoral optical models of patients were obtained by an intraoral scanner system preoperatively and at 3,6,and 12 months postoperatively,respectively.The standard tessellation language files of intraoral optical models at multiple time points were imported to Geomagic Studio 2013 to be superimposed and aligned for analyzing the peri-implant soft tissue contour on the labial side of the implant site at multiple levels.The amount of gingival margin recession,gingival papilla change,and thickness change of the labial side of the soft tissues at each postoperative point in time were measured at each postoperative time point,as well as evaluating the esthetic effect by the pink esthetic score(PES).ResultsThe patients were(40±13)years old(21-75 years),including 9 males and 13 females.No adverse events occurred in all the implants during the 12-month follow-up period.The recession level of the gingival margin of the implant site(GL)was 0.08(0.07)mm,the recession level of the mesial papilla(ML)was 0.19(0.25)mm,and the recession level of the distal papilla(DL)was 0.19(0.10)mm.The average collapse thickness of the soft tissue contour on the labial side of the implant(ΔD)was(0.39±0.09)mm,mainly occurring within 2 mm of the root of the gingival margin.The height of the alveolar bone was reduced by(0.17±0.08)mm.The thickness of the labial alveolar bone at 1,3,and 5 mm root side of the implant shoulder was reduced by(0.13±0.08),(0.12±0.10)and 0.04(0.17)mm,respectively.The postoperative pink esthetic score was 13.00(2.25)points at 12 months,which suggested that all implant sites achieved ideal esthetic results.ConclusionsThe labial soft tissue contour at implant sites shows minimal change following immediate implant placement and provisionalization using the modified socket-shield technique for 1 year in the esthetic zone.