牙龈生物型对上颌单颗后牙种植体周围骨组织、软组织健康及龈乳头美学效果的影响

Influence of gingival biotype width on the health of peri-implant bone and soft tissues and the aesthetic outcome of the gingival papilla for single maxillary posterior implants

目的:探讨牙龈生物型对上颌单颗后牙种植体周围骨组织、软组织健康及龈乳头美学效果的影响。方法:选择2019年5月—2022年9月收治的78例行上颌单颗后牙种植术患者,共植入78颗种植体。种植修复后1个月,根据牙周探诊结果分为薄龈生物型组(n=32)与厚龈生物型组(n=46),比较种植修复后6个月的颊侧角化龈宽度(keratinized mucosa width,KMW)、骨吸收量(implant bone loss,IBL)、改良菌斑指数(modified plaque index,mPLI)、种植体改良出血指数(modified bleeding index,mBLI)、种植体探诊深度(probing pocket depth,PPD)、龈乳头指数(papilla index Score,PIS)、食物嵌塞、牙龈边缘颜色满意度指数(gingival margin color satisfaction index,GMCS)。通过Pearson分析评估牙龈生物型及角化龈宽度与种植体周围骨组织、软组织健康及龈乳头美学效果的相关性,比较不同牙龈生物型及角化龈宽度患者发生黏膜退缩的情况。采用SPSS 27.0软件包对数据进行统计学分析。结果:厚龈组KMW高于薄龈组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,牙龈生物型与KMW呈正相关(r=-0.416,P=0.000)。薄龈组IBL显著高于厚龈组,薄龈组种植体PPD显著小于厚龈组,薄龈组PES评分显著低于厚龈组(P<0.05)。Pearson相关分析显示,牙龈生物型与PIS、GMCS、mBLI、PPD呈负相关,与食物嵌塞、IBL、mPLI呈正相关(P<0.05);KMW与PIS、GMCS、mBLI、PPD呈正相关,与食物嵌塞、IBL、mPLI呈负相关(P<0.05)。KMW>2 mm时,薄龈组和厚龈组相比有统计学差异(P<0.05)。KMW≤2 mm和>2 mm时,厚龈组差异有统计学意义(P<0.05)。结论:牙龈生物型对上颌单颗后牙种植体周围骨组织、软组织健康及龈乳头美学效果存在影响,对于预测种植体长期成功及美学效果具有指导意义。

PURPOSE:To explore the influence of gingival biotype and width of keratinized gingiva on peri-implant bone tissue,soft tissue health,and esthetic outcome of the papilla surrounding single posterior maxillary implants.METHODS:Seventy-eight patients who underwent single posterior maxillary implant surgery from May 2019 to September 2022 were selected,involving the placement of 78 implants.Based on periodontal probing outcomes one month post-restoration,the patients were divided into thin gingival biotype group(n=32)and thick gingival biotype group(n=46).Comparisons were made six months after implant restoration regarding buccal keratinized mucosa width(KMW),peri-implant bone tissue[implant bone loss(IBL)],soft tissue health[modified plaque index(mPLI),modified bleeding index for implants(mBLI),probing pocket depth(PPD)],and esthetic effect of the papilla[papilla index score(PIS),food impaction,gingival margin color satisfaction index(GMCS)].Statistical analysis was performed with SPSS 27.0 software package.RESULTS:The thick gingival biotype group showed significantly greater keratinized gingival width compared to the thin gingival biotype group(P<0.05).Spearman correlation analysis revealed a positive correlation between gingival biotype and keratinized gingival width(r=-0.416,P=0.000).For peri-implant bone tissue,bone loss in the thin gingival biotype group was significantly higher than that in the thick gingival biotype group.In soft tissue health,the probing pocket depth for implants in the thin gingival biotype group was significantly less than that in the thick gingival biotype group.In terms of esthetic effect of the papilla,PES score in the thin gingival biotype group was significantly lower than in the thick gingival biotype group(P<0.05).Pearson correlation analysis showed a negative correlation between gingival biotype and papilla index score,GMCS,bleeding on probing,and PPD,but a positive correlation with food impaction,bone loss and mPLI(P<0.05).The width of keratinized gingiva was positively correlated with papilla index score,GMCS,bleeding on probing and PPD,but negatively correlated with food impaction,bone loss and mPLI(P<0.05).There was significantly difference between thin and thick gingival biotype groups for KMW>2 mm(P<0.05).A significant difference was showed in thick gingival biotype group when KMW≤2 mm and>2 mm(P<0.05).CONCLUSIONS:Gingival biotype and keratinized mucosa width significantly influence peri-implant bone and soft tissue health as well as esthetic outcome of the papilla around single posterior maxillary implants,offering guidance for predicting the long-term success and esthetic outcomes of implants.