上颌无牙患者种植即刻过渡义齿修复后侧貌软组织的轮廓变化

Changes of soft tissue profile of maxillary edentulous patients with immediate denture

目的:比较上颌无牙患者在种植修复前与即刻过渡义齿修复后侧貌软组织轮廓变化,调查患者术后容貌满意度。方法:选择2018年1月至2022年12月于上海交通大学医学院附属第九人民医院行上颌种植即刻修复患者24例,收集患者修复前后病史、正侧位定位片,术前使用便携式三维面扫仪对患者进行面部扫描,设计种植即刻过渡义齿修复,行种植手术治疗。使用Dolphin Imaging 11.95软件分别对上颌无牙状态、种植即刻修复后状态下的头颅侧位片进行软组织角度测量,分析患者种植即刻过渡义齿修复前后角度变化,包括鼻唇角、prn'-sn'-ul'(Ls)、鼻尖角、全面突角、Z角、H角,以及线距测量项目,包括上唇距E线距离。术后使用电话问卷调查患者容貌满意度。采用SPSS 26.0软件包对数据进行统计学分析。结果:种植即刻过渡义齿前,无论男性还是女性,鼻唇角、上唇距E线距离均与标准值有显著差异,女性患者的Z角与标准值有显著差异。进行即刻过渡义齿修复后,男性、女性患者鼻唇角、上唇距E线距离与标准值无统计学差异;男性患者H角,女性患者鼻尖角与标准值有显著差异。男性与女性患者即刻过渡义齿修复后,鼻唇角、H角、上唇距E线距离与美貌人群标准值无统计学差异,全面突角、Z角与美貌人群标准值具有统计学差异。完成即刻过渡义齿修复后,相比种植治疗上颌无牙状态,患者的鼻唇角、Z角、H角均有显著变化。患者对种植即刻过渡义齿修复术后容貌满意度高。结论:种植即刻过渡义齿修复后,患者侧貌软组织轮廓即刻得到明显改善,侧貌软组织基本恢复到正常人水平,甚至部分达到美貌人群标准。进行种植即刻过渡义齿修复时,需结合患者主观美学诉求和个体情况,优化修复体功能和形态。

PURPOSE:To compare the changes of soft tissue profile of maxillary edentulous patients before and immediately after implant restoration,as well as to investigate patient satisfaction with postoperative facial appearance.METHODS:A total of 24 patients treated in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine from January 2018 to December 2020 were selected,the medical history and positive lateral cephalometric film of the patients before and after restoration were collected.Preoperative facial scanning of the patients was performed using the portable 3D facial scanner to design the immediate transitional denture restoration and then perform implant surgery.The collected lateral cephalograms of patients before and after treatment were imported into the computer.The angle measurement items before and after implant immediate denture restoration were analyzed including nasolabial angle,prn'-sn'-ul'(Ls),n'-prn'-sn',N-prn-Pog,Z angle,H angle and line measurements including the distance of upper lip to the E-plane and Sn-Prn.The soft tissue angle and lines were measured by Dolphin Imaging 11.95.Postoperative patient satisfaction with facial appearance was surveyed via telephone questionnaire.SPSS 26.0 software package was used for data analysis.RESULTS:Before restoration of immediate denture,the nasolabial angle and the distance of upper lip to the E-plane of both male and female patients was significantly different from the standard value,and the Z angle of female patients was significantly different from the standard value.After immediate denture restoration,there was no significant difference in nasolabial angle and the distance of upper lip to the E-plane between male and female patients,but there was significant difference in H angle,and nasal tip angle in female patients.After immediate denture restoration,there was no significant difference between the nasolabial angle,H angle and the distance of upper lip to the E-plane in male and female patients after immediate denture restoration,while the soft tissue convexity and Z angle between male and female patients after immediate denture restoration were significantly different compared with the standard value of the attractive individuals.After completion of immediate denture restoration,compared to the edentulous state in maxillary implant treatment,significant changes were observed in nasolabial angle,Z angle,and H angle in patients.The survey of seven questions had a mean score above 3 points(scoring standard 1-5,with 5 being the highest),indicating high patient satisfaction with the appearance after immediate denture restoration.CONCLUSIONS:After immediate denture restoration,the profile of the patient's soft tissue can be improved immediately,and the patient's soft tissue profile can basically return to the normal level,and even meet the standards of beautiful people.It is necessary to guide clinicians to further optimize the function and shape of prostheses in combination with patients'subjective aesthetic demands and individual conditions when conducting implant immediate transition denture restoration.