上颌牙列缺失患者种植支持固定修复前后唇部美学区软组织的变化

Facial soft tissue changes after full-arch implant-supported fixed prostheses restoration in patients with edentulous maxilla

目的:探讨上颌牙列缺失患者种植固定修复治疗前后鼻唇部软组织的变化及其影响因素。方法:选择2016年1月—2023年7月于上海交通大学医学院附属第九人民医院口腔第二门诊行上颌全牙弓种植固定修复的患者50例。收集患者修复前后的病史、CBCT和三维面部扫描数据,采用配对t检验或Wilcoxon符号秩和检验比较患者戴牙前后软组织的改变,将各变化量与患者基本信息、种植方案和剩余骨相关参数进行双变量相关分析。使用赤池信息准则选择各软组织指标变化量的多元线性回归模型。结果:种植固定修复后,上唇长(sn-sto)、上唇红长(ls-sto)、上唇红面积(UVA)显著增加(P<0.01),上唇凸点到E线的距离(ls-E)显著减少(P<0.01),鼻唇角(∠cm-sn-ls)显著减小(P<0.01),人中长(sn-ls)无显著改变(P>0.05)。除sn-sto和sn-ls外,其余软组织改变量均与年龄呈正相关关系(P<0.01),其余骨组织参数、种植方案、性别与各软组织改变量无显著相关性。多元逐步后退回归分析显示,各软组织变化量与年龄和术前软组织情况广泛相关,个别与骨形态相关。结论:上颌牙列缺失患者种植固定修复后鼻唇部软组织发生显著变化,主要为唇红部扩大和突出。面部软组织变化主要与患者年龄及原有软组织条件广泛相关;患者年龄越大、原有软组织形态越凹陷萎缩,丰满度改善越明显,唇部凸度改变量与剩余骨形状也存在相关性。

PURPOSE:To investigate the changes of nasolabial soft tissues before and after full-arch implant supported fixed restoration in maxillary edentulous patients and the influencing factors of the changes.METHODS:Fifty patients who underwent full-arch implant fixed restoration in the Department of Second Dental Center of Shanghai Ninth People's Hospital from January 2016 to July 2023 were selected.Patient's medical history,CBCT,and three-dimensional facial scan data were collected before and after restoration.Paired t test or Wilcoxon signed-rank test were used to compare the changes in soft tissues before and after restoration.The correlation between changes and patient's basic information,implant protocol and residual bone parameters were analyzed using bivariate correlation analysis.Akaike information criterion was used to select the multivariate linear regression model of each soft tissue index change.RESULTS:After implant fixed restoration,the upper lip height(sn-sto),the upper vermillion height(ls-sto),and the upper vermilion area(UVA)significantly increased(P<0.01),while the distance from ls to the E-line(ls-E)significantly decreased(P<0.01),the nasolabial angle(∠cm-sn-ls)significantly decreased(P<0.01),and the cutaneous upper lip height(sn-ls)did not change significantly(P>0.05).Except for sn-sto and sn-ls,the remaining soft tissue changes were positively correlated with age(P<0.01).Other residual bone parameters,implant protocol,and gender were not significantly related to each soft tissue change.Multivariate stepwise regression analysis showed that each soft tissue change was broadly related to age and preoperative soft tissue condition,and partially related to bone morphology.CONCLUSIONS:The nasolabial soft tissues of maxillary edentulous patients change significantly after implant fixed restoration,mainly the expansion and protrusion of the red part of the lip.The changes in facial soft tissues are primarily related to the patient's age and pre-existing soft tissue condition,with older patients and those with more atrophic original soft tissue morphology observing more apparent improvements in fullness.The change in lip prominence is also related to the residual bone shape.