美学区应用不可吸收性屏障膜进行骨增量的5年临床观察

A 5-year clinical observation on the application of non-resorbable membranes for bone augmentation in the aesthetic zone

本文报告了1例使用异种骨和致密型聚四氟乙烯(dense polytetrafluoroethylene,dPTFE)膜与生物可吸收性胶原膜Bio-Gide双层覆盖的引导骨再生(guided bone regeneration,GBR)伴软组织增量的美学区连续牙列缺损种植修复的病例。患者因外伤导致上颌前牙区连续多颗牙缺失伴有较严重的水平向和轻微的垂直向骨丧失。在导板辅助下植入种植体的同时,使用去蛋白牛骨矿物质(deproteinized bovine bone mineral,DBBM)+dPTFE+Bio-Gide进行GBR,6个月后先后通过同种异体脱细胞真皮基质AlloDerm+隧道瓣和结缔组织瓣(connective tissue graft,CTG)+改良隧道瓣进行软组织增量,临时修复体牙龈塑形后,完成最终美学修复,恢复了患者的功能和美观。戴牙5年后的临床随访可见,DBBM+dPTFE+Bio-Gide的GBR获得了理想的骨增量效果,AlloDerm/CTG+隧道瓣的软组织增量为最终的美学修复提供了令人满意的临床效果。

This case report describes the use of guided bone regeneration(GBR)combined with soft tissue augmentation for implant restoration in an extended edentulous space in the esthetic zone,employing heterogeneous bone and dense polytetrafluoroethylene(dPTFE)membranes with double-layered coverage using a pig-derived non-crosslinked collagen membrane(Bio-Gide).The patient presented with multiple teeth missing in the maxillary anterior region due to trauma sustained at a young age,accompanied by severe horizontal bone loss and slight vertical bone loss.Clinical treatment involved the simultaneous guided placement of implants with GBR using deproteinized bovine bone mineral(DBBM),dPTFE,and Bio-Gide membranes.After 6 months,soft tissue augmentation was performed in two stages:first using the tunneling technique with allogeneic de-epithelialized dermal matrix(AlloDerm),followed by a modified tunneling technique using a connective tissue graft(CTG).Gingival shaping was achieved with temporary restorations,followed by final aesthetic restoration to restore function and appearance.A 5-year clinical follow-up demonstrated that GBR with DBBM,dPTFE,and Bio-Gide achieved ideal bone volume gain,while AlloDerm/CTG with the tunneling technique produced satisfactory soft tissue augmentation,contributing to excellent aesthetic outcomes.