翻瓣植骨非埋入式即刻牙种植在上颌前牙区的应用及临床效果观察
发布时间：2019-06-27 10:59
【摘要】：目的:探讨翻瓣植骨非埋入式即刻牙种植的可行性,观察其在上颌前牙区应用的临床效果,为上颌前牙区即刻牙种植及骨增量技术的应用开辟新途径。方法:选择2015年02月至2016年05月因残根、牙折断或牙周病无保留意义的上颌前牙区的患牙,要求行即刻牙种植治疗且无即刻种植手术禁忌症的患者45例(男19例,女26例),年龄范围18~52岁(平均年龄36岁),计划共植入50颗种植体。常规口腔颌面部消毒,铺无菌洞巾,局麻下微创拔除患牙;在患牙近中或远中邻牙唇侧正中做斜行牙龈切口,切开黏骨膜,于患牙近远中牙龈乳头正中切开,用骨膜剥离子自唇侧斜行切口在骨膜深面向龈缘方向剥离牙龈黏骨膜,充分暴露拔牙窝唇侧的牙槽骨,用骨膜剥离子沿腭侧牙槽嵴顶适当分离腭侧黏骨膜,显露腭侧牙槽嵴顶;彻底搔刮拔牙窝,生理盐水冲洗牙槽窝,在牙槽窝根端向根方根据种植体植入的正确位置级差备洞制备种植窝,深度大于4mm;即刻植入合适直径和长度的种植体,安装一枚直径稍大于种植体直径且穿龈高度高出牙槽嵴顶黏膜1mm以上的愈合基台;根据唇侧牙槽骨缺损的范围,于唇侧骨缺损区植骨、盖胶原膜,黏骨膜瓣复位,间断缝合创口;术后6个月实施永久修复,修复后1年随访;根据红、白美学(PES/WES)评价标准,观察种植体周围软组织及修复体美学效果;根据锥形束CT(CBCT)数据测量,对比观察种植体唇侧牙槽骨的骨量变化;采用视觉测量尺(VAS)调查患者主观满意度。结果:45例患者的50颗种植体均成功实现了翻瓣植骨非埋入式即刻植入;所有种植体植入后均具有良好的初期稳定性,软组织创口均Ⅰ期愈合,无一例创口裂开,无一例发生植骨材料外露。术后6个月实施修复时所有种植体的上端牙龈健康且软组织袖口形态良好;所有种植体均实现了基台一体冠或基台一体桥修复;其中40例单颗牙即刻种植病例均完成基台一体冠修复,PES均值达到8.05±0.93,WES均值达到7.93±0.95,美学效果显著。修复后1年随访,种植体存留率100%,50颗种植体唇侧植骨区成骨效果显著;种植修复完成时与种植术后即刻相比,种植体唇侧骨厚度减少了0.67mm,而修复完成后1年复诊时与修复完成时相比,种植体唇侧骨厚度减少了0.08mm,骨组织稳定性良好。患者对修复效果满意度均较高,VAS均值达到8.42±1.01。结论:翻瓣植骨非埋入式即刻牙种植是一种行之有效的治疗方法,只需1次手术即可完成牙种植体植入、骨增量及种植体上方软组织成形,尤其对于美学要求较高的上颌前牙区种植,美学修复效果较为显著,软硬组织稳定性良好,具有广泛的临床推广应用前景。
[Abstract]:Objective: to investigate the feasibility of non-embedded immediate tooth implantation with flip flap bone grafting, to observe the clinical effect of its application in maxillary anterior tooth area, and to open up a new way for the application of immediate tooth implantation and bone increment technique in maxillary anterior tooth area. Methods: from February 2015 to May 2016, 45 patients (19 males and 26 females) with unreserved maxillary anterior teeth due to residual root, broken teeth or periodontal disease were enrolled in this study. A total of 50 implants were planned to be implanted in 45 patients (19 males and 26 females) with an age range of 18 to 52 years (mean age 36 years). Routine oral and maxillofacial disinfection, laying aseptic cave towels, minimally invasive extraction of affected teeth under local anesthesia; Oblique gingival incision was made in the middle of the labial side of the adjacent teeth, the mucoperiosteum was cut, and the mucoperiosteum was cut in the proximal and distal alveolar papilla of the affected teeth. The periosteal peeling ion oblique incision was used to peel the gum mucoperiosteum in the direction of the periosteum facing the margin of the gum, and the alveolar bone of the alveolar side of the tooth was fully exposed. The mucoperiosteum of the palatine side was properly separated along the alveolar crest of the palatine side by periosteum peeling ion, and the alveolar crest of the palatine side was exposed. The alveolar fossa was thoroughly scratched and pulled out, the alveolar fossa was washed with saline, and the implantation nest was prepared at the root end of the alveolar fossa according to the correct position of the implantation, the depth was more than 4 mm, and a healing base with a diameter slightly larger than the diameter of the implant and higher than the 1mm of the alveolar crest mucous membrane was installed immediately, and a healing base with a diameter slightly larger than the diameter of the implantation and higher than the height of the alveolar crest mucous membrane was installed at the root end of the alveolar fossa. According to the range of labial alveolar bone defect, bone grafting, capping collagen membrane, mucoperiosteal flap reduction and intermittent suture wound were performed 6 months after operation and followed up one year after repair. According to the evaluation criteria of red and white aesthetics (PES/WES), the aesthetic effects of soft tissue and restoration were observed, and the bone mass changes of labial alveolar bone were compared according to CT (CBCT) data of conical bundles. The subjective satisfaction of the patients was investigated by visual ruler (VAS). Results: all the 50 implants in 45 patients were successfully implanted without implantable bone grafting, all of them had good initial stability, soft tissue wounds healed in the first stage, none of them were cracked, and no bone graft materials were exposed. At 6 months after operation, the upper gums of all implants were healthy and the cuffs of soft tissue were in good shape, all of them achieved the restoration of platform crown or platform bridge, and 40 cases of immediate implantation of single tooth completed the restoration of platform crown, the mean value of PES was 8.05 卤0.93, and the mean value of Wes was 7.93 卤0.95. the aesthetic effect was remarkable. One year after restoration, the survival rate of the Implant was 100%, and the osteogenic effect was significant in the labial bone graft area of 50 implants. compared with the immediate after implantation, the thickness of the labial bone decreased by 0.67mm, and the thickness of the labial bone decreased by 0.08mm one year after the restoration, and the stability of the bone tissue was good. The patients were satisfied with the repair effect, and the mean value of VAS was 8.42 卤1.01. Conclusion: non-implantable immediate tooth implantation is an effective treatment. Dental implantation, bone increment and soft tissue formation above the implantation can be completed only once, especially for maxillary anterior tooth implantation with high aesthetic requirements. Aesthetic restoration effect is remarkable, soft and hard tissue stability is good, and it has a wide range of clinical application prospects.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1
本文编号：2506726
[Abstract]:Objective: to investigate the feasibility of non-embedded immediate tooth implantation with flip flap bone grafting, to observe the clinical effect of its application in maxillary anterior tooth area, and to open up a new way for the application of immediate tooth implantation and bone increment technique in maxillary anterior tooth area. Methods: from February 2015 to May 2016, 45 patients (19 males and 26 females) with unreserved maxillary anterior teeth due to residual root, broken teeth or periodontal disease were enrolled in this study. A total of 50 implants were planned to be implanted in 45 patients (19 males and 26 females) with an age range of 18 to 52 years (mean age 36 years). Routine oral and maxillofacial disinfection, laying aseptic cave towels, minimally invasive extraction of affected teeth under local anesthesia; Oblique gingival incision was made in the middle of the labial side of the adjacent teeth, the mucoperiosteum was cut, and the mucoperiosteum was cut in the proximal and distal alveolar papilla of the affected teeth. The periosteal peeling ion oblique incision was used to peel the gum mucoperiosteum in the direction of the periosteum facing the margin of the gum, and the alveolar bone of the alveolar side of the tooth was fully exposed. The mucoperiosteum of the palatine side was properly separated along the alveolar crest of the palatine side by periosteum peeling ion, and the alveolar crest of the palatine side was exposed. The alveolar fossa was thoroughly scratched and pulled out, the alveolar fossa was washed with saline, and the implantation nest was prepared at the root end of the alveolar fossa according to the correct position of the implantation, the depth was more than 4 mm, and a healing base with a diameter slightly larger than the diameter of the implant and higher than the 1mm of the alveolar crest mucous membrane was installed immediately, and a healing base with a diameter slightly larger than the diameter of the implantation and higher than the height of the alveolar crest mucous membrane was installed at the root end of the alveolar fossa. According to the range of labial alveolar bone defect, bone grafting, capping collagen membrane, mucoperiosteal flap reduction and intermittent suture wound were performed 6 months after operation and followed up one year after repair. According to the evaluation criteria of red and white aesthetics (PES/WES), the aesthetic effects of soft tissue and restoration were observed, and the bone mass changes of labial alveolar bone were compared according to CT (CBCT) data of conical bundles. The subjective satisfaction of the patients was investigated by visual ruler (VAS). Results: all the 50 implants in 45 patients were successfully implanted without implantable bone grafting, all of them had good initial stability, soft tissue wounds healed in the first stage, none of them were cracked, and no bone graft materials were exposed. At 6 months after operation, the upper gums of all implants were healthy and the cuffs of soft tissue were in good shape, all of them achieved the restoration of platform crown or platform bridge, and 40 cases of immediate implantation of single tooth completed the restoration of platform crown, the mean value of PES was 8.05 卤0.93, and the mean value of Wes was 7.93 卤0.95. the aesthetic effect was remarkable. One year after restoration, the survival rate of the Implant was 100%, and the osteogenic effect was significant in the labial bone graft area of 50 implants. compared with the immediate after implantation, the thickness of the labial bone decreased by 0.67mm, and the thickness of the labial bone decreased by 0.08mm one year after the restoration, and the stability of the bone tissue was good. The patients were satisfied with the repair effect, and the mean value of VAS was 8.42 卤1.01. Conclusion: non-implantable immediate tooth implantation is an effective treatment. Dental implantation, bone increment and soft tissue formation above the implantation can be completed only once, especially for maxillary anterior tooth implantation with high aesthetic requirements. Aesthetic restoration effect is remarkable, soft and hard tissue stability is good, and it has a wide range of clinical application prospects.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1
【参考文献】
相关期刊论文 前1条
1 王文芳;李志华;;牙槽骨开裂与开窗的研究进展[J];中华口腔医学杂志;2013年09期
，本文编号：2506726
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