根盾技术和不翻瓣即刻种植在不同牙龈生物型的种植美学比较

doi:10.13591/j.cnki.kqyx.2023.04.008

摘要/Abstract

摘要：

目的评估不翻瓣即刻种植(immediate implant placement,IIP)和采用根盾技术(socket-shield technique,SST)即刻种植术在不同牙龈生物型上颌前牙区单牙种植的美学和临床效果。方法研究共纳入30例需要进行上颌前牙单牙即刻种植和即刻修复并符合适应证的成年患者,随机分为试验组SST(n=15)和对照组IIP(n=15)组。并根据插入牙龈沟内的牙周探针的可见性,将患者分为薄龈生物型和厚龈生物型。术后即刻修复,4个月后完成最终修复,于12个月后复诊并进行临床检测。通过石膏模型数据分析种植位点唇侧轮廓突度、唇侧龈缘位置变化并采用粉色美学评分(PES)评估美学效果。临床检查包括改良龈沟出血指数(mSBI)、统计并发症及患者对治疗过程的满意度。结果 12个月后复查,种植体存留率100%。唇侧轮廓突度变化IIP组(-0.49±0.18)mm,SST组(-0.21±0.18)mm(P<0.05),其中薄龈生物型中IIP组(-0.58±0.17)mm,SST组(-0.20±0.19)mm(P<0.05)。唇侧龈缘位置变化IIP组(-0.76±0.22)mm,SST组(-0.41±0.12)mm,其中薄龈生物型IIP组(-0.82±0.23)mm,SST组(-0.20±0.19)mm(P<0.05)。PES评分IIP组10.47±1.15,SST组11.87±0.81,其中薄龈生物型IIP组9.78±0.92,SST组12.01±0.85(P<0.05)。而在厚龈生物型中均无统计学意义。种植体周围探查结果显示,SST组患者的mSBI有所降低。两组患者对最终的美学效果满意度均较高。结论根盾技术能有效维持薄龈生物型患者前牙种植位点的轮廓突度、牙龈边缘位置和牙龈的色形质,对改善薄龈生物型前牙种植美学具有重要意义。

关键词: 根盾技术, 即刻种植, 牙龈生物型, 前牙美学

Abstract:

Objective To compare the esthetics and clinical outcomes in different gingival biotypes between immediate implant placement(IIP) using the conventional flap-less approach and the socket-shield technique(SST). Methods Thirty patients with maxillary anterior tooth and corresponding indications that needed immediate implant and restoration were enrolled. Selected patients(n=30) were randomly allocated to two equal groups for modified immediate implant with SST(n=15) and conventional flap-less immediate implant(n=15). Then according to the visibility of the periodontal probe, the patients were divided into thin gingival and thick gingival biotype. The patients received provisional crown immediately after surgery and definitive restoration 4 months later. Twelve months after the restoration, the patients were revisited for clinical examination. The esthetic outcomes were evaluated by pink esthetic scores(PES) assessment and model analysis including the position of gingival margin and labial contour alternation. Clinical parameters, including the modified sulcus bleeding index(mSBI) was assessed. Postoperative complications and patient satisfaction were also analyzed. Results Twelve months after surgery, all the implants survived. Labial contour alteration were (-0.49±0.18)mm in IIP group and (-0.21±0.18)mm in SST group(P<0.05).For patients with thin gingival biotype, it was (-0.58±0.17)mm in IIP group, and (-0.20±0.19)mm in SST group(P<0.05). The recession of gingival margin reached (-0.76±0.22)mm in IIP group, and (-0.41±0.12)mm in SST group. For patients with thin gingiva, it was (-0.82±0.23)mm in IIP group, and (-0.20±0.19)mm in SST group(P<0.05). PES of IIP group was 10.47±1.15 and SST group was 11.87±0.81. For thin gingival biotype, PES of IIP was 9.78±0.92 and SST was 12.01±0.85 (P<0.05). However. there was no statistical significance for patients with thick gingival biotype. The results of peri-implant exploration showed decreased mSBI values in SST group. Patients in all groups were satisfied with the final esthetic effects. Conclusion SST could significantly improve the esthetic outcome of immediate implant crown by maintaining the contour of alveolar ridge, the gingival margin and the quality of peri-implant tissue, especially for patients with thin gingival biotype.

Key words: socket-shield technique, immediate implant placement, gingival biotype, anterior tooth aesthetics

中图分类号:

R783.4

朱蒙飞,刘鑫,唐旭炎. 根盾技术和不翻瓣即刻种植在不同牙龈生物型的种植美学比较[J]. 口腔医学, 2023, 43(4): 327-333.

ZHU Mengfei,LIU Xin,TANG Xuyan. Comparison of the esthetics in different gingival biotypes between the socket-shield technique and the flap-less immediate implant[J]. Stomatology, 2023, 43(4): 327-333.

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牙龈生物型	白色	绿色	蓝色
薄	可见	可见	可见
中等	不可见	可见	可见
厚	不可见	不可见	可见
很厚	不可见	不可见	不可见

组别	牙龈生物型		种植体直径
组别	厚	薄	3.5 mm	4.3 mm
IIP(n=15)	6(40.0)	9(60.0)	8(53.3)	7(46.7)
SST(n=15)	4(26.7)	11(73.3)	6(40.0)	9(60.0)
P	0.139		0.715

分组	唇侧轮廓突度变化/mm			唇侧龈边缘变化/mm			PES
分组	厚	薄	合计	厚	薄	合计	厚	薄	合计
IIP	-0.36±0.13	-0.58±0.17	-0.49±0.18	-0.63±0.16	-0.82±0.23	-0.76±0.22	11.50±0.50	9.78±0.92	10.47±1.15
SST	-0.22±0.21	-0.20±0.19	-0.21±0.18	-0.45±0.17	-0.20±0.19	-0.41±0.12	11.25±1.47	12.01±0.85	11.87±0.81
P	0.238	<0.001	<0.001	0.142	<0.001	<0.001	0.765	<0.001	0.002