关键词: 牙槽嵴即刻修复术, 即刻种植即刻修复, 唇侧骨板缺损

Abstract:

Objective To investigate and evaluate the clinical efficacy of immediate alveolar ridge reconstruction for tissue defects in the maxillary aesthetic zone. Methods Thirty patients undergoing immediate implant placement and restoration of maxillary anterior teeth at the Department of Prosthodontics, Changsha Stomatological Hospital, between June 2021 and June 2023 were enrolled. They were divided into an intact group (with intact labial bone walls) and a defect group (with three-wall bone defects, buccal bone plate defect≤6 mm, not exceeding 1/2 of the root length). Both groups received guided implant placement with the implant neck platform positioned 3-4 mm apical to the labial gingival margin. In the intact group, Geistlich Bio-Oss^® bone graft was placed in the jumping gap, while the defect group received corticocancellous bilayer grafts harvested from the maxillary tuberosity or three-layer connective tissue grafts fixed at the labial defect site. The jumping gap in the defect group was filled with a 1∶1 mixture of Geistlich Bio-Oss^® and autogenous bone particles. Immediate provisionalization was performed in both groups. Permanent restoration was performed 6 months post-surgery. Implant survival rate at 6 months after final restoration was recorded. The pink esthetic score (PES) was assessed immediately post-surgery and at 6 months after final restoration. Alveolar ridge dimensional changes and the width of the buccal bone plate around the implants were measured. Results Implant survival rates were 100% in both groups. Immediately post-surgery, scores for mesial papilla, distal papilla, gingival contour, gingival height, soft tissue color, and soft tissue texture showed no statistically significant differences (P>0.05). However, the alveolar process deficiency score and total PES score were significantly higher in the intact group compared to the defect group (P<0.05). At 6 months after final restoration, all indicator scores and the total PES score were comparable between the two groups, with no significant differences (P>0.05). Both groups demonstrated bone resorption at sites W1-W5 between immediate and 6-month evaluations. Significant resorption differences were observed at W1, W2, and W3 (P<0.05), while W4 and W5 showed no significant changes (P>0.05). Labial bone width and variation at sites P1 and P2 showed no inter-group differences at any time point (P>0.05). Conclusion Compared to immediate implant placement in cases with intact labial bone walls, immediate alveolar ridge reconstruction effectively restores labial bone defects and achieves satisfactory aesthetic outcomes.

Key words: immediate alveolar ridge reconstruction, immediate implant placement and provisionalization, buccal bone plate defect