上前牙即刻种植即刻修复术后软组织变化与不同跳跃间隙的相关性

doi:10.7518/hxkq.2023.2023153

摘要/Abstract

摘要：

目的评估上颌前牙美学区即刻种植即刻修复（IIPP）后种植体周软组织变化与术中不同跳跃间隙的相关性，为临床对不同跳跃间隙患者的唇侧软组织轮廓的变化趋势及长期稳定性评估提供依据。方法纳入32名上颌美学区单颗牙缺失患者，均接受IIPP临床程序。根据跳跃间隙大小分为A、B、C组，A组：水平缺损间隙（HDD）≤2 mm；B组：2 mm<HDD≤3 mm；C组：HDD>3 mm，术后均即刻修复。使用Geomagic studio 2013对种植体周软组织轮廓体积、唇侧牙龈边缘水平进行定量分析。使用粉色美学评分（PES）进行最终美学效果评价。结果所有种植体在术后6个月均产生骨结合，软组织轮廓平均厚度变化为0.62 mm±0.15 mm，美学评分指数平均为11.09±0.99。术后6个月3组牙龈黏膜水平的变化分别为（0.45±0.11）、（0.40±0.12）、（0.35±0.11）mm，术后6个月3组软组织轮廓体积平均厚度的变化分别为（0.77±0.16）、（0.63±0.17）、（0.54±0.11）mm。术中跳跃间隙大小和牙龈黏膜水平、平均厚度变化存在中度负相关关系，术中跳跃间隙大小与PES未见明显相关。结论上前牙IIPP术后6个月内唇侧软组织轮廓体积虽然存在持续性减小，但该术式可以达到较为满意的美学效果，并且当跳跃间隙大于3 mm时，种植体周软组织水平可以得到良好的维持。

关键词: 美学区, 即刻种植即刻修复, 跳跃间隙, 软组织

Abstract:

Objective This study aims to evaluate the correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization (IIPP) in the maxillary anterior region. Results will provide a basis for clinical evaluation of the change trend and long-term stability of the labial soft tissue contours of patients with different jumping gaps. Methods Thirty-two patients with single tooth loss in the maxillary aesthetic area were enrolled, and they all received immediate implant placement and restoration. All patients were divided into three groups: A, B, and C according to the size of the jumping gap, group A: horizontal defect dimension (HDD) ≤2 mm; group B: 2 mm<HDD≤3 mm; group C: HDD>3 mm. Geomagic studio 2013 was used to quantitatively analyze the contour volume of the soft tissue around the implant and the level of the labial gingival margin. The pink esthetic score (PSE) was used for the final aesthetic evaluation. Results All implants had osseointegration within 6 months after the surgery. The average thickness of soft tissue contour volume changed by 0.62 mm±0.15 mm, and the average PES was 11.09±0.99. The changes in the gingival mucosa levels in the three groups at 6 months after operation were 0.45 mm±0.11 mm, 0.40 mm±0.12 mm, and 0.35 mm± 0.11 mm, respectively. The changes in the average thickness of the soft tissue contour volume in the three groups at 6 months after the operation were 0.77 mm±0.16 mm, 0.63 mm±0.17 mm, and 0.54 mm±0.11 mm. A moderate negative correlation was found between the jumping gap size and the gingival mucosa level, and the average thickness changed. No significant correlation was found between size of jumping gap and PES. Conclusion Although the contour volume of the labial soft tissue continuously decreased within 6 months after IIPP in the maxillary anterior region, the surgical procedure can achieve a satisfactory aesthetic effect, and the level of soft tissue around the implant can be well maintained.

Key words: esthetics zone, immediate implant placement and provisionalization, jumping gap, soft tissue

中图分类号:

R 783

张邃, 孙毅, 黄长波, 何东宁. 上前牙即刻种植即刻修复术后软组织变化与不同跳跃间隙的相关性[J]. 华西口腔医学杂志, 2023, 41(6): 678-685.

Zhang Sui, Sun Yi, Huang Changbo, He Dongning. Correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization in the maxillary anterior region[J]. West China Journal of Stomatology, 2023, 41(6): 678-685.

图/表 10

图 1

图 2

图 3

图 4

图 5

图 6

图 7

表 1

图 8

图 9

参考文献 16

1	Ramanauskaite A, Sader R. Esthetic complications in implant dentistry[J]. Periodontol 2000, 2022, 88(1): 73-85.
2	Elaskary A, Abdelrahman H, Elsabagh HH, et al. Does grafting the jumping gap in immediately placed anterior implants using vestibular socket therapy influence the labial bone thickness[J]. J Oral Maxillofac Surg, 2022, 80(8): 1398-1407.
3	Kabi S, Kar R, Samal D, et al. Immediate dental implant placement with or without autogenous bone graft: a comparative study[J]. Natl J Maxillofac Surg, 2020, 11(1): 46-52.
4	Tian J, Wei D, Zhao Y, et al. Labial soft tissue contour dynamics following immediate implants and immediate provisionalization of single maxillary incisors: a 1-year prospective study[J]. Clin Implant Dent Relat Res, 2019, 21(3): 492-502.
5	Amato F, Polara G, Spedicato GA. Tissue dimensional changes in single-tooth immediate extraction implant placement in the esthetic zone: a retrospective clinical study[J]. Int J Oral Maxillofac Implants, 2018, 33(2): 439-447.
6	Parvini P, Müller KM, Cafferata EA, et al. Immediate versus delayed implant placement in the esthetic zone: a prospective 3D volumetric assessment of peri-implant tissue stability[J]. Int J Implant Dent, 2022, 8(1): 58.
7	Naenni N, Bienz SP, Benic GI, et al. Volumetric and li-near changes at dental implants following grafting with volume-stable three-dimensional collagen matrices or au-togenous connective tissue grafts: 6-month data[J]. Clin Oral Investig, 2018, 22(3): 1185-1195.
8	Levine RA, Dias DR, Wang P, et al. Effect of the buccal gap width following immediate implant placement on the buccal bone wall: a retrospective cone-beam computed tomography analysis[J]. Clin Implant Dent Relat Res, 2022, 24(4): 403-413.
9	Tan WL, Wong TL, Wong MC, et al. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans[J]. Clin Oral Implants Res, 2012, 23(): 1-21.
10	Araújo MG, Sukekava F, Wennström JL, et al. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog[J]. J Clin Periodontol, 2005, 32(6): 645-652.
11	Sanz M, Cecchinato D, Ferrus J, et al. Implants placed in fresh extraction sockets in the maxilla: clinical and radiographic outcomes from a 3-year follow-up examination [J]. Clin Oral Implants Res, 2014, 25(3): 321-327.
12	Arora H, Khzam N, Roberts D, et al. Immediate implant placement and restoration in the anterior maxilla: tissue dimensional changes after 2-5 year follow up[J]. Clin Implant Dent Relat Res, 2017, 19(4): 694-702.
13	Levine RA, Dias DR, Wang P, et al. Effect of connective tissue graft following immediate implant placement on esthetic outcomes at maxillary central incisor sites: a long-term cohort study[J]. Int J Periodontics Restorative Dent, 2022, 42(5): e143-e151.
14	Lang NP, Pun L, Lau KY, et al. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year[J]. Clin Oral Implants Res, 2012, 23(): 39-66.
15	Jiang X, Di P, Ren S, et al. Hard and soft tissue alterations during the healing stage of immediate implant pla-cement and provisionalization with or without connective tissue graft: a randomized clinical trial[J]. J Clin Periodontol, 2020, 47(8): 1006-1015.
16	Pluemsakunthai W, Le B, Kasugai S. Effect of buccal gap distance on alveolar ridge alteration after immediate implant placement[J]. Implant Dent, 2015, 24(1): 70-76.

测量指标	术后1月（T₁）	术后3月（T₂）	术后6月（T₃）	P值
?ML/mm	0.24±0.12	0.31±0.21	0.42±0.12	0.031
?d/mm	0.32±0.12	0.53±0.14	0.62±0.15	<0.001
?d≤0.5 mm	30（94%）	27（84%）	6（19%）	-
0.5 mm<?d≤1 mm	2（6%）	15（16%）	24（75%）	-
?d>1 mm	0	0	2（6%）	-
PES	11.24±0.87	11.21±0.93	11.09±0.99	0.284

[1]	刘峰, 詹雅琳, 刘欣然. 美学区天然基牙二次冠修复中预备体不良边缘的处理策略[J]. 华西口腔医学杂志, 2023, 41(6): 641-646.
[2]	刘雨婷, 袁泉. 美学区种植体植入轴向的影响因素及临床决策[J]. 华西口腔医学杂志, 2023, 41(5): 512-520.
[3]	李璐欣, 刘红红, 陈佳, 张志宏, 桑潇, 张莉丽, 王元天. 数字化方法测量种植体周围骨嵴上软组织高度可行性分析[J]. 华西口腔医学杂志, 2023, 41(4): 426-433.
[4]	付彧, 李紫薇, 赵梦晗, 史瑞新. 颏部形态对正畸治疗影响的研究[J]. 华西口腔医学杂志, 2023, 41(4): 443-449.
[5]	李德雄, 曹润源, 陈江. 丝素蛋白多孔支架用于口腔软组织增厚的初步研究[J]. 华西口腔医学杂志, 2022, 40(5): 513-521.
[6]	郭玉兴, 赵宁, 王佃灿, 王洋, 郭传瑸. 以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死手术后上颌骨缺损的临床应用[J]. 华西口腔医学杂志, 2022, 40(1): 61-67.
[7]	刘伟, 李泓霖, 向思捷, 苗诚, 李春洁, 韩波. 颊部外周型牙源性角化囊肿2例[J]. 华西口腔医学杂志, 2021, 39(6): 728-731.
[8]	闫圣杰,周聪,刘金,许香娜,杨云,陈鑫,兰晶. 上颌前牙区应用根膜技术即刻种植的临床效果观察[J]. 华西口腔医学杂志, 2019, 37(6): 615-620.
[9]	许亚梅,黄弘,王黎,吴庆庆,付钢,李姣. 改良盾构术与传统即刻种植术的临床效果对比研究[J]. 华西口腔医学杂志, 2019, 37(5): 490-495.
[10]	许春梅,张尽美,吴亚菲,赵蕾. 膜龈手术中自体软组织替代物的研究进展[J]. 华西口腔医学杂志, 2019, 37(2): 208-213.
[11]	高旭, 刘梅, 刘翠玲. 种植义齿排龈后种植体周围软组织损伤愈后的动物实验研究[J]. 华西口腔医学杂志, 2018, 36(3): 287-290.
[12]	刘金,蒲必双,夏玉兰,王成泽,王罡,兰晶. 上颌前牙倾斜角度对种植治疗设计的影响[J]. 华西口腔医学杂志, 2016, 34(6): 611-616.
[13]	黄冉冉孙旭尚针针张黎星. 下颌后牙区软组织水平种植体边缘骨吸收相关因素的临床研究[J]. 华西口腔医学杂志, 2016, 34(2): 145-149.
[14]	徐安秀邓锋王芬芬张向凤张翼. 鼻唇角改变对骨性Ⅰ类软组织侧貌影响的审美评价[J]. 华西口腔医学杂志, 2015, 33(5): 492-496.
[15]	申婷张丽娜耿宁汤亚玲秦丹青任东萍陈宇. 左侧腮腺区软骨肉瘤1例[J]. 华西口腔医学杂志, 2015, 33(1): 104-106.