美学区单颗牙即刻种植和延期种植的短期红色美学和种植体边缘骨吸收的临床效果比较及影响因素分析
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摘要
目的 :比较美学区单颗牙即刻种植和延期种植的短期红色美学和种植体边缘骨吸收的临床效果,并对其影响因素进行分析。方法:选择2008年1月—2015年12月在中国医科大学附属口腔医院种植中心行美学区单颗牙种植的患者共114例,分为即刻种植组和延期种植组。上部结构修复完成后随访1年,测量修复完成当天和1年后的红色美学评分(pink esthetic score,PES),修复完成1年后种植体边缘骨吸收量。采用SPSS 17.0软件包进行统计学分析。结果:上部结构修复完成1年后114颗种植体均稳固,即刻种植组在修复完成1年后种植体边缘骨吸收量为(0.36±0.39) mm,显著小于延期种植组(0.79±0.67mm)(P<0.001);2组在修复完成当天和1年后的PES得分差异均无统计学意义(P>0.05)。即刻修复对2组修复完成当天和1年后的PES得分,以及修复完成1年后的种植体边缘骨吸收量均无显著影响(P>0.05)。不翻瓣术修复完成当天和1年后的PES得分分别为9.58±1.67和11.58±1.57,修复完成1年后种植体边缘骨吸收量为(0.25±0.22) mm;而翻瓣术修复完成当天和1年后的PES得分分别为7.11±1.45和9.96±1.56,修复完成1年后种植体边缘骨吸收量为(0.43±0.47)mm,2组相比差异有统计学意义(P<0.05)。SLA和DAE表面处理方法对PES和边缘骨吸收量无显著影响(P>0.05),但植骨手术对修复完成当天和1年后的PES均有不利影响(P<0.05)。结论:美学区即刻种植的种植体边缘骨吸收速度小于延期种植,有利于延长种植体寿命。不翻瓣术提高了修复后的美观度,在选择合适病例的前提下,不翻瓣即刻种植能够达到良好的临床效果。
PURPOSE: To compare the short-term clinical effect and to assess the influencial factors of immediate implant placement and delayed implant placement around single-tooth implant in the aesthetic area. METHODS: A total of 114 patients requiring a single-tooth implant in the aesthetic area were reviewed at Center for Implant Dentistry of Stomatological Hospital of China Medical University. They were divided into immediate implant group and delayed implant group. The patients were followed up for 1 year after upper structure rehabilitation, and the pink esthetic score and the marginal bone absorption around the implants were measured. Statistical analysis was performed using SPSS 17.0 software package. RESULTS: After 1 year of upper structure rehabilitation, 114 implants were stable and the marginal bone absorption around the implants of the immediate implant group was(0.36±0.39) mm,significantly smaller than the delayed implant group [(0.79 ±0.67)mm, P <0.001]. The difference in PES score between the two groups were not statistically significant on the day of rehabilitation and 1 year after upper structure rehabilitation(P>0.05). Significant improvement of PES on the day of rehabilitation and 1 year after upper structure rehabilitation and marginal bone absorption was found with flapless surgery. SLA and DAE surface treatment methods had no significant impact on PES and marginal bone absorption(P>0.05). Graft procedure had an unfavorable effect on PES value both on the day of rehabilitation and 1 year after upper structure rehabilitation. CONCLUSIONS: Under appropriate indications, immediate implant placement and immediate repair could reduce the time of missing teeth. The marginal bone absorption of immediate implant group is smaller than delayed implant group. Flapless surgery avoids damage to gingival tissue, reduces postoperative reaction and improves the aesthetic outcomes after repair.
PURPOSE: To compare the short-term clinical effect and to assess the influencial factors of immediate implant placement and delayed implant placement around single-tooth implant in the aesthetic area. METHODS: A total of 114 patients requiring a single-tooth implant in the aesthetic area were reviewed at Center for Implant Dentistry of Stomatological Hospital of China Medical University. They were divided into immediate implant group and delayed implant group. The patients were followed up for 1 year after upper structure rehabilitation, and the pink esthetic score and the marginal bone absorption around the implants were measured. Statistical analysis was performed using SPSS 17.0 software package. RESULTS: After 1 year of upper structure rehabilitation, 114 implants were stable and the marginal bone absorption around the implants of the immediate implant group was(0.36±0.39) mm,significantly smaller than the delayed implant group [(0.79 ±0.67)mm, P <0.001]. The difference in PES score between the two groups were not statistically significant on the day of rehabilitation and 1 year after upper structure rehabilitation(P>0.05). Significant improvement of PES on the day of rehabilitation and 1 year after upper structure rehabilitation and marginal bone absorption was found with flapless surgery. SLA and DAE surface treatment methods had no significant impact on PES and marginal bone absorption(P>0.05). Graft procedure had an unfavorable effect on PES value both on the day of rehabilitation and 1 year after upper structure rehabilitation. CONCLUSIONS: Under appropriate indications, immediate implant placement and immediate repair could reduce the time of missing teeth. The marginal bone absorption of immediate implant group is smaller than delayed implant group. Flapless surgery avoids damage to gingival tissue, reduces postoperative reaction and improves the aesthetic outcomes after repair.
引文
[1] Esposito M, Zucchelli G, Cannizzaro G, et al. Immediate,immediate-delayed(6 weeks)and delayed(4 months)postextractive single implants:1-year post-loading data from a randomised controlled trial[J]. Eur J Oral Implantol, 2017, 10(1):11-26.
[2] Furhauser R, Florescu D, Benesch T, et al. Evaluation of soft tissue around single-tooth implant crowns:the pink esthetic score[J]. Clin Oral Implants Res, 2005, 16(6):639-644.
[3] Fu PS, Wu YM, Tsai CF, et al. Immediate implant placement following minimally invasive extraction:a case report with a 6-year follow-up[J]. Kaohsiung J Med Sci, 2011, 27(8):353-356.
[4] Felice P, Pistilli R, Barausse C, et al. Immediate non-occlusal loading of immediate post-extractive versus delayed placement of single implants in preserved sockets of the anterior maxilla:1-year post-loading outcome of a randomised controlled trial[J].Eur J Oral Implantol, 2015, 8(4):361-372.
[5]李伟,张志宏,边华琴,等.即刻与延期前牙种植义齿修复的临床效果及主观满意度调查[J].重庆医学, 2015, 44(8):1103-1105.
[6]曹建强,王丽芳,田碧媛,等.上前牙外伤脱落即刻种植美学修复设计的研究[J].口腔医学, 2017, 37(6):528-531.
[7]骆奇峰.上颌前牙单牙即刻种植即刻修复与延期种植修复对患者植体周围软组织和主观满意度的影响[J].中华全科医学,2017, 15(8):1355-1357.
[8]田瑞雪,唐旭炎,徐锦程.即刻种植和延期种植修复前牙的临床效果研究[J].中国现代医学杂志, 2017, 27(4):121-125.
[9] H覿mmerle CH, Chen ST, Wilson TG Jr. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets[J]. Int J Oral Maxillofac Implants,2004, 19(Suppl):26-28.
[10] Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites[J]. J Clin Periodontol, 2004, 31(10):820-828.
[11] Buser D, Chen ST, Weber HP, et al. Early implant placement following single-tooth extraction in the esthetic zone:biologic rationale and surgical procedures[J]. Int J Periodontics Restorative Dent, 2008, 28(5):441-451.
[12] Araújo MG, Sukekava F, Wennstr觟m JL, et al. Tissue modeling following implant placement in fresh extraction sockets[J]. Clin Oral Implants Res, 2006, 17(6):615-624.
[13]叶彬,林臻彦,谢丽丽,等.上颌前牙区即刻种植后骨量变化:水平向吸收是否影响骨结合[J].中国组织工程研究, 2014, 18(24):3835-3839.
[14] Salvi GE, Gallini G, Lang NP. Early loading(2 or 6 weeks)of sandblasted and acid-etched(SLA)ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial[J]. Clin Oral Implants Res, 2004, 15(2):142-149.
[15] Carini F, Longoni S, Pisapia V, et al. Immediate loading of implants in the aesthetic zone:comparison between two placement timings[J]. Ann Stomatol(Roma), 2014, 5(Suppl 2):15-26.
[16] Schincaglia GP, Marzola R, Glovanni GF, et al. Replacement of mandibular molars with single-unit restorations supported by wide-body implants:immediate versus delayed loading. A randomized controlled study[J]. Int J Oral Maxillofac Implants,2008, 23(3):474-480.
[17] Vandamme K, Naerti I, Geris L, et al. Influence of controlled immediate loading and implant design on peri-implant bone formation[J]. J Clin Periodontol, 2007, 34(2):172-181.
[18]张娇,江鹭鹭,封伟,等.上颌前牙区种植义齿即刻修复短期美学效果评价[J].中国实用口腔科杂志, 2013, 6(1):20-23.
[19]冼逢珠,陈俊兰,吴纪楠.不翻瓣技术在前牙即刻种植修复中的临床应用[J].口腔疾病防治, 2016, 24(8):482-486.
[20] Beretta M, Poli P, Grossi G, et al. Long-term survival rate of implants placed in conjunction with 246 sinus floor elevation procedures:results of a 15-year retrospective study[J]. J Dent,2015, 43(1):78-86.
[21] Subramani K, Jung RE, Molenberg A, et al. Biofilm on dental implants:a review of the literature[J]. Int J Oral Maxillofac Implants, 2009, 24(4):616-626.
[22]李悦,马凯,王敏雅,等.不同种植系统埋置式与非埋置式骨水平种植体周围骨变化的比较分析[J].中国实用口腔科杂志,2016, 9(7):415-418.
[2] Furhauser R, Florescu D, Benesch T, et al. Evaluation of soft tissue around single-tooth implant crowns:the pink esthetic score[J]. Clin Oral Implants Res, 2005, 16(6):639-644.
[3] Fu PS, Wu YM, Tsai CF, et al. Immediate implant placement following minimally invasive extraction:a case report with a 6-year follow-up[J]. Kaohsiung J Med Sci, 2011, 27(8):353-356.
[4] Felice P, Pistilli R, Barausse C, et al. Immediate non-occlusal loading of immediate post-extractive versus delayed placement of single implants in preserved sockets of the anterior maxilla:1-year post-loading outcome of a randomised controlled trial[J].Eur J Oral Implantol, 2015, 8(4):361-372.
[5]李伟,张志宏,边华琴,等.即刻与延期前牙种植义齿修复的临床效果及主观满意度调查[J].重庆医学, 2015, 44(8):1103-1105.
[6]曹建强,王丽芳,田碧媛,等.上前牙外伤脱落即刻种植美学修复设计的研究[J].口腔医学, 2017, 37(6):528-531.
[7]骆奇峰.上颌前牙单牙即刻种植即刻修复与延期种植修复对患者植体周围软组织和主观满意度的影响[J].中华全科医学,2017, 15(8):1355-1357.
[8]田瑞雪,唐旭炎,徐锦程.即刻种植和延期种植修复前牙的临床效果研究[J].中国现代医学杂志, 2017, 27(4):121-125.
[9] H覿mmerle CH, Chen ST, Wilson TG Jr. Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets[J]. Int J Oral Maxillofac Implants,2004, 19(Suppl):26-28.
[10] Botticelli D, Berglundh T, Lindhe J. Hard-tissue alterations following immediate implant placement in extraction sites[J]. J Clin Periodontol, 2004, 31(10):820-828.
[11] Buser D, Chen ST, Weber HP, et al. Early implant placement following single-tooth extraction in the esthetic zone:biologic rationale and surgical procedures[J]. Int J Periodontics Restorative Dent, 2008, 28(5):441-451.
[12] Araújo MG, Sukekava F, Wennstr觟m JL, et al. Tissue modeling following implant placement in fresh extraction sockets[J]. Clin Oral Implants Res, 2006, 17(6):615-624.
[13]叶彬,林臻彦,谢丽丽,等.上颌前牙区即刻种植后骨量变化:水平向吸收是否影响骨结合[J].中国组织工程研究, 2014, 18(24):3835-3839.
[14] Salvi GE, Gallini G, Lang NP. Early loading(2 or 6 weeks)of sandblasted and acid-etched(SLA)ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial[J]. Clin Oral Implants Res, 2004, 15(2):142-149.
[15] Carini F, Longoni S, Pisapia V, et al. Immediate loading of implants in the aesthetic zone:comparison between two placement timings[J]. Ann Stomatol(Roma), 2014, 5(Suppl 2):15-26.
[16] Schincaglia GP, Marzola R, Glovanni GF, et al. Replacement of mandibular molars with single-unit restorations supported by wide-body implants:immediate versus delayed loading. A randomized controlled study[J]. Int J Oral Maxillofac Implants,2008, 23(3):474-480.
[17] Vandamme K, Naerti I, Geris L, et al. Influence of controlled immediate loading and implant design on peri-implant bone formation[J]. J Clin Periodontol, 2007, 34(2):172-181.
[18]张娇,江鹭鹭,封伟,等.上颌前牙区种植义齿即刻修复短期美学效果评价[J].中国实用口腔科杂志, 2013, 6(1):20-23.
[19]冼逢珠,陈俊兰,吴纪楠.不翻瓣技术在前牙即刻种植修复中的临床应用[J].口腔疾病防治, 2016, 24(8):482-486.
[20] Beretta M, Poli P, Grossi G, et al. Long-term survival rate of implants placed in conjunction with 246 sinus floor elevation procedures:results of a 15-year retrospective study[J]. J Dent,2015, 43(1):78-86.
[21] Subramani K, Jung RE, Molenberg A, et al. Biofilm on dental implants:a review of the literature[J]. Int J Oral Maxillofac Implants, 2009, 24(4):616-626.
[22]李悦,马凯,王敏雅,等.不同种植系统埋置式与非埋置式骨水平种植体周围骨变化的比较分析[J].中国实用口腔科杂志,2016, 9(7):415-418.