数字化即刻种植修复与角度螺丝通道基台在美学区的应用1例并文献回顾

doi:10.12016/j.issn.2096-1456.2020.07.007

摘要/Abstract

摘要：

目的通过回顾1例上前牙即刻种植即刻修复病例资料以及相关文献复习,探讨数字化即刻种植即刻修复以及角度螺丝通道基台在美学区种植中的应用及相关影响因素。方法上前牙难治性慢性根尖炎1例拟拔除患牙后即刻种植即刻修复,通过CBCT和口内扫描获得患者数字化信息,根据患者信息进行术前评估,制定治疗方案,进行微创拔牙,数字化全程导板下植入种植体,即刻戴入临时修复体。术后6个月个性化取模,完成角度螺丝通道固位最终修复体。观察修复后美观度、软硬组织及牙龈轮廓维持效果,于修复完成后6个月复查,结合相关文献进行回顾性分析。结果该患者龈缘以及牙龈乳头的高度、牙龈轮廓维持较好,红白美学效果良好,修复后6个月牙龈无红肿、种植体周围软硬组织无明显改变,患者满意。回顾相关文献结果表明,基于CBCT及口内扫描数据结合数字化软件进行的术前设计和全程数字化导板使更加精准、安全,它不仅可以规避重要的解剖结构、避免严重的手术并发症,还可以将种植体植入到最佳的三维位置。此外,数字化印模技术和CAD/CAM的应用使得口腔印模更加高效、快捷、精确、简便、舒适,并且使得临时及最终修复体更加精密、制作更加快捷,极大提高了临床效率。结论美学区牙缺失后采用数字化即刻种植即刻修复并结合角度螺丝通道基台修复,可以很好地恢复缺失牙美观和功能,并能避免粘接剂残留带来的并发症,是一种良好的修复方法。

关键词: 数字化即刻种植, 种植修复, 角度螺丝通道基台, 术前评估, 美学区, 牙龈轮廓维, 牙龈乳头, 美学效果, 粘接固位, 螺丝固位

Abstract:

Objective To investigate the application of digital immediate implant and angle screw channel abutment in the aesthetic area and the related influencing factors by reviewing the data of one case of immediate implant repair of the upper anterior teeth and related literature. Methods One case of refractory chronic apicitis of the upper anterior teeth involved immediate implantation after extraction. The digital information of the patient was obtained by CBCT and intraoral scanning. According to the information from the patients, a preoperative evaluation was performed; a treatment scheme was formulated; a minimally invasive extraction was performed; implants were placed under a digital guide plate; and temporary restoration was immediately performed. Six months after the operation, the patients underwent individualized mold removal, and angle screw channel fixation was completed. We observed the cosmetic effects and soft and hard tissue and gingival contour maintenance effects after restoration and reexamined the patients 6 months after restoration. In addition, the relevant literature was reviewed. Results The height of the gingival margin and gingival papilla and gingival contour of this patient were well maintained. The red and white aesthetic effect was good. There was no redness or swelling of the gingiva nor obvious changes in the soft and hard tissues around the implant 6 months after restoration, and the patient was satisfied. The results in the literature review show that a preoperative design based on CBCT and intraoral scanning data combined with digital software and a whole digital guide plate make the procedure more accurate and safer. These factors can not only avoid important anatomical structures and serious surgical complications but can also result in implantation in the best three-dimensional position. In addition, the application of digital impression technology and CAD/CAM increases the efficiency, speed, accuracy, simplicity, and comfort of oral impressions and the construction of temporary and final prostheses more precise and faster, greatly improving clinical efficiency. Conclusion Digital immediate implant and angle screw channel abutment is a good method to restore the aesthetics and function of missing teeth and to avoid the complications caused by adhesive residue.

Key words: digital immediate implant, implant repair, angle screw channel abutment, preoperative evaluation, aesthetic area, gingival contour dimension, gingival papilla, aesthetic effect, cement-retained, screw-retained

中图分类号:

R782.1

万浩元,董天贞,邓蔓菁. 数字化即刻种植修复与角度螺丝通道基台在美学区的应用1例并文献回顾[J]. 口腔疾病防治, 2020, 28(7): 443-448.

WAN Haoyuan,DONG Tianzhen,DENG Manjing. Application of digital immediate implant restoration and angle screw channel abutment in the aesthetic area:case report and literature review[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2020, 28(7): 443-448.

图/表 4

图1 上前牙难治性慢性根尖炎患者初诊情况

Figure 1 The condition at the first diagnosis of the patient of refractory chronic apicitis of the upper anterior teeth a: patient’s smile image; b: intraoral profile image; c: intraoral front image; d: root position of the patient showed in CBCT

表1 美学风险评估表

Table 1 Esthetic risk assessment

Aesthetic risk factors	Low	Middle	High
Health status	Health*	-	Immunocompromise
Smoking habit	No*	A few（< 10/d）	A lot of（> 10/d）
Patients′ aesthetic expectations	Low	Middle	High*
Lip line	Low	Midlle	High*
Gingival biotype	Low arc,thick gum	Middle arc, middle thick gum*	High arc, thin gingiva
Dental crowns form	Squircle squoval*	-	Pointed round
Site infection	No	Chronic*	Acute
Alveolar ridge height of adjacent teeth	To the point of contact <5 mm	To the point of contact 5.5-6.5 mm*	To the point of contact ≥ 7 mm
Repair status of adjacent teeth	No restoration*	-	Have restoration
The width of the gap between the missing teeth	Single tooth（≥ 7 mm）* Single tooth（≥ 5.5 mm）	Single tooth（< 7 mm） Single tooth（< 5.5 mm）	Two or more teeth
Soft tissue anatomy	Soft tissue integrity*	-	Soft tissue defect
Anatomy of alveolar ridge	No bone defect	Horizontal bone defect	Vertical bone defect*

图2 上前牙难治性慢性根尖炎拔除患牙后进行数字化即刻种植即刻修复并结合角度螺丝通道基台修复治疗过程

Figure 2 Treatment process of digital immediate implant immediate restoration combined with angle screw channel abutment restoration after extraction of teeth with refractory chronic apicitis of upper anterior teeth a: implant placement was designed based on restoration-oriented principles; b: make planting and restoration plan and design guide board as planned; c: full guide plate in place; d: prepare holes step by step under guide plate; e: implant under guide plate; f: interstitial bone graft at the lip; g: temporary prosthesis immediately; h: CBCT image after impanting; i: gingival contour of 21# tooth was good; j: mold with personal shift lever; k: design of ASC abutment; l: complete the restration; m: angle between abutment screw and screw channel

图3 上前牙难治性慢性根尖炎拔除患牙后进行数字化即刻种植即刻修复并结合角度螺丝通道基台修复最终修复体戴入患者口内及CBCT情况

Figure 3 The condition of mouth and CBCT in patient with with intractable chronic apicitis of upper anterior teeth after extraction and immediate digital implant repair combined with angle screw channel abutment repair after final restoration was put in a: patient′s smile image after treatment; b: intraoral profile image after treatment; c-e: the condition of mouth after treatment; f: the CBCT image after treatment; g-i: the condition of mouth after 6 months of treatment; j: the CBCT image after 6 months of treatment

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