上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究

doi:10.12016/j.issn.2096-1456.2022.07.004

口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (7): 483-490.DOI: 10.12016/j.issn.2096-1456.2022.07.004

上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究

苏镇亚(), 李诗琪, 莫安春()

口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院种植科,四川成都（610041）

收稿日期:2021-11-08 修回日期:2022-01-16 出版日期:2022-07-20 发布日期:2022-04-25
通讯作者: 莫安春
作者简介:苏镇亚,主治医师,博士研究生,Email： suzhenya@stu.scu.edu.cn
基金资助:
国家重点研发项目(2016YFA0201703);四川省卫健委重点项目(19ZD008);四川大学华西口腔医院临床研究项目(LCYJ2020-YF-2)

A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area

SU Zhenya(), LI Shiqi, MO Anchun()

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Implantation, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2021-11-08 Revised:2022-01-16 Online:2022-07-20 Published:2022-04-25
Contact: MO Anchun
Supported by:
National Key Research and Development Program of China(2016YFA0201703);Sichuan Health Research Project(19ZD008);Clinical Research Project of West China Hospital of Stomatology, Sichuan University(LCYJ2020-YF-2)

摘要/Abstract

摘要：

目的探讨唇侧骨板部分缺损的患者行即刻种植和延期种植对术后软硬组织变化情况及美学效果的影响。方法将40例唇侧骨板呈有利型裂开式骨缺损,且缺损高度不超过4 mm的上颌单颗前牙患者分为即刻种植组（20例）和延期种植组（20例）,两组均在全程导板引导下植入Nobel Active种植体,种植体颈部平台位于唇侧龈缘根方3 ~ 4 mm。植入后两组均行即刻修复,并应用Bio-Oss骨粉及Bio-Gide膜同期行引导骨再生术（guided bone regeneration,GBR）。比较两组种植体成功率、种植体唇侧骨板厚度变化、种植体唇侧轮廓厚度变化以及红色美学评分（pink esthetic score,PES）。结果两组患者的种植体成功率均为100%,随访期间未发生并发症。两组术后唇侧骨板均在种植体颈部观察到最大的骨吸收量,术后12个月即刻种植组的颈部骨吸收量为（1.29 ± 0.71）mm,延期种植组为（1.43 ± 0.19）mm,但两组间在各测量位点骨吸收量差异均无统计学意义。即刻种植组和延期种植组术后6个月及12个月唇侧龈缘最高点以及近远中牙龈乳头高度的变化量差异均无统计学意义;PES评分在术后12个月分别为（10.95 ± 1.51）分和（11.05 ± 1.23）分。结论对于唇侧骨板呈有利型裂开式骨缺损,且缺损高度不超过4 mm的上颌单颗前牙,在即刻种植和延期种植后行即刻修复及同期GBR均为可行的治疗方案。

关键词: 即刻种植, 延期种植, 即刻修复, 引导骨再生术, 唇侧骨板缺损, 有利型骨缺损, 裂开式骨缺损, 翻瓣手术, 美学区, 上前牙区

Abstract:

Objective To investigate the effect of immediate and delayed implant placement on dimensional changes in hard and soft tissues as well as esthetic outcomes. Methods A total of 40 maxillary single anterior teeth with a dehiscence defect on the labial bone (≤4 mm) were categorized into two groups according to the timing of implant placement: immediate implant placement (n = 20) or delayed implant placement (n = 20). Guided bone regeneration (GBR) was conducted at the sites using a flap approach, and the implants were given immediate provisionalization. Implant survival rates, dimensional changes in hard and soft tissues during the six- and twelve-month follow-ups, and pink esthetic scores (PESs) were measured. Results The implant survival rates in both groups were 100%, and no complications occurred during the follow-up time. There was no significant difference between the two groups at the measurement sites in the dimensional change of hard and soft tissues during the six- and twelve-month follow-ups. The largest resorption was observed at the implant neck, with a loss of (1.29 ± 0.71) mm in the immediate implant placement group and (1.43 ± 0.19) mm in the delayed implant placement group. The mean PES scores were (10.95 ± 1.51) for the immediate implant placement group and (11.05 ± 1.23) for the delayed implant placement group. Conclusion Immediate implantation or delayed implantation combined with GBR and immediate provisionalization might both be a prospective treatment strategy for a maxillary single anterior tooth with a dehiscence defect on the labial bone.

Key words: immediate implant placement, delayed implant placement, immediate provisionalization, guided bone regeneration, labial bony defect, friendly bone defect, dehiscence defect, flap surgery, esthetics zone, maxillary anterior region

中图分类号:

苏镇亚, 李诗琪, 莫安春. 上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究[J]. 口腔疾病防治, 2022, 30(7): 483-490.

SU Zhenya, LI Shiqi, MO Anchun. A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2022, 30(7): 483-490.

图/表 6

图1 即刻种植组的外科手术流程及回访

Figure 1 The surgical flow and follow-up of immediate implant group a: baseline clinical situation of the hopeless 11; b: digital implant planning; c: the labial bony defect was observed and immediate provisionalization; d: the bone graft substitute was covered with a absorbable membrane; e: intraoral view at 12 months; f: CBCT image at 12 months after surgery

图2 延期种植组的外科手术流程及回访

Figure 2 The surgical flow and follow-up of delayed implant group a: baseline clinical situation of the hopeless 11; b: digital implant planning; c: the labial bony defect was observed; d: the bone graft substitute was grafted into the labial defect area; e: intraoral view at 12 months; f: CBCT image at 12 months after surgery

图3 上颌单颗种植体唇侧软硬组织变化分析

Figure 3 Labial dimensional change analysis of soft and hard tissues of maxillary single implant a: the STL(converted from Dicom in SimPlant software) superimposition results for different morphologies on three time points(T1: green, T2: blue, T3: yellow); b: the thickness of labial bone were measured from the labial outlines of to the implant(B0-B4: the thickness of labial bone contour at 0, 2, 4, 6, 8 mm apical from the implant neck); c: the STL superimposition results for different morphologies on three time points(T0: red, T2: blue, T3: yellow, MF: midfacial mucosal margin, MP: mesial papilla, DP: distal papilla); d: cross-section view(T0: red, T2: blue, T3: yellow, A1: midfacial mucosa at T0, A2: midfacial mucosa at T2, A3: midfacial mucosa at T3, A1A2: vertical distance between A1 and A2, A1A3: vertical distance between A1 and A3)

表1 两组唇侧骨板厚度在不同水平的测量及变化量

Table 1 Thickness changes of labial bone at different levels for both group x ± s, mm

Items	Groups	T1	t	P	T2-T1	t	P	T3-T1	t	P
B0	Group A	3.74 ± 0.71	1.125	0.268	-1.20 ± 0.69	0.658	0.515	-1.29 ± 0.71	0.607	0.547
	Group B	3.50 ± 0.60			-1.35 ± 0.76			-1.43 ± 0.19
B1	Group A	3.87 ± 0.65	-0.349	0.729	-1.11 ± 0.64	1.138	0.263	-1.23 ± 0.63	0.942	0.352
	Group B	3.95 ± 0.74			-1.30 ± 0.45			-1.39 ± 0.50
B2	Group A	3.80 ± 0.86	-0.996	0.326	-1.02 ± 0.85	1.551	0.137	-1.17 ± 0.84	1.048	0.307
	Group B	4.07 ± 0.79			-1.31 ± 0.14			-1.37 ± 0.85
B3	Group A	3.42 ± 0.98	-1.152	0.257	-0.83 ± 0.85	1.345	0.187	-0.98 ± 0.88	1.178	0.246
	Group B	3.73 ± 0.72			-1.17 ± 0.74			-1.28 ± 0.73
B4	Group A	2.69 ± 1.15	-1.000	0.328	-0.83 ± 0.57	0.417	0.679	-1.02 ± 0.73	0.863	0.394
	Group B	2.96 ± 0.33			-0.90 ± 0.50			-1.19 ± 0.49

表2 两组软组织高度变化在不同水平的测量

Table 2 Soft tissue dimensional changes at different levels for both groupx ± s, mm

Items	Groups	T2-T0	t	P	T3-T0	t	P
ΔMF	Group A	-0.57 ± 0.31	-0.252	0.820	-0.64 ± 0.30	-0.321	0.819
	Group B	-0.60 ± 0.32			-0.67 ± 0.35
ΔMP	Group A	-0.48 ± 0.23	-0.088	0.929	-0.55 ± 0.24	-0.027	0.600
	Group B	-0.49 ± 0.26			-0.55 ± 0.32
ΔDP	Group A	-0.51 ± 0.33	-0.019	0.626	-0.59 ± 0.36	0.242	0.324
	Group B	-0.52 ± 0.32			-0.56 ± 0.30

表3 红色美学分值评分

Table 3 Pink esthetics scores x ± s

Items	Groups	T2	t	P	T3	t	P
PES	Group A	10.35 ± 1.27	-0.554	0.583	10.95 ± 1.51	-0.230	0.819
	Group B	10.55 ± 1.01			11.05 ± 1.23

参考文献 22

[1]	郭磊, 洪峰, 王远勤. 即刻种植和早期种植对前牙美学区种植体周软组织影响的对比研究[J]. 口腔疾病防治, 2017, 25(4): 245-249. doi: 10.12016/j.issn.2096-1456.2017.04.009. DOI
	Guo L, Hong F, Wang YQ. A comparative study between the immediate and early implant on the aesthetic influences of the peri-implant soft tissues in the aesthetic area[J]. J Prev Treat Stomatol Dis, 2017, 25(4): 245-249. doi: 10.12016/j.issn.2096-1456.2017. 04.009. DOI
[2]	Buser D, Chappuis V, Belser UC, et al. Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late?[J]. Periodontol 2000, 2017, 73(1): 84-102. doi: 10.1111/prd.12170. DOI URL
[3]	Gomez-Meda R, Esquivel J, Blatz MB. The esthetic biological contour concept for implant restoration emergence profile design[J]. J Esthet Restor Dent, 2021, 33(1): 173-184. doi: 10.1111/jerd.12714. DOI PMID
[4]	Shibly O, Patel N, Albandar JM, et al. Bone regeneration around implants in periodontally compromised patients: a randomized clinical trial of the effect of immediate implant with immediate loading[J]. J Periodontol, 2010, 81(12): 1743-1751. doi: 10.1902/jop.2010.100162. DOI URL
[5]	Su Z, Chen Y, Wang M, et al. Evaluation of immediate implantation and provisionalization combined with guided bone regeneration by a flap approach in the maxillary esthetic zone: a retrospective controlled study[J]. Materials (Basel), 2021, 14(14): 3874. doi: 10.3390/ma14143874. DOI URL
[6]	Buser D, Weber HP, Lang NP. Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants[J]. Clin Oral Implants Res, 1990, 1(1): 33-40. doi: 10.1034/j.1600-0501.1990. 010105.x. DOI URL
[7]	Fürhauser 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. doi: 10.1111/j.1600-0501.2005.01193.x. DOI URL
[8]	Elsyad MA, Elgamal M, Mohammed AO, et al. Patient satisfaction and oral health-related quality of life (OHRQoL) of conventional denture, fixed prosthesis and milled bar overdenture for All-on-4 implant rehabilitation. A crossover study[J]. Clin Oral Implants Res, 2019, 30(11): 1107-1117. doi: 10.1111/clr.13524. DOI URL
[9]	Liu D, Shi L, Dai X, et al. Implants placed simultaneously with maxillary sinus floor augmentation in the presence of antral pseudocysts: presentation of a case series[J]. Quintessence Int, 2018, 49(6): 479-485. doi: 10.3290/j.qi.a40248. DOI
[10]	Kolerman R, Nissan J, Rahmanov A, et al. Radiological and biological assessment of immediately restored anterior maxillary implants combined with GBR and free connective tissue graft[J]. Clin Implant Dent Relat Res, 2016, 18(6): 1142-1152. doi: 10.1111/cid.12417. DOI URL
[11]	Chappuis V, Engel O, Shahim K, et al. Soft tissue alterations in esthetic postextraction sites: a 3-dimensional analysis[J]. J Dent Res, 2015, 94(9 Suppl): 187S-193S. doi: 10.1177/0022034515592869. DOI
[12]	Aludden HC, Mordenfeld A, Hallman M, et al. Lateral ridge augmentation with Bio-Oss alone or Bio-Oss mixed with particulate autogenous bone graft: a systematic review[J]. Int J Oral Maxillofac Surg, 2017, 46(8): 1030-1038. doi: 10.1016/j.ijom.2017.03. 008. DOI URL
[13]	Borges T, Fernandes D, Almeida B, et al. Correlation between alveolar bone morphology and volumetric dimensional changes in immediate maxillary implant placement: a 1-year prospective cohort study[J]. J Periodontol, 2020, 91(9): 1167-1176. doi: 10.1002/JPER.19-0606. DOI URL
[14]	Yang X, Zhou T, Zhou N, et al. The thickness of labial bone affects the esthetics of immediate implant placement and provisionalization in the esthetic zone: a prospective cohort study[J]. Clin Implant Dent Relat Res, 2019, 21(3): 482-491. doi: 10.1111/cid.12785. DOI URL
[15]	Esquivel J, Meda RG, Blatz MB. The impact of 3D implant position on emergence profile design[J]. Int J Periodontics Restorative Dent, 2021, 41(1): 79-86. doi: 10.11607/prd.5126. DOI URL
[16]	Liu R, Yang Z, Tan J, et al. Immediate implant placement for a single anterior maxillary tooth with a facial bone wall defect: a prospective clinical study with a one-year follow-up period[J]. Clin Implant Dent Relat Res, 2019, 21(6): 1164-1174. doi: 10.1111/cid.12854. DOI URL
[17]	Xu L, Wang X, Zhang Q, et al. Immediate versus early loading of flapless placed dental implants: a systematic review[J]. J Prosthet Dent, 2014, 112(4): 760-769. doi: 10.1016/j.prosdent.2014.01.026. DOI URL
[18]	Karl M, Irastorza-Landa A. Does implant design affect primary stability in extraction sites?[J]. Quintessence Int, 2017, 48(3): 219-224. doi: 10.3290/j.qi.a37690. DOI
[19]	Zhang X, Wang M, Mo A. An alternative method for immediate implant-supported restoration of anterior teeth assisted by fully guided templates: a clinical study[J]. J Prosthet Dent, 2021, 126(5): 636-645. doi: 10.1016/j.prosdent.2020.05.036. DOI URL
[20]	González-Martín O, Lee E, Weisgold A, et al. Contour management of implant restorations for optimal emergence profiles: guidelines for immediate and delayed provisional restorations[J]. Int J Periodontics Restorative Dent, 2020, 40(1): 61-70. doi: 10.11607/prd.4422. DOI PMID
[21]	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. doi: 10.1111/cid.12786. DOI URL
[22]	Stoupel J, Lee CT, Glick J, et al. Immediate implant placement and provisionalization in the aesthetic zone using a flapless or a flap-involving approach: a randomized controlled trial[J]. J Clin Periodontol, 2016, 43(12): 1171-1179. doi: 10.1111/jcpe.12610. DOI PMID

上颌美学区唇侧骨板部分缺损行即刻种植和延期种植的前瞻性队列研究

A prospective cohort study of immediate implantation and delayed implantation for a labial bony dehiscence defect in the maxillary aesthetic area

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