口腔疾病防治 ›› 2022, Vol. 30 ›› Issue (7): 483-490.DOI: 10.12016/j.issn.2096-1456.2022.07.004
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:
SU Zhenya(), LI Shiqi, MO Anchun(
)
Received:
2021-11-08
Revised:
2022-01-16
Online:
2022-07-20
Published:
2022-04-25
Contact:
MO Anchun
Supported by:
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。
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)
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 |
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 |
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 |
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 |
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