本文選題：上頜前牙 + 即刻種植�。� 參考：《昆明醫(yī)科大學》2016年碩士論文

【摘要】：[目的]通過對28例單顆上頜前牙美學區(qū)即刻種植患者的軟組織進行術(shù)前、戴牙、定期回訪的美學評價追蹤,應用相應美學指標進行評估比較,分析研究上頜前牙美學區(qū)即刻種植的軟組織美學恢復情況,為臨床上頜前牙即刻種植的軟組織美學修復提供一定的參考依據(jù)。[方法]按照納入標準篩選出接受單顆上頜前牙美學區(qū)即刻種植的28例患者年齡在21-60歲之間,平均年齡39.89±11.17歲；其中男性13人,占46.43%,女性15人,占53.57%,所有患者均接受骨引導再生技術(shù)(Guided Bone Regeneration, GBR),同時均未行軟組織增加技術(shù)。分別記錄每位患者術(shù)前、術(shù)中、戴牙及定期回訪時的軟硬組織測量數(shù)據(jù)。通過實際口內(nèi)測量、照片記錄以及X線片和CBCT影像學資料觀察評估即刻種植位點的齦緣位置及形態(tài)、牙齦乳頭位置及形態(tài)、附著齦寬度、種植體周骨量以及戴牙后紅色美學指數(shù)(pink esthstic score,PES)的變化。第一部分：根據(jù)測量數(shù)據(jù)比較患者接受前牙即刻種植后不同評估時間的牙齦軟組織指標(包括牙齦邊緣形態(tài)、附著齦寬度、牙齦乳頭指數(shù)和PES評分的修復變化情況)；第二部分：根據(jù)不同患者的術(shù)前評估,比較同一類型患者(治療原因、骨缺損類型、牙齦生物型、術(shù)前牙齦乳頭狀態(tài))接受前牙即刻種植后軟組織的修復變化情況。計數(shù)資料采用百分比表述,計量資料采用均數(shù)士標準差表述,通過χ2檢驗、方差分析、重復測量資料方差分析等統(tǒng)計學方法對數(shù)據(jù)進行分析處理。[結(jié)果]第一部分：不同評估時間時牙齦軟組織指標的變化情況。1、牙齦邊緣形態(tài)對稱率在戴牙即刻為50%、戴牙1-6個月為57.14%、戴牙1年為66.67%、戴牙2年為72.22%,不同評估時間牙齦邊緣形態(tài)的變化情況無統(tǒng)計學意義(p值0.05)；2、附著齦寬度在戴牙即刻為5.12±0.72mm、戴牙1-6個月為5.17±0.74mm、戴牙1年為5.23±0.67mm、戴牙2年為5.28±0.53mm,不同評估時間附著齦寬度的變化情況無統(tǒng)計學意義(p值0.05)；3、牙齦乳頭指數(shù)3度的百分率在戴牙即刻為28.57%、戴牙1-6個月為50%、戴牙1年為85.71%、戴牙2年為83.33%,不同評估時間內(nèi)牙齦乳頭指數(shù)的變化(χ2=22.542,p值0.001)有統(tǒng)計學意義;4、PES評分在戴牙即刻為10.14±1.69、戴牙1-6個月為11.29±1.49、戴牙1年為11.55±1.23、戴牙2年為11.72±1.0,不同評估時間與PES評分的變化(F=12.785,p0.001)有統(tǒng)計學意義,PES評分隨戴牙時間的增加而增加。第二部分：牙齦軟組織指標與術(shù)前評估因素(治療原因、骨缺損類型、牙齦生物型、牙齦乳頭位置)的相關(guān)性。1、牙齦邊緣形態(tài)的變化與中間型牙齦生物型(χ2=5.939,p值0.05)有統(tǒng)計學意義；2、附著齦寬度的變化與術(shù)前評估指標無統(tǒng)計學意義(p值0.05)；3、牙齦乳頭指數(shù)的變化與因固定義齒修復失敗(χ2=15.479,p值0.001)、B+C型骨缺損(χ2=21.917,p值0.001)、中間型牙齦生物型(χ2=19.949,p值0.001)和術(shù)前牙齦乳頭位置退縮(χ2=17.611,p值0.001)這4項術(shù)前評估指標有統(tǒng)計學意義；4、PES評分變化與治療原因、牙齦生物型、術(shù)前評估牙齦乳頭狀況無交互作用(p值0.05),PES評分變化和不同骨缺損類型(F=17.732,p=0.001)有線性趨勢。[結(jié)論]1、在牙槽嵴骨量充足穩(wěn)定的條件下,牙齦軟組織的4項評價指標中,附著齦寬度在本實驗的觀察期內(nèi)隨戴牙時間的增長變化不大；牙齦邊緣形態(tài)、牙齦乳頭指數(shù)、PES評分在戴牙即刻至戴牙2年的定期復診中均有一定程度的恢復,且牙齦乳頭指數(shù)和PES評分可隨戴牙時間的增長而增加,戴牙即刻至戴牙1年的增長趨勢變化明顯；戴牙1年后增長變緩趨于平穩(wěn)。2、即刻種植戴牙后牙齦軟組織指標變化與術(shù)前評估指標(治療原因、骨缺損類型、牙齦生物型、牙齦乳頭位置)的相關(guān)性分析得出以下四點：(1)中間型牙齦生物型可影響牙齦邊緣形態(tài)的對稱率。(2)術(shù)前評估指標對附著齦寬度的變化無明顯影響。(3)治療原因中固定義齒修復失敗、骨缺損類型中B+C型骨缺損、牙齦生物型的中間型、術(shù)前牙齦乳頭位置退縮的病例可影響戴牙后牙齦乳頭指數(shù)的變化。(4)PES評分均值隨戴牙時間增加而增加,不同骨缺損類型可能影響不同評估時間的PES評分的變化。
[Abstract]:[Objective] to study the aesthetic evaluation and comparison of the soft tissues of 28 patients with single maxillary anterior teeth in the American school area before and after the aesthetic evaluation, the aesthetic evaluation and comparison were carried out, and the soft tissue aesthetic restoration of the immediate implant in the maxillary anterior teeth was analyzed and studied. Aesthetical repair provides a reference basis. [Methods] 28 patients aged 39.89 + 11.17 years old, with an average age of 39.89 + 11.17 years old, were screened for immediate implantation in the United States school area of the maxillary anterior teeth according to the inclusion criteria, including 13 men, 46.43%, 15 women, 53.57%. All patients received bone guided regeneration (Guided Bone Regene). Ration, GBR), at the same time, no soft tissue added technique was performed. The soft and hard tissue measurements of each patient were recorded before, during, during, and at regular return. The gingival margin and shape of the immediate implant site, the position and shape of the gingival nipple were evaluated by actual intraoral measurements, photo records, X ray and CBCT imaging data. Changes in gingival width, periment bone mass and pink esthstic score (PES) after tooth wear. Part 1: according to the measured data, the gingival soft tissue indexes (including gingival edge morphology, gingival width, gingival papilla index and PES score) were compared. The second part: according to the preoperative assessment of different patients, compare the same type of patients (treatment cause, bone defect type, gingiva biologic type, gingival papilla state) to accept the repair changes of the soft tissue after immediate implant. The data were analyzed by statistical methods such as chi 2 test, variance analysis and repeated measurement data ANOVA. [results] the first part: the change of the soft tissue index of gingiva at different time of evaluation.1, the symmetry rate of the gingival edge was 50%, the tooth was 57.14%, the tooth was 66.67%, and the tooth was 72.22% for 2 years, and the 2 year was 72.22%. There was no statistical significance (P value 0.05) at the gingival edge morphology at the same time. 2, the width of the attached gingiva was 5.12 + 0.72mm at the moment, 5.17 + 0.74mm in the teeth for 1-6 months, 5.23 + 0.67mm in 1 years and 5.28 + 0.53mm in the teeth, and there was no statistical significance (P value 0.05) for the variation of gingival width at different time of assessment (0.05); 3, gingiva. The percentage of 3 degree nipple index was 28.57%, 1-6 months was 50%, 1 years was 85.71%, and 2 years was 83.33%. The changes of gingival papilla index (x 2=22.542, P value 0.001) in different evaluation time were statistically significant; 4, PES score was 10.14 + 1.69 at the moment of wearing teeth. 2 years was 11.72 + 1, with different evaluation time and PES score (F=12.785, p0.001). The PES score increased with the increase of dental time. The second part: the correlation between the soft tissue index of the gingiva and the preoperative assessment factors (treatment cause, bone defect type, gingival biologic type, gingiva papilla position), and the shape of gingiva edge. The changes in the gingival biologic type (x 2=5.939, P value 0.05) were statistically significant. 2, the variation of the gingival width was not statistically significant (P value 0.05); 3, the changes of the gingival papilla index and the failure of fixed denture repair (x 2=15.479, P value 0.001), B+C bone defect (x 2=21.917, P value 0.001), and intermediate gingival biologic type (x 2=19.949, P value 0.001) and preoperative gingival papilla position retraction (x 2=17.611, P value 0.001) these 4 preoperative assessment indicators were statistically significant; 4, PES score changes and treatment causes, gingival biologic type, preoperative assessment of the status of the gingival papilla (P value 0.05), PES score changes and different types of bone defect (F=17.732, p=0.001) have linear trend. [Conclusion] [conclusion]1, under the condition that the alveolar ridge is sufficient and stable, the gingival width of the gingival tissue varies little in the observation period of the gingival soft tissue with the increase of the time of tooth wear. The shape of the gingival edge, the index of the gingival papilla, and the PES score have a certain degree of recovery in the regular revisit of the teeth at the moment of wearing the teeth to the 2 year of the teeth. The gingival papilla index and PES score increased with the time of tooth wear, and the growth trend of wearing teeth immediately to 1 years was obvious. After 1 years of tooth wear, the growth slowed down to a smooth.2. The changes of the soft tissue index of the gingival tissue and the preoperative evaluation index (treatment cause, bone defect type, gingival biologic type, gingiva papilla position) The correlation analysis obtained the following four points: (1) the intermediate gingival biologic type could affect the symmetry of the gingival edge morphology. (2) the preoperative evaluation index had no significant influence on the change of the attached gingival width. (3) the failure of fixed denture repair, B+C bone defect in the type of bone defect, the intermediate type of gingival biologic type, and the position of the gingival papilla before the operation. The cases of retraction can affect the changes in the gingival papillary index of the teeth after wearing. (4) the mean PES score increases with the increase of the time of tooth wear, and the different types of bone defects may affect the changes of the PES score of the different evaluation time.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R783.6

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