翻瓣植骨非埋入式即刻牙種植在上頜前牙區(qū)的應(yīng)用及臨床效果觀察
發(fā)布時間：2019-06-27 10:59
【摘要】：目的:探討翻瓣植骨非埋入式即刻牙種植的可行性,觀察其在上頜前牙區(qū)應(yīng)用的臨床效果,為上頜前牙區(qū)即刻牙種植及骨增量技術(shù)的應(yīng)用開辟新途徑。方法:選擇2015年02月至2016年05月因殘根、牙折斷或牙周病無保留意義的上頜前牙區(qū)的患牙,要求行即刻牙種植治療且無即刻種植手術(shù)禁忌癥的患者45例(男19例,女26例),年齡范圍18~52歲(平均年齡36歲),計劃共植入50顆種植體。常規(guī)口腔頜面部消毒,鋪無菌洞巾,局麻下微創(chuàng)拔除患牙;在患牙近中或遠(yuǎn)中鄰牙唇側(cè)正中做斜行牙齦切口,切開黏骨膜,于患牙近遠(yuǎn)中牙齦乳頭正中切開,用骨膜剝離子自唇側(cè)斜行切口在骨膜深面向齦緣方向剝離牙齦黏骨膜,充分暴露拔牙窩唇側(cè)的牙槽骨,用骨膜剝離子沿腭側(cè)牙槽嵴頂適當(dāng)分離腭側(cè)黏骨膜,顯露腭側(cè)牙槽嵴頂;徹底搔刮拔牙窩,生理鹽水沖洗牙槽窩,在牙槽窩根端向根方根據(jù)種植體植入的正確位置級差備洞制備種植窩,深度大于4mm;即刻植入合適直徑和長度的種植體,安裝一枚直徑稍大于種植體直徑且穿齦高度高出牙槽嵴頂黏膜1mm以上的愈合基臺;根據(jù)唇側(cè)牙槽骨缺損的范圍,于唇側(cè)骨缺損區(qū)植骨、蓋膠原膜,黏骨膜瓣復(fù)位,間斷縫合創(chuàng)口;術(shù)后6個月實施永久修復(fù),修復(fù)后1年隨訪;根據(jù)紅、白美學(xué)(PES/WES)評價標(biāo)準(zhǔn),觀察種植體周圍軟組織及修復(fù)體美學(xué)效果;根據(jù)錐形束CT(CBCT)數(shù)據(jù)測量,對比觀察種植體唇側(cè)牙槽骨的骨量變化;采用視覺測量尺(VAS)調(diào)查患者主觀滿意度。結(jié)果:45例患者的50顆種植體均成功實現(xiàn)了翻瓣植骨非埋入式即刻植入;所有種植體植入后均具有良好的初期穩(wěn)定性,軟組織創(chuàng)口均Ⅰ期愈合,無一例創(chuàng)口裂開,無一例發(fā)生植骨材料外露。術(shù)后6個月實施修復(fù)時所有種植體的上端牙齦健康且軟組織袖口形態(tài)良好;所有種植體均實現(xiàn)了基臺一體冠或基臺一體橋修復(fù);其中40例單顆牙即刻種植病例均完成基臺一體冠修復(fù),PES均值達(dá)到8.05±0.93,WES均值達(dá)到7.93±0.95,美學(xué)效果顯著。修復(fù)后1年隨訪,種植體存留率100%,50顆種植體唇側(cè)植骨區(qū)成骨效果顯著;種植修復(fù)完成時與種植術(shù)后即刻相比,種植體唇側(cè)骨厚度減少了0.67mm,而修復(fù)完成后1年復(fù)診時與修復(fù)完成時相比,種植體唇側(cè)骨厚度減少了0.08mm,骨組織穩(wěn)定性良好�；颊邔π迯�(fù)效果滿意度均較高,VAS均值達(dá)到8.42±1.01。結(jié)論:翻瓣植骨非埋入式即刻牙種植是一種行之有效的治療方法,只需1次手術(shù)即可完成牙種植體植入、骨增量及種植體上方軟組織成形,尤其對于美學(xué)要求較高的上頜前牙區(qū)種植,美學(xué)修復(fù)效果較為顯著,軟硬組織穩(wěn)定性良好,具有廣泛的臨床推廣應(yīng)用前景。
[Abstract]:Objective: to investigate the feasibility of non-embedded immediate tooth implantation with flip flap bone grafting, to observe the clinical effect of its application in maxillary anterior tooth area, and to open up a new way for the application of immediate tooth implantation and bone increment technique in maxillary anterior tooth area. Methods: from February 2015 to May 2016, 45 patients (19 males and 26 females) with unreserved maxillary anterior teeth due to residual root, broken teeth or periodontal disease were enrolled in this study. A total of 50 implants were planned to be implanted in 45 patients (19 males and 26 females) with an age range of 18 to 52 years (mean age 36 years). Routine oral and maxillofacial disinfection, laying aseptic cave towels, minimally invasive extraction of affected teeth under local anesthesia; Oblique gingival incision was made in the middle of the labial side of the adjacent teeth, the mucoperiosteum was cut, and the mucoperiosteum was cut in the proximal and distal alveolar papilla of the affected teeth. The periosteal peeling ion oblique incision was used to peel the gum mucoperiosteum in the direction of the periosteum facing the margin of the gum, and the alveolar bone of the alveolar side of the tooth was fully exposed. The mucoperiosteum of the palatine side was properly separated along the alveolar crest of the palatine side by periosteum peeling ion, and the alveolar crest of the palatine side was exposed. The alveolar fossa was thoroughly scratched and pulled out, the alveolar fossa was washed with saline, and the implantation nest was prepared at the root end of the alveolar fossa according to the correct position of the implantation, the depth was more than 4 mm, and a healing base with a diameter slightly larger than the diameter of the implant and higher than the 1mm of the alveolar crest mucous membrane was installed immediately, and a healing base with a diameter slightly larger than the diameter of the implantation and higher than the height of the alveolar crest mucous membrane was installed at the root end of the alveolar fossa. According to the range of labial alveolar bone defect, bone grafting, capping collagen membrane, mucoperiosteal flap reduction and intermittent suture wound were performed 6 months after operation and followed up one year after repair. According to the evaluation criteria of red and white aesthetics (PES/WES), the aesthetic effects of soft tissue and restoration were observed, and the bone mass changes of labial alveolar bone were compared according to CT (CBCT) data of conical bundles. The subjective satisfaction of the patients was investigated by visual ruler (VAS). Results: all the 50 implants in 45 patients were successfully implanted without implantable bone grafting, all of them had good initial stability, soft tissue wounds healed in the first stage, none of them were cracked, and no bone graft materials were exposed. At 6 months after operation, the upper gums of all implants were healthy and the cuffs of soft tissue were in good shape, all of them achieved the restoration of platform crown or platform bridge, and 40 cases of immediate implantation of single tooth completed the restoration of platform crown, the mean value of PES was 8.05 鹵0.93, and the mean value of Wes was 7.93 鹵0.95. the aesthetic effect was remarkable. One year after restoration, the survival rate of the Implant was 100%, and the osteogenic effect was significant in the labial bone graft area of 50 implants. compared with the immediate after implantation, the thickness of the labial bone decreased by 0.67mm, and the thickness of the labial bone decreased by 0.08mm one year after the restoration, and the stability of the bone tissue was good. The patients were satisfied with the repair effect, and the mean value of VAS was 8.42 鹵1.01. Conclusion: non-implantable immediate tooth implantation is an effective treatment. Dental implantation, bone increment and soft tissue formation above the implantation can be completed only once, especially for maxillary anterior tooth implantation with high aesthetic requirements. Aesthetic restoration effect is remarkable, soft and hard tissue stability is good, and it has a wide range of clinical application prospects.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.1
本文編號：2506726
[Abstract]:Objective: to investigate the feasibility of non-embedded immediate tooth implantation with flip flap bone grafting, to observe the clinical effect of its application in maxillary anterior tooth area, and to open up a new way for the application of immediate tooth implantation and bone increment technique in maxillary anterior tooth area. Methods: from February 2015 to May 2016, 45 patients (19 males and 26 females) with unreserved maxillary anterior teeth due to residual root, broken teeth or periodontal disease were enrolled in this study. A total of 50 implants were planned to be implanted in 45 patients (19 males and 26 females) with an age range of 18 to 52 years (mean age 36 years). Routine oral and maxillofacial disinfection, laying aseptic cave towels, minimally invasive extraction of affected teeth under local anesthesia; Oblique gingival incision was made in the middle of the labial side of the adjacent teeth, the mucoperiosteum was cut, and the mucoperiosteum was cut in the proximal and distal alveolar papilla of the affected teeth. The periosteal peeling ion oblique incision was used to peel the gum mucoperiosteum in the direction of the periosteum facing the margin of the gum, and the alveolar bone of the alveolar side of the tooth was fully exposed. The mucoperiosteum of the palatine side was properly separated along the alveolar crest of the palatine side by periosteum peeling ion, and the alveolar crest of the palatine side was exposed. The alveolar fossa was thoroughly scratched and pulled out, the alveolar fossa was washed with saline, and the implantation nest was prepared at the root end of the alveolar fossa according to the correct position of the implantation, the depth was more than 4 mm, and a healing base with a diameter slightly larger than the diameter of the implant and higher than the 1mm of the alveolar crest mucous membrane was installed immediately, and a healing base with a diameter slightly larger than the diameter of the implantation and higher than the height of the alveolar crest mucous membrane was installed at the root end of the alveolar fossa. According to the range of labial alveolar bone defect, bone grafting, capping collagen membrane, mucoperiosteal flap reduction and intermittent suture wound were performed 6 months after operation and followed up one year after repair. According to the evaluation criteria of red and white aesthetics (PES/WES), the aesthetic effects of soft tissue and restoration were observed, and the bone mass changes of labial alveolar bone were compared according to CT (CBCT) data of conical bundles. The subjective satisfaction of the patients was investigated by visual ruler (VAS). Results: all the 50 implants in 45 patients were successfully implanted without implantable bone grafting, all of them had good initial stability, soft tissue wounds healed in the first stage, none of them were cracked, and no bone graft materials were exposed. At 6 months after operation, the upper gums of all implants were healthy and the cuffs of soft tissue were in good shape, all of them achieved the restoration of platform crown or platform bridge, and 40 cases of immediate implantation of single tooth completed the restoration of platform crown, the mean value of PES was 8.05 鹵0.93, and the mean value of Wes was 7.93 鹵0.95. the aesthetic effect was remarkable. One year after restoration, the survival rate of the Implant was 100%, and the osteogenic effect was significant in the labial bone graft area of 50 implants. compared with the immediate after implantation, the thickness of the labial bone decreased by 0.67mm, and the thickness of the labial bone decreased by 0.08mm one year after the restoration, and the stability of the bone tissue was good. The patients were satisfied with the repair effect, and the mean value of VAS was 8.42 鹵1.01. Conclusion: non-implantable immediate tooth implantation is an effective treatment. Dental implantation, bone increment and soft tissue formation above the implantation can be completed only once, especially for maxillary anterior tooth implantation with high aesthetic requirements. Aesthetic restoration effect is remarkable, soft and hard tissue stability is good, and it has a wide range of clinical application prospects.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R782.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 王文芳;李志華;;牙槽骨開裂與開窗的研究進展[J];中華口腔醫(yī)學(xué)雜志;2013年09期
，本文編號：2506726
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