【作者】 夏海斌；

【导师】 程祥荣；

【作者基本信息】 武汉大学 ， 口腔临床医学， 2004， 博士

【摘要】 对种植义齿成功率的评价着重关注于种植体的生存时间和种植体周围骨组织的吸收，没有考虑到修复体的美观。但对许多患者来说，种植义齿的美观和功能同等重要。影响种植义齿美观的因素包括种植区的解剖条件，种植体的位置和在种植体植入与修复过程中各阶段的软组织处理。软组织的形态极大地影响修复体的整体外观，在种植体植入和软组织处理时都要精心设计以最大程度地保存种植体周围软硬组织。在种植Ⅰ期和Ⅱ期手术时，有多种手术瓣设计和软组织处理方法的报道，以尽量保存软组织的外形与轮廓。此外，暂时修复体在种植体周围软组织成形方面也扮演着重要角色。 本研究旨在观察手术瓣设计及暂时冠对种植体周围软组织的影响，共分三个部分。第一部分观察种植Ⅰ期手术时，软组织切口设计对种植体邻面龈乳头和牙槽嵴水平的影响。第二部分观察种植Ⅱ期手术时，嵴顶旋转瓣对龈乳头高度和附着龈宽度的影响。第三部分观察暂时冠在上前牙种植体周围软组织塑形中的作用。 第一部分 种植Ⅰ期手术瓣设计对种植体邻面龈乳头高度和牙槽嵴水平的影响 种植体植入手术时对软硬组织的手术创伤可能影响日后修复的美观效果，临床医师手术时应尽量防止美学并发症的发生。本研究前瞻性观察在种植Ⅰ期手术时，采用两种不同的手术瓣设计对种植体邻面龈乳头高度和牙槽嵴水平的影响。一种是传统的宽瓣设计，即将龈乳头包括在手术瓣中，另一种是不翻开龈乳头的窄瓣设计。根据纳入标准和排除标准，共有43位患者的45颗种植体纳入研究，种植体的一侧为宽瓣切口，另一侧则为窄瓣切口。采用根尖片测量记录术前、术后邻面牙槽嵴水平的变化，术前、术后取模通过模型测量法记录龈乳头高度的变化。术后3个月时，窄瓣组的龈乳头高度和牙槽嵴水平的降低值分别为0.16±0.08mm，0.13±0.07mm；宽瓣组的龈乳头高度和牙槽嵴水平的降低值分别为0.65±0.20mm，0.17±0.09mm。经配对设计的t检验分析，宽瓣组和窄瓣组的种植体邻面龈乳头高度和牙槽嵴水平变化均具有显著性差异。种植Ⅰ期手术时，窄瓣切口较宽瓣切口更有利于种植体邻面跟乳头高度和牙槽蜡水平的保存，可为义齿修复创造更好的美观条件。 第二部分种植11期手术时靖顶旋转瓣对龋乳头高度和附着龋宽度的影响 软组织处理是影响种植义齿美观效果的重要因素之一。本研究前瞻性观察采用晴顶旋转瓣对上领美观区的单个种植体进行n期手术，对跟乳头高度和附着跟宽度的影响。根据纳入标准和排除标准，共有39位患者的41颗种植体纳入临床观察。所有种植体均采用改良的晴顶旋转瓣进行种植n手术。制取患者术前和术后一月的印模，灌注模型后测量记录种植体两侧敛乳头高度的变化。测量记录术前、术后种植体唇侧附着酿的宽度和跟乳头指数变化。术后种植体两侧跟乳头高度和唇侧附着酿宽度分别增加0.78士0.28~，0.59士0.38~。经配对设计的t检验分析，术前、术后种植体两侧跟乳头高度和唇侧附着龋宽度的变化具有统计学意义。经秩和检验分析，术前、术后跟乳头指数的变化无显著性差异。种植n期手术时晴顶旋转瓣的操作简单实用、预后好，可增加种植体的跟乳头高度和唇颊侧附着跟宽度。 第三部分暂时冠在上前牙种植体周围软组织塑形中的临床应用 即使种植区具有良好的软、硬组织条件，暂时修复体在重建种植体周围软组织外形方面发挥着重要作用。本研究使用暂时冠对上前牙单个种植体周围软组织进行形态调整，并观察其临床效果。共观察了在11颗埋植型种植体中的应用，其中2颗种植体通过在种植体植入时即转移其位置，在n期手术时即刻戴用暂时冠;另9颗种植体在n期手术基台连接术之后，再使用暂时冠进行颈部成形。暂时冠修复4一8周后，所有患者的种植体周围软组织无红肿、探诊无出血，患者无不适，对种植义齿及其周围软组织外观感到满意。暂时冠有助于种植体周围软组织的形态调整和种植体周围龋曲线的重建，可获得满意的穿跟外形。更多还原

【Abstract】 Studies on the success rates of implant dentures consider the survival time of the implant and sometimes the rate of peri-implant bone loss, but rarely take into account aesthetic aspects of the implant restoration. However, for many patients, successful dental implant treatment must result in a functionally as well as aesthetically acceptable outcome. Factors of importance for implant aesthetics include the anatomy of the implant recipient site, the position of the implant in the jaw and the soft tissue management procedures during the various phases of implant placement and restoration. The soft tissue that frames the restoration contributes greatly to the overall appearance of the restoration. To maximally preserve the peri-implant soft or hard tissues, each phase of rebuilding the implant site, placing the implant and managing the soft tissue must be carefully considered. For stage 1 and stage 2 of implant surgery, various surgical flap designs and soft tissue management procedures aim at preserving the contours of soft tissues. In addition, the provisional restorations play an important role on the shaping of the peri-implant soft tissues.This research focuses on the influence of surgery flap design and provisional restoration on peri-implant soft tissue. The clinical study was divided into three parts. The first part was to evaluate the effect of flap design of stage 1 surgery on the papillae height and interproximal crestal bone loss around single-tooth implants. The second part was to observe the influence of crestal rotated flap on the papillae height and width of attached gingiva around single-tooth implants in the esthetic zone of maxillae. The third part was to evaluate the provisional restorations in soft tissue management around dental implants in the anterior maxillae.Part one Influence of flap design of stage 1 surgery on the papillae height and interproximal crestal bone loss around single-tooth implantsThe surgical trauma delivered to soft and hard tissues during implant placement can influence the future esthetic result. The clinician should use surgical techniques that prevent esthetic complications, such as loss of interdental papillae. This prospective study investigated the loss of interdental papillae and interproximal crestal bone loss occurring after placement of single-tooth implants using two different flap designs: the conventional technique with a widely mobilized flap that included the interdental papillae, and a limited flap design that protected the interdental papillae. This study included 43 patients, 45 submerged implants were selected for which the flap design was wide (WF) on one side (mesial or distal) and limited (LF) on the other. Radiographs were used to determine the interproximal crestal bone height, impressions were taken and stone models were used to evaluate the loss of papillae. After three months, the mean interproximal bone loss and papillae loss were 0.13+ 0.07mm, 0.16+0.08mm in the LF sites and 0.17+0.09mm, 0.65+0.20mm for the WF sites. The papillae and interproximal crestal bone loss were of statistically significance less following the use of a limited flap design versus the widely mobilized flap procedure by the Students’ t test for paired data. The use of a limited flap design for single-tooth implants is indicated to avoid possible loss of the papillae and minimize interproximal crestal bone loss. Good esthetic outcomes can be achieved predictably when the corresponding surgical technique and principles described above are used.Part two Effect of crestal rotated flap on the papillae height and width of attached gingiva around single-tooth implants in the esthetic zone of maxillaeSoft tissue management is considered to be one of the paramount factors in achieving the optimal required final result. This prospective study investigated the height of interdental papillae and width of attached gingiva around single-tooth implants in the esthetic zone of maxillae after exposure of implant using crestal rotated flap. The study comprised 41 implan更多还原