上颌磨牙区新鲜拔牙创骨质条件不良的即刻种植
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摘要
目的探讨在上颌磨牙区上颌窦底骨质菲薄的拔牙创,开展即刻种植的可行性。方法收集上颌磨牙区上颌窦底骨质间隔菲薄的拔牙病例,实施同期上颌窦底内提升并即刻种植,观察植体初期稳定性的形式及效果,观察伤口生长及植体愈合情况,观察上颌窦的变化情况。术后六个月制作并佩戴种植牙冠,观察咀嚼功能恢复情况,MCT观察牙槽骨质生长情况并测试比较手术前后牙槽骨的变化。结果共收集32例上颌窦底骨质薄弱的上颌磨牙区拔牙病例实施即刻种植,平均年龄59.8岁。植体长度8.5～10 mm,直径4.5～5.5 mm。植体的最小就位扭力仅依靠手指就位能够维持静立不动,最大就位扭力达到30 Ncm。术后过程平稳,无植体松动失败。术后6月,上颌窦未见异常表现,完成种植牙冠制作佩戴,恢复咀嚼功能良好。随访时间12～96月,成功率100%。治疗前后,颊、腭及近、远中牙槽嵴高度变化差值分别为0.8069±0.6253(t=1.2904, P>0.1)、0.5275±0.3331(t=1.5836, P>0.05)、0.5416±0.4048(t=1.3379, P>0.05)、0.5172±0.3874(t=1.3351, P>0.05)mm,牙槽嵴宽度变化差值为0.5522±0.4381(t=1.2604, P>0.1)mm,术前后牙槽骨尺寸变化差异没有统计学意义(P>0.05)。结论在上颌磨牙区拔牙创骨质条件欠佳、上颌窦底骨质薄弱的情况下实施即刻种植,即可以避免损伤上颌窦底粘膜又能达到良好的种植效果。手术过程简单、创伤小,充分利用了现存牙龈以及牙槽嵴的有利条件,维持了牙槽嵴的形态,避免了延期种植的缺陷和不足。
Objective To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socket with poor bone quality beneath the sinus. Methods We collected the data from the patients undergoing extraction of maxillary molars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extraction were performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of the sinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory function was observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputed tomography(MCT). Results We analyzed 32 extraction cases with immediate implantation in the maxillary molar sockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameter of the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied from the minimum(in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N · cm. The postoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after the operation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installed on the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after the operation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolar ridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069 ± 0.6253 mm(t=1.2904, P>0.1), 0.5272 ±0.3331 mm(t=1.5836, P>0.05), 0.5416±0.4048 mm(t=1.3379, P>0.05), and 0.5172±0.3874 mm(t=1.3351, P>0.05), respectively; the change of the alveolar ridge width was 0.5522±0.4381 mm(t=1.2604, P>0.1) mm. The dimension of the alveolar bone underwent no significant changes after the operation in these patients. Conclusion Immediate implantation in the maxillary extraction socket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of less trauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as compared with delayed implantation.
Objective To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socket with poor bone quality beneath the sinus. Methods We collected the data from the patients undergoing extraction of maxillary molars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extraction were performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of the sinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory function was observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputed tomography(MCT). Results We analyzed 32 extraction cases with immediate implantation in the maxillary molar sockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameter of the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied from the minimum(in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N · cm. The postoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after the operation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installed on the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after the operation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolar ridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069 ± 0.6253 mm(t=1.2904, P>0.1), 0.5272 ±0.3331 mm(t=1.5836, P>0.05), 0.5416±0.4048 mm(t=1.3379, P>0.05), and 0.5172±0.3874 mm(t=1.3351, P>0.05), respectively; the change of the alveolar ridge width was 0.5522±0.4381 mm(t=1.2604, P>0.1) mm. The dimension of the alveolar bone underwent no significant changes after the operation in these patients. Conclusion Immediate implantation in the maxillary extraction socket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of less trauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as compared with delayed implantation.
引文
[1]Zuffetti F,Capelli M,Galli F,et al.Post-extraction implant placement into infected versus non-infected sites:a multicenter retrospective clinical study[J].Clin Implant Dent Relat Res,2017,19(5):833-40.
[2]石磊,黄盛兴,刘慧凤,等.前牙区数字化即刻种植即刻修复病例报道及文献回顾[J].口腔疾病防治,2017,25(2):119-22.
[3]Narad C,Lingraj JB,Aulakh KK,et al.Assessment of primary stability of the implant placed in prepared infected extraction sockets[J].J Oral Biol Craniofac Res,2016,8(3):154-7.
[4]Abi-Aad HL,Daher FI,Baba NZ,et al.Insertion torque of variablethread tapered implants in the posterior maxilla:a clinical study[J].JProsthodont,2018.12965.
[5]Luay Y,Asraa T,Mohemad I,et al.Evaluation of bone healing following immediate and delayed dental implant placement[J].JContemp Dent Pract,2009,10(4):35-42.
[6]周磊,岳新新.All-on-Four技术在口腔种植领域中的应用进展[J].口腔疾病防治,2017,25(1):1-7.
[7]Tallarico M,Xhanari E,Pisano M,et al.Single post-extractive ultrawide7 mm-diameter implants versus implants placed in molar healed sites after socket preservation for molar replacement:6-month post-loading results from a randomised controlled trial[J].Eur J Oral Implantol,2016,9(3):263-75.
[8]Levin BP.The correlation between immediate implant insertion torque and implant stability quotient[J].Int J Periodontics Restorative Dent,2016,36(6):833-40.
[9]Tettamanti L,Andrisani C,Bassi MA,et al.Post extractive implant:evaluation of the critical aspects[J].Oral Implantol(Rome),2017,10(2):119-28.
[10]Crespi R,Cappare P,Gastaldi G,et al.Buccal-lingual bone remodeling in immediately loaded fresh socket implants:a cone beam computed tomography study[J].Int J Periodontics Restorative Dent,2018,38(1):43-50.
[11]Gluckman H,Pontes CC,Du Toit J.Radial plane tooth position and bone wall dimensions in the anterior maxilla:a CBCT classification for immediate implant placemen[t J].JProsthDen,2018,120(1):50-6.
[12]Chen YQ,Yuan SS,Zhou N,et al.Transcrestal sinus floor augmentation with immediate implant placement applied in three types of fresh extraction sockets:a clinical prospective study with 1-year follow-up[J].Clin Implant Dent Relat Res,2017,19(6):1034-43.
[13]Jun SH,Park CJ,Hwang SH,et al.The influence of bone graft procedures on primary stability and bone change of implants placed in fresh extraction sockets[J].Maxillofac Plast Reconstr Surg,2018,40(1):10.
[14]Becker CM,Wilson J,Jensen OT.Minimum criteria for immediate provisionalization of single-tooth dental implants in extraction sites:a 1-Year retrospective study of 100 consecutive cases[J].J Oral Maxillofac Surg,2011,69(2):491-7.
[15]Cucchi A,Vignudelli E,Franco SA,et al.Tapered,double-lead threads single implants placed in fresh extraction sockets and healed sites of the posterior Jaws:a multicenter randomized controlled trial with 1 to 3 years of Follow-Up[J].Biomed Res Int,2017,13(9):5.
[16]Matys J,Swider K,Flieger R,et al.Assessment of the primary stability of root analog zirconia implants designed using cone beam computed tomography software by means of the periotest(R)device:An ex vivo study.A preliminary report[J].Adv Clin Exp Med,2017,26(5):803-9.
[17]AimettiM,Manavella V,Corano L,et al.Three-dimensional analysis of bone remodeling following ridge augmentation of compromised extraction sockets in periodontitis patients:A randomized controlled study[J].Clin Oral Implants Res,2018,29(2):202-14.
[18]Chappuis V,Araujo MG,Buser D.Clinical relevance of dimensional bone and soft tissue alterations post-extraction in esthetic sites[J].Periodontol 2000,2017,73(1):73-83.
[19]Gluckman H,Salama M,Du Toit J.A retrospective evaluation of 128socket-shield cases in the esthetic zone and posterior sites:partial extraction therapy with up to 4 years follow-up[J].Clin Implant Dent Relat Res,2018,20(2):122-9.
[20]Heckmann SM,Moertlbauer B,Rieder D,et al.Alveolar ridge dimension 6 months after implant placement with simultaneous hard tissue augmentation[J].Int J Oral Maxillofac Implants,2017,32(2):408-14.
[21]Scarano A.Traditional postextractive implant site preparation compared with pre-extractive interradicular implant bed preparation in the mandibular molar region,using an ultrasonic device:a randomized pilot study[J].Int J Oral Maxillofac Implants,2017,32(3):655-60.
[22]Valenzuela S,Olivares JM,Weiss N.Immediate implant placement by interradicular bone drilling before molar extraction:clinical case report with one-year follow-Up[J].Case Rep Dent,2018,7(1):6.
[23]Kara MI,Yanik S,Sari F.Simultaneous retrieval of root fragment,sinus lifting with particulated bone graft,and immediate dental implant insertion[J].J Craniofac Surg,2016,27(3):e309-11.
[24]Jun SH,Park CJ,Hwang SH,et al.The influence of bone graft procedures on primary stability and bone change of implants placed in fresh extraction sockets[J].Maxillofac Plast Reconstr Surg,2018,40(1):10.
[25]Demircan S,Cankaya AB.Is immediate implant placement possible in the maxillary molar area?An anatomical study[J].Quintessence Int,2016,47(10):853-9.
[26]Feng L,Zhang L,Cui Y,et al.Clinical evaluations of mineralized collagen in the extraction sites preservation[J].Regene biomate,2016,3(1):41-8.
[27]Norton MR.The influence of low insertion torque on primary stability,implant survival,and maintenance of marginal bone levels:a closed-cohort prospective study[J].Int J Oral Maxillofac Implants,2017,32(4):849-57.
[28]Valdec S,Pasic P,Soltermann A,et al.Alveolar ridge preservation with autologous particulated dentin-a case series[J].International JImplant Dentister,2017,3(1):10.
[29]Maiorana C,Poli PP,Deflorian M,et al.Alveolar socket preservation with demineralised bovine bone mineral and a collagen matrix[J].JPeriod Imp Sci,2017,47(4):194-210.
[30]Malchiodi L,Balzani L,Cucchi A,et al.Primary and secondary stability of implants in postextraction and healed sites:a randomized controlled clinical trial[J].Int J Oral Maxillofac Implants,2016,31(6):1435-43.
[31]赖红昌,史俊宇.上颌窦提升术[J].口腔疾病防治,2017,25(1):8-12.
[32]许竞,崔宝仪,高文峰,等.即刻种植牙龈软组织伤口的特点及其愈合方式[J].广东医学,2013,34(7):1066-9.
[33]Di Girolamo M,Arullani CA,Calcaterra R,et al.Preservation of extraction socket in immediate implant placement:a clinical study[J].Oral Implantol(Rome),2016,9(4):222-32.
[34]Choi HK,Cho HY,Lee SJ,et al.Alveolar ridge preservation with an open-healing approach using single-layer or double-layer coverage with collagen membranes[J].J Periodontal Implant Science,2017,47(6):372-80.
[35]Zuiderveld EG,Meijer H,den Hartog L,et al.Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites:ARCT[J].J Clin Periodontol,2017,45(2):253-64.
[36]El Chaar E,Oshman S,Cicero G,et al.Soft tissue closure of grafted extraction sockets in the anterior maxilla:a modified palatal pedicle connective tissue flap technique[J].Int J Periodontics Restorative Dent,2017,37(1):99-107.
[37]Assaf JH,Assaf DD,Antoniazzi RP,et al.Correction of buccal dehiscence during immediate implant placement using the flapless technique:a tomographic evaluation[J].J Periodontol,2017,88(2):173-80.
[38]Chang H,Kim S,Hwang JW,et al.Comparative,randomized,double-blind clinical study of alveolar ridge preservation using an extracellular matrix-based dental resorbable membrane in the extraction socket[J].J Periodontal Implant Science,2017,47(3):165-73.
[39]PirkerW,Immediate KA,Non-Submerged N.Root-analogue zirconia implant in single tooth replacement[J].Int J Oral Maxillofac Surg,2008,37(3):293-5.
[40]Felice P,Zucchelli G,Cannizzaro GA,et al.Immediate,immediatedelayed(6 weeks)and delayed(4 months)post-extractive single implants:4-month post-loading data from a randomised controlled trial[J].Eur J Oral Implantol,2016,9(3):233-47.
[41]Al Qabbani A,Razak NH,Al Kawas SA,et al.The efficacy of immediate implant placement in extraction sockets for alveolar bone preservation:a clinical evaluation using three-dimensional cone beam computerized tomography and resonance frequency analysis value[J].J Craniofac Surg,2017,28(4):e318-25.
[2]石磊,黄盛兴,刘慧凤,等.前牙区数字化即刻种植即刻修复病例报道及文献回顾[J].口腔疾病防治,2017,25(2):119-22.
[3]Narad C,Lingraj JB,Aulakh KK,et al.Assessment of primary stability of the implant placed in prepared infected extraction sockets[J].J Oral Biol Craniofac Res,2016,8(3):154-7.
[4]Abi-Aad HL,Daher FI,Baba NZ,et al.Insertion torque of variablethread tapered implants in the posterior maxilla:a clinical study[J].JProsthodont,2018.12965.
[5]Luay Y,Asraa T,Mohemad I,et al.Evaluation of bone healing following immediate and delayed dental implant placement[J].JContemp Dent Pract,2009,10(4):35-42.
[6]周磊,岳新新.All-on-Four技术在口腔种植领域中的应用进展[J].口腔疾病防治,2017,25(1):1-7.
[7]Tallarico M,Xhanari E,Pisano M,et al.Single post-extractive ultrawide7 mm-diameter implants versus implants placed in molar healed sites after socket preservation for molar replacement:6-month post-loading results from a randomised controlled trial[J].Eur J Oral Implantol,2016,9(3):263-75.
[8]Levin BP.The correlation between immediate implant insertion torque and implant stability quotient[J].Int J Periodontics Restorative Dent,2016,36(6):833-40.
[9]Tettamanti L,Andrisani C,Bassi MA,et al.Post extractive implant:evaluation of the critical aspects[J].Oral Implantol(Rome),2017,10(2):119-28.
[10]Crespi R,Cappare P,Gastaldi G,et al.Buccal-lingual bone remodeling in immediately loaded fresh socket implants:a cone beam computed tomography study[J].Int J Periodontics Restorative Dent,2018,38(1):43-50.
[11]Gluckman H,Pontes CC,Du Toit J.Radial plane tooth position and bone wall dimensions in the anterior maxilla:a CBCT classification for immediate implant placemen[t J].JProsthDen,2018,120(1):50-6.
[12]Chen YQ,Yuan SS,Zhou N,et al.Transcrestal sinus floor augmentation with immediate implant placement applied in three types of fresh extraction sockets:a clinical prospective study with 1-year follow-up[J].Clin Implant Dent Relat Res,2017,19(6):1034-43.
[13]Jun SH,Park CJ,Hwang SH,et al.The influence of bone graft procedures on primary stability and bone change of implants placed in fresh extraction sockets[J].Maxillofac Plast Reconstr Surg,2018,40(1):10.
[14]Becker CM,Wilson J,Jensen OT.Minimum criteria for immediate provisionalization of single-tooth dental implants in extraction sites:a 1-Year retrospective study of 100 consecutive cases[J].J Oral Maxillofac Surg,2011,69(2):491-7.
[15]Cucchi A,Vignudelli E,Franco SA,et al.Tapered,double-lead threads single implants placed in fresh extraction sockets and healed sites of the posterior Jaws:a multicenter randomized controlled trial with 1 to 3 years of Follow-Up[J].Biomed Res Int,2017,13(9):5.
[16]Matys J,Swider K,Flieger R,et al.Assessment of the primary stability of root analog zirconia implants designed using cone beam computed tomography software by means of the periotest(R)device:An ex vivo study.A preliminary report[J].Adv Clin Exp Med,2017,26(5):803-9.
[17]AimettiM,Manavella V,Corano L,et al.Three-dimensional analysis of bone remodeling following ridge augmentation of compromised extraction sockets in periodontitis patients:A randomized controlled study[J].Clin Oral Implants Res,2018,29(2):202-14.
[18]Chappuis V,Araujo MG,Buser D.Clinical relevance of dimensional bone and soft tissue alterations post-extraction in esthetic sites[J].Periodontol 2000,2017,73(1):73-83.
[19]Gluckman H,Salama M,Du Toit J.A retrospective evaluation of 128socket-shield cases in the esthetic zone and posterior sites:partial extraction therapy with up to 4 years follow-up[J].Clin Implant Dent Relat Res,2018,20(2):122-9.
[20]Heckmann SM,Moertlbauer B,Rieder D,et al.Alveolar ridge dimension 6 months after implant placement with simultaneous hard tissue augmentation[J].Int J Oral Maxillofac Implants,2017,32(2):408-14.
[21]Scarano A.Traditional postextractive implant site preparation compared with pre-extractive interradicular implant bed preparation in the mandibular molar region,using an ultrasonic device:a randomized pilot study[J].Int J Oral Maxillofac Implants,2017,32(3):655-60.
[22]Valenzuela S,Olivares JM,Weiss N.Immediate implant placement by interradicular bone drilling before molar extraction:clinical case report with one-year follow-Up[J].Case Rep Dent,2018,7(1):6.
[23]Kara MI,Yanik S,Sari F.Simultaneous retrieval of root fragment,sinus lifting with particulated bone graft,and immediate dental implant insertion[J].J Craniofac Surg,2016,27(3):e309-11.
[24]Jun SH,Park CJ,Hwang SH,et al.The influence of bone graft procedures on primary stability and bone change of implants placed in fresh extraction sockets[J].Maxillofac Plast Reconstr Surg,2018,40(1):10.
[25]Demircan S,Cankaya AB.Is immediate implant placement possible in the maxillary molar area?An anatomical study[J].Quintessence Int,2016,47(10):853-9.
[26]Feng L,Zhang L,Cui Y,et al.Clinical evaluations of mineralized collagen in the extraction sites preservation[J].Regene biomate,2016,3(1):41-8.
[27]Norton MR.The influence of low insertion torque on primary stability,implant survival,and maintenance of marginal bone levels:a closed-cohort prospective study[J].Int J Oral Maxillofac Implants,2017,32(4):849-57.
[28]Valdec S,Pasic P,Soltermann A,et al.Alveolar ridge preservation with autologous particulated dentin-a case series[J].International JImplant Dentister,2017,3(1):10.
[29]Maiorana C,Poli PP,Deflorian M,et al.Alveolar socket preservation with demineralised bovine bone mineral and a collagen matrix[J].JPeriod Imp Sci,2017,47(4):194-210.
[30]Malchiodi L,Balzani L,Cucchi A,et al.Primary and secondary stability of implants in postextraction and healed sites:a randomized controlled clinical trial[J].Int J Oral Maxillofac Implants,2016,31(6):1435-43.
[31]赖红昌,史俊宇.上颌窦提升术[J].口腔疾病防治,2017,25(1):8-12.
[32]许竞,崔宝仪,高文峰,等.即刻种植牙龈软组织伤口的特点及其愈合方式[J].广东医学,2013,34(7):1066-9.
[33]Di Girolamo M,Arullani CA,Calcaterra R,et al.Preservation of extraction socket in immediate implant placement:a clinical study[J].Oral Implantol(Rome),2016,9(4):222-32.
[34]Choi HK,Cho HY,Lee SJ,et al.Alveolar ridge preservation with an open-healing approach using single-layer or double-layer coverage with collagen membranes[J].J Periodontal Implant Science,2017,47(6):372-80.
[35]Zuiderveld EG,Meijer H,den Hartog L,et al.Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites:ARCT[J].J Clin Periodontol,2017,45(2):253-64.
[36]El Chaar E,Oshman S,Cicero G,et al.Soft tissue closure of grafted extraction sockets in the anterior maxilla:a modified palatal pedicle connective tissue flap technique[J].Int J Periodontics Restorative Dent,2017,37(1):99-107.
[37]Assaf JH,Assaf DD,Antoniazzi RP,et al.Correction of buccal dehiscence during immediate implant placement using the flapless technique:a tomographic evaluation[J].J Periodontol,2017,88(2):173-80.
[38]Chang H,Kim S,Hwang JW,et al.Comparative,randomized,double-blind clinical study of alveolar ridge preservation using an extracellular matrix-based dental resorbable membrane in the extraction socket[J].J Periodontal Implant Science,2017,47(3):165-73.
[39]PirkerW,Immediate KA,Non-Submerged N.Root-analogue zirconia implant in single tooth replacement[J].Int J Oral Maxillofac Surg,2008,37(3):293-5.
[40]Felice P,Zucchelli G,Cannizzaro GA,et al.Immediate,immediatedelayed(6 weeks)and delayed(4 months)post-extractive single implants:4-month post-loading data from a randomised controlled trial[J].Eur J Oral Implantol,2016,9(3):233-47.
[41]Al Qabbani A,Razak NH,Al Kawas SA,et al.The efficacy of immediate implant placement in extraction sockets for alveolar bone preservation:a clinical evaluation using three-dimensional cone beam computerized tomography and resonance frequency analysis value[J].J Craniofac Surg,2017,28(4):e318-25.