摘要
目的：即刻种植技术在临床上已得到广泛应用，取得了很高的成功率；而如何对种植体周围的软组织进行恰当的处理，从而达到理想的美学修复效果，是种植修复医生面临的新挑战。本课题旨在通过建立动物模型，拔牙后即刻植入种植体，探讨几种软组织处理方式对种植体周围软组织形态的影响。
方法：选取成年杂种犬6只，采用自体同颌对照方式，全麻后拔除双侧下颌第二、四前磨牙，立即植入BLB种植体，共计24枚。根据手术方式分为四组：A唇侧黏骨膜瓣滑行拉拢关闭创口；B脱细胞异体真皮基质补片(ADM)移植关闭创口；C自体游离龈瓣移植关闭创口；D二段式种植体一次手术种植方法，即植入种植体后直接连接牙龈愈合基台。3个月后，A、B、C三组行二期手术；二期手术2周后，四组均取石膏模型，行烤瓷冠修复，并负荷1个月后处死。手术前后均测量各组的龈沟探诊深度(PD)、附着龈宽度(AGW)、牙龈指数(GI)等指标，记录手术前后X线片及大体照片情况。
结果：1、所有实验动物均无感染及死亡，所有种植体均无临床动度，X线片显示种植体-骨结合良好，成功率100％；2、四组软组织均愈合良好，无明显感染征象，滑行黏骨膜瓣组软组织处理效果较后三组差；3、四组手术前后牙龈指数比较，P＜0.05，差异有显著性。
结论：1、即刻种植同期进行软组织处理方法可行；2、滑行黏骨膜瓣关闭软组织创口，导致前庭沟变浅，附着龈变窄，膜龈联合线退缩，破坏了周围软组织的正常解剖形态；3、ADM和自体游离龈移植可以增加软组织量，有效关闭软组织创口；4、二段式种植体一次手术组能减少手术次数，不影响周围软组织解剖形态，更宜临床推广应用；5、种植义齿修复后应加强口腔清洁维护。
Objective The technology of immediate implant has been applied to clinic and high success rate acquired. Nowadays more and more dentists are paying attention to disposal of soft tissue on immediate implant. In this study, animal models were built to assess the disposal result of soft tissue on immediate implant.
Methods Six adult dogs were chosen and numbered. Their second, fourth premolars of mandibles were extracted, and twenty-four BLB implants (Diameter 3.3&4.0mm, Length 13mm) were placed immediately into the sockets of the mesial or distal roots by means of self-comparing. Four groups were divided according operation: A. Routine placement, labial slipping mucoperiosteum flaps were roped in to close the socket; B. Using acellular dermal matrix (ADM) to close the socket; C. Using lingual free gingival flaps to close the socket; D. Two-stage implants were placing to the fresh sockets in one visit. The second stage operation was performed in the former three groups in three months. Ceramic crowns were fixed in each group two weeks later and functioned for one month. The probing depth of gingival groove, width of attached gingiva and indexes of gingiva were measured respectively in each group. X-rays and pictures were recorded preoperatively and postoperatively.
Results 1. All experimental animals were no postoperative inflammation and no sudden death, and all implants were no clinical mobility. X-ray showed the excellent interface between implants and mandibles. The survival rate was 100 percent. 2. Soft tissue of each group had good healing and was no obvious inflammation. The shape of soft tissue in the latter three groups was better than that of A group. 3. Differences of indexes of gingiva were significant in each group preoperatively and postoperatively (P＜0.05).
Conclusion 1. The technology of disposal of soft tissue on immediate implants was feasible. 2. Soft tissue defect closure with slipping mucoperiosteum flap resulted in destruction of normal anatomic form of gingiva. 3. ADM and autogenic free gingival flaps transplanted could effectively close sockets of teeth extraction, augment quantity of soft tissue. 4. Insert of two-stage implants in one visit reduced frequency and trauma of operation, didn't destroy anatomic form of soft tissue and should be spread in clinic. 5. The cleaning and maintenance of implant denture should be enhanced after ceramic crowns were fixed in each group.
引文
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