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上颌中切牙即刻种植即刻修复后唇侧软组织形态三维变化的定量分析

Quantitative three-dimensional methodology based on intraoral scan to assess the soft tissue contour alterations following single immediate implant and immediate provisionalization in maxillary central incisor: a 1-year prospective study

摘要:

目的 建立一种基于口内扫描的软组织形态三维变化的定量评价方法,评价上颌中切牙即刻种植即刻修复后唇侧软组织形态的三维变化.方法 前瞻性纳入2016年1月至2017年9月连续就诊于北京大学口腔医学院·口腔医院种植科,并满足单颗上颌中切牙即刻种植即刻修复适应证的患者29例,其中男性14例,女性15例,年龄(34.3±12.0)岁.患者拔牙后行即刻种植即刻修复,术后6个月行永久修复.口内扫描直接获取术前与术后1年患者上颌前牙区数字化模型,在分析软件中构建种植体唇侧软组织形态三维变化量模型,并进行定量分析.结果 29例患者中27例完成1年随访.术后1年种植体龈缘顶点较健侧中切牙龈缘顶点退缩(0.23±0.39) mm.与术前相比,术后1年所有患者种植体唇侧软组织均存在一定程度塌陷;唇侧软组织形态的唇腭向平均变化距离为(0.62±0.22) mm,近远中最大宽度为(11.03±1.74) mm,冠根向最大高度为(6.82±1.52) mm.龈缘顶点根方0、1、2、3、4、5 mm处唇侧软组织形态的唇腭向变化距离分别为(0.54±0.48)、(0.87±0.62)、(1.03±0.46)、(0.96±0.52)、(0.90±0.52)、(0.89±0.57) mm.结论 基于口内扫描进行种植体唇侧软组织形态三维变化的定量评价方法切实可行.与健侧中切牙龈缘相比,即刻种植即刻修复1年后种植体唇侧龈缘无显著退缩,唇侧软组织形态的唇腭向平均塌陷约0.62 mm.

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abstracts:

Objective To establish a quantitative three-dimensional method based on intraoral scan and apply it to evaluation of the facial soft tissue contour alterations following single immediate implant and immediate provisionalization (IIPP) in central incisor via intraoral scanning.Methods This study was a prospective clinical study.The trial was conducted at Department of Implantology,Peking University School and Hospital of Stomatology,from January 2016 to September 2017.Twenty-nine eligible consecutive patients (15 women,14 men) with a mean age of (34.3 ± 12.0) were included and received immediate replacement of the failure maxillary single central incisor.A screw-retained immediate restoration was delivered for each patient.At 6-month follow-up,impression was taken and a screw-retained permanent restoration was performed for each patient.The anterior maxillary region was scanned by an intraoral scanning system at pre-surgery and 1-year follow-up.The Standard Tessellation Language (STL) files were output to a dedicated software and superimposed.Mid-facial recession and gingival zenith symmetry at 1-year follow-up were measured in the digital models.Three-dimensional configurations of the contour change volume were calculated and reconstructed for visual analysis.Furthermore,the following parameters were used to analyze the reconstructed volume:mean contour change in thickness (Δ d),mesio-distal width (DW),coronal-apical height (DH),contour change at 0,1,2,3,4,5 mm apical to the free gingival margin on the implant site.Results Twenty-seven out of twenty-nine enrolled patients were finally available for analysis.At 1-year follow-up,the mid-facial mucosa level at implant site was (0.23±0.39) mm apical to the gingival zenith of the contralateral tooth.In general,a contour collapse was found in every patient./△ d,DW and DH of the collapsed volume were (0.62±0.22),(11.03± 1.74) and (6.82± 1.52) mm,respectively.Contour change at 0,1,2,3,4,5 mm apical to the free gingival margin on the implant site were (0.54±0.48),(0.87±0.62),(1.03±0.46),(0.96± 0.52),(0.90 ± 0.52),(0.89 ± 0.57) mm.Conclusions The described quantitative measurement based on intraoral scan can be an effective method for assessment of soft tissue contour changes.At 1 year following single IIPP treatment in maxillary incisor,free gingival margin is stable,with only mild recession.The mean level of the facial soft tissue contour collapse is 0.62 mm.

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