美学区单颗牙即刻种植和延期种植的短期红色美学和种植体边缘骨吸收的临床效果比较及影响因素分析

目的 比较美学区单颗牙即刻种植和延期种植的短期红色美学和种植体边缘骨吸收的临床效果,并对其影响因素进行分析。方法 选择2008年1月—2015年12月在中国医科大学附属口腔医院种植中心行美学区单颗牙种植的患者共114例,分为即刻种植组和延期种植组。上部结构修复完成后随访1年,测量修复完成当天和1年后的红色美学评分（pink esthetic score,PES）,修复完成1年后种植体边缘骨吸收量。采用SPSS 17.0软件包进行统计学分析。结果 上部结构修复完成1年后114颗种植体均稳固,即刻种植组在修复完成1年后种植体边缘骨吸收量为（0.36±0.39） mm,显著小于延期种植组（0.79±0.67mm）（P<0.001）;2组在修复完成当天和1年后的PES得分差异均无统计学意义（P>0.05）。即刻修复对2组修复完成当天和1年后的PES得分,以及修复完成1年后的种植体边缘骨吸收量均无显著影响（P>0.05）。不翻瓣术修复完成当天和1年后的PES得分分别为9.58±1.67和11.58±1.57,修复完成1年后种植体边缘骨吸收量为（0.25±0.22） mm;而翻瓣术修复完成当天和1年后的PES得分分别为7.11±1.45和9.96±1.56,修复完成1年后种植体边缘骨吸收量为（0.43±0.47）mm,2组相比差异有统计学意义（P<0.05）。SLA和DAE表面处理方法对PES和边缘骨吸收量无显著影响（P>0.05）,但植骨手术对修复完成当天和1年后的PES均有不利影响（P<0.05）。结论 美学区即刻种植的种植体边缘骨吸收速度小于延期种植,有利于延长种植体寿命。不翻瓣术提高了修复后的美观度,在选择合适病例的前提下,不翻瓣即刻种植能够达到良好的临床效果。     

不翻瓣上颌前牙即刻牙种植术临床效果评价

目的 研究不翻瓣上颌前牙即刻牙种植术在牙种植患者中的临床价值。方法 选取2014年9月—2015年8月收治的88例即刻牙种植术患者,根据投硬币法分为实验组和对照组,每组各44例。对照组为翻瓣上颌前牙即刻种植术,实验组为不翻瓣上颌前牙即刻种植术。观察比较2组患者的手术时间、种植体成活率、牙槽骨状况、满意度、美观度及术后症状。采用SPSS11.5软件包进行数据分析。结果 实验组手术时间[（29.34±2.42）min]显著短于对照组[（55.32±3.54）min]（P<0.05）,牙槽骨质量[（0.84±0.04）mm]显著优于对照组[（1.21±0.07）mm]（P<0.05）,种植成活率[93.18%（41/44）]显著高于对照组[72.73%（32/44）]（P<0.05）。治疗后,实验组患者的VAS评分[（8.32±0.42）分]和PES评分[（11.24±0.43）分]显著高于对照组[（5.78±0.24）分、（8.45±0.58）分]（P<0.05）。实验组患者术后疼痛[18.18%（8/44）]、红肿[15.91%（7/44）]、出血[11.36%（5/44）]发生率显著低于对照组[38.64%（17/44）、34.09%（15/44）、29.55%（13/44）]（P<0.05）。结论 不翻瓣种植术能提高牙种植患者的满意度、美观度及种植成功率,减少手术时间,减轻患者的疼痛感,降低术后疼痛、红肿等症状的发生率。     

上颌前牙翻瓣与不翻瓣即刻种植修复临床效果比较研究

目的    评估翻瓣与不翻瓣即刻种植修复病例的种植体存留率、软组织美学效果及种植体周围骨吸收情况。方法    2007年8月至2011年3月共41例在北京大学口腔医院种植科就诊的上颌前牙区单牙即刻种植患者纳入本研究,分为不翻瓣组（20例）和翻瓣组（21例）,两组均采用种植体支持暂时冠进行牙龈诱导塑形。评估两组修复后1、3年的骨吸收量并进行统计学分析。美学评价指标包括牙间乳头外形指数及种植体唇侧牙龈丰满度。结果    41例患者共植入41枚ReplaceSpeedy®种植体,追踪时间24 ~ 67个月,平均42.4个月,至最后一次复查未见种植体脱落。不翻瓣组与翻瓣组修复后1、3年的牙间乳头外形指数和唇侧牙龈丰满度比较,差异均无统计学意义（均P > 0.05）。修复后1、3年,不翻瓣组骨吸收量分别为（0.50 ± 0.04）mm和（0.55 ± 0.04）mm,翻瓣组分别为（0.59 ± 0.03）mm和（0.67 ± 0.03）mm,两组差异有统计学意义（P < 0.05）。两组患者对修复后美学效果满意,不翻瓣组患者对治疗过程舒适度的满意度高于翻瓣组。结论    上颌前牙翻瓣与不翻瓣即刻种植技术在选择合适的适应证及采用适当的技术时均能取得满意的临床效果。经种植体支持暂时冠牙龈诱导塑形,修复后牙龈稳定。两组种植体边缘骨水平稳定,不翻瓣组骨吸收低于翻瓣组。两组患者均对修复后美学效果满意,患者对不翻瓣即刻种植满意度更高。     

翻瓣与不翻瓣种植手术疗效对比的Meta分析

目的分析翻瓣与不翻瓣种植手术的疗效对比,为临床合理选择种植手术方式提供依据。 方法分别检索PubMed、Cochrane Library、Web of Science和Embase等数据库,时间为数据库建库至2021年9月1日,以Dental impalnts、Surgical flaps、Surgery等主题词及其下位词,查找关于翻瓣与不翻瓣种植手术的相关文献,严格按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于翻瓣与不翻瓣种植手术疗效相关的数据,包括共提取失败例数、手术时间、炎症、肿胀、改良菌斑指数（MPI）、牙龈出血指数（MSBI）、牙周袋深度（PD）、语言模拟疼痛评估量表（VAS）、种植体稳定性商数值（ISQ）、骨吸收、近中骨吸收、远中骨吸收、即刻负重近中骨吸收和即刻负重远中骨吸收等。采用RevMan 5.3软件计算疗效指标的比值比（OR）或均数差（MD）和95%置信区间（CI）,采用StataSE 12.0软件对存在异质性的研究进行敏感性分析和发表偏倚检验。 结果共纳入24篇相关研究,报道含翻瓣种植手术1 124例,不翻瓣种植手术1 184例。研究结果显示,不翻瓣种植术后MSBI[OR = -0.12,95% CI（-0.22,-0.01）,P = 0.03]、PD[OR = -0.21,95% CI（-0.25,-0.17）,P<0.001]、VAS[OR = -0.39,95% CI（-0.60,-0.19）,P = 0.000 2]、骨吸收[OR = -0.11,95% CI（-0.18,-0.03）,P = 0.007]明显低于翻瓣种植手术,差异有统计学意义;失败例数、MPI、ISQ、即刻负重近中骨吸收、即刻负重远中骨吸收在翻瓣与不翻瓣种植手术均无明显差异（P>0.05）。 结论不翻瓣种植术后疼痛的发生明显低于翻瓣种植手术,负荷后牙龈出血、牙周袋深度和骨吸收明显低于翻瓣种植手术。临床工作中,应根据病例的软硬组织条件选择适当的种植手术方式,不翻瓣种植手术具有更大优势。     

美学区相邻种植体即刻与延期翻瓣种植5年效果比较

目的：比较不同的种植手术时机，对美学区相邻种植体在最终修复后1年、3年、5年的临床效果差异。方法：选择美学区需相邻种植修复的患者48例共植入104颗种植体为研究对象，其中22例即刻翻瓣种植组植入49颗种植体；26例延期翻瓣种植组植入55颗种植体，于最终修复1年、3年、5年时复诊，拍摄X线片，测算种植体边缘骨吸收量（MBR）；拍摄口内照片评价粉色美学（PES）及白色美学(WES)分值。采用独立样本t检验，分别对两组间修复后1年、3年、5年的MBR、PES、WES进行比较(检验水准:α=0.05)。结果：最终修复第1年、第3年PES差异有统计学意义（P<0.05）；最终修复第5年MBR、PES、WES差异无统计学意义（P>0.05）。结论：美学区相邻种植体即刻翻瓣种植组在最终修复前3年与延期翻瓣种植组相比粉色美学效果欠佳；两组在最终修复5年后种植体周围边缘骨吸收量及粉、白美学效果无差异。     

应用不翻瓣技术行口腔种植短期临床疗效分析

目的观察并评价微创不翻瓣技术在口腔种植手术中的短期临床应用效果。方法选择2010年1月至2011年12月于中国医科大学附属口腔医院种植中心接受不翻瓣种植手术的患者25例（31枚种植体）作为未翻瓣组,同期接受经典翻瓣种植手术的患者25例（40枚种植体）作为对照组。记录并分析两组病例在手术当天及复诊时的相关临床资料,包括手术时间、术后肿痛不适时间、种植体脱落情况、种植体周围炎与骨吸收水平、牙龈乳头高度等。结果未翻瓣组中有1枚种植体脱落,对照组中无种植体脱落;未翻瓣组病例术后1年的骨吸收水平低于对照组（P〈0．05）,而两组的牙龈乳头指数差异并无统计学意义（P〉0．05）;未翻瓣组的手术时间、患者术后肿痛不适时间明显少于对照组（P〈0．05）。结论在严格控制手术适应证的前提下,不翻瓣手术可大大节省手术时间,减轻患者术后反应,获得更为满意的临床效果。     

上颌单颗前牙不翻瓣即刻种植的临床应用研究

目的：研究上颌单颗前牙不翻瓣即刻种植的短期临床效果。方法：17例上颌单颗前牙微创拔除后不翻瓣即刻植入种植体,经软组织塑形后,完成最终上部结构。随访3-9个月,对种植体周围软硬组织进行评价。结果：17例种植体均获得良好骨结合,种植体无松动脱落。种植体周围软硬组织状态良好,美学效果满意。结论：上颌单颗前牙不翻瓣即刻种植短期内可获得较满意的临床效果。     

不翻瓣对比翻瓣种植手术对牙列缺损患者即刻负重的影响：口内随机对照1年试验结果

目的：比较使用不翻瓣法和翻瓣法在牙列缺损患者口内植入种植体的成功率。材料与方法：选择40位患者．每名患者口内都有2处间隔的缺牙区域．剩余骨厚度≥5mm,高度≥10mm。将每位患者的缺牙区域随机分组,每侧采用翻瓣法或不翻瓣法至少植入1枚种植体。先在一侧植入种植体,2周后在另一侧植入种植体。种植体植入时扭矩〉48NCm．并采用塑料临时义齿修复即刻负载。2个月后行粘结或螺丝固位式烤瓷冠修复。评价结果包括修复体和种植体的失败率,并发症．术后疼痛肿胀程度．止痛药剂量．患者偏好,手术时间．边缘骨水平的改变．种植体初期稳定（1SQ）值。结果：采用不翻瓣法植入76枚种植体,翻瓣法植入67枚种植体。在不翻瓣组．有4例为了控制车针方向不得不进行翻瓣：翻瓣组有1位患者出血,2位患者颊侧骨板折裂。4枚种植体未达到预期稳定性（3枚属于不翻瓣组）．立刻将其替换为较大直径种植体。1年后无一枚脱落。其中2个固定桥修复无法按计划进行（每组各1个）．2个冠需重新修复（每组各1个）。每组各有2例种植失败,分属不同的患者。修复体和种植体的失败率．并发症数量．边缘骨水平的改变量和ISQ值均无显著统计学意义。但是,不翻瓣组所需的手术时间显著减少（减少17min,与翻瓣组相比节省近2／3的时间）．术后疼痛肿胀程度、止痛药剂量也显著减少．且患者更愿意接受。两组的ISQ值均会随着时间显著降低。结论：可以不翻瓣植入种植体并即刻负载．从而减少治疗时间和患者的不适。     

不翻瓣即刻种植近期临床效果观察

目的 探讨不翻瓣即刻种植术的近期临床效果.方法 拟行种植修复的患者65例,患牙拔除后行不翻瓣即刻种植术,共植入种植体86枚.随访24～48个月,通过临床、X线检查,分析种植体植入后牙龈情况、种植体松动度及种植体周围牙槽骨的吸收情况.结果 随访期间,86枚种植体中2枚因松动拔除,其余种植体周围牙龈无异常,种植体无松动,X线片检查种植体周围无透射影区,获得良好的骨结合,种植体周围软硬组织保持完好,美学效果满意.种植体2年成功率为97.7％.结论 不翻瓣即刻种植的近期临床效果满意.     

不翻瓣技术牙种植的临床观察

目的 观察不翻瓣微创技术在牙齿种植的临床应用效果.方法 采用全景X线曲面断层和线性断层投照技术,在拟行牙齿种植区域测量牙槽骨宽度、高度、厚度,明确骨质量,术前在石膏模型上绘出骨地图,制作种植导板.选择牙种植患者,在不作粘骨膜切开的情况下植入ITI柱状螺纹种植体,对旋入扭矩大于35 N·cm者,立即安装永久基台,作塑料牙即刻负荷.记录微创种植的手术时间;通过测定术前、术后1月、3月、半年和1年的X线牙槽骨改变,作临床评价.结果 不翻瓣组平均随访时间为12.3个月,除1例在植入后发生短期的种植体周围炎外,X线检查全部种植体周围骨质无明显透射阴影区,术后6个月平均牙槽嵴骨吸收量为0.15 mm.全部种植牙健存.不翻瓣组单个牙的平均种植时间是10.4min,而对照组为25.7min,两者具有显著性差异(P＜0.01).结论 对骨质量佳的种植牙区域可采用不翻开粘骨膜瓣的微创种植技术,手术简单,手术时间短,种植成功率高.     

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??Objective    To compare the changes of the periimplant papilla index and labial gingiva fullness between flap and flapless immediate implant placement after reshaping the perimplant soft tissue using implant supported provisional prostheses. Methods    From August 2007 to March 2011??41 patients were enrolled in Department of Implant Dentistry??School and Hospital of Stomatology??Peking University. The patients were classified into two groups. Group ??immediate implant using flapless technique and Bio-Oss Collagen in 20 cases. Group ??immediate implant placement using guided bone regeneration??GBR??after flap reflection in 21 cases. All the patients underwent sequential gingival architecture remodeling using implant-supported temporary prostheses. Marginal bone resorption after loading of 1 and 3 years were measured and statistical analysis was conducted. Esthetic evaluations included papilla index and the labial gingiva peri-implant soft tissue fullness. Results    Totally 41 implants were placed in 41 cases with ReplaceSpeedy® implants. The mean follow-up was 42.4 months??24-67 months??and no implant was lost until the last recall. One and three years after final restoration delivered?? papilla index and labial gingiva fullness were compared between two groups and no significance was observed ??P > 0.05??. After 1 and 3 years??marginal bone resorption was??0.50 ± 0.04??mm and??0.55 ± 0.04??mm in flapless group????0.59 ± 0.03??mm and??0.67 ± 0.03??mm in flap group respectively??and statistical significance was observed between two groups??P < 0.05??. Patients’ satisfaction was high in both groups and treatment comfort was higher in flapless group. Conclusion    The clinical results and gingival stability is predictable in choosing flap or flapless immediate implant technique in the maxillary anterior teeth when proper indication and technique are selected. Using implant supported provisional prostheses can reshape and stabilize periimplant soft tissue and the short-term results are predictable. Marginal bone level was stable and less bone resorption was founded in flapless group compared with flap group. Patients in both groups were satisfied with the clinical results and treatment comfort and flapless group had higher patient satisfaction.     

后牙即刻种植的临床观察

目的 :评价后牙即刻种植的方法、效果以及临床意义。方法 :对能满足即刻种植的20颗后牙经微创拔牙后,翻瓣或不翻瓣植入种植体,种植体周围植入骨粉,翻瓣者则覆盖生物膜。种植体植入3~6个月后常规取模,完成上部修复结构。种植体完成修复后随访6~34个月。结果:所有种植牙随访期间内正常行使功能,美学效果令人满意。CT示颊侧骨板骨吸收为(-0.65 mm±1.29 mm);近远中骨吸收为(1.23 mm±0.23 mm)。统计显示:即刻种植术前与术后龈乳头指数及种植体近远中骨吸收无明显差异,即刻种植后种植体颊向骨板吸收及种植体稳定系数与拔牙后牙槽嵴吸收有差异。结论:后牙即刻种植能有效维持种植体周围软硬组织的高度和宽度,对有即刻种植适应证的患者,可减少手术次数,缩短治疗时间,临床效果可靠。     

微创环切术对种植修复效果影响的研究

目的:研究微创环切术对口腔种植效果、疼痛程度及美观的影响。方法:90例口腔种植患者均分为2组, A组单牙位常规翻瓣植入种植体,B组微创环切术植入种植体,。对比分析2组种植效果、疼痛程度、手术时间及美观情况。结果:B组手术时间、术后疼痛时间分别为(13.95±0.26) min、(0.63±3.65) d,低于A组(28.05±0.53) min和(3.74±0.42) d,P<0.05。2组牙槽嵴骨吸收量及牙龈乳头高度对比则无明显差异;B组美学评分为(7.46±1.25)分,高于A组(13.05±1.74)分,P<0.01。结论:相比单牙位常规翻瓣种植,微创环切术在能缩短种植手术时间、减轻疼痛程度的基础上,提高美学效果,值得进一步推广和应用。     

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??Abstract??Objective To observe and evaluate the clinical effects of minimally invasive flapless technique in dental implant surgery. Methods Totally 25 patients ??31 implants?? who received flapless surgery during the period between January 2010 and December 2011 at the Implant Center of Stomatology Hospital of China Medical University were selected as the flapless group and another 25 patients ??40 implants?? who received traditional surgery during the corresponding period were selected as the control group. Related clinical data were recorded and analyzed on the day of surgery and follow-up??including length of surgery??duration of discomfort after operation??loss of implant??peri-implantitis and level of bone resorption??gingival papilla height??etc. Results One implant was lost in the flapless group??while no implant failed in the control group. Less bone resorption was observed in the flapless group??P < 0.05????while gingival papilla index showed no significant difference between the two groups??P > 0.05??. The length of surgery and duration of discomfort after operation in the flapless group were significantly less than the control group??P < 0.05??. Conclusion On the basis of strict control of operation indication??flapless surgery will save operation time to a large extent??relieve patients postoperative reaction and obtain more satisfactory clinical results.     

Ridge alterations following immediate implant placement in the dog: flap versus flapless surgery

Objective: To assess the healing process after flap or flapless surgery in immediate implant placement.
Material and Methods: This study was carried out on five Beagle dogs. Four implants were placed in the lower jaw in each dog immediately after tooth extraction. Flap surgery was performed before the extraction on one side (control), and flapless on the contrary (test). After 3 months of healing, the dogs were sacrificed and prepared for histological analysis.
Results: Ten implants were placed in each group. Two failed (one of each group). The percentage of bone–implant contact was very similar in both groups: 64.8% and 65.1% for the flap and the flapless group, respectively. The difference between the mean distance from the peri-implant mucosa margin to the first bone–implant contact at the buccal aspect was statistically significant between both groups (3.02 mm. flapless and 3.69 mm. flap group). The mean first bone–implant contact at the buccal aspect was located in relation to the sand-blasted and acid-etched level at 0.82 mm for the flapless group and 1.33 mm for the flap group. This difference was not statistically significant.
Conclusion: Flapless immediate implant surgery produces a significant reduction in the vestibular biologic width and a minor reduction in buccal bone plate resorption.     

上颌单颗前牙不翻瓣即刻种植修复的临床效果观察

目的 评价即刻种植即刻修复联合不翻瓣技术在上颌单颗前牙位点的临床应用效果,并探讨其技术要点.方法 选择上颌单颗中切牙无法保留的患者17例,采用不翻瓣技术,拔除患牙后即刻植入种植体,并即刻行种植体支持临时冠修复,术后2个月复诊调整临时冠外形,术后3个月行最终修复.最终修复后1、3、6、12、24个月复诊.最终修复即刻、1...     

上颌切牙不翻瓣即刻种植的临床效果

目的评估上颌切牙单牙不翻瓣即刻种植对牙槽骨和牙龈附着的影响。方法选择15例上颌前牙区因外伤、残根或根折等需拔除患牙行即刻种植修复的患者,共15颗切牙,术前行X线曲面断层片及牙科CT检查,评估牙槽骨高度、厚度与牙龈附着情况,微创拔除患牙后作植入前评估,采用不翻瓣即刻种植方法植入Anky-los种植体15颗,骨缺隙部分填充骨粉,穿龈愈合。术后5个月复诊行上部结构修复,对比术前与修复后的牙槽骨与牙龈退缩情况。结果 15颗种植体成功完成上部结构修复。修复时和术前比较,牙槽骨吸收(1.10±0.26)mm,牙龈退缩(0.81±0.31)mm,牙龈乳头形态保存良好。结论上颌切牙位点使用不翻瓣即刻种植,能有效保护种植区牙槽嵴,从而防止牙龈出现明显退缩,有利于维持种植区的美学效果。     

Comparison of implant stability by means of resonance frequency analysis for flapless and conventionally inserted implants

Background: Resonance frequency analysis (RFA) is a noninvasive technique for the quantitative assessment of implant stability. Information on the implant stability quotient (ISQ) of transmucosally inserted implants is limited. Purpose: The aim of this investigation was to compare the ISQ of conventionally inserted implants by raising a muco‐periostal flap with implants inserted using a flapless procedure. Materials and Methods: Forty elderly patients with complete edentulous maxilla were consecutively admitted for treatment with implant‐supported prostheses. A computer tomography was obtained for the computer‐assisted implant planning. One hundred ten implants were placed conventionally in 23 patients (flap‐group) and 85 implants in 17 patients by means of the flapless method (flapless‐group) using a stereolithographic template. RFA measurements were performed after implant placement (baseline) and after a healing time of 12 weeks (reentry). Results: All implants exhibited clinically and radiographically successful osseointegration. Bone level did not change significantly neither for genders nor type of surgical protocol. Mean ISQ values of the flapless‐group were significantly higher at baseline (p < .001) and at reentry (p < .001) compared with the flap‐group. The ISQ values were significantly lower at reentry compared with baseline for the flap‐group (p = .028) but not for the flapless‐group. This group showed a moderate, but insignificant increase. RFA measurements of males resulted in ISQ values that were thoroughly higher as compared with females at both time‐points in both groups. Correlation between RFA and bone level was not found. Conclusions: The flapless procedure showed favorable conditions with regard to implant stability and crestal bone level. Some changes of the ISQ values that represent primary (mechanical) and secondary (bone remodeling) implant stability were observed in slight favor of the flapless method and male patients. In properly planned and well‐selected cases, the minimal invasive transmucosal technique using a drill‐guide is a safe procedure.