Belser Urs C, Schmid Bruno, Higginbottom Frank, Buser Daniel
Department of Prosthodontics, School of Dental Medicine, University of Geneva, Switzerland.
Int J Oral Maxillofac Implants. 2004;19 Suppl:30-42.
To document the literature regarding outcomes of implant restorations in the anterior maxilla to formulate consensus statements with regard to esthetics in implant dentistry, to provide guidelines to clinicians, and to articulate remaining questions in this area to be addressed by future research.
The following areas of the recent literature were scrutinized: treatment outcomes of implant therapy for partial edentulism (including maxillary anterior tooth replacement); anterior maxillary single-tooth replacement; effect of implant design, diameter, and surface characteristics; soft tissue stability/contours around anterior implant restorations; ceramic abutments; influence of surgical techniques; and finally, evaluation of patient satisfaction.
The use of dental implants in the esthetic zone is well documented in the literature, and numerous controlled clinical trials show that the respective overall implant survival and success rates are similar to those reported for other segments of the jaws. However, most of the published studies do not include well-defined esthetic parameters. Currently, the literature regarding esthetic outcome is inconclusive for the routine implementation of certain surgical approaches, such as flapless surgery and immediate implant placement with or without immediate loading/restoration in the anterior maxilla. Considering anterior single-tooth replacement in sites without tissue deficiencies, predictable treatment outcomes, including esthetics, can be achieved because of tissue support provided by adjacent teeth. The replacement of multiple adjacent missing teeth in the anterior maxilla with fixed implant restorations is poorly documented. In this context, esthetic restoration is not predictable, particularly regarding the contours of the interimplant soft tissue.
This review has demonstrated that scientific documentation of esthetically relevant and reproducible parameters is rather scarce. Most of the reported outcome analyses primarily focus on implant survival. Elements of anterior implant success such as maintenance or reestablishment of harmoniously scalloped soft tissue lines and natural contours should be included in future studies.
梳理有关上颌前牙区种植修复效果的文献，就种植义齿美学问题形成共识声明，为临床医生提供指导，并明确该领域有待未来研究解决的遗留问题。
对近期文献的以下方面进行了详细审查：部分牙列缺损种植治疗的效果（包括上颌前牙替换）；上颌前牙单颗牙替换；种植体设计、直径和表面特性的影响；前牙种植修复周围软组织的稳定性/轮廓；陶瓷基台；手术技术的影响；最后是患者满意度评估。
文献中充分记录了在美学区域使用牙种植体的情况，众多对照临床试验表明，种植体的总体存留率和成功率与颌骨其他部位报道的相似。然而，大多数已发表的研究并未纳入明确的美学参数。目前，对于某些手术方法的常规应用，如在上颌前牙区进行无瓣手术以及即刻种植并即刻或延期加载/修复，关于美学效果的文献尚无定论。考虑在无组织缺损部位进行前牙单颗牙替换，由于相邻牙齿提供的组织支持，可实现包括美学效果在内的可预测治疗结果。关于上颌前牙区多颗相邻缺失牙采用固定种植修复的文献报道较少。在这种情况下，美学修复不可预测，尤其是种植体间软组织的轮廓。
本综述表明，关于美学相关且可重复参数的科学文献相当匮乏。大多数报道的结果分析主要集中在种植体存留率上。未来的研究应纳入前牙种植成功的要素，如维持或重建和谐的扇贝状软组织轮廓和自然外形。
