Zeren Karl J
University of Maryland, Dental School, Baltimore, Maryland, USA.
Int J Periodontics Restorative Dent. 2006 Apr;26(2):171-81.
Extraction sites in the esthetic zone present an obvious restorative challenge. This case report describes a surgical technique for the preservation of anterior esthetics that combines minimally invasive extraction with immediate implant placement. This single-stage approach preserves site morphology by protecting and supporting existing hard and soft tissues. Clinical success appears to be attributable to several important features of the technique. The first step involves the elevation, luxation, and extraction of the tooth using either a flapless or minimally invasive approach that reduces trauma to the adjacent tissues. The second step involves appropriate orientation, placement, and stabilization of the implant to preserve facial bone and soft tissue contours. Implant placement is accomplished using particulate freeze-dried bone allograft and enamel matrix derivative to achieve ridge preservation and bone augmentation. The composite graft material is considered critical for predictably resolving osseous voids and promoting implant integration, and consideration is given to the concept of osteogenic "jumping distance" between the implant and the eccentric walls of the alveolus. Finally, preservation of the soft tissue architecture during wound healing is achieved by placement of either a fixed or removable restoration. Consistent implant integration and preservation of the hard and soft tissue complexes have been achieved using this approach.
美学区域的拔牙位点带来了明显的修复挑战。本病例报告描述了一种保留前牙美学的手术技术，该技术将微创拔牙与即刻种植体植入相结合。这种单阶段方法通过保护和支持现有的硬组织和软组织来保留位点形态。临床成功似乎归因于该技术的几个重要特征。第一步涉及使用无瓣或微创方法对牙齿进行翻瓣、松动和拔除，以减少对相邻组织的创伤。第二步涉及种植体的适当定向、植入和稳定，以保留面部骨和软组织轮廓。使用颗粒状冻干同种异体骨移植和釉基质衍生物完成种植体植入，以实现牙槽嵴保存和骨增量。复合移植材料被认为对于可预测地解决骨缺损和促进种植体整合至关重要，并且考虑了种植体与牙槽窝偏心壁之间的成骨“跳跃距离”概念。最后，通过放置固定或可摘修复体来实现伤口愈合期间软组织结构的保留。使用这种方法已实现了种植体的持续整合以及硬组织和软组织复合体的保留。
