Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, University of Ghent, Ghent, Belgium.
J Clin Periodontol. 2011 Apr;38(4):385-94. doi: 10.1111/j.1600-051X.2010.01687.x. Epub 2011 Jan 27.
The main objective of this clinical study was to document midfacial soft tissue dynamics following single immediate implant treatment (IIT) and conventional implant treatment (CIT) in the anterior maxilla when performed by experienced clinicians in well-selected patients.
Appropriate bone volume and ideal soft tissue levels were considered requirements for implant therapy. Additional prerequisites for IIT were intact socket walls and a thick gingival biotype. CIT included standard flap elevation whereas IIT was either performed with a flap or flapless procedure. All implants were provisionally restored using cemented acrylic crowns. Bone levels, papillae and midfacial soft tissue levels were monitored at regular intervals. The aesthetic outcome was assessed after 1 year using the pink aesthetic score (PES) and white aesthetic score (WES).
Sixteen patients (10 men, six women; mean age 45) received an immediate implant and 23 patients (12 men, 11 women; mean age 40) had conventional implant surgery. One immediate implant failed in the early healing phase. The mean bone level from the implant-abutment interface was 0.85mm for IIT and 0.65mm for CIT after 1 year (p=0.144). Mesial papillae remained stable over time. Minute loss of distal papillae occurred following IIT (-0.38mm) and a tendency for re-growth was found following CIT (0.60mm). Midfacial soft tissues remained stable over time following IIT with only 7% showing advanced recession (>1mm). Flapless surgery induced less midfacial recession than flap surgery (p=0.023). Significant midfacial recession occurred following CIT (-1mm). Overall, 24% were aesthetic failures (PES<8 and/or WES<6) and 8% showed an (almost) perfect outcome (PES12 and WES9). The remainder (68%) demonstrated acceptable aesthetics.
Immediate implants demonstrated fairly stable midfacial soft tissue levels with only a minority of cases showing advanced recession. Irrespective of the timing of implant placement, aesthetic failures seem to be rather common and only a strict minority may show perfection.
本临床研究的主要目的是记录经验丰富的临床医生在经过精心选择的患者中进行上颌前部单即刻种植治疗（IIT）和传统种植治疗（CIT）时的中面部软组织动力学。
合适的骨量和理想的软组织水平被认为是种植治疗的要求。IIT 的附加前提条件是完整的牙槽窝壁和较厚的牙龈生物型。CIT 包括标准瓣提升，而 IIT 则采用瓣或无瓣手术。所有种植体均采用临时粘固的丙烯酸冠进行初步修复。定期监测骨水平、牙乳头和中面部软组织水平。1 年后使用粉红色美学评分（PES）和白色美学评分（WES）评估美学效果。
16 名患者（10 名男性，6 名女性；平均年龄 45 岁）接受了即刻种植，23 名患者（12 名男性，11 名女性；平均年龄 40 岁）接受了传统种植手术。1 枚即刻种植体在早期愈合阶段失败。1 年后，IIT 的种植体-基台界面的平均骨水平为 0.85mm，CIT 为 0.65mm（p=0.144）。近中牙乳头随时间保持稳定。IIT 后远中牙乳头有轻微丧失（-0.38mm），CIT 后有再生长趋势（0.60mm）。IIT 后中面部软组织随时间保持稳定，仅有 7%出现进展性退缩（>1mm）。无瓣手术引起的中面部退缩少于瓣手术（p=0.023）。CIT 后出现明显的中面部退缩（-1mm）。总体而言，24%的患者美学效果失败（PES<8 且/或 WES<6），8%的患者表现出近乎完美的效果（PES12 和 WES9）。其余 68%的患者表现出可接受的美学效果。
即刻种植体显示出中面部软组织水平相对稳定，仅有少数病例出现进展性退缩。无论种植体放置的时间如何，美学效果失败似乎都很常见，只有极少数患者可能表现出完美的效果。
