种植体周围软组织缺损的美学治疗:改良手术-修复方法的病例报告
Esthetic treatment of peri-implant soft tissue defects: a case report of a modified surgical-prosthetic approach.
作者信息
Zucchelli Giovanni, Mazzotti Claudio, Mounssif Ilham, Marzadori Matteo, Stefanini Martina
机构信息
Department of Odontostomatology, Bologna University, Bologna, Italy.
出版信息
Int J Periodontics Restorative Dent. 2013 May-Jun;33(3):327-35. doi: 10.11607/prd.1632.
A major esthetic concern is soft tissue defects around implant restorations, which often result in an extra long prosthetic crown. This report describes a modified prosthetic-surgical approach to the treatment of peri-implant horizontal and vertical soft tissue defects in an esthetically demanding patient. One month before surgery, the implant crown restoration was removed, the preexisting implant abutment was reduced, and a short provisional crown, at the level of the homologous contralateral incisor, was applied. A bilaminar technique, consisting of an envelope coronally advanced flap covering two connective tissue grafts, was used to treat the soft tissue defects around the implant site. Four months after surgery, a new implant abutment and provisional crown were applied for soft tissue conditioning before the final impression. Nine months after surgery, the peri-implant soft tissue margin was 4 mm more coronal compared with baseline and at the same soft tissue margin level of the right central incisor. A 2.2-mm increase in buccal soft tissue thickness measured 1.5 mm apical to the soft tissue margin was accomplished. The emergence profile of the replaced tooth faithfully reproduced that of the healthy homologous contralateral central incisor. Two years after surgery, the soft tissue margin was stable and the esthetic appearance of the implant site was well maintained. This report demonstrates the possibility of fully correcting severe vertical and horizontal peri-implant soft tissue defects and achieving high patient satisfaction through a combined mucogingival and prosthetic treatment.
一个主要的美学问题是种植体修复周围的软组织缺损,这常常导致修复冠过长。本报告描述了一种改良的修复 - 外科方法,用于治疗对美观要求较高的患者的种植体周围水平和垂直软组织缺损。手术前一个月,拆除种植体冠修复体,降低现有的种植体基台,并制作一个与对侧同名切牙平齐的短临时冠。采用双层技术,即冠状推进的包膜瓣覆盖两块结缔组织移植体,来治疗种植体部位周围的软组织缺损。术后四个月,在取最终印模前,应用新的种植体基台和临时冠进行软组织调整。术后九个月,种植体周围软组织边缘比基线水平冠向高出4mm,且与右侧中切牙的软组织边缘处于同一水平。在软组织边缘根尖向1.5mm处测量,颊侧软组织厚度增加了2.2mm。修复牙的龈缘外形忠实地再现了健康的对侧同名中切牙的龈缘外形。术后两年,软组织边缘稳定,种植体部位的美观效果得到良好维持。本报告证明了通过联合应用黏膜牙龈和修复治疗,完全纠正严重的种植体周围垂直和水平软组织缺损并获得患者高度满意的可能性。