Hamouda Nelly I, Mourad Samah I, El-Kenawy Mohamed H, Maria Ola M
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
Clin Implant Dent Relat Res. 2015 Jan;17 Suppl 1:e107-16. doi: 10.1111/cid.12135. Epub 2013 Aug 9.
Immediate implant insertion in mandibular molar extraction sockets raises a series of challenges for clinicians.
This preliminary study demonstrates the use of a modified insertion technique of implant placement at the time of mandibular molar extraction.
Immediate implants were placed at the time of molar extraction in 20 patients; a sulcular buccal incision with releasing periosteal incisions were made around the mandibular molar to be replaced, and implant insertion into the interseptal/interradicular bone was performed. The remnants of roots were atraumatically extracted, and the bony defects around the implant were grafted with synthetic resorbable bone substitute β- Tricalcium phosphate, and the flap was sutured. Three months later, implants were restored with single crown fixed prostheses. Patients were followed up at 6, 12, and 18 months after insertion using periapical standardized radiographs to monitor the changes in the marginal bone level.
Our modified insertion techniques showed an implant survival rate of 95%; one implant failed 4 weeks after insertion. No significant marginal bone loss around the implant was recorded at all times of follow-up. Satisfactory soft issue parameters were achieved.
The combination of immediate implant placement with engagement of the interseptal/interradicular bone, atraumatic extraction of remnant roots, and concomitant regenerative therapy showed preliminary favorable outcomes. However, wider application of this technique for longer following up periods is required for further conclusive recommendations.
在下颌磨牙拔牙窝即刻植入种植体给临床医生带来了一系列挑战。
本初步研究展示了在下颌磨牙拔除时采用改良种植体植入技术的应用情况。
对20例患者在磨牙拔除时即刻植入种植体；在下颌待替换磨牙周围做龈沟颊侧切口并附加骨膜松解切口，将种植体植入牙槽间隔/牙根间骨内。无创性拔除残留牙根，用可吸收合成骨替代物β-磷酸三钙植入种植体周围的骨缺损处，然后缝合瓣。3个月后，用单冠固定修复体修复种植体。在植入后6、12和18个月对患者进行随访，使用根尖标准化X线片监测边缘骨水平的变化。
我们的改良植入技术显示种植体存活率为95%；1枚种植体在植入后4周失败。在所有随访时间均未记录到种植体周围有明显的边缘骨丢失。获得了满意的软组织参数。
即刻种植体植入与牙槽间隔/牙根间骨结合、残留牙根的无创性拔除以及同期再生治疗相结合显示出初步的良好效果。然而，需要更长随访期更广泛地应用该技术以获得进一步的确切建议。
