Carini Fabrizio, Longoni Salvatore, Pisapia Valeria, Francesconi Manuel, Saggese Vito, Porcaro Gianluca
Department of Surgery and Translational Medicine, University of Milan-Bicocca, Monza, Italy.
Ann Stomatol (Roma). 2014 Oct 25;5(Suppl 2 to No 2):15-26. eCollection 2014 Oct-Dec.
Implant rehabilitation delivered in accordance with the traditional protocol has proven to be highly predictable and acceptable (1). Nevertheless, the application of immediate loading on post-extraction implants, especially for aesthetic zones, has now considerably increased (2). The aim of this work is to illustrate the immediate loading of implants placed in the aesthetic zone through tapered design fixtures with microgeometry of a high degree of porosity inserted at the same time or 4-8 weeks from dental avulsion (TSA® Advance, Phibo®).
A total of 15 implant fixtures of which 8 at an interval of 4-8 weeks from extraction (type 2) and the remaining according to the immediate post-extraction technique (type 1) were positioned. All implants were prosthesized within 24 hours from the placement. Definitive crowns replaced provisional restorations after 20-24 weeks. After 4 and 12 months from implant insertion, the following parameters were assessed: X-ray image, pain, mobility or suppuration, soft tissue condition and aesthetic appearance.
Percentage of osseointegration was 93.75%, and 53.5% of the osseointegrated fixtures was type 2. No statistically significant difference between the mean ISQ values for implants of type 1 and 2 both in the post-operative period and after 12 months was evident, indicating that the timing of insertion did not affect the achievement of stability for the implant fixtures tested in our study. Immediate post-extraction implants showed a greater propensity for gingival recession and a peri-implant radiolucency greater than those placed at an interval of 4-8 weeks. The values obtained for the PES/WES and the subjective evaluation of the analyzed sample showed the considerable aesthetic value and the high level of satisfaction guaranteed by the implant technique illustrated.
Although well-designed, high quality, randomized clinical trials are still needed as well as the requirement to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome, immediate/early placement and loading of a single TSA® Advance, Phibo® may be considered a valuable and predictable option in terms of implant success as well as hard and soft tissue stability.
按照传统方案进行种植修复已被证明具有高度可预测性和可接受性（1）。然而，即刻加载拔牙后种植体的应用，尤其是在美学区域，目前已显著增加（2）。本研究的目的是通过在拔牙同时或拔牙后4至8周植入具有高度孔隙率微观几何结构的锥形设计种植体（TSA® Advance，Phibo®），阐述美学区域种植体的即刻加载情况。
共植入15枚种植体，其中8枚在拔牙后4至8周植入（2型），其余按照拔牙后即刻技术植入（1型）。所有种植体在植入后24小时内进行修复。20至24周后，用最终牙冠替换临时修复体。在种植体植入后4个月和12个月，评估以下参数：X线影像、疼痛、松动或化脓、软组织状况及美学外观。
骨结合率为93.75%，骨结合种植体中53.5%为2型。1型和2型种植体在术后及12个月后的平均ISQ值之间无统计学显著差异，表明植入时间不影响本研究中测试的种植体的稳定性。拔牙后即刻植入的种植体牙龈退缩倾向更大，种植体周围透影区比在拔牙后间隔4至8周植入的种植体更大。所获得的PES/WES值以及对分析样本的主观评价显示了所阐述的种植技术具有相当的美学价值和较高的满意度。
尽管仍需要设计良好、高质量的随机临床试验，以及建立一个通用、完整且可重复的美学结果评估指标，但就种植成功以及软硬组织稳定性而言，即刻/早期植入并加载单个TSA® Advance、Phibo®种植体可被视为一种有价值且可预测的选择。
