Hanser Thomas, Khoury Fouad
Int J Periodontics Restorative Dent. 2016 Jul-Aug;36(4):465-73. doi: 10.11607/prd.2730.
This study evaluated volume stability after alveolar ridge contouring with free connective tissue grafts at implant placement in single-tooth gaps. A total of 52 single-tooth gaps with labial volume deficiencies in the maxilla (incisors, canines, and premolars) were consecutively treated with implants and concomitant free palatal connective tissue grafts in 46 patients between 2006 and 2009. Implants had to be covered with at least 2 mm peri-implant local bone after insertion. At implant placement, a free connective tissue graft from the palate was fixed inside a labial split-thickness flap to form an existing concave buccal alveolar ridge contour due to tissue volume deficiency into a convex shape. Standardized volumetric measurements of the labial alveolar contour using a template were evaluated before connective tissue grafting and at 2 weeks, 1 year, and 5 years after implantprosthetic incorporation. Tissue volume had increased significantly (P < .05) in all six reference points representing the outer alveolar soft tissue contour of the implant before connective tissue grafting to baseline (2 weeks after implant-prosthetic incorporation). Statistically, 50% of the reference points (P > .05) kept their volume from baseline to 1 year after prosthetic incorporation and from baseline to 5 years after prosthetic incorporation, respectively, whereas reference points located within the area of the implant sulcus showed a significant (P < .05) decrease in volume. Clinically, 5 years after prosthetic incorporation the originally concave buccal alveolar contour was still convex in all implants, leading to a continuous favorable anatomical shape and improved esthetic situation. Intraoral radiographs confirmed osseointegration and stable peri-implant parameters with a survival rate of 100% after a follow-up of approximately 5 years. Implant placement with concomitant free connective tissue grafting appears to be an appropriate long-term means to contour preexisting buccal alveolar volume deficiencies in single implants.
本研究评估了在单颗牙间隙种植体植入时使用游离结缔组织移植进行牙槽嵴轮廓修整后的体积稳定性。2006年至2009年间，连续对46例患者上颌（切牙、尖牙和前磨牙）存在唇侧体积不足的52个单颗牙间隙进行种植体植入，并同期进行游离腭部结缔组织移植。种植体植入后，种植体周围局部骨组织覆盖厚度不得少于2 mm。在种植体植入时，将取自腭部的游离结缔组织移植固定于唇侧的分层瓣内，由于组织体积不足，将原本凹陷的颊侧牙槽嵴轮廓整形成凸形。在结缔组织移植前以及种植修复体结合后2周、1年和5年，使用模板对唇侧牙槽嵴轮廓进行标准化体积测量。在代表种植体植入前牙槽嵴外侧软组织轮廓的所有六个参考点，结缔组织移植至基线（种植修复体结合后2周）时，组织体积均显著增加（P < 0.05）。统计学上，分别有50%的参考点在修复体结合后1年以及修复体结合后5年时，相对于基线保持其体积不变（P > 0.05），而位于种植体龈沟区域内的参考点体积则显著减小（P < 0.05）。临床上，修复体结合5年后，所有种植体原本凹陷的颊侧牙槽嵴轮廓仍为凸形，从而形成持续良好的解剖形态并改善美观情况。口腔内X光片证实种植体骨结合良好，种植体周围参数稳定，随访约5年后生存率为100%。种植体植入并同期进行游离结缔组织移植似乎是一种适当的长期方法，可用于修整单颗种植体颊侧已有的牙槽嵴体积不足。
