School of Dentistry and Oral Health, MHIQ, Griffith University, Gold Coast, QLD, Australia.
Clin Oral Implants Res. 2017 Oct;28(10):1188-1194. doi: 10.1111/clr.12939. Epub 2016 Jul 29.
This study evaluated the correlation between pre-operative buccal cortical bone thickness and peri-implant tissue response following immediate placement and restoration of implants in the maxillary aesthetic zone.
Eighteen patients (3 males, 15 females) with an age range of 19-57 years requiring the replacement of a single maxillary anterior tooth were included in this prospective study. Patients were selected on the basis of defined criteria: intact socket walls, absence of any acute infection in the sockets, absence of any gingival marginal pathology and attainment of a high primary stability (≥30 Ncm) at implant placement. Regardless of buccal bone thickness, all participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, grafting of the implant-socket gap and connection of a screw-retained provisional restoration. Buccal bone thickness was evaluated using pre-operative CBCT scans. Intra-oral photographs were taken before implant placement (baseline) and at 1- and 2-year follow-up to assess soft tissue changes around the implants. Aesthetic evaluation was carried out using the pink esthetic score (PES).
All implants remained osseointegrated during the follow-up period of 2 years with mesial papilla, distal papilla, and mid-facial gingiva showing a mean recession of 0.06 ± 0.71 mm, 0.25 ± 0.78 mm, and 0.22 ± 0.83 mm, respectively. Pink esthetic score values improved from a median value of 9 (IQR 8.75-10.25) pre-operatively to 11 (IQR 9.75-12) at the end of 2 years. No significant correlation was found between buccal bone thickness (range 0.45-1.24 mm) and soft tissue or aesthetic changes.
Within the limits of this study, no significant correlation could be found between pre-operative buccal bone width and the soft tissue and aesthetic outcome following immediate implant placement and restoration in the anterior maxilla. Therefore, favourable clinical and aesthetic outcomes could be achieved by applying a strict selection criteria and treatment protocol regardless of the initial thickness of the buccal bone.
本研究评估了在上颌美学区即刻植入和修复种植体后，术前颊侧皮质骨厚度与种植体周围组织反应之间的相关性。
本前瞻性研究纳入了 18 名（3 名男性，15 名女性）年龄在 19-57 岁之间，需要替换单个上颌前牙的患者。患者入选标准为：牙槽骨壁完整，牙槽窝内无急性感染，牙龈边缘无任何病理改变，种植体植入时具有较高的初始稳定性（≥30 Ncm）。无论颊侧骨厚度如何，所有参与研究的患者均接受相同的治疗策略，包括拔除患牙、无瓣手术、即刻种植体植入、种植体-牙槽窝间隙植骨和连接螺丝固位临时修复体。术前 CBCT 扫描评估颊侧骨厚度。在种植体植入前（基线）和 1 年及 2 年随访时拍摄口腔内照片，以评估种植体周围软组织变化。采用粉色美学评分（PES）进行美学评估。
所有种植体在 2 年的随访期间均保持骨整合，近中乳头、远中乳头和中面部龈颊侧分别平均退缩 0.06±0.71mm、0.25±0.78mm 和 0.22±0.83mm。粉色美学评分从术前中位数 9（IQR 8.75-10.25）提高到 2 年后的 11（IQR 9.75-12）。术前颊侧骨厚度（0.45-1.24mm）与软组织或美学变化之间无显著相关性。
在本研究范围内，在上颌前牙即刻植入和修复后，术前颊侧骨宽度与软组织和美学结果之间未发现显著相关性。因此，通过严格选择标准和治疗方案，即使初始颊侧骨厚度较薄，也可以获得良好的临床和美学效果。
