Private Practice Hürzeler/Zuhr, Munich, Germany.
Department of Periodontology, Johann-Wolfgang Goethe University Frankfurt, Frankfurt, Germany.
Clin Oral Implants Res. 2017 Nov;28(11):1450-1458. doi: 10.1111/clr.13012. Epub 2017 Mar 23.
Implant placement immediately after tooth extraction is often accompanied by resorption of surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more insight regarding the safety of the technique with regard to biological and implant-related long-term complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.
This study is a retrospective case series of 10 consecutive patients with implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1) and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions. Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).
All implants healed without adverse events. Peri-implant probing revealed healthy conditions. The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders. Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal aspect of the implants. A mean pink esthetic score of 12 was recorded.
Volumetric analysis showed a low degree of contour changes from extraction and implant placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue contours. This technique should not be used in routine clinical practice until a higher level evidence in the form of prospective clinical trials is available.
拔牙后立即植入种植体常伴有周围组织吸收。开发了一种临床技术，保留牙根颊侧部分以保留牙周韧带和束骨。该技术基于动物研究，表明利用这种方法有可能保留面部组织。本研究的目的是更深入地了解该技术在生物学和种植体相关的长期并发症方面的安全性，并观察种植体周围组织的临床外观。另一个目的是评估长期受影响面部轮廓的体积变化和美学效果。
这是一项回顾性病例系列研究，纳入 10 例上颌第一前磨牙种植体修复患者。在拔牙前（t1）和植入后 5 年（t2）进行印模。对模型的 3D 表面扫描进行数字叠加，以定量评估面部种植体周围组织轮廓和软组织退缩的变化。此外，还收集了临床数据（PPD、BOP、根尖放射线照片和照片）。
所有种植体均愈合良好，无不良事件。种植体周围探查显示健康状况。对影像学图像的比较显示，种植体肩处有生理性骨重塑。在面向口腔的颊侧，组织平均损失为-0.21±0.18mm。种植体平均退缩为-0.33±0.23mm，邻牙为-0.38±0.27mm。种植体肩骨边缘的平均骨量损失量在近中侧为 0.33±0.43mm，在远中侧为 0.17±0.36mm。记录的平均粉红色美学评分为 12。
体积分析显示，从拔牙和植入到随访，轮廓变化程度较低。种植体修复后的黏膜退缩与邻牙相当。在本描述性研究的限制范围内，种植窝保护技术在手术时具有较低的侵袭性，并且可以有效保留面部组织轮廓，获得较高的美学效果。在以前瞻性临床试验形式提供更高水平的证据之前，该技术不应常规应用于临床实践。
