1 Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
2 Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
J Dent Res. 2018 Mar;97(3):266-274. doi: 10.1177/0022034517737755. Epub 2017 Oct 26.
In aesthetic sites, the integrity of the facial bone wall dimension in the anterior maxilla is jeopardized by physiologic and structural changes postextraction. An effective regenerative protocol is key to reestablish and maintain the hard and soft tissue dimensions over time. The present prospective case series study examined the effectiveness of early implant placement with simultaneous contour augmentation through guided bone regeneration with a 2-layer composite graft in postextraction single-tooth sites over an observation period of 10 y among 20 patients. The median peri-implant bone loss was 0.35 mm between the 1- and 10-y examination. A success rate of 95% was obtained, with pleasing aesthetic outcomes and a high median Pink Esthetic Score (8). Implant crowns (ICs) revealed significant median facial recession between IC and IC (0.17 mm). The facial bone wall dimensions were assessed by preoperative cone beam computed tomography and 2 subsequent scans taken at 6 and 10 y. The median facial bone wall thickness increased significantly from 0 mm at surgery to 1.67 mm at the 10-y examination. The facial vertical bone wall peak (DIC) was located at a median distance of 0.16 mm coronal to the implant shoulder. The facial vertical bone loss of DIC amounted to 0.02 mm between 6 and 10 y. Equivalence testing was performed for the null hypothesis of a difference of >0.2 mm per year between 2 respective time points, showing stable bone conditions. Modulating factors influencing the regenerative outcomes at 10 y were the preoperative proximal crest width and soft tissue thickness. In conclusion, the present study confirmed the long-term effectiveness of early implant placement with simultaneous contour augmentation through guided bone regeneration with a 2-layer composite graft in postextraction single-tooth sites offering stable bone conditions with low risks of mucosal recessions over an observation period of 10 y ( ClinicalTrials.gov NCT03252106).
在美学部位，由于生理和结构的改变，上颌前部的面骨壁完整性受到威胁。有效的再生方案是随着时间的推移重新建立和维持硬组织和软组织的关键。本前瞻性病例系列研究检查了在 20 名患者中，在拔牙后单颗牙位，通过双层复合移植物引导骨再生进行早期种植体植入并同时进行轮廓增强，在 10 年的观察期内的有效性。在 1 年和 10 年的检查中，种植体周围的平均骨损失为 0.35 毫米。获得了 95%的成功率，具有令人满意的美学效果和较高的平均 Pink 美学评分（8）。种植体冠（IC）显示 IC 与 IC 之间的颊侧有明显的平均退缩（0.17 毫米）。通过术前锥形束计算机断层扫描和 6 年和 10 年的后续两次扫描评估颊侧骨壁的尺寸。颊侧骨壁的平均厚度从手术时的 0 毫米显著增加到 10 年时的 1.67 毫米。颊侧垂直骨壁的峰（DIC）位于种植体肩部冠方 0.16 毫米的中位数距离处。DIC 的颊侧垂直骨丢失在 6 年至 10 年之间为 0.02 毫米。对于两个相应时间点之间每年差异>0.2 毫米的零假设进行等效性检验，显示出稳定的骨条件。影响 10 年再生结果的调节因素是术前近中嵴宽度和软组织厚度。总之，本研究证实了在拔牙后单颗牙位，通过双层复合移植物引导骨再生进行早期种植体植入并同时进行轮廓增强的长期有效性，在 10 年的观察期内，提供了稳定的骨条件，粘膜退缩的风险较低（ClinicalTrials.gov NCT03252106）。
