Section of Graduate Periodontology, University Complutense, Madrid, Spain.
ETEP (Etiology and Therapy of Periodontal Diseases) Research Group, University Complutense, Madrid, Spain.
Clin Implant Dent Relat Res. 2019 Feb;21(1):145-153. doi: 10.1111/cid.12696. Epub 2018 Dec 3.
Collagen matrices used around immediate implants may reduce morbidity although there is limited evidence on their performance.
To evaluate soft and hard tissue changes when combining immediate implants, hard and soft tissue grafting, and an immediate provisional restoration.
In 12 patients, immediate implants were placed in the anterior maxillary and first premolar area together with a xenogeneic bone substitute. Then a xenogeneic collagen matrix was placed under the buccal mucosal margin with an immediate provisional restoration. Study casts and clinical measurements were taken before extraction (Baseline/BS) at 6 months (6M) and 12 months (1Y) after implant placement. Files from the scanned casts were matched to calculate the linear and volumetric changes at the buccal tissues. Cone Bean Computed Tomographies (CBCTs) were taken prior to extraction and at 6M. The superimposed DICOM files allowed for assessing hard tissue changes and the superimposition of DICOM and STL files allowed for evaluating of soft tissue thickness at BS and 6M.
After 6 months, the horizontal tissue contours decreased 0.66 ± 0.57 mm, concomitant with a horizontal bone loss of 1.31 ± 1.32 mm, measured 1 mm below the most coronal aspect of the ridge. In contrast, the soft tissue thickness, 1 mm below the gingival margin, increased 0.75 ± 1.12 mm. At 1-year, tissue contours had decreased 1.01 ± 0.67 mm compared to BS reaching statistical significance. The mean volume loss after 1Y was 20.43 ± 11.70 mm while the mean mucosal margin recession was 0.86 ± 0.67 mm. These changes had a limited clinical impact as the PES Scores remained stable.
The tested protocol resulted in a significant reduction of the tissue contours and osseous ridge dimensions that was partially compensated by a non-significant increase in soft tissue thickness.
在即刻植入物周围使用胶原基质可以降低发病率,尽管其性能的证据有限。
评估即刻植入物、硬组织和软组织移植以及即刻临时修复体联合应用时软组织和硬组织的变化。
在 12 名患者中,在前上颌和第一前磨牙区域同时植入即刻种植体和异种骨替代物。然后在颊侧黏膜边缘下放置异种胶原基质,并进行即刻临时修复。在拔牙前(基线/BS)、植入后 6 个月(6M)和 12 个月(1Y)取研究模型和临床测量值。扫描模型的文件进行匹配,以计算颊部组织的线性和体积变化。在拔牙前和 6M 时拍摄锥形束 CT(CBCT)。叠加 DICOM 文件允许评估硬组织变化,叠加 DICOM 和 STL 文件允许评估 BS 和 6M 时的软组织厚度。
6 个月后,水平组织轮廓下降 0.66±0.57mm,同时伴有 1.31±1.32mm 的水平骨丧失,测量值位于牙槽嵴最冠方 1mm 以下。相比之下,牙龈缘下 1mm 处的软组织厚度增加了 0.75±1.12mm。1 年后,与 BS 相比,组织轮廓下降 1.01±0.67mm,达到统计学意义。1Y 后平均体积损失为 20.43±11.70mm,平均黏膜边缘退缩为 0.86±0.67mm。这些变化的临床影响有限,PES 评分保持稳定。
该测试方案导致组织轮廓和牙槽嵴尺寸显著减少,部分由软组织厚度的非显著增加补偿。