Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Clin Implant Dent Relat Res. 2019 Oct;21(5):853-861. doi: 10.1111/cid.12843. Epub 2019 Aug 28.
Although there is ample research on alveolar ridge preservation (ARP), changes of the soft tissue profile are seldom reported. In addition, the use of a saddle connective tissue graft (S-CTG) has only been described in one study.
To evaluate changes in bone and external soft tissue profile following ARP of intact and nonintact sockets using collagen-enriched deproteinized bovine bone mineral (C-DBBM) and a S-CTG (a); to assess the need for additional hard and soft tissue grafting after ARP (b).
Patients in need of a single or multiple unit fixed reconstruction in the premaxilla were included in this prospective case series. After tooth extraction, sockets were grafted with C-DBBM and sealed with a S-CTG. Cone beam computed tomography slides taken before tooth extraction and 4 to 6 months after ARP were superimposed to measure changes in bone dimensions and external soft tissue profile. The need for additional hard and soft tissue grafting was registered. Implants were evaluated at 1 year. Patient-reported outcomes were registered on a 100 mm visual analogue scale at suture removal and 1 year following ARP.
Nineteen teeth (10 with intact sockets, 9 with nonintact sockets) in 14 patients (11 females; mean age 34) were extracted and treated with the abovementioned protocol. Volume loss could not be prevented and mainly occurred at the buccal aspect. Maximum horizontal bone resorption was 1.27 mm and maximum horizontal shrinkage of the soft tissue profile amounted to 0.87 mm, both at the most cervical aspect. Additional GBR was necessary in two sites with a nonintact buccal bone wall. The need for additional soft tissue grafting was moderate in sites with intact (3/10) and high in nonintact sockets (6/9). Implants demonstrated favorable clinical and esthetic outcomes. Pain intensity and patient satisfaction were 17 and 94, respectively.
Alveolar ridge preservation was not able to prevent relevant tissue changes. However, implants could be installed as planned. Although the application of a S-CTG partly compensated for the buccal bone loss, the need for additional soft tissue grafting was still moderate in intact sockets and high in nonintact sockets.
尽管有大量关于牙槽嵴保存（ARP）的研究，但很少有报道软组织轮廓的变化。此外，只有一项研究描述了使用鞍状结缔组织移植物（S-CTG）。
评估使用富含胶原蛋白去蛋白牛骨矿物质（C-DBBM）和 S-CTG 对完整和非完整牙槽窝的 ARP 后骨和外部软组织轮廓的变化（a）；评估 ARP 后是否需要额外的硬组织和软组织移植（b）。
本前瞻性病例系列纳入需要在前颌骨中进行单个或多个单位固定修复的患者。拔牙后，牙槽窝用 C-DBBM 移植并用 S-CTG 封闭。在拔牙前和 ARP 后 4 至 6 个月拍摄锥形束 CT 幻灯片，以测量骨尺寸和外部软组织轮廓的变化。记录是否需要额外的硬组织和软组织移植。植入物在 1 年后进行评估。在缝线拆除和 ARP 后 1 年，使用 100mm 视觉模拟量表记录患者报告的结果。
14 名患者（11 名女性；平均年龄 34 岁）共 19 颗牙齿（10 颗牙槽窝完整，9 颗牙槽窝不完整）接受了上述方案治疗。不能防止体积丢失，主要发生在颊侧。最大水平骨吸收为 1.27mm，最大水平软组织轮廓收缩为 0.87mm，均位于最颈侧。在 2 个颊侧骨壁不完整的部位需要进行额外的 GBR。颊侧骨壁完整的部位（10/19）需要额外软组织移植的需求为中度，颊侧骨壁不完整的部位（9/19）为高度。植入物表现出良好的临床和美学效果。疼痛强度和患者满意度分别为 17 和 94。
牙槽嵴保存不能防止相关的组织变化。但是，仍可以按计划植入种植体。尽管 S-CTG 的应用部分补偿了颊侧骨丢失，但在颊侧骨壁完整的部位，额外软组织移植的需求仍为中度，而在颊侧骨壁不完整的部位则为高度。
