Cheng Albert W, Berridge Joshua P, McGary Ryan T, Erley Kenneth J, Johnson Thomas M
United States Army Advanced Education Program in Periodontics, Fort Gordon, GA.
Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University of the Health Sciences, Fort Gordon, GA.
Clin Adv Periodontics. 2019 Jun;9(2):91-104. doi: 10.1002/cap.10049. Epub 2018 Nov 1.
How should clinicians manage dental extraction sockets when immediate implant placement is contraindicated, and alveolar ridge preservation is expected to result in inadequate bone volume for implant placement?
Three fundamental options for extraction socket management form a hierarchical continuum in sites where dental implant placement is planned: place an immediate implant, perform ridge preservation, or perform ridge augmentation. The available volume and quality of bone and keratinized mucosa are the primary considerations driving the decision, and each tier in the continuum encompasses a variety of techniques with attendant advantages and disadvantages.
Some immediate implant protocols require no mucoperiosteal flap and possibly produce the most favorable clinical and patient-centered outcomes compared with other extraction socket management approaches. Conversely, guided bone regeneration at dental extraction sites can result in substantial gains in alveolar ridge dimensions, although this treatment may adversely influence mucosal architecture and carry increased risk of postoperative morbidity. When favorable bone and mucosa are present at a dental extraction site, immediate implant placement may be the treatment of choice, barring unusual circumstances. Ridge preservation, typically associated with minimal postoperative morbidity, is a rational second choice when acceptable ridge dimensions are anticipated after healing.
当禁忌即刻种植且预期牙槽嵴保存不能提供足够的骨量用于种植时，临床医生应如何处理拔牙创？
在计划进行牙种植的部位，拔牙创处理的三种基本选择构成了一个分级连续体：即刻种植、进行牙槽嵴保存或进行牙槽嵴增量。骨和角化黏膜的可用量及质量是驱动决策的主要考虑因素，连续体中的每一层都包含多种技术，各有优缺点。
一些即刻种植方案无需切开黏骨膜瓣，与其他拔牙创处理方法相比，可能产生最有利的临床和以患者为中心的结果。相反，拔牙部位的引导骨再生可使牙槽嵴尺寸显著增加，尽管这种治疗可能对黏膜结构产生不利影响，并增加术后发病风险。当拔牙部位存在良好的骨和黏膜时，除非有特殊情况，即刻种植可能是首选治疗方法。牙槽嵴保存通常与术后发病率最低相关，当愈合后预期牙槽嵴尺寸可接受时，是合理的第二选择。
