Bodereau Enrique Fernández, Flores Viviana Yolanda, Naldini Pablo, Torassa Daniel, Tortolini Patricia
Department of Fixed Prosthodontics, Oral Surgery and Implantology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba 5000, Argentina.
Department of Oral Biology, Faculty of Dentistry, Universidad Nacional de Córdoba, Córdoba 5000, Argentina.
Dent J (Basel). 2020 Apr 1;8(2):30. doi: 10.3390/dj8020030.
Implant-prosthetic rehabilitation of missing teeth in the anterior maxilla is often challenging due to ongoing bone resorption and remodeling events and may require regeneration procedures involving the nasopalatine canal (NPC). We describe a surgical approach with a block graft in relation to the NPC and evaluate clinical performance, sensory perception, and aesthetic result of the implant-prosthetic treatment over a two- to nine-year (mean: 3.5 years) follow-up. Ten implants (six in the right central incisor and four in the left central incisor) were, respectively, placed in 10 consecutive patients with bone defects affecting the NPC and unfavorable widening of the incisive foramen. Treatment stages included: (1) Diagnosis: evaluation of clinical-aesthetic parameters using Cone Beam Computed Tomography; (2) Surgery: block graft placement by palatine and incisal with simultaneous guided bone regeneration, and late (6-10 months) implant placement; (3) Prosthetics: placement of a screw-retained crown (torque of 32 N/cm). At treatment initiation, all the NPCs evaluated in our study were free of pathologies. Treatment evaluation included bone crest thickness, neurosensory status, patients' treatment perception, and pink and white aesthetic scores (PES/WES). Pre-surgery, anterior ridge thickness at the level of the incisive foramen was (mean ± SD) 3.5 ± 2 mm, 5.4 ± 1.5 mm, and 6.1 ± 1.9 mm at heights of 4, 8, and 14 mm apical to the marginal bone crest, respectively. Post-treatment values were, respectively, 10.1 ± 2.0 mm, 10.5 ± 1.0 mm, and 13.4 ± 3.0 mm. The perception of treatment with the aesthetic pink and white indices (PES/WES) was an average of 7.5 and 7 points, respectively, out of a total of 10 each index, with a recovery of 100% of the neurosensory perception of the area. We propose that bone augmentation using block and particulate graft material can compensate for anatomical variations in the NPC, optimize implant's three-dimensional positioning and improve facial contour, providing tissue and implant stability and good aesthetic outcomes.
由于持续的骨吸收和重塑事件，上颌前部牙齿缺失的种植-修复重建通常具有挑战性，可能需要涉及鼻腭管（NPC）的再生程序。我们描述了一种与鼻腭管相关的块状骨移植手术方法，并在2至9年（平均：3.5年）的随访中评估种植-修复治疗的临床性能、感觉知觉和美学效果。分别为10例连续的骨缺损累及鼻腭管且切牙孔增宽不良的患者植入了10枚种植体（右侧中切牙6枚，左侧中切牙4枚）。治疗阶段包括：（1）诊断：使用锥形束计算机断层扫描评估临床美学参数；（2）手术：通过腭部和切牙进行块状骨移植并同时进行引导骨再生，后期（6 - 10个月）植入种植体；（3）修复：放置螺丝固位冠（扭矩为32 N/cm）。在治疗开始时，我们研究中评估的所有鼻腭管均无病变。治疗评估包括牙槽嵴厚度、神经感觉状态、患者对治疗的感知以及粉红和白色美学评分（PES/WES）。术前，在距边缘牙槽嵴顶4、8和14 mm高度处，切牙孔水平的前嵴厚度分别为（平均值±标准差）3.5±2 mm、5.4±1.5 mm和6.1±1.9 mm。治疗后的值分别为10.1±2.0 mm、10.5±1.0 mm和13.4±3.0 mm。美学粉红和白色指数（PES/WES）对治疗的感知平均每项指标满分10分中分别为7.5分和7分，该区域的神经感觉感知恢复率为100%。我们认为，使用块状和颗粒状移植材料进行骨增量可以弥补鼻腭管的解剖变异，优化种植体的三维定位并改善面部轮廓，提供组织和种植体稳定性以及良好的美学效果。
