Stomatology Department, Faculty of Dentistry, Sevilla University, C/Avicena s/n, 41092 Seville, Spain.
Department of Prosthodontics, Louisiana State University School of Dentistry, New Orleans, LA 70119, USA.
Int J Environ Res Public Health. 2022 Feb 27;19(5):2795. doi: 10.3390/ijerph19052795.
Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.
即刻种植方案在拔牙后被广泛应用，减少了手术步骤。这种方法提高了患者的满意度，并达到与晚期种植相似的成功率。然而，即刻种植并不能抵消牙槽骨的生理性重塑。出于这个原因，已经开发了一些额外的外科技术，如连接组织移植（CTG）或牙槽窝保护技术（SST）。在拔牙后即刻植入物以及 CTG 和/或 SST 放置后，观察到种植体周围组织的尺寸变化。共进行了 26 项手术干预，分析了种植体周围组织的尺寸变化变量。将术前状态和即刻术后情况与一年后的情况进行了比较。在这项 CBCT 放射学研究（Planmeca Promax 3D）中，在距离龈缘 3、5 和 7mm 处进行了测量，并进行了分析。种植体平台被用作测量牙槽嵴高度变化的参考点。在执行两种技术（CTG 和/或 SST）之一的一年后，在距离龈缘 5mm（0.65±1.16mm）和 7mm（0.95±1.45mm）处，牙龈厚度和颊侧皮质明显增加。此外，在 3mm 处记录到腭骨厚度增加（0.48±0.90mm）。在一年后，移植组在颊侧区域的种植体周围组织厚度增加，但 CTG 和 SST 组在临床方面相似。SST 的实施结果表明，一年后硬组织和软组织的颊侧厚度有了显著改善。观察到颊侧皮质骨厚度、整体黏膜厚度和距龈缘 3mm 处的颊侧骨明显增加。两种技术都检测到从骨嵴到平台的距离显著减少。两种技术（CTG 和 SST）都可以在前上颌种植体的颊侧区域为种植体周围组织提供足够的体积。但是，研究也存在一些局限性，如缺乏美学分析或样本量小，因此结果应谨慎解释。需要进一步的研究来进一步评估这些技术的长期预测性。
