Master Periodontology, Faculty of Dentistry, Ain Shams University, Cairo, Abbassia, Egypt.
Professor of Oral Medicine, Periodontology and Diagnosis, Faculty of Dentistry Ain shams university, Cairo, Egypt.
Clin Implant Dent Relat Res. 2022 Oct;24(5):548-558. doi: 10.1111/cid.13117. Epub 2022 Jun 28.
In the anterior region, the resorption of the buccal plate of bone after tooth extraction leads to contraction of the overlying soft tissues, resulting in an esthetic problem. In the socket shield technique, the buccal root section of the tooth is maintained, to preserve the buccal bone for immediate implant placement. The aim of this randomized clinical trial was to investigate the effect of leaving a gap or not between implant and retained root fragment on bone dimensions and soft tissue esthetics.
This was a two armed parallel group randomized clinical trial with allocation ratio 1:1. Patients were eligible in case they needed immediate implant replacing teeth in esthetic zone with sufficient buccal bone support. CBCT was performed immediately after the intervention and 12 months later.
Forty six patients (26 females and 20 males) were enrolled in the study with 23 of them placed in contact with shield and 23 were placed palatal leaving a gap to graft with a xenograft. After 12 months, excellent soft tissue stability was reported (mean pink esthetic score at placement group A: 12.00 ± 1.60 after 12 months 12.90 ± 1.69, group B 12.62 ± 2.07 and after 12 months 12.38 ± 2.20) Using both surgical techniques. Radiographic crestal bone level changes mean for group A was -0.26 ± 0.52 and for group B -0.34 ± 0.31. There was a strong positive correlation between clinical and radiographic bone width values which was statistically significant (r = 0.782, p < 0.001). Width and thickness of keratinized gingiva showed no significant difference between values measured in both groups. Nonsignificant difference between studied groups according to the labial plate of bone clinical and radiographic changes after immediate implantation.
Within the limitations of this study, the present data seem to support that the clinical outcome of the socket shield technique with immediate implant placement placed in contact or leaving a gap gave excellent esthetic results.
在前牙区，拔牙后颊侧骨板的吸收会导致覆盖软组织的收缩，从而导致美观问题。在牙槽骨盾技术中，保留牙的颊根部分，以维持颊侧骨用于即刻种植体植入。本随机临床试验的目的是研究种植体与保留的根段之间留有间隙或不留间隙对骨量和软组织美观的影响。
这是一项双臂平行组随机临床试验，分配比例为 1:1。符合条件的患者为需要在前牙区即刻植入牙齿以获得足够颊侧骨支持的患者。干预后即刻和 12 个月后进行 CBCT 检查。
46 名患者（26 名女性和 20 名男性）纳入本研究，其中 23 名患者与盾接触，23 名患者放置在腭侧留有间隙以用异种移植物移植。12 个月后，报道了良好的软组织稳定性（放置组 A 的平均粉红色美学评分：12.00±1.60，12 个月后为 12.90±1.69，组 B 为 12.62±2.07，12 个月后为 12.38±2.20）。使用两种手术技术。组 A 的放射状牙槽嵴骨水平变化平均值为-0.26±0.52，组 B 为-0.34±0.31。临床和放射学骨宽度值之间存在很强的正相关，具有统计学意义（r=0.782，p<0.001）。两组测量的角化龈宽度和厚度无显著差异。根据即刻植入后唇板的临床和放射学变化，两组之间无显著差异。
在本研究的限制范围内，目前的数据似乎支持牙槽骨盾技术即刻植入并接触或留有间隙的临床结果均能获得良好的美学效果。
