Tavelli Lorenzo, Zucchelli Giovanni, Stefanini Martina, Rasperini Giulio, Wang Hom-Lay, Barootchi Shayan
Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Center for clinical Research and evidence synthesis In oral TissuE RegeneratION (CRITERION), Boston, Massachusetts, USA.
Clin Implant Dent Relat Res. 2023 Apr;25(2):204-214. doi: 10.1111/cid.13188. Epub 2023 Feb 9.
Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion.
Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale.
The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points.
The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.
具有挑战性的种植体美学并发症通常表现为种植体位置不当以及相邻牙齿的邻间附着丧失。然而，关于这些情况的治疗证据有限。本研究的目的是评估通过种植体浸没垂直软组织增量术治疗上颌前部孤立性种植体周围软组织裂开（PSTD）且相邻牙齿出现邻间附着丧失后的临床、体积和患者报告结局。
连续纳入10例上颌前部孤立性PSTD患者，其特征为相邻牙列出现邻间附着丧失，并接受水平和垂直软组织增量治疗，包括拆除牙冠和基台、两次结缔组织移植以及浸没愈合。感兴趣的临床结局包括1年时PSTD的平均覆盖情况、PSTD的平均减少量、种植体及相邻部位的临床附着水平（CAL）增加量以及软组织表型改变。使用光学扫描评估体积变化。使用种植体裂开覆盖美学评分（IDES）进行美学结局的专业评估，而患者报告的美学评估采用0至10的视觉模拟量表。
1年时PSTD深度平均减少量和PSTD平均覆盖率分别为2.25毫米和85.14%。观察到角化组织宽度（KTW）平均增加1.15毫米，而黏膜厚度（MT）平均增加1.58毫米。1年时相邻牙列邻间部位的CAL平均增加1.45毫米。与邻间部位相比，种植体面部中部观察到更大的线性尺寸（LD）变化。最终IDES平均为6.90分，而患者报告的美学评估为8.83分。
本研究表明，采用浸没愈合的垂直软组织增量术是治疗具有挑战性的PSTD且相邻牙列出现邻间附着丧失的有效治疗方法。该技术在大多数情况下可有效解决美学并发症，使相邻牙列的邻间附着水平大幅增加。
