Int J Oral Maxillofac Implants. 2023 Oct 17;38(5):933-942. doi: 10.11607/jomi.10139.
To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas.
Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01.
No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year follow-up (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants.
The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery.
研究上颌美学区拔牙后即刻植入牙齿周围软硬组织成分的改建过程。
研究对象接受了即刻在拔牙窝内植入单颗种植体，未进行骨移植，使用数字化诊断印模和牙科铣床制作定制的类似牙齿的临时冠进行即刻临时修复。使用三维光学系统获取种植体植入后拔牙窝的术中及 1 年随访分层扫描。短期内，进行了计算机断层扫描。将原本存储为 STL（标准三角形语言）文件的牙龈轮廓数字印模转换为 DICOM（医学数字成像和通信）文件，以种植体肩为参照点，然后将其与 3D 放射图像叠加。使用称为 DentaScan 的程序测量观察到的体积和线性结果。测量种植体肩水平牙槽嵴的宽度和边缘骨水平。应用非参数检验，显著性水平设为 P <.01。
随访 1 年后无失败报告。治疗区域仅有轻微或无炎症，几乎无化脓迹象。与基线相比（0.983 ± 0.172 cm3），所有软硬组织的总体体积均显著减少（P <.0001），1 年调查（0.865 ± 0.156 cm3）。如果分别评估软组织和骨组织的变化，只有骨组织的损失有统计学意义（P <.0001）（从 0.434 ± 0.075 到 0.355 ± 0.061 cm3）。此外，与 1 年调查时的总体体积损失（-0.118 ± 0.083 cm3）相比，牙龈组织从基线到 1 年调查时的变化（-0.040 ± 0.067）似乎差异有统计学意义。从基线（12.6 ± 0.6 mm）到 1 年随访（12.1 ± 0.9 mm），宽度减少（-0.5 ± 0.7 mm）。种植体近中和远中边缘骨水平分别为 0.97 ± 0.70 mm 和 0.39 ± 0.78 mm。
本分析表明，即刻定制临时修复足以防止治疗区域各层的体积损失和线性收缩。此外，颊侧似乎是体积损失最严重的区域。与术前测量的总宽度相比，宽度的平均减少量（约 0.5 mm）似乎可以忽略不计。
