Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
Special Dental Care Clinic, Peking University School and Hospital of Stomatology, Beijing, China.
Clin Oral Investig. 2024 Jan 13;28(1):93. doi: 10.1007/s00784-024-05502-y.
A digitally designed stent was invented to assist vestibuloplasty and free gingival graft (FGG) after jaw reconstruction. This study aimed to compare the effects of conventional soft-tissue management comprising vestibuloplasty combined with FGG and modified soft-tissue management using a digitally designed stent on the vestibular sulcus depth (VD), keratinised-tissue width (KTW) and peri-implant tissue health in patients undergoing jaw reconstruction.
This prospective cohort study enrolled patients who underwent jaw reconstruction using a fibular flap, iliac flap, or onlay bone graft followed by implant-supported rehabilitation at the Peking University School and Hospital of Stomatology between May 2019 and July 2022. Patients in the stent group received digitally designed stents following vestibuloplasty combined with FGG for peri-implant soft-tissue management. Patients in the control group underwent a conventional vestibuloplasty combined with FGG. VD and KTW were evaluated immediately after implant loading (T2) and 1 year after implant loading (T3), and the atrophy rates of VD and KTW were calculated. Peri-implant clinical parameters were evaluated at T3. Comparisons between the groups were performed using the Mann-Whitney U test. The effects of age, sex, primary disease, reconstruction type, reconstructed jaw and the number and location of implants on VD and KTW were evaluated using linear regression analysis.
There were no significant differences in the atrophy rates of VD and KTW between the stent and control groups at T2 and T3 (both P ≥ 0.05). There were no significant differences in peri-implant clinical parameters between the stent and control groups at T3 (P ≥ 0.05). Reconstruction type, location of implants and primary disease influenced VD, and reconstruction type and age influenced KTW.
There was no significant difference in the maintenance of VD and KTW after jaw reconstruction between soft-tissue management using a digitally designed stent and the conventional method. Further, digitally designed stents do not affect peri-implant tissue health.
Digitally designed stents can simplify clinical procedures without adverse effects on peri-implant tissue health, but they do not promote keratinized mucosa augmentation and vestibuloplasty.
为了辅助颌骨重建后的前庭成形术和游离龈移植（FGG），设计了一种数字化支架。本研究旨在比较传统软组织管理（包括前庭成形术联合 FGG）和改良软组织管理（使用数字化设计的支架）对接受颌骨重建患者的前庭沟深度（VD）、角化组织宽度（KTW）和种植体周围组织健康的影响。
本前瞻性队列研究纳入了 2019 年 5 月至 2022 年 7 月期间在北京大学口腔医学院接受腓骨瓣、髂骨瓣或骨块移植后行种植体支持修复的颌骨重建患者。支架组患者在完成前庭成形术联合 FGG 后，采用数字化设计的支架进行种植体周围软组织管理。对照组患者接受传统的前庭成形术联合 FGG。在种植体加载后即刻（T2）和加载后 1 年（T3）评估 VD 和 KTW，并计算 VD 和 KTW 的萎缩率。T3 时评估种植体周围临床参数。使用 Mann-Whitney U 检验比较两组间的差异。采用线性回归分析评估年龄、性别、原发疾病、重建类型、重建颌骨、种植体数量和位置对 VD 和 KTW 的影响。
支架组和对照组在 T2 和 T3 时 VD 和 KTW 的萎缩率均无统计学差异（均 P≥0.05）。支架组和对照组在 T3 时种植体周围临床参数无统计学差异（P≥0.05）。重建类型、种植体位置和原发疾病影响 VD，而重建类型和年龄影响 KTW。
颌骨重建后，采用数字化设计支架进行软组织管理与传统方法相比，VD 和 KTW 的维持无显著差异。此外，数字化设计的支架不会影响种植体周围组织的健康。
数字化设计的支架可以简化临床操作，且不会对种植体周围组织健康产生不良影响，但不会促进角化黏膜的增加和前庭成形术。
