Brennand Roper Matthew, Fields Yasmin
Consultant in Restorative Dentistry, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK.
Specialty Registrar in Restorative Dentistry, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK.
Br Dent J. 2024 Dec;237(11):843-849. doi: 10.1038/s41415-024-8023-2. Epub 2024 Dec 13.
Hard and soft tissue remodelling after tooth extraction may result in a concave profile at the subsequent edentulous ridge. This defect may result in a sub-optimal aesthetic transition zone between the soft tissue and the pontic, which may appear to sit on the ridge, rather than emanating from within the ridge, as would a natural tooth. To optimise aesthetics, pontic site augmentation (PSA) (increasing the volume at the pontic site) and pontic site development (PSD) (remodelling the tissue at the pontic site) may provide a solution.This article discusses the role of soft tissue grafting for PSA, alongside the techniques employed for PSD. Biomaterial substitutes may be used for soft tissue grafting; although autogenous tissue remains the gold standard. Patients may benefit from biomaterial substitutes (as no donor site is required) but evidence for long-term volumetric stability within this specific scenario is limited.Studies suggest PSD may be initiated three months post-augmentation, with minimal changes in site volume following this time point; although again, clinical data are limited. PSD can be achieved via several techniques, depending on operator and patient preference, with the ultimate goal of tissue conditioning to accept a convex fit surface that facilitates hygiene practices. PSA and PSD play key roles in the creation of a natural emergence profile at edentulous sites, leading to optimal aesthetics and cleansability.
拔牙后软硬组织重塑可能导致后续无牙嵴出现凹形轮廓。这种缺陷可能导致软组织与桥体之间的美学过渡区不理想，桥体可能看起来位于牙槽嵴上，而不是像天然牙那样从牙槽嵴内部长出。为了优化美学效果，桥体部位增大术（PSA）（增加桥体部位的体积）和桥体部位塑形术（PSD）（重塑桥体部位的组织）可能提供一种解决方案。本文讨论了软组织移植在PSA中的作用，以及用于PSD的技术。生物材料替代品可用于软组织移植；尽管自体组织仍然是金标准。患者可能从生物材料替代品中受益（因为不需要供体部位），但在这种特定情况下长期体积稳定性的证据有限。研究表明，PSD可在增大术后三个月开始，在此时间点之后部位体积变化最小；不过，临床数据同样有限。PSD可通过多种技术实现，具体取决于操作者和患者的偏好，最终目标是对组织进行预处理，以接受有助于保持卫生的凸形贴合表面。PSA和PSD在无牙部位形成自然的龈缘轮廓方面发挥着关键作用，从而实现最佳美学效果和清洁性。
