Roy Marco, Cerea Mauro, Hedzelek Wieslaw, Vaira Luigi Angelo, Dorocka-Bobkowska Barbara
Department of Prosthodontics and Gerostomatology, Poznan University of Medical Sciences, 60-792 Poznan, Poland.
Independent Researcher, 24121 Bergamo, Italy.
J Stomatol Oral Maxillofac Surg. 2025 Jan 25:102263. doi: 10.1016/j.jormas.2025.102263.
Tooth agenesis, particularly the absence of upper lateral incisors, presents substantial challenges for clinicians due to the associated bone atrophy, which limits the use of traditional implant solutions. Current options, such as endosseous implants combined with guided bone regeneration (GBR), often fail due to insufficient osseointegration in atrophic bone. This study aims to evaluate the effectiveness of custom-made, additively manufactured subperiosteal implants in addressing these challenges METHODS: This retrospective study assessed 16 custom-made subperiosteal implants used in 12 patients (10 females, 2 males; mean age 25 ± 2.3 years) with lateral incisor agenesis who had previously experienced early implant failure with conventional endosseous implants. The protocol included subperiosteal implants combined with bovine bone grafts and PRF membranes, allowing for immediate loading and correct prosthetic alignment. Clinical evaluations focused on implant stability, peri-implant tissue health and esthetic (including probing depths and bleeding on probing), and prosthetic success over time.
During a follow-up period of 18 to 64 months (mean 48 ± 6.7 months), all patients maintained stable implants, with no implant failures reported. Biological outcomes demonstrated stable peri-implant health, with probing depths averaging 3 mm and minimal signs of inflammation. The mean pink esthetic score was 12.3 ± 1.1 (range: 10 to 14). Prosthetic complications were limited to minor adjustments, with two cases requiring recementing of crowns after three years.
The results indicate that this new protocol provides a reliable, single-procedure solution for the rehabilitation of lateral incisor agenesis in patients with significant bone atrophy, achieving a 100 % success rate in this study. Despite promising outcomes, the study is limited by a small sample size and the need for longer follow-up to assess durability. This approach offers a viable alternative for patients where traditional implants are not feasible due to bone deficiencies.
牙齿发育不全，尤其是上颌侧切牙缺失，由于相关的骨萎缩给临床医生带来了巨大挑战，这限制了传统种植解决方案的应用。目前的选择，如骨内种植体联合引导骨再生（GBR），由于萎缩骨中骨结合不足，常常失败。本研究旨在评估定制的、增材制造的骨膜下种植体在应对这些挑战方面的有效性。方法：这项回顾性研究评估了16个定制的骨膜下种植体，这些种植体用于12例（10名女性，2名男性；平均年龄25±2.3岁）侧切牙发育不全的患者，这些患者此前使用传统骨内种植体时早期种植失败。方案包括骨膜下种植体联合牛骨移植和PRF膜，允许即刻负重和正确的修复体对齐。临床评估集中在种植体稳定性、种植体周围组织健康和美观（包括探诊深度和探诊出血）以及随时间推移的修复成功情况。
在18至64个月（平均48±6.7个月）的随访期内，所有患者的种植体均保持稳定，未报告种植失败。生物学结果显示种植体周围健康稳定，探诊深度平均为3mm，炎症迹象轻微。平均粉色美学评分为12.3±1.1（范围：10至14）。修复并发症仅限于 minor adjustments，有2例在三年后需要重新粘固牙冠。
结果表明，该新方案为严重骨萎缩患者侧切牙发育不全的修复提供了一种可靠的单步解决方案，在本研究中成功率达到100%。尽管结果令人鼓舞，但该研究受样本量小以及需要更长随访时间来评估耐久性的限制。对于因骨量不足而传统种植不可行的患者，这种方法提供了一种可行的替代方案。
