個性化純鈦基臺在后牙種植修復中的臨床應用

程玉葉，周文清，陳建珊，張瑩，裴潤生，吳意華

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個性化純鈦基臺在后牙種植修復中的臨床應用

程玉葉，周文清，陳建珊，張瑩，裴潤生，吳意華

[摘要]目的：評價后牙單顆植入過深或牙齦黏膜組織過厚的種植體進行個性化純鈦基臺冠修復效果，并觀察其對軟組織健康及同期整復的療效。方法：選擇行后牙區單顆Straumann軟組織種植體患者56例，共植入60顆種植體，將其分為2組。觀察組30顆種植體采用個性化純鈦基臺修復，種植體頸部均位于齦下大于2 mm或種植體頸部牙齦厚度不一致，肩臺設計為齊齦肩臺。對照組30顆種植體采用成品純鈦基臺，要求種植體頸部位于齦上，齊齦或位于齦下小于2 mm。2組牙冠均選擇以粘結固位方式CAD/CAM紫晶全瓷冠修復。觀察1～2 a復查，檢測種植體改良菌斑指數( mPLI )、改良出血指數( mSBI )等臨床指標，比較牙齦軟組織的健康程度，及記錄齦乳頭位置及高度來評價牙齦整塑效果。結果：經1～2 a隨訪觀察，2組牙齦健康比較，差異無顯著性(P>0.05)。但觀察組對齦緣位置及齦乳頭高度均有較好的塑形效果，與對照組比較差異有統計學意義(P<0.05)。結論：個性化純鈦基臺同成品基臺相比，可以依據牙齦厚度設計基臺高度及外形，為患者提供最適合的穿齦高度，從而達到高美觀性、高生物相容性、較好的軟組織塑形及整復效果，是后牙種植義齒修復選擇的一種好方法。

[關鍵詞]后牙種植；個性化基臺；成品基臺；牙齦乳頭

Clinical evaluation on aesthetic effect of custom titanium abutment for dental implant restoration in posterior regionCHENGYu-ye,ZHOUWen-qing,CHENJian-shan,etal.(TheStomatologyHospitalofNantongCity,Jiangsu226001,China)

【Abstract】Objective：To evaluate the aesthetic effect of restoration with custom titanium abutment in posterior region and to observe the clinical status of soft tissue health and the restitution effect of the same period.Methods:56 patients were selected,who accepted the operation of single soft tissue implant at posterior region.The total implants number was 60, which were divided into two groups randomly:an experimental group and a control group.The experimental group was restored by the CAD/CAM custom titanium abutment,and the implant neck was located about 2mm subgingivally.The implantshoulder (IS) was flush with the gums.The control group used the finished titanium abutment.The implant neck was required to be located on the gingiva,flush with it or less than 2mm below it. All of the crowns were CAD/CAM all-ceramic crows using cement-retained mode.During the follow-up of 1 to 2 years,mPLI and mSBI and other clinical indicators were monitored and compared with the health status of the soft tissue,while papilla positions were recorded to evaluate the gingival shaping situation.Results:After 1～2 years of follow-up observation, there was no significant difference between custom titanium abutments and finished abutments in gingival health(P>0.05).However, the gingival shape was better and the position of papillae was more stable after using custom abutment.There were significant differences between the two groups(P<0.05).Conclusion:Compared with the finished abutment, the custom abutment can be designed according to the height and shape, so as to provide the most suitable transgingival height for patients, and achieve the perfect effect in aesthetics,biocompatibility,soft tissue remodeling and restoration.It is a good way for posterior implant prosthesis.

【Key words】Posterior implants; Custom abutment; Finished abutment; Gingival papilla

近年來，隨著種植義齒的廣泛運用，人們對種植修復的效果要求不再局限于遠期的成功率和恢復咀嚼功能，希望能夠得到更加自然、舒適、美觀的修復效果[1-3]。基臺作為連接植入體和上部結構的重要修復部件對種植義齒的功能及美觀效果至關重要。成品基臺雖種類繁多但形態單一，適應證的選擇相當嚴格，很難兼顧患者個性化功能和美學需求，特別是植體植入過深或牙齦厚度較高及植體位置不佳時。隨著……