切换至 "中华医学电子期刊资源库"

中华口腔医学研究杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 10 -14. doi: 10.3877/cma.j.issn.1674-1366.2023.01.002

所属专题: 总编推荐

专家论坛

种植体颊侧软组织开裂的研究进展及分类诊疗建议
黄晓琼1, 邓飞龙1,()   
  1. 1. 中山大学附属口腔医院,光华口腔医学院,广东省口腔重点实验室,广州 510055
  • 收稿日期:2022-11-14 出版日期:2023-02-01
  • 通信作者: 邓飞龙

Research progress, classification and treatment recommendations of peri-implant buccal soft tissue dehiscence

Xiaoqiong Huang1, Feilong Deng1,()   

  1. 1. Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2022-11-14 Published:2023-02-01
  • Corresponding author: Feilong Deng
  • Supported by:
    Science and Technology Major Project of Guangdong Provincial(2017B090912004)
引用本文:

黄晓琼, 邓飞龙. 种植体颊侧软组织开裂的研究进展及分类诊疗建议[J]. 中华口腔医学研究杂志(电子版), 2023, 17(01): 10-14.

Xiaoqiong Huang, Feilong Deng. Research progress, classification and treatment recommendations of peri-implant buccal soft tissue dehiscence[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2023, 17(01): 10-14.

种植体颊侧软组织开裂(PSTD)是种植术后常见的临床并发症,指种植体颊侧软组织边缘相对对侧同名牙或基线水平(最终修复完成时)根向退缩≥1 mm;在无对侧同名牙或基线水平数据情况下,定义为种植修复部件、基台或植体表面的不利暴露。PSTD会影响种植治疗的美学效果,并可能增加生物学并发症的发生率。目前针对PSTD的研究较为欠缺,不同临床研究对于PSTD的定义标准仍存在差异,且缺乏统一的分类标准,临床上对于软组织开裂的治疗也存在较大争议;随着患者对于口腔治疗的美学要求逐渐提高,发生PSTD后通过治疗改善的需求越来越迫切。因此,本文拟结合种植体周围软组织相关研究,明确PSTD定义,评估PSTD的发生率及其相关影响因素,确定其适应证和治疗目标,提出PSTD的临床改良分类和相应治疗建议,为防治种植治疗中软组织开裂提供临床建议,提高患者对种植治疗的满意度。

Peri-implant buccal soft tissue dehiscence (PSTD) is a common clinical complication after oral implantation. PSTD can be defined as an apical migration of the peri-implant soft tissue for more than 1 mm from the baseline examination (final restoration) or in comparison with the adjacent or contralateral natural tooth, exposing part of the prosthetic components, the implant shoulder or surface. PSTD may jeopardize the aesthetic outcome and increase the incidence of biological complications. The research on PSTD is lacking at present. The definition and classification of PSTD have not been standardized. The treatment for soft tissue dehiscence was controversial. With the increasing aesthetic demands of patients, the treatment of PSTD becomes more and more urgent. Therefore, we reviewed the research progress on peri-implant buccal soft tissue dehiscence. We clearly defined the concept, indications and treatment goals of PSTD, and identified the factors associated with the occurrence of PSTD. We also presented a new classification system of PSTD at single implant site and provided treatment recommendations. Furthermore, we provided several implications for the prevention and control of PSTD to improve patients′ satisfaction.

图1 种植体颊侧软组织开裂(PSTD)根据龈乳头高度分类示意图 A:Ⅰ类;B:Ⅱ类;C:Ⅲ类(#11为种植体支持牙冠,绿色横线代表种植体支持牙冠软组织边缘理想位置,即对侧同名牙龈缘平齐的位置,参考Zucchelli等[9]绘制)。
图2 切端观察种植体及修复体颊舌向位置示意图(#11为种植体支持牙冠) A:修复体轮廓位于连接两侧邻牙牙冠唇颊侧外形轮廓的假想曲线(红色曲线)内侧示意图;B:种植体颈部位于连接邻牙牙冠唇颊侧外形轮廓切线(蓝色直线)内侧示意图;参考Zucchelli等[9]绘制。
[1]
Tavelli L, Barootchi S, Avila-Ortiz G,et al. Peri-implant soft tissue phenotype modification and its impact on peri-implant health:A systematic review and network meta-analysis[J]. J Periodontol202192(1):21-44. DOI:10.1002/JPER.19-0716.
[2]
Avila-Ortiz G, Gonzalez-Martin O, Couso-Queiruga E,et al. The peri-implant phenotype[J]. J Periodontol202091(3):283-288. DOI:10.1002/JPER.19-0566.
[3]
Sanz M, Heitz-Mayfield L. Consensus report of DGI/SEPA/Osteology Workshop[J]. Clin Oral Implants Res202233(Suppl 23):3-7. DOI:10.1111/clr.13950.
[4]
Sanz M, Schwarz F, Herrera D,et al. Importance of keratinized mucosa around dental implants:Consensus report of group 1 of the DGI/SEPA/Osteology workshop[J]. Clin Oral Implants Res202233(Suppl 23):47-55. DOI:10.1111/clr.13956.
[5]
Jung RE, Becker K, Bienz SP,et al. Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures:Consensus report of group 2 of the SEPA/DGI/OF workshop[J]. Clin Oral Implants Res202233(Suppl 23):100-108. DOI:10.1111/clr.13955.
[6]
Guerrero A, Heitz-Mayfield LJA, Beuer F,et al. Occurrence,associated factors and soft tissue reconstructive therapy for buccal soft tissue dehiscence at dental implants:Consensus report of group 3 of the DGI/SEPA/Osteology workshop[J]. Clin Oral Implants Res202233(Suppl 23):137-144. DOI:10.1111/clr.13952.
[7]
Sanz-Martín I, Regidor E, Navarro J,et al. Factors associated with the presence of peri-implant buccal soft tissue dehiscences:A case-control study[J]. J Periodontol202091(8):1003-1010. DOI:10.1002/JPER.19-0490.
[8]
Sanz-Martín I, Regidor E, Cosyn J,et al. Buccal soft tissue dehiscence defects at dental implants-associated factors and frequency of occurrence:A systematic review and meta-analysis [J]. Clin Oral Implants Res202233(Suppl 23):109-124. DOI:10.1111/clr.13888.
[9]
Zucchelli G, Tavelli L, Stefanini M,et al. Classification of facial peri-implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone[J]. J Periodontol201990(10):1116-1124. DOI:10.1002/JPER.18-0616.
[10]
Gamborena I, Avila-Ortiz G. Peri-implant marginal mucosa defects:Classification and clinical management[J]. J Periodontol202192(7):947-957. DOI:10.1002/JPER.20-0519.
[11]
Cordaro L, Torsello F, Roccuzzo M. Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction sockets[J]. Clin Oral Implants Res200920(12):1307-1313. DOI:10.1111/j.1600-0501.2009.01724.x.
[12]
Cosyn J, Eghbali A, de Bruyn H,et al. Immediate single-tooth implants in the anterior maxilla:3-year results of a case series on hard and soft tissue response and aesthetics[J]. J Clin Periodontol201138(8):746-753. DOI:10.1111/j.1600-051X.2011.01748.x.
[13]
Seyssens L, de Lat L, Cosyn J. Immediate implant placement with or without connective tissue graft:A systematic review and meta-analysis[J]. J Clin Periodontol202148(2):284-301. DOI:10.1111/jcpe.13397.
[14]
Dierens M, de Bruecker E, Vandeweghe S,et al. Alterations in soft tissue levels and aesthetics over a 16-22 year period following single implant treatment in periodontally-healthy patients:A retrospective case series[J]. J Clin Periodontol201340(3):311-318. DOI:10.1111/jcpe.12049.
[15]
Nisapakultorn K, Suphanantachat S, Silkosessak O,et al. Factors affecting soft tissue level around anterior maxillary single-tooth implants[J]. Clin Oral Implants Res201021(6):662-670. DOI:10.1111/j.1600-0501.2009.01887.x.
[16]
Bittner N, Schulze-Späte U, Silva C,et al. Changes of the alveolar ridge dimension and gingival recession associated with implant position and tissue phenotype with immediate implant placement:A randomised controlled clinical trial[J]. Int J Oral Implantol(Berl)201912(4):469-480.
[17]
Cosyn J, Hooghe N, de Bruyn H. A systematic review on the frequency of advanced recession following single immediate implant treatment[J]. J Clin Periodontol201239(6):582-589. DOI:10.1111/j.1600-051X.2012.01888.x.
[18]
Fu JH, Su CY, Wang HL. Esthetic soft tissue management for teeth and implants[J]. J Evid Based Dent Pract201212(3 Suppl):129-142. DOI:10.1016/s1532-3382(12)70025-8.
[19]
Bienz SP, Pirc M, Papageorgiou SN,et al. The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes:A systematic review and meta-analysis[J]. Clin Oral Implants Res202233(Suppl 23):56-71. DOI:10.1111/clr.13789.
[20]
Weinfurt KP, Reeve BB. Patient-reported outcome measures in clinical research[J]. JAMA2022328(5):472-473. DOI:10.1001/jama.2022.11238.
[21]
Stefanini M, Tavelli L, Barootchi S,et al. Patient-reported outcome measures following soft-tissue grafting at implant sites:A systematic review[J]. Clin Oral Implants Res202132(Suppl 21):157-173. DOI:10.1111/clr.13767.
[22]
Soetebeer M, Jennes ME, Antonoglou GN,et al. Effectiveness of soft tissue augmentation procedures for coverage of buccal soft tissue dehiscence around dental implants:A systematic review [J]. Clin Oral Implants Res202233(Suppl 23):125-136. DOI:10.1111/clr.13918.
[23]
Mazzotti C, Stefanini M, Felice P,et al. Soft-tissue dehiscence coverage at peri-implant sites[J]. Periodontol 20002018,77(1):256-272. DOI:10.1111/prd.12220.
[24]
Zucchelli G, Mazzotti C, Mounssif I,et al. A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant[J]. Clin Oral Implants Res201324(9):957-962. DOI:10.1111/clr.12003.
[1] 刘远翔, 陈卓凡. 以拔牙窝萎缩性改变规律为基础的美学区即刻种植策略[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 407-412.
[2] 李芸, 乔栒柏, 邓华颉, 游云华. 增材制造Ti-6Al-4V钛合金种植体在牙缺失种植修复中的临床应用[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 359-364.
[3] 李秋兰, 李希庭, 王晓东. 数字化技术引导下的美学修复一例[J]. 中华口腔医学研究杂志(电子版), 2023, 17(04): 260-264.
[4] 任静, 耿宁波, 周天任, 陈松龄. 动态实时导航辅助下颌后牙区牙槽骨骨量不足种植[J]. 中华口腔医学研究杂志(电子版), 2022, 16(01): 27-33.
[5] 朱珠, 顾烨辰, 朱庆萍, 何峰, 张玮. 老年患者种植修复成功率与满意度的随访研究[J]. 中华口腔医学研究杂志(电子版), 2022, 16(01): 21-26.
[6] 呙誉东, 鄢雷, 张树新, 闫明. 改良上颌窦底提升术同期种植在上颌后牙区严重萎缩牙槽嵴病例应用的效果评价[J]. 中华口腔医学研究杂志(电子版), 2021, 15(06): 348-354.
[7] 杨雨虹, 李歆, 邓永强. 种植体周围软组织临床意义及软组织不足的防治[J]. 中华口腔医学研究杂志(电子版), 2021, 15(05): 272-277.
[8] 安维康, 张薇, 郑亚飞, 马楚凡. 影响短种植体成功率的因素探讨[J]. 中华口腔医学研究杂志(电子版), 2021, 15(03): 129-134.
[9] 林娟, 李燕燕, 宋晓萌, 朱珠, 谢雯静, 张玮. 前牙美学区牙槽嵴保存延期种植的临床研究[J]. 中华口腔医学研究杂志(电子版), 2021, 15(02): 92-97.
[10] 孙瑞瞳, 李享宜, 胡一淳, 高嘉阳, 胡博, 战德松, 付佳乐. 硅基陶瓷的临床应用现状与展望[J]. 中华口腔医学研究杂志(电子版), 2021, 15(02): 72-78.
[11] 吴文震, 邱妮, 肖玉鸿. 一种非手术组织增量方法:正畸牵引在口腔种植的应用[J]. 中华口腔医学研究杂志(电子版), 2020, 14(06): 390-395.
[12] 蔡毅超, 于皓. 数字化饰瓷技术在氧化锆陶瓷修复体制作中的应用[J]. 中华口腔医学研究杂志(电子版), 2020, 14(05): 330-333.
[13] 武东辉, 曹少萍, 朱韵莹, 梁坚强, 苏静君. 伴上颌窦囊肿或慢性上颌窦炎的上颌窦底外提升术效果评价[J]. 中华口腔医学研究杂志(电子版), 2020, 14(02): 108-114.
[14] 呙誉东, 周炼, 张东强. 帐篷螺丝技术在单颗上前牙水平向骨增量的临床应用[J]. 中华口腔医学研究杂志(电子版), 2020, 14(01): 41-46.
[15] 赖思煜, 习利军, 倪俊鑫. 两种材料在拔牙后引导骨组织再生位点保存术中的应用效果[J]. 中华口腔医学研究杂志(电子版), 2019, 13(05): 284-290.
阅读次数
全文


摘要