软组织增量在前牙区种植唇侧轮廓美学中的应用  

Application of soft tissue augmentation in labial contour aesthetics of anterior dental implants

作　　者：李少冰 陈晖璐 LI Shaobing;CHEN Huilu(Department of Implantology,Southern Medical Hospital of Stomatology,Guangzhou 510280,China;Department of Periodontics and Implantology,Southern Medical Hospital of Stomatology,Guangzhou 510280,China)

机构地区：[1]南方医科大学口腔医院种植中心,广东广州510280 [2]南方医科大学口腔医院牙周种植科,广东广州510280

出　　处：《口腔疾病防治》2023年第7期457-464,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81801008);新疆维吾尔自治区自然科学基金项目(2020D01C004);南方医科大学口腔医院科研培育计划基金项目(PY2021019)。

摘　　要：天然牙拔除后,其唇侧轮廓常因生理性骨改建而出现塌陷。在前牙区种植位点,为了获得理想的粉色美学效果,常使用骨增量或软组织增量来维持或重建唇侧组织轮廓。在前牙区选择软组织增量恢复美学效果时,需严格把控适应证,只有对于软组织健康且无骨缺损或仅有水平向轻度骨缺损的患者,才可以考虑直接通过软组织增量维持或重建唇侧组织轮廓。在即刻、早期和延期种植中,软组织增量的选择时机各不相同。即刻种植时,唇侧骨板完整,常推荐同期软组织移植以更好地维持唇侧组织轮廓;而在早期或延期种植时,患者已经存在较大范围骨缺损时,同期软硬组织增量风险较高,常选择在一期手术时行骨增量手术,二期手术时行软组织增量手术。软组织增量目前主要为邻近自体软组织移植,如游离龈移植、上皮下结缔组织移植或带蒂腭侧瓣移植等,但手术常伴有第二术区,会增加患者术后反应以及手术操作时长,因此寻找长期稳定的生物替代材料是发展的必然趋势。本文将对使用软组织增量进行唇侧轮廓维持和重建的适应证、时机以及不同方法作述评。After tooth extraction,labial contour collapses due to inevitable physiologic bone remodeling.To achieve optimal outcomes for pink esthetic treatment at anterior implant sites,bone or soft tissue augmentation has been advocated to maintain or reconstruct the labial tissue contour.When choosing soft tissue augmentation for esthetic restoration,it is necessary to strictly grasp the indications for surgery.Soft tissue augmentation to maintain or reconstruct the labial tissue contour could be considered in patients with healthy soft tissue and no bone defects or only mild horizontal bone defects.In immediate,early and late implant placement,the timing of soft tissue augmentation may vary.In immediate implantation,the labial bone plate is intact,so it is highly recommended to simultaneously manage soft tissue during implant placement.However,patients may have large bone defects with early or late implant placement.The risk of augmenting bone and soft tissue simultaneously is likely too high,and bone augmentation surgery is often performed at the first stage while soft tissue augmentation surgery is performed at the second stage.Therefore,soft tissue surgery is often carried out simultaneously with abutment connection.Currently,soft tissue augmentation is achieved mostly with adjacent autologous soft tissue grafts,such as free gingival grafts,subepithelial connective tissue grafts or pedicle palatal flaps,which are often accompanied by a second surgical area.The replacement of autogenous soft tissue grafting with new biological materials will become an inevitable trend.In this article,we analyze and summarize the indications,timing and different methods of soft tissue augmentation to maintain and reconstruct the labial contour.

关 键 词：前牙美学区 牙种植 种植体周软组织 软组织增量 游离龈移植 上皮下结缔组织移植 带蒂腭侧瓣移植 生物材料 

分 类 号：R78[医药卫生—口腔医学]