应用不翻瓣技术进行后牙区种植义齿修复的临床体会

摘要

目的:总结应用不翻瓣技术进行后牙种植义齿修复的临床体会.方法:后牙缺失需要进行种植义齿修复患者53例,男26例,女27例,平均年龄47.4±12.3岁,90颗缺牙.术前均进行CT扫描,三维重建分析缺牙区可用骨长度、宽度和高度,术中环形切除缺牙区黏骨膜进行不翻瓣种植体植入手术,必要时辅助手术导板引导种植体窝洞预备和种植体植入.记录手术耗时时间,术后即刻CT检查植入位置,观察有无并发症的发生,种植体骨结合后完成上部结构修复并定期随访.结果:53例患者应用不翻瓣种植手术成功植入90枚种植体,种植体植入位置良好,术中耗时平均(17.4±5.8)min,无上颌窦底黏膜穿孔、下颌神经损伤、骨壁侧穿等手术并发症,86枚种植体成功修复义齿并经3～10个月随访正常.结论:绝大多数后牙缺牙患者都适合进行不翻瓣种植手术,选择比种植体直径稍大的黏骨膜环切钻更有利于手术,种植体上方皮质骨需要修整后方能使愈合基台准确就位.%Objective: To summarize clinical experience of dental implant surgery with flapless technique.Method:53 patients, 26 men and 27 women,with an average age of 47.4±12.3 years,received flapless implant operation to restore 90 missing teeth in posterior area.By using a preoperative CT scan based three-dimensional reconstruction analysis,available length, width and height of the bone in edentulous ridge were measured carefully.All the patients underwent flapless implant surgery and some of operations aided with surgical guides.Finally the implants were introduced and their initial stability was checked.This was followed by immediate CT scan to perform a thorough examination on the placement,positioning, depth,angulation, and hex-orientation of the implant, and on the intactness of the sinus membrane and mandibular nerve.After osseointegration, the corresponding restoration were finished and followed-up.Result: 53 patients with flapless implant surgery were successful implantation of 90 implants without complications such as perforation of maxillary sinus mucosa, mandibular nerve damage, bone perforation etc.Every implants were in good position.The average time of operations was (17.4±5.8)min.Postoperative swelling and pain were in mild degree.86 implants were restored successfully and followed up for 3 to 10 months.Conclusion: Most patients with missing teeth in posterior area are suitable for dental implant surgery with flapless technique.It was helpful to choose tissue punch whose diameter was slightly larger than that of implant.To allow proper seating of the healing abutment, bone profiler was used to shape the coronal aspect of the crestal bone surrounding the implants.