A novel technique to preserve the alveolar ridge width following tooth extraction in the maxillary frontal area

目的：介绍1种使用微型钛支架、不需要植骨材料、进行上前牙美学区域牙槽嵴保存的临床新技术，并评价该技术的可行性，以及保存拔牙窝水平骨量的临床效果。方法：选取于北京大学口腔医院种植科就诊、全身情况良好、无牙周病或者牙周病史、单颗上颌中切牙不能保留、无急性炎症、需要拔除后延期种植修复、拔牙窝骨壁完整、邻牙健康的患者9例（女性6例，男性3例），平均年龄（26．0±5．7）岁（18～34岁），施行局部麻醉后微创拔除患牙，翻开唇侧软组织瓣，在唇侧骨板外使用微型钛支架支撑软组织，不使用任何植骨材料，复位并缝合软组织瓣，拔牙窝自然二期愈合。术后随访观察拔牙窝的愈合情况，并在拔牙术前和牙槽嵴愈合4个月后种植术前，进行锥形束计算机断层扫描（cone beam computerized tomography，CBCT）检查，通过专用软件进行影像学测量，评估该方法保存上颌中切牙拔牙窝水平骨量的临床效果。结果：9例拔牙窝在随访期内均正常愈合，拔牙前测量牙槽嵴顶牙槽骨水平向宽度为（7．51±0．48）mm （6．92～7．82 mm），术后4个月测量缺牙区牙槽嵴顶中点处水平向骨宽度为（6．81±0．44）mm （6．04～7．38 mm），保存的水平骨量为拔牙前的90．87％±2．91％（87．28％～95．60％）。结论：在拔牙窝唇侧使用微型钛支架来支撑软组织不影响拔牙窝的正常愈合，且在不使用任何植骨材料的情况下能较为有效地保存拔牙位点的水平骨量。Objective:To introduce a novel ridge preservation technique with micro-titanium plate avoiding the use of bone grafting materials,and evaluate the potential horizontal bone preservation effect of this new technique,applied on single maxillary central incisors after tooth extraction for future implant restoration.Methods:Nine patients (six women and three men),mean age (26.0 ±5.7)years(from 1 8 to 34 years)referred to the Department of Oral Implantology,Peking University School and Hospital of Stomotology,were selected and diagnosed with unsalvageable single middle incisor with fine general con-ditions,no signs of acute local inflammation,no ongoing or previous periodontitis,healthy neighboring teeth and intact buccal bone walls.Tooth extraction,delayed implant placement and implant-supported single crown restoration were selected as treatment plan.The teeth were extracted atraumatically with lo-cal anesthesia,followed by a reflection of a minor flap to exposed 2-3 mm of the buccal bone plate.Af-ter that,a micro-titanium plate was trimmed and bended to fit the convexity of the labial bone and fixed by two mini pins with intent to support the labial soft tissue.The flap was then repositioned over the micro titanium plate and secured with two single sutures.No bone grafting materials or releasing incisions were needed.The sockets were left to heal without any intention of primary wound closure.Cone-beam compu-ted tomographic (CBCT)scans were obtained before and four months after tooth extraction.Horizontal ridge widths were measured with CBCT software,and the preservation effects were calculated and recor-ded by the percentage of horizontal ridge alteration.Results:The nine extraction sockets were healed un-eventfully.The average socket width before extraction was (7.51 ±0.48)mm (6.92-7.82 mm).The average alveolar ridge labial-palatal width at the control point of the edentulous area was (6.81 ±0.44) mm (6.04-7.38 mm)4 months after tooth extraction,the mean percentage of ridge width preserved was 90.87%±2.91%(87.28%-95.60%).Conclusion:This novel ridge preservation method by the usage of a micro-titanium plate did not interfere with the natural socket healing process,and at the same time,largely preserved the width of alveolar ridge without any bone grafting procedures.Long term results remain to be seen.国家重点基础研究发展计划; 北京大学口腔医院新技术新疗法重点项目(2015-10)资助Supported by the Major State Basic Research Development Program of People’s Republic of China; Program for New Clinical Techniques and Therapies of Peking University School and Hospital of StomatologyPubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)1175-1794