Lateral cephalometric analysis of patients with maxillary alveolar protrusion and advanced periodontitis treated with immediate implants and cross-arch fixed prostheses

目的 探讨牙周炎晚期伴上颌牙槽骨前突畸形患者即刻种植全牙列固定修复后的侧貌变化特点及临床效果,为临床诊治提供参考依据.方法 选取2013年1月至2016年10月于北京大学口腔医学院·口腔医院种植科连续就诊的牙周炎晚期伴上颌牙槽骨前突畸形拟行全牙列固定修复的患者.拔除上颌余留患牙,截除上颌前部过突的牙槽骨,即刻植入4~6枚种植体行全牙列即刻固定修复,术后6个月完成最终修复.术中测量牙槽骨截骨高度.比较术前和最终修复后软硬组织头影测量项目的变化.采用视觉模拟评分法对容貌美观变化进行评价.结果 共完成10例患者的双颌全牙列种植固定修复,共植入89枚种植体;上颌平均植入4.5枚.上颌前部牙槽骨平均截骨高度(6.3±1.8)mm.最终修复后上中切牙切缘较术前向腭侧移动(5.5±2.7)mm,向根方移动(1.6±1.2)mm,上中切牙长轴向腭侧倾斜9.6°±8.1°.最终修复后患者鼻唇角比术前增大10.5°±6.4°.患者和医师均认为最终修复后容貌美观比术前有明显改善.结论 对牙周炎晚期伴上颌牙槽骨前突畸形的患者,通过拔除患牙,截除一定高度的上颌前部牙槽骨,腭向设计修复体排牙位置,可明显改善患者面下1/3解剖结构的位置关系及患者的美观感受.Objective To investigate the changes of the lateral cephelometric landmarks of soft tissue and hard tissue of patients with maxillary alveolar protrusion and advanced periodontitis treated with immediate implants and cross-arch fixed prostheses. Methods From January 2013 to October 2016, consecutive patients with advanced periodontitis and maxillary alveolar protrusion in need of immediate implants and cross-arch fixed prostheses were included in this study. All the patients were treated with provisional cross-arch fixed prostheses supported with 4 to 6 immediate implants after extraction of all the residual teeth and reduction of excessive alveolar bone. After 6 months, a final cross-arch fixed prosthesis was delivered. The lateral cephalometric landmarks of soft tissue and hard tissue at the time of pre-operation and final prosthesis delivery were analyzed. The change of patients' facial aesthetics was assessed using visual analogue scale (VAS). Results Ten patients were included in the study. All the patients underwent full arch rehabilitation of both jaws supported by a total of 89 dental implants. In the maxillae, the average number of inserted implants were 4.5. The mean height of alveolar bone reduction was (6.3±1.8) mm. Both the distance of U1-NA (the upper incisor to nasion-A point line) and U1-PP (the upper incisor to palatal plane ) were significantly reduced by (5.5 ± 2.7) mm and (1.6 ± 1.2) mm, respectively. The angle of U1-SN (between upper incisor to sella-nasion line) was reduced by 9.6° ± 8.1° palatally. The nasolabial angles were significantly increased by 10.5° ± 6.4° . Both the patients and dentists considered that the facial aesthetics was improved greatly after the treatment. Conclusions With the reduction of excessive alveolar bone and the realignment of artificial teeth, the treatment of immediate implants and cross-arch fixed prostheses could improve the facial aesthetics of the patients with advanced periodontitis and maxillary alveolar protrusion.国家重点研发计划(2016YFC1102705) Fund program:National Key Research and Development Program of China10625-6305