【病例分享】上颌侧切牙即刻种植美学修复一例
前 言
患者上颌前牙外伤折断,牙根无法保留,要求种植修复。微创拔除12剩余残根,腭侧壁上定点,先锋钻确认种植体植入位置。植入3.3mm*14mm 士卓曼钛锆合金亲水表面骨水平锥柱状种植体 (BLT) 种植体。临时义齿戴入正中,前伸侧方均无咬合接触。根尖片显示临时基台就位良好,无骨阻挡。CBCT显示种植体三维位置良好。10天后拆线,临时义齿稳定,牙龈愈合良好。临时义齿修复5个月后,个性化取模,个性化基台,口外预粘结,完成修复。术后1年和术后3年CBCT显示种植体唇侧骨板厚度大于2mm,牙冠颜色形态较自然,龈缘高度与邻牙协调,牙龈颜色质地健康,近远中牙龈乳头充盈完好,轮廓美学得到很好的维持。
初诊情况
患者情况
· 患者年龄:23岁
· 患者性别:女
· 主诉:上颌前牙外伤折断2日
· 现病史:上颌前牙外伤折断,已在急诊科将折断部分拔除,牙根无法保留,要求种植修复
· 既往史:自述健康,不吸烟,否认系统疾病及药物过敏史
· 家族史:健康
· 全身状况:健康
口内检查
· 12残根,断根位于唇侧位于牙龈下1mm,舌侧斜行折裂至龈下3mm-4mm;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-1.jpg?wid=1080)
术前口内照
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-2.jpg?wid=1080)
断根舌侧劈裂至龈下3mm-4mm
· 唇侧龈缘曲线完好,与邻牙协调,牙龈质地健康,无炎症,薄龈型;
· 残根不松,叩诊不适;
· 11、21之间有约1mm-1.5mm缝隙;
· 口内余牙健康,牙周卫生良好;
· 咬合关系:正常;
· 患者中线对称,中位笑线,患者面型左右对称,颌面部各部分比例协调,开口度,开口型正常;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-3.jpg?wid=1080)
术前微笑面相
· 双侧颞下颌关节活动度对称,无压痛,无弹响,颞肌咬肌无压痛。
· CBCT 检查
· 12 断根,根尖区剩余骨高度充足,可用骨高度19mm,骨宽度7.2mm。
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-4.jpg?wid=520)
术前根尖区显示12折裂
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-5.jpg?wid=1080)
术前 CBCT
诊断
· 12牙体缺损
美学风险评估
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-6.jpg?wid=1080)
外科手术过程
· 向患者交代病情及修复种类,患者决定种植修复12;
· 术后拟行临时义齿修复或个性化愈合基台;
· 术前复方氯已定漱口水含漱3次,每次3分钟;
· 口周及口内消毒;
· 12局麻下分根,微创拔除12剩余残根;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-7.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-8.jpg?wid=1080)
分根微创拔除残根
· 搔刮清理拔牙窝,可探及根尖区拔牙后唇侧有穿孔;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-9.jpg?wid=1080)
清理拔牙窝
· 腭侧壁上定点,先锋钻确认种植体植入位置;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-10.jpg?wid=1080)
偏腭侧定点
· 放置指示杆确定种植体方向,方向无误后,逐级备洞,腭侧骨板部门攻丝,植入3.3mm×14mm士卓曼钛锆合金亲水表面骨水平锥柱状种植体 (BLT) 种植体;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-11.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-12.jpg?wid=1080)
方向杆显示种植体轴向位置
· 初期稳定性大于35NCM,ISQ值73;
· 跳跃间隙大于2mm,跳跃间隙内放置骨粉;
· 根尖穿孔区局部翻瓣,暴露穿孔部位;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-13.jpg?wid=1080)
根尖穿孔区翻瓣
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-14.jpg?wid=1080)
周围皮质骨增加血运营养孔
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-15.jpg?wid=1080)
偏腭侧植骨种植体
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-16.jpg?wid=1080)
唇侧骨板下1mm
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-17.jpg?wid=1080)
唇侧跳跃间隙大于2mm
· 放置骨粉、骨膜;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-18.jpg?wid=1080)
根尖区局部植骨
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-19.jpg?wid=1080)
覆盖胶原膜
· 缝合;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-20.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-21.jpg?wid=1080)
缝合颌面观
· 橡皮障隔离术区;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-22.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-23.jpg?wid=1080)
术区橡皮障隔离
· 取模,制作临时义齿;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-24.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-25.jpg?wid=1080)
临时义齿完成
· 临时义齿戴入正中,前伸侧方均无咬合接触;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-26.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-27.jpg?wid=1080)
临时义齿口内就位
· 根尖片显示临时基台就位良好,无骨阻挡;
· CBCT显示种植体三维位置良好;
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-28.jpg?wid=1080)
术后 CBCT 显示种植体三维位置良好
· 10天后拆线,临时义齿稳定,牙龈愈合良好;
· 局部消毒,拆线,冲洗。
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-29.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-30.jpg?wid=1080)
拆线时愈合情况
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-31.jpg?wid=1080)
一个月复查
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-32.jpg?wid=1080)
每次复查的根尖片
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-33.jpg?wid=596)
龈缘曲线高度协调一致
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-34.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-35.jpg?wid=1080)
个性化取模
修复操作
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-36.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-37.jpg?wid=1080)
修复体制作完成
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-38.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-39.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-40.jpg?wid=1080)
个性化氧化锆基台
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-41.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-42.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-43.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-44.jpg?wid=1080)
口外预粘结
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-45.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-46.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-47.jpg?wid=1080)
口内完成修复当日
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-48.jpg?wid=1080)
术后一年的CBCT
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-49.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-50.jpg?wid=1080)
完成修复一年后复查
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-51.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-52.jpg?wid=1080)
修复后3年复查
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-53.jpg?wid=1080)
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-54.jpg?wid=1080)
患者微笑照
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-55.jpg?wid=1080)
术后三年的CBCT
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-56.jpg?wid=584)
不同时期CBCT截图
医生介绍
![](https://straumannprod-h.assetsadobe2.com/is/image/content/dam/sites/straumann/cn/news/202201212/20220121-57.jpg?wid=1080)