| Guided bone regeneration refers to the use of barrier membranes to block fibroblasts and epithelial cells with faster growth and migration rate in the soft tissue around the bone defect area,maintain the stability of blood clots in the gap of bone defect,and provide space and time for osteoblasts to enter the bone defect area,and ultimately achieve bone regeneration and directional repair.GBR is one of the most commonly used methods in dental implant surgery.It is mainly used to increase the local bone mass of the jaw,especially the alveolar bone,so as to create good hard tissue anatomical conditions for subsequent implant treatment.Its basic objectives are: first,to ensure adequate and healthy bone tissue around the implant;second,to restore the normal contour of alveolar bone,especially the dental arch contour in the aesthetic area.Since the application of GBR in dental implant surgery in 1990 s,its reliable therapeutic effect has been confirmed by a large number of basic and clinical studies.However,GBR technique also has some drawbacks.For example,in standard GBR procedures,additional incisions are needed to reduce the tension of the mucoperiosteal flaps so that the wounds can be completely closed tension-free after implantation of bone substitutes.However,this method increases the surgical trauma and time on the one hand,and on the other hand,it cuts off micro-vessels in the mucosa and gingival,which is not conducive to local blood circulation and postoperative recovery.At the same time,suture will also lead to shallow oral vestibular sulcus,affecting the initial soft tissue contour and aesthetic effect.In this study,we used the coronally advanced flaps in periodontal connective tissue graft surgery for the treatment of anterior teeth with depressed arch contour but unsevere bone defect in aesthetic area.We improved the design of the surgical approach and expanded the I-shape tunnel space to the root through the transverse incision of the alveolar ridge.Meanwhile,we used the Bio-Oss Collagen as the graft materials,which show better plasticity.On the one hand,the mucoperiosteal flap in dental arch depression is turned up from concave down to convex upward,and the length in horizontal direction remains unchanged.That is to say,without increasing tension,a tunnel-like bone graft space is created,which reduces the need for tension reduction in closing wounds and avoids various disadvantages of additional incision.In addition,the method simplifies the operation,and it is more convenient to use Bio-Oss Collagen during the surgery.In this study,the experimental results were collected by optical digital scanning which would bring the patients no trauma or financial burden.Objective: To verify the clinical effect of tunnel technique with Bio-Oss Collagen in aesthetic area of maxillary in the healing period within 6 months after operation.Methods: In the first operation,we chose the patients who meet the inclusion criteria and implants were implanted in the ideal three-dimensional position according to the principle of restoration-guided implantation,and then the patients were divided into two groups according to the intraoperative conditions for subsequent operation.The experimental group was enrolled when the labial bone plate of the implant was complete and thicker than 1 mm.The bone augmentation was achieved by using the tunnel technique together with Bio-Oss Collagen and Bio-Gide.The control group was enrolled when the thickness of the labial plate of the implant was less than 1 mm or part of the implant penetrated the labial plate.The bone augmentation was achieved by GBR(Bio-Oss + Bio-Gide).The CBCT images immediately after operation and 6 months after operation,as well as the digital optical scanning model data before operation,10 days after operation and 6 months after operation were analyzed and compared,and the two therapeutic plans were evaluated.Results: 1.Analysis and Research on Accuracy and Precision of Digital Intraoral Scanner There was no significant statistical difference between the software measurement data of optical scanning model and the actual measurement data(P > 0.05).It can be concluded that the virtual model obtained by using 3 Shape TRIOS Color optical scanner has higher accuracy.There was no significant statistical difference between the two groups(P > 0.05).It can be concluded that the virtual model obtained by using 3 Shape TRIOS Color optical scanner has high precision.2.The clinical effect of restoring dental arch contour in aesthetic area by Bio-Oss with classical GBR technique.(1)CBCT imaging results showed that there was significant statistical difference in the thickness of the implant labial bone plate between the two groups at 6 months after operation and immediately after operation(P < 0.05),indicating that the thickness of the implant labial bone plate in 6 months after operation was less than that immediately after operation.(2)By observing the images of the scanned models,we can find that the fullness of the dental arch contour in the implant area is the worst before operation,the best 10 days after operation,and the fullness at 6 months after operation is between the two.(3)Comparing the measured data of optical digital image at three time points(before operation,10 days after operation and 6 months after operation),the results showed that there were significant statistical differences(P < 0.05).It indicated that good arch contour was obtained immediately after GBR operation,and a certain amount of absorption occurred during the 6 months recovery period after operation,and the improvement of arch contour could be maintained after recovery period.3.The clinical effect of restoring dental arch contour in aesthetic area by Bio-Oss Collagen with the tunnel technique.(1)CBCT imaging results showed that there was significant statistical difference in the thickness of the implant labial bone plate between the two groups at 6 months after operation and immediately after operation(P < 0.05),indicating that the thickness of the implant labial bone plate in 6 months after operation was less than that immediately after operation.(2)By observing the images of the scanned models,we can find that the fullness of the dental arch contour in the implant area is the worst before operation,the best 10 days after operation,and the fullness at 6 months after operation is between the two.(3)Comparing the measured data of optical digital image at three time points(before operation,10 days after operation and 6 months after operation),the results showed that there were significant statistical differences(P < 0.05).It indicated that good arch contour was obtained immediately after tunnel operation,and a certain amount of absorption occurred during the 6 months recovery period after operation,and the improvement of arch contour could be maintained after recovery period.4.Preliminary study on clinical effect of restoring dental arch contour in aesthetic area with tunnel and GBR technique There was no significant statistical difference in the increase of dental arch contour width between the two treatments(P > 0.05).It can be concluded that the clinical effect of the two treatments on restoring dental arch contour in aesthetic area is similar.Conclusions: 1.3 Shape TRIOS Color intraoral optical scanning system combined with Geomagic Studio 2014 software is reliable in accuracy and precision of three-dimensional quantitative analysis of digital models.2.In the process of restoring the dental arch contour in aesthetic area,the classical GBR technique can obtain abundant bone mass and good dental arch contour fullness on the labial side of the implant after 6 months of recovery.3.In the process of restoring the dental arch contour in aesthetic area,the tunnel technique can obtain sufficient bone mass and good dental arch contour fullness on the labial side of the implant after 6 months of recovery.4.The clinical effect of tunnel technique and GBR technique in restoring the dental arch contour in aesthetic area is similar.In clinical practice,it is necessary to comprehensively analyze the patient’s condition and strictly follow the indications. |
PDF Full Text Request