| Objectives:With the improvement of the implant restoration, implant denture has been the preferred choices for patients who needed recovery of the losing teeth. After the anterior teeth missing, it is very important to recover the normal occlusion and pronunciation, the esthetics requirement for shape, color and fullness of dentures is also increasingly higher. At present, traditional implant restoration can cause gingival papilla faltness or absence, "blackness" of dental neck, mental abutments exposure, these problems are intractability. Personalized casting porcelain composite abutments can be designed personally, then repaire soft and hard tissue defects of anterior area. Base on the requirement of patients, we can design suitable size of personal abutments use CAD/CAM computer navigation. This study used CAD/CAM technology to produce personal abutments, casting porcelain or mental crown, to evaluate anterior area implant esthetic restoration effect.Methods:Thirty-eight patients with anterior teeth defects were choosed from Department of Planting Center, Shandong University, during the year from 2013 to 2015.All patients were examined before operation, and used X-ray, cone-bean CT to evaluate teeth situation. After preoperative communication, implanted the implants, then processed bone grafting and embedded cropping pattern. During this period, patients need transitional denture. Performed two-stage operation after 4 to 6 months, and made horizontal cast for implants. Made personal CAD/CAM abutments for each patient, then made all-ceramic and baked porcelain metal crowns to achieve good esthetics and function. After treatment needed 3 to 6 months follow-up visit, used healthy adjacent teeth or contralateral teeth as standard, examed patients’ implants and evaluated implant esthetic restoration effect. Two doctors who had neither part nor lot in this experiment were needed to perform white and red esthetic evaluation, then processed statistical analysis.Result:These 38 patients were aged from 18 to 63, included 24 males and 14 females.52 implants were implanted for these patients,24 leaf-combs and 28 leaf-combs were included, and all the implants were successfully implanted. The highest score of PES was 12, and the lowest score was 6, the average score was 7,27(Standard deviation was 4.30). The highest score of WES was 10, and the lowest score was 6, the average score was 8.11 (Standard deviation was 1.02). In the 7 indexs of PES, soft tissue texture got the highest score(1.5±0.77), marginal gingival levels got the lowest score(1.97±0.77), which indicated that the red esthetic of implants was better. In the 5 indexs of WES, dental crowns color got the lowest score(1.25±0.70), dental crowns texture got the highest score(1.92±0.77), which indicated that the white esthetic of implants was better. Jemt papilla index score: 4.00% was at Ⅰ degree,60.67% was at Ⅱ degree,35.33% was at Ⅲ degree, the 0 degree and Ⅳ degree were both 0.Conclusion:Compared with finished produced abutment, personalized casting porcelain composite abutment can effectively improve the implant esthetics and integrating degree. It can resolve the clinical problems of implants gingiva height and implant direction. Gingival porcelain can recover serious soft and hard tissue defect. But this need further observation. |
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