| Background:After more than half a century’s development of oral implantology,with the implant surface treatment technology growing maturity and the successful application of various bone augmentation surgeries,it has already been a reality for missing teeth in various conditions of sites obtaining stable osseointegration.However,in the aesthetic zone of maxillary anterior teeth,it’s often occurs that soft tissue around the implant is insufficient or retraction after implantation that seriously affect the aesthetic effect of implant prosthesis.Therefore,it has become an important method for getting good implanting aesthetic effect by soft tissue augmentation processing during implant synchronization or phase II.Professor Sclar firstly reported the method that using a palatal vascularized periosteal connective tissue flap(VIP-CT flap)for reconstruction horizontal and vertical soft tissue defects in maxillary anterior area.VIPCT flap’s donor area gets larger,because the preservation of blood supply from the connective tissue-periosteal vascular plexus near the incisive foramen,the soft tissue reconstruction effect for labial and coronal sites in maxillary anterior area is obviously,so it can provide enough tissue supports for the improvements and maintenance of transmucosal and gingival papillary morphology.When it is used in practical application,the degree of difficulty for harvesting VIP-CT flap and soft tissue effect after transplantation is often affected by the amount of soft tissue at the donor area,how to obtain the soft tissue thickness information of its donor area before operation programme and reduce the incidence of surgical complications is of great clinicalsignificance.In addition,the grafting effect of soft tissue grafts is also an important factor in judging the advantages and disadvantages of the soft tissue augmentation methods,VIP-CT flap as one kind of pedicled flap of connective tissue with good blood supply,can avoid the relatively large absorption and atrophy change after soft tissue free grafting,and can perform implant implantation and soft&hard tissue augmentation in synchronization,shorten the course of treatment.Part Ⅰ: Study on the Donor Sites Mucosa Thickness of VIP-CT Flap by Cone Beam Computed TomographyObjective:The application of cone beam CT(CBCT)on measuring the thickness of mucosa in the donor sites of vascularized periosteum and connective tissue flap(VIPCT flap)to provide reference for clinical development of flap surgery program.Methods:CBCT data of 96 patients were selected.The mucosal thickness of 3mm,6mm,9mm and12 mm distance from the palatal gingival margin sites from the maxillary central incisors to pre-molar were measured respectively(recorded as L3,L6,L9 and L12 loci respectively,only L3 and L6 loci were detected in the central incisors palatal area).SPSS17.0 software package was used for data applications,To compare the difference of the mucosa thickness of the left and right teeth,The grade frequency of mucosal thickness,differences in gender and age,tooth position and sites.Results:The average thickness of the mucosa was 2.09 to 4.54 mm at selected sites,The conditions that mucosal thickness was less than 2mm was infrequence(8.74%).Except the L9 and L12 loci from lateral incisor and canine,the thickness of the mucosa was thickened gradually from front to back with the teeth and from the near to the distant distance from gingival margin.Left and right about the same teeth loci mucosalthick-ness had no significant difference.There were statistically significant differences in the mucosa thickness with sex and age.Conclusions:The donor sites mucosal thickness of VIP-CT flap are greater than 2mm generally from the gingival margin with the distance of 3mm;mucosal thickness with the teeth from front to back,and the distance from the gingival margin from near to far gradually thickening,except the mucosa at the area with the distance from the lateral incisor and the canine gingival margin of 9mm had the trend of being thinner;the mucosal thickness of the elderly population is thicker than the younger population.Part Ⅱ : Evaluation of Soft Tissue Stability after VIP-CT Flap Using in Immediate Implantation and ProvisionalizationObjective:Evaluate the stability of peri-implant soft tissue after immediate implantation and provisionalization combined application of VIP-CT flap in synchronization in maxillary anterior teeth area.Methods:22 patients of maxillary anterior teeth with single tooth or adjacent teeth could not be retained and planned to get implant prosthesis(13 male,9 female,age 23 years old to 54 years old,average age 35 ± 9 years old),a total of 25 OSSTEM TSIII bone level implants were implanted.Immediate implantation and provisionalization,filling in horizontal defect dimensions at the lip side with Bio-OSS bone powders,and using VIP-CT flap for closing implant labial tooth extraction wound and increased thickness of the keratinized gingiva in synchronization.Planting success rate and VIPCT flap survival rate after surgery was observed,and indicators of the soft tissue,including the gingival margin levels,gingival papilla indices,probing bleeding index scores and pink esthetic scors(PES)was evaluated when the final prosthesiscompleted on the same day(T1),6 months later(T2)and 12 months later(T3)respectively.Using the SPSS17.0 software,statistical analysis of the soft tissue index changes during different period,the test level is α = 0.05.Results: During the observation period,the success rate of implantation was 100%;VIPCT flaps were all survival,no infection,donor and recipient area were healed well;T1~T3 period after final prosthesis,labial implant gingival margin levels remained stable,no statistical differences were found,compared with T1,T3 had the average gingival margin recession of 0.08mm;gingival papilla remained stable during the observation period,no significant differences between the gingival papilla index from the period T1 to T3;T1 to T3 period,peri-implant gingival remain healthy,bleeding on probing index were all less than or equal to 1 degree;PES scores indicated that soft tissues around implants could obtain a good aesthetic result,within observation period these scores decreased slightly,but the difference was not statistically significant.Conclusion: On the basis of proper 3-dimensional implant position and low metabolism of bone graft material is placed into the horizontal defect dimensions,the cases that immediate implantation and provisionalization in conjunction with VIP-CT flap in synchronization can get ideal and stable soft tissue effect in a short time. |
