| Objective:To investigate the key technology of immediate implant process in maxillary and mandibular molar area,and to explore the feasibility of immediate implant placement combined with flap surgery and non-submerged healing without bone graft in molar area,so as to provide reference for better clinical development of immediate implant in maxillary and mandibular molar area.Methods:Selected from September 2018 to September 2019 in the oral and maxillofacial surgery of Qingdao University Affiliated Hospital of 197 patients who required immediate dental implant treatment,according to the inclusion criteria of this study,35 teeth(upper molars 18)10,17 mandibular molars).Routine CBCT measurement and analysis were performed to determine the treatment plan and signed the informed consent.All operations were performed by the same surgeon.The operation was minimally invasive tooth extraction,buccal mucoperiosteal longitudinal incision,and subsequent cut The mesial and distal gingival valley mucosa of the affected tooth was opened,the buccal mucoperiosteal flap was turned up along the deep surface of the periosteum,and the palatal(lingual)side attached to the gum was peeled off.We trimed the inflammatory tissue on the mucoperiosteal surface of the buccal and palate(lingual)side,thoroughly scraped and polished the inflammatory tissue on the surface of the alveolar bone wall.We chose the correct three-dimensional position,used our homemade dental implants to locate the osteotome at the correct three-dimensional position,and used a small ball drill to prepare the hole at that position,and then we used a pioneer drill or a bone expander or summer’s osteotome to prepare the hole step by step The implant socket was prepared,and then the implant selected according to the preoperative design was placed in the correct three-dimensional position,and the torque is greater than 35N·cm.The surgeon selected and installed a healing abutment with a suitable diameter and height.The buccal gingival mucoperiosteal flap was reset and tightly sutured around the healing abutment.The alveolar socket was closed.The suture was removed 10 days after the operation.At 3months or 6-8 months after dental implant placement(3 months in the mandibular molar area;6-8 months in the maxillary molar area),we performed permanent crown restoration on the patient,and then The patient was followed up for 1 year.Count the survival rate of implants 1 year after permanent restoration.Conical bundle CT was taken immediately after operation and 6 months after operation,and 1 year after restoration was counted.Compare and observe the changes in the bone width and height of the implant’s buccal and lingual bone on the day of surgery(T1),during postoperative repair(T2),and 1 year after permanent repair(T3).The subjective satisfaction of patients was investigated by visual analog scale(VAS).All the data in this study conform to normal distribution..SPSS 24.0 statistical software was used for data analysis,and measurement data were expressed as mean ± standard deviation Results:All 35 teeth were successfully implanted with flaps,no bone grafting and nonembedded healing immediately.The average torque during implant placement was42.79±5.70N·cm,all of which achieved good initial stability.The soft tissue wounds healed at first stage.Before the repair,CBCT showed that all the implants and the alveolar socket bone wall had good osseointegration,and the permanent repair was completed on schedule.The survival rate of 35 implants was 100% at T3.Compared with T1,the difference in the vertical distance(CR)from the crest of the alveolar ridge to the implant platform for T2 is-1.05±1.67 mm on the buccal side and-1.57±1.89 mm on the lingual side.The difference is statistically significant respectively(P=0.035,P= 0.037).The difference in the vertical distance(D-R)of the bone defect gap was-4.27±2.88 mm on the buccal side and-3.75±2.76 mm on the lingual side,the difference was statistically significant(P=0.000,P=0.000).The horizontal distance(OC-S)from the buccal-lingual bone plate to the implant surface was 1.10±3.02 mm on the buccal side and-1.06±1.87 mm on the lingual side.The difference was statistically significant(P=0.038,P=0.029).Compared with T2,the difference in the vertical distance(CR)from the crest of the alveolar ridge to the implant platform was 2.20±1.58 mm on the buccal side and-2.19±1.04 mm on the lingual side.The difference was statistically significant(P=0.048,P=0.044)).The difference in the vertical distance(D-R)of the bone defect gap was0.55±1.13 mm on the buccal side and 0.30±0.59 mm on the lingual side,and the difference was not statistically different(P=0.65,P=0.38).The difference in the horizontal distance(OC-S)from the buccal-lingual bone plate to the implant surface was 0.08±1.96 mm on the buccal side and 0.22±1.89 mm on the lingual side,which was not statistically significant(P=1.21,P=0.97).At T1,the bone defect space around the implant was2.74±0.51 mm,and the maximum bone defect was 4.8mm.At T2,it was basically filled with new bone.VAS was 8.71±1.05,And patient satisfaction washigh.Conclusion:1.Minimally invasive tooth extraction,buccal gingival mucoperiosteal incision flap,no bone grafting in the jumping gap,non-embedded healing method is feasible,and the clinical treatment effect is satisfactory.2.The buccal gingival mucoperiosteal incision flap,and the complete removal of the gingival mucoperiosteal and the inflammatory granulation tissue on the surface of the alveolar bone wall after the extraction of the diseased tooth are the biological basis for ensuring the good healing of the alveolar socket after the implant is implanted.All the cases in this study completed permanent restoration and there was no marginal bone resorption and ossification of the skipping gap 1 year after the restoration.This benefited from the complete removal of the inflammatory tissue on the surface of the soft and hard tissues and the gingival mucoperiosteal flap tightly surrounding the healing abutment without tension.The suture closes the wound of the alveolar socket,so that the extraction socket and the implant can heal naturally without external interference,ensuring the success rate of immediate dental implantation in the molar area.3.Use a self-made positioning cone and a small ball drill to locate the correct threedimensional position,and then use a special dental implant socket preparation device to prepare the implant socket.The torque force after the implant is implanted is greater than35 N·cm and the initial stability of the implant is well healed. |
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