骨膜下周向结缔组织移植用于垂直向种植体软组织增量：一例报告

文献信息

中文摘要

背景： 垂直向种植体软组织增量适用于优化种植体周围软组织缺损或裂开病例的美学效果，尤其是当种植体周围黏膜在微笑时暴露时。本文描述了一种通过前庭切口骨膜下隧道入路使用骨膜下周向结缔组织移植（SC CTG）进行垂直向种植体软组织增量的方法。
方法： 一位78岁白人女性因未修复的#7和#8种植体存在种植体周围软组织缺损，且微笑时可见种植体周围黏膜边缘。首先对#7和#8两颗种植体进行使用SC CTG的垂直向种植体软组织增量，6周后仅对#8种植体再次进行。第二次增量后4周，对种植体进行临时修复，8个月后完成最终修复。
结果： 两颗种植体的种植体周围黏膜呈粉红色、质地坚韧、点彩状，并与修复体良好贴合。微笑时#7和#8种植体的黏膜暴露与对侧牙列相当且协调。患者对美学效果表示满意。
结论： SC CTG通过组织打孔器形成穿孔以允许愈合基台通过，仅依靠基台即可稳定移植物，并在通过前庭切口骨膜下隧道入路应用时无需缝合即可实现种植体周围黏膜表型的周向增强。在本病例报告的限制范围内，该方法似乎是垂直向种植体软组织增量的一种简单、有效且无需缝合的技术。
要点： 骨膜下周向结缔组织移植（SC CTG）通过组织打孔器形成穿孔以供愈合基台通过，仅依靠基台即可稳定移植物，并促进种植体周围黏膜表型的周向增强。为获得最佳效果，SC CTG应使用窄愈合基台或具有窄黏膜下轮廓的修复体进行稳定，以最大化周向组织增量并增强种植体周围组织稳定性。SC CTG的厚度和尺寸稳定性是垂直向软组织增量的关键决定因素。

英文摘要

BACKGROUND: Vertical implant soft tissue augmentation is indicated to optimize esthetic outcomes in cases of peri-implant soft tissue deficiency or dehiscence, particularly when the peri-implant mucosa is exposed during a full smile. This manuscript describes the use of a subperiosteal circumferential connective tissue graft (SC CTG) for vertical implant soft tissue augmentation via the vestibular incision subperiosteal tunnel access.
METHODS: A 78-year-old Caucasian female presented with peri-implant soft tissue deficiency at unrestored implants #7 and #8, with peri-implant mucosal margins visible during a full smile. Vertical implant soft tissue augmentation using a SC CTG was performed initially on both implants #7 and #8, and on implant #8 alone 6 weeks later. Four weeks after the second augmentation, the implants were provisionalized, and definitive restorations were delivered 8 months thereafter.
RESULTS: The peri-implant mucosa at both implants appeared pink, firm, stippled, and well adapted to the restorations. Mucosal display at implants #7 and #8 during a full smile was comparable to and harmonious with the contralateral dentition. The patient reported satisfaction with the esthetic outcome.
CONCLUSIONS: The SC CTG, featuring perforations created with a tissue punch to permit passage of the healing abutments, enabled graft stabilization solely by the abutments and facilitated circumferential enhancement of the peri-implant mucosal phenotype without the need for sutures when applied via the vestibular incision subperiosteal tunnel access. Within the limitations of this case report, this approach appears to be a simple, effective, and sutureless technique for vertical implant soft tissue augmentation.
KEY POINTS: The subperiosteal circumferential connective tissue graft (SC CTG), featuring a tissue punch-created perforation for healing abutment passage, enables graft stabilization by the abutment alone and facilitates circumferential enhancement of the peri-implant mucosal phenotype. For optimal outcomes, the SC CTG should be stabilized with a narrow healing abutment or a restoration with narrow submucosal contours to maximize circumferential tissue gain and enhance peri-implant tissue stability. The thickness and dimensional stability of the SC CTG are key determinants of vertical soft tissue gain.