在移除失败的植入物后，用复合结节移植体立即重建脊柱。

IF 0.9 Q3 DENTISTRY, ORAL SURGERY & MEDICINE Clinical Advances in Periodontics Pub Date : 2022-10-01 DOI:10.1002/cap.10228

Snjezana Pohl

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引用次数: 0

摘要

背景：当发现牙科种植体失效时，必须将其移除，从而造成缺损。有报道称，在拔除单个种植体后，使用自体复合结节移植体立即重建缺损。鉴于硬组织和软组织的大量损失，拔除一个以上失效种植体后的牙脊重建是一项更大的挑战。据笔者所知，这是第一份描述使用自体复合结节移植重建多个部位软硬组织的报告：三名种植失败且牙嵴缺损的患者接受了由上颌结节的骨、骨膜、结缔组织和上皮组成的复合结节移植，同时进行软硬组织重建。上颌小结节的骨块被放置在缺损的骨质边界之间，或被固定在颊侧以增加牙脊。小结节上的较小骨块用于填补缝隙。移植的软组织部分可自然愈合，因此无需进一步手术来增加角化牙龈和前庭深度。所有部位均顺利恢复，牙脊的尺寸也得以重建：结论：对于有足够结节骨量的患者，使用一体式复合结节骨移植似乎是一次手术重建牙脊的可行方法：为什么这些病例是新信息？在移除一个或多个失败的种植体后，需要立即重建较大的硬组织和软组织缺损。角化牙龈宽度和前庭深度得到改善。成功处理这些病例的关键是什么？通过锥形束计算机断层扫描对结节和缺损进行评估小心处理结节骨适当的移植物塑形复合结节移植物固定用于保护移植物区域的固定临时修复体这些病例成功的关键限制因素是什么？无法获得小结节一种对技术敏感的方法。

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Immediate ridge reconstruction with a composite tuberosity graft after removal of failing implants

Background

When a dental implant is discovered to be failing, the implant must be removed, resulting in a defect. Immediate reconstruction of the defect using an autogenous composite tuberosity graft has been reported following the removal of a single implant. Ridge reconstruction after the removal of more than one failing dental implant poses an even greater challenge, given the substantial loss of hard and soft tissue. To the author's knowledge, this is the first report to describe the use of an autogenous composite tuberosity graft for the reconstruction of hard and soft tissue for multiple sites.

Methods and Results

Three patients with failing implants and ridge defects received a composite tuberosity graft comprising the bone, periosteum, connective tissue, and epithelium of the maxillary tuberosity for simultaneous hard and soft tissue reconstruction. Bone from the maxillary tuberosity was positioned between the bony borders of the defect or fixed buccally to augment the ridge. Smaller bone pieces from the tuberosity were used to fill the gaps. The soft tissue portion of the graft was allowed to heal spontaneously, thus eliminating the need for further surgery to increase keratinized gingiva and vestibular depth. All sites recovered uneventfully, and the ridge dimensions were re-established.

Conclusion

For patients with sufficient tuberosity bone volume, using a one-piece composite tuberosity bone graft appears to be a promising approach for rebuilding the ridge in a single surgery.

Key points

Why are these cases new information?

Large hard and soft tissue defects are reconstructed immediately after the removal of one or more failed implants.
Keratinized gingival width and vestibular depth are improved.

What are the keys to the successful management of these cases?