The Probability of Lingual Plate Perforation of Immediate Virtual Implant Placement on Mandibular Posterior Teeth: A Preliminary Study

利用虛擬植體置放評估下顎後牙區立即植牙造成舌側穿孔之初探

黃良吉(Liang-Gie Huang) ； 宋承恩(Cheng-En Sung) ； 林明鴻(Ming-Hung Lin) ； 黃寶賢(Po-Hsien Huang) ； 毛念平(Lian-Ping Mau) ； 劉立德(Leader Liu) ； 沈一慶(E-Chin Shen) ； 傅鍔(Earl Fu) ； 黃仁勇(Ren-Yeong Huang)

《臺灣牙周病醫學會雜誌》 20卷2期 (2015/06) Pp. 91-102

https://doi.org/10.6121/TAP.2015.20.2.03

摘要

立即植牙是將植體置放入新鮮的拔牙窩洞中，已被證實是一可行的治療策略。然而，就技術上而言，這樣的術式在臨床上是極具有挑戰性，並且被視為是一個「技術敏感」的手術。因此，臨床醫生在施行這樣的術式時，應該隨時保持注意造成治療失敗的風險與併發症的可能，如：在下顎後牙區進行立即植牙，不慎穿出舌側皮質骨板導致舌側穿孔，可能破壞危及重要的解剖結構，造成神經或血管損傷等等。當舌側骨板穿孔（LPP）發生在下顎後牙區，它可能會導致進一步的炎症反應與後續的感染，最終對立即植入的植體產生不利影響，嚴重者甚至可能導致危及生命的狀況。本研究目的在評估下顎骨後牙區之解剖型態，量測下顎舌側凹陷的相關解剖參數，並經由模擬植體的置放評估舌側骨板穿孔的可能發生率。本研究符合參與資格之受試者共有200位病人，856顆牙齒之電腦斷層影像進行下顎骨形狀（C，P，U型）之分析，並量測下顎舌側凹陷的相關解剖參數（角度，高度，深度），透過虛擬植體置放預期可能發生舌側穿孔之機率為14.5%，其中又以下顎第二大臼齒38.3%之風險最高，且與其它牙齒相較具統計學之差異性（p＜0.001）。因此，牙齒型式與下顎骨及舌側凹陷之解剖構造都與下顎後牙區進行立即植牙產生舌側骨板穿孔的風險具相關聯性。

關鍵字

立即植牙 ； 舌側穿孔 ； 舌側凹陷

並列摘要

Immediate placement of a dental implant into a fresh extraction socket has got attention in recent days. Immediate dental implant placement has been shown to be a successful treatment procedure; however, it is still technically challenging and can be considered as a ＂technique-sensitive＂ procedure. Therefore, the clinician should always be aware that certain untoward risks and complications have been reported, such as immediate implant placement beyond the alveolar housing may result in perforation of the lingual cortex, damaging vital anatomical structures and causing neurovascular injuries. When lingual plate perforation (LPP) occurs in the posterior mandible region, it may result in inflammation and/or infection that could adversely influence the outcome of the immediate implant placement, and may even cause life-threatening events. The purposes of the present computer simulation study are to evaluate the prevalence of, and the dimensional parameters of lingual concavities, and to determine whether the presence of lingual concavities is related to a higher risk of LPP when performing an immediate implant surgery in the mandibular posterior region. The cone beam computed tomographic images from 200 subjects (856 teeth) were analyzed in regards to the shape of the mandible (C, P, U Type), dimensional parameters of lingual concavity (angle, height, depth), and determine the probability of LPP by virtual implant placement. The overall probability of LPP is 14.5%, with the mandibular second molar (38.3%) representing the highest risk for LPP compared to the other tooth types (p ＜ 0.001). It should be noted that the tooth type, shape of the mandible, and dimensional features of lingual concavities are all associated with risks of LPP during immediate implant placement.

並列關鍵字

immediate implant ； lingual plate perforation ； lingual concavity