上顎前牙美觀區立即植牙造成唇側皮質骨板穿孔之可能性評估

Probability of the Labial Bone Plate Perforation during Immediate Implant Placement in the Esthetic Zone

宋承恩(Cheng-En Sung) ； 林明鴻(Ming-Hung Lin) ； 黃寶賢(Po-Hsien Huang) ； 喻大有(Da-Yo Yuh) ； 毛念平(Lian-Ping Mau) ； 林富煌(Fu-Huang Lin) ； 傅鍔(Earl Fu) ； 黃仁勇(Ren-Yeong Huang)

《臺灣牙周病醫學會雜誌》 19卷2期 (2014/06) Pp. 98-108

https://doi.org/10.6121/TAP.2014.19.2.03

摘要

目的：近年來隨著人工植牙成功率與存活率的提升，植牙已為現代牙科治療帶來重大之影響。立即植牙目前常被廣泛運用於上顎前牙區，因為其相較於傳統植牙可以減少手術次數、縮短整體治療時間、增進前牙美觀，並且克服了病人許多心理層面的恐懼因素，但是相對的也存在一些潛在風險，尤其是上顎前牙區牙齒與齒槽骨之關係以及特殊的解剖構造，造成立即植牙手術時，唇側皮質骨板可能會發生穿孔，除了影響上顎美觀區立即植牙的成果，增加手術的難度外，也提高了植牙失敗的機會。本篇研究的主要目的為回顧電腦斷層影像資料庫，觀察國人上顎前牙區牙齒與齒槽骨間之關係（sagittal root position, SRP），並以虛擬植體的置放（virtual implant placement），評估上顎前牙區如採用立即植牙手術，造成唇側皮質骨穿孔的可能性。材料方法：本研究總共收錄97位患者的電腦斷層資料，其中包括43位男性，54位女性，平均年齡48.36 ± 13.64歲；共有546顆牙齒符合資格，其中包含正中門齒共178顆（32.6%）、側門齒177顆（32.4%）、犬齒191顆（35%）。結果：國人上顎前牙區牙齒與齒槽骨的關係（SRP）分類以Class I為最多（94.6%），其次依序為Class II（5%）、Class IV（0.4%）、無Class III（0%）。若以模擬植體置放評估上顎前牙區立即植牙可能造成唇側皮質骨穿孔的機率則將高達88.3%，其中前牙區牙齒與齒槽骨的關係分類中Class I與Class IV分別有92.2%及100%的機會造成唇側穿孔，遠高於Class II（14.3%），且在統計學上具顯著差異性（p ＜ .001）。此外，不同牙位間可能造成唇側皮質穿孔的機會則以犬齒最高（92.7%），其次是正中門齒（88.8%）及側門齒（83.1%）（p ＜ .05）。結論：本研究結果中，國人的上顎前牙與齒槽骨的關係（SRP），牙根走向多半是朝向唇側的皮質骨板（Class I），加上特殊的解剖構造，植體大小的選擇，於上顎前牙區進行立即植牙時，若是沿著牙齒原有的長軸來做鑽孔，有相當高的比例可能造成唇側皮質骨板的穿孔（88.3%），且犬齒牙位與SRP Class I的牙齒風險來的更高。綜上所述，詳細且完整的臨床及放射線術前檢查，妥慎的治療計畫以及細膩的手術技術，才能避免上顎前牙區立即植牙之唇側皮質骨穿孔的風險。

關鍵字

牙科植體 ； 診斷 ； 美觀區 ； 立即植牙

並列摘要

Background: Immediate implantation in the aesthetic zone not only reduces the frequency of treatment, shorten the overall treatment time, improves patient esthetics and has significant psychological benefits for the patient, but it may also increase the potential risks associated with the surgical procedures due to the special relationship between teeth and their osseous housing. Such risks include labial bone plate perforation. The purpose of this simulation study was to investigate the relationship between the teeth and the osseous housing in the anterior maxillary region, to classify the relationships found and to assess the probability of labial bone plate perforation when an immediate implant placement is carried out in the aesthetic zone; this was done by placing a virtual implant.Materials and Methods: The classification and relationship between teeth and the osseous housing were investigated using the sagittal root position (SRP) classification. Virtual implants were placed to simulate immediate implants in the anterior maxillary region and the probability of labial bone plate perforation was determined.Results: A total of 97 patients, including 43 males and 54 females (546 teeth), with mean age of 48.36 ± 13.64 years, are included in this study. The results show that the most prevalent SRP relationship in the anterior aesthetic zone is Class I (94.6%) followed by Class II (5%), Class IV (0.4%) and Class III (0%). The overall probability of labial bone plate perforation in aesthetic zone is 88.3%. A significant higher incidence of labial bone plate perforation in teeth that are Class I (92.2%) and Class IV (100%) was found based on the SRP classification (p ＜ .001). In terms of tooth type, during immediate implant placement, maxillary canines (92.7%) were more likely to be involved in labial plate perforation than central incisors, which was followed by lateral incisors (p ＜ .05).Conclusions: There is a high risk of labial bone plate perforation associated with immediate implant placement in the aesthetic zone, especially when the patient is either Class I or Class IV based on the SRP classification; this is most likely for the maxillary canines. To increase the safety and success rate of immediate implant placement, it is essential that there is a carefully evaluation of the anatomical features of any implant sites in the anterior maxillary region.

並列關鍵字

dental implants ； diagnosis ； esthetic zone ； immediate implant placement