上颌前牙区种植体周黏膜退缩的预防与处理

doi:10.12337/zgkqzzxzz.2025.12.007

摘要/Abstract

摘要： 上颌前牙区种植体周黏膜退缩是影响种植修复效果的美学并发症,主要表现为唇侧龈缘根向迁移,可伴或不伴有种植体透色、颈部螺纹及基台暴露、修复体与同名牙长度不协调及“黑三角”形成。前牙美学区唇侧正中黏膜退缩的易感与诱发因素包括唇侧骨开裂或骨开窗、薄牙周表型、角化黏膜量极少或缺失;即刻种植适应证选择不当、种植体植入位置偏唇侧、种植体或基台直径过大、修复体轮廓过凸;刷牙用力过大、种植体周炎症刺激等,其中种植体植入位置偏唇侧是最主要影响因素。种植体周黏膜退缩的预防需贯穿种植治疗全周期：术前借助锥形束计算机体层成像精准规划种植体植入位点,可联合数字化技术辅助植入;即刻种植建议同期行跳跃间隙植骨及结缔组织移植（CTG）以增厚软组织;早期或延期种植重点保存现有软硬组织、重建已丧失组织,骨增量时通过规范的引导骨再生和无张力缝合重建组织支撑;修复阶段需采用穿龈轮廓合理、生物相容性良好的过渡修复体及最终修复体,对软组织进行有效塑形与支撑。针对已发生的黏膜退缩,可采用分级治疗方案：轻度退缩（退缩量<2 mm）采用隧道瓣+CTG;重度退缩（退缩量≥2 mm）采用冠向复位瓣+CTG;合并龈乳头高度降低时应用结缔组织平台技术。综上,只有严格遵守医疗规范、防控医源性因素,并结合循证决策与精准操作,才能实现种植修复长期稳定的美学效果。

关键词: 美学区, 种植体周软组织开裂/缺损, 正中黏膜退缩, 结缔组织移植

Abstract: Peri-implant mid-facial recession, characterized by gingival recession, abutment exposure, and "black triangle" formation, critically compromises esthetic outcomes. Specific predisposing and precipitating factors are as follows: buccal bone dehiscence or fenestration, a thin periodontal phenotype, and insufficient or absent keratinized mucosa; improper case selection for immediate implant placement, overly buccal implant positioning, excessively large implant or abutment diameters, and over-contoured restorations; as well as aggressive tooth brushing and inflammatory stimuli from peri-implant diseases. Preventive strategies for mid-facial recession must be integrated throughout the entire implant treatment cycle. Preoperatively, CBCT is utilized for precise planning of implant placement, and digitally guided surgery may be selected for accurate implantation. In immediate implant cases, it is recommended to combine jump gap bone grafting and connective tissue graft (CTG) intraoperatively to thicken the soft tissue. For early or delayed implantation, the focus shifts to preserving existing tissue and reconstructing lost tissue. This involves using standardized guided bone regeneration (GBR) techniques and tension-free suturing during bone augmentation to rebuild lost support. During the prosthetic phase, provisional and final prostheses with appropriate emergence profiles and biocompatible materials are used to effectively shape and support the soft tissue. For managing the existing recession, a graded treatment protocol is proposed as follows. Mild recession (<2 mm): Tunnel technique + CTG. Severe recession (≥2 mm): coronally advanced flap (CAF) + CTG. Cases with loss of interdental papilla: connective tissue platform technique. In summary, achieving long-term stable aesthetics requires strict adherence to clinical protocols, control of iatrogenic factors, and a combination of evidence-based decision-making with precise surgical execution.

Key words: Esthetic zone, Peri-implant soft tissue dehiscence/deficiency, Mid-facial recession, Connective tissue graft

王妙贞,刘峰,刘艳,等. 上颌前牙区种植体周黏膜退缩的预防与处理[J]. 中国口腔种植学杂志, 2025, 30(6): 549-556. DOI: 10.12337/zgkqzzxzz.2025.12.007

Wang Miaozhen, Liu Feng, Liu Yan, Li Yi, Zhan Yaling, Liu Xinran. Prevention and management of maxillary anterior peri-implant soft tissue dehiscence[J].Chinese Journal of Oral Implantology, 2025, 30(6): 549-556.DOI: 10.12337/zgkqzzxzz.2025.12.007.

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