Ispitivanje estetskog ishoda fiksnih nadoknada na implantima nakon očuvanja alveolarnog grebena beta-trikalcijum fosfatom i kolagenom u gornjoj vilici

Abstract

Uvod Gubitak zuba u estetskoj regiji gornje vilice praćeno je dimenzionim promenama alveolarnog grebena što za posledicu ima redukciju njegove širine i visine. Beta trikalcijum fosfat (βTKF) sa kolagenom tip I (Kol 1) je sintetski materijal sa osteokonduktivnim svojstvima indikovan za očuvanje koštanog tkiva alveolarnog grebena po ekstrakciji zuba, što je od posebnog značaja u prednjoj regiji gornje vilice. Uspešnost estetskog ishoda nakon ugradnje implantata vrednuje se procenom stabilnosti mekog i koštanog tkiva kao i zubnih nadoknada na implantatima. Imajući u vidu značaj u postizanju estetskih kriterijuma, i objektivnog vrednovanja dobijenih rezultata, predložen je klinički sistem interpretacije estetskih parametara. Koriste se dve skale: modifikovana PES (Pink Esthetic Score), za meka periimplantna tkiva, i WES (White Esthetic Score) za procenu estetskih parametara zubne nadoknade na implantima . Ciljevi Poređenje dimenzione stabilnosti alveolarnog grebena 2, 4 i 9 meseci nakon vađenja zuba i prezervacije alveole βTKF + Kol 1; procena kvaliteta i kvantiteta novoformirane kosti u navedenim vremenskim intervalima histološkom i histomorfometrijskom analizom; utvrđivanje stabilnosti periimplantnog tkiva i komparativna analiza estetskih parametara mekog tkiva i estetskih parametara samih nadoknada oko definitivne, šrafom retinirane metalokeramičke nadoknade. Materijal i metod U istraživanje je bilo uključeno 90 pacijenata podeljenih u 3 grupe; grupa pacijenata kod kojih je zarastanje alveole posle primene βTKF + Kol 1 trajalo 2, 4 i 9 meseci. Nakon predviđenog vremena zarastanja, na mestu uzete biopsije, preparisano je ležište za implant Astra Tech TX promera 3.5S ili 4.0S i dužine 9 ili 11 mm. Za sve tri ispitivane grupe radjena je kvantitativna i kvalitativna histološka i histomorfometrijska analiza procentualne zastupljnosti mineralizovane i nezrele novoformirane kosti, zastupljenost vezivnog tkiva, partikula neresorbovanog materijala i krvnih sudova...

Introduction Tooth extraction in the aesthetic region of the upper jaw is accompanied by dimensional changes of the alveolar ridge, which results in a reduction in its width and height. Beta-tricalcium phosphate (βTCP) with collagen type I (Kol-1) is a synthetic material with osteoconductive properties indicated for the preservation of bone tissue of the postextraction sites. The success of the aesthetic outcome after implant placement in the anterior region of the upper jaw is evaluated by assessing the stability of soft and bone tissue at the implant placement site. Having in mind the importance in achieving aesthetic criteria, as well as the importance of objective evaluation of the obtained results, a clinical system of interpretation of aesthetic parameters using two scales, modified, PES (PinkEstheticScore) scale and scale for assessing aesthetic parameters of dental restoration on WES scale implants (WhiteEstheticScore). Aims Comparison of the degree of resorption of the alveolar ridge 2, 4 and 9 months after tooth extraction and preservation of the alveolus βTCP + Col-1; assessment of the quality and quantity of newly formed bone in the specified time intervals by histological and histomorphometric analysis; determining the stability of periimplant tissue and comparative analysis of aesthetic parameters of soft tissue and aesthetic parameters of the restorations around the definitive, screw-retained metal-ceramic restoration. Material and Method The study included 90 patients divided into 3 groups; group of patients in whom alveolar healing after preservation with βTCP + Col 1 lasted 2, 4 and 9 months. After the anticipated healing time, at the site of the biopsy, implant bed for Astra Tech TX with a diameter of 3.5S or 4.0S and a length of 9 or 11 mm was prepared. Quantitative and qualitative histological and histomorphometric analysis of percentage of mineralized and immature newly formed bone, connective tissue, particles of unresorbed material and blood vessels was performed for all three examined groups...