静的ガイド下完全アーチインプラント手術における角化粘膜維持のためのダブルガイドキット：前向きパイロット臨床研究
Yifan Xu1, Kai Zhang2, Zhen Fan3
1PhD student, Shanghai Engineering Research Center of Tooth Restoration and Regeneration & Tongji Research Institute of Stomatology & Department of Oral Implantology, Shanghai Tongji Stomatological Hospital and Dental School, Tongji University, Shanghai, PR China.
Statement Of Problem:
A mucosa-supported guide for complete arch implant-supported prostheses has been widely used to enhance the accuracy of implant placement. However, the flapless surgical protocol involves a gingiva punch, inevitably leading to a decrease in keratinized mucosa width. Whether a novel double-guide kit will preserve keratinized mucosa is unclear.
Purpose:
The purpose of this prospective pilot clinical study was to evaluate a novel double-guide kit with the purpose of preserving keratinized mucosa in patients requiring complete arch implant-supported prostheses.
Material And Methods:
A total of 16 participants scheduled for complete arch implant-supported prostheses were enrolled and randomly allocated to the control or double-guide group. In the control group, a traditional 1-piece surgical guide with a flapless protocol was designed and used. The double-guide kit, comprising a fixation pin guide and a working guide, allowed the incision of the keratinized mucosa and elevation of a full-thickness flap. The width of keratinized mucosa was measured at 2 timepoint: before implant osteotomy and 3 months after implant placement. The accuracy of implantation was evaluated by superimposing presurgical design and postsurgical cone beam computed tomography (CBCT) scans. The t test and nonparametric test were used for the analysis of reduction volume and accuracy based on the data types (α=.05).
Results:
Eight participants (10 jaws and 61 implants) were assigned to the control group, and 8 participants (11 jaws and 57 implants) to the double-guide group. All implants integrated satisfactorily with no loss during the follow-up of 6 to 26 months. At 3 months postoperatively, the mean ±standard deviation reduction of keratinized mucosa width in the control group was 1.8 ±1.3 mm on the buccal side and 1.5 ±1.7 mm on the lingual side, while that in the double guide group was 0.6 ±1.3 mm on the buccal side and 0.5 ±1.0 mm on the lingual side, revealing a significant statistical difference (P<.05). The implant accuracy was also better in the double-guide group (P<.05).
Conclusions:
The novel double-guide kit significantly reduced keratinized mucosa damage compared with traditional guided implant procedures while ensuring precise implant placement; this should be advantageous for the long-term stability of complete arch implant-supported prostheses.
