改良根盾技术在前牙美学区即刻种植中的应用

doi:10.12439/kqhm.1005-4979.2025.04.005

摘要/Abstract

摘要：

目的：评估改良根盾技术（modified socket-shield technique，MSST）在前牙美学区单牙即刻种植中的临床应用效果，并探讨其相关技术要点。方法：回顾性研究2022年12月至2023年12月在我科前牙美学区采用MSST进行即刻种植的5例病例。通过影像学分析，评估种植体周牙槽骨改建情况；通过粉色美学指数评分（pink esthetic score，PES）评估种植体周软组织美学效果；并通过视觉模拟评分法(visual analogue scale，VAS）了解患者对术后反应（疼痛、肿胀等）、最终修复效果及整个治疗过程的主观评价。结果：影像学分析结果显示，所有种植位点均获得了良好的骨结合，术后6个月种植体唇侧牙槽骨的垂直向平均变化量为（0.18±0.15） mm；种植体肩台根方2、4、6 mm唇侧牙槽骨的水平向平均变化量为（0.39±0.17）、（0.18±0.23）、（0.22±0.18） mm；种植体肩台水平唇腭向牙槽骨宽度的平均变化量为（0.10±0.10） mm；PES平均得分为（12.40±1.34）分，所有种植位点均获得了较理想的美学修复效果；VAS评分结果显示患者主观满意度较高。结论：MSST应用于前牙美学区即刻种植，可有效维持种植体周骨量与软组织轮廓，是美学区种植修复的可行技术方案。

Abstract:

Objective: To evaluate the clinical effect of the modified socket-shield technique (MSST) in the immediate implant placement of single teeth in the anterior esthetic zone, and to discuss the related technical points. Methods: Five cases of immediate implant placement using MSST in the anterior esthetic zone from December 2022 to December 2023 were reviewed. The alveolar bone remodeling around implants was evaluated by imaging analysis. The esthetic effect of peri-implant soft tissue was evaluated by pink esthetic score (PES). The visual analogue scale (VAS) was used to assess the patients' subjective evaluation of the postoperative reaction (pain, swelling, etc.), the final repair effect and the whole treatment process. Results: Radiographic analysis showed that all implant sites achieved good osseointegration. The average vertical change of the labial alveolar bone of the implant at 6 months postoperatively was (0.18±0.15) mm. The average horizontal changes of labial alveolar bone at 2, 4, and 6 mm apical to the implant shoulder were (0.39±0.17), (0.18±0.23), (0.22±0.18) mm, respectively. The average change of alveolar bone width at implant shoulder level was (0.10±0.10) mm. The average PES score was (12.40±1.34) points, and satisfactory esthetic results were obtained in all implant sites. The VAS score showed that the subjective satisfaction of patients was high. Conclusion: The application of MSST in immediate implant placement in the anterior aesthetic area can effectively maintain the bone volume and soft tissue contour around the implant, and is a feasible technical solution for aesthetic area implant restoration.

中图分类号:

吴浩颖, 王方. 改良根盾技术在前牙美学区即刻种植中的应用[J]. 《口腔颌面外科杂志》, 2025, 35(4): 278-289.

WU Haoying, WANG Fang. Application of modified socket-shield technique in immediate implant placement in the esthetic zone of anterior teeth[J]. 《Journal of Oral and Maxillofacial Surgery》, 2025, 35(4): 278-289.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2025/V35/I4/278

图/表 14

图1 MSST手术流程 A、B.术前正面及𬌗面口内像；C、D.微创拔除腭侧根片；E.调磨修整唇侧根片冠方形态；F.方向指示杆检查种植窝预备方向及深度；G、H.于唇侧根片和种植窝之间的间隙内置入骨移植材料；I.植入种植体，CGF膜覆盖创面，非潜入式愈合；J.术后即刻CBCT影像。

Figure 1 Surgical procedure of MSST

图2 种植体周牙槽骨骨量变化的评估指标 A.种植体肩台水平至唇侧牙槽嵴顶的垂直距离，记为LH；B.种植体肩台水平根方2、4、6 mm处唇侧骨板外缘至种植体唇侧表面的厚度，分别记为LT₂、LT₄、LT₆；C.种植体肩台水平唇腭向牙槽骨宽度，记为W_LP。红色虚线、蓝色实线、浅蓝色实线分别示种植体长轴中心线、种植体肩台水平及唇侧牙槽嵴顶水平；黄色实线示测量的距离。

Figure 2 Measurement indexes of bone mass change of peri-implant alveolar bone

表1 5例MSST患者基本信息

Table 1 Overview of the basic information of the five MSST patients

信息	病例1	病例2	病例3	病例4	病例5
性别	男	女	男	女	女
年龄/岁	35	62	69	54	31
牙位	21	23	11	22	21
患牙情况	外伤致冠根折，未行根管治疗(root canal therapy，RCT)	RCT后残根	RCT后冠根折	RCT后冠根折	RCT后冠根折
牙龈生物型	中厚龈	薄龈	中厚龈	薄龈	薄龈
术前唇侧骨板厚度/mm	0.67	1.01	0.84	1.18	0.86
牙根相对牙槽骨轴向及位置类型^①	ⅡB	ⅡA	Ⅳ	ⅡA	ⅡB
种植体品牌	ABT DFI	ABT DFI	Straumann SLActive RC BLT	Straumann SLActive RC BLT	Straumann SLActive NC BLT
种植体型号	5 mm×11.5 mm	3.3 mm×11.5 mm	4.1 mm×12 mm	3.3 mm×10 mm	3.3 mm×12 mm
植入扭矩/（N·cm）	15	35	<15	35	25
术中置入材料	Bio-Oss collagen+CGF膜	Bio-Oss collagen+CGF膜	Bio-Oss collagen+Bio-Oss CGF膜	Bio-Oss collagen+CGF膜	Bio-Oss collagen+CGF膜
愈合方式	潜入式	潜入式	潜入式	非潜入式	潜入式
愈合时间/月	6	6	6	6	6
术后6个月ISQ值
唇侧	83	81	72	68	65
腭侧	83	81	82	68	66
近中	83	81	72	71	70
远中	83	81	82	71	70
随访期并发症	无	根片外暴露	无	无	根片外暴露

图3 病例1治疗过程照片和影像学资料 A、B.术前口内照；C.术前CBCT示患牙冠根折，牙根相对牙槽骨轴向及位置类型为ⅡB；D.拔除牙冠；E.拔除腭侧根片，术中CBCT校验；F. 8字交叉缝合，潜入式愈合；G.使用天然牙冠制作临时粘接桥；H、I.术后即刻CBCT；J、K.术后6个月CBCT示骨结合良好，根片位置稳定，唇侧骨弓轮廓与邻牙协调；L.更换愈合基台；M.戴入树脂牙，软组织塑形；N—P.戴入终修复体的口内照及X线片。

Figure 3 Photographs and radiographs of the treatment course of case 1

图4 病例2治疗过程照片和影像学资料 A、B.术前口内照；C.术前CBCT示牙根相对牙槽骨轴向及位置类型为ⅡA；D.完成种植体植入；E.种植体与唇侧根片间隙内置入骨移植材料；F.覆盖CGF膜，8字交叉缝合，潜入式愈合；G、H.术后即刻CBCT；I.术后6个月根片小范围外暴露；J、K.术后6个月CBCT示骨结合良好，根片位置基本稳定，唇侧骨弓轮廓与邻牙协调；L.磨除暴露根片，更换愈合基台；M.戴入临时树脂牙软组织塑形；N—P.戴入终修复体口内照及X线片。

Figure 4 Photographs and radiographs of the treatment course of case 2

图5 病例3治疗过程照片和影像学资料 A、B.术前口内照；C、D.术前CBCT示牙根相对牙槽骨轴向及位置类型为Ⅳ；E、F.植入种植体，术中CBCT校验；G、H.术后6个月CBCT示骨结合良好，根片位置稳定，唇侧骨弓轮廓与邻牙协调；I.更换愈合基台后口内照；J.终修复体；K—M.戴入终修复体口内照及X线片。

Figure 5 Photographs and radiographs of the treatment course of case 3

图6 病例4治疗过程照片和影像学资料 A、B.术前口内照；C、D.术前CBCT示牙根相对牙槽骨轴向及位置类型为ⅡA；E、F.术后即刻CBCT；G、H.术后6个月CBCT示骨结合良好，根片位置稳定，唇侧骨弓轮廓与邻牙协调；I.临时修复体行软组织塑形；J、K.制作个性化取模杆；L—N.戴入终修复体口内照及X线片；O—R.戴牙后6个月复查口内照及CBCT。

Figure 6 Photographs and radiographs of the treatment course of case 4

图7 病例5治疗过程照片和影像学资料 A.术前口内照；B.术前CBCT示牙根相对牙槽骨轴向及位置类型为ⅡB；C、D.术中微创分离拔除腭侧根片；E.植入种植体，间隙内置入骨移植材料；F.覆盖CGF膜，8字交叉缝合，潜入式愈合；G、H.术后即刻CBCT；I.术后6个月口内照，根片小范围外暴露；J、K.术后6个月CBCT示骨结合良好，根片位置基本稳定，唇侧骨弓轮廓与邻牙协调；L.磨除暴露根片，戴入临时树脂牙，软组织塑形；M—O.戴入终修复体口内照及X线片；P—R.戴牙后18个月复查口内照及CBCT。

Figure 7 Photographs and radiographs of the treatment course of case 5

表2 MSST术后种植体周牙槽骨骨量变化的影像学评价结果

Table 2 Results of radiographic evaluation of peri-implant alveolar bone mass changes

病例编号	测量时间	测量指标/mm
病例编号	测量时间	LH	LT₂	LT₄	LT₆	W_LP
1	术后即刻	1.69	3.12	3.03	3.00	8.19
	术后6个月	1.33	2.70	2.95	2.93	7.97
	变化量（Δ）	-0.36	-0.42	-0.08	-0.08	-0.22
2	术后即刻	2.85	2.48	1.42	0.89	8.22
	术后6个月	2.52	1.83	1.11	0.73	8.23
	变化量（Δ）	-0.33	-0.65	-0.31	-0.16	0.01
3	术后即刻	3.14	3.96	2.83	2.97	8.86
	术后6个月	3.06	3.78	2.69	2.44	8.84
	变化量（Δ）	-0.08	-0.18	-0.14	-0.53	-0.02
4	术后即刻	1.56	3.02	2.06	1.85	8.26
	术后6个月	1.45	2.72	2.18	1.63	8.16
	变化量（Δ）	-0.11	-0.30	0.12	-0.22	-0.10
5	术后即刻	1.51	2.73	2.43	1.46	7.85
	术后6个月	1.48	2.32	1.96	1.35	7.68
	变化量（Δ）	-0.03	-0.41	-0.47	-0.11	-0.17
平均值（$\bar{x}±s$）	术后即刻	2.15±0.78	3.06±0.56	2.35±0.64	2.03±0.93	8.28±0.37
	术后6个月	1.97±0.78	2.67±0.72^①	2.18±0.72	1.82±0.87	8.18±0.43
	变化量（Δ）	-(0.18±0.15)	-(0.39±0.17)	-(0.18±0.23)	-(0.22±0.18)	-(0.10±0.10)
P值		0.055	0.007	0.155	0.056	0.083

表3 患者PES评价结果

Table 3 PES results of the patients

病例编号	各指标评分							PES总分
病例编号	近中龈乳头	远中龈乳头	软组织轮廓	龈缘水平	牙槽嵴缺陷	软组织颜色	软组织质地	PES总分
1	2	2	2	2	2	2	2	14
2	1	1	2	1	2	2	2	11
3	1	1	1	2	2	2	2	11
4	2	1	2	2	2	2	2	13
5	2	2	2	1	2	2	2	13
平均分（$\bar{x}±s$）								12.40±1.34

表4 患者VAS评分结果

Table 4 VAS results of the patients

病例编号	VAS评分
病例编号	问题1	问题2	问题3	问题4	问题5
1	2	8	8	10	7
2	1	9	9	8	9
3	1	10	10	9	9
4	2	10	9	8	8
5	3	9	9	9	8
平均分（$\bar{x}±s$）	1.80±0.84	9.20±0.84	9.00±0.71	8.80±0.84	8.20±0.84

表5 上颌前牙即刻种植CBCT矢状面牙根位置与倾斜度分类^[17]

Table 5 CBCT-based sagittal classification of root position and inclination for immediate implant placement in the anterior maxilla ^[17]

分类	分类依据
Ⅰ	牙根在牙槽窝内正中
ⅠA	伴有厚唇侧骨壁(≥1 mm)
ⅠB	伴有薄唇侧骨壁(<1 mm)
Ⅱ	牙齿舌倾
ⅡA	伴有厚嵴顶骨壁
ⅡB	伴有薄嵴顶骨壁
Ⅲ	牙齿唇倾，通常为厚腭侧骨壁及唇侧根尖骨壁，薄唇侧嵴顶骨壁
Ⅳ	牙齿整体唇侧位，位于牙槽骨轮廓外
Ⅴ	唇腭侧骨壁均薄

图8 上颌前牙即刻种植CBCT矢状面牙根位置与倾斜度分类

Figure 8 CBCT-based sagittal classification of root position and inclination for immediate implant placement in the anterior maxilla

图9 MSST根片厚度及跳跃间隙示意图

Figure 9 Diagram of the thickness of root fragment and jump gap in MSST

参考文献 38

[1]	Cardaropoli G, Araújo M, Lindhe J. Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs[J]. J Clin Periodontol, 2003, 30(9): 809-818.
[2]	Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog[J]. J Clin Periodontol, 2005, 32(2): 212-218.
[3]	Hämmerle CHF, Araújo MG, Simion M. Evidence-based knowledge on the biology and treatment of extraction sockets[J]. Clin Oral Implants Res, 2012, 23(Suppl 5): 80-82.
[4]	MacBeth N, Trullenque-Eriksson A, Donos N, et al. Hard and soft tissue changes following alveolar ridge preservation: A systematic review[J]. Clin Oral Implants Res, 2017, 28(8): 982-1004.
[5]	Slagter KW, Raghoebar GM, Hentenaar DFM, et al. Immediate placement of single implants with or without immediate provisionalization in the maxillary aesthetic region: A 5-year comparative study[J]. J Clin Periodontol, 2021, 48(2): 272-283.
[6]	Kan JYK, Rungcharassaeng K, Deflorian M, et al. Immediate implant placement and provisionalization of maxillary anterior single implants[J]. Periodontol 2000, 2018, 77(1): 197-212.
[7]	Tavelli L, Zucchelli G, Stefanini M, et al. Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series[J]. Clin Implant Dent Relat Res, 2023, 25(2): 204-214.
[8]	Ramanauskaite A, Sader R. Esthetic complications in implant dentistry[J]. Periodontol 2000, 2022, 88(1): 73-85.
[9]	Hürzeler MB, Zuhr O, Schupbach P, et al. The socket-shield technique: A proof-of-principle report[J]. J Clin Periodontol, 2010, 37(9): 855-862.
[10]	Siormpas KD, Mitsias ME, Kontsiotou-Siormpa E, et al. Immediate implant placement in the esthetic zone utilizing the "root-membrane" technique: Clinical results up to 5 years postloading[J]. Int J Oral Maxillofac Implants, 2014, 29(6): 1397-1405.
[11]	Du Toit J, Gluckman H. The modified socket-shield technique[J]. J Craniofac Surg, 2018, 29(7): 2005-2006.
[12]	Li XF, Li XH, Xu YM, et al. Comparing the modified socket-shield technique with the conventional immediate implantation technique in the anterior dentition: A 5-year retrospective clinical study[J]. Clin Oral Implants Res, 2024, 35(7): 747-756.
[13]	Bischof M, Nedir R, Szmukler-Moncler S, et al. Implant stability measurement of delayed and immediately loaded implants during healing[J]. Clin Oral Implants Res, 2004, 15(5): 529-539.
[14]	Fürhauser R, Florescu D, Benesch T, et al. Evaluation of soft tissue around single-tooth implant crowns: The pink esthetic score[J]. Clin Oral Implants Res, 2005, 16(6): 639-644.
[15]	Raes F, Cosyn J, Crommelinck E, et al. Immediate and conventional single implant treatment in the anterior maxilla: 1-year results of a case series on hard and soft tissue response and aesthetics[J]. J Clin Periodontol, 2011, 38(4): 385-394.
[16]	Jonker BP, Wolvius EB, van der Tas JT, et al. Esthetics and patient-reported outcomes of implants placed with guided bone regeneration and complete native bone: A prospective controlled clinical trial[J]. Int J Oral Maxillofac Implants, 2020, 35(2): 406-414.
[17]	Gluckman H, Pontes CC, Du Toit J. Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement[J]. J Prosthet Dent, 2018, 120(1): 50-56.
[18]	Chappuis V, Engel O, Reyes M, et al. Ridge alterations post-extraction in the esthetic zone: A 3D analysis with CBCT[J]. J Dent Res, 2013, 92(12 Suppl): 195S-201S.
[19]	Chappuis V, Araújo MG, Buser D. Clinical relevance of dimensional bone and soft tissue alterations post-extraction in esthetic sites[J]. Periodontol 2000, 2017, 73(1): 73-83.
[20]	Cook DR, Mealey BL, Verrett RG, et al. Relationship between clinical periodontal biotype and labial plate thickness: An in vivo study[J]. Int J Periodontics Restorative Dent, 2011, 31(4): 345-354.
[21]	Bäumer D, Zuhr O, Rebele S, et al. The socket-shield technique: First histological, clinical, and volumetrical observations after separation of the buccal tooth segment–a pilot study[J]. Clin Implant Dent Relat Res, 2015, 17(1): 71-82.
[22]	Schwimer C, Pette GA, Gluckman H, et al. Human histologic evidence of new bone formation and osseointegration between root dentin (unplanned socket-shield) and dental implant: Case report[J]. Int J Oral Maxillofac Implants, 2018, 33(1): e19-e23.
[23]	Staehler P, Abraha SM, Bastos J, et al. The socket-shield technique: A step-by-step protocol after 12 years of experience[J]. Int J Esthet Dent, 2020, 15(3): 288-305.
[24]	Buser D, Chappuis V, Belser UC, et al. Implant placement post extraction in esthetic single tooth sites: When immediate, when early, when late[J]. Periodontol 2000, 2017, 73(1): 84-102.
[25]	Gluckman H, Salama M, Du Toit J. Partial extraction therapies (PET) part 2: Procedures and technical aspects[J]. Int J Periodontics Restorative Dent, 2017, 37(3): 377-385.
[26]	Tan Z, Kang J, Liu WJ, et al. The effect of the heights and thicknesses of the remaining root segments on buccal bone resorption in the socket-shield technique: An experimental study in dogs[J]. Clin Implant Dent Relat Res, 2018, 20(3): 352-359.
[27]	Cocchetto R. Essay IV: Ongoing alveolar growth, continuous tooth eruption, and implants[J]. Int J Esthet Dent, 2020, 15(Suppl 1): S88-S97.
[28]	Pozzi A, Arcuri L, Kan J, et al. Navigation guided socket-shield technique for implant and pontic sites in the esthetic zone: A proof-of-concept 1-year prospective study with immediate implant placement and loading[J]. J Esthet Restor Dent, 2022, 34(1): 203-214.
[29]	Mitsias ME, Siormpas KD, Kontsiotou-Siormpa E, et al. A step-by-step description of PDL-mediated ridge preservation for immediate implant rehabilitation in the esthetic region[J]. Int J Periodontics Restorative Dent, 2015, 35(6): 835-841.
[30]	Glocker M, Attin T, Schmidlin PR. Ridge preservation with modified "socket-shield" technique: A methodological case series[J]. Dent J, 2014, 2(1): 11-21.
[31]	Troiano M, Benincasa M, Snchez P, et al. Bundle bone preservation with Root-T Belt: Case study[J]. Annals of Oral & Maxillofacial Surgery, 2014, 2(1): 7.
[32]	Atef M, El Barbary A, Dahrous MSE, et al. Comparison of the soft and hard peri-implant tissue dimensional changes around single immediate implants in the esthetic zone with socket shield technique versus using xenograft: A randomized controlled clinical trial[J]. Clin Implant Dent Relat Res, 2021, 23(3): 456-465.
[33]	谭震, 付刚, 文俊儒, 等. 牙根屏障技术的临床应用与评估[J]. 中华口腔医学杂志, 2020, 55(11): 851-856.
[34]	唐晓枫, 吴庆庆, 陈曦, 等. 改良牙根屏障技术即刻种植即刻修复后口内美学区软组织轮廓动态监测及美学评估[J]. 中华口腔医学杂志, 2024, 59(6): 551-558.
[35]	Sharma A, Maheshwari K, Tiwari B, et al. Socket shield technique: An unconventional method for immediate implant placement—A review[J]. Natl J Maxillofac Surg, 2022, 13(Suppl 1): S24-S35.
[36]	Zuhr O, Staehler P, Huerzeler M. Complication management of a socket shield case after 6 years of function[J]. Int J Periodontics Restorative Dent, 2020, 40(3): 409-415.
[37]	Gluckman H, Salama M, Du Toit J. A retrospective evaluation of 128 socket-shield cases in the esthetic zone and posterior sites: Partial extraction therapy with up to 4 years follow-up[J]. Clin Implant Dent Relat Res, 2018, 20(2): 122-129.
[38]	Chen L, Yang Z, Liu XQ, et al. CAD-CAM titanium preparation template for the socket-shield technique[J]. J Prosthet Dent, 2020, 123(6): 786-790.

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