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目的:不翻瓣微创手术术野极小,盲目进行极易发生不必要的手术并发症,因此临床开展较少。近年来,我科应用一种新的基于骨地图法的手术导板制作技术对部分患者进行了不翻瓣微创种植手术的尝试,并对比传统翻瓣种植手术,随访一年,取得了较为良好的治疗效果,现总结如下。方法:随着口腔种植技术的不断发展,不管是种植系统的设计还是术式的演变,都有了令人瞩目的进步。不翻瓣微创手术以其术中出血少、手术时间短、不需缝合、患者痛苦小等特点进一步诠释了以最小的侵袭达到最佳外科疗效的微创外科定义,本研究纳入了后牙区单颗牙缺失选择不翻瓣微创种植手术的患者25人,另选择常规翻瓣种植手术的患者25人作对照组。术前,不翻瓣组测量骨地图并制作手术导板,术中,应用牙龈环切刀切除黏骨膜,逐级扩大窝洞,植入种植体;翻瓣组手术常规进行。术后,比较两组的手术时间、术后24小时疼痛程度、术后4-6个月修复时种植体边缘骨吸收程度、以及修复后12个月的随访评估。结果:与常规翻瓣种植术式相比,不翻瓣微创手术在手术时间(P<0.01)、术后24小时疼痛程度及术后4-6个月修复时种植体边缘骨吸收程度(P<0.05)这三个方面均具有统计学意义,通过12个月的随访,部分患者甚至出现了垂直骨再生的现象。结论:随着种植技术的不断发展,患者不仅仅简单的要求恢复功能和美观,更重要的是在感知方面提出了更高的要求。不翻瓣微创种植手术不仅缩短了手术时间,减轻了传统翻瓣手术带来的疼痛、水肿和局部炎症反应,降低种植体边缘的骨吸收程度,更重要的是它极大地降低了患者的恐惧心理,非常适合推荐给敏感和痛觉过敏的患者使用,是一种值得推广的种植微创手术技术。
OBJECTIVE: Non-flap Minimally Invasive Surgery surgery is extremely small, blindly prone to unnecessary surgical complications, so less clinical development. In recent years, our department applied a new bone guide method based on bone map technique to make some patients with non-flap minimally invasive surgery attempt, and compared to the traditional flap surgery, followed up for one year, and achieved a relatively good Therapeutic effect, are summarized as follows. Methods: With the continuous development of dental implant technology, there have been notable improvements in both the design of implant systems and the evolution of surgical procedures. Non-flap minimally invasive surgery with its less bleeding, shorter operative time, no suture, the patient suffering small features further interpretation of minimal invasion to achieve the best surgical efficacy minimally invasive surgical definition, the study included the posterior teeth District single tooth missing selected non-flap minimally invasive surgery in patients with 25 patients, and the other to select the conventional flap surgery in patients with 25 as a control group. Preoperative, non-flap group bone map measurement and the production of surgical guide, intraoperative application of gingival ring knife removal of mucoperiosteal, step by step to expand the nest, implant; implant surgery routine. After operation, the operation time, the degree of pain at 24 hours after operation, the degree of edge bone resorption at implant restoration 4-6 months postoperatively, and the follow-up evaluation at 12 months after repair were compared. Results: Compared with conventional flap-flap surgery, the effect of flap-less minimally invasive surgery on operative time (P <0.01), degree of pain at 24 hours postoperatively and margin bone resorption at 4-6 months postoperatively P <0.05) These three aspects were statistically significant, by 12 months of follow-up, some patients even had the phenomenon of vertical bone regeneration. Conclusion: With the continuous development of implant technology, patients not only need to simply restore the function and beauty, but more importantly put forward higher requirements in perception. The non-flap minimally invasive implant surgery not only shortens the operation time, relieves the pain, edema and local inflammation caused by traditional flap surgery, but also reduces the degree of bone resorption at the edge of the implant. More importantly, it greatly reduces the patient’s Fear, ideal for patients with hypersensitivity and hyperalgesia, is a promising implantable minimally invasive surgical technique.