Augmentation des Implantatlagers durch forcierte orthodontische Extrusion^[*]

Zusammenfassung

Ziel: Beurteilung der Reaktion von Hart- und Weichgeweben auf eine orthodontische Implantatbettaugmentation (d. h. orthodontische Extrusion), Bestimmung der Menge des neu gebildeten Gewebes und der Beziehung zur Extrusionsstrecke, Untersuchung der Gewebereaktionen bei Zähnen mit unterschiedlich starkem Verlust an parodontalem Attachment, Erkennen der Grenzen für eine OISD (orthodontic implant site development), Ermittlung der Erfolgsrate der Implantate.

Material und Methoden: An insgesamt 32 nicht erhaltungswürdigen Zähnen wurde eine OISD durchgeführt und bei 13 Patienten 27 Implantate eingesetzt. Dabei wurden die Höhe des parodontalen Attachments an den zu extrahierenden Zähnen, die Menge an augmentiertem Alveolarknochen, Veränderungen im Volumen der Weichgewebe und das Ausmaß der orthodontischen Zahnbewegung bestimmt.

Ergebnisse: Nach der OISD konnten folgende Mittelwerte bestimmt werden: orthodontische Extrusionsbewegung 6,2±1,4 mm; Knochenaugmentation 4±1,4 mm; Bewegung des Gingivarandes nach koronal 3,9±1,5 mm: Bewegung der Mukogingivalgrenze nach koronal 3,1±1,3 mm; Augmentation der befestigten Gingiva 1,8±1,1 mm; Augmentation der Gingivadicke (bukkolingual) 0,7±0,4 mm; Rezessionen 1,8±1,2 mm; Verhältnis zwischen Knochenaugmentation und orthodontischer Bewegung (Effizienz) 68,9%±17,3%; Verhältnis zwischen Gingivaaugmenta­tion und orthodontischer Bewegung (Effizienz) 65,2%±19,9% und Reduzierung der Taschentiefe 1,8±0,9 mm. Die Erfolgsrate für die Implantate betrug 96,3%.

Schlussfolgerungen: Die orthodontische Implantatbettaugmentation war ein geeignetes Verfahren zur Regeneration von Gewebe im Bereich dieser nicht erhaltungswürdigen Zähne. Seine Effizienz betrug etwa 70% bei der Regeneration von Knochengewebe und 60% bei der Regeneration von Gingiva. Der Anteil an noch vorhandenem parodontalem Attachment hatte keinen Einfluss. OISD kann eine wichtige Behandlungsoption für eine Implantatbettaugmentation bei Patienten sein, bei denen auch eine konventionelle kieferorthopädische Behandlung erforderlich ist.

Abstract

Purpose: To evaluate the soft and hard tissue response to orthodontic implant site development (OISD) (i. e., forced extraction), to measure the amount of tissue that was regenerated and its relationship to the amount of orthodontic vertical tooth movement, to evaluate the tissue response in teeth with different degrees of periodontal attachment loss, to understand the limits of OSID, and to evaluate the implant survival rate.

Materials and Methods: A total of 32 hopeless teeth were treated with OSID, and 27 implants were placed in 13 patients consecutively. The level of periodontal attachment on the teeth to be extracted, amount of augmented alveolar bone, changes in soft tissue volume, and the rate of orthodontic tooth movement were recorded.

Results: Mean values after OSID were as follows: orthodontic exclusive movement, 6.2±1.4 mm; bone augmentation, 4±1.4 mm, coronal movement of the gingival margin, 3.9±1.5 mm; coronal movement of the mucogingival junction, 2.1±1.3 mm; keratinized gingival augmentation, 1.8±1.1 mm; gingival thickness (buccolingual dimension) augmentation, 0.7±0.4 mm; recession, 1.8±1.2 mm; bone augmentation/orthodontic movement ratio (efficacy). 68.9%±17.3%; gingival augmentation/orthodontic movement ration (efficacy), 65.2%±19.9%; and pocket depth reduction, 1.8±0.9 mm. The implant survival rate was 96.3%.

Conclusions: OISD was a viable treatment for these hopeless teeth to regenerate hard and soft tissues. Its efficacy was about 70% for bone regeneration and 60% for gingival augmentation. The residual attachment level on the tooth was not a limitation. OISD might be a valuable treatment option to regenerate tissues for implant site development in patients in need of conventional orthodontic therapy.

Schlüsselwörter

Knochenaugmentation - forcierte Eruption - Gingivaaugmentation - Implantatbettaugmentation - forcierte orthodontische Extrusion - orthodontische Implantatbettaugmentation

Key words

bone augmentation - forced eruption - gingiva augmentation - implant site development - orthodontic extrusion - orthodontic implant site development (OISD)

^* Dieser Artikel ist im englischen Original bereits erschienen im Int J Oral Maxillofac Implants. 2012; 27: 411–420.

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