Abstract

Purpose: Flapless surgery generates less trauma, the patients heal with minor or no swelling. In order to provide more loving care and beauties for some patients,we utilized flapless technique (FT) on implant prosthesis of one bicuspid missing case, and wanted to obtain a satisfied clinical effect.

Material & Methods: The right maxillary second bicuspid missing, there is sufficient quantity and quality of alveolar bone and soft tissue in a 38-year old male patient. FT was performed with using a NP implant（NobelReplace TM）. An immediate temporary abutment（NobelRpl TM）and a temporary crown was placed immediately. Check occlusion.

Results:Some usually done in my clinic for bicuspids and molars, FT generated less trauma, less postoperative bleeding, less discomfort for the patient, shorter surgery time, and a reduced healing time. The patients heal with minor or no swelling.

Conclusions:The reward is significantly less discomfort and faster healing possibly because of maintenance of vascular supply to the bone. If you know topography of ridge and the patients have nice wide bony ridge with nice thin soft tissues. This technique is great in experienced hands, but case selection is the key.

主诉：右侧上颌后牙缺失一年，要求种植修复。治疗中、治疗后尽量减少痛苦。并希望立刻取得疗效、快速修复，实现短期和长久美观效果。

治疗过程

患者,男, 38岁, 右侧上颌第二前磨牙缺失一年, 缺隙两侧有基牙(图1)。利用全景片、牙片、临床口腔检查及模型确定种植区牙槽骨宽度、高度、厚度和骨质情况、测定种植部位黏膜厚度等，经分析决定采用非翻瓣种植修复技术。

步骤1:利用（NobelBiocare TM）研发的导航工具（Drill Guide NP )和2.0mm初始钻在确定的种植位置上钻孔（图3），并达到要求的深度。

步骤2：在钻孔内放入软组织环切导航杆（Tissue Punch Guide）（图4）, 将对应大小的机用组织环切刀（Tissue Punch）套置于导航杆外切除软组织（图5-6）。

步骤3：常规方法步骤植入种植体，最后用扭矩扳手将其扭紧，扭力达40Ncm(图7-9) 。

步骤4：安放即刻修复临时基台桩(35Ncm力)和基台帽，并调节适合高度（图11-12）。

步骤5：利用树脂传统方法制作临时修复冠，粘固。轻度咬合接触(图13-14)。

治疗的临床意义：

传统种植手术需切开黏膜、翻瓣，术后会出现肿胀、疼痛，且复诊次数多。非翻瓣术式（Nobel Biocare TM）与传统术式相比能解除患者许多痛苦。不翻瓣、不缝合和拆线，大大减少手术时间，术后几乎无肿胀、疼痛。不需要二期手术修复，减少复诊次数。只要骨和黏膜条件允许，非翻瓣术式更安全简便,无痛苦,种植体位置更理想，部分病例可即刻修复、即刻负重，利于美观，同时有利于龈乳头形成和软组织改善。但适应症选择须慎重。