目的：通过完成1例无牙颌患者的微创式全口种植牙手术并椅旁行螺丝固位托牙式全口固定义齿即刻修复即刻负重病例，探讨老年无牙颌患者的全口牙种植手术、修复技术的临床操作技术要点。方法选取1例无牙颌女性老年患者，术前进行影像学检查和模型设计，制作外科手术导板，使用不翻瓣微创种植手术，一次在其上颌骨和下颌骨共植入16个骨水平种植体，即刻安装螺丝固位托牙式全口固定义齿并即刻负重。结果手术导板精确引导医生完成一期种植手术；微创种植手术创伤小，手术出血量少；手术时间明显缩短；患者未出现明显的术后疼痛肿胀；种植牙的托牙式全口固定义齿即刻修复后固位良好，并能即刻负重，马上恢复口腔功能，患者极为满意；术后8个月追踪，全部种植体均为良好骨结合，种植体不松动，全景片上种植体周围未见有明显的骨吸收；义齿功能良好，稳定舒适。结论利用手术导板精确地引导种植手术，微创种植手术的创伤明显小于常规翻瓣种植手术的创伤，手术部位术后无感染、无肿胀；微创种植的手术时间大大缩短；种植体骨结合好，经过8个月追踪，未发现有明显的种植体周围骨吸收；即刻修复可以减少患者常规种植后要等待3个月以上的愈合期；即刻负重技术可以马上恢复患者的口腔功能；螺丝固位托牙式全口固定种植义齿有良好的功能，又便于拆卸修理；全口种植托牙式义齿可以充分修复患者的口腔组织缺损，恢复正常面容效果良好，并且树脂托牙义齿制做便捷，价格便宜，适用广泛；单颌牙列缺失者种植6~8个人工牙根，在数量上可以达到充分承担咬合力和分散咬合力的生物力学要求，并能承担个别种植体失败的补偿；种植修复托牙式全口义齿将全部种植体通过基托进行整体联合连接，可以充分承担和分散咬合力量，并将咬合力量直接通过种植体传导于牙槽骨内部，对牙槽骨产生生理性刺激，中止牙槽骨的持续性吸收萎缩，并促进牙槽骨的骨质再生，保持牙槽骨的丰满。%Objective To investigate the know-how in full-mouth dental implantation and restoration for elderly edentulous patients througha completed case of minimally invasive full mouth dental implantation with screw retention of complete denture for immediateloadafterimmediate restoration technology. Methods An edentulous elderly female patient was selected for the treatment, with preoperative imaging and model design.Surgical operation template was preparedfor flapless minimally invasive dental implantation. A total of 16 dental implants were placed one-stage in her maxilla and mandible. And screw retention was fixed immediately for the complete denture with immediate load. Re-sults Surgical operation template guided the doctors precisely to complete one-stage implantation. Minimally invasive implantationresulted in little trauma and bleeding. The operation time was shortened significantly. The patient did not suffer significant postoperative pain and swelling. The dental implant was highly satisfactory for the patient, and was able to load and recover oral function immediately after good retention of complete dental implant. After 8 months of postoperative follow-up, all the implants showed excellent bone union without any loosening. And the panoramic radio-graph showed no significant bone resorption around the implants. The denture function was good, stable and comfort-able. Conclusion Using precise surgical operation template guided implant surgery, minimally invasive implant oper-ationmay result in less trauma than conventional flap implantation without infections and swelling on surgical sites. As the time of minimally invasive operation was shortened greatly, the stamina of both patients and doctors were saved up. The implants had excellent bone union, and no significant bone resorption around the implants was found after 8 months of follow-up. Immediate restoration can reduce more than 3 months of healing phase after conventional im-plantation surgery. Immediate loading technique can recover the patients′ oral function immediately, helping them to achieve the wish of"gaining teeth immediately after dental implant operation". Screw retention of complete denture for dental implant provides good functions, and the convenience for removal and restoration. Complete implant denture can fully repair patients' oral tissue defects, which had good effects to recover their normal facial features. Besides, resin denture is easy to produce at low costs and for wide application. The 6 to 8 artificial teeth roots implantation for single edentulous patients can fully meet biomechanical requirement of bearing and dispersing bite force, and assume the failure of individual implants. Implanting and repairing complete denture can connect all the implants entirely by basic denture, and fully bear and disperse bite force, so as to conduct bite force into the inside of alveolar bone by implants. With physiological stimulation to alveolar bone, it can stop persistent atrophicabsorption, stimulate regenera-tion, and maintain the fullness of the alveolar bone.
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