Abstract：
It is incumbent upon our profession to reevaluate our preference for routinely replacing a missing single maxillary incisor, especially a maxillary lateral incisor, with a dental implant in a young adult. The dental literature is replete with beautiful restorative results using implants in this area, but there is minimal discussion regarding the long-term consequences of this treatment. The maxillary lateral incisor is one of the most commonly missing teeth due to agenesis, and it is also one of the most common teeth to be lost due to trauma in the developing child.1 Therefore, the decision for replacement must be made with the long-term in mind, as these restorations are commonly placed between ages 18 and 21 and must serve the patient for many decades. There are several reasons that implants can be associated with complications or even fail, including the following: (1) Continued craniofacial growth, which has a predominant anterior and vertical component and has been shown to occur in the maxilla, resulting in the apparent submersion of the implant crown as the natural teeth move incisally in relation to the implant2,3-there is no evidence that this can be predicted, let alone how far into the future it may happen; (2) peri-implantitis, which has a patient-level prevalence estimate of nearly 25% according to the findings of a recent systematic review;4 (3) thinning and recession of the peri-implant mucosa due to poor implant placement, inadequate prosthetic management, and/or poor case selection, often resulting in compromised esthetics and a predisposition for the onset and progression of peri-implant diseases; and (4) mechanical failure of the implant, abutment screw, transmucosal abutment, and/or crown. Clinicians should also keep in mind that, once an implant is placed in the anterior maxilla, it precludes the possibility for palatal expansion in the adult patient because the space created by the expansion cannot be redistributed orthodontically. Canine substitution is one traditional method for replacement of the missing maxillary lateral incisor. It is still a viable option when the canine tooth has an acceptable shape and color, and the occlusion will not be compromised by the substitution.5 Additionally, the bonded single-wing zirconia bridge has become a primary treatment option.6 Zirconia has the strength of metal and beauty of porcelain, which makes it an ideal substrate for a bonded bridge. The literature has demonstrated the long-term success of this replacement option for the missing maxillary incisor.7 There are clearly many potential long-term disadvantages associated with replacing a single missing maxillary incisor with an implant in young adults. We should be prescribing the least-invasive treatment option for the replacement of these teeth. Therefore, when treatment-planning for a missing maxillary incisor in a young adult, alternatives to implant therapy-such as the bonded single-wing zirconia bridge and canine substitution-should be the primary treatment options. The implant should only be considered as a secondary treatment when the other options are not viable or have previously failed.
摘要：
我们的职业有责任重新评估我们对常规更换缺失的单个上颌切牙的偏好，尤其是上颌侧切牙,在一个年轻的成年人的牙科植入物。牙科文献充满了使用该领域植入物的美丽修复效果，但是关于这种治疗的长期后果的讨论很少。上颌侧切牙是最常见的牙齿缺失之一，它也是最常见的牙齿之一，由于创伤在发育中的儿童。更换的决定必须考虑长远，因为这些修复物通常放置在18至21岁之间，并且必须为患者服务数十年。植入物可能与并发症甚至失败有关的原因有很多，包括以下内容：(1)颅面持续生长，它具有主要的前部和垂直分量，并已被证明发生在上颌骨，导致植入物牙冠明显浸没，因为天然牙齿相对于植入物2,3-没有证据表明这可以预测，更不用说它可能发生在多远的未来；(2)种植体周围炎，根据最近的系统评价的结果，其患者水平的患病率估计接近25％；4（3）由于植入物放置不良而导致的植入物周围粘膜变薄和衰退，假体管理不足，和/或案例选择不佳，经常导致美学受损和种植体周围疾病的发生和发展的倾向；和（4）植入物的机械故障，基台螺钉,经粘膜基台，和/或皇冠。临床医生也应该记住，一旦植入物被放置在上颌骨前部，它排除了成人患者腭扩张的可能性，因为扩张产生的空间不能在正畸上重新分布。犬牙置换是一种传统的上颌侧切牙置换方法。当犬齿具有可接受的形状和颜色时，它仍然是一个可行的选择，并且替代不会损害遮挡。5此外，粘结单翼氧化锆桥已成为主要的治疗选择。6氧化锆具有金属的强度和瓷质的美感，这使得它成为粘合桥的理想基底。文献已经证明了这种替代方法对于缺失的上颌切牙的长期成功。7在年轻人中，用植入物替代单个缺失的上颌切牙显然有许多潜在的长期缺点。我们应该为更换这些牙齿开出侵入性最小的治疗方案。因此,当年轻成年人上颌切牙缺失的治疗计划时，植入物治疗的替代方法-例如粘合的单翼氧化锆桥和犬替代-应该是主要的治疗选择。仅当其他选择不可行或先前失败时，才应将植入物视为二次治疗。
