拔牙位点保存术对不同类型骨缺损患者骨增量的差异分析

doi:10.19439/j.sjos.2020.06.012

摘要/Abstract

摘要： 目的： 分析拔牙位点保存对不同类型骨缺损患者骨增量的差异。方法： 选择2017年1月—2019年6月合肥市第二人民医院收治的85例种植牙患者,按照随机数字表法分为实验组（43例）和对照组（42例）,实验组行拔牙位点保存术,对照组行常规拔牙;2组再分别按照拔牙窝骨缺损类型分为一壁组（术后牙槽窝剩余1个壁）、二壁组（剩余2个壁）、三壁组（剩余3个壁）、四壁组（剩余4个壁）4个亚组,记录术后疼痛、创面愈合、感染情况,分别于术后即刻和术后6个月做锥形束CT（CBCT）检查,检测各组牙槽骨骨高度、骨宽度、骨宽度恢复率等,采用SPSS 22.0软件包对数据进行统计学分析。结果： 2组术后24 h疼痛情况无显著差异（P>0.05）,术后7 d均愈合良好,术后6个月均未出现创面感染和骨感染情况。2组术前牙槽嵴颊侧骨高度（buccal volume,BV）、舌侧骨高度（lingual volume,LV）无显著差异（P>0.05）,术后实验组BV、LV均增加,其中,一、二壁亚组增量高于三、四壁亚组,对照组BV、LV均降低,其亚组间相比差异均有统计学意义（P<0.05）。术后实验组各亚组骨宽度均增加,对照组骨宽度均减少,实验组骨宽度增量与对照组相比具有统计学差异（P<0.05）,其中,实验组中一、二壁亚组骨宽度增量高于三壁亚组,对照组一、二壁亚组骨宽度减少量较三、四壁亚组更少,差异均具有统计学意义（P<0.05）。实验组术后骨宽度平均恢复率显著高于对照组,其中,实验组的一、二壁亚组术后平均骨宽度恢复率高于对照组（P<0.05）,而三、四壁亚组骨宽度恢复率与对照组相比无显著差异（P>0.05）。同组相比,根长70%处骨宽度变化小于根长50%和根长30%处,差异有统计学意义（P<0.05）。结论： 拔牙后进行拔牙位点保存较常规拔牙有助于缓解牙槽骨骨吸收和保持骨量,且骨缺损越小,骨量恢复效果越好。

关键词: 拔牙位点保存, 骨缺损, 骨增量, 牙槽骨

Abstract: PURPOSE: To explore the difference of bone augmentation in patients with different bone defects by extraction site preservation. METHODS: From January 2017 to June 2019, 85 patients with dental implants treated in Hefei Second People's Hospital were enrolled and divided into the experimental group (43 cases) and the control group (42 cases) according to random number table method. Patients in the experimental group received extraction site preservation, while patients in the control group underwent routine tooth extraction. The two groups were further divided into one-wall group (remaining one wall of the alveolar socket after surgery), two-wall group (remaining two walls), three-wall group (remaining three wall), and four-wall group (remaining four walls). Postoperative pain, wound healing, and infection were recorded. Cone-beam CT (CBCT) was performed immediately and 6 months after surgery to detect alveolar bone height, bone width, bone width recovery rate, etc. SPSS 22.0 software package was used for statistical analysis. RESULTS: There was no significant difference in pain between the two groups after 24 hours (P>0.05). All implants healed well after 7 days, and no wound infection or bone infection occurred 6 months after operation. There was no significant difference in buccal bone volume of alveolar ridge (BV) and lingual volume (LV) before surgery between the two groups (P>0.05). BV and LV in the experimental group increased after treatment, and the increase in one- and two-wall subgroups was significantly higher than that in three- and four-wall subgroups. BV and LV in the control group decreased, the differences between the subgroups were statistically significant (P<0.05). BV and LV increased in both groups after operation, but significantly higher in the experimental group than in the control group. The increase in bone height in one- and two-wall subgroups was significantly higher than that in three- and four-wall groups (P<0.05). Bone width of all subgroups in the experimental group increased, but decreased in the control group. The increase of bone width in the experimental group was significantly different from the control group(P<0.05). In the experimental group, the increase in bone width in one- and two-wall groups was significantly higher than that in three-wall group, and the decrease in bone width in one- and two-wall group in the control group was significantly less than that in three- and four-wall group(P<0.05). The average recovery rate of bone width in the experimental group was significantly higher than that in the control group. The average recovery rate of bone width in one- and two-wall group in the experimental group was significantly higher than that in the control group(P<0.05), while there was no significant difference in the recovery rate from the control group(P>0.05). The change of bone width at 70% of root length in the same group was significantly smaller than that at 50% and 30% of root length (P<0.05). CONCLUSIONS: Extraction site preservation after tooth extraction can relieve alveolar bone resorption and maintain bone mass in contrast to conventional tooth extraction. The smaller the bone defect, the better the bone mass recovery effect.

Key words: Extraction site preservation, Bone defect, Bone augmentation, Alveolar bone

中图分类号:

R782.1

熊际文, 周巍. 拔牙位点保存术对不同类型骨缺损患者骨增量的差异分析[J]. 上海口腔医学, 2020, 29(6): 623-627.

XIONG Ji-wen, ZHOU Wei. Differences of bone augmentation in patients with different bone defects by extraction site preservation[J]. Shanghai Journal of Stomatology, 2020, 29(6): 623-627.

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