拔牙后不同移植材料牙槽窝保存术对牙槽骨吸收的影响

doi:10.3969/j.issn.1005-4979.2020.01.005

摘要/Abstract

摘要：

目的：探究不同移植材料对拔牙后牙槽嵴保存效果的影响。方法：选取2018-10—2019-06期间于我院口腔门诊行拔牙术、即刻牙槽嵴保存术的63例患者（135颗患牙）。根据随机数字表法分为3个研究组（A、B、C组），且各研究组拔牙后使用不同移植材料行即刻牙槽嵴保存术。其中A组为同种异体骨移植（20例，42颗牙），B组Bio-Oss Collagen骨胶原移植（26例，55颗牙），C组Bone Ceramic人工合成骨移植（17例，38颗牙）；另取同期15例患者（33颗患牙）拔牙术后不填充任何骨替代材料作为对照组D组。各组在拔牙6个月后行延期种植，比较各组种植成功率、牙槽骨高度、牙槽骨宽度、牙龈乳头高度及美学效果。结果：A、B、C 3组的种植成功率及美学效果PES评分差异无统计学意义（P>0.05）。牙槽骨高度值及高度吸收值比较，B组和C组间无差异，但均高于A组且小于对照组D组（P<0.05）。牙槽骨宽度值及宽度吸收值比较，B组和C组间无差异，但均高于A组且小于对照组D组（P<0.05）。牙龈乳头高度0~Ⅰ级及Ⅳ级的病例占比，A、B和C组间无差异，但均低于对照组D组（P<0.05）；牙龈乳头高度Ⅲ级的病例占比，A、B和C组间无差异，但均高于对照组D组（P<0.05）。结论：微创拔牙后牙槽嵴保存术可有助于改善骨量丢失、保存牙龈乳头高度、提高美学效果，其中同种异体植入材料在减少牙槽骨横向及纵向吸收方面的效果更佳，具有推广价值。

关键词: 拔牙, 牙槽嵴保存术, 骨量吸收, 美学效果

Abstract:

Objective: To explore the influence of different transplantation materials on alveolar ridge preservation after tooth extraction. Methods: 63 cases of patients (135 teeth) underwent minimally invasive extraction and immediate alveolar ridge preservation in our hospital （from October 2018 to June 2019） were selected. And according to the random number table method the patients were divided into group A allogenic bone transplantation (20 cases, 42 teeth), group B Bio-Oss Collagen bone collagen transplantation (26 cases, 55 teeth), and group C Bone Ceramic artificial bone transplantation (17 cases, 38 teeth) according to the graft materials. Other 15 cases (33 teeth) without alveolar ridge preservation after minimally invasive tooth extraction in the same period were selected as control group. The success rate of implantation, alveolar bone height, width, gingival papilla height and aesthetic effect of all groups were compared. Results: There was no significant difference in success rate and aesthetic effect PES score among the group A, group B and group C(P>0.05). No difference of alveolar bone height and absorptive value was observed between group B and C, but those of group B and C were higher than those of group A and lower than those of the control group (P<0.05). No difference of the alveolar bone width and width absorption was observed between group B and C, but those of group B and C were higher than those of group A and lower than those of the control group (P<0.05). No difference of the proportion of the gingival papilla height in grades 0~I and IV, was observed between group A, B or C, but all lower than the control group. No difference of the proportion of the gingival papilla height in grade III, was observed between group A, B or C, but all higher than the control group (P<0.05). Conclusion: The minimally invasive alveolar ridge preservation after tooth extraction which can help to improve bone loss, preserve the height of gingival papilla, and improve aesthetic effect. And the allogenic implant materials have better effect in reducing transverse and longitudinal absorption of alveolar bone, thus it is worth promoting.

Key words: tooth extraction, alveolar ridge preservation, bone resorption, aesthetic effect

中图分类号:

R782.1

徐玉丽, 冉明, 杨星民. 拔牙后不同移植材料牙槽窝保存术对牙槽骨吸收的影响[J]. 《口腔颌面外科杂志》, 2020, 30(1): 23-27.

XU Yuli, RAN Ming, YANG Xingmin. Study on Alveolar Ridge Preservation with Different Implant Materials after Tooth Extraction for Bone Resorption and Aesthetic Effects[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(1): 23-27.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2020/V30/I1/23

图/表 4

参考文献 16

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组别	患牙数/颗	种植成功	基本成功	种植失败	PES评分 ($\bar{x} \pm s$)
A组	42	34/81.0	7/16.7	1/2.3	10.7±2.2
B组	55	43/78.2	9/16.4	3/5.4	10.1±1.9
C组	38	30/78.3	6/15.8	2/5.3	9.8±2.6
t/χ²		1.053			2.651
P		0.276			0.124

组别	患牙数/颗	种植成功	基本成功	种植失败	PES评分 ($\bar{x} \pm s$)
A组	42	34/81.0	7/16.7	1/2.3	10.7±2.2
B组	55	43/78.2	9/16.4	3/5.4	10.1±1.9
C组	38	30/78.3	6/15.8	2/5.3	9.8±2.6
t/χ²		1.053			2.651
P		0.276			0.124

组别	术前牙槽骨高度		术后6个月牙槽骨高度		牙槽骨高度吸收值
组别	近中	远中	近中	远中	近中	远中
A组(n=42)	10.62±1.53	9.92±1.17	11.02±1.24^a	10.13±1.09^a	-0.36±0.07^a	-0.42±0.13^a
B组(n=55)	10.79±1.24	9.89±1.26	11.47±1.16^a,b	10.87±1.14^a,b	-0.68±0.10^a,b	-0.75±0.15^a,b
C组(n=38)	10.68±1.39	9.85±1.24	11.55±1.28^a,b	10.85±1.23^a,b	-0.72±0.11^a,b	-0.77±0.19^a,b
D组(n=33)	10.74±1.36	9.95±1.31	11.94±1.39	11.56±1.27	-1.02±0.13	-1.14±0.25
F	0.326	0.439	5.356	5.627	6.124	5.983
P	0.583	0.474	0.041	0.035	0.028	0.031

组别	术前牙槽骨高度		术后6个月牙槽骨高度		牙槽骨高度吸收值
组别	近中	远中	近中	远中	近中	远中
A组(n=42)	10.62±1.53	9.92±1.17	11.02±1.24^a	10.13±1.09^a	-0.36±0.07^a	-0.42±0.13^a
B组(n=55)	10.79±1.24	9.89±1.26	11.47±1.16^a,b	10.87±1.14^a,b	-0.68±0.10^a,b	-0.75±0.15^a,b
C组(n=38)	10.68±1.39	9.85±1.24	11.55±1.28^a,b	10.85±1.23^a,b	-0.72±0.11^a,b	-0.77±0.19^a,b
D组(n=33)	10.74±1.36	9.95±1.31	11.94±1.39	11.56±1.27	-1.02±0.13	-1.14±0.25
F	0.326	0.439	5.356	5.627	6.124	5.983
P	0.583	0.474	0.041	0.035	0.028	0.031

组别	术前牙槽骨宽度		术后6个月牙槽骨宽度		牙槽骨宽度吸收值
组别	4 mm处	7 mm处	4 mm处	7 mm处	4 mm处	7 mm处
A组(n=42)	9.49±0.98	9.82±1.05	7.69±1.24^a	8.41±1.29^a	1.24±1.06^a	1.27±0.95^a
B组(n=55)	9.56±1.04	9.67±1.14	7.16±1.35^a,b	7.78±1.54^a,b	1.65±1.33^a,b	1.83±1.07^a,b
C组(n=38)	9.47±1.09	9.76±1.08	7.08±1.26^a,b	7.62±1.37^a,b	1.71±1.14^a,b	1.91±0.96^a,b
D组(n=33)	9.51±1.02	9.74±1.12	6.29±1.33	7.13±1.30	2.42±1.21	2.88±1.22
F	0.629	0.426	6.342	5.926	6.083	6.441
P	0.371	0.453	0.021	0.032	0.030	0.018

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