同期植骨的即刻与延期种植在上颌中切牙区的骨量对比研究

doi:10.3969/j.issn.1005-4979.2020.02.006

摘要/Abstract

摘要：

目的：分析比较上颌中切牙即刻种植与延期种植同期唇侧植骨术的疗效。方法：选择 2018年度行上颌中切牙区单颗牙种植的患者57例，根据治疗方式分为即刻组(28例)和延期组（29例），2组均同期行唇侧引导骨再生技术（guided bone regeneration，GBR）。所有患者于术前（T₀）、术后即刻（T₁）、术后6个月（T₂）进行锥形束CT（CBCT）检查，并通过影像分析软件测量种植体肩台下2 mm和10 mm处的唇侧水平骨量。结果：在观察期内，2组种植体存留率均为100%。在T₁~T₂时间段内，即刻组患者2个位点处的唇侧骨板吸收量小于延期组（P<0.05），即刻组2个位点处唇侧剩余骨厚度>2 mm的患者多于延期组, 且即刻组获得更好的美学效果与更高的满意度评分。结论：与延期种植相比，即刻种植同期唇侧植骨更有利于减缓牙槽骨吸收，能维持种植体周围软硬组织稳定。

关键词: 上颌中切牙, 即刻种植, 延期种植, 骨改建

Abstract:

Objective: To analyze and compare the clinical effects between immediate and delayed implantation placement with simultaneous bone grafting procedure in the maxillary central incisor area. Methods: 57 patients who received dental implantation in the maxillary central incisor area from January to December 2018 were included in this study. The patients were divided into two groups, the immediate group (n=28) and delayed group (n=29), according to the timing of implantation and the simultaneous guided bone regeneration (GBR). All peri-implant bone volumes were evaluated by cone-beam CT (CBCT) before surgery (T₀), immediately after operation (T₁) and 6 months after surgery (T₂). The image analysis software was used to measure the horizontal lingual bone mass at 2 mm and 10 mm sites below the implant shoulder. Results: The success rate of both groups was 100% during observation period. Within the T₁~T₂ time period, the immediate group showed less bone absorption at the lingual side than the delayed group both at the 2 mm and 10 mm sites below the implant shoulder (P<0.05). Meanwhile, there were more patients in the immediate group revealing thicker lingual bone (>2 mm) at both sites than in the delayed group. Also, the immediate group had better aesthetic effect and higher satisfaction score. Conclusion: Immediate implantation with simultaneous bone grafting procedure showed more reliable clinical effects both in reducing the absorption of alveolar bone at the lingual side and also maintaining the stability of the soft and hard tissues around the implants.

Key words: maxillary central incisor, immediate implant, delayed implant, bone remodeling

中图分类号:

R782

董事玲, 杨光雯, 丁梦, 李强, 董衡, 牟永斌. 同期植骨的即刻与延期种植在上颌中切牙区的骨量对比研究[J]. 《口腔颌面外科杂志》, 2020, 30(2): 90-95.

DONG Shiling, YANG Guangwen, DING Meng, LI Qiang, DONG Heng, MOU Yongbin. A Comparative Study of Alveolar Bone Volume after Immediate and Delayed Implantation with Guide Bone Regeneration in Maxillary Central Incisor Area[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(2): 90-95.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2020/V30/I2/90

图/表 7

图1 即刻组术中唇侧植骨过程注：A. 即刻种植术前；B. 拔除患牙；C. 植入1枚种植体；D. 唇侧骨粉移植；E. 放置胶原膜；F. 种植二期软硬组织形态。

Figure 1 Lingual bone grafting procedure in an immediate implant case

图2 测量方法示意图

Figure 2 Measurement diagram

表1 2组患者不同时间节点唇-腭侧牙槽嵴总厚度（$\bar{x}±s$，mm）

Table 1 Total lingual-palatal alveolar ridge thickness in two groups in different observation periods （$\bar{x}±s$，mm）

组别	2 mm 位点处		10 mm 位点处
组别	T₁	T₂	T₁	T₂
即刻组（n=28）	8.48±0.18	7.34±0.18	9.29±0.34	8.77±0.39
延期组（n=29）	7.43±0.24	6.62±0.21	9.07±0.44	8.84±0.46

图3 即刻组与延期组不同时间节点的CBCT截面图注：A. 即刻组种植术前（T₀）；B. 即刻组术后即刻（T₁）；C. 即刻组种植术后6个月（T₂）；D. 即刻组冠修复后3个月；E. 延期组拔牙后3个月（T₀）；F. 延期组术后即刻（T₁）；G. 延期组种植术后6个月（T₂）；H.延期组冠修复后3个月。

Figure 3 CBCT images showing thickness of bone between immediate and delayed groups at different time points

表2 2组患者种植术后6个月的唇侧牙槽骨改建情况（$\bar{x}±s$）

Table 2 Alveolar bone reconstruction 6 months after implantation at the lingual side in two groups （$\bar{x}±s$）

组别	即刻组（T₁~T₂）	延期组（T₁~T₂）	t值	P值
2 mm位点处	0.97±0.11^*	1.47±0.12	3.080	0.003
10 mm 位点处	0.55±0.06^*	0.88±0.10	2.758	0.008
唇侧骨高度吸收量	0.85±0.11	0.74±0.10	0.784	0.436

表3 2组患者T₂节点时各位点处唇侧骨厚度的分布（n/%）

Table 3 Distribution of bone thickness >2 mm on the lingual side at each site of T₂ period in two groups（n/%）

组别	2 mm位点处			10 mm位点处
组别	<1 mm	1~2 mm	>2 mm	<1 mm	1~2 mm	>2 mm
即刻组（n=28）	3/10.7	11/39.3	14/50.0	2/7.2	6/21.4	20/71.4
延期组（n=29）	6/20.7	14/48.3	9/31.0	5/17.2	12/41.4	12/41.4

图4 即刻组与延期组术后效果注：A. 即刻组唇侧咬合像；B. 即刻组唇侧轮廓；C. 即刻组上颌前牙区黑背景术后照；D. 延期组唇侧咬合像；E. 延期组唇侧轮廓；F. 延期组上颌前牙区黑背景术后照。

Figure 4 Restorative effects between the immediate and the delayed groups

参考文献 18

[1]	刘向辉, 张磊, 黄辉, 等. 上颌即刻种植后牙槽骨改建的CBCT分析[J]. 口腔颌面外科杂志, 2015, 25(4):280-283.
[2]	Paolantonio M, Dolci M, Scarano A, et al. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man[J]. J Periodontol, 2001, 72(11):1560-1571. doi: 10.1902/jop.2001.72.11.1560 pmid: 11759868
[3]	Chen ST, Darby IB, Reynolds EC. A prospective clinical study of non-submerged immediate implants: clinical outcomes and esthetic results[J]. Clin Oral Implants Res, 2007, 18(5):552-562. doi: 10.1111/clr.2007.18.issue-5 URL
[4]	MacBeth N, Trullenque-Eriksson A, Donos N, et al. Hard and soft tissue changes following alveolar ridge preservation: a systematic review[J]. Clin Oral Implants Res, 2017, 28(8):982-1004. doi: 10.1111/clr.2017.28.issue-8 URL
[5]	董衡, 周娜, 朱艳香, 等. 不同骨增量技术在上颌前牙区的临床对比研究[J]. 东南大学学报(医学版), 2018, 37(2):198-203.
[6]	Tonetti MS, Cortellini P, Graziani F, et al. Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial[J]. J Clin Periodontol, 2017, 44(2):215-224. doi: 10.1111/jcpe.12666 pmid: 27978602
[7]	Jiang X, Zhang Y, Di P, et al. Hard tissue volume stability of guided bone regeneration during the healing stage in the anterior maxilla: a clinical and radiographic study[J]. Clin Implant Dent Relat Res, 2018, 20(1):68-75. doi: 10.1111/cid.2018.20.issue-1 URL
[8]	Belser UC, Grütter L, Vailati F, et al. Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: a cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores[J]. J Periodontol, 2009, 80(1):140-151. doi: 10.1902/jop.2009.080435 pmid: 19228100
[9]	Haye R, Dosen LK, Tarangen M, et al. Good correlation between visual analogue scale and numerical rating scale in the assessment of nasal obstruction[J]. J Laryngol Otol, 2018, 132(4):327-328. doi: 10.1017/S0022215118000257 pmid: 29444717
[10]	Merheb J, Quirynen M, Teughels W. Critical buccal bone dimensions along implants[J]. Periodontol 2000, 2014, 66(1):97-105. doi: 10.1111/prd.2014.66.issue-1 URL
[11]	Huynh-Ba G, Pjetursson BE, Sanz M, et al. Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement[J]. Clin Oral Implants Res, 2010, 21(1):37-42. doi: 10.1111/clr.2010.21.issue-1 URL
[12]	Hansson S, Halldin A. Alveolar ridge resorption after tooth extraction: a consequence of a fundamental principle of bone physiology[J]. J Dent Biomech, 2012, 3:1758736012456543.
[13]	He L, Zhang JW, Li XC, et al. Irregular implant design decreases periimplant stress and strain under oblique loading[J]. Implant Dent, 2017, 26(5):744-750. doi: 10.1097/ID.0000000000000662 pmid: 28945670
[14]	Cooper LF, Reside GJ, Raes F, et al. Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation[J]. Int J Oral Maxillofac Implants, 2014, 29(3):709-717. doi: 10.11607/jomi.3617 pmid: 24818212
[15]	Lim HC, Shin HS, Cho IW, et al. Ridge preservation in molar extraction sites with an open-healing approach: a randomized controlled clinical trial[J]. J Clin Periodontol, 2019, 46(11):1144-1154. doi: 10.1111/jcpe.v46.11 URL
[16]	Noelken R, Geier J, Kunkel M, et al. Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla[J]. Clin Implant Dent Relat Res, 2018, 20(5):674-682. doi: 10.1111/cid.2018.20.issue-5 URL
[17]	黄宁, 夏斐然, 张月. 微创拔牙后延期种植与即刻种植的效果评价[J]. 上海口腔医学, 2019, 28(6):657-661.
[18]	Felice P, Pistilli R, Barausse C, et al. Immediate non-occlusal loading of immediate post-extractive versus delayed placement of single implants in preserved sockets of the anterior maxilla: 1-year post-loading outcome of a randomised controlled trial[J]. Eur J Oral Implantol, 2015, 8(4):361-372. pmid: 26669546

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