可吸收胶原膜与颗粒状异种骨在下颌后牙区水平骨增量中的应用

doi:10.3969/j.issn.1005-4979.2021.05.007

摘要/Abstract

摘要：

目的： 评估可吸收胶原膜与颗粒状异种骨在下颌后牙区水平骨增量中应用的临床效果。方法： 收集33例下颌单颗后牙缺失后接受种植同期引导骨再生（guided bone regeneration，GBR）患者的资料，将患者分为前磨牙组（n=16）和第一磨牙组（n=17）。将患者术前、术后即刻、术后6~8个月的锥形束CT（CBCT）数据经三维重建后进行拟合，测量种植体平台根方0、3、6 mm处植骨区轮廓的变化，评估水平骨增量的效果。结果： 前磨牙组和第一磨牙组在不同高度处的植骨量、吸收量、成骨量差异均无统计学意义（P>0.05）；同一组内，在种植体平台根方0、3 mm处的植骨量与吸收量均高于6 mm处（P<0.05），不同高度处的成骨量差异无统计学意义（P>0.05）。结论： 使用可吸收胶原膜与颗粒状异种骨在下颌后牙区行GBR时，植骨区冠方的轮廓在愈合期间发生明显的收缩；对于二壁或三壁型骨缺损，下颌后牙区GBR能够获得约2.0~2.5 mm的水平骨增量。

关键词: 下颌后牙区, 引导骨再生, 种植, 锥形束CT

Abstract:

Objective: To evaluate the clinical effect of guided bone regeneration technique (GBR) with resorbable collagen membrane and particulate xenograft in horizontal bone augmentation in the posterior mandible. Methods: A total of 33 patients who had missed a single mandibular posterior tooth and received implant placement combined with GBR procedure were included. Patients were divided into two groups: the premolar group (n=16) and the first molar group (n=17). CBCT datasets of patients before surgery, immediate post-surgery and 6-8 months after surgery were three-dimensionally reconstructed and superimposed. After that, alterations of bone graft contour at 0, 3, 6 mm below the implant platform during the healing stage were measured to evaluate the effect of horizontal bone augmentation. Results: There were no statistically significant differences about the amount of bone grafting, bone resorption, new bone formation between the premolar group and the first molar group at different vertical levels（P>0.05）. In each group, the amount of bone grafting and resorption at 0 mm and 3 mm below the implant platform were higher than that at 6 mm (P<0.05), and there was no statistical difference in the amount of new bone formation at different vertical levels (P>0.05). Conclusion: When GBR was performed in the posterior mandible using resorbable collagen membrane and particulate xenograft, greater horizontal reduction was observed near the coronal alveolar ridge during the healing stage. In addition, for two- or three-wall bone defects, the GBR procedure in posterior mandible can achieve a horizontal bone augmentation of about 2.0-2.5 mm.

Key words: posterior mandible, guided bone regeneration, implant, cone-beam computed tomography

孟兆理, 贾相斌, 周慧霞, 朱秀锋, 常晓峰. 可吸收胶原膜与颗粒状异种骨在下颌后牙区水平骨增量中的应用[J]. 《口腔颌面外科杂志》, 2021, 31(5): 302-307.

MENG Zhaoli, JIA Xiangbin, ZHOU Huixia, ZHU Xiufeng, CHANG Xiaofeng. Horizontal bone augmentation in the posterior mandible by means of GBR with resorbable collagen membrane and particulate xenograft[J]. 《Journal of Oral and Maxillofacial Surgery》, 2021, 31(5): 302-307.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2021/V31/I5/302

图/表 6

图1 GBR手术步骤 A. 切开翻瓣；B. 以修复为导向植入种植体，于颊侧骨壁使用球钻去皮质化；C. 螺纹暴露处覆盖自体骨屑，填入Bio-Oss骨粉；D. 覆盖Bio-Gide胶原膜。

Figure 1 Surgical procedures of GBR

图2 术前、术后即刻及术后6~8个月CBCT资料经三维重建并拟合 A. 术前模型；B. 术后即刻模型；C. 术后6~8个月模型；D. 将3组模型进行重叠。

Figure 2 Three-dimensional reconstruction and superimposition of the CBCT datasets before surgery, immediate post-surgery, and 6-8 months after surgery

图3 术前、术后即刻及术后6~8个月CBCT资料经重建后的拟合及数据测量红色曲线：术前轮廓；黄色曲线：术后即刻轮廓；绿色曲线：术后6~8个月轮廓；红色直线：位于种植体平台根方0、3、6、9 mm处并垂直于种植体长轴的直线，每条直线分别与术前、术后即刻、术后6~8个月的颊侧轮廓线相交于A、B、C 3点。

Figure 3 The superimposition and measurement of the CBCT datasets after reconstruction before surgery, immediate post-surgery and 6-8 months after surgery

表1 前磨牙组与第一磨牙组不同高度处的术前牙槽嵴宽度

Table 1 Preoperative alveolar ridge width at different vertical levels between premolar and first molar groups

组别	牙槽嵴宽度/mm
组别	0	3	6	9
前磨牙组	3.90±0.83	6.43±1.26	8.87±1.49	10.64±1.14
第一磨牙组	4.28±0.83	7.63±0.92^①	10.64±1.36^①	12.40±1.07^①
P值	0.199	0.004	0.001	0.000

表2 前磨牙组与第一磨牙组不同高度处植骨区轮廓的变化

Table 2 The contour alterations of bone graft area at different vertical levels in premolar and first molar groups

组别	根方0 mm处			根方3 mm处			根方6 mm处
组别	AB/mm	BC/mm	AC/mm	AB/mm	BC/mm	AC/mm	AB/mm	BC/mm	AC/mm
前磨牙组	2.98±1.21	0.90±0.78	2.08±1.14	3.17±0.93	0.68±0.69	2.49±0.83	1.93±1.14	0.10±0.66	1.83±1.00
第一磨牙组	3.56±1.15	1.22±0.89	2.34±0.88	3.57±1.26	1.04±0.91	2.52±0.77	1.93±1.36	-0.05±1.14	1.97±0.98
P值	0.165	0.278	0.466	0.318	0.208	0.923	0.998	0.658	0.685

图4 不同高度处的轮廓变化 *表示P<0.05，**表示P<0.01，***表示P<0.001，与种植体平台根方6 mm处比较。

Figure 4 Contour alteration at different vertical levels

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