同期种植水平骨增量中骨膜完整性在成骨中的作用探究

doi:10.3969/j.issn.1005-4979.2020.06.009

摘要/Abstract

摘要：

目的：探究用完整的骨膜覆盖骨替代材料而不使用生物胶原膜的骨膜引导骨再生技术与传统的引导骨再生技术（guided bone regeneration, GBR）对水平骨缺损的牙槽骨及软组织愈合修复结果比较。方法：本研究对2017—2019年行单颗牙种植手术同期水平骨增量手术的患者进行回顾分析，共纳入32例患者，随机分为引导骨再生组和骨膜引导骨再生组，并在后期随访过程中通过影像学检查及临床检查获取骨量变化及软组织数据。结果：所有病例均未出现种植体周围透射影、种植体周黏膜炎或种植体周炎。对于水平骨获取量，引导骨再生组为（1.83±1.59） mm，骨膜引导骨再生组为(1.97±1.45) mm，两组在成骨效果上无明显差异。结论：将Bio-oss脱蛋白小牛骨颗粒与完整的骨膜以骨膜引导骨再生的方法应用于单颗牙缺失水平骨缺损的同期种植病例中，其结果是可预期的，可以作为牙槽骨重建的替代方法。

关键词: 骨增量, 骨修复, 引导骨再生, 屏障膜, 骨膜, 牙种植

Abstract:

Objective: The aim of the clinical study was to evaluate bone healing of localized ridge defects treated with deproteinized bovine bone mineral (DBBM) particles without the use of biomembranes, but with the integrated periosteum; and compare its result with that of conventional guided bone regeneration(GBR).Methods: In this study, 32 patients who underwent single tooth implant surgery and horizontal bone augmentation in the same period from 2017 to 2019 were reviewed. They were divided into GBR group and periosteum guided bone regeneration（PGBR） group randomly. The bone volume and soft tissue were examined through radiographic measurement and clinical examination at follow-up. Results: Clinical and radiography examinations indicated that there were no peri-implant radiolucency, mobility, or peri-implant inflammation at follow-up. GBR group received average horizontal bone gain of (1.83±1.59) mm, and the mean bone gain of PGBR group was (1.97±1.45) mm, there was no statistically significant difference between the two groups. Conclusion: The use of the integrated periosteum with DBBM grafting can be a predictable and alternative option for reconstructing horizontal bone defects in single missing tooth.

Key words: bone augmentation, bone repair, guided bone regeneration, barrier membrane, periosteum, dental implant

林志辉, 张歆缘, 满毅. 同期种植水平骨增量中骨膜完整性在成骨中的作用探究[J]. 《口腔颌面外科杂志》, 2020, 30(6): 394-400.

LIN Zhihui, ZHANG Xinyuan, MAN Yi. The Exploration of Periosteal Integrity in Osteogenesis during Horizontal Bone Augmentation and Simultaneous Implantation[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(6): 394-400.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2020/V30/I6/394

图/表 9

图 1 PGBR组手术步骤注：A. 术区嵴顶切口，无垂直减张切口； B. 植入种植体； C. 颊侧存在骨缺损； D. 旋入大直径愈合基台，并于缺损区填入DBBM颗粒; E. 关闭创口。

Figure 1 Surgical procedure of periosteum guided bone re-generation group

图2 GBR组手术步骤注：A. 术区嵴顶切口，近远中行垂直减张切口；B. 植入种植体；C. 颊侧存在骨缺损；D. 于缺损区填入DBBM颗粒，覆盖可吸收胶原膜；E. 关闭创口。

Figure 2 Surgical procedure of guided bone regeneration group

图3 术前、术后CBCT检查注：A. 术前（T1）CBCT；B. 术后即刻（T2）CBCT；C. 术后6个月（T3）CBCT。

Figure 3 CBCT images showing implant before and after surgery

图4 CBCT测量指标注：I：种植体表面（箭头所指虚线）；O：颊侧骨外侧壁。

Figure 4 Landmarks used for CBCT measurements

表1 种植体基本情况（颗）

Table 1 Basic information of implants (piece)

种植系统	GBR组	PGBR组
Straumann	7	10
Nobel	5	3
威高	4	3

表2 T1时种植体表面至唇颊侧骨外侧壁的距离（mm）

Table 2 The distance between the implant surface and outer border of the buccal plate at T1（mm）

组别	种植体表面至颊侧骨外侧壁的距离（mm）
组别	肩台下1 mm处	肩台下3 mm处
GBR组	0.44±0.73	0.76±1.12
PGBR组	0.43±0.60	1.10±0.98
P	0.969	0.376

表3 T2时种植体表面至唇颊侧骨外侧壁的距离（mm）

Table 3 The distance between the implant surface and outer border of the buccal plate at T2（mm）

组别	种植体表面至颊侧骨外侧壁的距离（mm）
组别	肩台下1 mm处	肩台下3 mm处
GBR组	3.07±1.09	3.75±1.42
PGBR组	3.87±0.78^*	4.77±0.84^*
P	0.023	0.019

表4 T3时种植体表面至唇颊侧骨外侧壁的距离（mm）

Table 4 The distance between the implant surface and outer border of the buccal plate at T3（mm）

组别	种植体表面至颊侧骨外侧壁的距离（mm）
组别	肩台下1 mm处	肩台下3 mm处
GBR组	2.00±1.77	2.86±1.78
PGBR组	2.25±1.14	3.22±1.34
P	0.646	0.523

表5 T4随访临床检查参数（分）

Table 5 Clinical parameters at T4 （score）

组别	龈沟出血指数（SBI）	龈乳头指数（PIS）	唇颊侧丰满度（CPF）
GBR组	0.25±0.46	1.63±0.74	1.50±0.76
PGBR组	0.25±0.71	1.88±0.64	1.38±0.74
P	0.643	0.418	0.680

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