前牙美学区引导骨再生同期种植愈合期间边缘骨吸收的前瞻性研究

doi:10.19438/j.cjoms.2017.05.008

摘要/Abstract

摘要： 目的：研究前牙美学区引导骨再生（guided bone regeneration，GBR）同期种植愈合期间的边缘骨吸收情况。方法：纳入2015年9月—2016年4月在上海交通大学医学院附属第九人民医院口腔种植科需要行ＧＢＲ同期种植体植入患者。手术当天及二期手术阶段均拍摄平行投照根尖片及口腔颌面部锥形束CT，记录牙龈厚度（>2 mm或≤2 mm）、骨质分类及使用的膜的类型。手术当天根尖片近、远中边缘骨水平分别记为MB1及DB1，二期手术阶段分别记为MA1及DA1，2次差值记为MD1及DD1。手术当天及二期手术阶段CBCT对种植体近中及远中的测量值分别记为MB2、DB2、MA2及DA2，测量结果之差记为MD2及DD2；唇、腭侧骨吸收差值分别记为BD和LD。采用SPSS 21.0软件包对数据进行统计学分析。结果：纳入30例GBR同期种植体植入位点。根尖片上，近、远中骨吸收分别为（1.61±1.03）mm和（1.39±0.91）mm。CBCT上观察到近、远中，唇、腭侧骨吸收中位数（四分位间距）分别为1.34 mm（0.00~2.25 mm）、0.90 mm（0.00~2.00 mm）、0.71 mm（0.00~1.41 mm）和0.47 mm（0.00~1.49 mm）。根尖片与CBCT比较得出MB1/MB2和DB1/DB2的数值无显著相关性（P>0.05），而MA1/MA2 和DA1/DA2呈中等程度相关（P<0.01）。MD1中，将不同牙龈厚度、骨质亚类及膜的类型进行比较，结果分别为P=0.86、0.02和0.83。DD1中，结果均无显著差异（P=0.74、0.40和0.40）。结论：前牙美学区GBR同期种植愈合期间存在一定程度的边缘骨吸收。CBCT对种植体边缘骨的测量不一定准确。不同牙槽骨骨质类型可能对边缘骨吸收有影响。

关键词: 边缘骨丧失, 牙槽嵴增量, 种植牙, 根尖片, 锥形束CT

Abstract: PURPOSE: To investigate crestal bone resorption during the healing period of guided bone regeneration (GBR) with simultaneous implant placement in anterior aesthetic area. METHODS: From September 2015 to April 2016, patients received dental implants with simultaneous GBR were included in the study. Periapical film and cone-beam CT (CBCT) were acquired once the operation was finished and 6 months after surgery. Mucosal thickness (>2 mm or ≤2 mm), types of bone quality and different membrane used were also recorded. Mesial and distal marginal bone level in periapical film on the day of operation was recorded as MB1 and DB1. Bone level was recorded as MA1 and DA1　6 months after surgery. The difference of MB1/MA1 and DB1/DA1 was recorded as MD1 and DD1. MB2, DB2, MA2, DA2, MD2 and DD2 were identified on CBCT in the same way. Buccal and lingual alveolar bone loss was recorded as BD and LD. The data were analyzed using SPSS 21.0 software package. RESULTS: A total of 30 implants with GBR were analyzed. Mean MD1 and DD1 in periapical film were (1.61±1.03) mm and (1.39±0.91) mm, respectively. Median MD2, DD2, BD and LD in CBCT were 1.34 mm (0.00-2.25 mm), 0.90 mm (0.00-2.00 mm), 0.71 mm (0.00-1.41 mm), and 0.47 mm (0.00-1.49 mm), respectively. No significant correlation was observed in MB1/MB2 and DB1/DB2 (P>0.05). However, moderate correlation was observed in MA1/MA2 and DA1/DA2 (P<0.05). Results in different mucosal thickness, types of bone quality and membrane used were P=0.86, 0.02 and 0.83 in MD1 and P=0.74, 0.40 and 0.40 in DD1. CONCLUSIONS: Certain amount of peri-implant crestal bone loss was observed during the healing period of GBR with simultaneous implant placement in anterior aesthetic area. CBCT doesn't seem to be an accurate method to evaluate marginal bone level around implants. Different types of bone quality may have some impacts on crestal bone loss.

Key words: Crestal bone resorption, Guided bone regeneration, Dental implant, Periapical film, CBCT

中图分类号:

R782.1

张楚南，莫嘉骥，乔士冲，倪杰，王蓓，顾迎新. 前牙美学区引导骨再生同期种植愈合期间边缘骨吸收的前瞻性研究[J]. 中国口腔颌面外科杂志, 2017, 15(5): 416-421.

ZHANG Chu-nan, MO Jia-ji, QIAO Shi-chong, NI Jie, WANG Bei, GU Ying-xin.. Crestal bone resorption during the healing period of guided bone regeneration with simultaneous implant placement in anterior aesthetic area: a prospective clinical study[J]. China J Oral Maxillofac Surg, 2017, 15(5): 416-421.

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