罹患重度牙周炎下颌磨牙拔牙微翻瓣牙槽嵴保存效果评价

doi:10.19723/j.issn.1671-167X.2025.01.006

北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (1): 33-41. doi: 10.19723/j.issn.1671-167X.2025.01.006

罹患重度牙周炎下颌磨牙拔牙微翻瓣牙槽嵴保存效果评价

石宇彤¹^,², 危伊萍¹, 胡文杰¹^,*(), 徐涛³, 张浩筠¹

1. 北京大学口腔医学院·口腔医院牙周科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
2. 北京大学国际医院口腔科，北京 102206
3. 北京大学口腔医学院·口腔医院急诊科，北京 100081

收稿日期:2024-10-08 出版日期:2025-02-18 发布日期:2025-01-25
通讯作者: 胡文杰 E-mail:huwenjie@pkuss.bjmu.edu.cn
作者简介:第一联系人：
*These authors contributed equally to this work
基金资助:
首都卫生发展科研专项(2022-2-4103);首都临床特色应用研究基金(Z161100000516042)

Evaluation of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis

Yutong SHI¹^,², Yiping WEI¹, Wenjie HU¹^,*(), Tao XU³, Haoyun ZHANG¹

1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
2. Department of Oral Medicine, Peking University International Hospital, Beijing 102206, China
3. Department of Emergency, Peking University School and Hospital of Stomatology, Beijing 100081, China

Received:2024-10-08 Online:2025-02-18 Published:2025-01-25
Contact: Wenjie HU E-mail:huwenjie@pkuss.bjmu.edu.cn
Supported by:
the Capital's Funds for Health Improvement and Research(2022-2-4103);Capital Foundation for Clinical Characteristics and Application Research(Z161100000516042)

摘要/Abstract

摘要：

目的: 通过临床及影像学评价罹患重度牙周炎下颌磨牙拔牙同期微翻瓣牙槽嵴保存的效果，探讨该术式的适应证。方法: 选择2013年9月至2021年6月于北京大学口腔医院牙周科因重度牙周炎拔除下颌磨牙患者的临床资料进行回顾性分析，根据微创拔牙后进行同期微翻瓣牙槽嵴保存术(micro crestal flap-alveolar ridge preservation，MCF-ARP)或仅清创处理后自然愈合分为微翻瓣牙槽嵴保存组(MCF-ARP组)和自然愈合组。通过对拔牙前或拔牙即刻(作为基线)及种植前(拔牙愈合后)拍摄的锥形束计算机断层扫描配准后分析骨高度、宽度和体积及其变化，并比较两组种植时同期引导骨再生(guided bone regeneration，GBR)的比例。结果: 共纳入87例患者96颗下颌磨牙，MCF-ARP组愈合后拔牙窝底中心处距离下颌管骨皮质最冠方的高度(中心骨高度)平均增加了(8.34±2.81) mm，自然愈合组平均增加了(3.82±3.58) mm，两组间差异有统计学意义(P < 0.001)。MCF-ARP组高骨壁骨嵴顶下1 mm处的牙槽骨宽度平均增加了(3.50±4.88) mm，自然愈合组牙槽嵴宽度减少了(0.16±5.70) mm，两组间差异有统计学意义(P=0.019)。MCF-ARP组愈合后的牙槽骨中心骨高度均大于8 mm，其中97.1%的牙槽骨中心骨高度>10 mm；自然愈合组愈合后有23.1%的牙槽骨中心骨高度 < 8 mm，仅61.5%的牙槽骨中心骨高度>10 mm。愈合后MCF-ARP组牙槽窝总体积、颊侧体积和舌侧体积增加量及增加比例均大于自然愈合组，两组间差异有统计学意义(P < 0.001)。MCF-ARP组68颗种植体有5颗(8.3%)种植同期进行GBR，自然愈合组26颗种植体有8颗(30.8%)种植同期进行GBR，两组间差异有统计学意义(P=0.003)。结论: 对于罹患重度牙周炎的下颌磨牙，如果拔牙前拔牙窝底中心处距下颌管骨皮质最冠方距离较小(＜7 mm)时，临床医生可考虑进行拔牙同期微翻瓣牙槽嵴保存术，为未来种植治疗时提供充足的骨量，减少种植同期进行引导骨再生的比例，降低种植治疗的难度与风险，提高种植治疗的安全性。

关键词: 重度牙周炎, 下颌磨牙, 牙槽嵴保存, 种植

Abstract:

Objective: To evaluate the clinical and radiographic efficacy of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis compared with natural healing, and to preliminarily propose the surgical indication. Methods: A retrospective analysis was conducted on clinical data from patients with mandibular molars with severe periodontitis either receiving micro crestal flap-alveolar ridge preservation (MCF-ARP group) or undergoing natural healing in department of periodontology, Peking University School and Hospital of Stomatology from September 2013 to June 2021. Cone-beam computed tomography scannings performed before/immediately after extraction (as baseline) and repeated before implantation (after the extraction socket healing) were used to measure the ridge width, height and volumetric changes of the sockets, and the proportion of guided bone regeneration (GBR) during implant therapy were compared between the two groups. Results: Between baseline and healing, significant differences in changes of MCF-ARP group [(8.34±2.81) mm] and natural healing group [(3.82±3.58) mm] in the distances from mandibular canal to center of the tooth socket were recorded (P < 0.001). The ridge width at 1 mm below the most coronal aspect of the crest increased by (3.50±4.88) mm in the MCF-ARP group but decreased by (0.16±5.70) mm in the natural healing group, respectively (P=0.019). After healing, the MCF-ARP group showed the distances from mandibular canal to center of the tooth socket >8 mm in all the cases, with 97.1% exceeding 10 mm. Natural healing group displayed 23.1% of the cases with center bone height < 8 mm and 61.5% exceeding 10 mm. Volume changes at the buccal and lingual aspect as well as the total socket were significantly greater in the MCF-ARP group compared with natural healing group (P < 0.001).At the time of implantation, GBR was performed in 5 out of 68 subjects (8.3%) in the MCF-ARP group, whereas 8 out of 26 subjects (30.8%) in the natural healing group required GBR, reflecting significant difference (P=0.003). Conclusion: In the sites of mandibular molars with severe periodontitis, when the distances from mandibular canal to center of the tooth socket was not enough (less than 7 mm), clinicians could consider performing the micro crestal flap-alveolar ridge preservation to achieve augmentation for alveolar ridge and reduce the proportion of guided bone regeneration during implant therapy to reduce the difficulty and risk of injuries during implant therapy.

Key words: Severe periodontitis, Mandibular molars, Alveolar ridge preservation, Dental implant

中图分类号:

R782.1

石宇彤, 危伊萍, 胡文杰, 徐涛, 张浩筠. 罹患重度牙周炎下颌磨牙拔牙微翻瓣牙槽嵴保存效果评价[J]. 北京大学学报（医学版）, 2025, 57(1): 33-41.

Yutong SHI, Yiping WEI, Wenjie HU, Tao XU, Haoyun ZHANG. Evaluation of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis[J]. Journal of Peking University (Health Sciences), 2025, 57(1): 33-41.

图/表 11

图1

图2

图3

图4

表1

表2

表3

表4

表5

表6

图5

参考文献 26

1	Sun HY , Jiang H , Du MQ , et al. The prevalence and associated factors of periodontal disease among 35 to 44-year-old Chinese adults in the 4th national oral health survey[J]. Chin J Dent Res, 2018, 21 (4): 241- 247.
2	Dannewitz B , Krieger JK , Hüsing J , et al. Loss of molars in periodontally treated patients: A retrospective analysis five years or more after active periodontal treatment[J]. J Clin Periodontol, 2006, 33 (1): 53- 61. doi: 10.1111/j.1600-051X.2005.00858.x
3	Blanes RJ , Bernard JP , Blanes ZM , et al. A 10-year prospective study of ITI dental implants placed in the posterior region. Ⅰ: Clinical and radiographic results[J]. Clin Oral Implants Res, 2007, 18 (6): 699- 706. doi: 10.1111/j.1600-0501.2006.01306.x
4	Steinberg MJ , Kelly PD . Implant-related nerve injuries[J]. Dent Clin North Am, 2015, 59 (2): 357- 373. doi: 10.1016/j.cden.2014.10.003
5	Greenstein G , Tarnow D . The mental foramen and nerve: Clinical and anatomical factors related to dental implant placement: A literature review[J]. J Periodontol, 2006, 77 (12): 1933- 1943. doi: 10.1902/jop.2006.060197
6	Couso-Queiruga E , Stuhr S , Tattan M , et al. Post-extraction dimensional changes: A systematic review and meta-analysis[J]. J Clin Periodontol, 2021, 48 (1): 126- 144.
7	Fok MR , Pelekos G , Tonetti MS . Feasibility and needs for simultaneous or staged bone augmentation to place prosthetically guided dental implants after extraction or exfoliation of first molars due to severe periodontitis[J]. J Clin Periodontol, 2020, 47 (10): 1237- 1247. doi: 10.1111/jcpe.13344
8	Avila-Ortiz G , Chambrone L , Vignoletti F . Effect of alveolar ridge preservation interventions following tooth extraction: A systematic review and meta-analysis[J]. J Clin Periodontol, 2019, 46 (Suppl 21): 195- 223.
9	赵丽萍, 胡文杰, 徐涛, 等. 罹患重度牙周病变磨牙拔牙后两种牙槽嵴保存方法的比较[J]. 北京大学学报(医学版), 2019, 51 (3): 579- 585.
10	徐涛, 胡文杰, 毕小成, 等. 针对罹患重度牙周病变磨牙实施微创拔牙和位点保存术的初步探索(附1例报告)[J]. 中国实用口腔科杂志, 2018, 11 (1): 37- 43.
11	Wei Y , Xu T , Zhao L , et al. Ridge preservation in maxillary molar extraction sites with severe periodontitis: A prospective observational clinical trial[J]. Clin Oral Investig, 2022, 26 (3): 2391- 2399.
12	宿玉成. 口腔种植学[M]. 2版北京: 人民卫生出版社, 2014: 82-83, 85.
13	孟焕新. 临床牙周病学[M]. 2版北京: 北京大学医学出版社, 2014: 251.
14	Zhao L , Xu T , Hu W , et al. Preservation and augmentation of molar extraction sites affected by severe bone defect due to advanced periodontitis: A prospective clinical trial[J]. Clin Implant Dent Relat Res, 2018, 20 (3): 333- 344.
15	Zhang H , Xu T , Wei Y , et al. Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage Ⅲ/Ⅳ periodontitis: A randomized controlled trial[J]. J Clin Periodontol, 2024, 51 (10): 1311- 1322.
16	胡文杰. 牙槽嵴保存术的临床实施问题探讨[J]. 国际口腔医学杂志, 2021, 48 (3): 249- 258.
17	Burklein S , Grund C , Schafer E . Relationship between root apices and the mandibular canal: A cone-beam computed tomographic analysis in a german population[J]. J Endod, 2015, 41 (10): 1696- 1700.
18	Watanabe H , Mohammad Abdul M , Kurabayashi T , et al. Mandible size and morphology determined with CT on a premise of dental implant operation[J]. Surg Radiol Anat, 2010, 32 (4): 343- 349.
19	绳兰兰, 曲卫国, 李阳, 等. 正常青年人下颌管全长三维走向及下颌骨形态的锥形束CT测量[J]. 华西口腔医学杂志, 2016, 34 (2): 156- 161.
20	Vignoletti F , Matesanz P , Rodrigo D , et al. Surgical protocols for ridge preservation after tooth extraction. A systematic review[J]. Clin Oral Implants Res, 2012, 23 (Suppl 5): 22- 38.
21	Sun DJ , Lim HC , Lee DW . Alveolar ridge preservation using an open membrane approach for sockets with bone deficiency: A randomized controlled clinical trial[J]. Clin Implant Dent Relat Res, 2019, 21 (1): 175- 182.
22	Horváth A , Mardas N , Mezzomo LA , et al. Alveolar ridge preservation. A systematic review[J]. Clin Oral Investig, 2013, 17 (2): 341- 363.
23	Ben Amara H , Kim JJ , Kim HY , et al. Is ridge preservation effective in the extraction sockets of periodontally compromised teeth? A randomized controlled trial[J]. J Clin Periodontol, 2021, 48 (3): 464- 477.
24	Benic GI , Haemmerle CHF . Horizontal bone augmentation by means of guided bone regeneration[J]. Periodontol 2000, 2014, 66 (1): 13- 40.
25	Chiapasco M , Casentini P . Horizontal bone-augmentation procedures in implant dentistry: Prosthetically guided regeneration[J]. Periodontol 2000, 2018, 77 (1): 213- 240.
26	Cardaropoli D , Tamagnone L , Roffredo A , et al. Evaluation of dental implants placed in preserved and nonpreserved postextraction ridges: A 12-month postloading study[J]. Int J Periodontics Restorative Dent, 2015, 35 (5): 677- 685.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	MCF-ARP group (n=63)	Natural healing group (n=24)	P value
Age/years	51 (46, 57)	59 (54, 64)	0.003
Gender			0.376
Male	41 (65.1)	18 (75.0)
Female	22 (34.9)	6 (25.0)
Smoke			0.906
No	60 (95.2)	23 (95.8)
Yes	3 (4.8)	1 (4.2)
General condition
No systemic diseases	50 (82.5)	18 (75.0)	0.660
Hypertension	8 (12.7)	3 (12.5)	0.980
Diabetes	2 (3.2)	2 (8.3)	0.307
Coronary heart disease	1 (1.6)	0 (0.0)	0.476
Hepatitis B	2 (3.2)	1 (4.2)	0.822

Items	MCF-ARP group(n=68)	Natural healing group (n=26)	P value
Tooth position			0.778
Mandibular first molar	23 (33.8)	8 (30.8)
Mandibular second molar	45 (66.2)	18 (69.2)
Healing time/months	6 (6, 7)	7 (5, 8)	0.849
Clinical characteristics
Plaque index	1.4±0.6	1.1±0.5	0.182
Probing depth/mm	5.7±1.7	6.6±1.3	0.212
Gingival recession/mm	1.8±1.4	1.8±1.0	0.925
Bleeding index	3.5±0.7	3.2±1.2	0.703
Keratinized tissue width/mm	3.5±1.3	3.4±1.1	0.876
Thickness of the alveolar wall/mm
TB1	2.20±2.07	2.22±1.85	0.973
TL1	1.86±1.20	2.24±1.80	0.442
Alveolar septum			0.963
Yes	16 (23.5)	6 (23.1)
No	52 (76.5)	20 (70.9)

Items	Mandibular first molar (n=31)	Mandibular second molar (n=63)	P
BH	12.05±2.54	11.26±2.64	0.168
LH	14.24±2.74	11.83±3.49	0.001
CH	7.88±3.29	5.37±2.79	< 0.001

Items		BH	LH	CH	W
Baseline	MCF-ARP	11.49±2.62^#	12.53±3.46^#	6.03±3.08^#	5.36±4.93^#
	NH	11.60±2.66^#	12.88±3.46^#	6.62±3.43^#	5.15±5.07
	P value	0.867	0.660	0.849	0.872
6 months	MCF-ARP	10.65±2.61^#	11.22±3.66^#	14.38±2.85^#	8.85±3.01^#
	NH	10.33±2.88^#	11.53±3.71^#	10.44±4.70^#	5.00±4.18
	P value	0.521	0.720	< 0.001	< 0.001
Changes	MCF-ARP	-0.84±1.13	-1.31±1.09	8.34±2.81	3.50±4.88
	NH	-1.26±1.48	-1.35±0.96	3.82±3.58	-0.16±5.70
	P value	0.370	0.735	< 0.001	0.019

Group	< 8 mm	8-10 mm	>10-12 mm	>12 mm
MCF-ARP	0 (0.0)	2 (2.9)	12 (17.7)	54 (79.4)
Natural healing	6 (23.1)	4 (15.4)	5 (19.2)	11 (42.3)
P value	< 0.001

罹患重度牙周炎下颌磨牙拔牙微翻瓣牙槽嵴保存效果评价

Evaluation of micro crestal flap-alveolar ridge preservation following extraction of mandibular molars with severe periodontitis

RICH HTML

PDF (PC)

摘要/Abstract

引用本文

使用本文

图/表 11

参考文献 26

相关文章 15

Metrics

本文评价

推荐阅读 0

Items		Total volume	Buccal volume	Lingual volume
Baseline	MCF-ARP	1 205.26±544.91^#	636.54±366.59^#	568.72±230.29^#
	NH	1 226.83±536.97^#	648.57±341.94^#	578.26±227.18^#
	P value	0.953	0.939	0.716
6 months	MCF-ARP	1 785.73±797.43^#	905.82±465.46^#	879.90±367.04^#
	NH	1 511.65±755.96^#	776.58±410.39^#	735.07±377.94^#
	P value	0.038	0.168	0.016
Changes	MCF-ARP	580.46±333.92	269.28±150.64	311.18±210.28
	NH	284.82±367.33	132.98±163.80	156.81±217.72
	P value	< 0.001	< 0.001	< 0.001

[1]	聂骏男, 董佳芸, 路瑞芳. 骨瓣重建颌骨区域角化黏膜增量术后软组织愈合效果分析[J]. 北京大学学报（医学版）, 2025, 57(1): 57-64.
[2]	王鹃, 邱立新, 尉华杰. 下颌磨牙穿龈形态设计对种植体周围软组织影响的随机对照临床研究[J]. 北京大学学报（医学版）, 2025, 57(1): 65-72.
[3]	康一帆, 葛严军, 吕晓鸣, 谢尚, 单小峰, 蔡志刚. 即刻种植体支持式义齿修复的血管化髂骨瓣重建下颌骨缺损[J]. 北京大学学报（医学版）, 2025, 57(1): 78-84.
[4]	李虹, 马斐斐, 翁金龙, 杜阳, 吴彬彰, 孙凤. 口腔即刻种植时动态导航系统的种植精度分析[J]. 北京大学学报（医学版）, 2025, 57(1): 85-90.
[5]	张晗,秦亦瑄,韦帝远,韩劼. 牙周炎患者种植修复维护治疗依从性的影响因素[J]. 北京大学学报（医学版）, 2024, 56(1): 39-44.
[6]	王聪伟,高敏,于尧,章文博,彭歆. 游离腓骨瓣修复下颌骨缺损术后义齿修复的临床分析[J]. 北京大学学报（医学版）, 2024, 56(1): 66-73.
[7]	李穗,马雯洁,王时敏,丁茜,孙瑶,张磊. 上前牙种植单冠修复体切导的数字化设计正确度[J]. 北京大学学报（医学版）, 2024, 56(1): 81-87.
[8]	刘晓强,周寅. 牙种植同期植骨术围术期高血压的相关危险因素[J]. 北京大学学报（医学版）, 2024, 56(1): 93-98.
[9]	丁茜,李文锦,孙丰博,谷景华,林元华,张磊. 表面处理对氧化钇和氧化镁稳定的氧化锆种植体晶相及断裂强度的影响[J]. 北京大学学报（医学版）, 2023, 55(4): 721-728.
[10]	欧蒙恩,丁云,唐卫峰,周永胜. 基台边缘-牙冠的平台转移结构中粘接剂流动的三维有限元分析[J]. 北京大学学报（医学版）, 2023, 55(3): 548-552.
[11]	孟令玮,李雪,高胜寒,李悦,曹瑞涛,张毅,潘韶霞. 三种方法建立大鼠种植体周炎模型的比较[J]. 北京大学学报（医学版）, 2023, 55(1): 22-29.
[12]	孙菲,刘建,李思琪,危伊萍,胡文杰,王翠. 种植体黏膜下微生物在健康种植体和种植体周炎中的构成与差异：一项横断面研究[J]. 北京大学学报（医学版）, 2023, 55(1): 30-37.
[13]	梁炜,汤瑶,黄文斌,韩冰,林久祥. 上磨牙颊侧微种植体支抗在安氏Ⅱ类正畸减数拔牙患者垂直向控制中的作用[J]. 北京大学学报（医学版）, 2022, 54(2): 340-345.
[14]	孙菲,李思琪,危伊萍,钟金晟,王翠,胡文杰. 种植体周病非手术治疗中联合应用甘氨酸粉喷砂的临床效果评价[J]. 北京大学学报（医学版）, 2022, 54(1): 119-125.
[15]	李熠,尉华杰,邱立新. 种植体折裂的临床分型与临床治疗方案[J]. 北京大学学报（医学版）, 2022, 54(1): 126-133.