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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (1): 74-83. doi: 10.19723/j.issn.1671-167X.2026.01.010

• 论著 • 上一篇    下一篇

异种骨与人工合成骨在磨牙拔牙同期微翻瓣牙槽嵴保存术中的临床效果比较

张斯巧1,*, 刘建1,*, 徐涛2,*(), 胡文杰1,*(), 张浩筠1, 危伊萍1   

  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, 口腔数字医学北京市重点实验室, 北京 100081
    2. 北京大学口腔医学院·口腔医院急诊科, 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, 口腔数字医学北京市重点实验室, 北京 100081
  • 收稿日期:2025-10-10 出版日期:2026-02-18 发布日期:2025-12-09
  • 通讯作者: 徐涛, 胡文杰
  • 作者简介:

    * These authors contributed equally to this work

  • 基金资助:
    北京大学口腔医(学)院临床研究基金(PKUSS-2023CRF505)

Clinical comparison of xenograft versus synthetic bone graft materials in micro crestal flap-alveolar ridge preservation following extraction of molars

Siqiao ZHANG1, Jian LIU1, Tao XU2,*(), Wenjie HU1,*(), Haoyun ZHANG1, Yiping WEI1   

  1. 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 Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral Emergency, 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 Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2025-10-10 Online:2026-02-18 Published:2025-12-09
  • Contact: Tao XU, Wenjie HU
  • Supported by:
    the Clinical Research Foundation of Peking University School and Hospital of Stomatology(PKUSS-2023CRF505)

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摘要：

目的: 重度牙周病变的患者在磨牙拔牙同期实施微翻瓣牙槽嵴保存术(micro crestal flap-alveolar ridge preservation, MCF-ARP)时, 对采用以脱蛋白牛骨矿物基质(deproteinized bovine bone mineral, DBBM)为主要成分的异种骨移植材料和采用以羟基磷灰石(hydroxyapatite, HA)为主要成分的人工合成骨移植材料的临床效果进行比较, 为骨移植材料的临床应用推广提供参考。方法: 本研究为回顾性病例系列研究, 纳入2024年10月至2025年4月期间就诊的患者, 所有患者均在拔牙同期接受MCF-ARP手术, 分别植入DBBM或HA。使用锥形束计算机断层扫描(cone beam computed tomography, CBCT)结合口内扫描模型, 对比评估两组术前及术后6个月的硬组织变化及牙槽嵴轮廓塌陷量, 并分析术后软组织愈合过程。结果: 共纳入14例患者的14颗重度牙周病变磨牙, 术后6个月时, 两组患者在硬组织指标上的差异无统计学意义(P>0.05);术后2周和1个月时, HA组的拔牙窝中央轮廓垂直向塌陷量显著高于DBBM组[术后2周: (2.73±1.89) mm vs. (0.00±0.79) mm, P < 0.05;术后1个月: (2.74±1.13) mm vs. (0.35±2.34) mm, P < 0.05];后续愈合时间点的牙槽嵴轮廓塌陷量两组间比较差异无统计学意义(P>0.05)。创面愈合方面, HA组在术后2周和1个月时的创面未覆盖角化黏膜的面积比例显著高于DBBM组(术后2周: 47.88%±6.56% vs. 29.43%±14.25%, P < 0.05;术后1个月: 25.68%±13.06% vs. 7.19%±7.18%, P < 0.01)。结论: 本研究有限的样本分析显示, 重度牙周病变的患者在磨牙拔牙同期行MCF-ARP时, 使用DBBM和HA在术后6个月时的硬组织指标与牙槽嵴轮廓指标差异无统计学意义, 使用DBBM时早期软组织愈合更快, 未来需开展随机对照试验并结合组织学评估以进一步验证。

关键词: 牙周炎, 牙槽嵴保存术, 牙槽骨移植, 异种移植物

Abstract:

Objective: To compare the clinical outcomes between xenogeneic bone graft materials primarily composed of deproteinized bovine bone mineral (DBBM) and synthetic bone graft materials primarily composed of hydroxyapatite (HA) used in micro crestal flap-alveolar ridge preservation (MCF-ARP) of periodontally compromised molars, so as to provide a reference for their application and promotion. Methods: In this retrospective case series study, patients who received treatment between October 2024 and April 2025 were enrolled. All the patients underwent MCF-ARP, using either DBBM or HA. Hard tissue changes and alveolar ridge contour collapse were evaluated and compared between the two groups preoperatively and 6 months postoperatively using cone beam computed tomography (CBCT) and intraoral scanning. Soft tissue healing process after the surgery was also assessed. Results: A total of 14 molars from 14 patients were included. No significant differences were found in hard tissue changes between the two groups 6 months after the surgery (P>0.05). Two weeks and 1 month postoperatively, the vertical collapse of the contour at the ridge center was significantly greater in the HA group compared with the DBBM group [2 weeks: (2.73±1.89) mm vs. (0.00±0.79) mm, P < 0.05; 1 month: (2.74±1.13) mm vs. (0.35±2.34) mm, P < 0.05]. No significant differences were found in other sites at any other follow-up points (P>0.05). In terms of wound healing, the HA group showed a significantly higher percentage of wound area lacking keratinized tissue coverage compared with the DBBM group both 2 weeks and 1 month after the surgery (2 weeks: 47.88%±6.56% vs. 29.43%±14.25%, P < 0.05; 1 month: 25.68%±13.06% vs. 7.19%±7.18%, P < 0.01). Conclusion: Within the limitations of this study, the analysis suggests that there is no statistically significant difference in hard tissue and alveolar ridge contour parameters 6 months after MCF-ARP following extraction of periodontally compromised molars. However, early soft tissue healing is faster when using DBBM. Future randomized controlled trials with histological analysis are warranted for further validation.

Key words: Periodontitis, Alveolar ridge preservation, Alveolar bone grafting, Heterografts

中图分类号: 

  • R782.1

图1

微创拔牙同期分别应用DBBM或HA行MCF-ARP的手术过程"

图2

数据收集流程"

图3

DBBM组患者不同时间点的临床照片与CBCT图像"

图4

HA组患者不同时间点的临床照片与CBCT图像"

图5

CBCT影像学指标的测量"

图6

口内扫描牙槽嵴轮廓指标的测量"

图7

不同时间节点创面面积的测量"

表1

患者基线资料的比较"

Items DBBM (n=7) HA (n=7) t/Z P
Age/years 52.29±9.90 53.86±11.17 -0.28a 0.785
Gender 0.266
  Female 4 1
  Male 3 6
Tooth position >0.999
  Maxillary 5 6
  Mandibular 2 1
BH/mm 5.32±3.69 4.28±4.00 0.51a 0.618
LH/mm 5.85±3.97 4.67±3.74 0.57a 0.577
CH/mm 5.08±3.53 3.65±2.04 0.93a 0.374
TB1/mm 1.40±1.02 1.09±0.89 0.61a 0.555
TB3/mm 1.64±1.39 1.65±1.60 -0.02a 0.987
TL1/mm 1.46±0.40 1.58±1.07 -0.29a 0.780
TL3/mm 2.07±0.79 2.18±1.99 -0.13a 0.897
WH1/mm 1.83 (1.52, 2.19) 1.70 (1.31, 8.28) -0.06b 0.949
WH3/mm 6.83 (2.57, 13.26) 5.67 (1.60, 12.77) -0.06b 0.949

表2

硬组织指标变化的比较"

Items DBBM (n=7) HA (n=7) t/Z P
PBH/mm 3.45±4.01 6.11±3.38 -1.34a 0.204
PLH/mm 5.85±3.64 5.46±2.32 0.24a 0.813
PCH/mm 13.61±4.07 10.43±5.03 1.30a 0.217
DBH/mm -1.88±1.48 1.83±2.36 -3.53a 0.004*
DLH/mm 0.00±3.07 0.89±3.34 -0.52a 0.615
DCH/mm 8.53±2.56 6.77±3.45 1.09a 0.298
PWH1/mm 8.84±2.66 8.66±3.14 0.12a 0.908
PWH3/mm 10.55±2.65 11.37±2.46 -0.60a 0.558
DWH1/mm 7.10 (4.73, 8.94) 7.22 (-0.54, 9.58) -0.19b 0.848
DWH3/mm 3.13±6.10 4.59±5.17 -0.48a 0.637

图8

两组患者各随访节点的牙槽嵴轮廓塌陷量"

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