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

doi:10.19723/j.issn.1671-167X.2019.03.030

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 579-585. doi: 10.19723/j.issn.1671-167X.2019.03.030

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

赵丽萍^1,²,胡文杰^1△(),徐涛^1,²,詹雅琳^1,³,危伊萍¹,甄敏¹,王翠¹

北京大学口腔医学院·口腔医院, 1. 牙周科
^2. 急诊科
^3. 第一门诊部综合科, 国家口腔疾病临床医学研究中心口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室, 北京 100081

收稿日期:2019-03-18 出版日期:2019-06-18 发布日期:2019-06-26
作者简介:胡文杰,教授、主任医师、博士研究生导师,现任北京大学口腔医学院牙周科副主任(教学主任)、北京大学医学部口腔内科学住培基地主任和牙周专科医师培训基地主任。兼任中华口腔医学会牙周病学专业委员会常务委员、口腔种植专业委员会委员、口腔美学专业委员会委员、中国医药教育协会口腔医学专业委员会常务委员、北京市口腔医学会种植专业委员会常务委员、社区口腔分会常务委员、北京市健康科普专家、美国牙周病学会国际会员、国际牙科研究会会员等职。2011—2012年赴美国华盛顿大学牙医学院牙周科作为高级访问学者进行临床、教学和学术交流,曾多次出访美国、瑞典等国家和地区进行学术交流。
医疗专长:复杂牙周病的诊断和规范化治疗、牙周治疗和口腔各学科的综合治疗设计、前牙美学治疗、牙周病患者的种植治疗、锥束计算机断层扫描(cone beam computed tomography, CBCT)在疾病诊断和治疗中的应用、各种牙冠延长术。
研究方向:牙周病多学科综合治疗和设计、微笑美学和前牙美学系列问题的临床和基础研究、牙周病患者种植治疗相关的临床和基础研究、CBCT在牙周疾病诊断和治疗中的应用研究、牙周病和种植体周围病与口腔微生物组学和代谢组学研究、口腔与胃内幽门螺杆菌关系的研究等。
基金资助:
首都临床特色应用研究与成果推广基金(Z161100000516042)、北京大学临床科学家计划专项(BMU2019LCKXJ010)-中央高校基本科研业务费

Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

Li-ping ZHAO^1,²,Wen-jie HU^1△(),Tao XU^1,²,Ya-lin ZHAN^1,³,Yi-ping WEI¹,Min ZHEN¹,Cui WANG¹

^1. Department of Periodontology
^2. Department of Emergency
^3. Department of General Dentistry, First Clinical Division, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China

Received:2019-03-18 Online:2019-06-18 Published:2019-06-26
Supported by:
Supported by the Capital Foundation for Clinical Characteristics Application Research (Z161100000516042), the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKXJ010)

摘要/Abstract

摘要： 目的通过临床及影像学方法,针对罹患重度牙周病变伴有骨壁缺损的磨牙拔牙即刻植入Bio-Oss?覆盖Bio-Gide?胶原膜,采用翻瓣后冠向复位和微翻瓣胶原蛋白覆盖两种创口封闭方法进行牙槽嵴保存,比较6个月后软、硬组织变化。方法纳入23名患者共24颗重度牙周炎拔除磨牙,根据纳入时间分为牙槽嵴保存一组(翻瓣后冠向复位)和牙槽嵴保存二组(微翻瓣胶原蛋白覆盖),每组各12颗磨牙。拔牙前及术后6个月测量颊侧角化龈宽度,术后即刻及术后6个月拍摄平行投照根尖片评价牙槽骨高度的变化。术中及术后6个月种植手术时测量牙槽嵴顶中央处骨宽度。结果牙槽嵴保存一组及牙槽嵴保存二组的颊侧角化龈宽度分别减少了(1.6±1.5) mm (P=0.004)和(0.3±1.6) mm (P>0.05)。术后6个月两组牙槽窝中央牙槽骨高度均显著增加,牙槽嵴保存一组增加了(5.53±4.20) mm,牙槽嵴保存二组增加了(7.70±4.35) mm, 差异无统计学意义(P=0.226)。种植手术时,牙槽嵴保存一组的牙槽嵴顶中央颊舌/腭侧骨宽度为(9.5±2.2) mm,牙槽嵴保存二组为(9.3±1.0) mm,差异无统计学意义。结论两种牙槽嵴保存方法均有利于达到保持并改善拔牙位点牙槽骨的高度、减少牙槽骨吸收的目的,术后6个月牙槽骨宽度满足种植要求,微翻瓣覆盖胶原蛋白方法有利于保存更多颊侧角化龈。

关键词: 牙周疾病, 牙槽嵴增量, 磨牙, 平行投照根尖片

Abstract: Objective: To evaluate and to compare dimensional alterations of hard and soft tissues in molar extraction sites with irregular deficiency of bone plates due to advanced periodontitis receiving two different procedures, namely the flapped and flapless techniques with Bio-Gide? membrane covering the Bio-Oss? material for ridge preservation. Methods: Twenty-three patients with 24 infected-molar extraction sites received ridge preservation procedure, the first consecutive 12 sites belonged to the flap group (a full thickness mucoperiosteal flap and primary soft tissue closure) and the following 12 sites belonged to the flapless group (minimal flap with a collagen sponge and a secondary soft tissue closure). Width of keratinized tissue was evaluated before tooth extraction and after 6-month healing. Parallel periapical radiographs were taken immediately and 6 months after extraction to evaluate vertical bone changes. The width of the ridge was measured in the center of the ridge at the time of tooth extraction and after 6 months at implant placement. Results: After 6 months, width of keratinized tissue decreased (1.6±1.5) mm in the flap group (P=0.004) when compared with (0.3±1.6) mm in the flapless group (P>0.05). Both groups showed increases in ridge height from the central aspect, (5.53±4.20) mm for flap group and (7.70±4.35) mm for flapless group. These differences between the groups were not statistically significant (P=0.226). The ridge widths were (9.5±2.2) mm for flap group and (9.3±1.0) mm for flapless group at the time of implant insertion, and no statistical significance was observed between the flap and flapless groups. Conclusion: The study points out that both ridge preservation techniques were effective in increasing ridge height and minimizing ridge resorption after tooth extraction, and the ridge width allowed the placement of implants 6 months after ridge preservation. The flapless technique gave positive outcome in terms of the keratinized gingival width than that of the flap technique.

Key words: Periodontal diseases, Alveolar ridge augmentation, Molars, Parallel periapical radiograph

中图分类号:

R782.1

赵丽萍,胡文杰,徐涛,詹雅琳,危伊萍,甄敏,王翠. 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.

Li-ping ZHAO,Wen-jie HU,Tao XU,Ya-lin ZHAN,Yi-ping WEI,Min ZHEN,Cui WANG. Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis[J]. Journal of Peking University(Health Sciences), 2019, 51(3): 579-585.

图/表 7

图1

图2

图3

表1

患者及拔牙位点基本情况"

Items	Flap group	Flapless group	P
Age/years, $x ?$ ±s	49.3±7.4	46.1±5.9	0.247
Gender (male ∶female), n	9 ∶3	8 ∶4
Total number of teeth, n	12	12
Tooth position, n
Maxillary molar	2	2
Mandible molar	10	10
Probing depth/mm, $x ?$ ±s	5.9±1.4	5.9±2.0	0.972
Gingival recession/mm, $x ?$ ±s	1.0±0.9	1.4±1.2	0.442
Bleeding index, $x ?$ ±s	3.1±0.6	3.3±0.9	0.517
Healingtime/months, $x ?$ ±s	6.5±0.6	7.2±3.1	0.423

表1

表2

牙槽嵴保存术前及术后6个月角化龈宽度变化"

Items	Flap group	Flapless group	P
Baseline/mm, $x ?$ ±s	5.1±1.6	4.5±1.5	0.362
6 months/mm, $x ?$ ±s	3.5±2.1	4.2±1.3	0.325
Differences/mm, $x ?$ ±s	-1.6±1.5	-0.3±1.6	0.054
P	0.004	0.478

表2

表3

牙槽嵴保存术后6个月牙槽骨宽度变化及种植术前牙槽骨宽度"

Items	Flap group	Flapless group	P
BLWC/mm, $x ?$ ±s	-2.5±1.3	-1.9±2.5	0.510
BLW/mm, $x ?$ ±s	9.5±2.2	9.3±1.0	0.772

表3

表4

牙槽嵴保存后牙槽骨高度变化"

Items		Baseline	6 months	Differences	P
MHplate/mm, $x ?$ ±s	Flap group	4.47±3.18	3.80±1.38	0.67±2.39	0.875
	Flapless group	5.06±2.54	3.81±1.77	1.25±2.41	0.100
	P			0.561
CHplate/mm, $x ?$ ±s	Flap group	9.45±4.59	3.92±2.16	5.53±4.20	0.001
	Flapless group	11.86±4.39	4.17±2.26	7.70±4.35	0.000
	P			0.226
DHplate/mm, $x ?$ ±s	Flap group	5.35±3.45	3.07±1.84	2.28±2.46	0.008
	Flapless group	3.45±1.71	2.93±2.16	0.52±1.38	0.222
	P			0.044

表4

参考文献 23

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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

Two procedures for ridge preservation of molar extraction sites affected by severe bone defect due to advanced periodontitis

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