富血小板纤维蛋白联合骨替代材料修复种植区颌骨缺损的病例报告

发布时间：2018-04-13 14:28

本文选题：富血小板纤维蛋白 + 颌骨缺损　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:在行种植牙手术时,应用骨引导材料与自体富血小板纤维蛋白于种植区颌骨缺损处,通过观察其骨整合情况和临床效果,来评价此术式实际应用在临床上的可行性。材料与方法:临床上选取2014年10月到2016年04月到我院就诊的患者,皆知情同意并接受此研究方案的种植牙术式,其中女性6位,男性4位,总共10例作为研究对象,年龄为27-64周岁,平均为45.5周岁。于手术实施前按照手术预先设计方案所预估需要的量,采集患者20ml-80ml静脉血液后,不添加抗凝剂以及任何生物制剂,立即使用于无菌试管中以PRF专用离心机2700转/min离心12分钟制成自体血液制剂备用。常规先行全口超声洁治,并以0.12%氯己定溶液反复含漱10分钟,每次20ml持续2-3分钟,口腔内部及口腔颌面部以0.5%碘伏消毒后铺巾,遮盖住口腔以外的部分,术区行复方盐酸阿替卡因阻滞麻醉加盐酸甲哌卡因局部浸润麻醉,延牙槽嵴顶切口,全层翻瓣,于手术视野区域暴露完整牙槽骨面,清理骨面去除炎性组织及肉芽组织,按照术前所设计的手术方案,于预定位置及方向钻孔并逐级扩大后植入种植体,保证其扭矩值皆控制在30牛顿以上。于骨缺损处填入BonaGraft骨粉(60%HA/40%β-TCP),并在其表面以自体血液制剂制成的PRF覆盖,完成后以不可吸收缝线进行全层缝合。术后随诊追踪,以术后即刻拍摄的X线片为基准,对比观察术后X线片,进行治疗效果评价。结果:行种植手术后的前三个月随访,其种植体周围的骨整合均有良好的成效,种植体无一例松脱,其间无感染症状,无明显疼痛,未发现明显水肿,其中6例植入后仅出现轻微疼痛,并且皆达到初期愈合,未发现术后并发症。以术后拍摄的X片为基准,术后3个月影像学分析所有种植体皆得到良好的骨整合,缺损处骨量增加,未见吸收,可见新生骨密度依然低于周围骨密度。术后6个月影像学显示种植区骨密度进一步增高。结论:在行种植区骨增量手术时,使用骨粉搭配PRF可以广泛应用于多数临床指证,同时鉴于PRF取材于自体,制备方便,成本低廉,此外,PRF对于种植区又具有促进成骨、帮助粘膜修复以及止痛抗感染的效果,比起单纯应用骨粉或单纯应用PRF作为骨增量术的修复材料,两者同时使用具有更高的应用价值。
[Abstract]:Objective: to evaluate the clinical feasibility of bone guiding material and autologous platelet-rich fibrin in maxillary defect during dental implant operation.Materials and methods: all the patients who had been admitted to our hospital from October 2014 to April 2016 were enrolled in this study, including 6 females and 4 males. A total of 10 patients were enrolled in the study.Age is 27-64 years old, average is 45.5 years old.After collecting the venous blood of the patient with 20ml-80ml, no anticoagulants and any biological agents were added before the operation was performed according to the amount estimated by the pre-designed procedure.Immediately use in sterile tube centrifuge 2700 rpm PRF centrifuge for 12 minutes to make autologous blood preparation.The routine treatment was performed with complete oral ultrasound, and repeated gargling with 0.12% chlorhexidine solution for 10 minutes, lasting 2-3 minutes each time. The oral cavity and oral maxillofacial region were disinfected with 0.5% iodophor to cover the part outside the mouth.The operation area was treated with compound Atevacaine Hydrochloride Block Anesthesia with mepivacaine Hydrochloride Local infiltration Anesthesia, Alveolar crest incision, whole layer flap, exposure of intact alveolar bone surface in the area of visual field of operation, removal of inflammatory tissue and granulation tissue from bone surface.According to the operation plan designed before operation, the implant was implanted at a predetermined position and direction and expanded step by step to ensure that the torque value of the implant was controlled above 30 Newton.BonaGraft bone powder 60% 尾 -TCPP was added to the bone defect, covered with PRF made of autologous blood preparation, and sutured with non-absorbable suture.Follow up and follow up after operation. Take the X-ray film taken immediately after operation as the reference, compare and observe the X-ray film after operation, and evaluate the therapeutic effect.Results: following up for the first three months after implantation, the osseointegration around the implants had good results. None of the implants was loose, there was no infection, no pain, no obvious edema.In 6 cases, only slight pain was found after implantation, and all of them healed initially. No postoperative complications were found.According to the X ray taken after operation, 3 months after operation, all implants were well integrated, the bone mass in the defect was increased, no absorption was found, and the new bone density was still lower than that of the surrounding bone mineral density.At 6 months after operation, the bone mineral density in the planting area was further increased.Conclusion: bone powder combined with PRF can be widely used in most clinical evidences during incremental bone surgery in planting area. In view of the fact that PRF is derived from autologous materials, its preparation is convenient and its cost is low, in addition, it can promote osteogenesis in the planting area.Compared with using bone powder or PRF alone as repair materials of bone increment surgery, both of them have higher application value than that of using bone powder alone or using PRF as repair materials for bone increment surgery.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.6

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