不同负荷方式下种植体周围骨组织改建的影像学分析与方法比较

发布时间：2018-01-04 12:27

本文关键词：不同负荷方式下种植体周围骨组织改建的影像学分析与方法比较　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的建立即刻种植不同负荷方式修复的动物实验模型,利用CBCT、Micro-CT,联合口内X线片,评价不同负荷方式对牙种植体周围骨松质结构的影响,探讨CBCT测量的精确性。方法4只健康雄性Beagle犬(犬龄12-24个月),采用分口式设计于双侧下颌前磨牙、磨牙位点即刻植入24颗种植体,分别作五种修复:(1)即刻负荷3个月;(2)即刻负荷6个月;(3)延期负荷3个月;(4)延期负荷6个月;(5)未负荷。各阶段拍摄口内X线片监测种植体边缘骨吸收值。实验总时长9个月。Micro-CT和CBCT扫描所有样本,三维重建,获取图像,利用CTAn软件二值化分割,测量两者相配比区域内骨小梁形态及定量分析松质骨参数。统计学分析Micro-CT和CBCT检测骨小梁形态学所有参数的相关性。口内X线片测量离体样本颊舌侧和近远中侧边缘骨吸收量,与CBCT扫描重建图像相同感兴区域配比分析。结果不同负荷方式骨小梁形态学参数,骨体积分数、骨表面积体积比率、结构模型因子、骨小梁厚度、骨小梁孔隙率和连接密度统计学差异明显(p0.05)。较长负荷时间(6个月),即刻负荷比延期负荷或未负荷组有更大骨体积分数(36.141%)和骨小梁厚度(2.456mm),更低的骨表面体积比率(1.847 mm-1)和骨小梁孔隙率(63.859%)。较短负荷时间(3个月),不同负荷方式各骨小梁形态学参数无明显差异(p0.05)。Micro-CT和CBCT检测参数有显著相关性,r均大于0.75(0.76-0.99)。CBCT与口内X线片检测骨吸收量相关性显著(r=0.88,p0.0001)。口内X线片检测不同负荷方式种植体边缘骨吸收量无明显差异(p0.05),所有样本种植体颊、舌、近、远中,四方位边缘骨吸收量无明显差异(p0.05)。随种植术后时间推移,骨吸收速度明显减慢(P0.05),种植术后3个月骨吸收最快(1.78mm),术后6个月到第9个月的骨吸收最慢(0.11mm)。不同解剖区域检测10组骨小梁形态学参数均有统计学差异(组间P0.05),从种植体冠中部至根尖水平,骨体积分数、骨小梁厚度、骨小梁数量、骨小梁分离度、碎形维度、连接密度逐渐减少,而骨表面积体积比率、骨小梁模式因子、结构模型因子、骨小梁孔隙率测量值呈上升趋势。结论高分辨率CBCT定量分析种植体周围骨小梁形态,其精确性指标可作为临床种植术后骨改建评价依据;种植体不同层面骨小梁形态存在一定规律性变化;即刻负荷对种植术后骨改建具有明显优势,负荷时间越长,优势越突显;负荷促进骨质骨量提高;种植术后骨改建随时间延长逐渐趋向稳定;相同时间下,不同区域种植体边缘骨吸收程度差异不明显,单纯负荷对骨吸收影响不显著。
[Abstract]:Objective to establish the animal model of immediate implant, different load method using CBCT, Micro-CT, combined with intraoral radiographs, evaluation of different loads on dental implant surrounding bone effects in cancellous structure, to investigate the accuracy of CBCT measurement. Methods 4 healthy male Beagle dogs (dogs aged 12-24 months), by design port type in the bilateral mandibular premolars and molars were immediately implanted 24 implants were five repair: (1) immediate loading of 3 months; (2) immediate loading of 6 months; (3) delayed loading of 3 months; (4) delayed loading of 6 months; (5) no load. Each stage shooting inside the mouth X-ray monitoring implant marginal bone absorption value. The total length of 9 months.Micro-CT and CBCT scans of all samples, 3D reconstruction, image acquisition, using CTAn software, binarization segmentation, morphological analysis and quantitative measurement of both trabecular matching area of cancellous bone statistical parameters. Analysis of Micro-CT Correlation detection of CBCT and trabecular bone morphology. All parameters in X-ray measurement of isolated samples of buccal and lingual and distal lateral marginal bone resorption, and CBCT scan reconstruction images of the same interest area ratio analysis. The results of different load patterns of trabecular bone morphological parameters, bone volume fraction, bone surface area volume ratio model, structure factor, trabecular thickness, trabecular bone porosity and connectivity density statistically significant difference (P0.05). The longer the load time (6 months), immediate loading with greater bone volume fraction than delayed load or no load group (36.141%) and trabecular thickness (2.456mm), bone surface volume ratio lower (1.847 mm-1) and trabecular bone porosity (63.859%). A short time load (3 months), no significant difference between the different load patterns of trabecular bone morphological parameters (P0.05) and.Micro-CT CBCT detection parameters have significant correlation, R was greater than 0.75 (0.76-0.99).CBCT With the mouth X-ray detection of bone resorption was significantly correlated (r=0.88, P0.0001). The mouth X-ray detection of different load patterns of implant marginal bone resorption was no significant difference (P0.05), all samples of implant buccal, lingual, near, far, four marginal bone resorption was no significant difference (P0.05). With the passage of time after implantation, bone resorption rate was significantly reduced (P0.05), 3 months after implantation of bone resorption is the fastest (1.78mm), after 6 to ninth months of bone resorption is the slowest (0.11mm). Different anatomical regions were detected in 10 groups of bone trabecular morphology parameters (statistical difference group P0.05), from the central to the apical implant crown level, bone volume fraction, trabecular thickness, trabecular bone volume, trabecular separation, fractal dimension, connection density gradually decreased, and the bone surface area to volume ratio, trabecular pattern factor, structure factor model, trabecular bone the porosity measurement value increased.. The high resolution CBCT quantitative analysis of peri implant bone trabecular morphology, its accuracy can be used as indicators of clinical evaluation of bone remodeling after implantation according to different implant layer; trabecular morphology has certain regularity; immediate loading of implants after bone remodeling has obvious advantages, the load time is longer, more prominent advantages; to improve the load promote bone bone; bone remodeling gradually stabilized after implantation; at the same time, different areas of bone resorption degree of difference is not obvious, simple load has no significant effect on bone resorption.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6

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