不同比例珊瑚骨和自体碎骨早期干预拔牙窝的临床研究

发布时间：2018-02-05 03:38

本文关键词： 拔牙窝干预位点保存珊瑚转化羟磷灰石自体碎骨　出处：《南昌大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景：研究表明拔牙窝的牙槽嵴在牙拔除后的第一个月就会发生高度和宽度的丧失，且以颊侧骨板为甚，，进一步造成软组织的萎缩和塌陷，增大了日后牙种植手术的难度及患者的经济负担，同时伴有更高的美学风险。对拔牙窝进行早期干预，或可阻断或减轻牙槽嵴吸收及龈乳头萎缩。目的：本实验旨在通过临床表现、组织学及影像学等方面，比较研究不同比例珊瑚转化羟磷灰石（Coralline Hydroxyapatite, CHA）和自体碎骨（Autogenous Bone,AB）对新鲜拔牙窝骨再生的影响，并探讨自体碎骨植入拔牙窝在位点保存中的应用价值。材料和方法：随机选取60例患者，分为A组（血凝块组）、B组（完全CHA组）、C组（CHA：AB=80:20）、D组（CHA：AB=50:50）四组，每组15例。所有受试者需在患牙拔除前和创口愈合3~4个月两个时段，分别进行口腔临床检查、口腔模型制备以及拍摄颌骨曲面断层片。所有患牙需在微创下拔除并彻底清除炎性组织，根据分组情况植入所需生物材料。待愈合3~4个月后，使用2mm直径的环骨钻制取约6~8mm长度的骨块。使用电子游标卡尺对石膏模型进行数据测量，使用图像分析软件PACS（Carestream，11.0version）进行影像数据处理，使用数据处理软件ImageJ进行组织学数据处理。结果：（1）对照组与实验组间在口腔模型、影像、组织上均有显著差异（P0.001）。（2）CHA含量高者，在骨容量维持上更占优势，但三种处理方法间并无显著差异（P0.05）。（3）不同比例CHA与自体骨混合在成骨效果上有差异。CHA：AB（50:50）组与完全CHA组在新骨生成表现有显著差异（P0.001），而CHA：AB（50:50）与CHA：AB（80:20）新骨生成表现上无明显差异（P0.05）。不同比例CHA与自体骨混合在CHA残留率上有显著差异（P0.001）。结论：（1）使用生物材料与未使用生物材料的拔牙窝，3~4个月后其骨组织的临床改变、影像改变及组织改变有差异，提示早期进行拔牙窝干预有一定意义。（2）混有自体骨与未混自体骨的人工骨，植入拔牙窝3~4个月后其骨组织的临床改变、影像改变无显著差异，但组织学上有差异，提示自体骨的混入对颌骨质量的改善有一定作用。（3）自体骨在拔牙窝的位点保存中有一定的应用价值。
[Abstract]:Background: Studies have shown that the alveolar ridge of the extraction nest will lose its height and width in the first month after extraction, especially the buccal bone plate, which will further cause soft tissue atrophy and collapse. The difficulty of dental implant operation and the economic burden of the patients were increased in the future, and the aesthetic risk was also higher. Early intervention of extraction fossa may block or reduce alveolar ridge absorption and gingival papilla atrophy. Objective: The purpose of this study was to compare the different proportions of corals into hydroxyapatite Hydroxyapatite by clinical manifestation, histology and imaging. The effects of Chi) and autogenous BoneAB on bone regeneration in fresh tooth extraction fossa were studied, and the application value of autoclastic bone implantation in the preservation of extraction sites was discussed. Materials and methods: Sixty patients were randomly divided into four groups: group A (blood clot group, group B) (complete CHA group, group C, CHA: AB 80: 20, group D, group D, group A: AB: AB: 50: 50). Each group of 15 cases. All subjects need to perform oral clinical examination before extraction and 3 ~ 4 months of wound healing. The oral model was prepared and the maxillary curved surface tomograph was taken. All the affected teeth should be removed and completely removed inflammatory tissues were removed and the required biomaterials were implanted according to the grouping. After 3 ~ 4 months of healing. A bone block of about 6 ~ 8 mm in length was made with a ring bone drill of 2 mm diameter. The data of gypsum model was measured with electronic Vernier caliper and the image analysis software PACS(Carestream was used. 11.0 version) is used for image data processing, and ImageJ is used for histology data processing. Results: 1) there were significant differences in oral model, image and tissue between the control group and the experimental group (P 0.001). However, there was no significant difference among the three treatment methods in bone volume maintenance (P 0.05). There was significant difference in osteogenesis between different proportions of CHA and autogenous bone. There was significant difference in osteogenesis between CHA: AB 50: 50 group and complete CHA group (P 0.001). There was no significant difference in the performance of new bone formation between Ch: AB 50: 50 and Ch A: AB 80: 20 (P 0.05). There was significant difference in residual rate of CHA between different proportion of CHA and autogenous bone (P 0.001). Conclusion: 1) the clinical changes of bone tissue, image changes and tissue changes were different between those using biomaterials and those without biomaterials after 3 ~ 4 months, indicating that the early intervention of tooth extraction nest has some significance. (2) there was no significant difference in imaging changes between artificial bone with and without autogenous bone, but histological difference was found after implantation of extraction fossa 3 ~ 4 months later. The results suggest that the mixing of autologous bone can improve the quality of jaw bone. 3) autogenous bone has certain application value in the preservation of extraction fossa.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R782.11

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