上颌前牙区埋伏牙牵引不同导萌术式的临床研究

发布时间：2018-05-11 06:31

本文选题：埋伏牙 + 导萌术　；参考：《华北理工大学》2017年硕士论文

【摘要】：目的通过对上颌前牙区埋伏牙牵引不同导萌术式的相关临床研究,比较研究几种不同术式在牙周预后标准方面的优劣,为临床工作提供一定的参考。方法选取2014年3月至2016年10月期间,在唐山市口腔医院接受埋伏牙牵引助萌术的患者病例中,随机挑选120例患者作为研究对象。所有患者均为上前牙埋伏阻生,且已由正畸科提前预留出缺牙间隙。除外条件包括:患有牙周炎症或其他可能干扰实验结果的全身疾病或遗传性疾病的病例;高位阻生或倒置阻生特殊疑难病例;牵引方案需从腭侧牵出的病例以及患者医从性较差的病例。另外,牵引失败病例或数据收集失败病例,以及牵引周期大于6个月的,按照以上病例选择标准另行补充,以保证拟定样本量。将120例患者随机分成4组,每组30例,记为a、b、c、d组,利用CBCT、曲面断层及相关影像学设备辅助检查,明确埋伏牙位置,牙根形成情况,根尖是否存在畸形,确定手术切口位置,分别采用牙槽嵴顶切口封闭式导萌术(即由患牙所对应的牙槽嵴顶除做牙周翻瓣,直至暴露患牙)、就近切口封闭式导萌术(即由患牙就近处切口并翻开覆盖的软组织,暴露患牙)、根向复位瓣开放式导萌术(即暴露埋伏牙后,将翻开的龈瓣做保留并缝合于根方牙龈切口处)、去瓣开放式导萌术(即直接切除覆盖于埋伏牙牙面的软组织,暴露埋伏牙),其中d组为对照组。所有4组120例患者,均于术后每月复诊一次,共计追踪复诊6次,牵引完成后,通过CBCT及临床检查记录相关数据。相关数据包括:附着龈宽度、附着龈厚度、牙龈退缩、唇侧骨板厚度、牙根吸收情况。数据采集标准:术后复诊:间隔30±2天,追踪半年,共计追踪复诊6次。牵引完成标准:以患牙回归正常位置且能建立正常的颌关系为准。附着龈宽度:利用牙周探针测量膜龈联合至龈缘最高点的垂直距离。附着龈厚度:利用CBCT测量患牙唇侧附着龈厚度,精确到0.01mm。牙龈退缩:利用牙周探针探查釉牙本质界,若釉牙本质界在龈下,即无牙龈退缩,记为“-”,若在龈上,即有牙龈退缩,记为“+”。唇侧骨板厚度:利用CBCT测量唇侧牙槽骨嵴顶根方2mm处骨板厚度,精确到0.01mm。牙根吸收:通过CBCT观测根尖形态,记为“+”、“-”。原始数据录入Excel表,准备进行统计学分析。结果1.a、b、c组与对照组在附着龈宽度方面比较,通过统计学处理,P0.001,故P0.05,有统计学意义。2.a、b、c组与对照组在附着龈厚度方面比较,通过统计学处理,P0.001,故P0.05,有统计学意义;同时a、b、c三组实验组进行组间比较,P0.05,亦有统计学意义。3.a、b、c组与对照组在唇侧骨板厚度方面比较,通过统计学处理,P0.001,故P0.05,有统计学意义;同时a、b、c三组实验组进行组间比较,P0.05,亦有统计学意义。4.a、b组牙龈退缩发生率均为6.67%,c组牙龈退缩发生率为10%,对照组牙龈退缩发生率为16.67%,但未有统计学意义。5.a、b、c组与对照组均未发生牙根吸收。结论1.采用牙槽嵴顶切口封闭式导萌术式、就近切口封闭式导萌术式和根向复位瓣开放式导萌术式三种术式在保留附着龈宽度方面均优于采用去瓣开放式导萌术式的病例。2.四种术式在附着龈厚度预后方面,采用牙槽嵴顶切口封闭式导萌术式的预后最有优势。3.四种术式在唇侧骨板厚度预后方面,由厚到薄依次为:牙槽嵴顶切口封闭式导萌术式、就近切口封闭式导萌术式、根向复位瓣开放式导萌术式、去瓣开放式导萌术式。4.两种开放式导萌术式牙龈退缩发生率略高于两种封闭式导萌术式,但未见统计学差异。5.不同术式的选择与牙根吸收无明显关系。
[Abstract]:Objective to compare the advantages and disadvantages of several different surgical methods in the periodontal prognosis of the ambushed teeth in the maxillary anterior teeth, and to provide some reference for the clinical work. Methods to select the patients in the Tangshan City oral cavity hospital from March 2014 to October 2016. In the case, 120 patients were randomly selected as subjects. All the patients were impacted in the anterior teeth and had been reserved in advance by the orthodontic department. The traction scheme should be taken from the palatine side cases and the patients with poor medical treatment. In addition, the traction failure cases or the data collection failure cases and the traction cycle more than 6 months are supplemented in accordance with the above case selection criteria to ensure the proposed sample size. 120 patients are randomly divided into 4 groups, 30 cases in each group, which are recorded as a, B, C, D group. CBCT, surface fault and related imaging equipment were examined to determine the position of the ambush, the formation of the root, the abnormality of the root tip, the location of the incision, the closure of the alveolar crest incision (that is, the alveolar crest of the affected teeth, until the periodontal flap was exposed to the exposed tooth), and the closed incision in the close incision was performed. Open guided eruption (that is, after exposure of the ambushed teeth, the open gingival flap is retained and sutured at the root of the gingival incision), and the open guided sprouting (that is, the soft tissue covered by the ambush tooth surface, exposing the buried teeth), the D group is the right one. All 4 groups of 120 patients were treated once a month after the operation, and a total of 6 visits were followed up. After the traction was completed, the relevant data were recorded by CBCT and clinical examination. The data included: the width of the gingival, the thickness of the gingiva, the gingiva, the thickness of the lip and the root, and the absorption of the root. The standard of data collection: the postoperative review: the interval of 30 + 2 days, tracking. Six months, a total of 6 visits were traced. Traction completion criteria: the normal position of the affected teeth and the establishment of normal maxillary relationship. The width of the attached gingiva: using the periodontal probe to measure the vertical distance of the gingival joint to the highest point of the gingival margin. The thickness of the attached gingiva: the thickness of the gingiva attached to the labial lip and the 0.01mm. gingival retraction by CBCT: the use of teeth. Probe into the essential boundary of enamel, if the essential boundary of the enamel is under the gingiva, that is, no gingiva retreat, the "-" is recorded as "-". If on the gums, there is a gingiva retraction, "+". The thickness of the labial bone plate: the thickness of the bone plate at the 2mm of the alveolar ridge top root of the labial alveolus is measured by the CBCT: the apex morphology is observed by CBCT, and recorded as "+", "-". The original data entered the Excel table and prepared for statistical analysis. Results 1.a, B, C group and control group were compared with the control group in terms of the gingival width. Statistically, P0.001, P0.05,.2.a, B, C group and control group were compared with the control group on the thickness of attached gingiva, with statistical significance, P0.001, and therefore P0.05, three groups. The experimental group compared group, P0.05, also have statistical significance.3.a, B, C group and the control group in the lip bone plate thickness comparison, through statistical processing, P0.001, P0.05, there is statistical significance; meanwhile, a, B, C three groups of experimental group comparison, P0.05, also have the significance.4.a, B group gingival contraction rate is 6.67%, gum group shrinking The incidence of gingival contraction in the control group was 10%, but the rate of gingival contraction was 16.67%, but there was no statistical significance.5.a, B, both group C and the control group did not have root resorption. Conclusion 1. using the closed crest incision and the closed guide sprouting of the alveolar ridge, the close incision closed guide operation and the root reposition valve open guide have three methods to retain the width of the attached gingiva. The four types of case.2., which are superior to the open flap, have the best prognosis for the thickness of the attached gingival thickness. The prognosis of the closed crest incision closure is the most advantageous for the prognosis of the four kinds of surgical procedures for the thickness of the labial bone plate. The rate of gingival retraction in two open type of open guided eruption type.4. was slightly higher than that of two closed guided sprouting, but there was no statistical difference between the choice of.5. and the root resorption.

【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R782.1

【参考文献】