对牙槽骨颊侧骨缺损种植病例的回顾性研究

发布时间：2018-05-17 14:07

本文选题：牙种植 + 骨缺损　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的研究种植区域牙槽骨颊侧骨缺损及缺损原因、骨穿孔及同期植入骨粉和或骨膜情况与患者年龄、牙位等因素的相关性,为在牙种植临床工作中针对不同患者确定个性化的术前检查项目、制定手术方案、及术中注意事项等提供参考依据。方法选取2012年1月至2014年1月在山西医科大学第一医院口腔科门诊进行牙种植的病例69例(均按照口腔种植规范进行术前检查,排除全身系统性疾病,符合种植适应证,且冠修复3-12个月后种植体稳定性好、无松脱)。根据年龄将患者分为18-30岁年龄组、30-45岁年龄组、46-60岁年龄组；根据种植牙位将患者分为前牙组(包括切牙、尖牙)、后牙组(包括前磨牙、磨牙)。据病历记录及术中影像学资料,回顾患者种植位点牙槽骨颊侧骨缺损原因、有无骨穿孔、是否同期植入骨粉和或骨膜,然后经统计软件对其相关资料进行统计学分析。结果69例患者中18-30岁组：牙槽骨颊侧有缺损：前牙3例、后牙1例；骨缺损原因:外伤8例、经久不愈根尖病变14例、牙周病0例。31-45岁组：牙槽骨颊侧有缺损：前牙2例、后牙15例；骨缺损原因：外伤2例、经久不愈根尖病变16例、牙周病8例。46-60岁组：牙槽骨颊侧有缺损：前牙6例、后牙11例；骨缺损原因：外伤2例、经久不愈根尖病变12例、牙周病7例。牙槽骨颊侧有骨穿孔：前牙7例、后牙8例。牙槽骨颊侧骨缺损需种植同期植骨粉和或骨膜：前牙10例、后牙20例。通过统计学分析,结果显示：1.a.46-60岁组比18-30岁组的前牙牙槽骨颊侧有骨缺损的比率更高(P0.0125),但尚不能认为该比率在18-30岁组与31-45岁组间、及31-45岁组与46-60岁组间有差别(P0.0125);b.31-45岁组与46-60岁组分别比18-30岁组的后牙牙槽骨颊侧有骨缺损的比率更高(P0.0125),但尚不能认为该比率在31-45岁组与46-60岁组间有差别(P0.0125)。2.前牙组需同期植骨粉和或骨膜的比率显著大于后牙组(P0.05)。3.尚不能认为前牙组种植位点牙槽骨颊侧穿孔的比率与后牙组不等(0.05P1)。4.年龄段与导致牙槽骨颊侧骨缺损的原因间有关联(0.005P0.01),其两者间关系的密切程度居中(C=0.41∈[0,1])。结论通过此次回顾性研究,在牙种植临床工作方面可以提供一些参考：1.针对46-60岁年龄段的前牙种植患者和31-60岁年龄段的后牙种植患者,更应该注意其颊侧骨缺损的可能,做好相应的术前检查和准备工作,谨慎选择不翻瓣式种植术。2.进行前牙区种植时,对尚未拔牙的患者可以考虑牙槽窝即刻植骨与延期种植联合的方式；对于已经长期缺牙的患者,一定要对其颊侧可能需要同期植骨提前做好充分的预想准备,包括移植材料和操作工具,而且为了在可能发生的植骨和缝合过程中提供一定的便利,手术开始阶段一定要合理设计对黏骨膜的翻瓣方式。3.进行后牙区种植时,在术前CT检查及术中翻瓣后探查过程中,都不能忽略对其牙槽骨颊侧是否穿孔进行仔细确认,避免种植体部分螺纹外露可能而影响骨整合。4.对于术前影像学资料显示有骨缺损的患者,要将其年龄因素和骨缺损原因结合起来,通过综合分析制定出最佳治疗计划。
[Abstract]:Objective to study the causes of bone defect and defect of alveolar bone in implant area, bone perforation and the correlation of bone powder and periosteum in the same period with the patient's age, tooth position and other factors. Methods 69 cases of dental implant in the Department of Stomatology of the first hospital of Shanxi Medical University from January 2012 to January 2014 were selected for dental implants in the outpatient department of the first hospital of Shanxi Medical University. The 18-30 year old age group, 30-45 year old age group and 46-60 year old age group; the patients were divided into anterior teeth group (including incisor, incisor), posterior teeth group (including premolar and molar) according to dental implant position. Periosteum, and then statistical analysis of the related data. Results the 18-30 year old group of 69 patients: 3 cases of anterior teeth and 1 cases of posterior teeth, 8 cases of bone defect, 14 cases of long non healing root apical lesions, 0 cases of periodontitis.31-45 years old: 2 cases of anterior teeth, 15 cases of posterior teeth, and bone defect. Causes: 2 cases of trauma, 16 cases of chronic apical lesions, 8 cases of periodontitis.46-60 years old: 6 cases of anterior teeth and 11 cases of posterior teeth, 11 cases of bone defect: 2 cases of trauma, 12 cases of long non healing root apical lesions, 7 cases of periodontitis, bone perforation in the cheek of alveolar bone, 7 cases of anterior teeth, 8 cases of posterior teeth and 8 cases. Alveolar bone defect needs to be planted the same period of bone defect. Bone meal and periosteum: 10 cases of anterior teeth and 20 cases of posterior teeth. By statistical analysis, the results showed that the rate of bone defect on the buccal and buccal side of the anterior teeth of the 1.a.46-60 group was higher than that of the 18-30 year old group (P0.0125), but it was still not considered between the 18-30 year old group and the 31-45 year old group, and the 31-45 year group and 46-60 year old group (P0.0125); the b.31-45 year group and 46 group and the 46-60 year old group. The ratio of the -60 year old group to the buccal defect of the alveolar bone in the posterior teeth was higher than that of the 18-30 year old group (P0.0125), but there was no difference between the 31-45 year old group and the 46-60 year old group (P0.0125) the ratio of bone graft and periosteum in the.2. anterior teeth group was significantly greater than that in the posterior teeth group (P0.05).3. still could not be considered as the implant site of the anterior teeth. The ratio of perforation to the posterior teeth group (0.05P1).4. age is associated with the cause of the alveolar bone defect (0.005P0.01), and the relationship between the two is in the middle (C=0.41 [0,1]). Conclusion through this retrospective study, the clinical working side of dental implant can provide some reference: 1. for the 46-60 year old age group. The patients with dental implant and 31-60 year old age group should pay more attention to the possibility of the buccal bone defect, make the appropriate preoperative examination and preparation, carefully select the non flaps implant.2. for the anterior dental implant, and consider the combination of the immediate implant bone graft and the delayed implant for the patients who have not been extracted. In patients who have long been missing teeth, it is necessary to make full anticipation of early bone graft in the cheek, including transplant materials and tools, and to provide a certain convenience in the possible process of bone graft and suture. At the beginning of the operation, a reasonable design of the flap of the mucous periosteum should be carried out at the beginning of the operation. During dental implantation, during the preoperative CT examination and intraoperative examination, the perforation of the buccal side of the alveolar bone can not be ignored, and the part of the dental implants may be avoided, which may affect the bone integration.4. for patients with bone defects in the preoperative imaging data, which should be combined with the age factors and the causes of bone defects. Come, make the best treatment plan through comprehensive analysis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6

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