种植体早期稳定性影响因素的临床研究

发布时间：2018-08-04 20:23

【摘要】：随着口腔医学的发展,种植已经成为牙齿缺失、牙列缺损的重要修复方式;近年,由于临床医生与患者对早期恢复口腔功能的重视,种植体早期修复与负载成为研究的热点。种植体的早期稳定是判断骨结合、选择修复与负载时间的重要依据,是影响成功率的主要因素,因此受到诸多学者及医生的关注。影响早期稳定性的因素包括颌骨骨质与骨量、种植体形貌、手术方式等诸多方面,正确客观地分析这些因素在植入早期对稳定性的影响,有利于医生在术前对植入效果进行预判,防止骨结合不良,保证种植修复的成功。本临床研究以第四军医大学口腔医院修复科牙齿缺失患者为样本来源,首先,采用前瞻性队列研究方法,对不同因素与种植体早期稳定性的关系进行分析,初步判断影响种植体早期稳定性的相关因素;然后利用不同因素与种植体早期稳定性的相关关系,在术前对稳定性进行预测,并初步探讨其准确性与可靠度,以期为临床工作提供必要的参考与依据。第一部分种植体早期稳定性影响因素的临床研究[目的]初步探讨影响种植体早期稳定性的相关因素。[方法]于2014年9月至2015年9月,从第四军医大学口腔医院修复科选择单颗牙缺失并行种植修复的患者共106例,采用CBCT分别测量其种植区的颌骨密度(HU值)后,各植入Nobel ReplaceTM Tapered种植体一枚,共植入106枚。采用Ostell ISQ种植体稳定性测量仪分别于术后即刻、第12周测量ISQ值;采用CBCT测量各种植体周围骨壁厚度;采用X线影像测量各种植体边缘骨吸收水平;对所有临床资料进行统计分析。[结果]所有种植体均取得良好的初始ISQ值(68.07±10.31),术后第12周ISQ值均显著增高(P0.05)。统计学分析结果显示,种植区位置、HU值以及直径对ISQ值存在显著影响(P0.05),种植体周围骨壁厚度、种植体边缘骨吸收水平以及种植体长度对种植体的ISQ值影响不显著(P0.05)。[结论]本研究条件下种植体早期稳定性可能受种植区部位、HU值以及种植体直径的影响,而其他因素的影响尚缺乏临床依据。第二部分采用CBCT预测种植体早期稳定性的临床研究[目的]探讨采用CBCT测量HU值预测种植体早期稳定性的可行性。[方法]于2015年6月至2015年12月,选择修复科就诊的后牙区单颗牙齿缺失患者,其中上颌与下颌各10例。采用CBCT分别测量各种植区颌骨密度(HU值),利用第一部分所得线性回归方程分别计算ISQ预测值。在种植区各植入Nobel ReplaceTM Tapered种植体一枚,分别于术后即刻、第12周测量种植体ISQ值。采用Spearman秩相关比较分析ISQ预测值与测量值。[结果]种植体植入后即刻及第12周,ISQ测量值与预测值之间相关系数均呈显著相关性(P(27)0.05)。[结论]本研究条件下,初步认为术前采用CBCT测量HU值对种植体早期ISQ值进行预测是可行的。
[Abstract]:With the development of stomatology, implant has become an important way to repair tooth loss and dentition defect. In recent years, due to the attention of clinicians and patients to early recovery of oral function, implant early repair and loading become a hot topic. The early stability of implants is an important basis for judging bone union, choosing the time of repair and loading, and is the main factor affecting the success rate. Therefore, many scholars and doctors pay close attention to it. The factors that affect the early stability include the bone mass of the mandible, the shape of the implant, the operation method and so on. The influence of these factors on the stability in the early stage of implantation is analyzed correctly and objectively. It is helpful for doctors to predict the effect of implant before operation, to prevent poor bone bonding and to ensure the success of implant repair. In this clinical study, dental defects in the Department of Restoration, Department of Stomatology, fourth military Medical University were used as a sample source. First, a prospective cohort study was used to analyze the relationship between different factors and the early stability of implants. The correlation factors affecting the early stability of implants were preliminarily judged, and then the stability was predicted before operation by using the correlation between different factors and the early stability of implants, and the accuracy and reliability of these factors were preliminarily discussed. In order to provide the necessary reference and basis for clinical work. Part one: clinical study on the influencing factors of early implant stability [objective] to explore the related factors affecting the early stability of implants. [methods] from September 2014 to September 2015, 106 patients were selected from Department of Stomatology, Department of Stomatology, fourth military Medical University, and their maxillary density (Hu) was measured by CBCT. One Nobel ReplaceTM Tapered implant was implanted and 106 implants were implanted. Ostell ISQ implant stability measurement instrument was used to measure the ISQ value immediately and 12 weeks after operation, CBCT was used to measure the bone wall thickness around the implants, X-ray images were used to measure the bone resorption level at the edge of the implants. All clinical data were statistically analyzed. [results] all implants obtained good initial ISQ value (68.07 卤10.31), and the ISQ value increased significantly at the 12th week after operation (P0.05). The results of statistical analysis showed that the ISQ value was significantly affected by Hu value and diameter in planting area (P0.05), while the thickness of bone wall around implant, bone resorption level at implant edge and implant length had no significant effect on ISQ value of implant (P0.05). [conclusion] in this study, the early stability of implants may be affected by Hu value and implant diameter, but the effect of other factors is still lack of clinical basis. In the second part, we use CBCT to predict the early stability of implants [objective] to explore the feasibility of using CBCT to predict the early stability of implants. [methods] from June 2015 to December 2015, 10 cases of maxilla and 10 cases of mandible were selected from patients with single tooth loss in posterior teeth. The mandibular density (Hu) was measured by CBCT and the predicted value of ISQ was calculated by linear regression equation in the first part. One Nobel ReplaceTM Tapered implant was implanted in the planting area and the ISQ value was measured immediately after operation and 12 weeks after operation. The ISQ predicted value and the measured value were analyzed by Spearman rank correlation comparison. [results] the correlation coefficient between ISQs and predicted values was significantly correlated with the predicted values immediately after implant implantation and 12 weeks after implantation (P (27). [conclusion] under the condition of this study, it is feasible to use CBCT to predict the early ISQ value of implants.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.6
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本文编号：2165032