重度牙周炎患牙牙槽嵴保存术效果的CBCT评价
发布时间：2019-05-20 11:04
【摘要】：目的通过锥形束CT(Cone beam Computer Tomography,CBCT)观察重度牙周炎患牙拔除后即刻行牙槽嵴保存术(Alveolar Ridge Preservation,ARP)对缺牙区牙槽嵴高度与宽度、缺失牙邻牙骨量以及缺牙区的骨密度和轮廓的影响,并与拔牙创自然愈合的位点进行比较。评价牙槽嵴保存术对不同程度骨缺损的患牙拔牙区牙槽骨骨量保存的效果。方法因重度牙周炎需要拔除的共46名患者的75颗患牙纳入研究,其中包括31颗前牙和44颗后牙。纳入标准:(1)因重度牙周炎需要拔除的患牙;探诊深度6mm;附着丧失≥5 mm;牙槽骨吸收超过根长的1/2;后牙有Ⅱ度及以上根分叉病变;(2)至少剩余2个骨壁,骨壁的剩余高度≥3mm;(3)至少存在一颗邻牙;(4)经过牙周基础治疗,能够保持良好的口腔卫生状况。患者均同意参加实验,已签署知情同意书。排除标准:(1)年龄18岁的患者;(2)患牙处于急性感染期;(3)有全身系统性疾病或传染病史;(4)长期服用皮质类固醇、非甾体类抗炎药及双磷酸盐等影响骨代谢的相关药物;(5)有头颈部放疗史;(6)处于妊娠期或哺乳期。利用随机数字表,将患牙分为拔牙后即刻行ARP的实验组,以及自然愈合的对照组。再根据患牙拔除前的骨丧失量分为A组(骨吸收量为5~7mm)和B组(骨吸收量7mm)。实验组的患牙,采用微创拔牙技术拔除后,彻底清创,于拔牙窝内植入Bio-Oss?骨粉和Bio-Oss?Collagen,覆盖Bio-Gide?可吸收胶原膜,减张,缝合。对照组的患牙,微创拔除后,彻底清创搔刮拔牙窝,复位,缝合。运用CBCT+3D-Invivo5 dental软件进行测量。首先,测量牙齿拔除前与拔除6个月后,该牙位的近中、中央、远中三个矢状面上的牙槽骨颊、舌侧的高度,以及最高的剩余牙槽嵴顶下方1mm、4mm、7mm处的宽度。测量牙槽骨高度时,下颌患牙以下颌骨下缘的水平切线为基线,上颌患牙以上颌窦下缘或鼻窦下缘的水平切线为基线,测量颊侧或舌侧牙槽嵴顶到该切线的距离。然后,测量冠状位时该患牙的邻牙邻面的颊、舌侧和中点处釉牙骨质界(CEJ)到牙槽嵴顶的距离。最后,运用Lekholm和Zarb分类法,根据缺牙区的骨密度分为Ⅰ~Ⅳ类骨,观察拔牙窝愈合6个月后的密度及轮廓。轮廓的评价标准为:自然饱满愈合良好者记为2分;形态略凹陷低平者记为1分;形态不规则明显凹陷者记为0分。计算出拔牙前后在不同的位置骨量发生的改变。运用软件SPSS20.0,采用独立样本t检验和卡方检验的方法对相关数据进行统计学分析。结果1.实验组的牙槽骨在垂直方向和水平方向上的吸收量低于对照组。牙槽骨高度的吸收量,在缺牙区的近中颊、近中舌和远中颊侧有统计学差异(P0.05)。牙槽骨宽度的吸收量,在近中矢状面的牙槽嵴顶下方1mm处和缺牙区中央矢状面的牙槽嵴顶下1mm、4mm及7mm处有统计学意义(P0.05),其余均无统计学意义。此外,不同程度骨缺损的患牙之间,B组(骨丧失更严重的患牙)与A组相比,有统计学差异(P0.05)。2.拔牙后,对于邻牙牙槽骨高度的影响,实验组多数牙槽骨高度有所增加,而对照组有所降低。实验组与对照组相比在邻牙邻面的中间以及舌侧有统计学差异(P0.05)。不同的骨缺损程度下,A组与B组中有统计学差异主要集中在邻牙邻面的中间及舌侧,两组之间无统计学差异(P0.05)。3.ARP对骨轮廓与密度具有明显的影响,实验组的骨轮廓会更加平缓,并且骨质相对较好,其中影像学上显示的Ⅱ类骨明显多于对照组。不同骨缺损程度的患牙,ARP对骨轮廓与影像学上显示的密度的影响亦有显著性差异(P0.05),B组(骨缺损较大)的患牙,行ARP后效果更加明显。结论1.ARP能够有效地保存重度牙周炎患牙缺牙区牙槽骨的高度与宽度,对于重度骨缺损的患牙效果更显著。2.ARP能够有助于恢复邻牙邻面的骨壁高度。3.ARP有助于维持缺牙区牙槽嵴顶平缓的形态,以及良好的骨密度,为进一步的修复治疗尤其是种植修复提供更好的基础条件。
[Abstract]:Objective To study the effects of immediate post-extraction (ARP) on the height and width of the tooth groove, the bone mass of the missing tooth and the bone density and profile of the missing tooth area by the cone beam CT (CBCT). And compared with the site of the natural healing of the tooth extraction. To evaluate the effect of the preservation of alveolar bone in the alveolar bone of the tooth extraction area of different degree of bone defect. Methods A total of 46 patients with severe periodontitis were included in the study, including 31 anterior teeth and 44 posterior teeth. Inclusion criteria: (1) the affected tooth required to be removed due to severe periodontitis; the depth of the visit is 6 mm; the attachment loss is 5 mm; the alveolar bone resorption exceeds 1/2 of the root length; the posterior teeth have a degree of II and above for bifurcation lesions; (2) at least two bone walls are left, and the remaining height of the bone wall is 3 mm; (3) there is at least one adjacent tooth; (4) the periodontal foundation treatment can maintain good oral hygiene condition. The patient agreed to participate in the experiment and signed the informed consent form. Exclusion criteria: (1) a patient of 18 years of age; (2) the affected tooth is in an acute phase; (3) a history of systemic systemic or infectious diseases; (4) a drug related to the long-term administration of a corticosteroid, a non-opioid anti-inflammatory agent, and a diphosphate to affect bone metabolism; (5) history of head and neck radiotherapy; (6) in pregnancy or lactation. By using the random number table, the affected teeth were divided into experimental group with ARP immediately after tooth extraction, and the control group of natural healing. The amount of bone loss before the extraction was divided into group A (the amount of bone absorption was 5-7 mm) and group B (the amount of bone absorption was 7 mm). The teeth of the experimental group were removed by the method of minimally invasive extraction. Bio-Oss was implanted in the tooth extraction socket. Bone meal and Bio-Oss? Collection, covered with Bio-Gide? Can absorb the collagen film, reduce the tension, and stitch. The teeth of the control group, after the minimally invasive extraction, completely debridement and scraping the tooth extraction socket, and resetting and sewing. The CBCT + 3D-Invivo5 dental software was used for the measurement. First, the width at 1 mm,4 mm,7 mm below the top of the proximal, central, distal, and distal three sagittal planes of the tooth was measured before and after the removal of the tooth for 6 months. When the height of the alveolar bone was measured, the horizontal tangent of the lower edge of the lower jaw of the lower jaw of the lower jaw was the baseline, and the upper jaw and the lower edge of the upper jaw or the horizontal tangent of the lower edge of the lower jaw were the baseline, and the distance between the buccal or lingual cusp and the tangent was measured. Then, the distance between the enamel at the buccal, lingual and mid-point of the adjacent surface of the affected tooth at the coronal, lingual, and midpoint of the affected tooth is measured. Finally, according to the Lekolm and Zareb classification, the density and the profile of the tooth extraction socket after 6 months were observed according to the bone mineral density of the tooth-missing area. The standard of the evaluation of the profile is as follows: the well-healed well-healed person is recorded as 2 points; the lower flat with the shape of the shape is recorded as 1 point; the shape irregularity is marked as 0. The changes of bone mass at different positions before and after tooth extraction were calculated. The relevant data were statistically analyzed using the software SPSS10.0, the independent sample t test and the chi-square test. Results 1. The absorption of the alveolar bone in the experimental group was lower than that in the control group. The absorption of the height of the alveolar bone was significantly different from the buccal, proximal and distal buccal sides (P0.05). The absorption of the width of the alveolar bone was statistically significant at the height of 1 mm,4 mm and 7 mm below the top of the central sagittal plane of the sagittal plane (P0.05). In addition, there was a significant difference between the teeth of the different degree of bone defect and the group B (the teeth with more serious bone loss) than that of group A (P0.05). After the tooth extraction, the height of the alveolar bone in the experimental group was increased, and the control group decreased. There was a significant difference between the experimental group and the control group in the middle and the lingual side of the adjacent teeth (P0.05). In group A and group B, there was a significant difference between group A and group B on the middle and lingual side of the adjacent teeth, and there was no statistical difference between the two groups (P 0.05).3. ARP had a significant effect on the bone profile and density, and the bone profile of the experimental group was more gradual and the bone quality was relatively good. The second type of bone in the image was significantly higher than that of the control group. The effect of ARP on the bone profile and the density of the image was also significant (P0.05), and the effect of ARP was more obvious after the treatment of the teeth with different bone defects (P0.05). Conclusion 1. ARP can effectively preserve the height and width of the alveolar bone in the patients with severe periodontitis, and it is more effective in the treatment of severe bone defects.2. ARP can help to restore the height of the bone wall on the adjacent surface of the adjacent tooth. And provides a better basic condition for further repair and treatment, in particular for planting and repairing.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.42
本文编号：2481605
[Abstract]:Objective To study the effects of immediate post-extraction (ARP) on the height and width of the tooth groove, the bone mass of the missing tooth and the bone density and profile of the missing tooth area by the cone beam CT (CBCT). And compared with the site of the natural healing of the tooth extraction. To evaluate the effect of the preservation of alveolar bone in the alveolar bone of the tooth extraction area of different degree of bone defect. Methods A total of 46 patients with severe periodontitis were included in the study, including 31 anterior teeth and 44 posterior teeth. Inclusion criteria: (1) the affected tooth required to be removed due to severe periodontitis; the depth of the visit is 6 mm; the attachment loss is 5 mm; the alveolar bone resorption exceeds 1/2 of the root length; the posterior teeth have a degree of II and above for bifurcation lesions; (2) at least two bone walls are left, and the remaining height of the bone wall is 3 mm; (3) there is at least one adjacent tooth; (4) the periodontal foundation treatment can maintain good oral hygiene condition. The patient agreed to participate in the experiment and signed the informed consent form. Exclusion criteria: (1) a patient of 18 years of age; (2) the affected tooth is in an acute phase; (3) a history of systemic systemic or infectious diseases; (4) a drug related to the long-term administration of a corticosteroid, a non-opioid anti-inflammatory agent, and a diphosphate to affect bone metabolism; (5) history of head and neck radiotherapy; (6) in pregnancy or lactation. By using the random number table, the affected teeth were divided into experimental group with ARP immediately after tooth extraction, and the control group of natural healing. The amount of bone loss before the extraction was divided into group A (the amount of bone absorption was 5-7 mm) and group B (the amount of bone absorption was 7 mm). The teeth of the experimental group were removed by the method of minimally invasive extraction. Bio-Oss was implanted in the tooth extraction socket. Bone meal and Bio-Oss? Collection, covered with Bio-Gide? Can absorb the collagen film, reduce the tension, and stitch. The teeth of the control group, after the minimally invasive extraction, completely debridement and scraping the tooth extraction socket, and resetting and sewing. The CBCT + 3D-Invivo5 dental software was used for the measurement. First, the width at 1 mm,4 mm,7 mm below the top of the proximal, central, distal, and distal three sagittal planes of the tooth was measured before and after the removal of the tooth for 6 months. When the height of the alveolar bone was measured, the horizontal tangent of the lower edge of the lower jaw of the lower jaw of the lower jaw was the baseline, and the upper jaw and the lower edge of the upper jaw or the horizontal tangent of the lower edge of the lower jaw were the baseline, and the distance between the buccal or lingual cusp and the tangent was measured. Then, the distance between the enamel at the buccal, lingual and mid-point of the adjacent surface of the affected tooth at the coronal, lingual, and midpoint of the affected tooth is measured. Finally, according to the Lekolm and Zareb classification, the density and the profile of the tooth extraction socket after 6 months were observed according to the bone mineral density of the tooth-missing area. The standard of the evaluation of the profile is as follows: the well-healed well-healed person is recorded as 2 points; the lower flat with the shape of the shape is recorded as 1 point; the shape irregularity is marked as 0. The changes of bone mass at different positions before and after tooth extraction were calculated. The relevant data were statistically analyzed using the software SPSS10.0, the independent sample t test and the chi-square test. Results 1. The absorption of the alveolar bone in the experimental group was lower than that in the control group. The absorption of the height of the alveolar bone was significantly different from the buccal, proximal and distal buccal sides (P0.05). The absorption of the width of the alveolar bone was statistically significant at the height of 1 mm,4 mm and 7 mm below the top of the central sagittal plane of the sagittal plane (P0.05). In addition, there was a significant difference between the teeth of the different degree of bone defect and the group B (the teeth with more serious bone loss) than that of group A (P0.05). After the tooth extraction, the height of the alveolar bone in the experimental group was increased, and the control group decreased. There was a significant difference between the experimental group and the control group in the middle and the lingual side of the adjacent teeth (P0.05). In group A and group B, there was a significant difference between group A and group B on the middle and lingual side of the adjacent teeth, and there was no statistical difference between the two groups (P 0.05).3. ARP had a significant effect on the bone profile and density, and the bone profile of the experimental group was more gradual and the bone quality was relatively good. The second type of bone in the image was significantly higher than that of the control group. The effect of ARP on the bone profile and the density of the image was also significant (P0.05), and the effect of ARP was more obvious after the treatment of the teeth with different bone defects (P0.05). Conclusion 1. ARP can effectively preserve the height and width of the alveolar bone in the patients with severe periodontitis, and it is more effective in the treatment of severe bone defects.2. ARP can help to restore the height of the bone wall on the adjacent surface of the adjacent tooth. And provides a better basic condition for further repair and treatment, in particular for planting and repairing.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.42
【参考文献】
相关期刊论文 前3条
1 孙莲莲;王志兴;;牙周炎与全身疾病相关性的研究进展[J];继续医学教育;2016年02期
2 詹雅琳;胡文杰;甄敏;徐涛;路瑞芳;;去蛋白牛骨基质与可吸收胶原膜的磨牙拔牙位点保存效果影像学评价[J];北京大学学报(医学版);2015年01期
3 郝永明;赵伟;邢一栋;于丽丽;邹德荣;;牙种植区骨密度的CBCT评价[J];口腔颌面外科杂志;2014年03期
，本文编号：2481605
本文链接：https://www.wllwen.com/yixuelunwen/kouq/2481605.html
最近更新
教材专著
