本文關(guān)鍵詞： 拔牙窩 干預(yù) 位點保存 珊瑚轉(zhuǎn)化羥磷灰石 自體碎骨　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景： 研究表明拔牙窩的牙槽嵴在牙拔除后的第一個月就會發(fā)生高度和寬度的喪失，且以頰側(cè)骨板為甚，，進一步造成軟組織的萎縮和塌陷，增大了日后牙種植手術(shù)的難度及患者的經(jīng)濟負擔(dān)，同時伴有更高的美學(xué)風(fēng)險。對拔牙窩進行早期干預(yù)，或可阻斷或減輕牙槽嵴吸收及齦乳頭萎縮。 目的： 本實驗旨在通過臨床表現(xiàn)、組織學(xué)及影像學(xué)等方面，比較研究不同比例珊瑚轉(zhuǎn)化羥磷灰石（Coralline Hydroxyapatite, CHA）和自體碎骨（Autogenous Bone,AB）對新鮮拔牙窩骨再生的影響，并探討自體碎骨植入拔牙窩在位點保存中的應(yīng)用價值。 材料和方法： 隨機選取60例患者，分為A組（血凝塊組）、B組（完全CHA組）、C組（CHA：AB=80:20）、D組（CHA：AB=50:50）四組，每組15例。所有受試者需在患牙拔除前和創(chuàng)口愈合3~4個月兩個時段，分別進行口腔臨床檢查、口腔模型制備以及拍攝頜骨曲面斷層片。所有患牙需在微創(chuàng)下拔除并徹底清除炎性組織，根據(jù)分組情況植入所需生物材料。待愈合3~4個月后，使用2mm直徑的環(huán)骨鉆制取約6~8mm長度的骨塊。使用電子游標卡尺對石膏模型進行數(shù)據(jù)測量，使用圖像分析軟件PACS（Carestream，11.0version）進行影像數(shù)據(jù)處理，使用數(shù)據(jù)處理軟件ImageJ進行組織學(xué)數(shù)據(jù)處理。 結(jié)果： （1）對照組與實驗組間在口腔模型、影像、組織上均有顯著差異（P0.001）。 （2）CHA含量高者，在骨容量維持上更占優(yōu)勢，但三種處理方法間并無顯著差異（P0.05）。 （3）不同比例CHA與自體骨混合在成骨效果上有差異。CHA：AB（50:50）組與完全CHA組在新骨生成表現(xiàn)有顯著差異（P0.001），而CHA：AB（50:50）與CHA：AB（80:20）新骨生成表現(xiàn)上無明顯差異（P0.05）。不同比例CHA與自體骨混合在CHA殘留率上有顯著差異（P0.001）。 結(jié)論： （1）使用生物材料與未使用生物材料的拔牙窩，3~4個月后其骨組織的臨床改變、影像改變及組織改變有差異，提示早期進行拔牙窩干預(yù)有一定意義。 （2）混有自體骨與未混自體骨的人工骨，植入拔牙窩3~4個月后其骨組織的臨床改變、影像改變無顯著差異，但組織學(xué)上有差異，提示自體骨的混入對頜骨質(zhì)量的改善有一定作用。 （3）自體骨在拔牙窩的位點保存中有一定的應(yīng)用價值。
[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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R782.11

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本文編號：1492011