本文選題：即刻種植　切入點(diǎn)：后牙區(qū)　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:牙體缺損及牙列缺損是口腔醫(yī)學(xué)的常見病和多發(fā)病,在世界范圍內(nèi)有較高的患病率。后牙區(qū)牙體缺損或牙列缺損最直接的影響就是咀嚼困難。如何縮短缺牙時(shí)間,早期修復(fù),進(jìn)行微創(chuàng)治療,已經(jīng)成為學(xué)者們關(guān)注的問題。不翻瓣即刻種植是指微創(chuàng)拔除無法保留的殘根或殘冠后,將種植體同期植入的方法。即刻種植技術(shù)突破了經(jīng)典的骨結(jié)合理論,不再需要經(jīng)過6個(gè)月的骨愈合期,拔牙創(chuàng)口愈合與種植體骨結(jié)合同期完成,大大縮短臨床治療時(shí)間,減少了種植體周圍骨組織及軟組織的吸收。目前不翻瓣即刻種植大量文獻(xiàn)研究主要集中在前牙區(qū),針對(duì)后牙區(qū)的研究相對(duì)較少。后牙多為多根牙,拔牙窩形態(tài)與種植體形狀不匹配,初期穩(wěn)定性獲得較困難[1]。而且后牙區(qū)拔牙創(chuàng)口大,初期軟組織關(guān)閉比較困難。這些問題使得后牙區(qū)即刻種植受到限制[2],因此解決好后牙區(qū)即刻種植技術(shù)的難點(diǎn),將會(huì)更好地造福于患者。目的:本研究通過對(duì)比即刻種植和延期種植種植體植入后6個(gè)月、12個(gè)月、24個(gè)月種植體周圍邊緣骨量的變化,以及三種不同的種植體系統(tǒng)在后牙即刻種植中,術(shù)后6個(gè)月、12個(gè)月、24個(gè)月種植體周圍邊緣骨量的變化。探討即刻種植和延期種植種植體周圍骨組織變化的差異,不同種植體系統(tǒng)的選擇對(duì)即刻種植種植體周圍骨量的影響。從而為后牙區(qū)即刻種植技術(shù)的臨床效果和遠(yuǎn)期成功率提供客觀的參考依據(jù)。方法:選擇2012年1月至2013年12月就診于吉林大學(xué)口腔醫(yī)院種植科在后牙區(qū)進(jìn)行種植治療的52例患者,共植入種植體52枚。其中即刻種植26例,延期種植26例。種植體植入后3-6個(gè)月行永久修復(fù)。分別于術(shù)后當(dāng)天、術(shù)后6個(gè)月、12個(gè)月、24個(gè)月進(jìn)行影像學(xué)測量檢查,測量種植體周圍邊緣骨高度的變化。結(jié)果:1.術(shù)后6個(gè)月與術(shù)后當(dāng)天相比:即刻種植組近中邊緣骨增量為1.35±1.12mm,延期種植組近中邊緣骨增量為-0.52±0.47mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。2.術(shù)后6個(gè)月與術(shù)后當(dāng)天相比:即刻種植組遠(yuǎn)中邊緣骨增量為1.46±1.17mm,延期種植組遠(yuǎn)中邊緣骨增量為-0.46±0.44mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。3.術(shù)后12個(gè)月與術(shù)后當(dāng)天相比:即刻種植組近中邊緣骨增量為2.16±1.73mm,延期種植組近中邊緣骨增量為-0.69±0.58mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。4.術(shù)后12個(gè)月與術(shù)后當(dāng)天相比:即刻種植組遠(yuǎn)中邊緣骨增量為1.94±1.16mm,延期種植組遠(yuǎn)中邊緣骨增量為-0.60±0.45mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。5.術(shù)后24個(gè)月與術(shù)后當(dāng)天相比:即刻種植組近中邊緣骨增量為2.53±1.65mm,延期種植組近中邊緣骨增量為-0.97±0.78mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。6.術(shù)后24個(gè)月與術(shù)后當(dāng)天相比:即刻種植組遠(yuǎn)中邊緣骨增量為2.32±1.68mm,延期種植組遠(yuǎn)中邊緣骨增量為-0.72±0.63mm;兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。7.即刻種植組術(shù)后6個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為1.35±1.12mm,術(shù)后12個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為2.16±1.73mm,兩組相比P0.05,差異具有統(tǒng)計(jì)學(xué)意義。8.即刻種植組術(shù)后6個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為1.35±1.12mm,術(shù)后24個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為2.53±1.65mm,兩組相比P0.05,差異具有統(tǒng)計(jì)學(xué)意義。9.即刻種植組術(shù)后24個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為2.53±1.65mm,術(shù)后12個(gè)月與術(shù)后當(dāng)天相比近中邊緣骨增量為2.16±1.73mm,兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。10.即刻種植組術(shù)后6個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為1.46±1.17mm,術(shù)后12個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為1.94±1.16mm,兩組相比P0.05,差異具有統(tǒng)計(jì)學(xué)意義。11.即刻種植組術(shù)后6個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為1.46±1.17mm,術(shù)后24個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為2.32±1.68mm,兩組相比P0.05,差異具有統(tǒng)計(jì)學(xué)意義。12.即刻種植組術(shù)后24個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為2.32±1.68mm,術(shù)后12個(gè)月與術(shù)后當(dāng)天相比遠(yuǎn)中邊緣骨增量為1.94±1.16mm,兩組相比P0.05,差異沒有統(tǒng)計(jì)學(xué)意義。13.即刻種植組在種植體植入后6個(gè)月Straumann種植體近遠(yuǎn)中邊緣骨增加量與Biomet 3i種植體相比,Straumann種植體近遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,Biomet 3i種植體近遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,3種種植體的近遠(yuǎn)中邊緣骨增加量均無明顯差異(P0.05)。14.即刻種植組在種植體植入后12個(gè)月Straumann種植體近遠(yuǎn)中邊緣骨增加量與Biomet 3i種植體相比,Straumann種植體近遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,Biomet 3i種植體近遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,3種種植體的近遠(yuǎn)中邊緣骨增加量均無明顯差異(P0.05)。15.即刻種植組在種植體植入后24個(gè)月Straumann種植體近中邊緣骨增加量明顯高于Biomet 3i種植體,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。Straumann種植體近中邊緣骨增加量高于Nobel Replace種植體,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。Biomet 3i種植體近中邊緣骨增加量與Nobel Replace種植體相比,2種種植體的近遠(yuǎn)中邊緣骨增加量均無明顯差異(P0.05)。16.即刻種植組在種植體植入后24個(gè)月Straumann種植體遠(yuǎn)中邊緣骨增加量與Biomet 3i種植體相比,Straumann種植體遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,Biomet 3i種植體遠(yuǎn)中邊緣骨增加量與Nobel Replace種植體相比,3種種植體的近遠(yuǎn)中邊緣骨增加量均無明顯差異(P0.05)。結(jié)論:1.即刻種植邊緣骨2年內(nèi)呈增長趨勢,6個(gè)月增加最多,12個(gè)月后基本穩(wěn)定。延期種植邊緣骨2年內(nèi)呈吸收趨勢,6個(gè)月內(nèi)吸收最多,12個(gè)月后基本穩(wěn)定。2.不同種植系統(tǒng)可能對(duì)即刻種植邊緣骨組織產(chǎn)生影響。3.即刻種植與延期種植短期內(nèi)具有相似的成功率和臨床效果。
[Abstract]:Background: tooth defect and dentition defect of oral medicine is common and frequently occurring disease in the world, with a higher prevalence. Effect of posterior area of tooth defect or dentition defect is the most direct chewing difficulties. How to shorten the time of tooth loss, early repair, minimally invasive treatment, has become a scholar focus. Flapless immediate implant is a minimally invasive extraction can not keep the residual roots or crowns after implant placement methods. Immediate implant technology breaks through the classical bone binding theory, no longer need to go through 6 months of bone healing, wound healing and osseointegration period, shorten treatment time, reduce the peri implant bone and soft tissue absorption. The flapless immediate implant literature research mainly concentrated in the anterior region, the posterior region is relatively small. After multiple Root tooth, tooth nest shape and implant shape does not match the initial stability is difficult to obtain [1]. and posterior tooth extraction wound, early closure of soft tissue is difficult. These problems make the posterior area of immediate implant is limited to [2], therefore solve the technical difficulties of immediate implants in the posterior area, will be better for the benefit of patients. Objective: 6 months after the comparison of immediate implant and delayed implant implant after 12 months, 24 months of peri implant marginal bone mass, and three different implant systems in the teeth after immediate implantation, 6 months after surgery, 12 months, 24 months of implant edge to investigate the difference of bone mass. Immediate implantation and delayed implant bone around the implant changes, different implant systems choose implant effect of peri implant bone for immediate clinical effect. So as to the posterior area of immediate implant technology The fruit and the long-term success rate provides objective basis. Methods: 52 cases from January 2012 to December 2013 in planting Department of Stomatological Hospital of Jilin University in the posterior area to plant patients treated with implants were implanted in 52 cases. The immediate implant in 26 cases, 26 cases of delayed implant. 3-6 months for permanent repair implant. On the day after surgery, 6 months after surgery, 12 months, 24 months of radiographic measurement inspection, measuring body around the marginal bone height changes. Results: 1. implant 6 months after operation and postoperative day compared with immediate implant group near the edge of bone increment was 1.35 + 1.12mm, extension the marginal bone planting group for -0.52 + 0.47mm increment of nearly two; group P0.05, the difference was not statistically significant.2. 6 months after surgery and postoperative day: immediate implant group compared to distal marginal bone increment was 1.46 + 1.17mm group, delayed implant distal marginal bone in increments of -0.46 + 0.44mm; Two group P0.05, the difference was not statistically significant.3. 12 months after surgery and postoperative day compared with immediate implant marginal bone in group increment was 2.16 + 1.73mm, delayed implant marginal bone group was -0.69 + 0.58mm increment in two groups; compared to P0.05, the difference was not statistically significant.4. 12 months after surgery and surgery the day after the immediate implant group compared: distal marginal bone increment was 1.94 + 1.16mm group, delayed implant distal marginal bone in increments of -0.60 + 0.45mm; two group P0.05, the difference was not statistically significant.5. 24 months after surgery and postoperative day compared with immediate implant marginal bone in group increment was 2.53 + 1.65mm. Delayed implant marginal bone group was -0.97 + 0.78mm increment in two groups; compared to P0.05, the difference was not statistically significant.6. 24 months after surgery and postoperative day: immediate implant group compared to distal marginal bone increment was 2.32 + 1.68mm group, delayed implant distal marginal bone in increments of -0.72. 0.63mm; two group P0.05, the difference was not statistically significant.7. immediate implant group 6 months after operation and postoperative day compared to the marginal bone near the incremental was 1.35 + 1.12mm, 12 months after surgery and postoperative day compared to the marginal bone near the incremental was 2.16 + 1.73mm, two group P0.05, the difference was statistically significant.8. immediate implant group 6 months after operation and postoperative day compared to the marginal bone near the incremental was 1.35 + 1.12mm, 24 months after surgery and postoperative day compared to the marginal bone near the incremental was 2.53 + 1.65mm, two group P0.05, the difference was statistically significant.9. immediate implant group 24 months after operation and operation the day after the bone near the edge compared to increment was 2.53 + 1.65mm, 12 months after surgery and postoperative day compared to the marginal bone near the incremental was 2.16 + 1.73mm, two group P0.05, the difference was not statistically significant.10. immediate implant group 6 months after operation and postoperative day compared to 1 in the far edge of bone augmentation .46 + 1.17mm, 12 months after surgery and postoperative day compared to distal marginal bone increment was 1.94 + 1.16mm, two group P0.05, the difference was statistically significant.11. immediate implant group 6 months after operation and postoperative day compared to distal marginal bone increment was 1.46 + 1.17mm, 24 months after surgery and surgery when days of distal marginal bone increment was 2.32 + 1.68mm, two group P0.05, the difference was statistically significant.12. immediate implant group 24 months after operation and postoperative day compared to distal marginal bone increment was 2.32 + 1.68mm, 12 months after surgery and postoperative day compared to 1.94 in the far edge of bone augmentation two + 1.16mm, compared to P0.05 group, the difference was not statistically significant.13. immediate implant implant in group Straumann after 6 months of implant in the near and far edge of bone increased with Biomet 3I implants compared to Straumann implants in the near and far edge of bone increased with Nobel Replace implants compared to Biomet 3 i縐嶆浣撹繎榪滀腑杈圭紭楠ㄥ鍔犻噺涓嶯obel Replace縐嶆浣撶浉姣，

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