本文選題：埋伏牙 + 導(dǎo)萌術(shù)��； 參考：《華北理工大學(xué)》2017年碩士論文

【摘要】：目的通過(guò)對(duì)上頜前牙區(qū)埋伏牙牽引不同導(dǎo)萌術(shù)式的相關(guān)臨床研究,比較研究幾種不同術(shù)式在牙周預(yù)后標(biāo)準(zhǔn)方面的優(yōu)劣,為臨床工作提供一定的參考。方法選取2014年3月至2016年10月期間,在唐山市口腔醫(yī)院接受埋伏牙牽引助萌術(shù)的患者病例中,隨機(jī)挑選120例患者作為研究對(duì)象。所有患者均為上前牙埋伏阻生,且已由正畸科提前預(yù)留出缺牙間隙。除外條件包括:患有牙周炎癥或其他可能干擾實(shí)驗(yàn)結(jié)果的全身疾病或遺傳性疾病的病例;高位阻生或倒置阻生特殊疑難病例;牽引方案需從腭側(cè)牽出的病例以及患者醫(yī)從性較差的病例。另外,牽引失敗病例或數(shù)據(jù)收集失敗病例,以及牽引周期大于6個(gè)月的,按照以上病例選擇標(biāo)準(zhǔn)另行補(bǔ)充,以保證擬定樣本量。將120例患者隨機(jī)分成4組,每組30例,記為a、b、c、d組,利用CBCT、曲面斷層及相關(guān)影像學(xué)設(shè)備輔助檢查,明確埋伏牙位置,牙根形成情況,根尖是否存在畸形,確定手術(shù)切口位置,分別采用牙槽嵴頂切口封閉式導(dǎo)萌術(shù)(即由患牙所對(duì)應(yīng)的牙槽嵴頂除做牙周翻瓣,直至暴露患牙)、就近切口封閉式導(dǎo)萌術(shù)(即由患牙就近處切口并翻開(kāi)覆蓋的軟組織,暴露患牙)、根向復(fù)位瓣開(kāi)放式導(dǎo)萌術(shù)(即暴露埋伏牙后,將翻開(kāi)的齦瓣做保留并縫合于根方牙齦切口處)、去瓣開(kāi)放式導(dǎo)萌術(shù)(即直接切除覆蓋于埋伏牙牙面的軟組織,暴露埋伏牙),其中d組為對(duì)照組。所有4組120例患者,均于術(shù)后每月復(fù)診一次,共計(jì)追蹤復(fù)診6次,牽引完成后,通過(guò)CBCT及臨床檢查記錄相關(guān)數(shù)據(jù)。相關(guān)數(shù)據(jù)包括:附著齦寬度、附著齦厚度、牙齦退縮、唇側(cè)骨板厚度、牙根吸收情況。數(shù)據(jù)采集標(biāo)準(zhǔn):術(shù)后復(fù)診:間隔30±2天,追蹤半年,共計(jì)追蹤復(fù)診6次。牽引完成標(biāo)準(zhǔn):以患牙回歸正常位置且能建立正常的頜關(guān)系為準(zhǔn)。附著齦寬度:利用牙周探針測(cè)量膜齦聯(lián)合至齦緣最高點(diǎn)的垂直距離。附著齦厚度:利用CBCT測(cè)量患牙唇側(cè)附著齦厚度,精確到0.01mm。牙齦退縮:利用牙周探針探查釉牙本質(zhì)界,若釉牙本質(zhì)界在齦下,即無(wú)牙齦退縮,記為“-”,若在齦上,即有牙齦退縮,記為“+”。唇側(cè)骨板厚度:利用CBCT測(cè)量唇側(cè)牙槽骨嵴頂根方2mm處骨板厚度,精確到0.01mm。牙根吸收:通過(guò)CBCT觀測(cè)根尖形態(tài),記為“+”、“-”。原始數(shù)據(jù)錄入Excel表,準(zhǔn)備進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.a、b、c組與對(duì)照組在附著齦寬度方面比較,通過(guò)統(tǒng)計(jì)學(xué)處理,P0.001,故P0.05,有統(tǒng)計(jì)學(xué)意義。2.a、b、c組與對(duì)照組在附著齦厚度方面比較,通過(guò)統(tǒng)計(jì)學(xué)處理,P0.001,故P0.05,有統(tǒng)計(jì)學(xué)意義;同時(shí)a、b、c三組實(shí)驗(yàn)組進(jìn)行組間比較,P0.05,亦有統(tǒng)計(jì)學(xué)意義。3.a、b、c組與對(duì)照組在唇側(cè)骨板厚度方面比較,通過(guò)統(tǒng)計(jì)學(xué)處理,P0.001,故P0.05,有統(tǒng)計(jì)學(xué)意義;同時(shí)a、b、c三組實(shí)驗(yàn)組進(jìn)行組間比較,P0.05,亦有統(tǒng)計(jì)學(xué)意義。4.a、b組牙齦退縮發(fā)生率均為6.67%,c組牙齦退縮發(fā)生率為10%,對(duì)照組牙齦退縮發(fā)生率為16.67%,但未有統(tǒng)計(jì)學(xué)意義。5.a、b、c組與對(duì)照組均未發(fā)生牙根吸收。結(jié)論1.采用牙槽嵴頂切口封閉式導(dǎo)萌術(shù)式、就近切口封閉式導(dǎo)萌術(shù)式和根向復(fù)位瓣開(kāi)放式導(dǎo)萌術(shù)式三種術(shù)式在保留附著齦寬度方面均優(yōu)于采用去瓣開(kāi)放式導(dǎo)萌術(shù)式的病例。2.四種術(shù)式在附著齦厚度預(yù)后方面,采用牙槽嵴頂切口封閉式導(dǎo)萌術(shù)式的預(yù)后最有優(yōu)勢(shì)。3.四種術(shù)式在唇側(cè)骨板厚度預(yù)后方面,由厚到薄依次為:牙槽嵴頂切口封閉式導(dǎo)萌術(shù)式、就近切口封閉式導(dǎo)萌術(shù)式、根向復(fù)位瓣開(kāi)放式導(dǎo)萌術(shù)式、去瓣開(kāi)放式導(dǎo)萌術(shù)式。4.兩種開(kāi)放式導(dǎo)萌術(shù)式牙齦退縮發(fā)生率略高于兩種封閉式導(dǎo)萌術(shù)式,但未見(jiàn)統(tǒng)計(jì)學(xué)差異。5.不同術(shù)式的選擇與牙根吸收無(wú)明顯關(guān)系。
[Abstract]:Objective to compare the advantages and disadvantages of several different surgical methods in the periodontal prognosis of the ambushed teeth in the maxillary anterior teeth, and to provide some reference for the clinical work. Methods to select the patients in the Tangshan City oral cavity hospital from March 2014 to October 2016. In the case, 120 patients were randomly selected as subjects. All the patients were impacted in the anterior teeth and had been reserved in advance by the orthodontic department. The traction scheme should be taken from the palatine side cases and the patients with poor medical treatment. In addition, the traction failure cases or the data collection failure cases and the traction cycle more than 6 months are supplemented in accordance with the above case selection criteria to ensure the proposed sample size. 120 patients are randomly divided into 4 groups, 30 cases in each group, which are recorded as a, B, C, D group. CBCT, surface fault and related imaging equipment were examined to determine the position of the ambush, the formation of the root, the abnormality of the root tip, the location of the incision, the closure of the alveolar crest incision (that is, the alveolar crest of the affected teeth, until the periodontal flap was exposed to the exposed tooth), and the closed incision in the close incision was performed. Open guided eruption (that is, after exposure of the ambushed teeth, the open gingival flap is retained and sutured at the root of the gingival incision), and the open guided sprouting (that is, the soft tissue covered by the ambush tooth surface, exposing the buried teeth), the D group is the right one. All 4 groups of 120 patients were treated once a month after the operation, and a total of 6 visits were followed up. After the traction was completed, the relevant data were recorded by CBCT and clinical examination. The data included: the width of the gingival, the thickness of the gingiva, the gingiva, the thickness of the lip and the root, and the absorption of the root. The standard of data collection: the postoperative review: the interval of 30 + 2 days, tracking. Six months, a total of 6 visits were traced. Traction completion criteria: the normal position of the affected teeth and the establishment of normal maxillary relationship. The width of the attached gingiva: using the periodontal probe to measure the vertical distance of the gingival joint to the highest point of the gingival margin. The thickness of the attached gingiva: the thickness of the gingiva attached to the labial lip and the 0.01mm. gingival retraction by CBCT: the use of teeth. Probe into the essential boundary of enamel, if the essential boundary of the enamel is under the gingiva, that is, no gingiva retreat, the "-" is recorded as "-". If on the gums, there is a gingiva retraction, "+". The thickness of the labial bone plate: the thickness of the bone plate at the 2mm of the alveolar ridge top root of the labial alveolus is measured by the CBCT: the apex morphology is observed by CBCT, and recorded as "+", "-". The original data entered the Excel table and prepared for statistical analysis. Results 1.a, B, C group and control group were compared with the control group in terms of the gingival width. Statistically, P0.001, P0.05,.2.a, B, C group and control group were compared with the control group on the thickness of attached gingiva, with statistical significance, P0.001, and therefore P0.05, three groups. The experimental group compared group, P0.05, also have statistical significance.3.a, B, C group and the control group in the lip bone plate thickness comparison, through statistical processing, P0.001, P0.05, there is statistical significance; meanwhile, a, B, C three groups of experimental group comparison, P0.05, also have the significance.4.a, B group gingival contraction rate is 6.67%, gum group shrinking The incidence of gingival contraction in the control group was 10%, but the rate of gingival contraction was 16.67%, but there was no statistical significance.5.a, B, both group C and the control group did not have root resorption. Conclusion 1. using the closed crest incision and the closed guide sprouting of the alveolar ridge, the close incision closed guide operation and the root reposition valve open guide have three methods to retain the width of the attached gingiva. The four types of case.2., which are superior to the open flap, have the best prognosis for the thickness of the attached gingival thickness. The prognosis of the closed crest incision closure is the most advantageous for the prognosis of the four kinds of surgical procedures for the thickness of the labial bone plate. The rate of gingival retraction in two open type of open guided eruption type.4. was slightly higher than that of two closed guided sprouting, but there was no statistical difference between the choice of.5. and the root resorption.

【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R782.1

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