重度牙周炎患牙牙槽嵴保存術(shù)效果的CBCT評價(jià)
發(fā)布時(shí)間：2019-05-20 11:04
【摘要】：目的通過錐形束CT(Cone beam Computer Tomography,CBCT)觀察重度牙周炎患牙拔除后即刻行牙槽嵴保存術(shù)(Alveolar Ridge Preservation,ARP)對缺牙區(qū)牙槽嵴高度與寬度、缺失牙鄰牙骨量以及缺牙區(qū)的骨密度和輪廓的影響,并與拔牙創(chuàng)自然愈合的位點(diǎn)進(jìn)行比較。評價(jià)牙槽嵴保存術(shù)對不同程度骨缺損的患牙拔牙區(qū)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顆患牙納入研究,其中包括31顆前牙和44顆后牙。納入標(biāo)準(zhǔn):(1)因重度牙周炎需要拔除的患牙;探診深度6mm;附著喪失≥5 mm;牙槽骨吸收超過根長的1/2;后牙有Ⅱ度及以上根分叉病變;(2)至少剩余2個(gè)骨壁,骨壁的剩余高度≥3mm;(3)至少存在一顆鄰牙;(4)經(jīng)過牙周基礎(chǔ)治療,能夠保持良好的口腔衛(wèi)生狀況�；颊呔鈪⒓訉�(shí)驗(yàn),已簽署知情同意書。排除標(biāo)準(zhǔn):(1)年齡18歲的患者;(2)患牙處于急性感染期;(3)有全身系統(tǒng)性疾病或傳染病史;(4)長期服用皮質(zhì)類固醇、非甾體類抗炎藥及雙磷酸鹽等影響骨代謝的相關(guān)藥物;(5)有頭頸部放療史;(6)處于妊娠期或哺乳期。利用隨機(jī)數(shù)字表,將患牙分為拔牙后即刻行ARP的實(shí)驗(yàn)組,以及自然愈合的對照組。再根據(jù)患牙拔除前的骨喪失量分為A組(骨吸收量為5~7mm)和B組(骨吸收量7mm)。實(shí)驗(yàn)組的患牙,采用微創(chuàng)拔牙技術(shù)拔除后,徹底清創(chuàng),于拔牙窩內(nèi)植入Bio-Oss?骨粉和Bio-Oss?Collagen,覆蓋Bio-Gide?可吸收膠原膜,減張,縫合。對照組的患牙,微創(chuàng)拔除后,徹底清創(chuàng)搔刮拔牙窩,復(fù)位,縫合。運(yùn)用CBCT+3D-Invivo5 dental軟件進(jìn)行測量。首先,測量牙齒拔除前與拔除6個(gè)月后,該牙位的近中、中央、遠(yuǎn)中三個(gè)矢狀面上的牙槽骨頰、舌側(cè)的高度,以及最高的剩余牙槽嵴頂下方1mm、4mm、7mm處的寬度。測量牙槽骨高度時(shí),下頜患牙以下頜骨下緣的水平切線為基線,上頜患牙以上頜竇下緣或鼻竇下緣的水平切線為基線,測量頰側(cè)或舌側(cè)牙槽嵴頂?shù)皆撉芯�的距離。然后,測量冠狀位時(shí)該患牙的鄰牙鄰面的頰、舌側(cè)和中點(diǎn)處釉牙骨質(zhì)界(CEJ)到牙槽嵴頂?shù)木嚯x。最后,運(yùn)用Lekholm和Zarb分類法,根據(jù)缺牙區(qū)的骨密度分為Ⅰ~Ⅳ類骨,觀察拔牙窩愈合6個(gè)月后的密度及輪廓。輪廓的評價(jià)標(biāo)準(zhǔn)為:自然飽滿愈合良好者記為2分;形態(tài)略凹陷低平者記為1分;形態(tài)不規(guī)則明顯凹陷者記為0分。計(jì)算出拔牙前后在不同的位置骨量發(fā)生的改變。運(yùn)用軟件SPSS20.0,采用獨(dú)立樣本t檢驗(yàn)和卡方檢驗(yàn)的方法對相關(guān)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1.實(shí)驗(yàn)組的牙槽骨在垂直方向和水平方向上的吸收量低于對照組。牙槽骨高度的吸收量,在缺牙區(qū)的近中頰、近中舌和遠(yuǎn)中頰側(cè)有統(tǒng)計(jì)學(xué)差異(P0.05)。牙槽骨寬度的吸收量,在近中矢狀面的牙槽嵴頂下方1mm處和缺牙區(qū)中央矢狀面的牙槽嵴頂下1mm、4mm及7mm處有統(tǒng)計(jì)學(xué)意義(P0.05),其余均無統(tǒng)計(jì)學(xué)意義。此外,不同程度骨缺損的患牙之間,B組(骨喪失更嚴(yán)重的患牙)與A組相比,有統(tǒng)計(jì)學(xué)差異(P0.05)。2.拔牙后,對于鄰牙牙槽骨高度的影響,實(shí)驗(yàn)組多數(shù)牙槽骨高度有所增加,而對照組有所降低。實(shí)驗(yàn)組與對照組相比在鄰牙鄰面的中間以及舌側(cè)有統(tǒng)計(jì)學(xué)差異(P0.05)。不同的骨缺損程度下,A組與B組中有統(tǒng)計(jì)學(xué)差異主要集中在鄰牙鄰面的中間及舌側(cè),兩組之間無統(tǒng)計(jì)學(xué)差異(P0.05)。3.ARP對骨輪廓與密度具有明顯的影響,實(shí)驗(yàn)組的骨輪廓會更加平緩,并且骨質(zhì)相對較好,其中影像學(xué)上顯示的Ⅱ類骨明顯多于對照組。不同骨缺損程度的患牙,ARP對骨輪廓與影像學(xué)上顯示的密度的影響亦有顯著性差異(P0.05),B組(骨缺損較大)的患牙,行ARP后效果更加明顯。結(jié)論1.ARP能夠有效地保存重度牙周炎患牙缺牙區(qū)牙槽骨的高度與寬度,對于重度骨缺損的患牙效果更顯著。2.ARP能夠有助于恢復(fù)鄰牙鄰面的骨壁高度。3.ARP有助于維持缺牙區(qū)牙槽嵴頂平緩的形態(tài),以及良好的骨密度,為進(jìn)一步的修復(fù)治療尤其是種植修復(fù)提供更好的基礎(chǔ)條件。
[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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R781.42
本文編號：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.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R781.42
【參考文獻(xiàn)】
相關(guān)期刊論文 前3條
1 孫蓮蓮;王志興;;牙周炎與全身疾病相關(guān)性的研究進(jìn)展[J];繼續(xù)醫(yī)學(xué)教育;2016年02期
2 詹雅琳;胡文杰;甄敏;徐濤;路瑞芳;;去蛋白牛骨基質(zhì)與可吸收膠原膜的磨牙拔牙位點(diǎn)保存效果影像學(xué)評價(jià)[J];北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2015年01期
3 郝永明;趙偉;邢一棟;于麗麗;鄒德榮;;牙種植區(qū)骨密度的CBCT評價(jià)[J];口腔頜面外科雜志;2014年03期
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