本文選題：牙槽窩 + 保護(hù)　； 參考：《武漢大學(xué)》2013年博士論文

【摘要】：牙槽骨是牙齒存在的基礎(chǔ),也是缺牙后義齒修復(fù)的基礎(chǔ)。臨床上有許多病人在拔除牙齒后,牙槽骨出現(xiàn)明顯吸收,嚴(yán)重影響到各種修復(fù)體的制作,特別是種植牙,更需要豐滿的牙槽嵴。為了減少或防止拔牙后牙槽骨的吸收,保持牙槽窩位點(diǎn)的形態(tài)和骨量,國(guó)內(nèi)外學(xué)者做了大量研究。保持拔牙窩位點(diǎn)牙槽嵴骨量的方法,是目前研究的熱點(diǎn),在拔牙后新鮮的牙槽窩內(nèi)植入不同材料,采用不同方法防止牙槽窩部位骨吸收。本試驗(yàn)就是選取犬作為實(shí)驗(yàn)動(dòng)物,通過(guò)拔除其下頜前磨牙的一個(gè)牙根,保留另外一個(gè)牙根,同期在牙槽窩內(nèi)植入自體回收碎骨屑和不同比例自體骨與人工骨混合骨粉,表面覆蓋膠原膜。術(shù)后8、12周取標(biāo)本作硬組織切片檢查及影像學(xué)檢查；將膠原膜與明膠海綿制成條狀植入兔前牙拔牙窩內(nèi),8-12周后行組織學(xué)檢測(cè),對(duì)比牙槽窩成骨效果；總結(jié)臨床上行牙槽窩植骨保護(hù)并完成種植手術(shù)的病例,用環(huán)鉆環(huán)切牙槽窩骨柱,并行硬組織切片制作,檢測(cè)骨形成與人工骨代謝比例。 第一部分：不同植骨方式在牙槽窩位點(diǎn)保護(hù)中成骨效應(yīng)的實(shí)驗(yàn)研究 通過(guò)不同的方式在拔牙后牙槽窩中植骨,對(duì)比研究牙槽窩位點(diǎn)骨質(zhì)保護(hù)效果,探尋合理的牙槽窩保護(hù)方式。選擇三條雜交狗,分別拔除下頜左、右P2、P3、P4前磨牙近中根,保留遠(yuǎn)中根,并行根管治療。在拔牙窩中分別植入自體回收碎骨屑、純羥基磷灰石以及不同比例的自體骨屑與人工骨的混合物,表面覆蓋膠原膜。第三只狗在左右下頜牙槽窩中即刻植入種植體,并在頰側(cè)造成的5x2mm的骨缺損處植入不同骨質(zhì)。術(shù)后8周、12周時(shí)取出下頜標(biāo)本行影像學(xué)、組織學(xué)檢測(cè)。 結(jié)果發(fā)現(xiàn)：標(biāo)本大體觀察可見(jiàn)牙槽窩頂部有輕微凹陷。12周時(shí)骨密度高于8周時(shí)。組織學(xué)表明,植入人工骨比例越高,人工骨殘余率越高。12周植入75%骨屑和25%人工骨組新骨形成率為55.3±5.6,8周時(shí)為45.5±7.2,均高于其他組(P0.05)。 由實(shí)驗(yàn)可以得出結(jié)論：拔牙后牙槽窩即刻植入自體回收碎骨屑和不同比例羥基磷灰石混合骨可以有效保護(hù)牙槽窩位點(diǎn)骨量,特別是75%自體回收碎骨屑和25%羥基磷灰石組與骨屑和羥基磷灰石各占50%的植骨方式,新骨形成量最多,骨質(zhì)較硬,牙槽窩骨量保護(hù)效果最好。為了減少自體骨的需求,臨床可以考慮用回收碎骨屑和羥基磷灰石各占50%的植骨方式來(lái)保護(hù)牙槽窩。 第二部分膠原蛋白膜和明膠海綿用于兔牙槽窩保護(hù)的實(shí)驗(yàn)研究 本實(shí)驗(yàn)是為了探究膠原蛋白膜和明膠海綿對(duì)拔牙后牙槽窩的保護(hù)作用。實(shí)驗(yàn)選用的六只大耳白家兔分別拔除左右下頜切牙。1號(hào)和2號(hào)家兔在左下頜牙槽窩內(nèi)填入牙槽窩形態(tài)的明膠海綿條,右牙槽窩填入牙槽窩形態(tài)的膠原蛋白膜條;3號(hào)和4號(hào)家兔左牙槽窩內(nèi)空置不作處理,右牙槽窩內(nèi)填入膠原蛋白膜；5號(hào)和6號(hào)家兔左牙槽窩內(nèi)填入明膠海綿,右牙槽窩內(nèi)不作處理。在實(shí)驗(yàn)后第8、12周分別處死1、3、5號(hào)兔子和2、4、6號(hào)兔子,進(jìn)行x線片、組織病理學(xué)切片對(duì)比分析。 結(jié)果顯示：拔牙后第8周,1號(hào)兔子右側(cè)牙槽窩密度略高于左側(cè),3、5號(hào)兔子左側(cè)牙槽窩密度略高于右側(cè)。拔牙后12周,雙側(cè)X線片顯示牙槽窩內(nèi)骨密度明顯增加,且2、4號(hào)兔子右側(cè)高于左側(cè),6號(hào)兔子左側(cè)高于右側(cè)。X線觀察明膠海綿和膠原蛋白膜組兔牙槽骨密度無(wú)明顯差異。術(shù)后第8周,填有明膠海綿、膠原蛋白膜的牙槽窩內(nèi)都有纖維性成骨現(xiàn)象,雙側(cè)牙槽窩內(nèi)均充滿粗大的骨小梁,右側(cè)較左側(cè)成骨活躍。明膠海綿組成骨細(xì)胞呈網(wǎng)格狀,有新生骨形成,骨小梁較粗大密集,而空白組牙槽窩內(nèi)大部分由脂肪組織填充骨小梁相對(duì)細(xì)小散亂,骨小梁的成熟度較低。術(shù)后第12周,明膠海綿組和膠原蛋白組均可見(jiàn)明顯的纖維組織填充并有成熟的骨組織梁,而空白組牙槽窩內(nèi)主要是脂肪組織,只有少量的纖維組織。組織學(xué)切片顯示明膠海綿組和膠原蛋白組均有明顯的成骨現(xiàn)象。 由實(shí)驗(yàn)可以得出結(jié)論：與空白對(duì)照組相比,明膠海綿和膠原蛋白膜對(duì)兔牙槽窩都有一定的保護(hù)作用,兩者對(duì)于牙槽窩保護(hù)作用未見(jiàn)明顯差異。此兩種材料簡(jiǎn)單易得,可以成為臨床常用的牙槽窩保護(hù)方法。 第三部分牙槽窩位點(diǎn)保護(hù)技術(shù)在種植外科的應(yīng)用研究 選擇我院口腔頜面外科門(mén)診病人50人,其中男性22人,女性28人。因創(chuàng)傷致牙脫位、斷裂,牙槽窩骨折者25例,牙周病15例,殘根伴根尖囊腫6例,咬合致牙折4例。病人在局麻下微創(chuàng)拔除病灶牙根,刮凈牙槽窩,分別植入Bioss骨粉和羥基磷灰石骨粉人工骨,其中使用Bioss骨粉的有20人,使用羥基磷灰石的有30人。植入后,牙槽窩表面用可吸收膠原膜覆蓋,嚴(yán)密縫合創(chuàng)口。5-6月后局麻下用環(huán)鉆鉆取牙槽窩上方骨柱,行硬組織切片檢測(cè),對(duì)比新骨形成和人工骨代謝情況。 結(jié)果顯示：50例病人中,牙槽窩骨質(zhì)均得到有效保護(hù),牙槽嵴的寬度均滿足臨床種植需求。剛植入人工骨粉時(shí),數(shù)字牙片顯示牙槽窩的骨密度高,人工骨顆粒清晰,到3個(gè)月時(shí),骨粉密度漸變淡,顆粒也漸漸變得模糊,人工骨粉與自體骨銜接面也逐漸模糊。由骨柱標(biāo)本所制作的硬組織切片來(lái)看,無(wú)論是羥基磷灰石還是Bioss人工骨粉,在牙槽窩中均有新骨形成,在人工骨粉顆粒間有骨質(zhì)形成,越往根方,骨質(zhì)形成越多,骨結(jié)構(gòu)越成熟。Bioss骨粉植入的牙槽窩標(biāo)本,其新骨形成量多,人工骨代謝更快。 利用Bioss和羥基磷灰石人工骨粉,在拔牙后即刻在牙槽窩中植入骨粉。臨床追蹤50例病人,術(shù)后無(wú)一失敗,均成功完成種植修復(fù),術(shù)后種植體無(wú)松動(dòng),軟硬組織美學(xué)效果良好。
[Abstract]:Alveolar bone is the basis of tooth existence, and it is also the basis of denture repair after tooth deficiency. There are many patients in clinic after removing teeth, the alveolar bone appears obvious absorption, seriously affecting the production of various restorations, especially the implant teeth, more need plump alveolar ridge. In order to reduce or prevent the absorption of alveolar bone after tooth extraction, keep the alveolar site. A large number of studies have been made by scholars at home and abroad. The method of maintaining the bone mass of the alveolar ridge at the tooth socket loci is a hot spot at present. Different materials are implanted in the fresh alveolar fossa after extraction, and different methods are used to prevent the alveolar bone resorption. This experiment is to select the dogs as experimental animals by removing their mandibular premolars. One tooth root, the other root was retained, the autogenous bone crumbs were implanted in the alveolar bone and the bone powder mixed with the artificial bone in the same period, and the collagen membrane was covered on the surface. After 8,12 weeks, the specimens were examined for hard tissue section examination and imaging examination, and the collagen membrane and gelatin sponge were inserted into the tooth socket of the anterior teeth of the rabbit, 8-12 After weeks, histological examination was performed to compare the osteogenesis effect of alveolar fossa, and to summarize the cases of alveolar bone graft protection and completion of the implant surgery. The bone column of the alveolar nest was cut through the ring drill ring, and the hard tissue section was made, and the proportion of bone formation and artificial bone metabolism was detected.
Part one: Experimental Study on the osteogenesis effect of different bone grafting methods in the protection of alveolar fossa sites.
In different ways, bone graft in alveolar fossa after tooth extraction was used to compare the effect of bone protection in alveolar loci and to explore a reasonable way to protect the alveolus. Three hybrid dogs were selected to remove the middle root of mandibular left, right P2, P3, P4 anterior molar and the distal root and root canal treatment. Third dogs were implanted in the left and right mandibular alveolar fossa and implanted with the implant in the left and right mandibular alveolar fossa, and the bone defects were implanted in the buccal side of the 5x2mm. 8 weeks after the operation, the image of the mandibular mark was taken out and the histological examination was taken out at 12 weeks.
The results showed that the bone density was higher than 8 weeks at.12 weeks at the top of the alveolar fossa. Histology showed that the higher the ratio of artificial bone, the higher the residual rate of artificial bone, the rate of.12 weeks implanted into 75% bone and the new bone formation rate of 25% artificial bone group was 45.5 + 7.2 at 55.3 + 5.6,8 weeks, all higher than that of the other groups (P0.05).
It can be concluded from the experiment that the bone mass of alveolar loci can be effectively protected by implantation of autogenous recycled bone debris and different proportion of hydroxyapatite in the alveolar fossa after tooth extraction, especially in the 75% bone fragments and 25% hydroxyapatite group and bone crumbs and hydroxyapatite, which each occupies 50% of the bone graft, and the amount of bone formation is the most. In order to reduce the need of autogenous bone, it is possible to protect the alveolus by using the bone graft and the hydroxyapatite with 50% bone graft in order to reduce the need of autogenous bone.
The second part is an experimental study on the protective effect of collagen membrane and gelatin sponge on rabbit alveolar fossa.
The experiment was to explore the protective effect of collagen membrane and gelatin sponge on the alveolar fossa after tooth extraction. Six rabbits were selected to remove the gelatin sponge in the left and right mandibular incisors.1 and No. 2 rabbits in the alveolar fossa of left mandible. The right alveolar fossa was filled with the form of collagen membrane in the alveolar fossa; 3 No treatment was done in the left alveolar fossa of rabbit and No. 4. Collagen membrane was filled in the right alveolar fossa. The left alveolar fossa in No. 5 and 6 rabbits was filled with gelatin sponge and the right alveolar fossa was not treated. 1,3,5 rabbits and 2,4,6 rabbits were sacrificed at week 8,12 after the experiment. X-ray films were performed and histopathological sections were compared and analyzed.
The results showed that eighth weeks after extraction, the density of the right alveolar fossa on the right side of rabbit was slightly higher than that on the left side. The density of the left alveolar fossa in 3,5 rabbit was slightly higher than that on the right. 12 weeks after extraction, bilateral X-ray showed that the bone density increased obviously in the alveolar fossa, and the right side of 2,4 rabbit was higher than that on the left side, and the left side of No. 6 rabbit was higher than that on the right. The X-ray film of gelatin sponge and collagen membrane was observed by X-ray. There was no significant difference in the density of the alveolar bone in the group of rabbits. Eighth weeks after the operation, there was a gelatin sponge filled with fibrous osteogenesis in the alveolar nest of the collagen membrane. Both the bilateral alveolar fossa was full of large bone trabeculae, and the right side was more active than the left side. The gelatin sponge formed a gridding bone cell, the new bone formed and the bone trabecula was thicker and dense than the blank group. Most of the trabecular bone trabeculae filled with fat tissue were relatively small and scattered, and the maturity of bone trabecula was low. Twelfth weeks after the operation, the gelatin sponge group and the collagen group showed obvious fibrous tissue filling and mature bone tissue beam, while the main fat tissue in the blank group was only a small amount of fibrous tissue. The gelatin sponge group and collagen group showed obvious osteogenesis.
It can be concluded from the experiment that gelatin sponge and collagen membrane have certain protective effects on the alveolar fossa of rabbits compared with the blank control group, and the protection of the alveolar fossa is not obviously different. These two materials are simple and easy to get, and can be used as a common method of protecting the alveolar nest in clinical.
The third part is the application of alveolar fossa site protection technology in implant surgery.
There were 50 patients in the outpatient department of oral and maxillofacial surgery in our hospital, including 22 men and 28 women. There were 25 cases of tooth dislocation, fracture, alveolar fracture, 15 cases of periodontitis, 6 cases of root apical cyst and 4 cases of occlusal fracture. The patients were minimally invasive removal of the root of the tooth and the alveolar fossa under local anesthesia. The patients were implanted with Bioss bone powder and hydroxyapatite bone powder respectively. In artificial bone, there were 20 people using Bioss bone powder and 30 people using hydroxyapatite. After implantation, the surface of the alveolar surface was covered with absorbable collagen membrane. After close suture, the bone column of the alveolar ridge above the alveolar bone was drilled under local anesthesia for.5-6 months, and the new bone formation and artificial bone metabolism were compared.
The results showed that both of the 50 patients were effectively protected in the alveolar bone, and the width of the alveolar ridge met the needs of clinical cultivation. When artificial bone powder was implanted, the digital teeth showed a high bone density in the alveolar fossa and a clear particle of artificial bone. At 3 months, the bone powder density gradually became pale, and the particles gradually became blurred. The artificial bone powder joined the bone with the autogenous bone. The surface also gradually blurred. From the hard tissue sections of the bone column specimens, the new bone formed in the alveolar fossa, whether it was hydroxyapatite or Bioss artificial bone powder. The bone formed between the artificial bone powder particles, the more the root square, the more bone formed, the more mature the bone structure was implanted in the alveolar fossa with.Bioss bone powder, with a large amount of new bone formation. Artificial bone metabolism is faster.
With Bioss and hydroxyapatite artificial bone powder, bone powder was implanted in the alveolar bone immediately after tooth extraction. 50 patients were traced and no failure after the operation. The implant was successfully completed. The implant was not loosened after the operation, and the aesthetic effect of soft and hard tissue was good.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R783.1

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