牙槽嵴保存术在牙周感染位点中的应用:从软硬组织再生到后续种植修复

doi:10.13591/j.cnki.kqyx.2024.02.010

摘要/Abstract

摘要：

牙周炎会导致牙周软硬组织破坏,其感染位点在拔牙后往往会存在硬组织缺损及软组织缺陷等问题,影响后续种植修复。牙槽嵴保存术可以在拔牙同期对牙槽窝进行处理,促进牙槽窝的重建并减少牙槽嵴的吸收,实现软硬组织的保存。本文拟对牙周感染位点的牙槽嵴保存术,兼顾其术后软组织改变以及对后续种植影响,从感染对牙槽窝愈合的影响、感染位点行牙槽嵴保存术的疗效以及感染位点牙槽嵴保存术的影响因素三方面进行综述。

关键词: 牙槽嵴保存术, 牙周感染位点, 软硬组织, 影响因素

Abstract:

Periodontitis can lead to the destruction of hard and soft tissue, and the periodontally compromised extraction sockets often suffer from hard and soft tissue defects, which will affect the followed implant restoration. Alveolar ridge preservation (ARP) can be performed at the same time with tooth extraction to promote the reconstruction of alveolar socket and reduce the resorption of alveolar ridge, in order to preserve hard and soft tissue. Taking the postoperative soft tissue change and followed implant placement into account, this review aims to focus on the effect of periodontal infection on the healing of the alveolar socket, the effectiveness of ARP at periodontally compromised extraction sockets, and its influencing factors.

Key words: alveolar ridge preservation, periodontally compromised site, soft and hard tissue, influencing factor

中图分类号:

R781.4

孙徐麟, 戴安娜, 黄佳萍, 徐晟瀛, 丁佩惠. 牙槽嵴保存术在牙周感染位点中的应用:从软硬组织再生到后续种植修复[J]. 口腔医学, 2024, 44(2): 130-138.

SUN Xulin, DAI Anna, HUANG Jiaping, XU Shengying, DING Peihui. Application of alveolar ridge preservation technique in periodontally compromised extraction sockets: From soft and hard tissue regeneration to followed implant restoration[J]. Stomatology, 2024, 44(2): 130-138.

图/表 1

表1

牙周感染位点行牙槽嵴保存术相关文献主要结果汇总"

作者(年份)	研究设计	分组类型及手术方法	人数	拔除牙位	随访时间	硬组织相关指标	软组织相关指标	种植相关指标
Romano等 (2019)^[28]	病例系列报告	仅ARP组:Bio-Oss +双层Bio-Gide+拉拢缝合	9	前牙、前磨牙	12个月	颊侧骨壁高度增加(2.91±1.08)mm;距牙槽嵴顶1 mm处骨壁水平宽度减少(2.57±1.32)mm	未评估	种植同期骨增量手术概率为0%
Noh等 (2021)^[29]	病例系列报告	ARP组:Bio-Oss +双层Bio-Gide+未拉拢缝合;早期植入(自然愈合)组:无	9/7	无要求	3、6、 12个月	未评估	软组织体积(12个月):ARP组增加(0.88 ± 4.31)mm³,早期植入组增加(0.95 ± 3.14)mm³	种植同期骨增量手术概率:ARP组为77.8%,早期植入组为100.0%;种植体存活率:两组均为100.0%
Kim等 (2017)^[26]	回顾性研究	仅ARP组:骨移植物不确定+Bio-Gide+未拉拢缝合	297	无要求	无	未评估	未评估	未评估
Lee等 (2021)^[30]	回顾性研究	ARP组:牙槽窝移植物未知+Bio-Gide+未拉拢缝合;自然愈合组:无	247/ 171	无要求	无	未评估	未评估	种植同期骨增量手术概率:ARP组23.5%,自然愈合组45.0%;种植失败率:ARP组1.6%,自然愈合组0.6%
Wei等 (2021)^[31]	回顾性研究	ARP组:Bio-Oss +Bio-Gide+未拉拢+医用海绵;自然愈合组:无	20/11	上颌磨牙	无	未评估	未评估	种植同期骨增量手术概率:ARP组25.0%,自然愈合组63.7%;种植体存活率:两组均为100.0%
Zhao等 (2018)^[25]	前瞻性临床试验	ARP组:Bio-Oss +Bio-Gide+拉拢缝合;自然愈合组:无	18/18	磨牙	6个月	颊侧骨壁中央高度:ARP组增加(1.00±2.30)mm,自然愈合组减少(0.85±2.52)mm;距牙槽嵴顶1 mm处骨壁水平宽度:ARP组增加0.21~5.30 mm,自然愈合组减少0.12~1.00 mm	角化龈宽度:ARP组减少(1.10±1.70) mm,自然愈合组减少(0.70±1.40)mm	未评估
Wei等 (2022)^[33]	前瞻性临床试验	ARP组:Bio-Oss +Bio-Gide+未拉拢缝合+医用海绵;自然愈合组:无	18/18	上颌磨牙	6个月	颊侧骨壁高度:ARP组增加(0.20±1.75)mm,自然愈合组减少(1.55±0.97)mm;拔牙窝体积:ARP组增加35.5%,自然愈合组增加8.0%	未评估	种植同期骨增量手术概率:ARP组16.7%,自然愈合组50.0%
Zhao等 (2022)^[32]	前瞻性临床试验	ARP组:Bio-Oss+Bio-Gide+拉拢缝合;自然愈合组:无	16/14	磨牙	3年	未评估	未评估	种植同期骨增量手术概率:ARP组6.3%,自然愈合组35.7%;种植体存活率:两组均为100.0%
Lee等 (2018)^[34]	随机对照试验	DBBM组:Bio-Oss+Bio-Gide+拉拢缝合;DPBM组:DPBM +Bio-Gide+拉拢缝合	50/50	无要求	4个月	骨壁垂直高度:DBBM组减少(1.45±1.92)mm,DPBM组减少(1.22±2.16)mm;骨壁水平宽度:DBBM组减少(1.83±2.85)mm,DPBM组减少(1.43±3.40)mm;拔牙窝体积:DBBM组减少(8.1±22.2)%,DPBM组减少(6.5±24.2)%	近中龈乳头高度:DBBM组减少(0.82±1.22)mm,DPBM组减少(0.87±1.21)mm;远中龈乳头高度:DBBM组减少(0.15±1.60)mm,DPBM组减少(0.23±1.65)mm	未评估
Aimetti等 (2018)^[23]	随机对照试验	ARP组:Bio-Oss +双层Bio-Gide+未拉拢缝合;自然愈合组:无	15/15	前牙、前磨牙	12个月	骨壁水平宽度:ARP组减少(1.97±1.55)mm,自然愈合组减少(3.83±1.49)mm;拔牙窝体积:ARP组减少9.1%,自然愈合组减少35.2%	未评估	未评估
Koo等 (2020)^[35]	随机对照试验	DBBM组:Bio-Oss+Bio-Gide+拉拢缝合;DPBM组:DPBM +Bio-Gide+拉拢缝合	42/39	无要求	4个月	未评估	未评估	未评估
Lim等 (2020)^[36]	随机对照试验	ARP组:Bio-Oss +双层Bio-Gide+未拉拢缝合;早期植入(自然愈合)组:无	9/7	前牙、前磨牙	12个月	未评估	近中龈乳头高度:ARP组增加(0.52 ± 0.50)mm,早期植入组增加(0.03±0.99)mm;远中龈乳头高度:ARP组增加(0.54±0.57)mm,早期植入组增加(0.05±0.72)mm	未评估
Ben Amara等 (2021)^[22]	随机对照试验	ARP组:Bio-Oss +双层Bio-Gide+未拉拢缝合;自然愈合组:无	13/13	无要求	6个月	骨壁垂直高度:ARP组增加(0.25±1.45)mm,自然愈合组减少(0.39±0.90)mm;距牙槽嵴顶1 mm处骨壁水平宽度:ARP组减少(6.13±4.82)mm,自然愈合组减少(9.40±4.00)mm;拔牙窝体积:ARP组减少26.5%,自然愈合组减少50.3%	未评估	未评估

表1

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