牙槽嵴保存术在牙周炎拔牙患者中的应用进展

doi:10.13591/j.cnki.kqyx.2023.02.012

摘要/Abstract

摘要：

牙槽嵴保存术(alveolar ridge preservation,ARP)是近年来快速发展的用于保存拔牙后牙槽骨三维体积的一种术式,可通过减少牙槽骨吸收为后期种植修复创造条件,降低种植手术的难度。ARP在牙周炎拔牙患者中有一定应用难度,本文从ARP特点入手,对比其与引导性组织再生术、引导性骨再生技术及即刻种植的异同及优劣,着重探讨了ARP在牙周炎拔牙患者中的应用特殊性及应用进展,以期为ARP的临床应用和研究提供方向。

关键词: 牙槽嵴保存术, 牙周炎, 拔牙, 应用

Abstract:

Alveolar ridge preservation (ARP) has developed rapidly as a method for preserving the alveolar socket's bone volume after tooth extraction. ARP can create conditions for implant restoration, and reduce operation difficulties by decreasing alveolar ridge absorption. There are certain difficulties of ARP applicationin patients with tooth extracted due to periodontitis. This paper mainly introduces the characteristics of ARP, compares the similarities and differences among ARP, guided tissue regeneration, guided bone regeneration and immediate implant, and then summarizes their advantages and disadvantages. The paper focuses on the specificity of ARP and the progress of ARP application in patients with tooth extracted due to periodontitis, in order to offer direction for clinical application and future research on ARP.

Key words: alveolar ridge preservation, periodontitis, tooth extraction, application

中图分类号:

R783.4

张超颖, 龚佳幸, 俞梦飞, 钱颖, 朱子羽, 陆科杰, 王慧明. 牙槽嵴保存术在牙周炎拔牙患者中的应用进展[J]. 口腔医学, 2023, 43(2): 159-165.

ZHANG Chaoying, GONG Jiaxing, YU Mengfei, QIAN Ying, ZHU Ziyu, LU Kejie, WANG Huiming. Application progress of alveolar ridge preservation in patients with tooth extracted due to periodontitis[J]. Stomatology, 2023, 43(2): 159-165.

图/表 1

表1

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项目	ARP^[9,12]	GTR^[17]	GBR^[18]	IM^[10,22]
适应证①计划种植修复,但无法早期开展者; ②维持牙槽嵴轮廓以行固定义齿修复; ③上颌后牙区骨量不足,后续种植很可能需上颌窦窦底提升等辅助手术; ④合适的牙槽骨解剖条件等①垂直型骨吸收:窄而深的二壁、三壁骨袋; ②单一位点的牙龈退缩; ③Ⅱ类根分叉病变等①小范围颌面和颅骨缺损; ②种植骨增量等①骨壁完整且厚度>1.00 mm,厚龈生物型; ②拔牙后牙槽窝骨量足等
优点①缩短治疗周期,减少就诊次数; ②适应证较宽; ③保持良好的骨体积,为种植创造条件; ④有助于降低后续种植的操作难度等①技术成熟,牙周再生效果好,成功率高; ②创伤较小等①技术成熟、成功率高; ②常用于辅助种植骨增量 ③可预测且有效实现颌骨、颅骨小范围的骨再生等①减少就诊次数; ②保留软组织形态,美学效果佳; ③创伤小等
缺点①单次诊疗时间较长; ②技术敏感性高; ③ARP是否需要翻瓣和创口的初期封闭仍存在争议等①适应证较窄,但随着生物材料的进步,适应证也在拓宽; ②技术敏感性高; ③单次诊疗时间较长等可能引起生物材料暴露、感染等并发症①可能引起牙龈退缩; ②适应证选择严格
相关性①ARP包括GBR,且形式更多; ②GBR由GTR发展而来的,多辅助于种植手术; ③IM可同期行GBR; ④ARP与IM不能阻止牙槽骨吸收