›› 2021, Vol. 41 ›› Issue (4): 312-317.

• 临床研究 • 上一篇    下一篇

块状自体骨联合脱细胞牛骨基质重建牙槽嵴的影像学观察

刘堃1,王舒思1,张磊1,汤春波2   

  1. 1. 合肥市口腔医院
    2. 南京医科大学附属口腔医院
  • 收稿日期:2020-06-03 修回日期:2020-08-09 出版日期:2021-04-28 发布日期:2021-04-16
  • 通讯作者: 汤春波 E-mail:cbtang@njmu.edu.cn
  • 基金资助:
    合肥市卫计委2018年应用医学研究项目;合肥市借转补项目

Imaging observation of alveolar ridge reconstruction with autogenous bone blocks and deproteinized bovine bone matrix

  • Received:2020-06-03 Revised:2020-08-09 Online:2021-04-28 Published:2021-04-16

摘要: 目的 探索以外斜线或颏部为供区的自体块状骨联合去蛋白牛骨基质表面覆盖可吸收生物膜进行牙槽嵴缺损修复时的骨再生效果及其吸收规律,为临床操作提供参考。 方法 选择2018年7月—2019年9月时间段内,术前CBCT评估骨量严重不足,需先行骨增量再行种植体植入患者共10例。手术以下颌外斜线或颏部为供区取自体块状骨,结合骨引导再生术重建缺损区牙槽骨。术后对创口愈合情况和并发症发生率进行记录。分别于术前、术后即刻和种植体植入前拍摄CBCT,对受区牙槽嵴顶、牙槽嵴中段和牙槽嵴基底部骨宽度进行测量。数据采用SPSS 23.0进行统计学分析。 结果 10例患者均顺利完成取骨和植骨手术,术后均无头晕、头痛等不适。2例颏部取骨患者术后无局部麻木或异样感。1例患者(2个位点)出现移植骨块暴露,暴露率为9.52%,其余位点至种植体植入前均愈合良好。牙槽嵴顶、中段和基底部实际骨增量分别为:(3.93±1.80)mm、(3.90±1.60)mm和(2.89±1.43)mm,增量效果明显。牙槽嵴顶、中段和基底部增量骨吸收比例分别为:28.00%(13.55%,42.20%)、17.10%(8.20%,30.55%)和10.00%(5.80%,24.70%)。三组间移植骨吸收率有显著性差异(P<0.05)。两两比较,牙槽嵴顶与牙槽嵴基底部吸收率存在显著性差异(P<0.05)。其余各组间吸收率均无显著性差异(P>0.05)。 结论 口内来源自体骨联合去蛋白牛骨基质进行引导性骨再生时,牙槽嵴顶处吸收率较基底部明显增大,提示临床操作时,我们更应关注嵴顶处的骨增量水平。

关键词: 骨增量, Bio-oss骨粉, 定量分析, 锥形束CT

Abstract: Objective To evaluate the clinical effect and absorption rule of alveolar ridge reconstructed by autologous bone blocks and deproteinized bovine bone covered by absorbable membrane with outer oblique line or chin as a donor site, and to provide references for clinical operation. Methods A total of 10 patients who were diagnosed with severe alveolar ridge defects by cone beam CT and needed bone augmentation before implant insertion were selected during the period from July 2018 to September 2019. Guided bone regeneration was carried out with mandibula external oblique line or chin as a donor site. Complications were recorded postoperatively. CBCT was taken pre-operation, immediately post-operation and before implant insertion. The width of the top, middle and base of the alveolar ridge were measured. Data were analyzed by SPSS 23.0. Results All of the 10 patients successfully underwent the operation of bone harvesting and grafting. There was no discomfort such as dizziness or headache and no local numbness or abnormal feeling in 2 cases of chin osteotomy postoperatively. One patient (2 sites) underwent bone graft exposure. The exposure rate was 9.52%, and the other sites healed uneventfully before the implant placement. The actual bone increment at the top, middle and base of alveolar ridge were 3.93 ± 1.80mm, 3.90 ± 1.60mm and 2.89 ± 1.43mm, respectively. The increment effect was obvious. The ratio of incremental bone resorption was 28.0 (28.26) %, 17.1 (22.35) % and 10 (18.9) %, respectively. There was a significant difference in bone resorption rate among the three groups (P < 0.05). There was a significant difference in absorptivity between the top of alveolar ridge and the base of alveolar ridge (P < 0.05). There was no significant difference in the absorption rate among the other groups (P > 0.05). Conclusion The absorption rate at the top of alveolar ridge is significantly higher than the base when guided bone regeneration is carried out by oral autogenous bone blocks combined with deproteinized bovine bone matrix, suggesting that we should pay more attention to increase the bone volume at the top of alveolar ridge in clinical operation.

Key words: Bone augmentation, Bio-oss, Quantitative analysis, Cone beam CT

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