牙周炎患牙位点保存术的临床疗效观察

Clinical effects on the prevention of alveolar bone absorption by site preservation after tooth extraction due to periodontitis

目的观察位点保存术在牙周炎患牙拔除后牙槽骨量改变的临床效果。方法纳入门诊确诊为牙周炎不能保留的患牙85颗,随机分为2组:1常规拔牙组,40颗患牙,采用传统的牙拔除术;2位点保存组,45颗患牙,经微创拔牙后牙槽窝同期植入Bio-OSS胶原,覆盖Bio-Gide胶原膜并且严密缝合。对比两组患牙的临床疗效,并分别于术前术后行X线和锥形束CT(cone beam CT,CBCT)影像学检查,评估2组牙槽骨量变化情况及比较牙槽骨的密度情况。结果两组术区均无感染,愈合良好,牙龈质地坚韧,颜色粉红。X线和CBCT结果显示,常规拔牙组牙槽骨水平和垂直吸收增加,位点保存组牙槽骨垂直和水平吸收量显著低于常规拔牙组(P<0.05),术后6月CBCT显示位点保存组新生骨密度显著高于常规拔牙组。结论位点保存术可有效预防及减少牙周炎患牙拔除后牙槽骨的吸收,改善牙槽骨高度和宽度,成骨效果良好,有利于满足后期的修复需要。

Objective To observe the clinical effects on prevention of alveolar bone absorption by site preservation after tooth extraction due to periodontitis. Methods The experimental group consisted of 40 patients with 45 extracted teeth due to periodontitis. The fresh sockets were immediately grafted and filled with Bio-oss collagen and Bio-Gide after minimally invasive tooth extraction, while 40 teeth of control group were only treated with cotton balls bitten tightly over the socket for half an hour. Two groups were observed for changes in alveolar bone densit~ by X-ray and cone beam CT （CBCT） after 6 months. Results There were the wound healing and no infection in extraction site of all patients with or without site preservation operation. The gingiva of extraction site was pink and tough in all groups. The alveolar bone loss in regular extraction patients significantly increased in horizontal and vertical aspects by X-ray and CBCT, while site preservation improved the alveolar bone defects （P〈 0.05）. After site preservation for 6 months, CBCT analysis showed that the density of new alveolar bone markedly enhanced compared with regular extraction group. Conclusion The technique of site preservation after tooth extraction due to periodontitis is a method which can prevent and reduce disuse atrophy absorption of the alveolar ridge so that the height and width of the alveolar bone can meet aesthetic requirements.