骨质疏松高危患者种牙区骨密度测定和手术对策

Evaluating the effect of Cancellous bone Mineral Density of Edentulous Ridge on the dental implant surgery strategy for patients with high risk of osteoporosis

目的:观察后牙缺失患者缺牙区松质骨CT值对种植修复的影响。方法:我科2008年10月到2009年7月后牙缺失患者年龄26～69岁,平均年龄46.7岁。按照年龄和绝经与否分成骨质疏松高危组,绝经期女性和65岁以上老年男性,18例患者,24颗牙;骨质疏松低危组,非绝经期女性和64岁以下男性,23例患者,31颗牙。CT扫描后测定患者第三颈椎椎体和缺牙区松质骨的CT值作为该区的骨密度值,进行统计分析。将缺牙区骨密度低的患者进行手术设计,实施骨挤压种植手术。术后检查种植体初期稳定性,完成修复后做随访。结果:骨质疏松高危组患者第三颈椎椎体松质的密度与骨质疏松低危组差异无统计学意义(t=0.8403,p>0.05),骨质疏松高危组患者缺牙区松质骨的密度与骨质疏松低危组差异无统计学意义(t=0.5102,p>0.05),骨质疏松高危组患者缺牙区松质骨的密度与第三椎体松质骨的密度之间的差值和骨质疏松低危组相比差异也无统计学意义(t=0.4578,p>0.05)。两组患者种植体初期稳定性均好,除骨质疏松高危组有2例失败病例外均成功完成Ⅱ期种植修复,并随访正常。结论:绝经期女性和65岁以上老年男性缺牙区松质骨的密度和其他人群无明显差异,种植手术时更应关注缺牙区的骨质情况,骨挤压和充分发挥骨皮质作用有利于增加骨密度低的患者种植义齿的初期稳定性。

Objective： To investigate the effect of cancellous bone mineral density of edentulous ridge on the dental implant surgery strategy for patients with high risk of osteoporosis.Methods The evaluated material consisted of patients with posterior teeth missing who came to visit from October 2008 to July 2009.The average age of study objects is 46.7 years-old （26-69y）.We divided those objects into two groups： Patients in high risk of osteoporosis（PHRO）,including 18 postmenopausal females and males over 65,total number of observed teeth is 24.Patients in low risk of osteoporosis（PLRO）,including 23 females before postmenopausal and males under 64.Total number of observed teeth is 31.After CT scanning,the cancellous bone mineral density of edentulous ridge and the third cervical segment were measured and the results were recorded using Hounsfield Units（HU）.The data was analyzed with spss10.0.Then we designed surgery plan for patients with low cancellous bone density in edentulous ridge and perform bone condensing technique.We checked the initial stability of implants after implants placement and followed up those patients after restoration.Results： There is no significant difference of cancellous bone density of the third cervical segment between PHRO and PLRO（t=0.8403,p〉0.05）,cancellous bone density in edentulous ridge is not significantly different from PHRO and PLRO（t=0.5102,p〉0.05）,The range of density between cancellous bone in edentulous ridge and the third cervical segment is also not significantly different between group PHRO and PLRO（t=0.4578,p〉0.05）.The initial clinical stability of implants is good both in PHRO and PLRO.We performed the second stage implant restoration for all evaluated material except two cases in PHRO and followed up all objects.Conclusion： There is no difference of cancellous bone density in PHRO and PLRO,so we should pay more attention to bone quality in edentulous ridge for dental implants.The results of our study also suggest that bone condensing technique and surgery designed to attach more bone cortex to two ends of implants enhancing the initial implants stability and prosthetic success for the patients who have low cancellous bone density.