自体块状骨结合引导骨再生技术重建前牙区骨量不足的临床研究

A clinical study of anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration (GBR) technique

目的:比较自体块状骨结合引导骨再生(GBR)技术重建前牙区骨量不足术后种植位点和非种植位点骨量变化的差异。方法:2010年12月—2011年8月间,术前全景片及CT评估14例患者(73个缺牙位点)前牙区骨量不足,于颏部或下颌支处取自体块状骨结合GBR技术重建前牙牙槽骨,并延期行种植体植入术(共植入42颗种植体)。术后即刻、3、6、9个月和最长随访时间点(平均13.8个月)行CT检查。利用Simplant 11.04软件三维重建并测量牙槽嵴顶骨宽度(alveolar crestal bone width,ACBW)、牙槽骨中部骨宽度(alveolar midway bone width,AMBW)和牙槽骨高度(alveolar bone height,ABH)。测量的所有数据按照种植位点(即种植体植入的位点)和非种植位点(即未植入种植体,后期利用桥体修复的位点)分为2组。采用SAS 9.0软件包对该2组数据进行配对t检验。结果:14例患者均顺利完成植骨和种植体植入手术,术后无头晕、头痛等不适,切口均愈合良好,42颗种植体在愈合和随访期内骨结合良好。术后2组骨改建评价显示:对种植位点的ACBW和AMBW,术后即刻骨增量和术后3个月骨吸收量有显著差异(P<0.05),而对ABH术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05);对非种植位点的ACBW和ABH,术后即刻骨增量,术后3、6和9个月骨吸收量有显著差异(P<0.05),而对AMBW术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05)。术后2组中ACBW、AMBW和ABH的骨量变化显示:术后即刻骨增量,术后3、6个月骨吸收量无显著差异(P>0.05);术后9个月和最长随访时间点骨吸收量存在显著差异(P<0.05)。结论:非种植位点较种植位点在种植体植入后发生更多的骨吸收,其原因是二期种植体植入手术产生的创伤和种植体能保存骨量两者相互作用所致。因此,即刻或同期植入种植体,避免二次手术,对骨量保存具有重要意义。

PURPOSE： To evaluate and compare the differences of bone resorption between implant placement sites （IPS） and non-implant placement sites（NIPS） after anterior alveolar bone reconstruction achieved through autogenoas block bone in combination with guided bone regeneration（GBR） technique. METHODS： From Dec. 2010 to Aug. 2011, a consecutive series of 14 patients （73 edentulous sites） with anterior alveolar bone atrophy were treated with autogenous block bone grafts in combination with GBR technique and delayed implant placement 6 months after augmentation. CT scans were performed preoperatively （T0）, immediately after augmentation （T1）, 3 months after augmentation （T2）, 6 months after augmentation before implant placement （T3）, 9 months after augmentation （T4）, and the longest postoperative follow-up point （mean. 13.8 months） （TS）. Alveolar crestal bone height （ACBW）, alveolar midway bone width （AMBW）, and alveolar bone height （ABH） were selected as measurement parameters in Simplant 11.04 software. All results were divided into two groups： implant placement sites （IPS） and non-implant placement sites （NIPS）, and compared by the paired t test using SAS 9.0 software package. RESULTS： All block bone grafts and implant placement surgeries were completed successfully. Dizziness, headache and other uncomfortable conditions didn＇t occur and the incisions healed excellently. All implants remained clinically osseointegrated at the longest postoperative follow-up point. The bone remodelling of both groups for these three parameters were as follows： a） there were significant differences for the bone augmentation and resorption of ACBW and AMBW at T1 and T2 （P〈0.05） and ABH at T1, T2 and T3 （P〈0.05） in IPS;b） there were significant differences for the bone augmentation and resorption of ACBW and ABH at T1, T2, T3 and T4 （P〈0.05） and AMBW at T1, T2 and T3 （P〈0.05） in NIPS; c） there were no significant differences at other time periods for these three parameters of both groups （P〉0.05）. CONCLUSIONS： A more rapid and initial loss of alveolar bone in NIPS resulted from the mucoperiosteal flap reflection during implant placement surgery, while a less bone loss of alveolar happened in IPS due to implant placement. This reminded us of the importance of bone grafts in combination with immediate or early implant placement. Supported by Research Fund of Science and Technology Committee of Shanghai Municipality （134119a5400） and the Seventh College Students Innovation Training Program of Shanghai Jiao Tong University School of Medicine （2013061）.