健康管理对老年人口腔微创种植体边缘骨稳定性的影响

Effects of health management of stomatology on the marginal bone resorption of minimally invasive implant in the elderly

目的 探讨口腔健康管理对于老年人围种植手术调节作用和种植修复负载后种植体周围边缘骨稳定性的影响。方法 37名老年上颌后磨牙区后天性牙缺失患者，excel表格随机值降序随机法分为口腔健康管理组[n=18，平均年龄（65．22~5．38）岁]和对照组[n=19，平均年龄（63．74~6．69）岁1，口腔健康管理组同绕种植牙修复负载前后时间周期，应用图像说明，模型示教、手术演示等口腔健康管理方法，使患者明确口腔健康管理对于口腔种植手术重要性并且达到知行合一；对照组患者接受同种植手术常规指导。比较两组围种植体手术血压、心率差变化，检测种植负载后种植体边缘牙槽骨吸收（MBL）状况，记录负载后相同时间点种植体周围改良菌斑指数（mPLI）、改良出血指数（mSBI）和探诊深度（PD）；统计学分析两组间差异。结果和对照组比较，口腔健康管理组种植术前完成程序健康指导方案前后，术中患者舒张压差值【（8．86±0．31）mmHg]（1mmHg=0．133kPa）、收缩压差值[（19．18±0．22）mmHg]和心率变化差值[（11．23±0．19）次／min]，均小于对照组[（16．55±1．08）mmHg，（28.31±2．30）mmHg），（20．19±1．84））次／minl（P〈0．05或0．01）；负载12个月时口腔健康管理组种植体周围mPLI和mSBl分别为2．6（2，4）、2．1（2，4），均低于对照组【4．3（3，7）、4．3（3，7）]（P〈0．01）。结论 科学有效的口腔健康管理方法有利于安全顺利地完成老年人种植牙手术，术后保护种植牙周围软硬组织健康，且能促进老年种植牙负载后周围牙槽骨的长期稳定性。

Objective To evaluate the effects of health management of stomatology on the marginal bone resorption of minimally invasive implant in the elderly.Method Tottally 54 implants were placed in 37 elderly patients of missing teeth in maxillary molar areas and the patients were randomly divided into health management group and control group.Patients in the group of health management were guided to master the proper techniques of oral hygiene practices before and after the implantation and periodontal maintenance were carried out carefully until 1 year after loading of restoration.In the control group, oral hygiene was applied. X-ray and CBCT examinations were made and implant marginal alveolar bone loss （MBL） was measured 3, 6, 9, 12 months after loading with Planmeca PROMAX3D software. Besides, 3, 6, 9, 12 months after loading, improved plaque index （iPLI）, modified bleeding index （mBI） and probing depth （PD） were also recorded. SPSS 15.0 was applied to analyze the data. Result Differences in diastolic and systolic blood pressure and changes in heart rate in patients during the intraoperative period were （8.86± 0.31） mmHg（1 mmHg=0.133 kPa）, （19.18±0.22） mmHg, （20.19± 1.84） times/min, which were significantly lower than those of the control group values [（16.55±1.08） mmHg, （28.31±2.30） mmHg, （20.19±1.84） times/ mini （P〈0.05 or 0.01）; at 12 months after the load around the implant in oral health management group, the values of MBL and mSBI were 2.6 （2, 4）, 2.1 （2, 4）, which were significantly better than control group [4.3（3, 7）, 4.3（3, 7）] （P〈0.01）; simultaneously, there was significant difference in the values of MBL and PD between experimental group （1.42 ± 0.03, 0.77 ± 0.24） and eontrol group （1.59 ± 0.04, 0.54± 0.17） （P〈0.01）.Conclusion Well-performed health management of peri-implant could reduce the MBL and keep healthy soft tissue environment around implants.