罹患重度牙周病变磨牙拔牙后位点保存与自然愈合后种植治疗效果对比研究

Clinical efficacy of implant treatment following alveolar ridge preservation or natural healing in the extraction sockets of molars with severe periodontitis

目的观察罹患重度牙周病变磨牙拔牙后位点保存与自然愈合后种植修复的临床效果。方法纳入2013—2016年就诊于北京大学口腔医院牙周科的10例患者,共有13颗罹患重度牙周病变而拔除的磨牙,根据患者对治疗方案的选择,分为位点保存组(6例,共6颗患牙)和自然愈合组(5例,共7颗患牙)。分别在拔牙后经位点保存或自然愈合后行种植治疗,6~8个月后接受上部结构修复,随访12~30个月。观察种植体留存情况并记录种植体周围软组织状况,包括探诊深度(PD)、出血指数(BI)、菌斑指数(PLI)、龈乳头指数(PI)及种植修复体食物嵌塞与否。修复后每6个月拍摄平行投照根尖片,测量种植体边缘牙槽骨高度,计算边缘骨丧失量(MBL)。根据Karoussis等2004年提出的种植体成功标准,计算种植体成功比例。并采用视觉模拟评分法(VAS),获得患者对种植体咀嚼功能、美观、整体满意度的主观评价。结果两组种植体修复后12~30个月存留率均为100%;位点保存组成功比例为100%,自然愈合组为42.9%。种植体负重1年时两组的PD差异有统计学意义(P<0.05),PLI、BI、PI差异无统计学意义(P>0.05);位点保存组与自然愈合组种植体修复后1年时近远中MBL均<1 mm,两组的远中MBL差异有统计学意义(P<0.05)。位点保存组种植体修复1年后每年边缘骨丧失均<0.2 mm,近中为(0.03±0.16)mm,远中为(0.05±0.10)mm。两组种植体咀嚼功能、美观、患者满意度VAS评分均>85。结论罹患重度牙周病变磨牙拔牙后位点保存为种植提供了良好的条件,种植修复后12~30个月的成功比例高于自然愈合组,是可靠的牙槽嵴增量方式。

Objective To observe the clinical efficacy of implant treatment following alveolar ridge preservation in the molar extraction sockets with severe periodontitis and compare it with the natural healing control group. Methods Ten patients with a total of 13 molar extraction sockets with severe periodontitis receiving implant placement following alveo- lar ridge preservation （6 patients, 6 tooth） or natural healing （5 patients, 7 tooth） were recruited in Peking University School and Hospital of Stomatology from 2013 to 2016. In a 12-30 months follow-up period, each implant was examined with the following parameters：probing depth, bleeding index, plaque index, papilla index（PI） and food impaetion. Paral- lel periapieal radiographs were taken every 6 months to evaluate the peri-implant marginal bone loss. Success rate was defined using the criteria from Karoussis et al （2004）. Additionally, each patient completed retro- spectively a satisfaction questionnaire using Visual Analog Scale （VAS）. Results There was a 100% survival rate of implants in both groups. The success rate was around 100% for implants in ridge-pre- served sites and around 42.9% for implants in natural healing sites. There were no statistically significant differences in the BI, PLI or PI between two groups except for the PD（P 〈 0.05）. Marginal bone loss of the implant in both groups at the 12th month after implant loading was 〈1 mm. Af- ter the first year of service, annual marginal bone loss did not exceed 0.2 mm in ridge preservation group, the mesial and distal sites were（0.03 ＋ 0.16）mm and（0.05 ＋ 0.10）mm on average. All the patients were satisfied with the implant with VAS i〉 85. There were no statistically significant differences between PI and food impaction. Conclusion Implant placement at ridge-preserved molar sites with severe periodontitis is a predictable procedure resulting in very high sur- vival rates and higher success rates compared to implant placement in natural healing sites.