富血小板纤维蛋白膜在骨组织再生位点保存术中的应用效果

Effect of platelet-rich fibrin membrane for ridge preservation with guided bone regeneration

目的探讨富血小板纤维蛋白膜(PRF)应用于骨组织再生(GBR)位点保存术时,PRF对牙龈组织愈合、骨量保存以及新生骨的影响。方法选取2015年1月-2017年1月湖北省某医院收治的拔牙后行GBR位点保存术的60例患者为研究对象。采用随机数字表法将患者分为观察组(n=30)和对照组(n=30)。2组患者均行微创拔牙术和GBR位点保存术。观察组患者Bio-Oss骨替代材料表面用PRF膜覆盖,对照组患者Bio-Oss骨替代材料表面用海奥胶原膜覆盖。比较2组患者创面愈合所需时间、创面愈合率;比较2组患者拔牙术前及术后3个月时牙槽骨高度和宽度。比较2组患者的新生骨百分比。结果观察组患者创面愈合所需时间短于对照组,差异有统计学意义(P<0.05)。观察组患者术后1周和2周时创面愈合率均高于对照组,差异均有统计学意义(P<0.05)。拔牙术前,2组患者牙槽骨宽度及牙槽骨高度比较,差异无统计学意义(P>0.05);术后3个月时,2组患者牙槽骨宽度、牙槽骨高度均小于拔牙术前,而观察组患者大于对照组,差异均有统计学意义(P<0.05)。观察组病例的新生牙龈病理组织学较对照组病例更接近自然愈合2年的病例。对照组病例的新生骨病理组织学较观察组病例更接近自然愈合2年的病例。观察组患者新生骨百分比高于对照组,差异有统计学意义(P<0.05)。结论 PRF应用于GBR位点保存术中,可有效促进牙龈软组织创面的恢复,抑制牙槽骨吸收,避免牙槽骨骨量进一步减少,并促进新生骨形成,为术后种植牙提供良好条件,值得临床推广应用。

Objective To assess the effect of platelet-rich fibrin（PRF）membrane on gingival healing,bone mass preservation and newly regenerated bone when used for ridge preservation with guided bone regeneration（GBR）.Methods A total of 60 patients who underwent GBR ridge preservation after tooth extraction at a Hubei hospital between January 2015 and January 2017 were included in this study.Based on a random number table,patients were divided into the trial group（n=30）and the control group（n=30）.All patients received minimally invasive extraction and ridge preservation with GBR.In the trial group,PRF membrane was used to cover the surface of bone substitute material Bio-Oss,while in the control group,Heal-All collagen membrane was used.The time to wound healing,wound healing rate,height and width of alveolar bone（both before extraction and 3 months after extraction）,as well as the percentage of newly regenerated bone were compared between the two groups.Results As compared with the control group,the time to wound healing was significantly shorter in the trial group（P〈0.05）;the wound healing rates at 1 week and 2 weeks after tooth extraction were significantly higher in the trial group（P〈0.05）.Before extraction,the height and width of alveolar bone were similar between the two groups（P〉0.05）;at 3 months after extraction,the height and width of alveolar bone were decreased in both groups,but those in the trial group were significantly larger compared with the control group（P〈0.05）.The newly regenerated gingival histology in the trial group was similar to the condition after two years of natural healing,while the newly regenerated bone histology in the control group was similar to the condition after two years of natural healing.The percentage of newly regenerated bone was significantly higher in the trial group than that in the control group（P〈0.05）.Conclusion When used for GBR ridge preservation,PRF is effective in promoting the wound healing of gingival tissues,inhibiting alveolar bone absorption,preventing further bone mass loss,and facilitating the formation of newly regenerated bone,which may provide a sound condition for subsequent dental implant and thus deserves widespread clinical application.