牙槽嵴保存术对缺牙区及邻牙牙槽骨变化的影响

The influence of alveolar ridge preservation (ARP) on the change of alveolar bone of alvealar bone of the edentulous area and the adjacent tooth

目的:通过锥形束CT(CBCT)观察重度牙周炎患牙拔除后行牙槽嵴保存术(ARP)对缺牙区及邻牙邻面牙槽骨的影响。方法:因重度牙周炎拔除的46名患者的75颗患牙纳入研究,将患牙分为拔牙后同时行ARP的实验组和拔牙后自然愈合的对照组。另根据拔牙前的骨丧失量分为A组(丧失量5～7 mm)和B组(丧失量>7 mm)。观察拔牙前与拔牙6月后该牙位矢状面上颊舌侧牙槽骨高度变化以及牙槽嵴顶下方1、4、7 mm处的宽度变化以及缺失牙邻牙邻面骨高度变化。结果:实验组颊侧牙槽嵴高度吸收量为(0.69±0.36)mm,对照组吸收量(1.77±0.95)mm(t=-3.977,P=0.004);实验组舌侧牙槽嵴高度吸收量为(0.71±1.51)mm,对照组吸收量(1.71±1.24)mm(t=-3.115,P=0.003)差异均有统计学意义(P<0.05)。实验组牙槽嵴顶下方1 mm处牙槽骨宽度减少了(2.39±1.34)mm,对照组减少了(4.63±2.20)mm(t=5.331,P=0.000);实验组牙槽嵴顶下4 mm处减少了(1.28±1.18)mm,对照组减少了(2.15±1.91)mm(t=2.816,P=0.007);实验组牙槽嵴顶下7 mm处减少了(0.81±1.38)mm,对照组减少了(1.50±1.44)mm(t=2.125,P=0.037),差异均有统计学意义(P<0.05)。实验组邻牙邻面舌侧骨吸收量(-0.22±1.02)mm,对照组吸收量(0.37±0.82)mm(t=-2.766,P=0.007),实验组邻牙邻面中间骨吸收量(-0.48±1.51)mm,对照组中间骨吸收量(0.55±1.07)mm(t=-3.443,P=0.001),差异具有统计学意义(P<0.05)。而实验组邻牙邻面颊侧骨吸收量(-0.09±1.17)mm,对照组骨吸收量(0.34±0.81)mm,差异无统计学意义(t=-1.840,P=0.070)。结论:ARP有助于减少拔牙区牙槽嵴高度宽度的降低,恢复邻牙邻面骨高度,利于后期缺失牙的修复。

Objective： The aim of this study is to observe the influence of alveolar ridge preservation （ARP） on the change of alveolar bone of the edentulous area and the adjacent tooth after extracting the teeth with severe periodontitis through cone beam computer tomography （CBCT）. Methods： Seventy-five teeth of 46 patients which had to be extracted for severe periodontitis were selected. We divided the teeth into two groups. The experimental group received ARP immediately after teeth extraction, and the control group had no treatment. Besides this, we separated A （bone loss： 5-7 mm） and B （bone loss〉7 mm） group according to bone loss before extraction. The buccal and lingual alveolar bone height of the edentulous area and the proximal surface of the adjacent teeth were measured. The widths at 1, 4, 7 mm below alveolar ridge crest were also recorded. Results： Absorbance of the buccal side height of alveolar ridge was （0.69±0.36）mm, while the corresponding control was （1.77±0.95）mm （t=-3.977, P=0.004）; absorbance of the lingual side height of alveolar ridge was （0.71 ±1.51）mm, while the corresponding control was （1.71±1.24）mm （t=-3.115, P=0.003）; there were statistical difference between the experimental group and the control group （P〈0.05）. The width of alveolar bone 1 mm under the alveolar ridge at buccal decreased by （2.39±1.34）mm, while the corresponding control was （4.63±2.20）mm （t=5.331, P=0.000）; the width of alveolar bone 4 mm under the alveolar ridge at buccal decreased by （1.28±1.18）mm, while the corresponding control was （2.15±1.91）mm （t=2.816, P=0.007）, the width of alveolar bone 7 mm under the alveolar ridge at buccal decreased by （0.81±1.38）mm, while the corresponding control was （1.50±1.44）mm （t=2.125, P=0.037）, there were statistical difference between the experimental group and the control group （P〈0.05）. The bone absorbance of the proximal surface of the adjacent teeth on lingual side was （-0.22±1.02）mm, while the corresponding control was （0.37±0.82）mm （t=-2.766, P=0.007）, the bone absorbance of the proximal surface of the adjacent teeth in the middle was （-0.48±1.51）mm, while the corresponding control was （0.55±1.07） mm（t=-3.443, P=0.001）, and there were statistical difference between the experimental group and the control group （P〈0.05）. However, the bone absorbance of the proximal surface of the adjacent teeth on buccal side was （-0.09±1.17）mm, while the corresponding control was （0.34±0.81）mm and there were no statistical difference between the experimental group and the control group （t=-1.840, P=0.070）. Conclusion： ARP could reduce the loss of the height and width of the alveolar ridge in the extraction area and restore the bone wall height of the proximal surface of the adjacent tooth. This is beneficial to the repair of the missing teeth in the later period.