不同骨增量技术在上颌前牙区的临床对比研究

Alveolar ridge reconstruction with different bone grafts in the anterior maxillary region: a clinical contrastive study

目的:评估不同骨增量技术对上颌前牙区牙槽骨水平骨增量的临床疗效。方法:筛选2013~2016年内行上颌前牙延期种植患者33例,共植入51枚种植体。根据植骨术的不同分为3组:A组,钛网植骨;B组,自体骨外置植骨(Onlay植骨);C组,常规引导骨组织再生术(GBR)。锥形束CT(CBCT)对术区牙槽骨进行扫描测量与分析,评估植骨术后牙槽骨水平向骨增量(L1)、种植术前较植骨术后的牙槽骨吸收量(L2)和种植术后1年的牙槽骨吸收量(L3)等。结果:CBCT评估显示A组术后L1[(5.17±0.37)mm]与B组[(5.31±0.36)mm]相比无明显差异,两者均大于C组[(3.87±0.57)mm];但A组L2[(0.07±0.05)mm]小于B组[(0.38±0.12)mm]和C组[(0.35±0.09)mm],P<0.05,差异有统计学意义。种植体植入后1年随访有微量的骨质丧失,A组大于B组或C组,B组与C组之间差异无统计学意义。结论:GBR采用钛网在上颌前牙缺失的种植修复中可提供令人满意的水平骨增量效果。相比于采用可吸收膜的常规GBR可以增加更多的骨量,并且可提高GBR适应证范围。该术植骨后植骨材料吸收较缓慢,优于Onlay植骨术和常规GBR手术。

Objective:To evaluate the clinical effect of different bone graft techniques on increasing horizontal bone mass in the anterior maxillary region.Methods:A total of 33 implantation patients including 51 implants were enrolled in this study from 2013 to 2016.According to the different bone grafts surgeries,all the patients would be divided into 3 groups[group A guided bone regeneration(GBR)with titanium mesh,group B with onlay bone graft and group C GBR with absorbable membrane].The changes of bone mass were evaluated by cone beam CT(CBCT).The alveolar bone increase value(L1);absorption value(L2)and resorption(L3)were compared.Results:The CBCT showed that there were no significant differences between group A[(5.17±0.37)mm]and group B[(5.31±0.36)mm]in L1 after operation,which were higher than that in group C[(3.87±0.57)mm].There were statistically differences in L2,which group A[(0.07±0.05)mm]were smaller than those of group B[(0.38±0.12)mm]and group C[(0.35±0.09)mm].One year after implantation with a trace of bone loss,in which group A was the highest.There was no significant difference between group B and group C in L3(P>0.05).Conclusion:GBR using titanium mesh can provide satisfactory horizontal bone proliferation in the restoration of maxillary anterior teeth.Compared to the conventional GBR with absorbable membrane,guided bone regeneration using titanium mesh can increase the amount of bone and improve the scope of its indications.After the bone grafting,bone meal absorption is slower than onlay bone graft and conventional GBR surgery.