富血小板血浆联合Bio-oss人工骨粉在牙种植体周围骨缺损修复中的应用效果观察

Clinical efficacy of platelet rich plasma combined with Bio 一 oss artificial bone powder in repairing bone defects around implant

目的观察富小板血浆联合Bio-oss人工骨粉在牙种植体周围骨缺损修复中的临床疗效。方法选择2015年1月至2017年1月在丽水市人民医院完成种植修复、后期复查时确诊为牙种植体周围缺损的患者70例为观察对象.按照入院先后顺序均分为观察组和对照组,每组35例。对照组采用Bio-oss人工骨粉进行修复治疗,观察组则采用富血小板血浆联合Bio-oss人工骨粉进行治疗。结果治疗前,观察组患者和对照组患者的探针深度(PD)、临床附着丧失(CAL)以及菌斑指数(PI)、龈沟出血指数(SBI)水平分别为(7.18 ±1.31) mm,(5.68 ±0.87) mm,(1.23 ±0.31),(2.48 ±0.34)和(7.22 ± 1.28) mm、(5.74 ± 0.83) mm、(1.27 ±0.33)、(2.53 ±0.36),均明显高于治疗后(P<0.05)。两组患者治疗前的骨密度(BMD)水平分别为(35.48 ±4.58)g/cm^3 .(35.74 ±4.61)g/cm^3,明显低于治疗后(P <0.05)。观察组患者在治疗后3个月、6个月的 PD、CAL 及 PI、SBI 水平分别为(4.48 ± 1.01) mm,(4.27 ± 0.53) mm ,(0.68 ±0.21),(1.12 ±0.13)和(3.43±0.76)mm、(0.58±0.54)mm、(0.38±0.07)、(0.41 ±0.08),均明显低于对照组,差异有统计学意义[(5.19 ±0.83)mm、(4.83 ±0.71 )mm、(0.89 ±0.27)、( 1.46 ±0.21)和(4.14 ±0.98)mm、(4.21 ±0.62)mm、(0.49 ±0.11),(0.63 ±0.13)](t= 3.213、3.739、3.632、8.144 和 3.387、4.533、4.991、8.526,P = 0.002、0.000,0.000、0.000和0.001、0.000、0.000、0.000)。两组患者在治疗6个月后的牙尖交错位习惯咬合状态(ICP-HB)、最大力紧咬合状态(ICP-MC)时的颍肌前部(TA)肌电值和咬肌(MA)肌电值水平分别为(76.81 ±15.17),(67.56 ±14.43),(74.24 ± 13.28),(68.27 ±13.03)和(66.44 ± 13.28)、(58.76 ± 13.07)、(65.58 ±11.55)、(59.04 ± 10.76) mV,均明显高于治疗前[(46.48 ± 11.15)、(38.19 ± 13.04)、(54.83 ± 12.57)、(56.48 ±13.13)和(45.71 ± 10.98),(38.23 ± 13.11),(55.14 ±12.69)、(56.61 ± 13.08) mV](P <0.05),且治疗后观察组患者在ICP-HBJCP-MC时的TA、MA肌电值水平均明显高于对照组,均差异有统计学意义(t =3.042、2.674、2.911、2.994, P = 0.003、0.009、0.004,0.003 )c 结论富小板血浆联合 Bio-oss 人工骨粉在牙种植体周围骨缺损修复中的效果显著,富血小板血浆能够加快和提升牙种植体周围骨缺损的修复速度和修复质量,使种植修复治疗效得以长期保持,值得在临床中广泛推广应用。

Objective To research the clinical effect of platelet rich plasma combined with Bio-oss artificial bone meal in repairing bone defects around implants.Methods From January 2015 to January 2017,70 cases who completed the implant repair in Lishui People's Hospital,and later confirmed the defects around the implant were selected in the research.They were equally divided into observation group and control group according to admission,with 35 cases in each group.The control group was treated with Bio-oss artificial bone powder.The observation group was treated with platelet rich plasma combined with Bio-oss artificial bone powder.The clinical effects of the two groups were compared and analyzed.Results Before treatment,the probe depth (PD),clinical attachment loss (CAL),plaque index (PI),gingival sulcus hemorrhage index (SBI) of the observation group and the control group were (7.18 ± 1.31)mm,(5.68 ±0.87)mm,(1.23 ±0.31),(2.48 ±0.34) and (7.22 ± 1.28)mm,(5.74 ±0.83) mm,(1.27 ± 0.33),(2.53 ± 0.36),respectively,which were significantly higher than those after treatment (all P < 0.05).Before treatment,the bone mineral density (BMD) levels of the two groups were (35.48 ± 4.58) g/cm3 and (35.74 ±4.61) g/cm3,respectively,which were significantly lower than those after treatment (all P < 0.05).The levels of PD,CAL,PI and SBI in the observation group at 3 months and 6 months after treatment were (4.48 ± 1.01) mm,(4.27 ±0.53)mm,(0.68 ±0.21),(1.12 ±0.13) and (3.43 ±0.76) mm,(3.58 ±0.54)mm,(0.38 ±0.07),(0.41 ±0.08),respectively,which were significantly lower than those in the control group [(5.19 ± 0.83) mm,(4.83 ±0.71)mm,(0.89 ±0.27),(1.46 ±0.21) and (4.14 ±0.98)mm,(4.21 ±0.62)mm,(0.49 ±0.11),(0.63 ±0.13)],the differences were statistically significant (t =3.213,3.739,3.632,8.144 and 3.387,4.533,4.991,8.526,P =0.002,0.000,0.000,0.000,0.001,0.000,0.000,0.000,0.000,0.000).The levels of TA anterior temporalis muscle EMG and MA masseter muscle EMG in the two groups at 6 months after treatment were (76.81 ± 15.17) mV,(67.56 ±14.43)mV,(74.24 ± 13.28) mV,(68.27 ± 13.03) mV,(66.44 ± 13.28) mV,(58.76 ± 13.07) mV,(65.58 ±11.55) mV,(59.04 ± 10.76) mV,respectively,which were significantly higher than those before treatment [(46.48 ±11.15) mV,(38.19± 13.04) mV,(54.83 ±12.57) mV,(56.48 ±13.13) mV and (45.71 ±10.98) mV,(38.23 ±13.11)mV,(55.14±12.69) mV,(56.61 ± 13.08) mV] (all P <0.05).After treatment,the ICP-HB,ICMAP-MC,TA,EMG levels in the observation group were significantly higher than those in the control group,the differences were statistically significant (t =3.042,2.674,2.911,2.994,P =0.003,0.009,0.004 and 0.003).Conclusion The effect of rich plate plasma combined with Bio-oss artificial bone powder on the repair of bone defect around the implant is significant.The platelet rich plasma can speed up and improve the repair speed and repair quality of bone defect around the implant,so that the therapeutic effect of implant repair can be maintained for a long time.