重度牙周炎拔牙后位点保存不同膜覆盖技术的疗效评价

Effects of Ridge Preservation with Different Membrane Techniques after Extraction of Severe Periodontitis Related Teeth

目的:评价重度牙周炎患牙拔除后应用不同位点保存膜覆盖技术的临床疗效。方法:收集重度牙周炎预后无望的患牙共21颗,拔除后行位点保存,即植骨后盖膜,随机分3组:Bio-Gide膜组、PRF膜组、Bio-Gide+PRF双层膜组。术前及术后6个月进行临床检查,测量颊侧角化龈宽度(ketatinized tissue width,KTW)、邻牙邻面牙龈退缩(gingival recession,GR),并根据平行投照根尖片测量邻面牙槽骨高度(adjacent bone height,ABH)及拔牙窝深度(socket depth,SD),CBCT测量颊舌向骨宽度(buccal-lingual bone width,BLW)。结果:术后与术前相比,3组的GR、ABH均稳定无明显变化(P>0.05),SD术后较术前均有明显改善(P<0.05),仅有PRF膜组的BLW术后效果不佳(P<0.05);术后3组间比较结果显示:PRF膜组与Bio-Gide+PRF双膜组的KTW明显优于Bio-Gide膜组(P<0.05),而BLW在Bio-Gide+PRF双膜组数值最大,优于Bio-Gide膜组,更优于PRF膜组(P<0.05)。结论:重度牙周炎患牙拔除后行位点保存术可有效维持邻面牙槽骨高度,植骨材料覆盖Bio-Gide+PRF双层膜对保持牙槽骨宽度、角化龈宽度更具有优势。

Objective:To compare the clinical effects of different treatment techniques of ridge preservation following tooth extraction in patients with severe periodontitis.Methods:A total of 21 hopeless teeth diagnosed with severe periodontitis at our institution were included.Tooth extraction and ridge preservation were operated in each socket.All sockets were grafted with Bio-Oss after tooth extraction.They were divided into three groups by covering different membranes:Bio-Gide group,PRF group,and Bio-Gide+PRF group.Clinical and radiographic examinations were carried out pre operation,3 and 6 months post-operation.Keratinized tissue width(KTW)and gingival recession(GR)of adjacent tooth were measured.Adjacent bone height(ABH)and socket depth(SD)were measured using parallel projection of apical radiographs.Buccal-lingual bone width(BLW)was measured using CBCT.Results:There was no significant difference at GR and ABH among three groups 6 months post-operation(P>0.05).Compared to pre-operative parameters,after 6 months,SD values of 3 groups had significant change(P<0.05).Only BLW result of PRF group became worse after surgery(P<0.05).After surgery,the values of KTW from high to low were as follows:Bio-Oss+PRF group,Bio-Oss+Bio-Gide+PRF group,and Bio-Oss+Bio-Gide group.Conclusion:All techniques following tooth extraction in advanced periodontitis patients can effectively maintain the adjacent alveolar bone height and reduce the further recession of soft tissue.Covering Bio-Gide+PRF membrane after Bio-Oss grafting is more beneficial to maintain the width of buccal-lingual alveolar bone and has advantages of promoting soft tissue healing and preserving sufficient keratinized gingiva.