钛网在上前牙唇侧重度骨缺损种植中的临床研究

Clinical research on titanium mesh and collagen membrane using in implantation of severe labial bone defect of anterior teeth

目的:探讨在上前牙种植时使用钛网联合胶原膜和富血小板纤维蛋白(platelet rich fibrin,PRF)在修复唇侧骨板重度缺损的骨再生效果。方法:选择20例上前牙种植唇侧骨板重度缺损的患者,随机分为两组。一组使用骨粉+胶原膜+PRF进行骨增量,一组使用钛网+骨粉+胶原膜+PRF进行骨增量。埋入式愈合6个月二期手术,1月后修复。观察两组患者术前骨缺损情况及二期手术、修复1年后唇侧的骨厚度及边缘骨高度,并进行统计分析。结果:二期手术时实验组唇侧骨板重建丰满,新骨覆盖种植体顶端,CBCT示唇侧颈部骨厚度为2.82±0.12mm,对照组唇侧虽有新骨形成但成骨量较少,CBCT示唇侧骨厚度1.03±0.11mm,二者具有明显差异。对照组修复后1年唇侧骨厚度0.97±0.13mm,骨高度降低1.10±0.03mm。实验组修复后1年唇侧骨厚度2.77±0.21mm,骨高度降低0.89±0.05mm,但仍在植体顶端,与对照组有明显差异(P<0.05)。结论:在上前牙种植唇侧重度骨缺损时联合使用钛网和胶原膜引导骨再生(guided bone regeneration,GBR)比单纯使用胶原膜引导骨再生有更明显的成骨效果,因此在前牙重度骨缺损时可加用钛网保障骨增量的效果。

Objective:To investigate the effect of bone regeneration through titanium mesh combined with collagen membrane and platelet rich fibrin(PRF)in the repair of severe defects in the labrum plates during implanting of the anterior teeth.Methods:Twenty patients with severe buccal bone defect of maxilla were selected and randomly divided into two groups.Whenbone regeneration,One group were treated with bone powder,collagen membrane and PRF in dental implantation,and the other group were treated with titanium mesh,bone powder,collagen membrane and PRF.Two-stage surgery was carried out after 6 months of submerged healing,and prosthesis was used after 1 month.The repairs of the defect were observed at the second stage surgery.The height of margin bone around implants and the thickness of bone at implants lingual side were measured,at the time of the second stage operation,6 months and 1year after permanent restoration.The differences were analyzed by SPSS 19.0 software package with t test.Results:During the second stage operation,the labial bone plate was reconstructed and plump,and the new bone covered the top end of the implant.The CBCT showed that the thickness of lip and neck bone was 2.82±0.12 mm,the control group had less new bone formation,and the thickness of lip was 1.03±0.11.while the new bone was formed in the labial bone of the control group,but most of the height was less than experiment group.CBCT showed the thickness of the labial bone were 0.97±0.13 mm and 2.77±0.21 mm 1 year after restoration,which was significantly different between the two groups.Conclusion:The results indicate that bone augmentation at severe defect in anterior teeth implantation can be achieved using titanium mesh and collagen membrane.This method is worthy of wide clinical application.