牙本质壳技术治疗牙缺失伴严重骨缺损一例报告

Dentin shell technique for the treatment of severe alveolar bone defect at the edentulous site

本文分析一例牙周炎致牙缺失伴缺牙区严重骨缺损及邻牙牙周破坏的治疗过程及随访结果,初步探究牙本质壳技术用于缺牙区牙槽骨骨增量的可行性及临床效果。纳入病例为由于慢性牙周炎导致左侧下颌第一磨牙缺失,缺牙区牙槽骨显著吸收,嵴顶至下牙槽神经管距离约3.63 mm。本研究运用一项新颖的牙本质壳技术,拔除患者的无功能第三磨牙,加工成牙本质薄片,固定在剩余牙槽骨上作为“外壳”,骨代用材料颗粒和浓缩生长因子的混合物填充至“壳”内的空间,完成牙槽骨的三维重建。骨增量手术后6个月,牙槽嵴垂直高度增量10.62 mm,水平宽度恢复,成功植入2颗种植体。种植手术后6个月复查显示牙槽嵴高度、宽度稳定,骨质进一步致密,呈现良好的愈合。病例最终修复及修复后随访效果较为理想。牙本质壳技术作为一项新颖的牙槽嵴三维重建方式,为口内存在无功能天然牙的骨缺损病例提供了一种微创的选择,但其临床效果仍然需要未来更大样本量、更长随访期的研究支持。

The purpose of this clinical case analysis was to report the treatment and follow-up outcomes of one case with severe bone defect at the edentulous site,and to conduct a preliminary investigation of the efficacy of dentin shell technique for alveolar bone augmentation based on this case.One partial edentulous case caused by chronic periodontitis was included.Because of the significant bone resorption,the vertical distance between alveolar crest and inferior alveolar nerve canal was 3.63 mm approximately.Dentin shell technique was applied to conduct bone augmentation in this case.The non-functional third molar was extracted and processed into dentin shells with a thickness of≤2 mm.The dentin shells were fixed at the recipient sites as an external barrier.The space between dentin shells and host bone was filled with Bio-Oss particles mixed with concentrated growth factor(CGF).A vertical bone gain of 10.62 mm was achieved 6 months after the bone augmentation surgery.Two implants were placed.The bone height and width remain stable without significant bone resorption,and the bone density increased,which indicated favorable bone regeneration outcome 6 months after implant placement.The outcomes of definitive restoration and follow-up were satisfying.Dentin shell technique is a novel three-dimension bone augmentation method and provides a novel choice for patients with non-functional natural teeth.But the efficacy of dentin shell technique needs further investigation in clinical trials with larger sample sizes and longer follow-up periods.