多根牙不同深度即刻种植后牙槽嵴骨形态变化的CBCT研究

Clinical study of alveolar ridge bone morphology after immediate implantation of multiple roots teeth by CBCT

目的:研究多根牙不同植入深度即刻种植手术后受植区的牙槽骨形态的变化。方法:选取过往即刻种植的病例38例,共44颗牙,根据种植体颈部颈缘高度分为骨下0、1、2、3 mm共4组,均从根间隔以不同的种植体植入深度植入并植骨。调取术后即刻和术后6月的锥形束CT数据,重建受植区的三维影像,测量受植区牙槽骨宽度(5个平面)、植体唇颊侧(4个平面)和舌腭侧骨壁宽度(4个平面),统计学分析多根牙即刻种植后受植区牙槽骨的形态变化。结果:术后即刻与术后6月相比,多根牙受植区牙槽骨宽度减少量5个平面分别为(1.158±0.567)、(0.676±0.390)、(0.391±0.257)、(0.163±0.149)、(0.053±0.083)mm(P<0.01),种植体颊侧骨壁宽度减少量4个平面分别为(0.701±0.382)、(0.436±0.274)、(0.274±0.178)、(0.121±0.115)mm(P<0.01),种植体舌侧骨壁宽度减少量4个平面分别为(0.448±0.308)、(0.233±0.170)、(0.119±0.119)、(0.041±0.056)mm(P<0.01)。在相同的测量平面内不同深度的植入骨吸收也有显著性差异,骨下0 mm组和骨下1 mm组骨吸收最多,而骨下2、3 mm组骨吸收较少(P<0.05)。结论:多根牙即刻种植时,受植区牙槽骨宽度均减小,骨吸收主要发生在种植体颈部。从种植体颈部到根方,牙槽骨吸收逐渐减少;多根牙即刻种植深度以骨下2 mm为宜。

Objective:To study the changes of multiple roots teeth in alveolar bone morphology in the implant area after immediate implantation by different depth.Methods:44 teeth were selected from 38 patients who had been implanted for the previous multiple roots teeth.The cases were implanted from different depth in the middle of multiple roots with bone grafts and were divided into 4 groups-0,1,2,3 mm below the bone by height of cervical border of implant neck.The CBCT images were took for immediate plant and 6 months later,the 3-D images of plantation area were recon-structed alveolar ridge width(5 planes),alveolar ridge width in labial and buccal(4 planes),lingual and palatal side(4 planes)were measured with Simplant software.The morphology of alveolar bone in the planted area was analyzed statistically after immediate plant.Results:The width morphology of alveolar bone in the planted area was(1.158±0.567)mm,(0.676±0.390)mm,(0.391±0.257)mm,(0.163±0.149)mm,(0.053±0.083)mm in 5 measurement plane between immediate plant and 6 months later(P<0.01).The width morphology of alveolar bone in buccal side was(0.701±0.382)mm,(0.436±0.274)mm,(0.274±0.178)mm,(0.121±0.115)mm in 4 measurement plane(P<0.01).The width morphology of alveolar bone in lingual or palatal side was(0.448±0.308)mm,(0.233±0.170)mm,(0.119±0.119)mm,(0.041±0.056)mm in 4 measurement plane(P<0.01).The width morphology was different significantly between immediate plant and 6 months by different planting depths,The bone absorption was highest in the subosseous 0 mm group and the subosseous 1 mm group,the subosseous 2 and 3 mm group had less bone absorption(P<0.05).Conclusions:The alveolar bone width of the implanted area all decreased when multiple roots teeth were implanted immediately,and bone absorption mainly occurred in the neck of the implant;from the neck of the implant to the root,the alveolar bone absorption becomes less and less.Implantation depth of immediate implantation of multiple roots teeth should be 2 mm below bone.