浓缩生长因子联合脱蛋白牛骨矿物质对牙槽嵴位点保存的效果观察

Effect of concentrated growth factor combined with deproteinized bovine bone mineral on alveolar ridge preservation

目的 观察拔除单根牙后牙槽窝内植入浓缩生长因子(concentrated growth factor, CGF)和脱蛋白牛骨矿物质(deproteinized bovine bone mineral, DBBM)后牙槽骨高度、宽度和骨密度变化,探讨二者联合对牙槽嵴位点保存的效果。方法 拟行单根牙种植术患者32例,拔除单根牙后牙槽窝内植入DBBM 16例为对照组,植入CGF联合DBBM 16例为联合组。2组拔牙后第1、3周评估Landry创面愈合指数;分别于拔牙前及拔牙后3个月行口腔颌面锥形束CT检查,测量颊、腭侧牙槽骨高度,牙槽嵴顶下3 mm(W1)、7 mm(W2)、11 mm(W3)宽度,牙槽骨骨密度;拔牙后3、6个月评估牙槽骨新骨轮廓评分。结果 (1)对照组、联合组拔牙后第3周Landry创面愈合指数(4.88±0.34、5.00±0.10)均大于拔牙后第1周(2.44±0.51、4.00±0.63)(t=-15.912,P<0.001;t=-6.350,P<0.001);联合组拔牙后第1周Landry创面愈合指数大于对照组(P<0.05),第3周与对照组比较差异无统计学意义(P>0.05)。(2)拔牙前对照组颊侧牙槽骨高度[(17.31±1.18)mm]、腭侧牙槽骨高度[(16.93±1.26)mm]、W1宽度[(6.28±0.78)mm]、W2宽度[(8.02±0.56)mm]、W3宽度[(10.87±0.44)mm]、牙槽骨骨密度[(1 360.31±38.32)Hu]与联合组[(17.26±1.29)mm、(16.84±1.27)mm、(6.43±0.57)mm、(8.24±0.52)mm、(10.91±0.52)mm、(1 356.50±54.79)Hu]比较差异均无统计学意义(P>0.05);拔牙后3个月,联合组颊侧牙槽骨高度[(16.96±1.29)mm]、腭侧牙槽骨高度[(16.79±1.29)mm]、W1宽度[(5.90±0.62)mm]、W2宽度[(7.60±0.77)mm]、W3宽度[(10.14±0.59)mm]、牙槽骨骨密度[(2 265.25±28.73)Hu]均大于对照组[(14.14±1.18)mm、(14.18±1.23)mm、(3.41±0.68)mm、(5.24±1.02)mm、(8.03±0.93)mm、(2 051.75±130.49)Hu](P<0.05);拔牙后3个月,对照组颊侧牙槽骨高度、腭侧牙槽骨高度均小于拔牙前(P<0.05),联合组与拔牙前比较差异均无统计学意义(P>0.05);2组拔牙后3个月W1、W2、W3宽度均小于拔牙前(P<0.05),牙槽骨骨密度大于拔牙前(P<0.05)。(3)联合组拔牙后3个月牙槽骨新骨轮廓评分高于对照组(P<0.05),拔牙后6个月2组牙槽骨新骨轮廓评分比较差异无统计学意义(P>0.05)。结论 拔牙后采用CGF联合DBBM保存牙槽嵴位点可促进牙槽骨组织再生,维持牙槽骨体积,提高牙槽骨骨密度,为牙种植术提供良好手术条件。

Objective To observe the changes of the height, width and bone mineral density of alveolar bone after concentrated growth factor(CGF) and deproteinized bovine bone mineral(DBBM) implantation in the alveolar fossa after tooth extraction, and to investigate the effect of CGF combined with DBBM on the preservation of alveolar ridge sites. Methods In 32 patients scheduled for single tooth root dental implantation, 16 patients received DBBM implantation in the alveolar fossa after extraction of a single root(control group), and 16 patients received CGF combined with DBBM implantation(combination group). Landry wound healing index was evaluated in the 1 st and 3 rd weeks after tooth extraction in two groups. Cone-beam CT was done before and 3 months after tooth extraction to measure the height of buccal and palatal alveolar bone, the width of alveolar bone 3 mm(W1), 7 mm(W2) and 11 mm(W3) below the crest of alveolar ridge and the mineral density.The alveolar bone contour scores were evaluated 3and 6 months after tooth extraction.Results(1)The Landry wound healing indexes were greater in the 3rd week after tooth extraction in control group and combination group(4.88±0.34,5.00±0.10)than those in the 1st week after tooth extraction(2.44±0.51,4.00±0.63)(t=-15.912,P<0.001;t=-6.350,P<0.001).The Landry wound healing index was greater in the1st week after tooth extraction in combination group than that in control group(P<0.05),and showed no significant difference in the 3rd week after tooth extraction between two groups(P>0.05).(2)The buccal alveolar bone height,palatal alveolar bone height,W1width,W2width,W3width and alveolar bone mineral density showed no significant differences between control group[(17.31±1.18)mm,(16.93±1.26)mm,(6.28±0.78)mm,(8.02±0.56)mm,(10.87±0.44)mm,(1 360.31±38.32)Hu]and combination group [(17.26±1.29)mm,(16.84±1.27)mm,(6.43±0.57)mm,(8.24±0.52)mm,(10.91±0.52)mm,(1 356.50±54.79)Hu]before tooth extraction(P>0.05),and were greater in combination group [(16.96±1.29)mm,(16.79±1.29)mm,(5.90±0.62)mm,(7.60±0.77)mm,(10.14±0.59)mm,(2 265.25±28.73)Hu]than those in control group [(14.14±1.18)mm,(14.18±1.23)mm,(3.41±0.68)mm,(5.24±1.02)mm,(8.03±0.93)mm,(2 051.75±130.49)Hu]3months after tooth extraction(P<0.05).The heights of buccal and palatal alveolar bone were smaller in control group 3months after tooth extraction than those before tooth extraction(P<0.05),and showed no significant differences in combination group(P>0.05).The widths of W1,W2and W3in both two groups 3months after tooth extraction were smaller than those before tooth extraction(P<0.05),and the bone mineral densities of alveolar bone were greater than those before tooth extraction(P<0.05).(3)The new bone contour score was higher in combination group than that in control group3months after tooth extraction(P<0.05),and showed no significant difference between two groups 6months after tooth extraction(P>0.05).Conclusion CGF combined with DBBM can effectively improve the regeneration of alveolar bone,maintain the volume of alveolar bone,and increase the bone density,which provides a good surgical condition for dental implantation.