自体牙移植术后松动度与手术时间相关性的初步研究

A preliminary study on the correlation between postoperative loosening and surgical time of autologous tooth transplantation

目的观察自体牙移植患者术后移植牙松动状态,找出影响移植牙松动的临床因素,为降低移植牙手术失败率和减少术后并发症提供理论基础。方法回顾性选取2019年9月至2021年9月首都医科大学附属北京天坛医院收治的14例自体牙移植患者作为研究对象。记录手术时间、术后X线片检查结果、移植牙术后松动度和松动时间。对比手术时间长短与术后松动度的关系、术后骨嵴顶至釉牙骨质界距离与术后3个月骨高度恢复情况。结果14例患者中手术时间50~110 min,平均(76±19)min。手术时间在60 min以内的有5例患者,90 min以内的有5例患者,长于90 min的患者有4例。手术时间60 min以内的患者在术后2周移植牙松动度Ⅱ度。术后即刻颊侧骨嵴顶到釉牙骨质界的距离在2~3 mm的移植牙,在术后3个月颊侧骨高度可以恢复至釉牙骨质界水平;两者的距离在3~4 mm的移植牙,在术后3个月颊侧骨高度部分恢复至釉牙骨质界水平;两者距离大于4 mm的移植牙,在术后3个月颊侧骨高度未恢复。结论自体牙移植手术时间越长,术后2周移植牙松动度越大。术中应修整拔牙窝骨形态使其与移植牙牙根形态及长度相匹配,减少牙槽嵴顶至釉牙骨质界距离,这样有利于移植牙松动度的恢复。

Objective To observe the looseness of the transplanted teeth in patients with autogenous tooth transplantation and finding out the clinical factors affecting the looseness of the transplanted teeth.To provide a theoretical basis for reducing the failure rate of transplanted teeth surgery and postoperative complications.Methods Fourteen patients with autologous tooth transplantation admitted to Beijing TianTan Hospital,Capital Medical University from September 2019 to September 2021 were retrospectively selected as the study subjects.The operation time,postoperative X-ray film,the mobility and the time after tooth transplantation were recorded.Results Among the 14 patients,the surgical time was 50-110 minutes,with an average of(76±19)minutes.There were 5 patients with surgery time less than 60 minutes,5 patients with surgery time less than 90 minutes,and 4 patients with surgery time longer than 90 minutes.The patients with less than 60 minutes operation time had less than I degree of looseness when the stitches were removed 2 weeks after operation;The degree of looseness was aboutⅡdegree when the stitches were removed within 90 minutes after operation;the patients whose operation time was longer than 90 minours had a degree of looseness more than Ⅱ degree when the stitches were removed 2 weeks after operation.The distance from the crest of buccal bone ridge to the enamel cementum boundary was 2 mm to 3 mm immediately after surgery,and the height of buccal bone could return to the level of enamel cementum boundary three months after surgery;The buccal bone height of the transplanted teeth with a distance of 3 mm to 4 mm partially recovered to the level of the enamel cementum boundary three months after operation;For transplanted teeth with a distance greater than 4 mm,the height of the buccal bone only slightly recovered three months after surgery.Conclusion The longer the operation time of autogenous tooth transplantation,the greater the mobility of the transplanted teeth in two weeks after operation.During the operation,the bone shape of the extraction socket should be trimmed to match the shape and length of the root of the transplanted tooth,and the distance from the crest of the alveolar ridge to the boundary of enamel and cementum should be reduced.This is beneficial for the restoration of transplanted teeth.