帐篷钉技术在下颌后牙区骨增量的应用疗效分析

Efficacy Analysis of Tent Nail Technique for Bone Augmentation in Mandibular Posterior Region

目的:评估帐篷钉技术于下颌后牙区应用后对水平向及垂直向骨增量的临床效果。方法:选取下颌后牙区牙槽嵴顶水平向骨宽度≤5 mm的患者9例,共17个位点。对骨缺损区进行骨增量手术,术中于骨缺损区置入1~2枚帐篷钉,并采用可吸收胶原膜联合脱矿牛骨(DBBM)和自体骨1∶1混合物,术后6个月进行影像及生物学并发症检查。收集纳入患者术前、术后当日以及术后6个月的CBCT影像数据,将其分别导入Mimicis软件进行拟合匹配,测量术后当日及术后6个月骨高度及骨宽度的变化量。结果:测量结果显示纳入研究的患者术前平均骨宽度及骨高度分别为(4.04±0.65)mm、(13.64±2.91)mm,术后当日的骨宽度及骨高度分别为(12.21±1.24)mm、(16.95±2.26)mm;经植骨后,6个月后骨宽度及骨高度分别为(9.13±2.27)mm、(15.49±2.21)mm,较术前分别增加了(5.09±2.03)mm、(1.84±2.25)mm;骨愈合的6个月期间宽度及高度的吸收量分别为(3.08±1.41)mm、(1.46±0.57)mm。结论:本研究表明,帐篷钉在骨愈合过程中的空间维持作用显著,并且在下颌后牙区严重萎缩的牙槽嵴中应用帐篷钉技术结合GBR(DBBM和自体骨1∶1混合)进行骨增量取得了较好的临床效果。

Objective:To evaluate the clinical effect of tent nail technique on horizontal and vertical bone augmentation in the mandibular posterior region.Methods:A total of 17 sites in 9 patients with alveolar crest width≤5 mm in the mandibular posterior region were selected.During the operation,1-2 tent nails were inserted into the bone defect area,absorbable collagen membrane combined with 1∶1 mixture of demineralized bovine bone(DBBM)and autologous bone were used.Imaging and biological complications were examined at 6 months after operation.The CBCT data of the patients before surgery,on the day of surgery,and 6 months after surgery were collected and imported into Mimicis software for fitting and matching,respectively.The changes of bone height and bone width on the day of surgery and 6 months after surgery were measured.Results:The initial mean bone width of 9 subjects was(4.04±0.65)mm,the mean bone height was(13.64±2.91)mm.The bone width and height on the postoperative day were(12.21±1.24)mm and(16.95±2.26)mm.After 6 months,the bone width became(9.13±2.27)mm,and the bone height became(15.49±2.21)mm.The bone width increased by(5.09±2.03)mm and the bone height increased by(1.84±2.25)mm at 6 months after surgery compared with the preoperative values.During 6 months of bone healing,the absorption of bone width and height was(3.08±1.41)mm and(1.46±0.57)mm.Conclusion:The present study showed that tent nails played a significant role in spatial maintenance during bone healing,and the application of tent nails combined with GBR(1∶1 mixture of DBBM and autogenous bone)for bone augmentation in the severely atrophied mandibular posterior region achieved good clinical results.