富自体生长因子纤维蛋白和低能量激光治疗对正畸患者拔牙位点牙槽骨变化影响的比较

Effect of concentrated growth factors andlower-level laser therapyon alveolar bone atrophy after tooth extraction site in orthodontic patients

目的比较富自体生长因子纤维蛋白(CGF)和低能量激光治疗(LLLT)对正畸患者拔牙位点牙槽骨变化影响的比较。方法选取2020年6月至2022年5月于天津市北辰医院口腔科就诊的正畸治疗需拔牙患者21例,随机分为对照组、LLLT组和CGF组,每组各7例,分别有28个拔牙位点。对照组为拔牙创自然愈合,LLLT组微创拔牙后第1、2、7天均使用二极管激光仪治疗(波长808 nm,平均输出功率0.25 W,能量密度为4 J/cm^(2),光斑面积0.28 cm^(2)),每个位点照射20 s。CGF组微创拔除牙后,立即将CGF膜置于拔牙窝内。比较各组拔牙前后拔牙创处牙槽骨高度、宽度以及牙槽骨愈合后骨轮廓及骨密度,同时测量拔牙创处龈沟液中生长因子骨桥蛋白(OPN)和转移生长因子-β1(TGF-β1)浓度。结果与对照组比较,LLLT组和CGF组拔牙创处牙槽骨高度、宽度降低,差异均具有统计学意义(均P<0.05);与LLLT组比较,CGF组拔牙创处牙槽骨高度、宽度降低,差异均具有统计学意义(均P<0.05)。LLLT组和CGF组拔牙创愈合后骨轮廓评分和骨密度分级均优于对照组(均P<0.05);而LLLT组与CGF组拔牙创愈合后骨轮廓评分和骨密度分级比较差异无统计学意义(P>0.05)。拔牙后1、6个月,对照组、LLLT组和CGF组拔牙创处龈沟液中OPN浓度比较差异均无统计学意义(均P>0.05);但拔牙后1个月,与对照组比较,LLLT组和CGF组拔牙创处龈沟液中TGF-β1浓度升高,差异均有统计学意义(均P<0.05);而拔牙后6个月,3组TGF-β1浓度比较差异均无统计学意义(均P>0.05)。结论LLLT和CGF治疗均能有效地减少拔牙创牙槽骨高度和宽度,促进拔牙创牙槽骨骨轮廓及骨密度的恢复,为如何延缓拔牙创牙槽骨的萎缩提供临床数据支持。

Objective To compare the effects of concentrated growth factors(CGF)and lower-level laser therapy(LLLT)on alveolar bone changes at the extraction site in orthodontic patients.Methods Twenty-one patients who underwent orthodontic treatment at the Department of Stomatology,Tianjin Beichen Hospital,from June 2020 to May 2022 were enrolled and randomly divided into the control group,LLLT group,and CGF group,with 7 patients in each group and 28 extraction sites.The control group received natural healing with tooth extraction(minimally invasive healing with tooth extraction).The LLLT group received diode laser treatment on the 1st,2nd,and 7th days after minimally invasive tooth extraction(wavelength 808 nm,average output power 0.25 W,energy density 4 J/cm^(2),spot area 0.28 cm^(2)),with each site irradiated for 20 seconds.After minimally invasive tooth extraction in the CGF group,immediately place the CGF membrane in the extraction socket.The changes in alveolar bone height and width before and after tooth extraction and bone density and bone contour after alveolar bone healing were measured.Meanwhile,the concentration changes of growth factors osteopontin(OPN)and transforming growth factor-β1(TGF-β1)in gingival crevicular fluid at tooth extraction were measured and statistically analyzed.Results Compared with the control group,the height and width of the alveolar bone at the tooth extraction wound in the LLLT group and CGF group decreased significantly(all P<0.05).Compared with the LLLT group,the height and width of the alveolar bone at the tooth extraction wound in the CGF group decreased,and the differences were statistically significant(all P<0.05).The bone contour score and bone density grading of the LLLT and CGF groups after tooth extraction wound healing were better than those of the control group(all P<0.05).There was no statistically significant difference in bone contour score and bone density grading between the LLLT group and the CGF group after tooth extraction wound healing(P>0.05).At 1 and 6 months after tooth extraction,there was no statistically significant difference in the concentration of OPN in the gingival crevicular fluid at the extraction site among the control group,LLLT group,and CGF group(all P>0.05).One month after tooth extraction,compared with the control group,the concentration of TGF-β1 in the gingival crevicular fluid of the tooth extraction wound increased in the LLLT group and the CGF group,and the differences were statistically significant(all P<0.05).Six months after tooth extraction,there was no statistically significant difference in TGF-β1 concentration among the three groups(all P>0.05).Conclusions Both LLLT and CGF treatments can effectively reduce the height and width of alveolar bone in tooth extraction wounds,promote the recovery of alveolar bone contour and bone density in tooth extraction wounds and provide clinical data support for how to delay the atrophy of alveolar bone in tooth extraction wounds.