可吸收胶原膜在颊侧袋形瓣引导性骨再生手术中的作用:一项回顾性影像学队列研究

Role of collagen membrane in modified guided bone regeneration surgery using buccal punch flap approach:A retrospective and radiographical cohort study

目的:在颊侧袋形瓣引导性骨再生手术基础上,探讨放置可吸收胶原膜是否有利于维持术后牙槽嵴轮廓稳定。方法:收集2019年6月至2023年6月因单颗后牙缺失采用种植体植入同期进行颊侧袋形瓣引导性骨再生手术患者,根据骨粉表面是否覆盖胶原膜分为胶原膜覆盖组和无覆盖组。术前(T0)、术后即刻(T1)和术后3~7个月(T2)拍摄锥形束CT,利用Mimics软件测量种植体光滑-粗糙交界面下不同水平(0、2、4和6 mm)处颊侧骨板厚度(thickness of the buccal bone plate,BBT,分别表示为BBT-0、-2、-4、-6)。结果:收集胶原膜覆盖组15例,无胶原膜覆盖组14例,共计29例患者进行统计分析。在T0、T1和T2三个时间点,不同水平的BBT在两组间差异均无统计学意义(P>0.05)。T2时,BBT-0在胶原膜覆盖组和无覆盖组分别为(1.22±0.55)mm和(1.70±0.97)mm,相应的BBT-2分别为(2.32±0.94)mm和(2.57±1.26)mm。T1~T2愈合阶段不同水平处颊侧骨板吸收的绝对值[(0.47±0.54)~(1.33±0.75)mm]和百分数[(10.04%±24.81%)~(48.43%±18.32%)],以及T0~T2阶段颊侧骨板新骨形成厚度[(1.27±1.09)~(2.75±2.15)mm]在两组间差异均无统计学意义。结论:颊侧袋形瓣引导骨再生手术无论是否使用胶原膜均可有效修复种植体颈部颊侧骨缺损。与无胶原膜覆盖相比,胶原膜覆盖植骨材料不能提高术后牙槽嵴轮廓的稳定性。

Objective:To investigate whether the placement of absorbable collagen membrane increase the stability of alveolar ridge contour after guided bone regeneration(GBR)using buccal punch flap.Methods:From June 2019 to June 2023,patients who underwent GBR using buccal punch flap simultaneously with a single implant placement in posterior region(from first premolar to second molar)were divided into coverage group,in which particular bone graft was covered by collagen membrane and non-coverage group.Cone beam CT(CBCT)was taken before surgery(T0),immediately after surgery(T1),and 3-7 months after surgery(T2),and the thickness of the buccal bone plate at different levels(0,2,4,and 6 mm)below the smooth-rough interface of the implant(BBT-0,-2,-4,-6)was mea-sured after superimposition of CBCT models using Mimics software.Results:A total of 29 patients,including 15 patients in coverage group and 14 patients in non-coverage group,were investigated in this study.At T0,T1,and T2,there was no significant difference in BBT between the two groups(P>0.05).At T1,BBT-0 was(2.50±0.90)mm in the coverage group and(2.97±1.28)mm in the non-coverage group,with corresponding BBT-2 of(3.65±1.08)mm and(3.58±1.26)mm,respectively.At T2,BBT-0 was(1.22±0.55)mm in the coverage group and(1.70±0.97)mm in the non-coverage group,with corresponding BBT-2 of(2.32±0.94)mm and(2.57±1.26)mm,respectively.From T1 to T2,there were no statistically significant differences in the absolute values[(0.47±0.54)-(1.33±0.75)mm]and percentages[(10.04%±24.81%)-(48.43%±18.32%)]of BBT change between the two groups.The thickness of new bone formation in the buccal bone plate from T0 to T2 ranged from(1.27±1.09)mm to(2.75±2.15)mm with no statistical difference between the two groups at all levels.Conclusion:In the short term,the GBR using buccal punch flap with or without collagen membrane coverage can effectively repair the buccal implant bone defect.But collagen membrane coverage showed no additional benefit on alveolar ridge contour stability compared with non-membrane coverage.