自体骨柱用于前牙美学区早期种植临床效果研究

Clinical effect of autogenous bone column in early implantation in anterior esthetic zone

目的 研究自体骨柱用于前牙美学区早期种植的临床效果。方法 选取2018年1月至2020年1月于大连市口腔医院种植科就诊的单侧上颌前牙缺失伴水平骨量不足,需行引导骨再生术(guided bone regeneration,GBR)的单颗牙种植修复治疗患者55例。将患者分为对照组(14例)、自体骨柱组(24例)及自体骨屑组(17例),在早期种植同期分别采用Bio-Oss■骨粉、自体骨柱结合Bio-Oss■骨粉、自体骨屑结合Bio-Oss■骨粉行GBR。记录3组患者种植体存留率及并发症;分别于GBR当天及GBR后第15个月测量种植体颈部肩台至唇侧骨壁的宽度、种植体表面1/2处至唇侧骨壁宽度、种植体唇侧颈部(肩台)边缘至唇侧牙槽骨顶点(唇侧骨壁冠方最高点)的高度,并计算唇侧骨壁吸收量;测量3组患者GBR后当天骨增量体积及GBR后第15个月骨吸收量体积;于GBR后第15个月测量植骨区域近远中邻牙的牙髓活力;于永久修复后当天(骨愈合后第6个月)及GBR后第15个月评估3组患者粉白美学指数。结果 3组患者种植体均正常行使功能,存留率为100%,且无并发症发生。GBR后第15个月自体骨柱组种植体颈部肩台至唇侧骨壁的宽度及种植体唇侧颈部边缘至唇侧牙槽骨顶点的高度均大于对照组和自体骨屑组,而自体骨柱组这2个位置的二维骨吸收量均小于对照组和自体骨屑组,差异均有统计学意义(均P <0.05)。GBR后第15个月自体骨屑组及自体骨柱组唇侧三维骨体积吸收量均小于对照组(均P <0.05)。GBR后第15个月植骨区域近远中邻牙牙髓活力均正常。GBR后第15个月自体骨柱组粉白色美学指数均大于对照组和自体骨屑组,差异均有统计学意义(均P <0.05)。结论 应用Bio-Oss■骨粉行GBR时,加入自体骨后骨吸收量显著降低;加入自体骨柱后有利于维持唇侧骨量,并能更好地恢复前牙区美学轮廓。

Objective To study the clinical effect of early implantation with autogenous bone column in anterior esthetic zone.Methods From January 2018 to January 2020,55 patients with unilateral maxillary anterior tooth loss and horizontal bone deficiency who needed guided bone regeneration(GBR)were selected from the Department of Implantology,Dalian Stomatological Hospital.The patients were divided into control group(n=14),autogenous bone group(n=24)and autogenous bone debris group(n=17),and were treated with Bio-Oss®bone powder,autogenous bone combined with Bio-Oss®bone powder,and autogenous bone debris combined with Bio-Oss®bone powder for GBR at the same time of early implantation.The implant survival rate and complications of the three groups were recorded,and the width from the shoulder of the implant neck to the labial bone wall,the width from the 1/2 of the implant surface to the labial bone wall,and the height from the edge of the labial neck(shoulder)to the top of the labial alveolar bone(the highest coronal point of the labial bone wall)were measured on the day of GBR and 15 months after GBR,and the labial bone wall resorption was calculated.The volume of bone increment on the day of GBR and the volume of bone resorption at the 15th month after GBR were measured in the three groups.The pulp vitality of the mesial-distal adjacent teeth in the bone graft area was measured on the 15th month after GBR.The pink and white aesthetic index of the three groups was evaluated on the day of permanent restoration(at the 6th month after bone healing)and at the 15th month after GBR.Results All the implants in the three groups functioned normally,the survival rate was 100%,and no complications occurred.At 15 months after GBR,the width from the shoulder of the implant neck to the labial bone wall and the height from the labial neck edge of the implant to the labial alveolar crest in the autogenous bone column group were greater than those in the control group and the autogenous bone debris group,while the bone resorption in the two-dimensional space of the autogenous bone column group was less than that in the control group and the autogenous bone debris group,the differences were statistically significant(all P<0.05).At the 15th month after GBR,the labial three-dimensional bone volume resorption in the autogenous bone column group and autogenous bone debris group was less than that in the control group,respectively(all P<0.05).The pulp vitality of the proximal and distal adjacent teeth in the graft area was normal at 15 months after GBR.At the 15th month after GBR,the pink-white aesthetic index of the autologous bone column group was higher than that of the control group and the autologous bone debris group,and the differences were statistically significant(P<0.05).Conclusion The use of Bio-Oss®bone powder in GBR can significantly reduce the amount of bone resorption after adding autogenous bone,and the addition of autogenous bone column is beneficial to maintaining the labial bone mass and restoring the aesthetic contour of the anterior region.