浓缩生长因子联合引导性骨再生修复前牙区囊肿刮治根尖术后组织缺损的效果

Effect of concentrated growth factors combined with guided bone regeneration in repairing tissue defects after anterior cystic apical surgery

目的探讨浓缩生长因子(CGF)联合引导性骨再生(GBR)修复前牙区囊肿刮治根尖术后组织缺损的效果。方法开展前瞻性随机对照试验。选取2020年1月至2023年1月西安市第三医院收治的80例前牙区囊肿刮治根尖术后组织缺损患者作为研究对象,采用随机数字表法分为对照组和观察组,各40例。对照组男24例、女16例,年龄(46.91±8.02)岁,接受GBR治疗;观察组男19例、女21例,年龄(46.58±7.94)岁,接受CGF联合GBR治疗。对比两组患者手术前后牙周探诊深度(PD)、临床附着丧失(CAL)、牙龈退缩量(GR)及术后3个月的美学修复效果[红色美学标准(PES)及白色美学标准(WES)]、修复效果满意度情况。统计学方法采用t检验、χ^(2)检验。结果术前,两组患者PD、CAL及GR比较,差异均无统计学意义(均P>0.05);术后,观察组PD、CAL均低于对照组[(4.51±1.06)mm比(5.33±1.01)mm、(5.08±1.13)mm比(6.84±1.42)mm],GR高于对照组[(2.97±0.80)mm比(2.49±0.87)mm],差异均有统计学意义(t=3.542、6.134、2.569,均P<0.05)。术后3个月,观察组近中龈乳头、远中龈乳头、唇侧龈缘曲度、唇侧龈缘高度、根部凸度/软组织颜色与质地及PES总分均高于对照组[(1.84±0.57)分比(1.32±0.42)分、(1.96±0.64)分比(1.41±0.51)分、(1.86±0.68)分比(1.35±0.66)分、(1.97±0.65)分比(1.46±0.52)分、(1.92±0.67)分比(1.49±0.54)分、(9.55±1.45)分比(7.03±1.38)分],差异均有统计学意义(t=4.288、4.251、3.404、3.875、3.160、7.962,均P<0.05)。术后3个月,观察组牙冠形态、牙冠外形轮廓、牙冠颜色、牙冠表面质地、透明度/个性化及WES总分均高于对照组[(1.94±0.61)分比(1.68±0.52)分、(1.95±0.50)分比(1.47±0.54)分、(1.86±0.33)分比(1.43±0.46)分、(1.91±0.49)分比(1.52±0.41)分、(1.93±0.56)分比(1.56±0.54)分、(9.59±1.26)分比(7.66±1.34)分],差异均有统计学意义(t=2.051、4.125、4.804、3.861、3.008、6.636,均P<0.05)。观察组总满意度为97.50%(39/40),高于对照组的72.50%(29/40),差异有统计学意义(χ2=9.804,P=0.002)。结论CGF联合GBR在前牙区囊肿刮治根尖术后组织缺损修复中具有较好临床效果,可为患者提供一种结合生物材料与再生技术新策略,并为口腔颌面外科在牙周组织重建领域增加治疗新思路。

Objective To explore the effect of concentrated growth factors(CGF)combined with guided bone regeneration(GBR)in repairing tissue defects after anterior cystic apical surgery.Methods Eighty patients with tissue defects after anterior cystic apical surgery treated at Xi'an No.3 Hospital from January 2020 to January 2023 were selected for the randomized controlled trial,and were divided into a control group and an observation group by the random number table method,with 40 cases in each group.There were 24 males and 16 females in the control group;they were(46.91±8.02)years old.There were 19 males and 21 females in the observation group;they were(46.58±7.94)years old.The control group were treated with GBR,while the observation group with CGF and GBR.The periodontal probing depths(PD),clinical attachment loss(CAL),gingival recession(GR),aesthetic restoration effects[pink esthetic score(PES)and white esthetic score(WES)],and overall satisfaction rates were compared between the two groups.t and χ^(2) tests were applied.Results There were no statistical differences in PD,CAL,and GR between the two groups before the operation(all P>0.05).After the operation,the PD,CAL,and GR in the observation group were better than those in the control group[(4.51±1.06)mm vs.(5.33±1.01)mm,(5.08±1.13)mm vs.(6.84±1.42)mm,and(2.97±0.80)mm vs.(2.49±0.87)mm],with statistical differences(t=3.542,6.134,and 2.569;all P<0.05).Three months after the treatment,the scores of near middle gingival papilla,far middle gingival papilla,labial gingival margin curvature and height,and root convexity/soft tissue color and texture and total score of PES in the observation group were higher than those in the control group[(1.84±0.57)vs.(1.32±0.42),(1.96±0.64)vs.(1.41±0.51),(1.86±0.68)vs.(1.35±0.66),(1.97±0.65)vs.(1.46±0.52),(1.92±0.67)vs.(1.49±0.54),and(9.55±1.45)vs.(7.03±1.38)],with statistical differences(t=4.288,4.251,3.404,3.875、3.160,and 7.962;all P<0.05).Three months after the treatment,the scores of crown shape,crown contour,crown color,and crown surface texture,and transparency/individualization and total score of WES in the observation group were higher than those in the control group[(1.94±0.61)vs.(1.68±0.52),(1.95±0.50)vs.(1.47±0.54),(1.86±0.33)vs.(1.43±0.46),(1.91±0.49)vs.(1.52±0.41),(1.93±0.56)vs.(1.56±0.54),(9.59±1.26)vs.(7.66±1.34)],with statistical differences(t=2.051,4.125,4.804,3.861,3.008,and 6.636;all P<0.05).The overall satisfaction rate in the observation group was higher than that in the control group[97.50%(39/40)vs.72.50%(29/40)],with a statistical difference(χ2=9.804;P=0.002).Conclusion CGF combined with GBR repairing tissue defects after anterior cystic apical surgery is clinically effective,may provide the patients with biomaterial and a new regeneration strategy and a choice in periodontal tissue reconstruction at department of oral and maxillofacial surgery.