皮质骨厚度及颌骨骨密度对种植术中疼痛的影响

Effects of cortical bone thickness and jaw bone density on pain during implant surgery

目的:探讨种植位点不同皮质骨厚度及颌骨骨密度对种植手术术中疼痛的影响。方法:选择2021年8月—2022年8月南昌大学第四附属医院接受种植体植入手术的患者187例(种植位点数263个),分析种植位点不同皮质骨厚度及颌骨密度HU值对麻醉效果的影响。采用SPSS 26.0软件包对数据进行统计学分析。结果:疼痛位点的皮质骨平均厚度为(3.90±1.36)mm,显著大于非疼痛位点的(2.24±0.66)mm(P<0.05)。下颌前牙、前磨牙、磨牙区皮质骨厚度在疼痛及非疼痛位点的比较中,差异有统计学意义。疼痛位点的骨密度平均HU值为(764.46±239.75),非疼痛位点的平均HU值为(612.23±235.31),差异有统计学意义(P<0.05)。下颌前牙及前磨牙区疼痛位点与非疼痛位点HU值相比,差异无统计学意义(P>0.05),下颌磨牙区疼痛与非疼痛位点的HU值相比较,差异有统计学意义(P<0.05)。结论:皮质骨厚度大的位点,阻挡浸润麻药渗透的作用较大,种植过程中更易发生术中疼痛。在下颌前牙及前磨牙区,种植位点HU值对浸润麻药的渗透作用影响较小,在下颌磨牙区的影响较大,下颌磨牙区HU值高的种植位点更易发生术中疼痛。当计划种植位点的皮质骨厚度大于3.9 mm以及在下颌磨牙区骨密度均值大于665 HU时,若有足够的备洞安全距离,建议在术前施加下颌神经阻滞麻醉联合阿替卡因浸润麻醉,以避免患者发生术中疼痛。

PURPOSE:To investigate the effects of different cortical bone thickness and jaw bone density at implant sites on intraoperative pain during implant surgery.METHODS:One hundred and eighty-seven patients(263 implant sites)who underwent implant placement surgery at the Fourth Affiliated Hospital of Nanchang University from August 2021 to August 2022 were selected to investigate the effects of different cortical bone thickness and jaw bone density HU values at implant sites on the anesthetic effect under local infiltration anesthesia with epinephrine in articaine.SPSS 26.0 software package was used for data analysis.RESULTS:The mean cortical bone thickness at the painful sites[(3.90±1.36)mm]was significantly greater than that at the non-painful sites[(2.24±0.66)mm],and the difference was statistically significant(P<0.05).The differences in cortical bone thickness in the mandibular anterior,premolar,and molar regions were statistically significant in the comparison of pain and non-pain sites.The mean HU value of bone density was(764.46±239.75)for the painful sites and(612.23±235.31)for the non-painful sites,with significant difference(P<0.05).The difference was not significant(P>0.05)when comparing the HU values of painful sites with non-painful sites in the mandibular anterior teeth and anterior molar region,while the difference was significant(P<0.05)when comparing the HU values of painful sites with non-painful sites in the mandibular molar region.CONCLUSIONS:Sites with large cortical bone thickness have a greater effect on blocking infiltrative anesthetic penetration and are more prone to intraoperative pain during implantation.In the mandibular anterior and premolar regions,the HU value of the implant sites had less effect on infiltrative anesthetic penetration,and the effect was greater in the mandibular molar region,and the implant sites with high HU values in the mandibular molar region were more likely to have intraoperative pain.When the cortical bone thickness in the planned implant site is greater than 3.9 mm and the mean bone density in the mandibular molar region is greater than 665 HU. If there is sufficient safe distance for hole operation, it is recommended to apply mandibular nerve block anesthesia combined with articaine infiltration anesthesia to avoid intraoperative pain and bad surgical experience for the patients.