自体块状骨移植重建牙槽骨骨量不足后种植修复的临床观察

摘要

目的 探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果.方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration, GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗.按照自体块状骨的供区来源分为颌骨组(16例34颗)和髂骨组(14例47颗)两组,通过临床随访及影像学检查,分别计算并比较其种植体存留率.结果 30例自体块状骨移植结合GBR后骨增量明显且愈合良好,术后均无明显供区并发症.同期或延期种植体植入,经平均7.8个月(4~18个月)骨结合期后,除1例种植体因松动拔除,其余29例均完成永久修复.种植体植入后平均随访期为26个月(9~68个月),植入的81颗种植体在随访期内存留率为98.76%.其中颌骨组升支取骨失败1颗,种植体存留率为97.06%;髂骨组失败0颗,种植体存留率为100%,两者统计学上无显著性差异(P>0.05).结论 自体块状骨移植重建牙槽骨骨量不足后种植修复,其种植体存留率,较骨量正常情况下的种植修复无明显差异.颌骨与髂骨两种供区的块状自体骨,其移植重建牙槽骨骨量不足均可取得理想的种植修复临床效果.但颌骨内取骨因避免了第二术区、减少手术时间、术后并发症小等优点,临床上应予以优先选择.%Objective To explore the clinical effect of implant restoration on reconstruction of alveolar bone deficiency with autogenous block graft.Methods From January 2010 to December 2016, 30 cases of reconstruction of alveolar bone deficiency with autogenous block graft and guided bone regeneration (GBR) were included.A total of 81 implants were divided into two groups according to the different donor site of autogenous block graft.Mandible group performed 14 cases of 47 implants, and ilium group contained 14 cases of 47 implants.By clinical follow-up and radiographic examination, survival rates of implants were calculated and compared.Results 30 cases of autogenous block graft combined with GBR significantly increased the bone volume after spontaneous healing, no significant complications of donor site were detected after surgery.After an average of 7.8 months (4-18 months) of the osseointegration period with simultaneous or delayed implant surgery, except one failure because of the loose implant, the remaining 29 cases were restored with ceramic crowns or bridges.After 26 months (range 9 to 68 months) of the mean follow-up period, the total survival rate was 98.76% in 81 implants.Survival rate was 97.06% in the mandible group including one failure,while the survival rate of the ilium group was 100%.There was no statistically significant difference between the two groups (P>0.05).Conclusion Combined with autogenous block graft, the implant survival rate has no significant difference compared with no grafts in conventional condition.Moreover, both mandible and ilium procedures are predictable for the reconstruction of alveolar bone deficiency.However, mandible harvesting can be a preference in clinical procedures due to the advantages of avoiding the second field, reducing the operation time and few postoperative complications.