前牙拔牙位点保存术后牙槽嵴软硬组织变化的临床研究

摘要

目的 采用锥形束CT (cone beam computed tomography, CBCT) 和模型间接测量法评价前牙拔牙同期位点保存6个月后牙槽嵴骨量及软组织量的变化.方法 纳入29例患者共32颗符合拔牙适应证的前牙, 试验组牙拔除术后应用去骨蛋白牛骨基质 (deproteinizedboving bone mineral, DBBM, Bio-Oss?) 和可吸收生物膜 (海奥) 进行拔牙位点保存术, 对照组行常规拔牙术后未予特殊处理.全部患者拔牙术前取石膏模型, 术后即刻及术后6个月拍摄CBCT并于术后6个月再次取石膏模型, 通过CBCT和模型测量对比分析术后6个月牙槽骨及软组织高度和宽度的变化.结果 通过对比手术前后的CBCT测量结果, 牙槽骨高度在唇侧和腭侧牙槽骨的高度测量结果差异有统计学意义 (P<0.05) .术后6个月试验组唇侧和腭侧牙槽骨高度显著高于对照组 (P<0.05) , 分别为 (16.31±0.94) mm和 (18.61±1.10) mm, 牙槽骨宽度在根长的20％、70％测量值也显著高于对照组 (P<0.05) , 分别为 (4.43±0.32) mm和 (4.79±0.37) mm, 但在根长50％处两种方法测量结果差异无统计学意义 (P>0.05) .软组织高度在上颌牙龈缘最高点及下颌牙龈缘最低点处, 试验组 ( (9.26±0.40) mm) 显著高于对照组 (P<0.05) , 但在近中龈乳头、远中龈乳头处软组织两组间无显著统计学差异 (P>0.05) .结论 前牙拔牙同期进行位点保存术处理, 对拔牙后牙槽嵴高度、宽度和牙龈软组织的保存均具有积极意义, 值得临床实践中推广.%Objective To evaluate the changes of alveolar bone and soft tissue after 6 months of the front tooth extraction site preservation by cone beam computed tomography ( CBCT) and model measurement. Method A total of 32 teeth from 29 patients with indications for the front tooth extraction were enrolled. Deproteinizedbovine bone mineral ( DBBM, Bio-Oss) and absorbable biofilm ( Hao) were used in the experimental group when the extraction site was performed, while the control group received no special treatment after routine extraction. The gypsum model was employed before the operation ( baseline) and after six months, while the CBCT was taken immediately after the operation ( baseline) and six months later as well. The changes of the height and width of alveolar bone and soft tissue were compared and analyzed by CBCT and model measurement. Results Before and after the surgery, there were statistically significant differences in the heights of the labial and palatal alveolar bone assessed by CBCT ( P<0.05).After 6 months, the heights of labial and palatal alveolar bone of the experimental group were significantly higher than those of the control group ( P< 0.05) , which were ( 16.31±0.94) mm and ( 18.61±1.10) mm respectively. The alveolar bone widths, measured at 20％ and 70％ of the root length, were also significantly higher than the control group ( P<0.05) , which were ( 4.43± 0.32) mm and ( 4.79± 0.37) mm respectively, but there was no significant difference between the two groups at 50％ of the root length ( P>0.05). The heights of soft tissue were significantly higher in the treatment group ( ( 9.26 ± 0.40) mm) than the control group ( P<0.05) at the highest point of the maxillary gingival margin and the lowest point of the mandibular gingival margin, but in soft tissue between mesial papilla and distal nipple, there was no statistically significant difference ( P>0.05). Conclusions The simultaneous preservation of extraction sites of the front teeth has positive significance for the preservation of height, width and alveolar soft tissue after tooth extraction, which is worthy of promotion in clinical practice.