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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 223 -229. doi: 10.3877/cma.j.issn.1674-1366.2019.04.006

所属专题： 文献；

临床研究

改良骨劈开联合引导骨再生术修复上颌前牙区水平向严重骨缺损的临床效果
周震1, 王亚敏2,†(), 杨熙2, 刘文静3, 张兆强4   
  1. 1. 南方医科大学口腔医院种植中心，广州　510280
    2. 南方医科大学口腔医院牙周科，广州　510280
    3. 南方医科大学口腔医院修复科，广州　510280
    4. 南方医科大学口腔医院颌面外科，广州　510280
  • 收稿日期:2019-04-25 出版日期:2019-08-01
  • 通信作者: 王亚敏

Clinical study of modified splitting osteotomy combined with guided bone regeneration applied in severe bone horizontal defect in anterior maxilla

Zhen Zhou1, Yamin Wang2,†(), Xi Yang2, Wenjing Liu3, Zhaoqiang Zhang4   

  1. 1. Centre of Implantology, Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
    2. Department of Periodontology, Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
    3. Department of Prosthodontics, Stomatology Hospital, Southern Medical University, Guangzhou 510280, China
    4. Department of Maxillofacial Surgery, StomatologyHospital, Southern Medical University, Guangzhou 510280, China
  • Received:2019-04-25 Published:2019-08-01
  • Corresponding author: Yamin Wang
  • About author:
    Corresponding author: Wang Yamin, Email:
  • Supported by:
    Guangdong Provincial Self-financing Science and Technology Program(2017ZC0124); Guangdong Provincial Medical Research Foundation(B2018119); Natural Science Foundation of Guangdong Province(2018A030313759)
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周震, 王亚敏, 杨熙, 刘文静, 张兆强. 改良骨劈开联合引导骨再生术修复上颌前牙区水平向严重骨缺损的临床效果[J/OL]. 中华口腔医学研究杂志(电子版), 2019, 13(04): 223-229.

Zhen Zhou, Yamin Wang, Xi Yang, Wenjing Liu, Zhaoqiang Zhang. Clinical study of modified splitting osteotomy combined with guided bone regeneration applied in severe bone horizontal defect in anterior maxilla[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(04): 223-229.

目的

评价上颌前牙区水平向严重骨缺损应用改良骨劈开联合引导骨再生术（GBR）的临床效果。

方法

选取2015年2月至2016年3月就诊于南方医科大学口腔医院种植中心，上颌前牙区水平向严重骨缺损的拟采取分阶段骨增量患者50例，符合上颌前牙区单牙缺失，4 mm≥水平向骨宽度≥2 mm，垂直向骨高度正常。按照简单随机抽样法分为观察组和对照组，各25例。观察组使用改良骨劈开联合GBR；对照组使用常规GBR。各组于骨增量后6个月植入种植体25枚，植入后4 ~ 6个月行上部结构修复，随访6个月行临床及影像学检查，以种植体存留率、红色美学指数（PES）、水平向骨宽度、边缘骨吸收量评估临床效果。使用SPSS 21.0软件进行数据分析。

结果

两组随访率100%，愈合期及随访过程中均无种植体脱落，种植体存留率均为100%。观察组PES修复当日为6.96 ± 0.98，负重6个月为8.28 ± 1.28；对照组修复当日为7.12 ± 1.13，负重6个月为8.12 ± 1.30。观察组和对照组修复当日及负重6个月PES差异均无统计学意义（t0 = -0.535，P0 = 0.595；t6 = 0.439，P6 = 0.663）。观察组术后6个月水平向骨宽度为（7.08 ± 0.40）mm，对照组为（5.81 ± 0.53）mm，差异具有统计学意义（t = -9.461，P<0.001）。观察组负重6个月的近中边缘骨吸收量为（0.34 ± 0.02）mm，对照组为（0.45 ± 0.04）mm，差异具有统计学意义（t = -12.86，P<0.001）。观察组负重6个月的远中边缘骨吸收量为（0.35 ± 0.02）mm，对照组为（0.44 ± 0.04）mm，差异有统计学意义（t = -10.44，P<0.001）。

结论

应用改良骨劈开联合GBR有效解决上颌前牙区水平向严重骨缺损并取得良好的临床效果。

关键词: 引导组织再生术, 牙种植体, 截骨术, 牙槽嵴, 骨缺损
Objective

To evaluate the clinical effect of severe horizontal bone defect in anterior maxilla (the horizontal width ≥ 2 mm and ≤ 4 mm) with modified splitting osteotomy combined with guided bone regeneration guided bone regeneration (GBR) .

Methods

The data being collected is from February 2015 to March 2016 from selected 50 patients, whose horizontal bone widths were within the range of 2 mm and 4 mm, and the vertical bone heights were normal. Using simple randomized sampling, they were divided into the observation group (the number is 25) and the control group (the number is 25) . Observation group was treated with modified splitting osteotomy combined with GBR, while GBR was applied in the control group. Twenty-five implants were implanted in each group 6 months after operations, and superstructure was performed 4 to 6 months after implantation. Follow-up visit was carried on in half a year, when the clinical and imaging examinations were performed. SPSS 21.0 was used for statistical analysis.

Results

The follow-up rate was 100%. During the healing and follow-up periods, none of the implants fell off, and the survival rate was 100%. In observation group, the pink esthetic scores of restoration day was 6.96 ± 0.98, and that of 6 months after restoration was 8.28 ± 1.28. In control group, the PES of restoration day was 7.12 ± 1.13, and that of 6 months after restoration was 8.12 ± 1.30. There was no significant difference between the two groups at restoration day (t = -0.535, P = 0.595) . There was no significant difference between the two groups 6 months after restoration (t = 0.439, P = 0.663) . Horizontal width of observation group was (7.08 ± 0.40) mm, and that of control group was (5.81±0.53) mm. The horizontal width of observation group was larger than that of control group 6 months after operation (t = -9.461, P<0.001) . The mesial marginal bone loss of the observation group was (0.34 ± 0.02) mm, and that of control group was (0.45 ± 0.04) mm. The mesial marginal bone loss of the observation group was lower than that of the control group 6 months after loading (t = -12.86, P<0.001) . The distal marginal bone loss of the observation group was (0.35 ± 0.02) mm, and that of control group was (0.44 ± 0.04) mm. The distal marginal bone loss of the observation group was lower than that of the control group 6 months after loading (t = -10.44, P<0.001) .

Conclusion

The modified splitting osteotomy combining with guided bone regeneration can effectively solve the problem of severe bone defect in anterior maxilla and thus achieve good clinical results.

Key words: Guided tissue regeneration, Dental implants, Osteotomy, Alveolar process, Bone defect
图1 种植体边缘骨吸收测量示意图
表1 本研究50例上颌前牙区水平向严重骨缺损患者的基线资料
组别 例数 性别（例，男/女） 年龄（岁，±s） 缺牙时间（月，±s） 缺失牙位（例） 缺牙原因（例）
中切牙 侧切牙 龋病 牙周病 外伤
观察组 25 10/15 28.1 ± 4.2 6.0 ± 0.5 14 11 6 15 4
对照组 25 11/14 27.4 ± 5.1 5.6 ± 0.6 16 9 8 14 3
图2 两组上颌前牙区水平向严重骨缺损患者引导骨再生（GBR）术前、后随访照片　A、B、C：观察组（改良骨劈开联合GBR）术前、永久修复当日及负重6个月照片；D、E、F：对照组（常规GBR）术前、永久修复当日及负重6个月照片
图3 两组上颌前牙区水平向严重骨缺损患者引导骨再生（GBR）术前、后的CBCT图像　A、B、C：观察组（改良骨劈开联合GBR）术前、术后6个月及修复当日；D、E、F：对照组（常规GBR）术前、术后6个月及修复当日
表2 两组上颌前牙区水平向严重骨缺损患者术前、后红色美学指数（PES）的比较（±s）
组别 例数 修复当日 负重6个月
观察组 25 6.96±0.98 8.28±1.28
对照组 25 7.12±1.13 8.12±1.30
t值 ? -0.535 0.439
P值 ? 0.595 0.663
表3 两组上颌前牙区水平向严重骨缺损患者水平向骨宽度术前、后的比较（mm，±s）
组别 例数 术前 术后6个月
观察组 25 2.88 ± 0.53 7.08 ± 0.40
对照组 25 2.79 ± 0.51 5.81 ± 0.53
t值 ? -0.603 -9.461
P值 ? 0.549 <0.001
表4 两组上颌前牙区水平向严重骨缺损患者永久修复负重6个月边缘骨吸收量比较（mm，±s）
组别 例数 近中边缘骨吸收量 远中边缘骨吸收量
观察组 25 0.34 ± 0.02 0.35 ± 0.02
对照组 25 0.45 ± 0.04 0.44 ± 0.04
t值 ? -12.86 -10.44
P值 ? <0.001 <0.001
图4 右上前牙区水平向严重骨缺损患者改良骨劈开联合引导骨再生术式照片　A：右上前牙缺失术前口内照片；B：手术翻瓣暴露水平向骨缺损；C：超声骨刀行改良骨劈开U型切口；D："青枝骨折"；E：骨板唇舌侧植入骨粉；F：覆盖胶原膜；G：可吸收线关闭创口；H：术后6个月暴露成骨骨面；I：种植体植入
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