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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 (05) : 284 -290. doi: 10.3877/cma.j.issn.1674-1366.2019.05.005

所属专题： 文献；

临床研究

两种材料在拔牙后引导骨组织再生位点保存术中的应用效果
赖思煜1,†(), 习利军1, 倪俊鑫1   
  1. 1. 广州中医药大学深圳医院口腔科，深圳　518034
  • 收稿日期:2019-05-29 出版日期:2019-10-01
  • 通信作者: 赖思煜

Application effect of two materials in preservation of guided bone regeneration sites after tooth extraction and its influence on short-term aesthetics

Siyu Lai1,†(), Lijun Xi1, Junxin Ni1   

  1. 1. Department of Stomatology, Shenzhen Hospital, Guangzhou University of Traditional Chinese Medicine, Shenzhen 518034, China
  • Received:2019-05-29 Published:2019-10-01
  • Corresponding author: Siyu Lai
  • About author:
    Corresponding author: Lai Siyu, Email:
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引用本文：

赖思煜, 习利军, 倪俊鑫. 两种材料在拔牙后引导骨组织再生位点保存术中的应用效果[J/OL]. 中华口腔医学研究杂志(电子版), 2019, 13(05): 284-290.

Siyu Lai, Lijun Xi, Junxin Ni. Application effect of two materials in preservation of guided bone regeneration sites after tooth extraction and its influence on short-term aesthetics[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2019, 13(05): 284-290.

目的

探讨富血小板纤维蛋白（PRF）与口腔胶原膜应用于拔牙后引导骨组织再生（GBR）位点保存术中的效果。

方法

从2016年6月至2018年9月期间收治的拔牙后GBR位点保存患者中选取84例进行研究，采用随机数字表法分组，观察组与对照组各42例，两组微创拔牙后均植入Bio-Oss骨替代材料，观察组表面覆盖PRF膜，对照组表面覆盖口腔胶原膜（海奥），对两组创面愈合率、牙槽骨宽度及高度、美学评分进行观察，采用独立样本t检验进行比较。

结果

观察组术后2周创面愈合率为（77.1 ± 6.1）%，与同期对照组（65.8 ± 3.7）%对比，差异有统计学意义（t = 10.188，P<0.001）；观察组术后4周创面愈合率为（98.8 ± 12.5）%，与同期对照组（78.7 ± 7.1）%对比，差异有统计学意义（t = 9.084，P<0.001）。拔牙前，两组牙槽骨高度差异无统计学意义（t = 0.022，P = 0.982）；拔牙后1个月，观察组牙槽骨高度为（15.1 ± 1.9）mm，与同期对照组（14.2 ± 1.8）mm对比，差异有统计学意义（t = 2.091，P = 0.039）；拔牙后3个月，观察组牙槽骨高度为（14.2 ± 1.8）mm，与同期对照组（14.0 ± 1.3）mm，差异有统计学意义（t = 2.608，P = 0.010）。拔牙前，两组牙槽骨宽度差异无统计学意义（t=0.062，P=0.950）；拔牙后1个月，观察组牙槽骨宽度为（7.1 ± 0.6）mm，与同期对照组（6.8 ± 0.7）mm对比，差异有统计学意义（t=2.392，P=0.019）；拔牙后3个月，观察组牙槽骨宽度为（6.9 ± 0.4）mm，与同期对照组（6.4 ± 0.5）mm对比，差异有统计学意义（t = 5.748，P<0.001）。修复后即刻，两组PES评分差异无统计学意义（t = 0.142，P = 0.887）；修复后3个月，观察组PES评分为（12.4 ± 4.0）分，与同期对照组（10.5 ± 2.0）分对比，差异有统计学意义（t = 2.644，P = 0.009）；修复后6个月，两组PES评分差异无统计学意义（t = 0.617，P = 0.538）。修复后即刻，两组WES评分差异无统计学意义（t = 0.261，P = 0.794）；修复后3个月，观察组WES评分为（9.1 ± 1.0）分，与同期对照组（8.1 ± 0.7）分对比，差异有统计学意义（t = 5.176，P<0.001）；修复后6个月，两组WES差异无统计学意义（t = 1.318，P = 0.191）。

结论

PRF用于拔牙后GBR位点保存术中的效果优于口腔胶原膜，可提高创面愈合率，也能保持牙槽骨宽度与高度，取得满意的短期美学效果，更值得推广。

关键词: 富血小板纤维蛋白, 引导骨组织再生, 伤口愈合, 美学评分, 胶原膜, 位点保存术
Objective

To evaluate the effect of platelet-rich fibrin (PRF) and Haiao collagen membrane on the site preservation after tooth extraction with guided bone regeneration (GBR) .

Methods

A total of 84 cases received site preservation after tooth extraction with GBR from June 2016 to September 2018, were selected and grouped with the random number table method. Both the test and control group enrolled 42 cases for each. A bone substitute (Bio-Oss) was filled in the socket after minimally invasive tooth extraction. The test and control groups were covered with PRF and Haiao collagen membrane, respectively. Then, the wound healing rate, alveolar bone width and height, and aesthetic score of two groups were recorded and compared with the independent sample t test.

Results

The wound healing rate after two weeks in the test group was (77.1 ± 6.14) %, compared with the control group of (65.8 ± 3.7) %, which was significantly higher (t= 10.188, P<0.001) . The wound healing rate after four weeks in the test group was (98.8 ± 12.5) %, compared with the control group of (78.7 ± 7.1) %, which was significantly higher (t = 9.084, P<0.001) . There was no significant difference in alveolar bone height between the two groups before extraction (t = 0.022, P = 0.982) . After extraction for one month, the alveolar bone height in the test group was (15.1 ± 1.9) mm. Compared with the control group of (14.2 ± 1.8) mm, it was significantly higher (t = 2.091, P=0.039) . After extraction for three months, the alveolar bone height in the test group was (14.2 ± 1.8) mm. Compared with the control group of (14.0 ± 1.3) mm, the test group was significantly higher (t = 2.608, P = 0.010) . There was no significant difference in alveolar bone width between the two groups before extraction (t = 0.062, P = 0.950) . After extraction for one month, the alveolar bone width in the test group was (7.1 ± 0.6) mm. Compared with the control group of (6.8 ± 0.7) mm, it was significantly wider (t = 2.392, P = 0.019) . After extraction for three months, the alveolar bone width in the test group was (6.9 ± 0.4) mm. Compared with the control group of (6.4 ± 0.5) mm, it was significantly wider (t = 5.748, P<0.001) . There was no significant difference in the PES scores between the two groups after immediate restoration (t = 0.142, P = 0.887) . After three months, the PES score in the test group was (12.4 ± 4.0) , and the control group was (10.5 ± 2.0) . The former was significantly higher (t = 2.644, P = 0.009) . After six months, the PES score in the test group was (12.9 ± 4.18) . Compared with the control group of (12.5 ± 3.7) , the test group was significantly higher (t = 0.617, P = 0.538) . There was no significant difference in the WES scores between two groups after immediate restoration (t = 0.261, P = 0.794) . After three months, the WES score in the test and control groups were (9.1 ± 1.0) and (8.1 ± 0.7) , respectively, indicating the former was significantly higher (t = 5.176, P<0.001) . After six months, there was no significant difference in the WES score between the two groups (t = 1.318, P = 0.191) .

Conclusions

The effect of PRF on the site preservation after tooth extraction with GBR was better than that of Haiao membrane, which indicated that PRF can improve the wound healing rate, maintain the width and height of alveolar bone, and achieve satisfactory short-term aesthetic effect.

Key words: Platelet-rich fibrin, Guided bone regeneration, Wound healing, Aesthetic score, Collagen membranes, Site preservation
表1 两组拔牙后引导骨组织再生位点保存患者基线资料比较
组别 例数 性别（男/女） 年龄（岁） 拔牙位置（磨牙/前磨牙） 牙槽骨密度(Hu)
观察组 42 24/18 42.51 ± 3.06 35/7 721.52 ± 31.58
对照组 42 22/20 42.47 ± 3.02 33/9 725.79 ± 32.44
检验值 ? χ2 = 0.192 t = 0.060 χ2=0.308 t = 0.611
P值 ? 0.661 0.952 0.578 0.543
图1 拔牙后引导骨组织再生（GBR）位点保存患者拔牙前后口内照及影像学检查　A：拔牙前口内照；B：拔牙前根尖片；C：GBR手术；D：GBR术后3个月全颌曲面断层片
表2 拔牙后引导骨组织再生位点保存患者术后2、4周创面愈合率比较（%， ± s）
组别 例数 术后2周 术后4周
观察组 42 77.1 ± 6.1 98.8 ± 12.5
对照组 42 65.8 ± 3.7 78.7 ± 7.1
χ2值 ? 10.188 9.084
P值 ? 0.000 0.000
表3 拔牙后引导骨组织再生位点保存患者拔牙前、后牙槽骨宽度与高度比较（mm， ± s）
组别 例数 牙槽骨高度 牙槽骨宽度
拔牙前 拔牙后1个月 拔牙后3个月 拔牙前 拔牙后1个月 拔牙后3个月
观察组 42 15.3 ± 2.1 15.1 ± 1.9 14.2 ± 1.8 7.5 ± 0.8 7.1 ± 0.6 6.9 ± 0.4
对照组 42 15.2 ± 2.0 14.2 ± 1.8 14.0 ± 1.3 7.4 ± 0.7 6.8 ± 0.7 6.4 ± 0.5
t值 ? 0.022 2.091 2.608 0.062 2.392 5.748
P值 ? 0.982 0.039 0.010 0.950 0.019 0.000
表4 拔牙后引导骨组织再生位点保存患者美学评分对比（分， ± s）
组别 例数 PES WES
修复后即刻 修复后3个月 修复后6个月 修复后即刻 修复后3个月 修复后6个月
观察组 42 10.5 ± 3.7 12.4 ± 4.0 12.9 ± 4.2 7.7 ± 0.6 9.1 ± 1.0 9.5 ± 1.1
对照组 42 10.4 ± 3.5 10.5 ± 2.0 12.5 ± 3.7 7.7 ± 0.5 8.1 ± 0.7 9.2 ± 0.9
t值 ? 0.142 2.644 0.617 0.261 5.176 1.318
P值 ? 0.887 0.009 0.538 0.794 0.000 0.191
图2 观察组典型病例引导骨组织再生（GBR）位点保存术前后影像资料　A：位点保存术前；B：位点保存术后1个月；C：位点保存术后6个月
图3 对照组典型病例引导骨组织再生（GBR）位点保存术前后影像资料　A：位点保存术前；B：位点保存术后1个月；C：位点保存术后6个月
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