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骨缺损是种植牙手术中最常见的临床问题,如何增加骨缺损区域的骨量,临床工作者们在20世纪90年代初逐渐形成了引导骨再生术(guided bone regeneration,GBR),是以重建骨组织为目的的一种引导组织再生技术,其要领是生物屏障膜对软组织中成纤维细胞的阻挡。在整个成骨过程中,生物屏障膜的存在是影响成骨质量的重要因素之一。传统的GBR在大量的临床实践中发现存在以下问题:骨组织早期吸收率达70%,屏障膜降解产物的生物组织反应性强、降解速率较快、屏障膜结构稳定性较差等缺点。本研究通过制取一种人工的富血小板纤维蛋白(platelet-rich fibrin,PRF),将其制成PRF碎块及PRF膜共同运用于临床研究中,比较其与传统GBR术后骨愈合的情况。
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86颗种植体在术后6个月均达到了临床种植体成功的标准,并顺利完成种植Ⅱ期修复。
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结果显示,2组病人术后即刻和术后6个月的唇侧骨板顶部、中间部和根尖部的测量值均高于拔牙前,差异均有统计学意义(P < 0.05);拔牙前、术后即刻唇侧骨板3部位数据测量值2组间差异均无统计学意义(P>0.05),但术后6个月,观察组相关测量数据均高于对照组,差异均有统计学意义(P < 0.05)(见表 1)。
分组 n 唇侧骨板顶部 唇侧骨板中间部 唇侧骨板根尖部 观察组 拔牙前 45 0.40±0.24 0.71±0.23 1.22±0.35 术后即刻 45 2.44±0.24* 2.72±0.18* 3.20±0.27* 术后6个月 45 2.32±0.26* 2.58±0.17* 2.96±0.24* F — 960.48 1 518.64 637.79 P — < 0.01 < 0.01 < 0.01 MS组内 — 0.061 0.037 0.083 对照组 拔牙前 41 0.48±0.27 0.82±0.21 1.29±0.30 术后即刻 41 2.38±0.29* 2.74±0.20* 3.25±0.25* 术后6个月 41 1.80±0.40*△ 2.18±0.29*△ 2.77±0.38*△ F — 368.91 708.23 424.02 P — < 0.01 < 0.01 < 0.01 MS组内 — 0.105 0.057 0.101 t检验:与组内拔牙前比较*P < 0.05;与同时点观察组比较△P < 0.05 表 1 2组病人不同时间点唇侧骨板3处部位相关测量值的比较(x±s;mm)
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组内比较显示,2组术后6个月ISQ值均高于术后即刻,差异均有统计学意义(P < 0.05);组间比较显示,2组术后即刻、术后6个月ISQ值差异均无统计学意义(P>0.05)(见表 2)。
分组 n ISQ值 术后即刻 对照组 45 49.59±3.28 观察组 41 50.11±3.06 t — 1.06 P — >0.05 术后6个月 对照组 45 69.37±4.25* 观察组 41 70.52±4.59* t — 1.20 P — >0.05 组内配对t检验: *P < 0.05 表 2 2组病人术后即刻及术后6个月ISQ值的比较(x±s)
富血小板纤维蛋白在伴有骨缺损的牙即刻种植中的临床应用
Clinical application value of platelet-rich fibrin in immediate dental implant with bone defect
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摘要:
目的探究富血小板纤维蛋白(PRF)对即刻种植牙周围骨缺损修复的效果。 方法根据即刻种植牙的适应证且通过术前口腔锥形术CT(CBCT)检查均表现为病灶牙有明显的唇侧骨板较薄或骨缺损者纳入研究对象,共纳入74例病人,86颗患牙;将74例病人随机分为观察组和对照组,每组37例病人,观察组共计45颗患牙,采用种植牙同期混入PRF的骨移植材料+口腔修复膜+PRF膜的术式;对照组共计41颗患牙,采用种植牙同期混入骨移植材料+口腔修复膜的术式;术前均测量矢状位患牙唇侧骨板的顶部、中间部、根尖部3个部位厚度;即刻植入种植体,按照上述术式对2组患牙进行处理后严密缝合创面;术后即刻、术后6个月复诊CBCT检查,同时测量矢状位种植体唇侧骨板3个部位厚度及种植体稳定系数(ISQ)值。 结果2组术后即刻和术后6个月的唇侧骨板顶部、中间部和根尖部的测量值均高于拔牙前,差异均有统计学意义(P < 0.05);拔牙前、术后即刻唇侧骨板3个部位测量值2组间差异无统计学意义(P>0.05),但术后6个月,观察组3个部分测量值均高于对照组,差异均有统计学意义(P < 0.05)。组内比较发现,2组术后6个月ISQ值均高于术后即刻,差异均有统计学意义(P < 0.05);但2组间术后即刻、术后6个月ISQ值差异均无统计学意义(P>0.05)。 结论混入PRF的骨移植材料+口腔修复膜+PRF膜较传统的修复方式更能有效的修复唇侧骨缺损,值得临床推广。 Abstract:ObjectiveTo investigate the effects of platelet-rich fibrin(PRF) in the repair of bone defect around immediate implant teeth. MethodsA total of 74 patients(86 affected teeth) with obvious labial bone plate thinness or bone defect detected by preoperative cone beam CT(CBCT) and conforming to the indications of immediate dental implant were investigated, and divided randomly into the observation group(37 cases, 45 teeth) and control group(37 cases, 41 teeth).The dental implants in the observation group were treated with the PRF bone graft material, oral repair film and PRF film, and the control group was implanted with bone graft material and oral repair film at the same time.The thickness of the top, middle and apex of labial bone plate in sagittal position in two groups were measured before operation.The NobelReplace Conical Connection was immediately implanted, and the affected teeth in two groups were treated with the above surgical procedures, and the wound surface was tightly sutured.Two groups were examined using CBCT at immediate time after surgery and after 6 months of operation, and the thickness and implant stability quotient (ISQ) of the three parts of the labial bone plate in sagittal implant were measured. ResultsThe measurement values of the top, middle and apical part of the labial bone plate in two groups at immediate time after surgery and after 6 months of surgery were higher than those before extraction(P < 0.05).The differences of the measurement value of three parts of labial bone plate before and at immediate time after tooth extraction were not statistically significant between the two groups(P>0.05), but after 6 months of surgery, the measured values of the three parts in observation group were higher than those in control group(P < 0.05).The results of intra-group comparison showed that the ISQ values in the two groups after 6 months of surgery were higher than that at immediate time after surgery(P < 0.05).However, there was no statistical significance in the ISQ values at immediate time and after 6 months of surgery between the two groups(P>0.05). ConclusionsCompared with the traditional repair method, the PRF bone graft material, oral repair film and PRF film can more effectively repair the labial bone defect, which is worthy of clinical promotion. -
Key words:
- dental restoration /
- immediate implant /
- bone defect /
- platelet-rich fibrin /
- cone beam CT
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表 1 2组病人不同时间点唇侧骨板3处部位相关测量值的比较(x±s;mm)
分组 n 唇侧骨板顶部 唇侧骨板中间部 唇侧骨板根尖部 观察组 拔牙前 45 0.40±0.24 0.71±0.23 1.22±0.35 术后即刻 45 2.44±0.24* 2.72±0.18* 3.20±0.27* 术后6个月 45 2.32±0.26* 2.58±0.17* 2.96±0.24* F — 960.48 1 518.64 637.79 P — < 0.01 < 0.01 < 0.01 MS组内 — 0.061 0.037 0.083 对照组 拔牙前 41 0.48±0.27 0.82±0.21 1.29±0.30 术后即刻 41 2.38±0.29* 2.74±0.20* 3.25±0.25* 术后6个月 41 1.80±0.40*△ 2.18±0.29*△ 2.77±0.38*△ F — 368.91 708.23 424.02 P — < 0.01 < 0.01 < 0.01 MS组内 — 0.105 0.057 0.101 t检验:与组内拔牙前比较*P < 0.05;与同时点观察组比较△P < 0.05 表 2 2组病人术后即刻及术后6个月ISQ值的比较(x±s)
分组 n ISQ值 术后即刻 对照组 45 49.59±3.28 观察组 41 50.11±3.06 t — 1.06 P — >0.05 术后6个月 对照组 45 69.37±4.25* 观察组 41 70.52±4.59* t — 1.20 P — >0.05 组内配对t检验: *P < 0.05 -
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