【作者】 王丽杰；

【导师】 柳忠豪； 周文娟；

【作者基本信息】 大连医科大学 ， 口腔医学， 2022， 硕士

【摘要】 目的:通过对拔除单颗牙与连续2颗牙行位点保存临床效果的评价研究,探讨拔牙间隙对位点保存临床效果的影响。方法:纳入2021年8月-2021年11月期间,于滨州医学院附属烟台口腔医院种植科及口腔颌面外科就诊、存在单颗牙或相邻两颗牙需拔除并行位点保存术的患者34名,男性11名,女性23名,年龄18至70岁。共纳入45个位点,根据拔牙位点分为两组,A组(25颗)为单颗牙组,B组(20颗)为连续2颗牙组。术后14天、30天、90天复诊随访。通过测量拔牙位点骨高度及宽度的变化,评价A、B两组位点保存的骨组织保存效果;通过对拔牙位点总体体积的变化量的测量,观察两组的轮廓的变化;通过对角化龈宽度变化的测量,来观察软组织的保存效果;通过通用创口愈合评估表评估患者创口愈合等级来观察术后的创口愈合情况;通过VAS视觉量表量化患者术中疼痛、术后感受、及总体治疗的满意度评价患者的主观感受。使用SPSS26.0软件,对测得的结果进行统计分析,P<0.05为差异具有统计学意义。结果:1.患者报告结果测量(PROMS)位点保存术后两组患者术中疼痛、及总体满意度无统计学意义(P>0.05);B组术后出血较A组明显,此差异无统计学意义(P>0.05);B组的疼痛程度较A组剧烈,此差异具有统计学意义(P<0.05);A组患者术后肿胀程度较B组患者较轻,此差异具有统计学意义(P<0.05);B组患者有更明显的术后刷牙不适,此差异具有统计学意义(P<0.05)。2.创口愈合评分对比位点保存术后14天A组平均创口愈合指数为2.50,B组平均创口愈合指数为2.05;术后30天A组平均创口愈合指数为1.85,B组平均创口愈合指数为1.65。3.轮廓塌陷对比术后30天B组的轮廓塌陷大于A组,此差异具有统计学意义(P<0.05);术后1月至3月两组的轮廓塌陷差异无统计学意义(P>0.05)。4.角化龈变化对比位点保存术后30天至90天期间B组的角化龈减少多于A组,此差异具有统计学意义(P<0.05);位点保存术后14天至90天期间B组的角化龈减少大于A组,此差异具有统计学意义(P<0.05);术后90天B组的角化龈宽度减少大于A组,此差异具有统计学意义(P<0.05)。A组与B组角化龈宽度在术后14与30天均减少,在14天至30天减少更多。5.骨高度宽度变化对比位点保存术后90天两组间颊舌侧骨高度减少无统计学意义(P>0.05);术后90天两组拔牙窝中央骨高度均增加,两组差异无有统计学意义(P>0.05)术后90天两组骨宽度的变化差异无统计学意义(P>0.05)。结论:1.单颗牙拔除与连续2颗牙拔除使用Bi-oss与Bio-gide胶原膜进行位点保存均可以获得良好的临床效果。2.单颗拔牙进行位点保存更具优势。更多还原

【Abstract】 Objective:To evaluate the influcences of tooth extraction spaces on clinical effcet of alveolar ridge preservation,and support clinical decision.Methods:From August to November in 2021,a total of 34 patients(11 males and23 females,aged 18 to 70 years)who were admitted to the Department of Implantology and the Department of Oral and maxillofacial Surgery in Yantai Stomatological Hospital affiliated to Binzhou Medical University and had a single tooth or two adjacent teeth requiring simultaneous site preservation were included.A total of 45 sites were included,which were divided into two groups according to extraction sites: group A(25 teeth)was A single tooth group,and group B(20 teeth)was A continuous 2 teeth group.Follow-up at14 d,30d and 90 days postoperatively.By measuring the change of bone height and width at the extraction site,the preservation effect of bone tissue was evaluated in Group A and Group B.The change of extraction site contour was observed by measuring the change of the total volume at the extraction site.The effect of soft tissue preservation was observed by measuring the width of keratinized gingiva.The wound healing grade was evaluated by the universal wound healing assessment scale.Subjective feelings of the patients were evaluated by VAS visual scale which was used to quantify the pain during the operation,the postoperative feeling and the overall treatment satisfaction.SPSS26.0 software was used for statistical analysis of the results,P<0.05 for the difference was statistically significant.Results:1.Patient report outcome measures(PROMS)There was no significant difference in pain and overall satisfaction between the two groups after alveolar ridge preservation(P>0.05).The postoperative bleeding in Group B was more significant than that in Group A,and the difference was statistically significant(P<0.05).The patients in group A had less swelling and pain than those in group B.The patients in group B had more obvious discomfort of brushing teeth postoperatively,the difference was statistically significant(P<0.05).2.Comparison of wound healing scoresAfter alveolar ridge preservation 14 days,the average wound healing index was 2.50 in group A and 2.05 in group B.The average wound healing index was 1.85 in group A and 1.65 in group B 30 days after surgery.3.Contour collapseThe contour collapse of Group B was greater than that of Group A at 1month postoperatively(P<0.05),and there was no significant difference between the two groups at 1 month postoperatively and 90 days postoperatively(P>0.05).4.Changes in keratinized gingivaThe keratinized gingiva decreased more in group B than in Group A from 30 to 90 days after alveolar ridge preservation(P<0.05).The reduction of keratinized gingiva in Group B was greater than that in Group A from 14 to 90 days after alveolar ridge preservation(P<0.05),and the change of keratinized gingiva width in Group B was greater than that in Group A from90 days after alveolar ridge preservation,the difference was statistically significant(P<0.05).The width of keratinized gingiva in Group A and group B decreased at 14 and 30 days postoperatively,and decreased more at 14 to30 days postoperatively.5.Changes in bone height and widthThere was no significant difference in the height of the buccal-lingual bone between the two groups after extraction 90 days(P>0.05),and the height of the central bone in Group A and Group B was not statistically significant(P>0.05).The change of bone width in group A and in Group B was not statistically significant(P>0.05).Conclusion:1.After single tooth extraction and 2 teeth extraction,alveolar ridge preservation can achieve great clinical effect by using Bio-oss and Bio-gide.2.Single tooth extraction with alveolar ridge preservation has a better clinical effect.更多还原