【作者】 马国武； 仲维剑； 张晓燕；

【Author】 MA Guo-wu,ZHONG Wei-jian,ZHANG Xiao-yan (College of Stomatology,Dalian Medical university,Liaoning Dalian,China 116044)

【机构】 大连医科大学口腔医学院；

【摘要】 目的:比较拔牙后即刻种植与拔牙窝内即刻植骨在预防牙槽嵴吸收中的作用方法:拔除四只犬双侧下颌第二、第三前磨牙,实验组拔牙窝分别植入种植体(A组)和Bio-oss骨粉(B组),对照组(C组)拔牙窝自然愈合五个月处死动物,观测牙槽嵴的高度和宽度的变化,对骨质进行影像学检查、组织学观察、扫描电镜钙磷能谱分析。结果:牙槽嵴高度减少: A组0.27±0.07mm,B组0.49±0.07 mm,C组1.40±0.15 mm;牙槽嵴宽度减少:A组0.24±0.13 mm,B组0.21±0.10mm,C组1.19±0.51mm,AC和BC两组间的差异有显著性意义(P<0.05)。影像学观察可见种植体与骨组织接触紧密,BC两组灰度值分别为73.04±7.05、45.10±4.71,两组骨密度差异有显著性意义(P<0.05)。组织切片可见A组的种植体周围板层骨包绕紧密;B组的Bio-oss颗粒部分降解,周围有大量板层骨及编织骨生成;C组骨小梁稀疏、纤细,骨髓腔面积大。扫描电镜钙磷能谱分析测定钙磷比值分别为A组2.01±0.12,B组1.98±0.14,对照组C组1.53±0.22,AC和BC两组间的差异有显著性意义(P<0.05),A、B两组差异无显著性意义(P>0.05)。结论:拔牙后即刻种植和拔牙窝内植入Bio-oss联合使用钛膜,均能有效的防止牙槽骨吸收。在拔牙后短期内维持牙槽嵴骨量和骨质的效果上,二者无显著性差别,但均优于自然愈合的拔牙创。讨论:如果拔牙后残存的骨量能保证种植体的初期稳定性,应提倡进行即刻种植,可以有效地防止牙槽骨的萎缩,最大限度的保存种植区软硬组织的形态和功能。牙槽保存术应用于延期种植病人牙槽嵴骨量的维持,但远期的效果还有待进一步观察。更多还原

【Abstract】 Objectives:To compare the effects of immediate implant placement and dental socket preservation on maintenance of alveolar ridge after tooth extraction Methods:After the mandibular second and third premolars of four dogs were extracled on both sides,immediate implant placements(group A)and Bio-oss particle filling(group B)were performed as experimental groups.Those sockets left without any treatment used as control.The animals were sacrificed 5 months after operation.The changes of width and height of alveolar ridge were measured.The quality of new bone in the extraction socket was evaluated by X-ray radiographic examination, histological observation and SEM energy spectrum analysis.Results:Height resorption of alveolar ridge was 0.27±0.07 mm in group A,0.49±0.07 mm in group B,l.40±0.15 mm in group C.Width resorption of alveolar ridge was 0.24±0.13 mm in group A ,0.21±0.10 mm in group B,1.19±0.51 mm in group C.Significant differences were found between A and C,B and C(P<0.05).Radiographic examination revealed the significantdifference on the grey scale value between the new bone in group B and C.Histological examination showed a large amount of woven bone on the surface of Bio-oss particles in group B,and slim trabeculae sparsely scattered in the bone marrow in group C.SEM energy spectrum analysis demonstrated that calcium-phosphorus ratio was 2.01±0.12 for group A,1.98±0.14 for group B and 1.53±0.22 for group C.Conclusions:Both immediate implant placement and filling of Bio-oss in the socket after tooth extraction in conjunction with pure titanium membranes can effectively prevent alveolar ridge bone resorption.Discussion:Immediate implant placement should be advocated to enhance the maintenance effects of hard and soft tissue around the implant areas.More evidences are need to assess the long term effects of dental socket preservation.更多还原