上海口腔医学 ›› 2016, Vol. 25 ›› Issue (3): 352-356.

• 论著 • 上一篇    下一篇

钛网联合浓缩生长因子重建上前牙唇侧骨板重度缺损的临床疗效评价

林海燕, 张维丹, 于艳春, 贾洪宇, 王仁飞   

  1. 杭州口腔医院 种植中心,浙江中医药大学口腔医学院,浙江 杭州 310000
  • 收稿日期:2016-04-08 修回日期:2016-05-20 出版日期:2016-06-25 发布日期:2016-07-22
  • 通讯作者: 林海燕,E-mail: lhaiyanlily@163.com
  • 作者简介:林海燕(1975-),硕士,副主任医师,副教授

Clinical study of titanium mesh in conjunction with concentrate growth factors to rebuild severe bone defect of anterior maxilla

LIN Hai-yan, ZHANG Wei-dan, YU Yan-chun, JIA Hong-yu, WANG Ren-fei   

  1. Hangzhou Stomatology Hospital of Zhejiang Chinese Medical University. Hangzhou 310000, Zhejiang Province, China
  • Received:2016-04-08 Revised:2016-05-20 Online:2016-06-25 Published:2016-07-22

摘要: 目的 在上颌前牙唇侧骨板重度缺损的重建术中,应用钛网联合浓缩生长因子(concentrate growth factors,CGF)并且同期植入种植体,观察唇侧骨板修复情况以及种植体唇侧颈部新生边缘骨的稳定性。方法 选择20例上颌前牙唇侧骨板重度缺损患者,其中15例为单侧中切牙缺失,5例为双侧中切牙缺失,共25个植入位点。在种植体植入同期进行钛网联合CGF的复合引导骨再生(GBR)技术,埋入式愈合6个月后进行常规二期手术,临时修复3个月后进行永久修复。观察二期手术时骨缺损的修复情况,测量二期手术时、永久修复后3、6、12、18个月种植体唇侧颈部的骨厚度和边缘骨高度。应用SPSS19.0软件包对数据进行非参数多样本检验、Fierdman检验。结果 二期手术时唇侧骨板重建完整,新骨爬行至种植体顶端,唇侧颈部骨厚度平均为(2.69±0.154) mm;修复后3、6、12、18个月,唇侧颈部骨厚度分别为(2.67±0.152) mm、(2.66±0.153) mm、(2.65±0.153) mm和(2.65±0.151) mm,以种植体-基台连接处为基线,唇侧颈部边缘骨高度分别为基线下(0.02±0.048) mm、(0.69±0.085) mm、(0.87±0.019) mm和(0.87±0.013) mm。统计学分析表明,修复后3~12个月,唇侧颈部骨厚度随时间显著减小(P<0.001),以种植体-基台连接处为基线,唇侧颈部边缘骨高度随时间亦显著降低(P<0.001);两者在12个月和18个月的差异无显著性(P>0.05)。结论 钛网联合CGF的复合GBR技术能有效重建上前牙唇侧重度骨缺损,颈部新生边缘骨厚度和高度在永久修复1年后趋于稳定,是一种值得临床推广应用的有效和可靠的方法

关键词: 钛网, 浓缩生长因子技术, 唇侧骨板重建, 种植牙

Abstract: PURPOSE: To evaluate the effect of overlaying titanium mesh with concentrate growth factors(CGF) for rebuilding severe buccal bone defect of anterior maxilla when used in association with dental implantation. METHODS: Twenty patients with severe buccal bone defect of maxilla were selected. A total of 25 dental implants were placed, including 5 cases in bilateral central incisor area and 15 cases in unilateral central incisor area. After implantation, the defects were treated with Bio-oss and Bio-guid in conjunction with fixation of titanium mesh and then CGF technology was used. Two-stage surgery was carried out after 6 months of submerged healing, and permanent prosthesis was used 3 months after temporary restoration. The repairs of the defect were observed at the second stage surgery. The height of margin bone around implants and the thickness of bone at implants lingual side were measured, at the time of the second stage operation, and 3, 6, 12, 18 months after permanent restoration. The differences were analyzed by SPSS 19.0 software package with multi-sample nonparametric test and Fierdman test. RESULTS: At the time of second operation, the bone plate at lingual side was completely reconstructed, and new bone was formed at the top of implants. Clinical measurements showed that the averaged thickness of bone at lingual side was (2.69±0.154) mm at that time. Three, 6, 12, 18 months after restoration, the values were (2.67±0.152) mm, (2.66±0.153) mm, (2.65±0.153) mm, (2.65±0.151) mm, respectively. Implant-abutment junction was used as a base line to assess vertical bone absorption, the marginal bone of implant neck at lingual side was all inferior to the base line, the distance was (0.02±0.048) mm, (0.69±0.085) mm,(0.87±0.019) mm, (0.87±0.013) mm, respectively. Statistical analysis showed the thickness of bone of labial side decreased significantly over time after permanent restoration (P<0.01). Likewise, the height of marginal bone was also decreased significantly (P<0.01). However, the difference between them at 12 months and 18 months was not statistically significant (P>0.05). CONCLUSIONS: The results indicate that bone augmentation at maxilla can be achieved using titanium mesh in conjunction with CGF. The height and thickness of newly formed bone at the implant neck margin will be stabilized after 1 year. This method is worthy of wide clinical application.

Key words: Titanium mesh, Concentrate growth factor, Rebuilding buccal bone plate, Dental implant

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