Ugo Covani, Istituto Stomatologico Tirreno, Lucca, Italy.
Clin Oral Implants Res. 2012 May;23(5):526-35. doi: 10.1111/j.1600-0501.2011.02386.x. Epub 2011 Dec 8.
To radiographically analyze extraction sites left untreated or treated using a socket preservation technique.
A total of 20 patients scheduled for single extraction in the maxilla from second to second premolar were enrolled in this study. All sites showed a bone defect >5 mm at the buccal wall and no soft tissue recession. At baseline (T0), tooth extraction was performed; subsequently, sites were randomly allocated to the control (CG: left to heal without grafting) or test group (TG: grafted using hydroxyapatite). Two months later (T1), implants were inserted and eventual GBR procedure was performed. Three months later, the definitive crown was placed. Follow up was 24 months (T2). A cone-beam computed tomographic examination (CT) was performed at each time point. At each radiographic analysis, horizontal and vertical widths of the sockets were measured. Comparisons between CG and TG were performed by a Wilcoxon non-parametric test.
At the end of the study, no patient dropped out and all implants inserted (10 in each group) resulted integrated. GBR procedures were performed at T1 only in the CG. In the CG, the mean value of the horizontal width in the coronal CT slices was 0.98 mm (± 0.37), 7.70 mm (± 0.92), 7.45 mm (± 0.69) at T0, T1 (after bone regeneration) and T2, respectively. In the TG, the mean value of the horizontal width in the coronal CT slices was 0.96 mm (± 0.41), 8.97 mm (± 1.91), 9.48 mm (± 1.56); at T2, it was 9.52 mm (± 1.87) at T0 (pre- and post-socket preservation) T1 and T2, respectively. At each follow up, the mean horizontal bone width in TG was statistically significantly greater than in the control group (P < 0.05). At T0, mean value of the vertical bone defect length (BDL) was 6.93 mm for TG, 6.5 mm for CG. At T1 and T2, mean BDL value was 0 for both groups. Statistically significant difference was not found between TC and CG at any time point (P > 0.05).
This randomized controlled trial suggested that in sites with buccal bone defects >5 mm, the application of HA can minimize alveolar crest resorption following tooth extraction. Furthermore, compared with traditional regenerative procedure carried out following socket healing, this preservation technique seems to result in better horizontal regeneration of the buccal bone wall.
分析未治疗或采用窝洞保存技术治疗的拔牙窝的 X 光片。
本研究共纳入 20 名计划在上颌第二前磨牙至第二磨牙之间进行单颗拔牙的患者。所有部位颊侧壁骨缺损均>5mm，无软组织退缩。在基线（T0）时进行拔牙，随后将部位随机分配至对照组（CG：不进行植骨愈合）或实验组（TG：使用羟基磷灰石植骨）。2 个月后（T1），植入种植体并进行最终 GBR 手术。3 个月后，放置最终牙冠。随访时间为 24 个月（T2）。在每个时间点进行锥形束 CT 检查。在每次放射学分析中，测量牙槽窝的水平和垂直宽度。通过 Wilcoxon 非参数检验比较 CG 和 TG。
研究结束时，无患者脱落，所有植入的种植体（每组 10 个）均成功整合。仅在 CG 中于 T1 进行 GBR 手术。在 CG 中，T0、T1（骨再生后）和 T2 时，冠状 CT 切片的水平宽度的平均值分别为 0.98mm（±0.37）、7.70mm（±0.92）和 7.45mm（±0.69）。在 TG 中，冠状 CT 切片的水平宽度平均值分别为 0.96mm（±0.41）、8.97mm（±1.91）、9.48mm（±1.56）；在 T2 时，T0（保存前后）、T1 和 T2 的平均值分别为 9.52mm（±1.87）。在每个随访期，TG 的平均水平骨宽度均明显大于对照组（P<0.05）。T0 时，TG 的垂直骨缺损长度（BDL）平均值为 6.93mm，CG 为 6.5mm。在 T1 和 T2 时，两组的平均 BDL 值均为 0。在任何时间点，TC 与 CG 之间均未发现统计学显著差异（P>0.05）。
这项随机对照试验表明，在颊侧壁骨缺损>5mm 的部位，使用 HA 可最大程度减少拔牙后牙槽嵴吸收。此外，与在牙槽窝愈合后进行传统再生治疗相比，这种保存技术似乎可导致颊侧骨壁更好的水平再生。
