Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Oral and Craniomaxillofacial Surgery, University Hospital Freiburg, Freiburg, Germany.
J Dent. 2018 Dec;79:102-106. doi: 10.1016/j.jdent.2018.10.011. Epub 2018 Oct 26.
The reconstruction of extended and complex defects of the alveolar bone is a frequent requirement prior to implant placement. The aim of this study was to assess and compare location, intensity, and experience of pain after bone graft harvesting for dental implants with respect to the donor site.
In this prospective non-randomized intervention study, a consecutive sample of 23 patients who received autologous bone grafts from intra-oral (IO; N = 8) or extra-oral (EO; N = 15) donor sites prior to insertion of dental implants for fixed dental prostheses were recruited. All patients completed a self-administered questionnaire regarding pain location, intensity, and experience at baseline (B; before surgery), at the first follow-up (F1; 3 days after surgery), and at the second follow-up (F2; 4 weeks after surgery). Relative Risk Ratios (RRR) were determined for pain locations. For pain intensity and pain experience, 95% confidence intervals were evaluated using percentiles of a bootstrap with 1000 replications to assess statistical significance.
Both patient groups did perceive pain in the mouth/face after the intervention, but patients in the EO donor site group had additional pain at the hip, felt their pain longer and of higher intensity, and had more negative pain experiences than patients with IO donor sites (all p < 0.05).
While both IO and EO bone graft harvesting are procedures that are associated with pain in a large proportion of patients, an EO donor site is expected to lead to more pain-related burdens than an IO donor site.
Prior to bone graft harvesting, surgeons can now provide patients with tailored information regarding pain perceptions to be expected. This will help the patients with making an informed decision, and on whether or not to agree with surgery.
在植入物放置之前,牙槽骨的扩展和复杂缺损的重建是经常需要的。本研究的目的是评估和比较在种植体植入前,取自口腔(IO;n=8)或口腔外(EO;n=15)供区的骨移植物的位置、强度和疼痛经历。
在这项前瞻性非随机干预研究中,连续招募了 23 名接受自体骨移植物的患者,这些患者在植入固定义齿的种植体之前,来自口腔内(IO;n=8)或口腔外(EO;n=15)供区。所有患者在基线(B;手术前)、第一次随访(F1;手术后 3 天)和第二次随访(F2;手术后 4 周)时完成了一份关于疼痛位置、强度和体验的自我管理问卷。疼痛位置的相对风险比(RRR)确定。对于疼痛强度和疼痛体验,使用 1000 次 bootstrap 的百分比评估 95%置信区间,以评估统计意义。
两组患者在手术后都感到口腔/面部疼痛,但 EO 供区组的患者在臀部也感到疼痛,他们的疼痛持续时间更长,强度更高,疼痛体验也更差,而 IO 供区组的患者则没有(均 p<0.05)。
虽然 IO 和 EO 骨移植物采集都是与大多数患者疼痛相关的程序,但与 IO 供区相比,EO 供区预计会导致更多的与疼痛相关的负担。
在进行骨移植物采集之前,外科医生现在可以向患者提供有关预期疼痛感知的个性化信息。这将帮助患者做出知情决策,以及是否同意手术。