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使用生物活性合成骨移植材料和胶原膜进行种植位点开发的显微外科技术与宏观外科技术比较：一项随机对照临床试验。

Comparison of microsurgical and macrosurgical technique using bioactive synthetic bone graft and collagen membrane for an implant site development: A randomized controlled clinical trial.

作者信息

Jain Deepali, Mohan Ranjana, Singh Vikram Deep

机构信息

Department of Periodontology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India.

出版信息

J Indian Soc Periodontol. 2019 Sep-Oct;23(5):448-460. doi: 10.4103/jisp.jisp_738_18.

DOI:10.4103/jisp.jisp_738_18
PMID:31543619
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6737851/
Abstract

BACKGROUND

Implant site development can be effective in minimizing postextraction alveolar ridge resorption in the esthetic region. Microsurgical approach has demonstrated substantial improvement in soft-tissue architecture.

AIM AND OBJECTIVES

The aim of the present study was to evaluate and compare the efficacy of microsurgical technique with conventional one for implant site development utilizing biphasic hydroxyapatite/beta-tricalcium phosphate bone graft substitute and collagen membrane.

MATERIALS AND METHODS

Thirty extraction sites were planned for implant placement and randomly divided into control (macrosurgical/conventional) and test (microsurgery) sites. Clinical measurements were recorded at four different points of extraction socket, i.e., mesiobuccal, midbuccal, distobuccal, and midlingual/palatal at baseline, 3, 6, and 9 months. Postoperative neovascularization at control and test site was evaluated by ultrasound Doppler flowmetry at baseline, 10 day, and 1 month. Radiological assessment of bone density (Hounsfield units) was measured at control and test sites at baseline, 6 and 9 months by computed tomography. Data was subjected to statistical analysis.

RESULTS

Significant socket fill at all the four different sites was observed and found to be statistically significant at test as compared to control group with better tissue contour after 3, 6, and 9 months. Test group demonstrated better neovascularization ( < 0.05) with significantly higher bone density ( = 0.000) at different time intervals.

CONCLUSIONS

The results indicate that the augmentation of extraction sockets, not only improved the quality of bone in both the techniques but the utilization of microsurgical instruments and microsutures under magnification definitely enhanced the quality of soft tissues which is imperative for successful implant placement and its survival.

摘要

背景

种植位点开发可有效减少美学区域拔牙后牙槽嵴吸收。显微外科方法已证明在软组织结构方面有显著改善。

目的

本研究的目的是评估和比较显微外科技术与传统技术在利用双相羟基磷灰石/β-磷酸三钙骨移植替代物和胶原膜进行种植位点开发方面的疗效。

材料与方法

计划在30个拔牙位点植入种植体，并随机分为对照组（宏观外科/传统组）和试验组（显微外科组）。在拔牙窝的四个不同点，即近中颊侧、颊侧中部、远中颊侧和舌侧/腭侧中部，于基线、3个月、6个月和9个月记录临床测量数据。通过超声多普勒血流仪在基线、10天和1个月时评估对照组和试验组术后的新生血管形成情况。在基线、6个月和9个月时，通过计算机断层扫描测量对照组和试验组的骨密度（亨氏单位）。对数据进行统计分析。

结果

在所有四个不同位点均观察到明显的牙槽窝填充，与对照组相比，试验组在3个月、6个月和9个月后组织轮廓更好，差异有统计学意义。试验组在不同时间间隔显示出更好的新生血管形成（P<0.05），骨密度显著更高（P = 0.000）。

结论

结果表明，牙槽窝增量不仅在两种技术中均改善了骨质量，而且在放大条件下使用显微外科器械和显微缝线肯定提高了软组织质量，这对于种植体的成功植入及其存活至关重要。

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