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关于牙槽嵴保存术的那些事儿——亚博手机版网址口腔医院种植科科普系列二

发布时间:2020-09-08    新闻来源:口腔种植科    字体大小T|T

 
 

随着口腔种(zhong)植(zhi)技术日益成熟,越(yue)来越(yue)多的(de)(de)患(huan)者(zhe)在(zai)拔(ba)(ba)(ba)牙(ya)后选择进行(xing)种(zhong)植(zhi)牙(ya)修(xiu)复。但(dan)拔(ba)(ba)(ba)牙(ya)窝的(de)(de)自然愈合(he)可(ke)能造成后期拔(ba)(ba)(ba)牙(ya)窝位置(zhi)的(de)(de)骨组(zu)织/软组(zu)织的(de)(de)缺损(sun)情况,进而影响(xiang)后续(xu)牙(ya)种(zhong)植(zhi)术的(de)(de)开展。越(yue)来越(yue)多的(de)(de)专(zhuan)家学者(zhe)认为拔(ba)(ba)(ba)牙(ya)位点(dian)的(de)(de)牙(ya)槽嵴保存术能够(gou)预防或减少骨组(zu)织/软组(zu)织缺损(sun)的(de)(de)发(fa)生(sheng),利于(yu)进行(xing)后续(xu)的(de)(de)牙(ya)种(zhong)植(zhi)术。因此(ci),建议种植牙(ya)治疗(liao)计(ji)划应从拔牙(ya)当时(shi)开始设计(ji)

 

 
 
那么,什么是牙槽嵴保存术呢? 
 
 

 

牙槽嵴保存术, 是一种通(tong)过在拔(ba)牙(ya)(ya)(ya)窝(wo)内植(zhi)(zhi)入(ru)不(bu)同生物骨(gu)替代材料(liao)并覆盖生物屏(ping)(ping)障膜来(lai)达到减少(shao)或限(xian)制拔(ba)牙(ya)(ya)(ya)后牙(ya)(ya)(ya)槽(cao)(cao)骨(gu)生理(li)(li)性吸收的(de)手术(shu)方法(fa)。早在 2004 年,Rose 等【1-2】就(jiu)命名(ming)该技术(shu)为牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)保存术(shu),并指出植(zhi)(zhi)入(ru)的(de)植(zhi)(zhi)骨(gu)材料(liao)能(neng)维持牙(ya)(ya)(ya)槽(cao)(cao)窝(wo)的(de)容量及防止牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)轮廓变(bian)形(xing),覆盖生物屏(ping)(ping)障膜则可(ke)以阻挡软组织长入(ru)不(bu)理(li)(li)想的(de)位置,亦用来(lai)阻隔或维持牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)形(xing)态。

牙(ya)槽(cao)嵴保存的基本步骤一般包(bao)括(kuo):①微创(chuang)或无创(chuang)拔(ba)(ba)牙(ya);②清理拔(ba)(ba)牙(ya)创(chuang);③填入(ru)骨(gu)替代材料,如自体(ti)骨(gu)、人工(gong)骨(gu)、人工(gong)骨(gu)粉、骨(gu)生(sheng)长(zhang)因子等(deng)等(deng);④生(sheng)物膜覆(fu)(fu)盖(gai),如吸收或不可吸收膜;⑤缝(feng)合创(chuang)口或使用自体(ti)结缔组织瓣对(dui)创(chuang)口进行覆(fu)(fu)盖(gai)【3】。

 

              微创拔牙                                   拔牙窝彻底(di)清创                       填(tian)充骨替代材料(liao)

 

             充填(tian)材料(liao)严密充填(tian)                     可靠(kao)的创口关闭                             牙槽骨形(xing)成

 

 
 

 

 
 
牙槽(cao)嵴保存很有必要吗?
 
 

 

为了(le)实(shi)现“以假(jia)乱真”的(de)种(zhong)(zhong)(zhong)植(zhi)(zhi)美学修复,种(zhong)(zhong)(zhong)植(zhi)(zhi)体(ti)三维方向的(de)定位必须有一(yi)个确切的(de)范围,因此对(dui)种(zhong)(zhong)(zhong)植(zhi)(zhi)区域骨(gu)的(de)宽度(du)、高(gao)度(du)以及骨(gu)质都有严格的(de)要(yao)求。种(zhong)(zhong)(zhong)植(zhi)(zhi)医师在(zai)术(shu)(shu)前都会评估分析患(huan)者(zhe)的(de)影像(xiang)资料(术(shu)(shu)前拍摄的(de)CBCT等),当现有的(de)骨(gu)量无(wu)法为种(zhong)(zhong)(zhong)植(zhi)(zhi)体(ti)的(de)正确植(zhi)(zhi)入提供条件时,就(jiu)需(xu)要(yao)先进行一(yi)次(ci)牙槽骨(gu)增量手术(shu)(shu),待种(zhong)(zhong)(zhong)植(zhi)(zhi)位点处条件满足后(需(xu)在(zai)骨(gu)增量手术(shu)(shu)6个月之后,重新拍摄CBCT),才可实(shi)施种(zhong)(zhong)(zhong)植(zhi)(zhi)手术(shu)(shu)。

1jpg.gif

 

拔牙(ya)后牙(ya)槽窝(wo)自然愈合(he)的(de)(de)(de)(de)过程(cheng)中,牙(ya)槽骨(gu)(gu)(gu)的(de)(de)(de)(de)形态会发(fa)生明显(xian)的(de)(de)(de)(de)改(gai)变。主要表现为牙(ya)槽骨(gu)(gu)(gu)的(de)(de)(de)(de)高度和宽度都有所减少(shao),牙(ya)槽嵴颊(jia)、舌(she)侧(ce)(ce)骨(gu)(gu)(gu)壁(bi)发(fa)生吸收(shou),骨(gu)(gu)(gu)密度有所下(xia)降(jiang),牙(ya)龈(yin)(yin)软(ruan)组织发(fa)生改(gai)变。吸收(shou)丧失的(de)(de)(de)(de)牙(ya)槽嵴很难自行再生,牙(ya)槽骨(gu)(gu)(gu)宽度的(de)(de)(de)(de)吸收(shou)多于牙(ya)槽高度的(de)(de)(de)(de)吸收(shou);颊(jia)侧(ce)(ce)牙(ya)槽嵴骨(gu)(gu)(gu)吸收(shou)多于舌(she)侧(ce)(ce)牙(ya)槽嵴骨(gu)(gu)(gu)吸收(shou)【4-6】。牙(ya)槽窝(wo)自然愈合(he)过程(cheng)中,软(ruan)组织(牙(ya)龈(yin)(yin))的(de)(de)(de)(de)变化:牙(ya)龈(yin)(yin)会出现退缩(suo)、角化龈(yin)(yin)减少(shao)甚(shen)至消(xiao)失【7-9】。

 

哦.png

拔牙后未进(jin)行牙槽嵴(ji)保存与(yu)进(jin)行牙槽嵴(ji)保存的牙槽嵴(ji)形状比较

 

拔牙(ya)(ya)(ya)后行牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)保(bao)存(cun)(cun)(cun)术者,其(qi)牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)宽度及(ji)高度的(de)吸(xi)(xi)收(shou)显著降(jiang)低(di)。Cardaropoli等【10】认为拔牙(ya)(ya)(ya)后在牙(ya)(ya)(ya)槽(cao)窝内填塞骨(gu)充填物可(ke)以有效(xiao)阻止牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)吸(xi)(xi)收(shou),牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)形态至少可(ke)以保(bao)存(cun)(cun)(cun)85%,从而(er)便于使后期(qi)的(de)种植体植入达到理想的(de)位(wei)置。而(er)且(qie)(qie),牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)保(bao)存(cun)(cun)(cun)术也可(ke)以使牙(ya)(ya)(ya)槽(cao)嵴(ji)(ji)(ji)有效(xiao)支(zhi)持龈乳头和(he)(he)龈缘等,有利于避免龈乳头和(he)(he)龈缘等随牙(ya)(ya)(ya)槽(cao)骨(gu)的(de)吸(xi)(xi)收(shou)而(er)退缩,引(yin)起龈缘与天然牙(ya)(ya)(ya)列协调性(xing)差等美学修复(fu)问题,从而(er)使后期(qi)的(de)种植义齿(chi)更加(jia)稳固且(qie)(qie)具有舒适、美观(guan)等优点【11-12】。

 

牙槽嵴(ji)(ji)保存术虽然不能完全阻(zu)止牙槽嵴(ji)(ji)的改变,但可以减少或(huo)减缓牙槽嵴(ji)(ji)宽度和高(gao)度的吸(xi)收。行牙槽嵴(ji)(ji)保存术后,种植体植入很少再(zai)需要(yao)骨增量手术,但是也需要(yao)根据术前CBCT及术中(zhong)的实际情况而(er)定。

 

综上(shang)所述,牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)保(bao)存(cun)术(shu)(shu)(shu)可(ke)以减(jian)少或(huo)减(jian)缓牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)骨(gu)组(zu)(zu)(zu)织(zhi)(zhi)和软(ruan)组(zu)(zu)(zu)织(zhi)(zhi)的吸收(shou),维持(chi)牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)软(ruan)硬组(zu)(zu)(zu)织(zhi)(zhi)外(wai)(wai)形,避免或(huo)简化骨(gu)组(zu)(zu)(zu)织(zhi)(zhi)/软(ruan)组(zu)(zu)(zu)织(zhi)(zhi)手术(shu)(shu)(shu)(如(ru)拔牙(ya)(ya)(ya)牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)保(bao)存(cun)术(shu)(shu)(shu)或(huo)可(ke)避免患者(zhe)未来行骨(gu)增量手术(shu)(shu)(shu)上(shang)颌窦外(wai)(wai)提(ti)升(sheng)的情况(kuang))、简化种(zhong)植体植入手术(shu)(shu)(shu),缩短治疗(liao)周(zhou)期(qi),减(jian)少患者(zhe)痛苦(ku),并有益于种(zhong)植功能及美学效果(guo)的提(ti)高。因(yin)而,种(zhong)植牙(ya)(ya)(ya)修复治疗(liao)计(ji)划应(ying)从拔牙(ya)(ya)(ya)时开始(shi)设计(ji),拔牙(ya)(ya)(ya)即刻应(ying)行牙(ya)(ya)(ya)槽(cao)(cao)嵴(ji)保(bao)存(cun)术(shu)(shu)(shu),以最大化的保(bao)存(cun)拔牙(ya)(ya)(ya)位(wei)点(dian)的骨(gu)组(zu)(zu)(zu)织(zhi)(zhi)和软(ruan)组(zu)(zu)(zu)织(zhi)(zhi),为(wei)后期(qi)种(zhong)植打下良好的基础。

 

最后,为达到预期治疗效果,建议您于专业口腔医院就诊。口腔诊疗的良好治疗效果不仅仅需要患者的积极配合,而且需要治疗的医生具有过硬的专业知识。关心每一位患者的就诊感受是亚博手机版网址口腔医院口腔种植科一直秉承的工作理念,亚博手机版(医院)于2002年开始口腔种植的临床医疗, 2011年正式成立口腔种植科,是我省唯一专门从事集口腔种植临床、科研和研究生教学工作为一体的专业化科室。了解亚博手机版网址口腔医院种植科请点击:

 

 

 
 

 

 

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 (本文图片均来源(yuan)网络)

 

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[3] Barone A,Ricci M,Romanos GE,et al.Buccal bone deficiency in fresh extraction sockets: a prospective single cohort studyJ.Clin Oral Implants es,2015,26(7) : 823830

[4] Lang NP,Pun L,Lau KY,et al.A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year J.Clin Oral Implants Res,2012,23( Suppl 5) : 3966

[5] Placement of endosseous implants into tooth extraction sites. Block M S,Kent J N. Journal of Oral and Maxillofacial Surgery . 1991

[6] Araújo MG, Wennstrom JL, Lindhe J. Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation. Clin Oral Implants Res.2006,17 (6) :606-614

[7] Mauricio G. Araújo, Flavia Sukekava, Jan L. Wennstrm and Jan Lindhe . Tissue modeling following implant placement in fresh extraction sockets. Clinical Oral Implants Res.2006,17 (6) :615624

[8]戈怡(yi). 拔(ba)牙(ya)位点保存技术(shu)的实(shi)验研究[D].中国(guo)协和医科大(da)学,2008.

[9] Horváth, Attila, Mardas N , Mezzomo, Luis André, et al. Alveolar ridge preservation. A systematic review[J]. Clinical Oral Investigations, 2013, 17(2):341-363.

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[12] Wang HL,Kiyonobu K,Neiva RF.Socket augmentation: rationale and technique[J].Implant Dent,2004,13( 4) : 286296

 

 
 
 
 
 
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