去膜化GBR技术在后牙种植中的应用

目的: 探讨植骨后未覆盖屏障膜技术对后牙区种植体颊侧较小骨缺损的临床效果。方法: 选取2017年2月—2018年7月青岛大学附属医院口腔种植中心行后牙区种植手术的患者60例,所有患者种植体未暴露且颊侧至邻牙牙槽嵴顶弧线距离>1 mm。将患者随机分为单纯植骨无生物膜组（骨粉组,30例）和植骨并覆盖生物膜组（GBR组,30例）。分别于术后即刻及术后6个月通过锥形束CT（CBCT）测量种植体肩台下0、3、6 mm处（分别设为T1、T2、T3）颊侧牙槽嵴水平骨量变化。采用SPSS 22.0软件包对两组患者的牙槽嵴水平骨量变化、种植体周围软组织评价和患者满意度进行比较。结果: 术后6个月较术后即刻各位点牙槽嵴水平骨量变化为骨粉组：T1（-0.48±0.73）mm、T2（-0.64±0.95）mm、T3（-0.28±0.80）mm,GBR组：T1（-0.35±0.66）mm、T2（-0.49±0.74）mm、T3（-0.30±0.84）mm。2组各位点的牙槽嵴水平骨量变化无显著差异（P>0.05）。术后6个月复查, 2组种植体周围软组织均健康且无显著差异（P>0.05）。患者均有较高的满意度。结论: 后牙区种植体颊侧较小骨缺损可通过单纯植骨达到与GBR术相同的临床效果,能获得健康稳定的软组织以及较高的满意度。

Short-term therapeutic evaluation on bone augmentation technology without applying membrane in slight posterior buccal bone substitute implantation

PURPOSE: To investigate the clinical effects of the technology without covering collagen membrane after bone grafting on posterior-region implant with small buccal bone substitute. METHODS: Patients who were subjected to posterior region implant surgery at Department of Implant, Affiliated Hospital of Qingdao University from February, 2017 to July, 2018 were selected. The implants were not exposed, and the distances from the buccal sides to the adjacent alveolar ridge were more than 1 mm. The patients were randomly divided into bone-grafting without membrane group (alloplastic bone substitute group, 30 cases) and bone-grafting with membrane covering group (GBR group, 30 cases). The horizontal bone mass variations of buccal alveolar ridge were obtained by comparing values in immediate post-surgery and 6 months after surgery through cone-beam CT (CBCT), from 0, 3 and 6 mm apical to implant platforms respectively, where were set as T1, T2 and T3, respectively. The evaluations on horizontal bone mass variations of alveolar ridge, peri-implant soft tissues and satisfaction degrees of the patients in two groups were compared and analyzed using SPSS 22.0 software package. RESULTS: According to the horizontal bone mass variations of alveolar ridge, the T1, T2 and T3 values of the alloplastic bone substitute group were (-0.48±0.73) mm, (-0.64±0.95) mm and (-0.30±0.84) mm, respectively; while the T1, T2 and T3 values of the GBR group were (-0.35±0.66) mm, (-0.49±0.74) mm and (-0.30±0.84) mm, respectively. The horizontal bone mass variations of alveolar ridge of two groups had no significant difference (P>0.05). Through reexamination 6 months after surgery, it was shown that all the peri-implant soft tissues in two groups were healthy. In addition, all the patients had high satisfaction degrees. CONCLUSIONS: For posterior implant with small buccal bone defects, the clinical effect is the same to GBR surgery simply through bone grafting, and healthy and stable soft tissues and high satisfaction degree can be obtained.