郭苏伟　王蕻雁　田博　李娟娟

[摘要]目的：分析美學区种植同期应用引导骨组织再生技术（GBR）愈合期内唇侧骨板吸收情况，并探讨其影响因素。方法：回顾性分析笔者医院2015年1月-2018年7月美学区种植同期应用GBR术治疗的49例患者临床资料，分析患者的锥形束CT资料，记录牙龈厚度、骨质分类、所用屏障膜及牙槽嵴形态特征，利用iCAT Vision软件对种植体肩台下2mm、体部中点、根尖处的唇侧骨板进行测量，通过统计学分析判断患者性别、年龄、牙龈厚度、牙槽骨骨质、牙槽嵴高度、牙槽嵴宽度、牙槽嵴倒凹深度及所用胶原膜是否为GBR术后愈合期内唇侧骨板吸收的相关影响因素。结果：本组患者种植体肩台下2mm、体部重点、根尖处的唇侧骨板吸收均值分别为（0.73±0.60）mm、（0.85±0.70）mm、（0.54±0.38）mm，吸收比例分别为23.8%、18.5%、12.3%;相关分析显示患者年龄、牙龈厚度、牙槽嵴倒凹深度与GBR术后愈合期内唇侧骨板吸收显著相关（P<0.05）;多元线性回归分析显示年龄（β=0.503，P<0.05）、牙龈厚度（β=-0.207，P<0.05）、牙槽嵴倒凹深度（β=-0.181，P<0.05）是影响GBR术后愈合期内唇侧骨板吸收的相关因素。 结论：美学区种植同期应用GBR术后愈合期内唇侧骨板存在吸收现象，其吸收情况与年龄、牙龈厚度及牙槽嵴倒凹深度相关。

[关键词]引导骨组织再生技术;种植体;唇侧骨板;骨吸收;影响因素

[中图分类号]R782.12    [文献标志码]A    [文章编号]1008-6455（2020）08-0122-03

Absorption and Related Influencing Factors of Labial Bone Plate During Healing Period of GBR

GUO Su-wei1， WANG Hong-yan1， TIAN bo2， LI Juan-juan3

（1.Department of Stomatology， Fengtai Hospital of Traditional Chinese and Western Medicine， Beijing 100072，China;

2. Department of Stomatology， Ruitai Songbai Stomatology Clinic， Beijing 100074，China; 3. Department of Stomatology，Southern Hospital of PLA Fifth Medical Center，Beijing 100071，China）

Abstract： Objective  To analyze the absorption of labial bone plate during healing period of guided bone regeneration （GBR） in the aesthetic area and explore its influencing factors. Methods  The clinical data of 49 patients with GBR in the aesthetic area from January 2015 to July 2018 in our hospital were analyzed retrospectively， the patient's cone beam CT data were analyzed， and the thickness of the gums， the classification of bone， the barrier film used and the morphological characteristics of alveolar ridge were recorded， used the iCAT Vision software to measure labial bone plate at 2mm under the shoulder of implant， midpoint of implant and root tip， and statistically analyzed the gender， age， gingival thickness， alveolar bone quality， alveolar ridge height， alveolar ridge width，alveolar sulcus depth and collagen membrane whether or not influencing factor of labial bone plate during healing period of GBR. Results  In this group of patients， the average absorption of labial bone plate at 2mm under the shoulder of implant， midpoint of implant and root tip were （0.73±0.60）mm，（0.85±0.70）mm，（0.54±0.38）mm，and the absorption ratios were 23.8%，18.5% and12.3%. Correlation analysis showed that the patient's age， gingival thickness， alveolar sulcus depth and the absorption of labial bone plate during healing of GBR were significantly correlated （P<0.05）. Multiple linear regression analysis showed patient's age （β=0.503，P<0.05）， gingival thickness （β=-0.207，P<0.05）， alveolar sulcus depth （β=-0.181，P<0.05） were influencing factor of labial bone plate during healing period of GBR. Conclusion  The labial bone plate during healing period of patients with GBR in aesthetic area has absorption phenomenon， and the absorption is related to patient's age， gingival thickness and alveolar sulcus depth.

Key words： guided bone regeneration; implant; labial bone plate; bone resorption; influencing factor

随着口腔科种植技术的逐渐发展和成熟，种植术已成为治疗牙列缺损和缺失的主要方法，据报道无论是生理性缺牙造成的骨组织吸收还是外伤性缺牙引起的骨组织缺损，常出现骨量不足引起的牙槽嵴过低、过窄或局部凹陷现象，进而导致种植失败。因此，种植位点的吸收问题受到关注，尤其前牙缺损或者缺失患者，这一区域为颌面部的美学区域，骨量不足不仅影响了治疗效果，还影响到面部美观度，增加了前牙美学区种植修复的难度[1-2]。……