自体骨联合PRF在阻生下颌第三磨牙致第二磨牙远中骨缺损的应用  

Application of Autogenous Bone Combined with PRF in Distal Bone Defect of Secondary Molars Caused by Impacted Mandibular Third Molars

作　　者：李晶 孙晓军[2] 孟兵[3] LI Jing;SUN Xiaojun;MENG Bing(School of Stomatology,Shanxi Medical University,Taiyuan 030001,China;Oral Multidisciplinary Center,the First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Stomatology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学口腔医学院,太原030001 [2]山西医科大学第一医院口腔多学科诊疗中心,太原030001 [3]山西医科大学第一医院口腔科,太原030001

出　　处：《医学综述》2021年第5期1012-1016,共5页Medical Recapitulate

基　　金：山西省社科联重点课题(SSKLZDKT2019189)。

摘　　要：目的探讨自体骨联合富血小板纤维蛋白(PRF)对阻生下颌第三磨牙(M3)致第二磨牙(M2)远中骨缺损的治疗效果。方法选取2019年1—7月在山西医科大学第一医院口腔多学科诊疗中心就诊要求拔除下颌阻生M3的20例患者(双侧共计40颗)为研究对象,采用双侧自身随机对照分组,术前两组M2均行牙周洁治及根面平整,一侧为实验组,采用超声骨刀和高速涡轮机微创拔牙后,取磨牙后垫处自体骨混合PRF凝胶置于M2远中骨缺损处,并行PRF膜覆盖,无张力严密缝合切口;另一侧为对照组,间隔1周微创拔除,不植骨无张力严密缝合切口。术后3 d复诊,比较两组肿胀、疼痛、张口受限情况,以及术前和术后6个月M2远颊、中央、远舌探诊深度(PD)、附着丧失(AL)和锥形束CT所测的骨缺损深度(ODD)变化情况。结果实验组疼痛及肿胀情况较对照组明显减轻[(4.05±0.24)mm比(3.83±0.37)mm,(4.70±1.30)mm比(3.30±0.87)mm](P<0.05),两组张口受限程度比较差异无统计学意义(P>0.05);治疗前两组患者的远颊牙周探诊深度(PD)、中央PD以及远舌PD比较差异无统计学意义(P>0.05);术后6个月,实验组中央PD较对照组减小[(4.45±1.70)mm比(7.45±1.73)mm](P<0.05),而远颊PD和远舌PD比较差异无统计学意义(P>0.05)。治疗前两组患者的远颊AL、中央AL以及远舌AL比较差异无统计学意义(P>0.05);术后6个月,实验组的远颊AL、中央AL均较对照组减小[(1.85±1.14)mm比(4.85±1.66)mm,(4.90±1.12)mm比(5.05±1.50)mm](P<0.05),而远舌AL比较差异无统计学意义(P>0.05)。治疗前两组患者的ODD与对照组相比差异无统计学意义(P>0.05),而术后实验组ODD较对照组缩小[(3.77±0.75)mm比(5.56±1.02)mm](P<0.05)。结论阻生M3拔除术后同期行自体骨移植混合PRF凝胶可较好地修复M2远中骨缺损。Objective To explore the therapeutic effect of autogenous bone combined with platelet-rich fibrin(PRF)for distal bone defect of second molar(M2)caused by impacted mandibular third molar(M3).Methods A total of 20 patients with 40 teeth requiring the extraction of mandibular impacted M3 in the oral multidisciplinary center of the First Hospital of Shanxi Medical University from Jan.to Jul.2019 were included.The self bilateral random grouping was adopted,and both groups were given periodontal scaling and root planing of the M2 distal root surface before operation.One side as the trial group,receiving minimally invasive tooth extraction with ultrasonic scalpel and high speed turbine,and the autogenous bone in molar posterior pad was obtained and mixed with PRF gel and grafted to the distal osseous defect of M2,then covering PRF membraneclosing the wounds tightly without tension.The other side as the control group,was performed removal after the interval of one week,closing the wound tightly without tension.The swelling,pain and restriction of mouth opening of the two groups were compared at postoperative 3 d visit.The M2 far buccal,central and distant tongue probing depth(PD),altitude loss(AL)and CBCT measured osseous defect depth(ODD)were compared before surgery and 6 months after surgery.Results The swelling and pain of the trial group were significantly reduced compared with the control group[(4.05±0.24)mm vs(3.83±0.37)mm,(4.70±1.30)mm vs(3.30±0.87)mm](P<0.05),and there was no significant difference in the degree of mouth opening restriction between the two groups(P>0.05).Before treatment,there was no statistically significant difference between the two groups in far buccal,central and distant tongue PD(P>0.05);6 months after the operation,the central PD of the trial group decreased compared with that of the control group[(4.45±1.70)mm vs(7.45±1.73)mm](P<0.05),while the far buccal PD and distal tongue showed no statistically significant difference(P>0.05).There was no significant difference in AL of distal b

关 键 词：下颌阻生第三磨牙 第二磨牙 自体骨 富血小板纤维蛋白 牙周骨缺损 

分 类 号：R782.1[医药卫生—口腔医学]