自体牙移植修复单颗牙缺失预后因素的筛选及分析  

Screening and analysis of prognostic factors of repairing single missing tooth by autotransplantation of teeth

作　　者：李永清 惠小勇 许广杰 马媛媛[1] 杨霞 许杰[2] 朱庆林[3] 张洲铭 邬雪 侯锐[1] Li Yongqing;Hui Xiaoyong;Xu Guangjie;Ma Yuanyuan;Yang Xia;Xu Jie;Zhu Qinglin;Zhang Zhouming;Wu Xue;Hou Rui(Department of Oral&Maxillofacial Surgery,School of Stomatology,The Fourth Military Medical University&State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Clinical Research Center for Oral Diseases,Xi′an 710032,China;Department of Periodontology,School of Stomatology,The Fourth Military Medical University&State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture,Xi′an 710032,China;Department of Operative Dentistry&Endodontics,School of Stomatology,The Fourth Military Medical University&State Key Laboratory of Military Stomatology&National Clinical Research Center for Oral Diseases&Shaanxi Key Laboratory of Stomatology,Xi′an 710032,China)

机构地区：[1]第四军医大学口腔医学院口腔颌面外科军事口腔医学国家重点实验室口腔疾病国家临床医学研究中心陕西省口腔疾病临床医学研究中心,西安710032 [2]第四军医大学口腔医学院牙周病科,军事口腔医学国家重点实验室,口腔疾病国家临床医学研究中心,陕西省口腔疾病国际联合研究中心,西安710032 [3]第四军医大学口腔医学院牙体牙髓病科军事口腔医学国家重点实验室口腔疾病国家临床医学研究中心陕西省口腔生物工程技术研究中心,西安710032

出　　处：《中华口腔医学杂志》2022年第5期495-502,共8页Chinese Journal of Stomatology

基　　金：国家口腔疾病临床医学研究中心专项课题(LCC202001);陕西省重点研发计划(2022SF-147);第四军医大学口腔医学院教育教学研究立项课题(2019-21)。

摘　　要：目的筛选影响牙根发育完成自体牙移植修复单颗牙缺失的预后因素并进行分析,为临床判断手术预后提供参考。方法纳入2017年1月至2019年12月于第四军医大学口腔医学院口腔颌面外科接受自体牙移植术的患者,共176例(共188颗牙),其中男性85颗,女性103颗,年龄(33.0±9.8)岁(16~65岁)。对影响牙根发育完成自体牙移植修复单颗牙缺失预后的可能因素进行归纳并分组,对临床检查和影像学检查数据进行记录并判定结果,调取患者以往病历中的手术记录和照片资料(包括性别、年龄、吸烟状况、阻力分析牙根形态、供牙位置等16个因素)进行回顾性分析。采用生存分析方法进行统计学分析,筛选出影响移植牙累积存活率的因素。结果 188颗移植牙的5年累积存活率为88.4%,单因素Log-Rank分析显示,年龄(P=0.001)、性别(P=0.008)、吸烟情况(P<0.001)、受区位置(P<0.001)、受区牙槽骨高度(P<0.001)、供牙离体时间(P<0.001)、是否使用供牙模型(P<0.001)和初期稳定性(P<0.001)8个因素均与移植牙累积存活率显著相关。多因素Cox风险比例回归分析显示,吸烟情况(β=-2.812,P=0.049)、受区牙槽骨高度情况(β=1.521,P=0.020)、供牙离体时间(β=-2.001,P=0.019)、是否使用供牙模型(β=1.666,P=0.034)和初期稳定性(β=-1.417,P=0.033)5个因素与移植牙累积存活率显著相关。结论通过吸烟情况、受区牙槽骨高度情况、供牙离体时间、是否使用供牙模型和初期稳定性5个因素可预判牙根发育完成牙齿行自体牙移植术的预后,在手术中使用供牙模型,减少供牙离体时间,采取有效方法恢复牙槽骨高度,保持良好的初期稳定性,术后做好口腔卫生宣教,可获得移植牙的良好预后。Objective To screen and analyze the factors affecting the prognosis of replacing single missing tooth by autograft tooth,so as to provide reference for clinical judgment of surgical prognosis.Methods A total of 176 patients(188 teeth)underwent autotransplantation of teeth in the Department of Oral&Maxillofacial Surgery,School of Stomatology,The Fourth Military Medical University from January 2017 to December 2019,including 85 teeth of males and 103 teeth of females were involved.The age was(33.0±9.8)years(16-65 years).The possible factors affecting the prognosis of replacing single missing tooth by autograft tooth were summarized and grouped,and the clinical and imaging data were recorded and judged.The surgical records and photographic data from the patients′previous medical records were retrospectively analyzed.The survival analysis method was used for statistical analysis to screen out the factors affecting the cumulative survival rate of transplanted teeth.Results The 5-year cumulative survival rate of 188 transplanted teeth was 88.4%.Univariate Log-Rank analysis showed that age(P<0.001),sex(P=0.008),smoking(P<0.001),position of recipient area(P<0.001),height of alveolar bone in recipient area(P<0.001),time of donor tooth in vitro(P<0.001),use of donor model(P<0.001)and initial stability(P<0.001)were significantly correlated with cumulative survival rate of transplanted teeth.Multivariate Cox proportional hazard regression analysis showed that smoking(β=-2.812,P=0.049),alveolar bone height(β=1.521,P=0.020),donor time(β=-2.001,P=0.019),use of donor model(β=1.666,P=0.034)and initial stability(β=-1.417,P=0.033)were significantly correlated with the cumulative survival rate of transplanted teeth.Conclusions The prognosis of autogenous tooth transplantation can be predicted by smoking,height of alveolar bone in recipient area,time of donor teeth in vitro,use of donor model and initial stability.Good prognosis of transplanted teeth can be obtained by using donor model during operation,reducing the time of d

关 键 词：牙缺失 自体牙移植 预后 生存分析 因素分析 

分 类 号：R783.6[医药卫生—口腔医学]