国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (3): 249-259.doi: 10.7518/gjkq.2021059

• 专家笔谈 •    下一篇

牙槽嵴保存术的临床实施问题探讨

胡文杰()   

  1. 北京大学口腔医学院·口腔医院牙周科 国家口腔医学研究中心 国家口腔数字化医疗技术和材料国家工程实验室 口腔数字医学北京市重点实验室 北京 100081
  • 收稿日期:2021-01-15 修回日期:2021-02-20 出版日期:2021-05-01 发布日期:2021-05-14
  • 通讯作者: 胡文杰
  • 作者简介:胡文杰，教授，博士，Email：<email>huwenjie@pkuss.bjmu.edu.cn</email> 专家简介 胡文杰，教授，博士研究生导师。现任北京大学口腔医学院牙周科副主任（教学主任），兼任中华口腔医学会牙周病学专业委员会第4、5、6届常务委员，口腔种植专业委员会委员和口腔美学专业委员会委员，北京市口腔医学会种植专业委员会常务委员；美国牙周病学会国际会员，国际牙科研究会会员，国家自然基金委同行评议专家；北京大学医学部口腔内科学住院医师规范化培训基地和牙周专科培训基地主任。作为第一负责人，承担国家自然科学基金3项，首都卫生行业发展基金1项，首都临床特色专项项目2项，教育部留学回国启动基金1项，国际合作项目多项，并担任3项卫生部临床重点学科项目和科技部重大专项子课题负责人，2018年获批北京大学首批临床科学家计划专项课题。发表中英文论文120篇（其中SCI收录25篇），主编、参编及编译专著15部，获实用新型专利3项，指导已毕业和在研硕士、博士研究生29名。
  • 基金资助:
    北京市科学技术委员会首都临床特色应用研究基金(Z161100000516042);北京大学临床科学家计划专项(BMU2019LCKXJ010)

Related problems in clinical practice of alveolar ridge preservation

Hu Wenjie()   

  1. Dept. of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2021-01-15 Revised:2021-02-20 Online:2021-05-01 Published:2021-05-14
  • Contact: Wenjie Hu
  • Supported by:
    Capital Foundation for Clinical Characteristics and Application Research of Beijing Municipal Science & Technology Commission(Z161100000516042);Peking University Clinical Scientist Program(BMU2019LCKXJ010)

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摘要：

良好的软硬组织条件是种植治疗成功实施的重要保证。拔牙窝自然愈合会导致牙槽骨吸收和改建,有可能影响以修复为导向的种植治疗。牙槽嵴保存术可有效保存和重建牙槽骨,对于重度牙周炎患牙,进行彻底清创、微创拔牙和微翻瓣牙槽嵴保存是值得临床推广应用的治疗方法。本文针对拔牙窝自然愈合后的软硬组织变化、牙槽嵴保存术成功的影响因素及重度牙周炎患牙拔牙位点牙槽嵴保存术的特点等临床问题进行探讨。

关键词: 拔牙窝愈合, 牙槽嵴保存, 微创拔牙, 重度牙周炎, 种植治疗

Abstract:

Good soft and hard tissue conditions are important for the successful placement of dental implants.However, following tooth extraction, the alveolar ridge undergoes physiological remodeling that results in vertical and horizontal bone reduction, which affects prosthetically driven implant restoration. Alveolar ridge preservation can effectively preserve and reconstruct the volume of alveolar bone. Alveolar ridge preservation with minimally invasive extraction and minimally flap at molar extraction sites with severe periodontitis is strategically recommended to clinicians. This article discusses the changes in soft and hard tissues after natural healing of tooth extraction sockets, the influencing factors of successful alveolar ridge preservation, and the characteristics of alveolar ridge preservation at tooth extraction sites with severe periodontitis.

Key words: extraction socket healing, alveolar ridge preservation, atraumatic extraction, severe periodontitis, implant therapy

中图分类号: 

  • R782.1

图1

拔牙自然愈合后的照片（左）和锥形束CT矢状面截图（右） 上：非牙周炎患牙拔牙后;下：牙周炎患牙拔牙后;左：口内照片;右：锥形束CT矢状面。"

图2

拔牙窝自然愈合术后即刻和术后6个月锥形束CT矢状面截图 a：术后即刻近中面;b：术后即刻中央;c：术后即刻远中面;d：术后6个月近中面;e：术后6个月中央;f：术后6个月远中面;B：颊侧。"

图3

拔牙窝牙槽嵴保存术后即刻和术后6个月锥形束CT矢状面截图 a：术后即刻近中面;b：术后即刻中央;c：术后即刻远中面;d：术后6个月近中面;e：术后6个月中央;f：术后6个月远中面;B：颊侧。"

图4

罹患重度牙周炎磨牙（17牙）微创拔牙清创术及微翻瓣牙槽嵴保存术过程 a：术前;b：微创拔牙清创术后;c：牙槽嵴保存术,术中植入Bio-Oss?骨粉;d：牙槽嵴保存术,术中覆盖Bio-Gide?膜;e：创口表面覆盖胶原蛋白膜;f：胶原蛋白膜和拔除后的患牙。"

图5

罹患重度牙周炎磨牙（17牙）微创拔牙清创术及微翻瓣牙槽嵴保存术,术后即刻（上）与术后半年（下）的影像学检查 左：平行投照根尖片;中：锥形束CT矢状面;右：锥形束CT冠状面;上：术后即刻;下：术后半年。"

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