脱矿牙本质基质颗粒应用于后牙区即刻种植骨缺损的1~5年临床疗效

doi:10.7518/hxkq.2025.2024419

摘要/Abstract

摘要：

目的评价脱矿牙本质基质颗粒（DDM）应用于后牙区即刻种植牙槽骨缺损的短中期临床疗效。方法选取后牙区即刻种植修复患者76例，共植入110枚单纯锥度固位种植体。根据骨移植材料不同分为A组（脱矿牙本质基质颗粒）和B组（去蛋白无机小牛骨）。在种植术后即刻（T0）、冠修复即刻（术后8个月，T1）和最终随访节点（术后1~5年，T2）分别拍摄口腔锥形束CT和曲面断层片。记录A组和B组平均随访时间。主要观察临床指标为种植体总体存留率、种植体近远中边缘骨吸收量、种植体颊侧平齐颈部平台和颈部平台下1 mm的骨宽度、颊侧骨高度，种植体并发症是次要观察临床指标。结果在1~5年追踪观察时期，A组平均随访38.2个月，B组平均随访39.9个月。A组有2枚种植体发生种植失败，其中有1例发生种植体折断，种植体总体存留率为96.4%；B组有4枚因种植体周围炎而种植失败，种植体总体存留率为92.6%；2组之间种植体总体存留率差异无统计学意义（P>0.05）。A组种植体近中边缘骨平均骨吸收量为（1.011±2.047）mm，远中边缘骨平均骨吸收量为（0.841±2.183）mm；B组种植体近中边缘骨平均骨吸收量为（1.546±1.778）mm，远中边缘骨平均骨吸收量为（1.431±1.909）mm；2组之间近、远中边缘骨吸收量差异无统计学意义（P>0.05）。A组种植体颊侧平齐颈部平台骨宽度平均骨吸收量为（0.782±2.084）mm，颊侧颈部平台下1 mm骨宽度平均骨吸收量为（0.681±2.307）mm；B组种植体颊侧平齐颈部平台骨宽度平均骨吸收量为（1.071±1.474）mm，颊侧颈部平台下1 mm骨宽度平均骨吸收量为（0.949±1.525）mm；2组之间骨宽度吸收量差异无统计学意义（P>0.05）。A组种植体颊侧骨高度平均骨吸收量为（1.044±2.214）mm；B组种植体颊侧骨高度平均骨吸收量为（1.075±1.456）mm，2组之间差异无统计学意义（P>0.05）。结论 1~5年随访结果表明，DDM可以增加颊侧牙槽骨缺损区的骨高度和宽度。DDM能得到与去蛋白无机小牛骨相同的维持牙槽骨轮廓和骨增量效果，可作为临床上一种潜在的新型修复骨缺损的骨移植材料。

关键词: 脱矿牙本质基质颗粒, 骨缺损, 即刻种植, 单纯锥度固位

Abstract:

Objective This study aims to evaluate the short- to medium-term clinical efficacy of demineralized dentin matrix (DDM) particles applied during the immediate implantation of alveolar bone defects in the posterior region. Methods A total of 76 patients with 110 simple taper retentive implants were included in the conducted study and divided into Groups A and B in accordance with the bone grafting materials. Cone beam computed tomography and panoramic radiographs were taken immediately after implant surgery, immediate crown repair, and final follow-up time. The average follow-up time for Groups A and B was recorded. The primary observed clinical indicators were overall survival rate of the implant, bone resorption of the mesial and distal margins of the implant, buccal bone width resorption at the platform level and 1 mm below the platform, and bone height of the implant. Implant complication was a secondary observed clinical indicator. Results During the 1-to-5-year follow-up observation period, the mean follow-up of Group A was 38.2 months while that of Group B was 39.9 months. In Group A, two implants failed, one of which fractured, and implant overall survival rate was 96.4%. Four implants failed in Group B due to peri-implantitis, and implant overall survival rate was 92.6%. No statistically significant difference in implant overall survival rate was found between the two groups (P>0.05). In Group A, the average bone resorption in the mesial and distal margins of the implants was (1.011±2.047) mm and (0.841±2.183) mm, respectively. In Group B, the average bone resorption of the mesial and distal margins of the implants was (1.546±1.778) mm and (1.431±1.909) mm, respectively. No statistically significant difference was noted between the two groups (P>0.05). In Group A, buccal bone width resorption at the platform level and 1 mm below the platform of the implant was (0.782±2.084) mm and (0.681±2.307) mm, respectively. In Group B, buccal bone width resorption at the platform level and 1 mm below the platform of implant was (1.071±1.474) mm and (0.949±1.909) mm, respectively. No statistically significant difference was found between the two groups (P>0.05). In Group A, the buccal bone height of resorption of the implant was (1.044±2.214) mm. In Group B, the buccal bone height of resorption of the implant was (1.075±1.456) mm. No statistically significant difference in bone height was observed between the two groups (P>0.05). Conclusion During the 1-to-5-year follow-up observation period, DDM particles can effectively increase the height and width of alveolar bone, and they can achieve the same effect of maintaining alveolar bone contour and bone augmentation compared with deproteinized inorganic calf bone. DDM particles can be used as a potential new bone grafting material for the treatment of bone defects in clinical practice.

Key words: demineralized dentin matrix particles, bone defect, immediate implantation, simple taper retention

中图分类号:

R783.4

吴昊, 曹宁, 曹良伟, 于飞, 张旭, 魏士博, 魏洪武, 郭水根. 脱矿牙本质基质颗粒应用于后牙区即刻种植骨缺损的1~5年临床疗效[J]. 华西口腔医学杂志, 2025, 43(4): 570-583.

Wu Hao, Cao Ning, Cao Liangwei, Yu Fei, Zhang Xu, Wei Shibo, Wei Hongwu, Guo Shuigen. Clinical efficacy of demineralized dentin matrix particles in immediate implantation for bone defects in posterior region: a 1 to 5-year follow-up study[J]. West China Journal of Stomatology, 2025, 43(4): 570-583.

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长度/mm	直径/mm					合计/n
长度/mm	3.5	4.0	4.5	5.0	6.0	合计/n
合计	7	15	34	44	6	106
5	0	0	3	3	2	8
6	0	1	13	31	4	49
7	0	0	4	0	0	4
8	6	9	13	8	0	36
10	0	3	1	2	0	6
11	1	2	0	0	0	3

组别	近中边缘骨高度/mm			近中边缘骨吸收量/mm
组别	T0	T1	T2	ΔT1-T0	ΔT2-T1	ΔT2-T0
P值	0.011	0.000	0.000	0.159	0.866	0.147
A组	4.510±1.836	3.981±1.592	3.499±1.454	-0.529±2.125	-0.481±0.543	-1.011±2.047
B组	3.688±1.442	2.642±1.195	2.142±1.400	-1.046±1.662	-0.500±0.605	-1.546±1.778

组别	远中边缘骨高度/mm			远中边缘骨吸收量/mm
组别	T0	T1	T2	ΔT1-T0	ΔT2-T1	ΔT2-T0
P值	0.125	0.000	0.000	0.204	0.416	0.135
A组	3.837±1.818	3.386±1.412	2.995±1.378	-0.450±2.211	-0.391±0.372	-0.841±2.183
B组	3.341±1.528	2.390±1.263	1.910±1.415	-0.950±1.873^a	-0.480±0.708^a	-1.431±1.909

组别	T0		T1		T2
组别	N0	B0	N1	B1	N2	B2
P值	0.036	0.116	0.003	0.017	0.002	0.012
A组	4.176±1.499	3.848±1.708	3.679±1.478	3.439±1.661	3.394±1.571	3.164±1.752
B组	3.659±1.012	3.414±1.083	2.948±1.034	2.802±1.018	2.588±1.060	2.465±1.020

组别	ΔT1-T0		ΔT2-T1		ΔT2-T0
组别	N1-N0	B1-B0	N2-N1	B2-B1	N2-N0	B2-B0
P值	0.529	0.577	0.337	0.383	0.403	0.472
A组	-0.497±2.046	-0.406±2.263	-0.285±0.298	-0.275±0.390	-0.782±2.084^a	-0.681±2.307^a
B组	-0.710±1.456	-0.611±1.537	-0.360±0.494	-0.337±0.359	-1.071±1.474^a	-0.949±1.525^a