梯形瓣和角形瓣对引导骨再生术后黏膜血供及成骨效果的影响

doi:10.7518/hxkq.2025.2024449

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (5): 679-688.doi: 10.7518/hxkq.2025.2024449

• 临床研究 • 上一篇

梯形瓣和角形瓣对引导骨再生术后黏膜血供及成骨效果的影响

陈双镇¹(), 张贤月², 贾晓凤¹, 夏荣¹(), 姜凡²()

^1.安徽医科大学第二附属医院口腔科，合肥 230601
^2.安徽医科大学第二附属医院超声医学科，合肥 230601

收稿日期:2024-12-12 修回日期:2025-04-16 出版日期:2025-10-01 发布日期:2025-10-21
通讯作者: 夏荣,姜凡 E-mail:doubletown@outlook.com;xiarongqh@aliyun.com;ahultrasound2005@126.com
作者简介:陈双镇，住院医师，硕士，E-mail：doubletown@outlook.com
基金资助:
安徽省学术和技术带头人后备人选科研活动经费资助项目(2021H253)

Effect of trapezoidal and modified triangular flaps on mucosal blood supply and osteogenesis after guided bone regeneration

Chen Shuangzhen¹(), Zhang Xianyue², Jia Xiaofeng¹, Xia Rong¹(), Jiang Fan²()

^1.Dept. of Stomatology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
^2.Dept. of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China

Received:2024-12-12 Revised:2025-04-16 Online:2025-10-01 Published:2025-10-21
Contact: Xia Rong,Jiang Fan E-mail:doubletown@outlook.com;xiarongqh@aliyun.com;ahultrasound2005@126.com
Supported by:
Anhui Province Academic and Technical Leader Reserve Candidate Research Funding(2021H253)

摘要/Abstract

摘要：

目的通过彩色多普勒血流成像技术（CDFI）及锥形束计算机断层扫描技术（CBCT）评估使用梯形瓣和角形瓣进行上颌前牙区引导骨再生（GBR）术后黏膜血管参数变化及成骨效果。方法将单颗上颌前牙种植手术同期GBR的患者随机分为梯形瓣组和角形瓣组，采用不同的翻瓣方式行GBR术后，在不同的时间间隔（术前，术后2 h、1 d、3 d、1周、2周和4周）利用CDFI测量术区黏膜血管参数，拍摄术前、术后2 h、术后6月时CBCT图像评估骨增量效果。结果缺牙区唇侧黏膜血液流速低于同颌对侧同名牙，差异有统计学意义（P<0.001）；缺牙区术后黏膜血液流速较术前有所增加，术后2周时达到峰值流速后下降至参照牙血流水平，2组间差异存在统计学意义（P<0.05）。术后6月梯形瓣组和角形瓣组种植体平台颊侧牙槽嵴宽度较术后2 h分别减少（1.3±0.9）、（0.9±0.7）mm；种植体平台根方5 mm颊侧牙槽嵴宽度分别减少（0.9±0.6）、（0.3±0.6）mm；种植体平台根方10 mm颊侧牙槽嵴宽度分别减少（0.6±0.8）、（0.2±0.6）mm；牙槽嵴高度分别减少（1.9±1.4）、（1.4±1.3）mm；移植物体积变化分别为（136±78）、（114±85）mm³，差异均无统计学意义（P>0.05）。结论牙齿缺失后，缺牙区唇侧黏膜血液流速降低；角形瓣组在上颌前牙GBR术后可以获得更好的术区血流微循环；梯形瓣和角形瓣在上颌前牙区骨增量手术中均可获得预期的骨增量效果，翻瓣方式对牙槽骨尺寸参数变化无显著影响。

关键词: 引导骨再生, 彩色多普勒血流成像技术, 梯形瓣, 角形瓣

Abstract:

Objective Color doppler flow imaging (CDFI) and cone-beam computed tomography (CBCT) were utilized to evaluate changes in mucosal vascular parameters and the osteogenic effects following guided bone regeneration (GBR) in the maxillary anterior region using trapezoidal or modified triangular flaps. Methods Patients undergoing single maxillary anterior dental implant surgery with GBR were randomly allocated into two groups: a trapezoidal flap group and a modified triangular flap group. After GBR surgery, the mucosal vascular parameters at the surgical site were assessed at various time intervals (preoperative, 2 h, 1 and 3 days, and 1, 2, and 4 weeks postoperative) using CDFI. In addition, the effects of bone augmentation were evaluated through the analysis of CBCT images obtained preoperatively, 2 h, and 6 months postoperative. Results The buccal mucosa in the edentulous area had a lower blood flow rate than the corresponding tooth in the same jaw, and the difference was statistically significant (P<0.001). The mucosal blood flow rate in the surgical area increased compared with that in the preoperative period. The peak flow rate was recorded at 2 weeks postoperatively and then decreased to levels comparable to those of the reference tooth. A statistically significant difference was observed between the two groups (P<0.05). The buccal alveolar ridge width of the implant platform was reduced by (1.3±0.9) mm in the trapezoidal flap group and (0.9±0.7) mm in the modified triangular flap group, respectively, at 6 months postoperatively, compared with 2 h postoperative. The buccal alveolar ridge width of the 5 mm from the implant platform was reduced by (0.9±0.6) mm and (0.3±0.6) mm, respectively. The buccal alveolar ridge width of the 10 mm from the implant platform was reduced by (0.6±0.8) mm and (0.2±0.6) mm, respectively. The height of the alveolar ridge was reduced by (1.9±1.4 ) mm and (1.4±1.3) mm. The change in graft volume was (136±78 ) mm³ and (114±85) mm³. However, the differences between the two groups were not statistically significant (P>0.05). Conclusion When a tooth is missing, blood flow to the buccal mucosa on the side of the missing tooth is reduced. The modified triangular flap group demonstrated superior microcirculation of blood flow in the operative area after GBR of the maxillary anterior teeth. Trapezoidal and modified triangular flaps achieved the anticipated bone augmentation during bone augmentation surgery in the maxillary anterior region, with no considerable effect on the changes in alveolar bone size parameters.

Key words: guided bone regeneration, color doppler flow imaging, trapezoidal flap, modified triangular flap

中图分类号:

R783

陈双镇, 张贤月, 贾晓凤, 夏荣, 姜凡. 梯形瓣和角形瓣对引导骨再生术后黏膜血供及成骨效果的影响[J]. 华西口腔医学杂志, 2025, 43(5): 679-688.

Chen Shuangzhen, Zhang Xianyue, Jia Xiaofeng, Xia Rong, Jiang Fan. Effect of trapezoidal and modified triangular flaps on mucosal blood supply and osteogenesis after guided bone regeneration[J]. West China Journal of Stomatology, 2025, 43(5): 679-688.

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特征		梯形瓣组	角形瓣组	P值
年龄/岁		36.1±14.1	34.8±13.0	0.828
性别	男	4（36.4%）	6（54.5%）	0.392
	女	7（63.6%）	5（45.5%）
缺失位置	中切牙	7（63.6%）	7（63.6%）	0.565
	侧切牙	3（27.3%）	4（36.4%）
	尖牙	1（9.1%）	0（0%）
牙龈生物型	厚龈生物型	4（36.4%）	3（27.3%）	0.647
	薄龈生物型	7（63.6%）	8（72.7%）
缺牙原因	外伤	5（54.5%）	6（54.5%）	0.700
	先天缺失	3（27.3%）	1（9.1%）
	龋病	1（9.1%）	2（18.2%）
	根尖周疾病	2（18.2%）	2（18.2%）
缺牙时间/年		3.7±6.4	4.4±7.8	0.809
种植体尺寸	3.4 mm×12 mm	9（81.8%）	9（81.8%）	1.000
	3.4 mm×14 mm	2（18.2%）	2（18.2%）
唇侧骨壁厚度/mm		0.41±0.32	0.55±0.22	0.345

指标	总体	缺失牙	参照牙	平均差值	95%置信区间
Vm/（cm/s）	4.42±2.43	3.14±1.00	5.71±2.77	-2.57±2.78*	1.30，3.84
Vmax/（cm/s）	7.22±3.61	5.02±1.52	9.41±3.79	-4.39±3.88*	2.64，6.15
S/D	2.60±0.73	2.43±0.40	2.77±0.93	-0.34±0.77	-0.09，0.78
PI	1.02±0.37	0.96±0.23	1.09±0.46	-0.13±0.34	-0.09，0.36
RI	0.59±0.08	0.58±0.06	0.61±0.08	-0.03±0.08	-0.01，0.08

组别	时间	Vm/（cm/s）	Vmax/（cm/s）	S/D	PI	RI
梯形瓣	T0	3.08±1.16	4.93±1.77	2.51±0.53	0.99±0.30	0.59±0.08
	T1	3.92±2.10	6.60±3.04	2.52±0.43	1.09±0.34	0.59±0.07
	T2	4.97±1.20	7.63±1.62	2.32±0.31	0.86±0.16	0.56±0.05
	T3	6.96±2.10	10.74±2.95	2.35±0.64	0.87±0.25	0.55±0.10
	T4	8.19±5.79	11.93±7.32	2.40±0.24	0.89±0.13	0.58±0.05
	T5	8.41±3.43	13.41±4.99	2.29±0.46	0.85±0.18	0.55±0.07
	T6	5.44±1.34	8.49±2.08	2.39±0.28	0.91±0.14	0.58±0.05
角形瓣	T0	3.19±0.87	5.12±1.31	2.35±0.23	0.93±0.13	0.57±0.04
	T1	6.16±2.82	9.91±4.51	2.70±0.51	1.02±0.21	0.62±0.06
	T2	6.87±2.36	10.74±2.53	2.55±0.59	0.97±0.27	0.59±0.09
	T3	7.56±2.22	11.57±2.67	2.50±0.36	0.96±0.21	0.59±0.06
	T4	8.26±2.74	12.61±4.16	2.43±0.50	0.91±0.24	0.57±0.07
	T5	8.44±1.70	12.53±2.68	2.24±0.26	0.83±0.13	0.54±0.05
	T6	6.39±2.35	10.04±3.38	2.50±0.39	0.96±0.17	0.59±0.07

测量参数及时间点		梯形瓣组	角形瓣组	P值
A-EA/mm	T1	3.4±0.8	3.2±0.9	0.850
	T7	2.9±0.7	3.0±0.8	0.468
	T7-T1	-0.6±0.8	-0.2±0.6	0.347
M-EM/mm	T1	4.4±0.8	4.1±0.8	0.390
	T7	3.6±0.3	3.8±0.9	0.587
	T7-T1	-0.9±0.6	-0.3±0.6	0.075
B-EB/mm	T1	3.6±0.9	3.6±0.6	0.618
	T7	2.3±0.7	2.6±1.0	0.645
	T7-T1	-1.3±0.9	-0.9±0.7	0.303
C-P/mm	T1	3.8±1.5	3.3±1.2	0.449
	T7	1.9±0.5	1.9±0.6	1.000
	T7-T1	-1.9±1.4	-1.4±1.3	0.460
体积/mm³	T1-T0	448±48	418±120	0.521
	T7-T0	312±70	304±141	0.884
	T7-T1	-136±78	-114±85	0.601

梯形瓣和角形瓣对引导骨再生术后黏膜血供及成骨效果的影响

Effect of trapezoidal and modified triangular flaps on mucosal blood supply and osteogenesis after guided bone regeneration

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